Menopausal symptoms and associated factors in HIV-positive women

Objective

To evaluate menopausal symptoms and their associated factors in HIV-positive women.

Methods

A cross-sectional study was conducted with 537 women of 40–60 years of age, 273 of whom were HIV-positive and 264 HIV-negative. The women were interviewed to obtain data on their sociodemographic characteristics and menopausal symptoms.

Results

The mean age of the seropositive women was 47.7 ± 5.8 years compared to 49.8 ± 5.3 for the seronegative women (p < 0.001). Bivariate analysis showed a lower prevalence of vasomotor symptoms in the seropositive group (p = 0.009), specifically hot flashes (p < 0.002) and sweating (p = 0.049). Vaginal dryness was also less prevalent in this group (p < 0.005). There were no statistically significant differences between the groups with respect to depression or insomnia. Multiple analysis showed that hot flashes were associated with being peri- or postmenopausal (PR = 2.12; 95%CI: 1.52–2.94). Vaginal dryness was less common in women without a partner (PR = 0.67; 95%CI: 0.49–0.90) and was associated with older age (PR = 1.03; 95%CI: 1.01–1.06) and being in the peri- or postmenopause (PR = 1.69; 95%CI: 1.10–2.60). Depression was inversely associated with being employed (PR = 0.74; 95%CI: 0.58–0.96) and directly associated with the presence of chronic diseases (PR = 1.30; 95%CI: 1.01–1.067). Insomnia was associated with a lower body mass index (PR = 0.96; 95%CI: 0.95–0.97) and with being peri- or postmenopausal (PR = 1.48; 95%CI: 1.11–1.97). No correlation was found between HIV serological status and any of the menopausal symptoms.

Conclusions

In this study, after controlling for confounding variables, HIV infection was not found to be associated with vasomotor, genitourinary or psychological symptoms or with insomnia.     

An alternative to Unibase/glycol as an effective nonhydrating electrolyte medium for the measurement of electrodermal activity

Although Unibase cream has been an effective medium for electrodermal recordings, its production has recently been discontinued. This study compared alternative media to Unibase for effectiveness. Three base creams similar to Unibase were initially compared for in vitro viscosity and effectiveness. Based upon this analysis one cream was eliminated. A volunteer sample of 6 postmenopausal women with hot flashes and 6 young women without flashes was recruited. Media were evaluated for viscosity and effectiveness of skin conductance. Results indicated that one electrolyte media produced readings within the normal range, identified true positive hot flashes, and produced few false negative readings whereas the second produced largely unreadable results with many false negative hot flashes. An appropriate substitute for Unibase as an effective electrolyte medium for measurement of electrodermal activity was identified.     

Ambulatory Electrodermal Monitoring: Effects of Ambient Temperature, General Activity, Electrolyte Media, and Length of Recording

The feasibility of long-term monitoring of electrodermal activity (EDA) from freely moving subjects was assessed by examining several confounding variables including epidermal hydration, ambient temperature, and physical activity. EDA was monitored from 12 subjects during a normal working day. A portable 4 channel cassette recorder (Medilog) was employed to record skin conductance, ambient temperature, and arm movements. The effects of epidermal hydration were assessed using different 0.05 KCl electrolyte media. EDA was quantified throughout the day during several 5-min rest periods and subsequent simple reaction time tasks. In order to distinguish between the influence of time of day and electrode/electrolyte aging, an extra pair of fresh electrodes was applied at each measurement period. Significant effects of temperature, electrolyte medium, and time of measurement on several indices of EDA were obtained. The implications of these data for long-term ambulatory EDA monitoring were discussed.     

Hot flashes and blood pressure in midlife women

Objectives

Recent epidemiological studies suggest that hot flashes may have a detrimental impact on the cardiovascular system. The purpose of this study was to examine the associations between hot flashes and blood pressure among women aged 45–54 years who had never used hormone therapy.

Study design

Data were analyzed from 603 women who participated in the Midlife Health Study, a cross-sectional study conducted in the Baltimore Metropolitan region.

Main outcome measures

All participants came to the clinic where systolic and diastolic blood pressures were measured, height and weight were assessed, and a questionnaire was administered that ascertained detailed data on history of hot flashes and participant demographics and health habits.

Results

The data showed that 56.9% of the participants reported ever experiencing hot flashes. In the age-adjusted analyses, both systolic and diastolic blood pressures were significantly and positively associated with hot flashes. However, the estimates were markedly attenuated and not statistically significant after adjustment for age, race, smoking status, current alcohol use, body mass index, and use of an anti-hypertensive agent or a cholesterol-lowering medication. Similar results were observed for moderate or severe hot flashes, hot flashes experienced for one or more years, and hot flashes experienced within the previous 30 days.

