Profile of menopausal women in west Anatolian rural region sample

OBJECTIVES: The aim of this study was to evaluate age at menopause, climacteric symptoms and related factors in women living in west Anatolian rural region of Turkey. METHOD: This study included 761 menopausal women living in three rural towns. Questionnaires regarding to 10 climacteric symptoms, menopausal status, sociodemographic characteristics, parity, breastfeeding, presence of chronic illness, direct sun exposure, smoking, caffeine use and hormone replacement therapy (HRT) were filled out by face-to-face interview. Logistic regression analysis was used to assess confounding factors on the age of menopause and menopausal status. RESULTS: Mean age at menopause was 44.38+/-5.30 years. Breastfeeding more than one year, low level of direct sun exposure and mother's early age at menopause were associated with early onset of menopause. The most prevalent climacteric symptoms were urine leakage, decreased libido, lack of energy and poor memory in post-menopausal and hot flushes in peri-menopausal women. Somatic and psychological symptoms were associated with hot flushes. HRT and osteoporosis treatment usage were higher in surgical menopause group. Osteoporosis and Type 2 Diabetes Mellitus (DT) were more common in natural menopause group. No association was found with onset of menopause and smoking, excess caffeine use, BMI, marital status and presence of chronic illness. Cardiovascular risk factors such as hypertension (HT), diabetes and obesity were common in post-menopausal women. CONCLUSION: Onset of menopause in Turkish women living in rural region is earlier on average women living in western or industrialized countries. Hot flushes in peri-menopausal, and urogenital, and psychological in post-menopausal women are the most prevalent symptoms. Primary care services in rural districts should focus on cardiovascular risks of menopausal women.     

A study on the menopause in Malaysia

In an attempt to gather data on the menopause in Malaysia, 400 women (13% Chinese, 70% Malays and 16% Indians), representing the three major ethnic groups in Malaysia, were interviewed. The majority (76%) of these women were still married and living with their husbands and 63% of them were working. Most of them (90%) had attained menarche by the age of 15 years and 50% of them had married before the age of 20. Their reproductive record was good, since 76% of them had 3 or more children who were still alive. The mean age at menopause in the Malaysian women studied was 50.7 years. Analysis of the climacteric symptoms reported showed significant differences in the vasomotor and nervosity indices in the perimenopausal and postmenopausal groups. Eighty percent (80%) of the women saw no need to consult a doctor about their climacteric symptoms. When they did, most of them (84%) received medication, but 43% of them did not comply with the prescribed treatment. Dyspareunia and urinary incontinence were evidently regarded as embarrassing complaints in all three groups, since around 80% of the women did not seek medical advice. This is not surprising in view of the fact that 89% of them rated their health as good.     

Menopause in highland Guatemala Mayan women

Objectives: To explore any feelings and symptoms surrounding menopause among Mayan women in three ethnolinguistic groups in highland Guatemala and compare these with previous reports from Mexico. Methods: This was a qualitative exploratory study of the experiences around menopause of eight middle aged women and one local key informant in each of three villages in western highland Guatemala (n=27). Individual interviews were conducted in women with irregular menses or whose menses has ceased in the last 3 years. Field notes were kept and then an analysis undertaken by the author. Results: Twenty-four Mayan women, aged 38–55, and three Mayan key informants (all women over age 50) were interviewed. Most women reported some symptoms, including hot flashes, night sweats, changes in libido, irritability, moodiness, abdominal cramps and menstrual clots occurring at some stage during the last 3 years. Although women reported symptoms, they mostly accepted them with equanimity; and rejoiced at the cessation of their periods. Conclusions: Highland Guatemalan Mayan women reported symptoms that were not reported in Mayan women in Yucatan, Mexico in the years surrounding menopause. The reasons for this disparity are unclear but may reflect differences in body weight and diet. Despite these symptoms, Mayan women looked forward to menopause and their newfound freedom and status. Symptoms in women in the years around menopause must be interpreted in geographical, nutritional, biological, psychological and cultural context.     

