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Menopause and perceived health status among women of the French GAZEL cohort
Abstract
The aim of this study was to evaluate the effect of menopause on women's quality of life. Women (1171) aged from 45-52 years who work for the French national gas and electricity company volunteered for this study (response rate 75%). They completed a self-administered questionnaire pertaining to general health. Quality of life was measured by the Nottingham Health Profile (NHP). Within this group 289 women were postmenopausal. After controlling for age, those women were more likely to show a lower quality of life than women still menstruating for 4 of the 6 sections of the NHP: social isolation (odds ratio 1.4; 95% confidence interval 1.1-1.9), pain, sleep and energy (odds ratios 1.5; 95% confidence intervals 1.1-2.0). Those alterations of quality of life are explained by the climacteric complaints the women report. Those findings suggest that the treatment of menopausal symptoms with medication of proven efficacy may prevent lowering of quality of life due to menopause.
... When a woman reaches middle age, estrogen and progesterone production decayed and onwards most women face various vasomotor symptoms and psychosomatic difficulties that can be severe in some individuals. Certain difficulties are habitually let by hormonal imbalances, notably Hot Flush, Night Sweating, Anxiety, Sleep Disturbances, Muscles and Joints pain, Formication, Frequent Urination, and many more [5][6][7]. One of the studies explains that the most basic physical and psychological discomforts were Headache (88.80%), ...
... These two problems are more prevalent in urban populations [7].Hot flush was noted at almost four-third; comparatively, one of the Indian studies has shown similar according to the data obtained from their respondents and percentages nearby to our findings another Premenopausal and postmenopausal comparative study for postmenopausal women by K, Shilpa & Ugargol, Amit. And Sharma, S., & Mahajan, N [7,18] and contradictory to our findings reported these study by Sagdeo, M &Arora, Dimple., Sharma S, Tandon V, Mahajan A., Mahajan, N., Aggarwal, M., &Bagga, A [5,17,23]. A Thai study by Punyahotra, S., Dennerstein, L., & Lehert, P. showed a percentage of total night sweating of a quarter which fully supports our study-moreover, Sagdeo, M & Arora, Dimple. Represent the symptoms differently; the percentage of urban and rural is almost multiplying that of the current study [28,6]. ...
... This is associated with various physical and psychological factors [39] in this study, dizziness reported almost two-thirds of the total population and the same percentage found in urban and hilly areas. Dasgupta, Doyel & Ray, Subha denotes in their study nearby percentages as our study but another study by Ledésert, B., Ringa, V., & Bréart, G. Represent one-fourth of the total respondent [27,5]. A study on menopausal status classified headaches category among women aged 40-54 who regularly visited the Headache Clinic [40].We found nearly a half at the subject population, but it has a few high percentages at the hilly area. ...
... The relationship between quality of life (QOL) and menopausal status is controversial. Studies using the Nottingham Health Pro le (NHP) have shown a positive relationship between menopausal status and QOL when comparing pre-menopausal to peri-menopausal and menopausal women in the 45-55 year age range (Ledesert, Ringa, & Breart, 1995;Oldenhave, Jaszmeann, Haspels, & Everaerd, 1993). Women experiencing severe climacteric symptoms reported lower QOL when compared with those experiencing only mild symptoms as measured by a time trade-off and symptoms impact rating scale (Daly et al., 1993). ...
... Dennerstein (1996), reported that menopausal status did not affect well-being. However, Oldenhave et al. (1993) and Ledesert et al. (1995) show a positive relationship between menopausal status and QOL in pre-menopausal and perimenopausal women. We found that when lifestyle, health differences and HRT usage were accounted for, QOL was related to the menopause, but the relationship differed as a function of the measure used. ...
... Thus, our data support the apparently contradictory assertion of Dennerstein (1996) that lifestyle is important to QOL and Oldenhave et al. (1993) and Ledesert et al. (1995) that menopausal status is important to QOL. Our data also show that both are important. ...
Objectives. To determine whether quality of life (QOL) changes during the menopause as a function of menopausal status and other medical and lifestyle variables. Design. A postal questionnaire sent to three different samples of women. Method. A total of 1188 questionnaires were received from (a) two samples recruited from two Family Health Service Association (FHSA) lists and (b) one sample recruited through an advertisement in a women's magazine. The questionnaires consisted of (a) a seven domain, 48-item, condition-specific QOL questionnaire which was developed for this study (MQOL), (b) a single item global QOL questionnaire (GQOL), (c) questions about medical history, (d) questions about work status, (e) questions assessing menopausal status using two different techniques. Results. Both the MQOL and GQOL indicated a relationship with menopausal status. GQOL and MQOL showed a U-shaped relationship with menopausal status, with lowest scoresassociated with the middle of the menopause. However, domain scores of Sleep and Energy failed to reach the levels reported by women who perceive themselves to be pre-menopausal, and domain scores of Symptom Impact and Social Interaction indicate steady decline during the menopausal transition. Women who experienced the menopause long ago reported the highest GQOL, feelings and cognition domain scores. Medical history and work outside the home play an important role in determining MQOL-womenwho had undergone hysterectomy, those who had tried but discontinued HRT while still in the middle of the climacteric, and those with greater co-morbidity had poorer QOL. Those who worked outside the home reported better MQOL, and those recruited through the magazine reported poorer QOL. Conclusions. QOL is affected by the menopause, but the way it is affected depends on the measure of QOL used. QOL during the menopause is also affected by medical and lifestyle variables. QOL during the menopause is a complex interaction of several different kinds of variable.
