Bone loss during oestriol therapy in postmenopausal women

In contrast to all other oestrogens examined thus far oestriol hemisuccinate (12 mg/day) did not prevent bone loss in 28 postmenopausal women. The average bone loss, however, was somewhat less than expected from placebo studies, while the bone loss achieved by a group taking 4–6 mg/day was equal to that achieved by previous placebo groups. To be an effective agent for prevention of post-menopausal osteoporosis oestriol would have to be prescribed in daily doses considerably in excess of 12 mg.     

Hormonal and psycho-relational aspects of sexual function during menopausal transition and at early menopause

Objective

The aim of the present observational, cross-sectional study was to examine the effects of hormonal and psycho-relational variables on sexual function during menopausal transition and at early postmenopause in women with hot flushes.

Study design

The sample comprised 138 women referred to a clinic for the treatment of hot flushes. They were categorised according to their stage of menopausal transition using the STRAW criteria: early menopausal transition (EMT) if their menstrual cycle was 7 or more days different from normal; late perimenopause (LMT) if they had experienced 60 days or more of amenorrhoea; and early postmenopause (EPM) if their amenorrhoea had lasted for at least 12 months but less than 4 years.

Main outcome measures

Sexual function was measured by using the Female Sexual Function Index (FSFI), while anxiety (state and trait), depression, eating disorder and marital adjustment were evaluated by validated self-report questionnaires. Levels of free testosterone (FT), dehydroepiandrosterone sulfate (DHEAS) and estradiol (E2) were also measured.

Results

Overall sexual function varied significantly with stage of menopause, with total FSFI score less in EPM than in EMT (p = .009). A similar pattern was evident on FSFI sub-scales for sexual desire (p = .02), arousal (p = .01) orgasm (p = .01) and also pain (p = .02), but not for lubrication and satisfaction. Ratings for anxiety, depression and eating disorder did not differ across the menopausal sub-groups, and neither did ratings of marital adjustment. Both FT (p = .01) and DHEAS (p = .03) levels were slightly reduced at EPM in comparison with EMT, as were E2 levels (p = .001 EMT versus LMT; p = .0001 LMT versus EPM). In multiple regression analyses, plasma FT level was the only factor to predict FSFI full score (β = .48; p = 0.004) in women at EMT, while in women at LMT the depression score was the only factor to do so (β = −.62; p = 0.0001). The best model predicting FSFI full score at EPM included levels of DHEAS and E2 levels and state anxiety score.

Conclusions

Hormonal and some psychological variables are relevant to sexual function in symptomatic women during menopausal transition and at early menopause but their role differs with the specific stage of reproductive ageing.     

Reducing depression during the menopausal transition with health coaching: Results from the healthy menopausal transition randomised controlled trial

ObjectiveTo determine if health coaching (HC) decreases the incidence of depression, reduces the severity of symptoms, and increases quality of life during the menopausal transition (MT).Research design and methodsParallel, single-blinded, randomised controlled trial of 6 sessions of phone-delivered HC compared with usual care. Participants were 351 community-dwelling women free of major depression going through the MT, of whom 180 were assigned the intervention and 171 usual care. The primary outcome of interest was the incidence of clinically significant depressive symptoms over 52 weeks. Other study measures included the Hospital Anxiety and Depression Scale, quality of life (SF-12), the Menopause Rating Scale (MRS), diet, body mass index, alcohol use, smoking and physical activity. We considered that women with Patient Health Questionnaire (PHQ-9) scores between 5 and 14 (inclusive) had sub-threshold depressive symptoms.ResultsNine women developed clinically significant symptoms of depression during the study—2 had been assigned HC (odds ratio, OR = 0.26, 95%CI = 0.05, 1.29; p = 0.099). Intention-to-treat showed that, compared with usual care, the intervention led to a greater decline in depressive scores, most markedly for participants with sub-threshold depressive symptoms. Similar, but less pronounced, benefits were noticed for anxiety scores and the mental component summary of the SF-12. The intervention led to a decline in MRS scores by week 26 and subtle improvements in body mass, consumption of vegetables and smoking.ConclusionsHC addressing relevant risk factors for depression during the MT improves mental health measures. Our findings indicate that women with sub-threshold depressive symptoms may benefit the most from such interventions, and suggest that HC could play a useful role in minimizing mental health disturbance for women going through the MT.     