The menopausal experience of Greek women living in Sydney

OBJECTIVE: This study was undertaken to investigate the menopausal experience of Greek women as part of a wider survey of four immigrant groups living in Sydney, Australia (the others being Indian, Arabic, and Chinese) and to examine the relationship between common symptoms and various sociodemographic factors. DESIGN: A total of 217 women were interviewed about their menopausal experiences by experienced health workers using the 29-item Menopause-Specific Quality of Life questionnaire. RESULTS: A total of 217 women participated in the survey. The mean age at menopause for postmenopausal women was 48.6 years (95% CI: 47.7-49.5). More than 96% of the women had lived in Sydney for more than 20 years. A majority (57%) had only received primary education. It was found that the most commonly reported symptoms related to feelings of fatigue (66%) and a decrease in physical strength and stamina (>60%), and nearly as many (59%) complained of lower backache. Fifty percent of the women also complained of psychosocial symptoms, such as feeling nervous and memory loss. Hot flushes were reported by 43%, which is similar to other ethnic groups. The prevalence of vaginal dryness was 79.2% for postmenopausal Greek women in our study. CONCLUSION: Significant findings were found for retired Greek women in the pre- or perimenopausal stage and with psychosocial symptoms (P<0.05); there was also an association between postmenopausal obese and married women with sexual problems (P<0.05).     

Climacteric symptoms among women aged 60-62 in Link?ping, Sweden, in 1986

By means of a simple postal questionnaire, all women aged 60, 61 and 62 (n = 2015) living in the community of Link?ping, Sweden, were screened for vasomotor symptoms and local vaginal complaints. After one reminder, answers were received from 73% of the women. At the time of the survey (April 1986) all the women were post-menopausal, the median period since menopause being 11 yr. Slightly over one in four of the women (27%) were suffering from sweating and hot flushes. Ten percent (10%) of the women who were more than 15 yr post-menopausal still had moderate to severe climacteric symptoms. Vasomotor symptoms were significantly more common among oophorectomized women than among those whose ovaries were intact. Local vaginal symptoms were positively correlated with urinary problems, repeated urinary tract infections and a high risk of disturbance of sexual activity. It was concluded that climacteric symptoms often persist for more than 15 yr after the menopause.     

Age and symptom experience at menopause in the Selska Valley, Slovenia

OBJECTIVE: To assess age and symptom experience at menopause in a high-altitude population in the Selska Valley of Slovenia. DESIGN: In four mountain villages, all houses were approached and 80% of eligible residents were interviewed. Additional women were interviewed for comparison in the valley below. Age at interview ranged from 32.7 to 85.5 years, with a mean of 58.2 years. The majority of women (62%) were aged 40 to 65 years. RESULTS: Of the 58 women interviewed, 7 had undergone menopause by hysterectomy (12%). Recalled age at natural menopause ranged from 42 to 54, with a mean of 50.3 (SD 2.9). By probit analysis, median age at natural menopause was 52.03. Fifty-five percent of participants reported ever having experienced a hot flash, although only 24% reported hot flashes during the 2 weeks before being interviewed. When the sample was limited to women aged 40 to 65, frequency of hot flashes in the 2 weeks before the interview was 39%. For all participants, the most frequent complaint was lack of energy (66%), followed by backaches (59%), and joint stiffness (53%). CONCLUSIONS: In contrast to expectations, age at menopause was not earlier and hot flash frequency was not significantly lower at higher elevations.     

Menopausal transition in Movima women, a Bolivian Native-American

BACKGROUND: Although it is well accepted that socio-cultural influences may affect the onset of menopause and the symptoms experienced, there are scant data related to native indigenous populations. OBJECTIVE: Our purpose was to study in a native population of South America (The Movima, Bolivia) the menopausal transition. SUBJECTS AND METHODS: In this cross-sectional survey a total of 125 Movima women between 35 and 54 years old was included. All of them answered a questionnaire and a face-to-face interview focused on the menopausal experiences of middle-aged Movima women and additionally, history and physical examination, demographic and socio-economic information were obtained. RESULTS: The onset of natural menopause in the Movima was at 42.3+/-6.17 years. Loss of libido was the main complaint of the menopause, occurring in a 51% of interviewed women, hot flushes in a 45%, genital itching in a 40.8% and dyspareunia in a 40% were also frequently reported. CONCLUSION: This is the first data recorded on menopausal transition of the Movima natives. The age of menopause and the symptoms experienced are different to those from women of developed countries. Data related to minority groups are important to adapt the health system to their particular requirements.     