Conclusions

These findings indicate that hot flashes are not significantly associated with blood pressure during midlife.     

A pilot study of a Hatha yoga treatment for menopausal symptoms

OBJECTIVE: To assess the feasibility and efficacy of a yoga treatment for menopausal symptoms. Both physiologic and self-reported measures of hot flashes were included. METHODS: A prospective within-group pilot study was conducted. Participants were 12 peri- and post-menopausal women experiencing at least 4 menopausal hot flashes per day, at least 4 days per week. Assessments were administered before and after completion of a 10-week yoga program. Pre- and post-treatment measures included: Severity of questionnaire-rated menopausal symptoms (Wiklund Symptom Check List), frequency, duration, and severity of hot flashes (24-h ambulatory skin-conductance monitoring; hot-flash diary), interference of hot flashes with daily life (Hot Flash Related Daily Interference Scale), and subjective sleep quality (Pittsburgh Sleep Quality Index). Yoga classes included breathing techniques, postures, and relaxation poses designed specifically for menopausal symptoms. Participants were asked to practice at home 15 min each day in addition to weekly classes. RESULTS: Eleven women completed the study and attended a mean of 7.45 (S.D. 1.63) classes. Significant pre- to post-treatment improvements were found for severity of questionnaire-rated total menopausal symptoms, hot-flash daily interference; and sleep efficiency, disturbances, and quality. Neither 24-h monitoring nor accompanying diaries yielded significant changes in hot flashes. CONCLUSIONS: The yoga treatment and study procedures were feasible for midlife women. Improvement in symptom perceptions and well being warrant further study of yoga for menopausal symptoms, with a larger number of women and including a control group.     

The Use of Alternative Methods in Reducing Menopausal Complaints in Turkey

Background

Millions of women experience menopause every year, therefore the aim of this study is to determine the rates of application of alternative methods applied by women in order to reduce their complaints caused by menopause and alternative application methods.

Materials and Methods

This study was carried out on 246 women in their menopausal period. The data was obtained by the researcher through face to face interviews during the home visits. During the collection of data, a questionnaire form by the researcher that was developed in accordance with the literature information was applied.

Results

37.4% of women were determined to use alternative methods to reduce their menopausal symptoms. In the consequence of statistical analysis, a significant relation was found between the menopausal complaints such as hot flashes, night sweats and sleeping problem and the use of alternative methods in order to reduce their menopausal complaints (p<0.05).

Conclusion

It was determined that the women at their menopausal ages experienced vasomotor complaints and sleeping problems and they used alternative methods to reduce those problems.     

Differential factors associated with hot flashes in Chinese perimenopausal and postmenopausal women

Objective

This study investigated factors associated with hot flashes in Chinese perimenopausal and postmenopausal women.

Methods

This cross-sectional study recruited Chinese women aged 40–60 years who were perimenopausal or postmenopausal and examined factors associated with hot flashes. Participants completed a questionnaire detailing demographic information, characteristics of menstruation, reproductive history, use of hormone replacement therapy or oral contraceptives, personal lifestyle factors (exercise, multivitamin use, soy products use, diet), and symptoms of hot flashes. Height, weight, blood pressure, and waist and hip circumference were also measured.

Results

A total of 1399 participants (817 perimenopausal women and 582 postmenopausal women) completed the study. In perimenopausal women, college or higher education decreased the prevalence of hot flashes (odds ratio (OR) 0.63; 95% confidence interval (CI) 0.46–0.86). In postmenopausal women, an omnivorous diet decreased the prevalence of hot flashes (OR 0.38; 95% CI 0.17–0.85). Strenuous exercise (≥3 times a week) increased the prevalence of hot flashes (OR 1.41; 95% CI 1.08–1.83) in perimenopausal women.

Conclusions

It is possible that modifiable risk factors for hot flashes exist in Chinese perimenopausal and postmenopausal women. Future studies with larger populations are needed to confirm these findings.     

A comparative study of menopausal hot flashes and their psychosocial correlates in Taiwan and the United States

Objective

To compare the frequency, severity, and interference of menopause-related hot flashes and their psychosocial correlates in Taiwanese and U.S. women.

Study design

Cross-sectional study, using a convenience sample of 101 Taiwanese and 121 U.S. midlife women.

Main outcome measures

Hot-flash measures, including frequency, severity (Women's Health Initiative Symptom Scale), hot flash related daily interference; and psychosocial measures: Attitudes toward Menopause and Aging Scale, Coping Strategies Questionnaire, Sense of Coherence Questionnaire, Center for Epidemiological Studies-Depression Scale, Spielberger State-Trait Anxiety Inventory, and State-Trait Anger Scale.

