Prevalence and clustering of menopausal symptoms in older women by hysterectomy and oophorectomy status

This study examines the association of hysterectomy and oophorectomy with the prevalence and clustering of menopausal symptoms in a large population-based sample of older women. Subjects were 1121 women aged 50-89 from the Rancho Bernardo Study. Information on menopause, hysterectomy, oophorectomy, estrogen use, and other covariates was obtained in 1984-1987. A 1989 mailed survey obtained information on menopausal symptoms. In this sample, 22.1% reported hysterectomy with bilateral oophorectomy, and 25.3% reported hysterectomy with ovarian conservation. Mean time since hysterectomy was 26 (+/-12) years. Overall, 37% reported current estrogen use, and 40% reported past use. The duration of estrogen use was longer for women who had a hysterectomy (p < 0.001). Age-adjusted comparisons indicated that more women who had a hysterectomy, with or without bilateral oophorectomy, reported greater energy after menopause (p = 0.003 and p = 0.001, respectively), and more women with bilateral oophorectomy reported greater interest in sex (p = 0.007) and that life was getting better (p = 0.012) than women with natural menopause. Principal components factor analysis of the symptom data for all women yielded four factors: psychological, vasomotor, positive feelings, and self-image. Analyses performed within each group of women yielded similar factors and loadings. Adjusted comparisons of factor scores indicated that positive feelings were significantly higher in women who had a hysterectomy, with or without bilateral oophorectomy (p < 0.01) than in women with natural menopause. This difference was limited to current estrogen users. Vasomotor symptoms, psychological symptoms, and negative self-image did not differ by hysterectomy or oophorectomy status before or after stratification for estrogen use (p > 0.10). This study found after a hysterectomy, women are more likely to recall positive feelings about their menopause than women with natural menopause. Relief from symptoms leading to hysterectomy and use of replacement estrogen may be partly responsible. Results do not support the thesis that surgical menopause is associated with a sustained increased prevalence of vasomotor, psychological, or other symptoms.     

Vasomotor symptoms are not associated with reduced bone mass in postmenopausal women: the Rancho Bernardo Study

The association of menopause-related vasomotor symptoms with later bone mineral density (BMD) at axial and appendicular sites was examined in community-dwelling older women. Subjects were 894 postmenopausal women from the Rancho Bernardo Study who had BMD measured in 1988-1991 and responded to a 1989 mailed survey that included questions about menopause symptoms. Mean age was 73 years (SE +/- 9.5, range 47-97), and mean age at menopause was 47 years (SD +/- 6.8, range 21-62). Vasomotor symptoms were recalled by two thirds (68%) and night sweats by 36% of all women, with no significant differences in symptom frequency by age or type of menopause. Postmenopausal estrogen (PME) had been used by 644 women (72%) for an average duration of 12.3 (+/-11) years. Among women who reported current estrogen use with a duration >3 years, those who experienced vasomotor symptoms had significantly higher BMD at the lumbar spine (p = 0.01), femoral neck (p = 0.05) and midshaft radius (p = 0.05) compared with women who did not experience symptoms. Vasomotor symptoms were not associated with BMD among past or never PME users or among women who reported current PME use for 3 or fewer years. Analyses stratified by age, type of menopause, or when PME use began showed similar results. Women who reported night sweats also had no difference in BMD compared with women without night sweats. In conclusion, vasomotor symptoms are not a marker for low BMD years after menopause in women with access to healthcare. Vasomotor symptoms significantly increased the likelihood of continued use of PME, which was in turn associated with higher BMD levels.     