The continuum of ovarian aging and clinicopathologies associated with the menopausal transition

The increased length of time that women live after the menopause has provided the impetus for the scientific and public communities to better understand the relationship between ovarian aging and pathologic conditions that present later in life. The maximal size of the ovarian germ cell pool occurs at midgestation and is followed by a continuous decline in oogonia through birth, puberty, the reproductive years, and finally, the menopause. The association between the relative hypoestrogenemia that occurs in the menopausal transition and the symptomatology of that stage of life has been widely studied. Similarly, the disease processes associated with prolonged lack of exposure to gonadal steroids has received a great deal of scientific inquiry. Although much progress has been made regarding our understanding of the clinicopathologies that occur later in the life of women, firm conclusions of associations and causality continue to elude physicians and scientists, prompting the need for additional research on this patient population.     

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.     

Assessing menopausal symptoms among healthy middle aged women with the Menopause Rating Scale

BACKGROUND: The frequency and intensity of menopausal symptoms within a given population, as assessed by several tools, vary and depend on several factors among them age, menopausal status, chronic conditions and socio-demographic profile. OBJECTIVE: Determine the frequency and intensity of menopausal symptoms as well as associated risk factors among healthy middle aged Ecuadorian women. DESIGN: In this cross-sectional study healthy women aged 40 or more, with intact uterus and ovaries, working at the Luis Vernaza Hospital, Guayaquil, Ecuador, were asked to fill out the Menopause Rating Scale (MRS) questionnaire. Symptom frequency and intensity, as well as obtained scores, were assessed and correlated to demographic data. RESULTS: During the study period, 300 subjects were surveyed. Mean age was 45.1+/-3.1 years (median 45). According to menopausal status women were premenopausal (40.6%); perimenopausal (48%) and postmenopausal (11.4%). A 62% of women were not sexually active and 8.3% had less than 12 years of schooling. The 5 most frequent symptoms of the 11 composing the MRS (n=300) were: muscle and joint problems (77%), depressive mood (74.6%), sexual problems (69.6%), hot flushes (65.5%) and sleeping disorders (45.6%). In general, peri- and postmenopausal women significantly presented higher rates of menopausal symptoms when compared to premenopausal women. Total and subscale MRS scores significantly increased in relation to age and the menopausal stage. Women with lower educational level presented higher somatic and psychological scorings in comparison to their counterparts. Sexually inactive women presented higher total as well as somatic, psychological and urogenital scorings. Logistic regression analysis confirmed significant associations found during univariate analysis. CONCLUSION: In this specific healthy population, age, the menopause, sexual inactivity and educational level were independent risk factors predicting more severe menopausal symptoms.     

Factors associated with menopausal symptom severity in middle-aged Brazilian women from the Brazilian Western Amazon

Objective

To determine the frequency and severity of menopausal symptoms and associated factors in middle-aged Brazilian women.

Methods

A cross-sectional study was carried out involving 1415 women aged 35–65 years attended at the Outpatient unit of the Clinicas Hospital of Rio Branco, Acre state, Brazil. The Menopause Rating Scale (MRS) was used to assess the severity of menopause symptoms. The Stata 10 statistical package was used for all data analysis whereas Pearson's x² nonparametric association test was used for bivariate analysis, adopting a level of statistical significance of 5%. On the multivariate analysis, independent variables positively associated with the dependent model were retained in the final model (p < 0.005).

Results

Overall, 54.1% of participants were premenopausal, 10.1% perimenopausal, and 35.8% postmenopausal. Irritability was the most frequent symptom (78.3%), followed by joint and muscular discomfort (74.8%), and anxiety (72.7%). Mean total MRS score was 15.6 + 8.8 (median 15). After adjusting for confounding factors, the logistic regression analysis found low educational level (OR:1.53; [95% CI:1.21–1.95]; p < 0.001); self-perceived poor/very poor health (OR:4.48; [95% CI: 3.53–5.69]; p < 0.001), and menopausal transition phase (OR:1.73; [95% CI:1.18–2.53]; p = 0.005) to be statistically significantly associated with more severe menopausal symptoms.

Conclusion

Among Brazilian women, atypical symptoms of the menopause were the most frequently reported. Severe menopausal symptoms were more likely in women with low educational level, self-perceived poor health and at the menopausal transition phase.     