Results

Using ANCOVA with demographic variables as covariates, U.S. women reported greater frequency and daily interference from hot flashes compared with Taiwanese women. Greater depression, greater catastrophizing about hot flashes, lower sense of coherence, lower state/trait anger, and more positive attitudes toward aging were reported in the U.S. cohort. The groups were similar in their frequency of specific coping strategies, and they did not differ significantly in menopause symptom severity, attitudes towards menopause, state/trait anxiety, or overall negative psychosocial characteristics. Hierarchical multiple regression analyses indicated that hot-flash related daily interference was predicted by marital status, frequency of hot flashes, and negative psychosocial characteristics among the U.S. women; and by frequency of hot flashes and negative psychosocial characteristics among the Taiwanese women.

Conclusions

Despite differences in the frequency and daily interference from hot flashes in the two samples, the predictors of interference were similar. Results highlight the importance of considering both psychosocial factors and cultural differences in providing guidance and treatment for women experiencing menopause-related hot flashes.     

Obesity and fat distribution in relation to hot flashes in Dutch women from the DOM-project

The authors studied obesity and fat distribution in relation to the occurrence of hot flashes in a population-based study comprising 2904 women aged 40–44 and 569 women aged 54–69 presenting for mammographic screening (the DOM-project). Women aged 40–44 in the upper tertiles of Quetelet's index and waist/hip ratio reported hot flashes significantly more often than women in the respective lower tertiles. These associations were independent of each other and independent of age. After adjustment for age, waist/hip ratio and menopausal status, the odds ratio comparing the upper tertile of Quetelet's index to the lower tertile was 1.70 (95% confidence interval, 1.30 – 2.21). After adjustment for age, Quetelet's index and menopausal status, the odds ratio comparing the upper tertile of waist/hip ratio to the lower tertile was 1.37 (95% CI, 1.05 – 1.78). In women aged 54–69 no significant associations between Quetelet's index and complaints of hot flashes were observed. Women in the upper tertile of waist/hip ratio reported hot flashes more often than women in the lower tertile, but this result was not significant (OR 1.38; 95% CI, 0.87 – 2.22).     

Ambulatory Monitoring of Respiration: Inhibitory Breathing in the Natural Environment

Because previous work found that sustained inhibitory breathing (i.e., low frequency breathing without increased tidal volume) can occur in laboratory animals under conditions of behavioral stress, this study sought to determine whether a comparable respiratory pattern could be observed in ambulatory human subjects in their natural environments. Tidal volume, breathing frequency, and minute ventilation were monitored continuously during 24-hour sessions via inductive plethysmography and a portable microprocessor. Mean tidal volume and minute ventilation were significantly higher during the daytime than at night for all subjects. However, mean breathing frequency was not consistently higher during the daytime, because episodes of low frequency breathing offset episodes of high breathing frequency. Tidal volume during low frequency breathing was comparable to that observed during medium or high frequency breathing. Thus, low frequency breathing was indicative of low minute ventilation. The eliciting stimuli, physiological concomitants, and relevance to health of this energetically inefficient breathing pattern remain to be determined.     

A critical view of the effects of phytoestrogens on hot flashes and breast cancer risk

The increased risk of breast cancer recently observed with some specific estro-progestin associations has raised concerns about the harmful effects of menopausal hormone replacement therapy (HRT). It has been proposed that phytoestrogens (PEs), which have a similar chemical structure to estrogens, could be used as HRT. The main selling points of these preparations concern the management of hot flashes and their potential beneficial effects on breast tissue. In this review, we will address the effects of PE on hot flashes and breast cancer risk as well as the questions raised on a chemical point of view. We conclude that the efficacy of a PE rich diet or nutritional supplements is not clearly established. The use of PE as an alternative for HRT cannot be advocated for now, due to insufficient and conflicting data on efficacy and safety. Moreover, due to the hormone dependence of breast cancer, PE use must be contraindicated in breast cancer survivors.     

To exercise,or, not to exercise,during menopause and beyond

Menopausal symptoms in women can be severe and disruptive to overall quality of life. Hormone replacement therapy, is known to be effective in ameliorating symptoms, however, reporting of side effects has resulted in alternative treatment options. Exercise has been assessed as an alternative treatment option for alleviating menopausal symptoms, including, psychological, vasomotor, somatic and sexual symptoms. Here we report the effects of physical activity and exercise on menopause symptoms in menopausal women.     