... 1,2 Although some women report experiencing the menopausal transition without any VMS, 3 other women report that these symptoms can be frequent and severe and interfere with daily activities and quality of life. [4][5][6][7][8][9][10][11][12] Recent estimates suggest that frequent menopausal VMS can continue for a median of 7.4 years. 13 Further, VMS are the chief menopause-related problems for which women in the United States seek medical attention. ...
... We did not find that expectations about acupuncture at baseline were related to response. This may be, however, because we did not use the validated Acupuncture Expectancy Scale, 46 which allows for a wider distribution (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) of scores than did our expectations rating scale. Study participants in all groups expected acupuncture to be helpful. ...
Objective:
To examine the trajectories of responses to acupuncture treatment for menopausal vasomotor symptoms (VMS) and the characteristics of women in each trajectory.
Methods:
Two hundred nine perimenopausal and postmenopausal women aged 45 to 60 years experiencing at least four VMS per day were recruited and randomized to receive up to 20 acupuncture treatments within 6 months or to a waitlist control group. The primary outcome was percent change from baseline in the mean daily VMS frequency. Finite mixture modeling was used to identify patterns of percent change in weekly VMS frequencies over the first 8 weeks. The Freeman-Holton test and analysis of variance were used to compare characteristics of women in different trajectories.
Results:
Analyses revealed four distinct trajectories of change in VMS frequency by week 8 in the acupuncture group. A small group of women (11.6%, n?=?19) had an 85% reduction in VMS. The largest group (47%, n?=?79) reported a 47% reduction in VMS frequency, 37.3% (n?=?65) of the sample showed only a 9.6% reduction in VMS frequency, and a very small group (4.1%, n?=?7) had a 100% increase in VMS. Among women in the waitlist control group, 79.5% reported a 10% decrease in VMS frequency at week 8. Baseline number of VMS, number of acupuncture treatments in the first 8 weeks, and traditional Chinese medicine diagnosis were significantly related to trajectory group membership in the acupuncture group.
Conclusions:
Approximately half of the treated sample reported a decline in VMS frequency, but identifying clear predictors of clinical response to acupuncture treatment of menopausal VMS remains challenging.
... Many middle-aged women do, however, report a number of signs and symptoms during the menopausal transition 22,36 but only vasomotor symptoms (hot flushes and sweating) and vaginal dryness are associated with the decreased oestrogen production that arises in relation to menopause [36][37][38][39] . Vasomotor symptoms are often associated with sleep disturbances and decreased overall well-being 36,38,[40][41][42][43] . Other common signs and symptoms reported by women are mood changes, anxiety, decreased libido, headache, backache, and joint pain and stiffness 36,44 but proof of correlation with the hormonal changes is missing. ...
... Health-related quality of life (HRQoL) can be viewed as a dimension of QoL and refers to the effect of an individual's physical, psychological, social and emotional functions on his or her overall QoL [63][64][65] . During the menopausal transition different signs and symptoms can be experienced by the women and HRQoL may be affected 42,43,66 . Results from several crosssectional and longitudinal cohort studies 45,67 have suggested that perimenopause is associated with a higher level of somatic symptoms leading to decreased well-being in women during this period of life. ...
... Clinicians have administered estrogen to depressed peri-and postmenopausal women for years and have observed that it quickly improves mood and well-being [1][2][3][4][5]. Some epidemiological studies show higher rates of depressed mood at the time around natural menopause, among menopause clinic attenders [6], in selected groups of the general population and in fully representative general population samples [7][8][9][10]. Oophorectomized women are more often depressed than both hysterectomized and non-hysterectomized women with intact ovaries [11,12]. ...
... Adequate statistical control of vasomotor complaints requires that correlation of difference scores are avoided and that the depression variable is heterogenized and the vasomotor variable homogenized. 10. Samples in studies of effects of HRT on mood should be selected according to their mood level, not according to their climacteric complaints. ...
In this paper a number of methodological issues relating to research on the relationship between the menopause, mood and hormone replacement therapy (HRT) are discussed. These issues relate to problems of design and statistical analyses, problems which have prevented the reaching of definite conclusions regarding the relationship between menopause, mood and hormones. These problems are discussed under three main headings, namely, the assessment of menopausal status, statistical modelling and the design and analyses of clinical trials. Problems relating to concepts and measurement of dependent variables are the subject matter of the papers that follow. Within the three main headings more specific issues are detailed. The paper concludes with a list of recommendations on how research in this important area might be further advanced.
... Clinicians have administered estrogen to depressed peri-and postmenopausal women for years and have observed that it quickly improves mood and well-being [1][2][3][4][5]. Some epidemiological studies show higher rates of depressed mood at the time around natural menopause, among menopause clinic attenders [6], in selected groups of the general population and in fully representative general population samples [7][8][9][10]. Oophorectomized women are more often depressed than both hysterectomized and non-hysterectomized women with intact ovaries [11,12]. ...
... Adequate statistical control of vasomotor complaints requires that correlation of difference scores are avoided and that the depression variable is heterogenized and the vasomotor variable homogenized. 10. Samples in studies of effects of HRT on mood should be selected according to their mood level, not according to their climacteric complaints. ...