Influence of pattern of menopausal transition on the amount of trabecular bone loss. Results from a 6-year prospective longitudinal study

INTRODUCTION: Bone density is lower in postmenopausal than in premenopausal women. Recent findings have suggested that accelerated bone loss already begins before menopause. Despite numerous cross-sectional studies on menopause-related bone density, longitudinal data on perimenopausal bone density changes are scarce. This study sought to characterize the dynamics of changes leading to postmenopausal osteopenia and to possibly find the time point at which accelerated bone loss begins. METHODS: We prospectively followed 34 pre-, peri- and early postmenopausal women without prior external hormone use, measuring their lumbar spine trabecular bone density with quantitative computer tomography at 0, 2 and 6 years. The analysis of the changes over time was done in a tri-parted fashion, since menopausal status changed variably for individual subjects: we grouped the participants according to their currently valid menopausal classification for prospective (baseline classification), interim (2 years) and retrospective (6-year classification) analysis. RESULTS: Six different patterns of menopausal transition were identified in our sample. Bone loss in the groups not reaching postmenopause during 6 years of observation was >50% of the maximum bone loss observed during the study period. Invariably for all analyses, the perimenopausal phase with estrogen levels still adequate was associated with the greatest reduction of trabecular bone mineral density, reaching 6.3% loss annually in the lumbar spine. By comparison, the average rate of loss was slower in the early postmenopause; total bone loss differed by pattern of menopausal transition (one-way ANOVA p<0.05). CONCLUSION: The presented data for the first time show the perimenopausal course of trabecular bone loss (as measured by QCT of the lumbar spine). Acceleration of bone loss during perimenopause reached half-maximal values of the total bone loss measured around menopause, despite adequate serum estradiol levels.     

Hot flash severity in hormone therapy users/nonusers across the menopausal transition

OBJECTIVES: The purpose of this study was to examine the pattern of and factors that influence hot flash severity across the menopausal transition (MT) and early postmenopause (PM). METHODS: Women from the Seattle Midlife Women's Health Study (N=302) provided data for these analyses: at least one annual health questionnaire and a menstrual calendar. A subset of women provided a first morning voided urine specimen from 1997 through 2005. Urine samples were assayed for estrone glucuronide and FSH. Linear mixed effects modeling was used to identify change in hot flash severity scores over time, including the relationship to age, MT-related, psychosocial and lifestyle factors. RESULTS: Increases in hot flash severity were associated with late transition stage, early postmenopause, use of HRT, duration of early transition stage, age of entry into early PM and level of FSH. Age of entry into early transition and estrone levels were associated with decreased hot flash severity. Not associated with hot flash severity were being in early transition stage, age of entry into or duration of late transition stage and all of the psychosocial (anxiety, stress, depressed mood) and lifestyle variables (BMI, activity level, sleep, alcohol use). CONCLUSIONS: Variables associated with reproductive aging independently predicted changes in hot flash severity; psychosocial and lifestyle variables did not. The effect of age dropped out when factors associated with reproductive aging were considered. Use of HRT ameliorated but did not eliminate severe hot flashes suggesting that there is room for alternative approaches less likely to cause harm.     

Increased menopausal symptoms among Afro-Colombian women as assessed with the Menopause Rating Scale

BACKGROUND: Increased frequency and severity of menopausal symptoms have been associated to black race. However, this situation has not been described in any Latin American population. OBJECTIVE: Compare frequency and severity of menopausal symptoms among Afro and non-Afro Hispanic Colombian climacteric women. METHODS: In this cross-sectional study, healthy Afro and non-Afro-Colombian women aged 40-59 years were asked to fill out the Menopause Rating Scale (MRS) questionnaire in order to compare symptom frequency and intensity. RESULTS: A total of 578 women were surveyed (201 Afro-Colombian and 377 non-Afro-Colombian). Mean age of the whole sample was 47.9+/-5.9 years (median 47), with no differences among studied groups in terms of age, parity, and hormone therapy (HT) use. Intensity of menopausal symptoms, assessed with the total MRS score, was found to be significantly higher among Afro-Colombian women (10.6+/-6.7 vs. 7.5+/-5.7, p=0.0001), which was due to higher somatic and psychological subscale scores. In this group, the frequency of somatic symptoms, heart discomfort and muscle and joint problems, was found to be higher than in non-Afro-Colombian women (38.8% vs. 26.8% and 77.1% vs. 43.5%, respectively, p<0.05); equally, all items of the psychological subscale (depressive mood, irritability, anxiety and physical exhaustion) were also found to be higher among black women. On the other hand, compared to black women non-Afro-Colombian ones presented more bladder problems (24.9% vs. 14.9%, p=0.005). After adjusting for confounding factors, logistic regression analysis determined that black race increased the risk for presenting higher total MRS scorings (OR: 2.31; CI 95%: 1.55-3.45, p=0.0001). CONCLUSION: Despite the limitations of this study, as determined with the MRS Afro-Colombian women exhibited more impaired quality of life (QoL) when compared to non-Afro-Colombian ones, due to a higher rate and severity of menopausal somatic and psychological symptoms.     