The menopausal transition was associated in a prospective study with decreased health functioning in women who report menopausal symptoms

OBJECTIVE: To examine change in health functioning as women progress through the menopausal transition. STUDY DESIGN AND SETTING: Prospective study of 2,489 women followed through four phases of the Whitehall II study. Health functioning was assessed with the eight subscales of the SF-36. RESULTS: Compared with peri- and postmenopausal women who did not experience menopausal symptoms, women who reported vasomotor symptoms or menopausal depression experienced large and significant declines on most scales of the SF-36. Women who reported the greatest symptom severity experienced the largest declines in functioning. For example, decline in physical functioning for perimenopausal women experiencing severe vasomotor symptoms was 3.3 (standard error SE=1.1) greater than those who experienced no vasomotor symptoms. Decline in role limitation-emotional for perimenopausal women experiencing severe menopause-associated depression was 18.4 (SE=2.3), compared with those who did not experience these symptoms. Vasomotor symptom reporting was predicted by low socioeconomic position, high body mass index, and limiting long-term illness at baseline. Menopause-associated depression was additionally predicted by smoking and depression. CONCLUSION: The menopausal transition is associated with decreased health functioning in women who report menopausal symptoms. Menopausal symptoms are strongly related to all aspects of health functioning assessed by the SF-36. Socioeconomic and behavioral risk factors for menopausal symptoms and associated declines in health functioning have been identified.     

武汉市妇女绝经相关因素的调查

目的评估武汉市40~65岁妇女自然绝经过程中绝经相关症状的发生及影响因素。方法选取2014年4~10月武汉市参加年度健康体检、年龄40~65岁的956名妇女为调查对象,采用问卷形式调查妇女的基本信息、月经状况、运动锻炼情况、重要躯体疾病以及围绝经期相关症状,用Greene评分法评估绝经症状,分析绝经症状的发生情况及影响因素。结果月经不规律妇女出现的得分高的前五位绝经相关症状是:感到疲惫或精力不足、失眠、感到头晕或无力、潮热、肌肉或关节酸痛(P0.05);得分高的常见的症候群是:焦虑症状、躯体症状、抑郁症状和血管舒缩症状(P0.05)。绝经后妇女出现的得分高的绝经症状是:失眠、潮热、感到疲倦或精力不足和肌肉关节酸痛(P0.05);常见症候群是血管舒缩症状和性生活问题(P0.05)。躯体疾病对5种绝经症候群均有显著影响(P0.05);40~50岁者较61~65岁者更易有抑郁症状(P0.05);体质量指数增加更易有血管舒缩症状(P0.05)。结论绝经症状在绝经的各个阶段侧重表现不同,慢性躯体疾病是绝经症状的不良影响因素。     

Menopausal transitions,symptoms and country of birth: the Australian Longitudinal Study on Women's Health

OBJECTIVE: To assess differences among the menopausal transitions and symptoms experienced by women participating in the Australian Longitudinal Study on Women's Health, according to their countries of birth. METHODS: Data from 8,466 women aged 45-50 in 1996, who responded to surveys in 1996 and 1998 and had not had a hysterectomy, were analysed. Women were categorised by country of birth and cross-sectionally by menopausal status at Survey 1 and 2, as well as longitudinally by transition through menopause between Surveys 1 and 2. Four endocrine-related and 10 general symptoms were assessed. RESULTS: Women bom in Asia were twice as likely as Australian-bom women to be post-menopausal at Survey 1, twice as likely to become post-menopausal between surveys, less likely to remain peri-menopausal, and less likely to report hot flushes and night sweats. Odds ratios for each symptom at Survey 2 were near unity for all country of birth groups compared with Australian bom women, with or without adjustment for symptoms at Survey 1, menopausal transition category, behaviour, lifestyle and demographics. CONCLUSIONS: Asian-born women entered menopause earlier and passed through it more quickly, but once this was taken into account all women showed the same prevalences of symptoms. There may be differences between ethnic groups that influence the timing of menopause, but the subjective experience appears similar. IMPLICATIONS: The timing of menopause may be affected by biological or dietary differences. Asian-bom women's lower reported prevalence of symptoms may be explained by a more rapid peri-menopausal transition. With increasing numbers of Asian-Australian women reaching menopause, an understanding of country-of-birth differences has implications for public health.     