In this paper a number of methodological issues relating to research on the relationship between the menopause, mood and hormone replacement therapy (HRT) are discussed. These issues relate to problems of design and statistical analyses, problems which have prevented the reaching of definite conclusions regarding the relationship between menopause, mood and hormones. These problems are discussed under three main headings, namely, the assessment of menopausal status, statistical modelling and the design and analyses of clinical trials. Problems relating to concepts and measurement of dependent variables are the subject matter of the papers that follow. Within the three main headings more specific issues are detailed. The paper concludes with a list of recommendations on how research in this important area might be further advanced.
... Menopause and/or its associated symptoms are often thought to have a negative impact on quality of life. 3,4 However, among nonclinic samples of women, the impact of menopause on well-being or mood has been mixed. [5][6][7][8][9][10][11][12] A few cross-sectional studies have looked at broader quality of life outcomes, 4,[13][14][15][16][17][18][19][20] also with mixed results, although some studies report greater bodily pain and role limitations due to physical health. ...
... 3,4 However, among nonclinic samples of women, the impact of menopause on well-being or mood has been mixed. [5][6][7][8][9][10][11][12] A few cross-sectional studies have looked at broader quality of life outcomes, 4,[13][14][15][16][17][18][19][20] also with mixed results, although some studies report greater bodily pain and role limitations due to physical health. 21 Cross-sectional studies, however, are limited by their inability to examine HRQL changes over the menopausal transition. ...
The aim of this study was to examine changes in health-related quality of life (HRQL) during the menopausal transition, controlling for chronological aging, symptoms, and other covariates.
This was a prospective, longitudinal study of women aged 42 to 52 years at baseline recruited at seven US sites (N = 3,302) in the multiethnic Study of Women's Health Across the Nation. Women eligible for the cohort had an intact uterus, had at least one ovary, were not currently using exogenous hormones, were either premenopausal or early perimenopausal, and were self-identified as one of the study's designated racial/ethnic groups. Data from the baseline interview and six annual follow-up visits are reported. HRQL was assessed with five subscales from the Medical Outcomes Study Short-Form Health Survey, with reduced functioning defined as being in the lowest 25% on a subscale. Covariates included symptoms, medical conditions, sociodemographics variables, physical activity, and psychological factors.
With adjustment for baseline age, chronological aging, and relevant covariates, the odds of reduced role-physical functioning were significantly greater at late perimenopause (odds ratio, 1.46; 95% CI, 1.08-1.99) and postmenopause (odds ratio, 1.49; 95% CI, 1.09-2.04) compared with premenopause. Menopause status was unrelated to bodily pain, vitality, role-emotional, or social functioning. Hormone therapy users were more likely to report reduced functioning. Other variables significantly related to HRQL across all domains included vasomotor symptoms, urine leakage, poor sleep, arthritis, depressed mood, perceived stress, and stressful life events.
The menopausal transition showed little impact on HRQL when adjusted for symptoms, medical conditions, and stress.
... As regards cessation of menstruation, it was found that slightly more than tow-thirds (67.2%) of the study subjects had complete cessation of menstruation. Ledesert et al., (19) who did not find that menopause status was related to the overall well-being. ...
The aim of this study was to assess the association between menopausal symptoms and the women’s quality of life (QOL). An exploratory descriptive study was conducted at Faculty of Nursing, university of Alexandria. Subjects of the study included all employees of the previously mentioned setting aged between 40 to 55 years old. Assessment sheet, Menopause Rating Scale and Quality of Life scale are the tools for data collection. Findings revealed that those who had no psychological symptoms reported better quality of life (X=94.50±11.475) than those who had severe psychological symptoms (X=62.64±12.549). The same results were observed with the somatic symptoms and urogenital symptoms, as the mean score of quality of life of those who had no somatic (X=88.00±11.314) or urogenital symptoms (X=83.14±12.104) was higher than who had severe somatic (X=75.31±11.026) or sever urogenital symptoms (X=68.50±12.021). In relation to the total score of menopause rating scale and the total score of quality of life, it was found that better quality of life was reported among those who had no symptoms (X=88.00±11.314) or mild symptoms (X=88.04±11.314). The results also revealed that there were statistically significant differences between the total score of quality of life and the number of living children (p
... 1,2 Although some women report experiencing the menopausal transition without any VMS, 3 for other women, these symptoms can be frequent and severe, and can interfere with daily activities and quality of life. [4][5][6][7][8][9][10][11][12] Recent estimates suggest that frequent menopausal VMS can continue for a median of 7.4 years. 13 Further, VMS are the chief menopauserelated problems for which US women seek medical attention. ...
Objective:
The aim of the study was to evaluate the short and long-term effects of acupuncture on vasomotor symptoms (VMS) and quality of life-related measures.
Methods:
A total of 209 perimenopausal and postmenopausal women aged 45 to 60 years, experiencing four or more VMS per day, were recruited from the community and randomized to receive up to 20 acupuncture treatments within the first 6 months (acupuncture group) or the second 6 months (waitlist control group) of the 12-month study period. The primary outcome was mean daily frequency of VMS. Secondary outcomes were VMS interference with daily life, sleep quality, depressive symptoms, somatic and other symptoms, anxiety, and quality of life.