Effects of isoflavones and amino acid therapies for hot flashes and co-occurring symptoms during the menopausal transition and early postmenopause: A systematic review

Aims

Review controlled clinical trials of isoflavones and amino acid preparation effects on hot flashes and at least one other symptom including mood, sleep, pain, and cognitive function that women report during the menopausal transition and early postmenopause.

Methods

An experienced reference librarian searched PubMed/Medline, CINAHL Plus, PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, AMED, and Alt-Health Watch for English-language randomized controlled trials between 2004 and July 2011. Seventeen trials of isoflavones and amino acid effects on hot flashes and one additional symptom were identified.

Results

In five trials of soy isoflavone preparations, two (6 g soy germ extract and 25 g soy protein in soy nuts) significantly decreased hot flashes, but no other symptoms. In the seven trials of other isoflavones, six significantly reduced hot flashes; in addition, red clover (80 mg) significantly reduced mood symptoms; Rexflavone (350 mg) for women with Kupperman Index > 20 significantly reduced sleep symptoms; two trials had significant reductions for pain: isoflavone powder (90 mg) and red clover (80 mg). The only trial in this systematic review that significantly reduced cognitive symptoms was red clover (80 mg). In one trial, red clover isoflavone (80 mg/day) significantly relieved hot flashes, mood, pain, and cognitive symptoms. Amino acids yielded no significant results. Equol supplements of 30 mg/day for non-Equol producing women significantly reduced mood symptoms in one trial. The magnolia bark extract combination significantly reduced hot flashes, mood, and sleep symptoms.

Conclusions

Isoflavone trials yielded significant reductions on hot flashes and co-occurring symptoms during the menopausal transition and postmenopause, but studies require replication with larger sample sizes and attention to measurement of outcomes.     

Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women

STUDY OBJECTIVES: Examine age-adjusted odds and racial/ethnic differences in self-reported difficulties falling and staying asleep and early morning awakening in midlife women to determine whether difficulty sleeping increased with progression through the menopausal transition. DESIGN: Longitudinal analysis. SETTING: Community-based. PARTICIPANTS: 3,045 Caucasian, African American, Chinese, Japanese, and Hispanic women, aged 42-52 years and pre- or early peri-menopausal at baseline, participating in the Study of Women's Health Across the Nation (SWAN). Interventions: None. MEASUREMENTS AND RESULTS: Self-reported number of nights of difficulty falling asleep, staying asleep, and early morning awakening during the previous 2 weeks were obtained at baseline and 7 annual assessments. Random effects logistic regression was used to model associations between each of the 3 sleep measures and the menopausal transition, defined by bleeding patterns, vasomotor symptoms (VMS), and estradiol (E2) and follicle stimulating hormone (FSH) serum levels. Adjusted odds ratios (ORs) for difficulty falling asleep and staying asleep increased through the menopausal transition, but decreased for early morning awakening from late perimenopause to postmenopause. Naturally and surgically postmenopausal women using hormones, compared with those who were not, generally had lower ORs for disturbed sleep. More frequent VMS were associated with higher ORs of each sleep difficulty. Decreasing E2 levels were associated with higher ORs of trouble falling and staying asleep, and increasing FSH levels were associated with higher ORs of trouble staying asleep. Racial/ethnic differences were found for staying asleep and early morning awakening. CONCLUSIONS: Progression through the menopausal transition as indicated by 3 menopausal characteristics--symptoms, bleeding-defined stages, and endogenous hormone levels--is associated with self-reported sleep disturbances.     