Phytoestrogens and the menopause – do they really help?

Summary  Studies have recently questioned the safety of hormone replacement therapy (HRT) during the menopause with regard to an increased risk of breast cancer and heart disease. Most notably the US Women's Health Initiative and British Million Women Study resulted in a considerable media furore which has prompted women, who may previously have been happy to take HRT, to explore alternative approaches to the menopause. It is widely accepted that diet and lifestyle play a large part in symptom relief and evidence is strengthening for the role of phytoestrogens in the relief of hot flushes. It is estimated that three-quarters of women in the UK experience one or more symptoms of the menopause, and that for one third these symptoms are severe. This article distinguishes the fact from the fiction and provides an overview of the practicalities of a diet and lifestyle to relieve menopausal symptoms.     

Perceptions, attitudes, and self-management of natural menopausal symptoms in ghanaian women

The use of hormone replacement therapy (HRT) to alleviate menopausal symptoms is associated with risks of cardiovascular and thromboembolic diseases and breast cancer. In this qualitative study, we investigated how women in low-resource settings manage menopausal symptoms without HRT. We interviewed 34 menopausal Ghanaian women about their sources of information, perceptions, attitudes, and self-management methods for alleviating menopausal symptoms. The majority of the women used a combination of nonhormonal medications and complimentary and alternative medicine (CAM), including dietary modifications, exercise, and other lifestyle changes to effectively manage menopausal symptoms. Sources of information about menopause influenced participants' perceptions, attitudes, and self-management choices.     

Tubal ligation does not affect hormonal changes during the early menopausal transition

BACKGROUND: To determine if women with a bilateral tubal ligation (BTL) were more likely to experience hormonal changes indicative of the transition to menopause or an increase in menopausal symptoms compared to women without a BTL. METHODS: Menopausal symptoms and hormone profiles of 134 women reporting a BTL were compared throughout the course of a 4-year follow-up study to 172 women without a BTL. Generalized linear regression models for repeated measures were used to estimate the independent effect of BTL on menopausal symptoms and hormonal levels adjusted for covariates. RESULTS: Forty-four percent of women reported a BTL and over one-half of women with a BTL experienced hot flashes. Women with a BTL had similar hormonal levels over the study period compared to women without a BTL. In addition, no relationship was found between BTL and any of the menopausal symptoms, including hot flashes, decreased libido or increased anxiety adjusting for age, race, body mass index (BMI), education, menopausal status and parity. CONCLUSION: These findings document that women with a BTL have similar changes in sex hormone levels over the perimenopausal period compared to women without a BTL independent of other covariates. In addition, the reporting of menopausal symptoms was similar between the groups.     

Perceptions,Attitudes, and Self-Management of Natural Menopausal Symptoms in Ghanaian Women

The use of hormone replacement therapy (HRT) to alleviate menopausal symptoms is associated with risks of cardiovascular and thromboembolic diseases and breast cancer. In this qualitative study, we investigated how women in low-resource settings manage menopausal symptoms without HRT. We interviewed 34 menopausal Ghanaian women about their sources of information, perceptions, attitudes, and self-management methods for alleviating menopausal symptoms. The majority of the women used a combination of nonhormonal medications and complimentary and alternative medicine (CAM), including dietary modifications, exercise, and other lifestyle changes to effectively manage menopausal symptoms. Sources of information about menopause influenced participants’ perceptions, attitudes, and self-management choices.     