Results:
The VMS frequency declined by 36.7% at 6 months in the acupuncture group and increased by 6.0% in the control group (P < 0.001 for between-group comparison). At 12 months, the reduction from baseline in the acupuncture group was 29.4% (P < 0.001 for within-group comparison from baseline to 12 months), suggesting that the reduction was largely maintained after treatment. Statistically significant clinical improvement was observed after three acupuncture treatments, and maximal clinical effects occurred after a median of eight treatments. Persistent improvements were seen in many quality of life-related outcomes in the acupuncture group relative to the control group.
Conclusions:
We found that a course of acupuncture treatments was associated with significant reduction in VMS, and several quality-of-life measures, compared with no acupuncture, and that clinical benefit persisted for at least 6 months beyond the end of treatment.
... Existing data on women's health status at mid-life were derived mainly from clinical-based studies. Prospective population-based studies only appeared in the more recent literature (Ledesert et al., 1995;Kuh et al., 1997;Stadberg et al., 1997). Nevertheless, the data accumulated so far are insufficient. ...
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.
... In a study controlled for age with a large sample size, the odds ratio for sleep problems in postmenopausal women was 1.5 compared to premenopausal [20]. Postmenopausal women were also 1.5 times more likely to have an AHI greater than 5 relative to premenopausal women and indeed presented lower sleep efficiency and REM sleep, and more sleep alterations due to menopause status [15]. ...
Our objective was to investigate the influence of menopausal status on sleep patterns in a representative sample of women from São Paulo, Brazil.
A population-based survey with a probabilistic three-stage cluster sample of the city of São Paulo was used to represent the local population according to gender, age (20-80 years) and socioeconomic status.
The female participants answered a sleep questionnaire, underwent polysomnographic recording and allowed their hormone levels to be measured. They also completed a gynecological questionnaire for classification of the reproductive aging stages: premenopausal or reproductive, perimenopausal or menopausal transition, and postmenopausal, defined as being after 12 months of amenorrhea. Women were allocated into early (the first 5 years after menopause) and late (after the first 5 years) stages.
A total of 535 women were included in this study: 339 were premenopausal, 53 were early postmenopausal, 118 were late postmenopausal and 25 were using hormone therapy or isoflavone compounds. Our main findings were that women in postmenopause spent more time in N3 sleep, had a higher apnea-hypopnea index (AHI) and lower SaO2 compared with premenopausal women after an analysis adjusted for confounding factors. We found no significant differences between early and late postmenopausal women in the adjusted analysis.
Our results indicate menopause itself exerts a modest, but important influence on objective sleep patterns, independent of age, in particular on AHI and SaO2.
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
... 23 Hemingway et al. suggested lack of access to health care and increased risk of diseases and disabilities from diseases as the possible major causes for lower quality of life among individuals with undesirable socioeconomic status. 22 About 72% of our participants reported 24 Vasomotor symptoms would probably reduce quality of life of individuals by affecting sleep quality and sexual and marital relations. 25 We found chronic diseases such as diabetes and hypertension to be predictors of reduced quality of life. ...
Introduction:
There have been limited studies on quality of life and its predictors among postmenopausal women. Due to the importance of this subject in health promotion, this study was performed to assess quality of life and its predictive factors in postmenopausal women living in Ilam, Iran.
Methods:
In this descriptive correlational study, 400 postmenopausal married women who aged 50-59 years old and lived in Ilam were recruited from 80 randomly selected clusters. The participants were interviewed by a female interviewer using the standard questionnaire of quality of life (SF-36). Data was analyzed by analysis of variance (ANOVA), student's t-test, and linear regression analysis in SPSS.
Results:
Mean scores (standard deviation) of quality of life in 4 dimensions of physical functioning, general health, mental health, and vitality were 76.8 (19.2), 71.1 (29.2), 74.3 (18.8), and 73.1 (19.6), respectively (with possible range of 0-100). According to linear regression analysis, women with chronic diseases, vasomotor symptoms, or insufficient family income and divorced and widowed subjects had significantly lower scores in all the 4 dimensions of quality of life. Aging was associated with reduced quality of life only in physical functioning dimension (p < 0.001). Although in univariate analysis, quality of life was significantly lower among illiterate participants and those with more children and longer duration of menopause at least in one dimension, the differences were not found to be significant in linear regression analysis.
Conclusion:
Chronic diseases, vasomotor symptoms and insufficient income were strong predictors of all the 4 dimensions of quality of life of postmenopausal women. Therefore, interventions are necessary to improve quality of life and health among this group of individuals.
... 绝经期是一个正常的生理过程，以卵巢激素 分泌减少而导致的永久停经为主要特征，通常发 生在45~55岁之间 [1] 。北美绝经协会把围绝经期／绝 经过渡期定义为因自然绝经的最后一次月经期之前 的几年发生月经周期和内分泌改变时与最后一次 月经后12个月之间的时段，具体包括绝经前2～5 年 ， 平 均 4 年 ， 绝 经 和 绝 经 后 1 年 ， 通 常 发 生 在 40~60岁阶段 [2] 。在这个阶段中，由于卵巢功能逐 渐衰退， 雌激素水平下降， 出现以植物神经系统 功能紊乱为主伴有精神心理症状的一组症候群， 许多妇女会有身体方面不适的体验，如潮热、盗 汗、睡眠障碍、疲乏和性功能障碍，同时伴随着 心理方面的改变，如情绪不稳定、抑郁、焦虑和 易激惹 [3] 。绝经期综合症在不同群体及个体中发生 的频率及严重程度不同，对个体及社会产生的影 响各异，但有大量研究 [4][5][6] 表明这些症状和感受不 同程度地影响着绝经期妇女的日常生活，并与其 健康相关的生存质量密切相关。 对 绝 经 期 妇 女 生 存 质 量 的 测 评 较 困 难 ， 目 前 仍 没 有 一 个 全 面 且 准 确 有 效 的 测 评 工 具 。 Zol lner等 [7] 关于绝经期生存质量测量工具的文献 综 述 表 明 ： 目 前 国 际 上 用 来 测 量 绝 经 期 妇 女 生 存 质 量 的 量 表 主 要 有 格 林 尼 更 年 期 量 表 (G re e n e [9] 。但本量表属于生存质量普适性量表，对 于围绝经期妇女的生存质量评估不具有针对性和 [10][11] 。 ...