Menopause-specific questionnaire assessment in US population-based study shows negative impact on health-related quality of life

Objective

To use the Menopause-Specific Quality of Life Questionnaire (MENQOL) to assess the impact of menopausal symptoms on health-related quality of life in a large US population-based study.

Methods

Participants were recruited from the US population through random-digit-dialing and probability sampling. Analyses included 2703 postmenopausal women 40–65 years old in our Menopause Epidemiology Study. Respondents answered a 30-min questionnaire, including the MENQOL.

Results

Scores for each domain were: vasomotor: 3.2 ± 2.2; psycho-social: 3.3 ± 1.8; physical: 3.5 ± 1.5; sexual: 2.9 ± 2.1. There were significant differences in the MENQOL scores by age, smoking, exercise, education, employment status and BMI. Women aged 60–65 years (p < 0.0001), with a bachelor’s degree or higher level of education (p < 0.0001), who exercised at least 3 days a week (p < 0.0001), who had never smoked (p < 0.0001), with a body mass index ≤25 kg/m² (p < 0.0001), and who had significantly lower scores indicating better quality of life. Hot flashes affected work (46.0%), social activities (44.4%), leisure activities (47.6%), sleep (82.0%), mood (68.6%), concentration (69.0%), sexual activity (40.9%), total energy level (63.3%) and overall quality of life (69.3%).

Conclusion

Symptoms experienced during menopause and socio-demographic characteristics affect the quality of life in postmenopausal women. Hot flashes impact the daily activities of most postmenopausal women, especially those with more frequent/severe symptoms. Treatments that safely and effectively treat these symptoms could improve quality of life among postmenopausal women.     

Managing menopausal symptoms and depression in tamoxifen users: implications of drug and medicinal interactions

Objective

Tamoxifen, a medication used in the treatment of breast cancer, often induces menopausal symptoms. Certain medications and natural supplements taken or prescribed to alleviate tamoxifen-induced hot flashes and depressive states in women with breast cancer interact with tamoxifen. This paper reviews potentially problematic interactions and offers treatment recommendations.

Methods

Medline (1950-June 1, 2010), Embase Classic + Embase (1947-June 1, 2010) and PsycINFO (1967-June 1, 2010) were searched through Ovid. The word “tamoxifen” was searched with “depression” and then with “menopaus*” and “symptoms”, with “treatment” as a limit. “Tamoxifen” was later searched with the MeSH terms “drug interaction” or “drug incompatibility”.

Results

Venlafaxine is efficacious for the treatment of hot flashes and depression and safe to use in combination with tamoxifen. Gabapentin is also efficacious in treating tamoxifen-induced hot flashes and, since it does not interact with cytochrome P450 system, is likely safe to use in patients using tamoxifen. Desvenlafaxine and pregabalin may be alternatives to venlafaxine and gabapentin, respectively, although desvenlafaxine has not yet been studied in this population. Paroxetine, fluoxetine and bupropion are strong CYP2D6 inhibitors which should be avoided in tamoxifen users. Fluvoxamine and nefazodone both inhibit CYP3A, which could potentially affect the metabolism of tamoxifen. Clonidine can be an alternative agent but may carry significant side effects. Evidence of medicinal products for the treatment of tamoxifen-induced hot flashes is equivocal at best.

Conclusions

Clinicians should remain cautious about using strong inhibitors and/or inducers of cytochrome 2D6 and 3A4 concomitantly with tamoxifen. Use of natural menopausal supplements and diets rich in isoflavones should not be encouraged in tamoxifen users until more data is available. There are however safe treatments for hot flashes and depression in tamoxifen users.     

Duloxetine for major depressive disorder and daytime and nighttime hot flashes associated with the menopausal transition

Background

We sought to obtain preliminary data regarding the efficacy of duloxetine for major depressive disorder (MDD) during the menopausal transition. The secondary outcomes were vasomotor symptoms (VMS, or hot flashes), specifically assessed as daytime or nighttime, and anxiety.

Methods

After a single-blind placebo lead-in, peri- and postmenopausal women with MDD (n = 19) received eight weeks of open-label treatment with duloxetine (60 mg/day). The Hamilton Rating Scale for Depression (17-item) (HAM-D) was the primary outcome measure. Hot flashes were monitored prospectively using daily diaries, the Greene Climacteric Scale (GCS), and the Hot Flash-Related Daily Interference Scale (HFRDIS). Anxiety was measured with the Generalized Anxiety Disorder scale (GAD-7).