Natural history of menopause symptoms in primary care patients: a MetroNet study

BACKGROUND: The association between changes in menopausal status and menopause-related symptom reporting over the course of the menopause transition is not well understood, especially whether there are any racial differences in this association. OBJECTIVE: To determine (1) the prevalence and the natural history of menopause symptoms among primary care patients approaching, or at menopause; (2) the relationship between self-reported symptoms and menopausal status; and (3) whether this relationship varies in African American and white women. STUDY DESIGN: Cross-sectional self-report survey of 342 women aged 40 to 55 years (31.6% African American) were recruited from 8 family practice centers in 2000 and 2001. RESULTS: Among 251 women without surgical menopause, 133 (53.0%) were premenopausal, 72 (28.7%) were peri-menopausal, and 46 (18.3%) were postmenopausal. The most commonly reported symptoms were joint/muscle pain and headache, which did not vary by menopausal status. As many as 28.6% of the women with regular menstruation reported hot flashes, and 18.8% had night sweats; although both symptoms were strongly associated with changes in menopausal status (P < .01). During the natural menopausal transition, white women had increasing trends of nervousness, memory loss, vaginal dryness, loss of sexual interest, hot flashes, and night sweats while African American women only had increasing trend of painful sex and hot flashes. In multivariate analyses, loss of sexual interest was associated with postmenopause status in white but not in African American women. CONCLUSIONS: Symptoms are not uncommon among premenopausal women and become more prevalent as the transition through menopause occurs. The prevalence of vasomotor symptoms in premenopausal women may be an under-recognized aspect of the natural history of the menopause transition. African American and white women may present different symptoms through menopause transition.     

Androgen replacement in menopause

Menopause and the years leading to the menopausal transition are associated with significant decline in sex steroid levels. In contrast to the abrupt decline in estrogens at the time of menopause, a fall in the circulating testosterone and the adrenal preandrogens most closely parallel increasing age. Their accelerated decrease occurs in the years preceding menopause. It is now recognized that the decline in androgens plays a significant role in affecting perimenopausal and menopausal symptomatology and quality of life. Loss of circulating levels of androgens affects libido, vasomotor symptoms, mood and well-being, bone structure, muscle mass. Also, it influences cardiovascular profile. In the menopausal female (in whom these symptoms are clearly linked to low levels of bioavailable testosterone levels), hormone replacement therapy may be of benefit. Recently, interest is increasing in the use of androgen replacement not only for women who have undergone premature or surgical menopause but also for those who experience natural menopause and premenopausal loss of libido from diminished free testosterone.     

The effect of menopause on grip and pinch strength: results from the Chicago, Illinois, site of the Study of Women's Health Across the Nation

Women may experience a decline in physical function during menopause. Whether this decline is due to aging or to changes in hormonal status is unknown. The authors performed a longitudinal data analysis on data collected between 1996 and 2001 to determine the effects of menopausal status, age, race, and use of hormone replacement therapy (HRT) on 3-year changes in grip and pinch strength. Participants were 563 women from the Chicago, Illinois, site of the Study of Women's Health Across the Nation. According to adjusted analyses, women who became postmenopausal showed a 1.04-kg decline in grip strength (p = 0.10) and a 0.57-kg decline in pinch strength (p = 0.002) relative to women who remained premenopausal. Women who became early perimenopausal showed a 0.20-kg decline in pinch strength (p = 0.04), whereas women who transitioned to late perimenopause showed a 0.93-kg decline in grip strength (p = 0.07). Effects of menopausal status on grip and pinch strength did not vary by race. A significant HRT-by-race interaction for grip strength was found; African-American HRT users had greater grip strength during the study, whereas Caucasian HRT users did not (p = 0.05). Greater physical activity was the strongest predictor of grip and pinch strength (p < 0.0001). Results indicate that transition through menopause is associated with a decline in grip and pinch strength.     

Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups

In recent years, research on menopausal symptomalogy has focused on identifying symptom groupings experienced by women as they progress from premenopausal to postmenopausal status. However, most of these studies have been conducted among Caucasian women from western cultures. This leaves open the question of whether the findings from these studies can be extended to women of other racial/ethnic groups or cultures. Furthermore, many of the previous studies have been conducted on relatively small samples. This paper addresses the diversity of the menopause experience by comparing symptom reporting in a large cross-sectional survey of women aged 40-55 years among racial/ethnic groups of women in the United States (Caucasian, African-American, Chinese, Japanese, and Hispanic). Evaluation of the extent to which symptoms group together and consistently relate to menopausal status across these five samples provides evidence for or against a universal menopausal syndrome. The specific research questions addressed in this paper are: (1) How does the factor structure of symptoms among mid-aged women compare across racial/ethnic groups? (2) Is symptom reporting related to race/ethnicity or menopausal status? and (3) Does the relation between menopausal status and symptoms vary across racial/ethnic groups? Analyses are based on 14,906 women who participated in the multi-ethnic, multi-race, multi-site study of mid-aged women called the Study of Women's Health Across the Nation (SWAN). Study participants completed a 15-min telephone or in-person interview that contained questions on a variety of health-related topics. Items of interest for these analyses include symptoms, menstrual history (to assess menopausal status), health status, and sociodemographics. Factor analysis results showed that across all five racial/ethnic groups, two consistent factors emerged; one consisting of clearly menopausal symptoms -- hot flashes and night sweats -- and the other consisting of psychological and psychosomatic symptoms. Results of regression analyses showed racial/ethnic differences in symptom reporting, as well as differences by menopausal status. Controlling for age, education, health, and economic strain, Caucasian women reported significantly more psychosomatic symptoms than other racial/ethnic groups. African-American women reported significantly more vasomotor symptoms. Perimenopausal women, hormone users, and women who had a surgical menopause reported significantly more vasomotor symptoms. All of these groups, plus postmenopausal women, reported significantly more vasomotor symptoms than premenopausal women. The pattern of results argues against a universal menopausal syndrome consisting of a variety of vasomotor and psychological symptoms.     

Change in psychological and vasomotor symptom reporting during the menopause

There remains uncertainty regarding what health symptoms can be directly attributed to the menopause. The association between changes in menopausal status and changes in vasomotor symptom and psychological symptom reporting was investigated and the effects of changing menopausal status were compared with those related to life events and difficulties. Reports of common health symptoms, menopausal status and life events and difficulties have been collected prospectively from 1572 British women followed up since their birth in 1946, every year between 47 and 52 years. Regression models for repeated measures were fitted with the change in symptom scores between consecutive years as the outcome. Estimates from these models were obtained using generalised estimating equations, thus allowing appropriately for the correlation between repeated measures on the same woman. Vasomotor symptoms were found to be strongly related to changes in menopausal status with increases being observed as women move through the menopause. Psychological symptoms were more strongly associated with current life events and difficulties, particularly those experienced in family life, than with menopausal status. An increase in symptoms was, however, observed in premenopausal and perimenopausal women starting hormone replacement therapy. These effects were not confounded or modified by previous psychological morbidity, social or behavioural factors. The findings suggest that vasomotor symptoms are dependent on changing hormone levels associated with the menopause, while psychological symptoms are not. The possibility that there is a small subgroup of women who experience increased psychological problems at the time of the menopause, and who in this cohort are identified by their use of HRT, is suggested. The mechanism behind this rise remains unclear. Factors other than the menopause should be considered, such as concurrent life events and past experiences and behaviours, when considering the treatment of psychological symptoms in women during middle life.     

Age-related differences in health complaints: the Hilo women's health study

The purpose of this study was to determine the age distribution of health-related complaints and symptom groupings from a random postal survey carried out in the multi-ethnic city of Hilo, Hawaii. Symptom frequencies and factor analyses were compared across three age categories: < 40 (32%), 40-60 (48%), and > 60 years (19%), (n = 1,796). Younger women were most likely to report headaches, menstrual complaints, irritability, and mood swings.Women at midlife were most likely to report fluid retention, trouble sleeping, loss of sexual desire, vasomotor symptoms, and nervous tension. Older women reported the least number of symptoms overall. Using multiple linear regression, menopause status, ethnicity, and alcohol intake were significantly associated with the factor scores for symptoms of menopause, after controlling for age, education, BMI, exercise, smoking habits, and financial comfort.     