Objective:
To investigate the criterion-related validity of Menopause-Specific Quality of Life Questionnaire (MENQOL)-Chinese version and to evaluate the effect of menopausal symptoms on health related quality of life.
Methods:
This study was a cross-sectional survey. Three communities were randomly chosen in Changsha, and then 340 menopausal women aged 45-55 years were randomly chosen from the documented data of the 3 community health service centers. They were required to fill out 4 questionnaires: demographic questionnaire, MENQOL-Chinese version, Kupperman Index (KI) and World Health Organization Quality of Life (WHQOL)-BREF. Correlation analysis was used to measure the criterion-related validity.
Results:
MENQOL-Chinese version subscales (vasomotor, psycho-social, sexual and physical) and KI total score were positively correlated (r=0.800, 0.751, 0.607, 0.906 respectively); while negatively correlated with WHOQOL-BREF total score (r =-0.694, -0.851, -0.585, -0.873 respectively); MENQOL-Chinese version subscales (vasomotor, psycho-social, sexual and physical) were significantly correlated with WHOQOL-BREF subscales (physical, psychological, social relationship, environment), and the physical domain was the highest among the correlation coefficients (r=-0.915).
Conclusion:
MENQOL-Chinese version shows relatively high criterion-related validity compared with KI and WHOQOL-BREF, which can be widely used to measure the quality of life of menopause women in China.
... Hence, it seems reasonable to hypothesize that the difference of the effect of MetS on HRQoL in the reproductive age and post-menopausal groups could be related to several factors, such as different expectations image and thus the HRQoL, and secondly, through anxiety, which is the most common psychological disturbance observed in obese patients in clinical settings. 8,[35][36][37] This study has both strengths and limitations. To the best of our productive age and postmenopausal women, enabling us to make direct comparisons between HRQoL of those with and without MetS in different eras of women's lives. ...
Background:
Given the lack of data clarifying the manner in which women with metabolic syndrome (MetS) in different eras of their life perceive their health-related quality of life (HRQoL), this study aimed at investigating the association between MetS and HRQoL in reproductive age and post menopausal women.
Methods:
This was a cross-sectional study conducted within the framework of Tehran Lipid and Glucose Study (TLGS). Metabolic syndrome was defined according to the Joint Interim Statement (JIS) and HRQoL was assessed using the Short Form Health Survey (SF-36). Logistic regression analysis was used to estimate the odds ratio (OR) of poor HRQoL with 95% confidence intervals (CIs) for reproductive age and post-menopausal women separately and adjusted for confounding variables.
Results:
All 603 participants with (n = 340) and without (n = 263) MetS were studied. Overall, in both physical and mental domains, those without MetS had higher scores in all subscales of SF-36 except for vitality, role emotional and mental component summary. Unadjusted odds ratios (95% CI) for poor physical HRQoL were 2.8 (1.7-4.6); (P < 0.001) and 1.5 (0.7-3.4) for the reproductive age and post-menopausal groups, respectively. Compared to the post-menopausal group, the odds ratio of reporting poor HRQoL for reproductive age women was significantly higher, even after adjusting for age (OR: 1.7, 95% CI: 1.0-3.0, P < 0.05).
Conclusion:
The results indicate that MetS is associated with poor HRQoL in reproductive age, but not in post-menopausal women, and the association is observed mainly in relation to physical rather than mental health.
... Longitudinal studies using subjective measures and conducted among healthy women have shown that HFs occurring during the menopause transition are associated with the development of insomnia symptoms (Dennerstein et al., 2000;Dennerstein et al., 2007;Hollander et al., 2001;Kravitz et al., 2008;Pien et al., 2008). Cross-sectional studies of large community-based samples have also suggested that HFs are related to sleep dissatisfaction (Jansson et al., 2003;Ledesert et al., 1995;Pien et al., 2008;Young et al., 2003), and that insomnia symptoms increase with the frequency and severity of HFs (Kravitz et al., 2008;Ohayon, 2006;Oldenhave et al., 1993). With the exception of Freedman and Roehrs's research (2004), studies using objective measurements of both sleep (i.e., polysomnography) and HFs (i.e., sternal skin conductance) among healthy women have found an association between HFs and various sleep alterations (Erlik et al., 1981;Freedman & Roehrs, 2006;Gonen et al., 1986;Woodward & Freedman, 1994). ...
The aim of this study was to assess longitudinally the relationship between hot flashes and insomnia symptoms in women receiving adjuvant treatments for breast cancer.