Results

Of 19 participants treated with duloxetine, 16 (84.2%) were evaluable (returned for ≥1 follow up), and 13 (68.4%) completed the study. Three discontinued due to side effects. The pre-treatment and final median HAM-D scores were 15 (interquartile range [IQR] 14–18), and 6.5 (IQR 4–11.5), respectively, reflecting a significant decrease (p = .0006). The response and remission rates were 56.3% (all responders were also remitters, having ≥50% decrease in HAM-D scores and final scores ≤7). Anxiety improved with treatment (p = .012). GCS and HFRDIS scores decreased significantly. Among those who reported hot flashes at baseline, number and severity of hot flashes improved significantly overall (p = .009 and p = .008, respectively). Daytime but not nighttime hot flashes improved significantly.

Conclusions

These data support further study of duloxetine for the treatment of a spectrum of symptoms associated with the menopausal transition.     

The Standardized Mental Stress Test Protocol: Test-Retest Reliability and Comparison with Ambulatory Blood Pressure Monitoring

The mental stress test protocol is used extensively in research, but different laboratories often employ different stress tasks, utilize different dependent variables to index the stress response, and perform different transformations on the gathered data. The present study determined the test-retest reliability of 11 cardiovascular dependent variables during a resting baseline and three common stress tasks: playing a video game, performing a choice reaction-time test, and performing a cold-pressor test. Sixty healthy, middle-aged males underwent testing twice, approximately three months apart. Instructions were delivered via videotape and data were gathered on-line by computer to ensure a standard laboratory environment. Each task elicited significant increases in blood pressure, vascular rigidity, LVET, heart rate, and stroke volume. In addition, the cold-pressor test led to increases in total systemic resistance and mean systolic ejection rate. The absolute levels of the 11 dependent variables were correlated across tasks (partial r, baseline removed, = .06 to .69, 32 of 33 comparisons significant at p<.05), indicating that reactivity to stress generalizes across alternate test forms. The absolute levels also showed significant test-retest reliability (r= .32 to .82; 40 of 44 comparisons significant at p<.05). In addition, for 19 of 33 comparisons, absolute levels showed greater test-retest reliability than change scores derived by subtracting the initial resting baseline value from the stress-task value. Finally, blood pressures taken during the stress tests were more highly correlated with the average blood pressures measured via ambulatory monitoring than casual office pressures, suggesting that such stress values may more accurately reflect average blood pressure.     

Menopausal symptoms following breast cancer treatment: A qualitative investigation of cognitive and behavioural responses

Objectives

Menopausal symptoms – hot flushes and night sweats (HF/NS) – are particularly troublesome for women who have undergone breast cancer treatment. Non-medical treatments, such as cognitive behaviour therapy, are being developed but there is a lack of information about cognitive and behavioural reactions to HF/NS in breast cancer patients.

Methods

Thirty-five women who had completed active breast cancer treatment with at least 10 HF/NS per week completed questionnaires assessing HF/NS, mood and beliefs, and took part in interviews to elicit cognitive and behavioural reactions and a thematic content analysis used to analyse the data.

Results

The mean weekly frequency of HF/NS was 76 (SD = 46) (57 HF and 19 NS). Smokers reported significantly more night sweats, but BMI and mood were not associated with HF/NS frequency. Cognitive and behavioural responses were varied but broadly similar to those of well women. The main cognitive themes were: embarrassment/social anxiety, loss of control, beliefs about NS, sleep and tiredness, and the main behaviours were: carry on and ignore them, cool down, avoidance, communication with others.

Conclusions

The results are discussed within a cognitive behavioural framework and might inform the development of psychological interventions for these treatment related symptoms.     

高血压病患者动态血压变异性与微循环变化的关系

目的 :探讨高血压病 (EH)患者的动态血压变异性 (ABPV)、甲襞微循环变化特点及二者的关系。方法 :以 3 0例年龄相当、血压正常的健康者作对照组观察了 67例EH患者的动态血压变异性(ABPV)、甲襞微循环变化。结果 :发现高血压病组微循环的管袢形态、血流流态、袢周状态积分值及总积分值明显高于正常对照组。相关分析结果显示 :正常对照组甲襞微循环总积分值仅与年龄呈弱相关 (r=0 .3 75 ,P <0 .0 5 ) ,与偶测血压 (CBP)、动态血压的各参数平均值 (ABP)、ABPV无显著性相关。高血压病组总积分值主要与CBP、ABP呈显著正相关 ,与 2 4h、夜间的ABPVs、ABPVd呈显著负相关 ,其中与 2 4hABPs关系最为显著 (r =0 .60 4,P <0 .0 1)。结论 :高血压病昼夜血压水平与血压的变异性 ,对微循环恶化改变的发生发展起重要的作用。