Menopausal symptoms and symptom clustering in Chinese women

Objectives: this paper aims to report the prevalence of symptoms in the Hong Kong Chinese perimenopausal women; to construct reported symptoms into symptom groupings; and to clarify whether the symptom groups are associated with menopausal status. Methods: a random telephone survey of perimenopausal women aged 44–55 years was conducted in 1996. Eligible subjects were identified through telephone dialing of a random sample of the numbers listed in the residents’ telephone directory. Standardized questionnaire, including a 22-item symptom check list, was administered over the telephone. The principal component analysis method followed by varimax rotation was used to examine the relations among the symptoms. Results: differences in the prevalence of menstrual problems across the menopausal status were noted with perimenopausal women having the most complaints. Musculoskeletal conditions were the top complaints reported by the respondents, followed by headaches and psychological symptoms. About 10% of the women complained of hot flushes, and less than 5% of cold sweats. Five symptom clusters, namely psychological, musculoskeletal/gastrointestinal, non-specific somatic, respiratory, and vasomotor, have been identified. After adjustment for age, the analysis of variance showed that psychological, non-specific somatic and vasomotor symptoms were significantly associated with menopausal status, while musculoskeletal and respiratory were of borderline statistical significance. Conclusions: compared with pre- and post-menopausal women, perimenopausal women had the highest reports of symptom complaints. Musculoskeletal complaints were the most prevalent complaints, followed by psychological symptoms. While vasomotor symptoms were significantly associated with menopausal status, their prevalence was comparatively lower than that reported in Caucasian populations.     

Determinants of ovarian volume in pre-, menopausal transition, and post-menopausal women: a population-based study

OBJECTIVE: To verify the association of smoking, parity, body mass index, use of oral contraceptives, and hormone therapy with ovarian volume in pre-, menopausal transition, and post-menopausal women from southern Brazil. METHODS: Cross-sectional study with 273 women aged 36-62 years, representative of the urban population of Passo Fundo, southern Brazil. Participants completed an in-home interview and had their anthropometric measurements and ultrasound exams performed at a clinical center, using a standardized method. The right and left ovaries were measured by ultrasound. Mean ovarian volume was calculated according to age, menopausal status, smoking habit, parity, body mass index (BMI), use of oral contraceptives (OC), and hormone therapy (HT). RESULTS: Ovarian volume decreased after the age of 44 years when adjusted for menopausal status and OC use (p = 0.010). The mean ovarian volume decreased with menopausal status adjusted for age (p = 0.001) and with current OC use, adjusted for age (p = 0.001). There was a positive association between ovarian volume and BMI>or=30 in every woman adjusted for menopausal status and age (p = 0.005). On the other hand, there was no association with smoking, past OC use, and HT. In a linear regression model, post-menopause, menopausal transition, age, and BMI were significantly and independently associated with ovarian volume. CONCLUSION: Ovarian volume decreases with menopausal transition and even more in post-menopause. The reduction of ovarian volume also occurred with aging and OC use. Ovarian volume, however, is positively associated with obesity. Smoking, parity, and hormone treatment do not affect ovarian volume in pre-, menopausal transition, and post-menopausal women.     

Factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women

OBJECTIVES: The aim of this study was to investigate factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women. METHODS: This is a cross-sectional study and included 886 women. Data were collected with a questionnaire including questions about demographics and independent variables tested, the Menopause Symptom Checklist and The MOS 36-Item Short Form Health Survey. RESULTS: The mean age of the women included in the study was 48.62 years (standard deviation (S.D.)=5.75, range: 40-60 years). Of all women, 32.1% were premenopausal, 23.9% perimenopausal and 44.2% postmenopausal. Stepwise multiple regression analyses, performed to determine factors associated with menopausal symptom score, revealed 12 statistically significant variables which increased the strength of the model. These variables were as follows in the order of their contribution to the strength of the model: health problems, recent life stresses, being a primary school graduate, absence of relaxation methods, number of pregnancy, financial problems, tea consumption, inadequate and unbalanced nutrition, coffee consumption, age, being a secondary school graduate and dissatisfaction in marriage. Besides, there was a significant and moderately negative relation between total menopausal symptom scores and quality of life scores. CONCLUSIONS: A large number of factors were associated with experiencing menopausal symptoms and menopausal symptoms had negative effects on the quality of life among Turkish women. Stress management and health promoting practices should be incorporated into menopausal care programs to improve health and quality of life of middle-aged women.     

Bone loss in perimenopausal women: a longitudinal study

A longitudinal evaluation of bone mineral density (BMD) and metabolism was performed in premenopausal women. During the 2-year observation period, the menstrual pattern, plasma estradiol and FSH levels as well as the values of bone markers and BMD did not show any significant modification in a group of eumenorrhoic women (n = 37). Conversely, in agematched oligomenorrhoic women (n = 37) a significant (P < 0.05) increase in the cycle length with a concomitant significant (P < 0.05) increase in circulating plasma FSH and parallel decrease of plasma estradiol levels (P < 0.05) was evident. In this group a significant (P < 0.05) increase in both urinary excretion of OH-P/Cr and plasma BGP levels paralleled a significant (P < 0.05) decrease in radial BMD. These data suggest that premenopausal impairment of ovarian function can lead to a bone loss in a significant proportion of women in which prevention should be considered before menopause.     