Fifty-eight participants completed a 7-day daily diary assessing hot flashes, the Menopause-Specific Quality of Life Questionnaire, and the Insomnia Severity Index, before and after chemotherapy or radiotherapy and at a 3-month follow-up evaluation.
A first canonical correlation analysis (n = 55) revealed a marginally significant relationship between pretreatment versus posttreatment change scores in hot flashes and sleep (R = 0.39), and a second analysis (n = 51) showed a significant relationship between posttreatment and follow-up changes in hot flash activity and sleep (R = 0.59).
These results show that increases in vasomotor symptoms occurring within the few months after the termination of initial adjuvant treatments for breast cancer are significantly associated with concurrent increases in insomnia symptoms and vice versa.
... The relationship between hot flushes and disturbed sleep has long been described. A strong association between sleep and hot flushes has been reported in mid-aged women of the Women's Health Across the Nation (SWAN) study [27] and other similar studies [28]. Premenopausal women aged 45-49 reported poor sleep in relation to hot flushes, depression, caffeine consumption and lower estradiol levels [29]. ...
Although the menopause associates to poor sleep quality, insomnia severity data in the menopausal transition is scarce or lacking.
To assess insomnia prevalence, severity and related factors in mid-aged women.
In this cross-sectional study 340 women (40 to 59 years) completed the Insomnia Severity Index (ISI) and a general questionnaire containing personal/partner data. Hot flush presence and intensity was also assessed with the Menopause Rating Scale (MRS).
Median age of the sample was 48.0 years, with 63.5% having lower education and 52.9% being postmenopausal. At the moment of the survey 7.1% were on hormone therapy, 8.2% on phytoestrogens and 2.1% on psychotropic drugs. A 63.8% were abdominally obese (waist circumference > 88 cm) and 65.5% sedentary. According to item 1 of the MRS, 60.9% presented hot flushes, graded in 17.4% as severe-very severe. Regarding the partner (n=255), erectile dysfunction was present in 23.9%, premature ejaculation 37.6%, 35.3% abused alcohol and 42.4% were faithful. The ISI tool displayed a high internal consistency (alpha Cronbach coefficient=0.87), identifying 41.5% of women with some degree of insomnia (Total ISI score ≥8) further categorized as sub-threshold or mild (32.0%), moderate (7.4%) and severe (2.1%). Multiple linear regression analysis obtained two best fit models predicting total ISI scores, one not including and one including partner data. In the first model, hot flush severity, psychotropic use and sedentarism displayed significant positive correlations with total ISI scores. In the second, hot flush intensity, psychotropic drug use and male erectile dysfunction positively correlated whereas partner faithfulness inversely with ISI scores.
In this mid-aged series insomnia severity was related to female and partner factors; several of which are susceptible of intervention.
... One originality of the work in the GAZEL Cohort Study was the simultaneous consideration in the analysis of HRT use of numerous factors such as type of medical follow-up (general practitioners or gynecologist, man or woman), women's expectations of HRT, their cosmetic practices, and their representations of menopause. HRT use was shown to be associated with hot flushes, osteoporosis prevention, and anti-aging expectations (Ringa et al, 1994), as well as a "demedicalized" cosmetic usage (Fauconnier et al, 2000). The follow-up at 3, 6, and 10 years showed very strong adhesion to HRT and confirmed the existence of a "healthy user effect", that is, that the women in good health were the most compliant (). ...
The GAZEL Cohort Study was set up in 1989 among Électricité de France-Gaz de France (EDF-GDF) workers. It is an open epidemiologic laboratory characterized by a broad coverage of health problems and determinants and accessible to the community of researchers. At inception in 1989, the GAZEL Cohort Study included 20 625 volunteers working at EDF-GDF then aged from 35 to 50 years (15 011 men and 5614 women). The cohort is broadly diverse in terms of social, economic, and occupational status, health, and health-related behavior. The data collected routinely cover diverse dimensions and come from different sources: annual self-administered questionnaire (morbidity, lifestyles, life events, etc.); personnel department of EDF-GDF for social, demographic, and occupational characteristics; EDF-GDF special social insurance fund (for sickness absences and cancer and ischemic heart disease registries), occupational medicine (occupational exposure and working conditions), Social Action Fund (healthcare utilization), Health Screening Centers for standardized health examination and the constitution of a biobank, and the National Death Register (causes of death). Follow-up has been excellent, and the number of subjects lost to follow-up was exceptionally low; active participation by the self-administered questionnaire is also elevated. Today, more than 40 projects on diversified themes have been set up in the GAZEL Cohort Study by some 30 French and foreign teams. Different health problems taking into account behavioral, social, psychological and medical occupational risk factors have been the object of research projects in the cohort. A substantial proportion of the research work has focused on social inequalities in health. Here, we present a brief panorama of the main fields covered by research in the GAZEL Cohort Study that have already been published over the years.
... 10 For a number of women, menopause is related to decreased HRQoL, sleep disturbances, and psychological and sexual disorders. 11,12 In addition, according to Blumel et al 13 and Matthews and Bromberger, 14 postmenopausal women show worse HRQoL than do women of similar age who still had normal ovarian function. However, these studies did not consider whether changes in eating behaviors and/or HRQoL observed at menopause were related to chronological aging and/or to ovarian aging. ...