Symptoms of multiple sclerosis in women in relation to sex steroid exposure

ObjectiveTo investigate if women with multiple sclerosis (MS) experience changes in MS symptoms related to pregnancy, the postpartum period, menopause or use of oral contraception (OC) or postmenopausal hormone therapy (HT).MethodsWomen with diagnosed MS were recruited from registers of all MS patients known in two counties of Sweden, respectively. Ninety-four women were recruited in Linköping and 52 in Sundsvall. The women answered a questionnaire with categorized alternatives regarding their MS symptoms related to menstruation, pregnancy, delivery, menopause and use of OC or HT.ResultsForty percent of the women reported worsening of MS symptoms related to menopause, whereas 56% reported no change of symptoms and 5% reported decreased symptoms. More than a fourth of the women reported decreased symptoms during pregnancy, 64% reported unchanged symptoms and 10% reported increased symptoms. Every third woman reported increased symptoms after delivery, 59% reported no change and 5% reported decreased symptoms. Few women reported changes in MS symptoms in relation to use of HT or OC.ConclusionThe presented data indicate a relationship between high-oestrogen states and ameliorated symptoms whereas low-oestrogen states seem to relate to a worsening of the disease. A majority of women, however, reported no changes in MS symptoms in relation to the different oestrogen states.     

更年期女性伴发抑郁情绪的现状研究

目的了解更年期女性伴发抑郁情绪的现状,为制定更年期女性的心理干预措施提供依据。方法以某市区10个居民小区45~55岁359名女性作为调查对象。采用改良更年期Kupperman评分表、流调中心用抑郁量表（CES-D）进行问卷调查。结果可疑抑郁23人,占6.40%,肯定抑郁31例,占8.64%。更年期症状与抑郁情绪呈正相关,即Kupperman评分越高,抑郁评分也越高（P〈0.001）。结论更年期症状是影响中年女性抑郁情绪的高危因素,改善更年期症状可减低更年期抑郁的发生。     

Attitudes toward menopause among middle-aged women: a community survey in an island of Taiwan

OBJECTIVES: The purpose of this report is to explore the attitudes toward menopause of middle-aged women in Taiwan as well as to examine related factors. METHODS: A large community-based sample of Taiwanese women aged 40-54 years who are living on the islet of Kinmen were recruited for this study. Attitudes toward menopause were collected with a self-administered questionnaire. RESULTS: Of a targeted population of 1429 individuals, 1113 (78%) participated in the study. The mean age was 48.5+/-4.0 years (range, 43-57 years) and 434 women (39%) were premenopausal. The rate of current hormone use was 13.5%. Compared to premenopausal women, fewer postmenopausal women agreed that menopause depressed them, and that interests distracted their attention from menopause (p<0.01, Mann-Whitney test). Postmenopausal women did not believe that menopause would change their lives, and not having periods made women feel regretful. Compared with the illiterate women, higher educated women were more regretful about menopause (p<0.05, Mann-Whitney test). Women who experienced vasomotor symptoms within 2 weeks of the study expressed a more negative attitude regarding menopause. CONCLUSIONS: Women in Taiwan held a more positive attitude toward menopause as compared to prior studies in other countries. They had a more positive attitude when they actually faced menopause. Education and vasomotor symptoms had a significantly negative impact on menopausal perceptions. This report provides more insight on the perception of menopause in Taiwanese women that will guide future public health initiatives.     

The menopausal age,related factors and climacteric symptoms in Turkish women

An interview based survey to reveal age at menopause and associated factors was conducted in a clinic based sample of Turkish women living mainly in an urban area. Interviews by a psychologist were obtained from 1500 women aged 41–70. The study included only women who had undergone natural menopause and had their last menstrual bleeding at least 1 year previously. The mean and median age at menopause was 47.8±4.0 and 51, respectively. Parity and BMI had a statistically significant impact on the age of menopause (P=0.0397 and 0.0403). The most common symptoms were muscle and–or joint and–or bone pain (82.3%) and hot flushes (73.9%). Although the population was clinic based, this study is the first one of its kind in Turkish women.     

Climacteric symptoms in an unselected sample of Swedish women

A questionnaire on climacteric symptoms was sent to every woman living in the city of Linköping, Sweden (120,000 inhabitants) who was born in 1928 or 1930. Of the 1246 women concerned, 1118 (90%) responded. At the time of the survey, 252 women (23%) were pre-menopausal. In the total sample, 10B had undergone hysterectomy and/or bilateral oophorectomy. The median age at natural menopause was 51 yr.

Climacteric symptoms were reported by 75% of the women, the predominating complaints being sweating attacks and hot flushes. Vaginal dryness and tenderness were experienced by 30% of the post-menopausal women, the discomfort tending to become more common as the duration of the post-menopausal period lengthened.