Relations among menopausal symptoms,sleep disturbance and depressive symptoms in midlife

Objectives

To investigate the relations among hot flashes, other menopausal symptoms, sleep quality and depressive symptoms in midlife women.

Methods

A large population-based cross-sectional study of 639 women (ages 45–54 years) consisting of a questionnaire including the Center for Epidemiologic Studies-Depression (CES-D) Scale, demographics, health behaviors, menstrual history, and menopausal symptoms.

Results

After controlling for menopausal status, physical activity level, smoking status and current self-reported health status elevated CES-D score is associated with frequent nocturnal hot flashes, frequent trouble sleeping, experiencing hot flashes, nausea, headaches, weakness, visual problems, vaginal discharge, irritability, muscle stiffness, and incontinence.

Conclusions

The present study found significant links between depressive symptoms and several menopausal symptoms including hot flashes, sleep disturbance, irritability, muscle stiffness, and incontinence after controlling for covariates. These findings suggest that a potential mechanism in which bothersome menopausal symptoms may influence depressed mood during the midlife is through sleep disturbance.     

Application of the 10-item Cervantes Scale among mid-aged Ecuadorian women for the assessment of menopausal symptoms

Background

The majority of instruments used to evaluate menopausal symptoms are long and complex. In this sense, more simple tests are being designed to rapidly obtain a snapshot of the global clinical picture.

Objective

To assess menopausal symptoms in mid-aged women using the short 10 item version of the original menopause Cervantes Scale (CS-10).

Method

This was a cross sectional study in which a total of 451 Ecuadorian women (40–59 years) were surveyed with the CS-10 and a general socio-demographic questionnaire containing personal and partner data.

Results

Median age of the whole sample was 48 years. A 41.2% were postmenopausal, 44.3% abdominally obese (waist circumference >88 cm), 6% diabetic, 16.9% hypertense, 11.5% smoked, 6.9% currently used hormone therapy, 9.5% phytoestrogens and 6.7% psychotropic drugs. For the entire sample, median [interquartile range] CS-10 global scores were 10.0 [9.5], and for pre-, peri- and postmenopausal women: 5.0 [7.0], 11.0 [9.0] and 13.5 [8.0], respectively. The CS-10 displayed good internal consistency (Cronbach's alpha 0.87). According to the CS-10, the three most prevalent menopausal symptoms were: muscle and joint pains (88.5%), hot flushes (77.6%) and skin dryness (71.4%). Multiple linear regression analysis found that postmenopausal status, parity, unhealthy perceived status, psychotropic drug use, partner erectile dysfunction, lower coital frequency and living at high altitude were related to higher CS-10 global scores.

Conclusion

In this mid-aged Ecuadorian female sample severity of menopausal symptoms, as determined by the CS-10, were related to environmental and female/partner personal and socio-demographical aspects.     

Endogenous hormones, participant characteristics, and symptoms among midlife women

OBJECTIVES: The primary aim of this study was to examine the associations between endogenous hormone levels and symptoms other than hot flashes in a sample of midlife women. METHODS: Data from a community-based sample of 603 women aged 45-54 years who had never used hormone therapy were analyzed. Each participant completed a questionnaire to obtain data on demographic and lifestyle characteristics as well as symptoms, including headache, insomnia, vision problems, vaginal discharge and dryness, irritability, and incontinence. In addition, each participant provided a blood sample that was used to measure estrogen, androgen, and sex hormone binding globulin (SHBG) concentrations by enzyme-linked immunosorbent assay. RESULTS: Prevalence rates of symptoms ranged from 51.4% (irritability) to 18.6% (vision problems). In adjusted analyses, the free estradiol index (FEI) was significantly and positively associated with the reporting of insomnia (odds ratio (OR) 1.28; 95% confidence interval (CI) 1.01-1.61). Further, higher SHBG levels were significantly associated with lower odds of reporting vision problems (OR 0.44; 95% CI 0.23-0.81). CONCLUSIONS: This study provides evidence that hormones are associated with insomnia and visual problems during midlife. However, some of these results conflict with previous findings. Given the overall paucity of literature on these issues, more investigation is warranted.