Attitudes toward menopause in relation to symptom experience in Puebla, Mexico

OBJECTIVE: To examine how attitudes toward menopause were associated with symptom frequencies after controlling for menopause status and level of education. METHODS: Women aged 28-70 (n = 755) were interviewed from May, 1999 through August, 2000 in the city of Puebla, Mexico. Over 90% of the sample were aged 40-60. Participants were asked to select from a set of dichotomies to describe "how a woman feels during menopause." Symptom frequencies were assessed by a checklist of everyday complaints experienced during the two weeks before interview. Symptom presence or absence was examined in relation to attitudes while controlling for menopause status and level of education using binary logistic regression analyses. RESULTS: The majority of respondents said that a menopausal woman feels "insecure" and "unattractive" yet "complete," "necessary," and "successful." Pre-menopausal women and respondents who had undergone a hysterectomy were more likely to express negative attitudes. Post-menopausal women and women with fewer years of education were significantly more likely to report symptoms such as hot flashes, joint aches, and nervous tension. A range of negative attitudes were associated with nervous tension, feeling blue, and head aches; however, only a few negative attitudes were significantly predictive of estrogen-related symptoms (e.g., hot flashes). CONCLUSIONS: There is a high value placed on both external appearance and familial responsibility among menopausal women in Puebla, Mexico, and negative characterizations of menopause reflect these values. Negative attitudes were associated with more frequently reported symptoms compared with positive attitudes. The challenge remains to separate factors related to the hormonal changes of menopause from those not associated with hormonal changes to better understand symptom experience.     

Comparison of regimens containing oral micronized progesterone or medroxyprogesterone acetate on quality of life in postmenopausal women: a cross-sectional survey

A cross-sectional survey was conducted to examine quality of life (QOL) related to physiological, somatic, and vasomotor effects of changing progestogen treatment from medroxyprogesterone acetate (MPA) to micronized progesterone in postmenopausal women. Eligible women (n = 176) were currently using hormone replacement therapy (HRT) containing micronized progesterone for 1-6 months and had previously received HRT containing MPA. QOL was assessed via telephone interview using the Greene Climacteric Scale and the Women's Health Questionnaire. When compared with the MPA-containing regimen, women using micronized progesterone-containing HRT experienced significant improvement in vasomotor symptoms, somatic complaints, and anxiety and depressive symptoms. Women reported improved perceptions of their patterns of vaginal bleeding and control of menopausal symptoms while on the micronized progesterone-containing regimen. Approximately 80% of women reported overall satisfaction with the micronized progesterone-containing regimen. A micronized progesterone-containing HRT regimen offers the potential for improved QOL as measured by improvement of menopause-associated symptoms.     

Women's knowledge about menopause, hormone replacement therapy (HRT), and interactions with healthcare providers: an exploratory study

This community mail-based survey received responses from 665 women to questions in three areas: (1) sources of information about menopause, (2) knowledge of health risks associated with menopause, and (3) knowledge about hormone replacement therapy (HRT). Women received information from many sources, including healthcare providers, friends, and mothers, but the number one source of information about menopause was women's magazines (76%). Over half of women surveyed said they had left healthcare appointments with unanswered questions about menopause and HRT. Although women seemed to have a basic understanding of the symptoms of menopause, their knowledge of the long-term health risks affected by menopause was poor. For example, women were much more likely (60%) to know that osteoporosis risk increased with menopause than to know that heart disease risk increased (30%) despite the much higher prevalence and severity of heart disease as a health problem of menopausal women. Many women thought that menopause itself (independent of aging) increased the risk of breast cancer. This finding may help explain the low percentage of women who take HRT for menopause despite proven health benefits. It is clear that better education about menopause needs to be accomplished regarding the long-term risk associated with menopause and the pros and cons of HRT. Strategies for improving education and interactions with healthcare providers are suggested.