Aerobic exercise is known to improve health-related quality of life (QoL). The aim of this study was to compare the effects of a 16-week walking program on eating behaviors and QoL between late premenopausal and early postmenopausal obese and sedentary women, once chronological aging is taken into account.
Sixteen women 49 +/- 2 years old and 14 women 53 +/- 2 years old, whose body mass index ranged between 29 and 35 kg/m, were subjected to three sessions per week of 45-minute walking at 60% of their heart rate reserve. Fat mass and lean mass (bioelectrical impedance), cardiorespiratory fitness estimated by maximum oxygen consumption (2-km walking test), eating behaviors (Three-Factor Eating Questionnaire), and QoL, estimated by the Short Form-36 Health Survey, Pittsburgh Sleep Quality Index, and Perceived Stress Scale-10 questionnaires, were recorded before and after exercise.
With the exception of a higher attitude of self-regulation in postmenopausal than in premenopausal women (P = 0.05), no between-group differences were observed in body composition, eating behaviors, and QoL at baseline. In all participants, body weight and fat mass decreased, whereas cardiorespiratory fitness increased after walking (0.001 < P < 0.0001). Situational susceptibility was the only eating behavior reduced after training in all women (P = 0.02). Neither the sleep quality index nor the perceived stress score changed in response to endurance exercise. Finally, in all women, Short Form-36 physical and mental scores increased after walking (0.001 < P < 0.05).
Despite modest body weight and fat mass losses, a 16-week walking program seems to be sufficient to improve physical and mental well-being, irrespective of menopause status.
... The typical complaints included too early morning awakenings or intermittent sleep [38]. According to a French survey with 1000 responders, the odds ratio (OR) for sleeping problems after controlling for age was 1.5 in postmenopausal women compared with menstruating women [39]. In another study with over 1200 participants in UK, the risk for sleep disturbance was even higher: 1.5 in perimenopausal women and 3.4 in postmenopausal women compared with premenopausal women [40]. ...
Sleeping problems are a serious public health problem, imposing a substantial burden on individuals and society. Although sleeping problems occur throughout the lifespan, and in both sexes, menopause can be considered as one important milestone of increasing occurrence in sleeping problems. However, to determine whether sleeping problems are caused by the menopause or merely occur by coincidence during the menopause is not always easy because several, particularly age-related, changes take place at the same time. The most important factors are general diseases, medications, weight changes and mood symptoms. According to women's own judgment, hormone therapy significantly improves sleep quality. Hormone therapy can thus be considered as a first-line treatment for climacteric sleeping problems. If sleeping problems are accompanied by other disorders, hormone therapy should be kept in mind as an adjuvant therapy. According to worldwide consensus on hormone therapy, the main indication of hormone therapy is alleviation of climacteric symptoms, including climacteric sleeping problems. However, when choosing hormone therapy for a patient, contraindications and possible long-term side effects should be individually considered. This review illustrates the effect of menopause on sleep and evaluates different treatment options, especially hormone therapy, in alleviation of symptoms.
... HRQOL is thought to provide a general measure of an individual's wellbeing and has been shown to be influenced by a number of factors, including physical, psychological, social, and functional areas of life [1]. Several studies have reported decreases in HRQOL across the menopausal transition; this has been shown to be due primarily to the experiencing of menopausal symptoms such as hot flashes, mood changes and insomnia [2][3][4]. However, change in HRQOL may also be due to other medical, psychological, and social changes such as declining health and children leaving home [5]. ...
Only a few studies have examined the association between race/ethnicity and health-related quality of life (HRQOL) during midlife. Thus, the purpose of this study was to examine this association in the context of a population-based study of Caucasian and African-American women aged 45-54 years.
Data from 626 pre- and peri-menopausal African-American and Caucasian women aged 45-54 years were analyzed. HRQOL was measured using Cantril's Self-Anchoring Ladder of Life, a validated measure of overall life satisfaction. Body mass index was determined using measured height and weight. Information on race and other variables such as education was based on self-report. Logistic regression models were constructed to examine the unadjusted and adjusted associations between race and low present HRQOL (< or =6 on Cantril's Ladder of Life).
In both the unadjusted and adjusted analyses, race was not significantly associated with low present HRQOL (unadjusted OR 1.57; 95% CI 0.93, 2.65; adjusted OR 0.82; 95% CI 0.42, 1.61). In the fully adjusted model, only the number of menopausal symptoms and self-rated health were significantly associated with present HRQOL.
Findings from this population-based study suggest that race is not a statistically significant determinant of present HRQOL among midlife women.
... Indeed, at a similar degree of obesity, postmenopausal women were characterized by higher fasting glucose levels, larger waist girth, and higher resting systolic blood pressure (BP) than premenopausal women (Ozbey et al. 2002). Moreover, health-related quality of life is known to deteriorate in women during menopause (Blumel et al. 2000;Ledésert et al. 1994). ...