After the menopause, every third woman experienced periods of depression more often than previously. Depression was positively correlated to the severity of the vasomotor symptoms.

Fifty percent of the women expressed interest in receiving oestrogen treatment, although only 7% were using oestrogens at the time of the survey. This discrepancy is probably due to widespread apprehension in Swedish society - shared by the doctors - in regard to ‘hormonal treatment’.     

Discussing menopause in general practice

The dual objective is, first, to determine if menopausal women discuss the menopause with a doctor, and if so to which extent; second, to ascertain potential differences between those who do and those who do not. METHODS: A postal questionnaire was sent to 1251 Danish women randomly selected among all 51-year-old women born and living in Denmark. Completed questionnaires were returned by 972 (77%) women. RESULTS AND CONCLUSIONS: More than two thirds (71.8%) of the peri and postmenopausal women had discussed the menopause with a doctor; either with the general practitioner (GP) or with another doctor. There were significant differences between women who had discussed the menopause with a doctor and those who had not. The more problematic the symptoms the greater the likelihood that the woman would have discussed the menopause. Women who had not discussed the menopause with a doctor, had fewer symptoms and were more critical of hormone replacement therapy (HRT). Menopausal symptoms do not necessarily create problems for women in their daily lives. For example almost all women reported hot flushes (87.2%), but few felt very bothered by this symptom (13.8%). Doctors most often listen to menopausal women with severe symptoms. This "bias" may direct the focus upon the negative aspects of menopause. It is suggested that active intervention among women who have not consulted a doctor about menopause is inappropriate, partly because they apparently have chosen non-medical solutions and partly because they have so few symptoms that the use of resources in this way could be considered wasteful.     

Depressive symptoms, menopausal status, and climacteric symptoms in women at midlife

OBJECTIVE: Previous studies have found increased rates of depression in women aged 45 to 54 years, but the factors that influence these rates are not understood. It was assessed whether higher rates of depressive symptoms were associated with menopausal status, climacteric symptoms, and use of hormone replacement therapy. DESIGN: Cross-sectional survey. SETTING: Community sample. METHODS: Data are from 581 women ages 45 to 54 years who were interviewed by telephone between October 1998 and February 1999. MEASURES: Depression was measured with the abbreviated CES-D, a depressive symptoms screening measure. Women's reported perception of menopausal stage, frequency of periods in the preceding 12 months, and history of oophorectomy were used to classify their menopausal status into four categories: (1) no indication of menopause; (2) close to menopause; (3) had begun menopause; and (4) had completed menopause. RESULTS: There were 168 women (28.9%) who reported a high level (> or = 10) of depressive symptoms when the abbreviated CES-D was used. In a logistic-regression analysis, significant factors associated with increased depressive symptoms included physical inactivity, inadequate income, use of estrogen/progesterone combination, and presence of climacteric symptoms (trouble sleeping, mood swings, or memory problems). Menopausal status was not associated with depressive symptoms. CONCLUSIONS: In this sample of women age 45 to 54 years, climacteric symptoms but not menopausal status were associated with higher rates of depressive symptoms.     

Depressive symptoms in the transition to menopause: the roles of irritability,personality vulnerability,and self-regulation

Although the transition to menopause represents a period of risk for depressive symptoms, there is little research into personality or trait-like factors that may confer vulnerability to depression during the transition to menopause. This study investigated whether the personality trait of self-criticism moderated the effects of irritability on depressive symptoms in women transitioning to menopause and whether these effects were mediated by lower levels of emotional regulation. Participants were 376 women, of whom 157 had entered the transition phase to menopause. These women in the transition phase completed measures of self-criticism, irritable mood, emotional regulation, and depressive symptoms. All analyses controlled for attitudes toward menopause and somatic symptoms. Moderated mediation regression analyses showed that higher levels of irritability were associated with poorer emotional regulation in highly self-critical women, but not in less self-critical women, and poorer emotional regulation was, in turn, related to higher levels depressive symptoms. Findings suggest that the transition to menopause may represent an especially vulnerable period for women with high levels of self-criticism. Although irritability is transitory for most women, for women who are highly self-critical, irritability may tax their ability to self-regulate and lead to more encompassing symptoms of depression.     

Health profile of middle-aged women: The Women's Health in the Lund Area (WHILA) study

BACKGROUND: Middle-aged women experience various health-related problems. The aim of this study was to evaluate the impacts of menopause status and hormone intervention on women's health. METHODS: In an ongoing, population-based study, 4943 women, born 1935 to 1945 and living in the Lund area of Southern Sweden, were included in this analysis. They completed a generic questionnaire pertaining to socio-demographic background and current health-related symptoms. Among the cohort, 9% of women were pre-menopausal (PM), 52% were post-menopausal without hormone replacement therapy (PMO) and 39% were current hormone replacement therapy users (PMT). RESULTS: Hot flushes and vaginal dryness were strongly related to menopausal status. The prevalence of somatic symptoms worsened progressively from the groups of PM to PMO to PMT. The most abundant complaints were headache and muscle-skeletal-joint problems. A total of 85% of women experienced psychological problems. Contrary to our expectation, a poorer profile of psychological health was found in the PMT group when compared with the PMO group. CONCLUSIONS: The high prevalence of symptoms in middle-aged women could be attributed to age, hormonal influence as well as personality.     

The age at menopause and associated factors at the health center area in Ankara, Turkey

OBJECTIVES: This study is performed in one health center area in Ankara, Turkey on a women population of 50-65 years in order to demonstrate menopausal status of women, age at menopause and factors related with the age at menopause. METHODS: This is a cross-sectional study which has been performed on a women population of 50-65 years. The local population was 17,153 in this area by 2001. All of the household determining forms are screened in order to detect the all of the women who were in 50-65 years group, then name and addresses of the these women's are listed. There were 1089 women aged 50-65 years who were constituting 7% of the population. After choosing the first name randomly from the list of the women, 1/3 systematic sampling method was used and, the number of the women in the sampling was 363 (95% C.I., +/-5% S.E.). The response rate among those eligible women who were contactable during the study was 99% (360/363). Data were collected by interviews through questionnaires. The questionnaire consisted of a series of questions concerning age at menopause, socioeconomic status, age at menarche, age at first pregnancy, regularity of menstrual cycles, parity, duration of breast feeding, use of OCs, BMI, smoking habit, age at menopause of the mother and the sister. Chi-square and t-test methods were used for statistical analyses. RESULTS: 4.2% of the women were in premenopause, 13.3% were in perimenopause, 72.8% were in natural menopause and 9.7% were in surgical menopause. Average age at natural menopause was 47+/-4.2 years. Education, age at menarche, smoking, age at menopause of the mother and the sister were found to be related with the age at menopause. CONCLUSIONS: Ninety-six percent of the women over age of 50 years, are at menopause or perimenopause. The results of this study suggest that, for factors of genetic and age at menarche, there are not many possibilities for the lifestyle changes that would modify age at menopause with the subsequent reduction in risk for chronic diseases, but daughters or sisters of women with an early menopause and women who smoked or less educated could be counselled with respect to family timing.     

Climacteric symptoms in a Tanzanian community

Climacteric symptoms were investigated among healthy women living in and around a small town in Tanzania. The incidence of symptoms was high and similar to that recorded in Western societies. Statistically significant associations were observed between some symptoms and the number of years since menopause. More attention needs to be paid to climacteric problems among African women.     

A community-based study of menopause symptoms and estrogen replacement in older women

This study examines the symptoms after a natural menopause recalled by women aged 50–89 years. We determined the frequency and clustering of symptoms, the effect of age on symptoms, and the relation of symptoms to the use of estrogen therapy in a cross-sectional, community-based study of 589 Caucasian, middle- to upper-middle-class women from Rancho Bernardo, California. At the time of menopause, 55% of the women reported that they felt life was getting better and 57% were more cheerful. The most frequently recalled symptoms were hot flushes (74%), propensity to weight gain (45%), night sweats (35%), tiredness (32%), and insomnia (28%). Irritability was reported by one-fourth depression by one-fifth. Nearly 11% reported anxiety about looking older. The recalled prevalence of hot flushes, irritability, weepiness and tiredness did not vary by current age, but younger women were significantly more likely than older women to have experienced night sweats, visible flushes, depression, anxiety about looking older and insomnia. Principal components factor analysis yielded four main independent factors: psychological symptoms (21% of the variance), vasomotor symptoms (14%), positive feelings (11%), and negative self-image (8%). The four symptom groupings suggest different causal mechanisms. Forty-two percent reported past, and 27% reported current use of estrogen therapy. Both past and current hormone users were significantly more likely to report menopause symptoms than non-users. Estrogen use was not associated with positive feelings or self-image at the time of menopause. Although three-quarters experienced symptoms, the majority of women reported positive feelings about menopause.