The duration of the numerous weight-loss studies that combine physical activity and diet varies from 3 to 14months, and these studies have often considered pre- and postmenopausal women separately. The purpose of this study was to compare the effects of a 3-week weight-reducing program that combines caloric restriction and exercise on the metabolic profile, eating behaviors, and perceived health of sedentary obese pre- and postmenopausal women, after adjustment for age. In 10 pre- and 22 postmenopausal women, before and after weight loss, body composition, fasting lipid-lipoprotein profile, glucose and insulin levels, eating behaviors, and perceived health state were assessed. Body mass index, fat mass, and waist girth decreased after weight reduction in both groups (p< 0.0001). Reductions in fasting serum cholesterol and low-density lipoprotein-cholesterol levels were greater in pre- than in postmenopausal women (p< 0.0001), whereas triacylglycerol, glucose, and high-density lipoprotein-cholesterol levels decreased similarly in both groups (p< 0.05). Neither fasting insulin nor free fatty-acid concentrations were modified after weight loss in either group. Disinhibition (p< 0.005) and hunger scores on the three-factor eating questionnaire (TFEQ) (p< 0.05) and the state-anxiety score on the statetrait anxiety inventory (STAI) questionnaire (p< 0.0005) decreased in both groups, but restriction (TFEQ) increased (p< 0.01) and trait anxiety (STAI) decreased (p< 0.001) after weight reduction only in premenopausal women. Improvements in selected lipid-lipoprotein indices, eating behaviors, and perceived health-state components were better in pre- than in postmenopausal women, suggesting that menopausal status has an influence on some metabolic and behavioral responses to weight loss.
... Menopause appears to be associated with weight gain (11)(12)(13). Because symptoms associated with menopause, such as hot flashes, negatively affect HRQoL (14)(15)(16), it was initially thought that menopause itself had a negative impact on HRQoL. However, it now appears that menopause has a neutral to weakly positive impact on HRQoL (14,17,18). ...
Weight loss improves health-related quality of life (HRQoL). However, regain after loss is common; little is known about the impact of weight regain on HRQoL in postmenopausal women. Woman on the Move through Activity and Nutrition (WOMAN) is a randomized lifestyle intervention trial of diet, physical activity, and weight loss in 508 postmenopausal women aged 52-62 years. This analysis focused on the women who lost > or =5 lb during the initial phase of the study, baseline to 6 months (n = 248). This cohort was divided into three groups based on subsequent weight change between 6 and 18 months: weight loss (WL; > or =5 lb loss), weight stable (WS; <+/-5 lb change), and weight regain (WR; > or =5 lb gain). HRQoL was measured at baseline, 6, and 18 months using the Short Form-36. Of the 248 women studied, 51 (21%) continued to lose weight after initial weight loss, while 127 (51%) maintained a stable weight, and 70 (28%) regained weight. Between baseline and 6 months, women in WR group had decreased mental health and social-functioning scores, while the WL and WS groups improved in these subscales. Between baseline and 18 months, energy improved most significantly in those with continued weight loss (P = 0.0003). Weight loss was correlated with a small to moderate improvement in perceived general health and energy, which was reversed by weight gain. Further study is needed to investigate the impact of a decline in mental health and social functioning on future weight regain.
Background: Sleep disturbances are common during the menopausal transition and several factors can contribute to this increased incidence. This study examined the association between sleep reactivity, arousal predisposition, sleep disturbances, and menopause.
Methods: Data for this study were derived from a longitudinal, population-based study on the natural history of insomnia. A total of 873 women (40–60 years) were divided into two groups according to their menopausal status at baseline: reproductive (n = 408) and postmenopausal (n = 465). Participants were evaluated annually throughout the five-year follow-up period. Four questionnaires were used to examine sleep quality, insomnia severity, sleep reactivity, and arousal predisposition. The data were analyzed using two approaches: cross-sectional with a multivariate analysis and binary regression, and longitudinal with a linear mixed models using menopausal groups (3) x time (5) design.
Results: Cross-sectional analyses showed that postmenopausal women reported significantly more severe insomnia and poorer sleep quality than reproductive women. Sleep reactivity and arousal predisposition were significant predictors of sleep disturbances. Longitudinal analyses revealed increased sleep disturbances in the two years before and after the menopausal transition. Sleep reactivity and arousal predisposition did not moderate the temporal relationship between menopausal transition and sleep disturbances.
Conclusion: More sleep disturbances were reported during the menopausal transition, but those difficulties were not explained by sleep reactivity and arousal predisposition. These results suggest the involvement of other psychophysiological factors in the development of sleep disturbances during the menopause.
Objective
To evaluate efficacy and safety of fresh Salvia officinalis extract tablets in relieving typical symptoms in menopausal women and to gain insight in the mode of action by measuring altered cerebral wave intensities.
Methods
Randomized 80 menopausal women from 48 – 65 years of age received Menosan® tablets [3′400 mg ethanolic extract of freshly harvested Salvia officinalis L.] or placebo under double-blind conditions for 4 weeks. An efficacy analysis evaluated the developments of the menopausal rating scale [MRS], hot flush severity score [HFS] and quantitative electroencephalography [qEEG] intensities in the per protocol population. Results were further corroborated by data from the intention to treat population including late postmenopausal women.
Results
Salvia off. distinctly reduced MRS by 39.2% from 15.3 ± 6.87 to 9.3 ± 5.75 and significantly in comparison to placebo (p = 0.002). The HFS score decreased by 55.3% from 15.9 ± 13.77 to 7.1 ± 7.41, reaching significance on week 3 onwards (p = 0.028). Clinical effects of Salvia off. correlated with relevant reduction of frontal lobe beta2 wave qEEG intensities at electrodes F3/4/7/8 and are underpinned by secondary parameters and ITT analysis. Salvia off. within 4 weeks significantly reduced the somato-vegetative (e.g. hot flushes) and psychological MRS subscale (e.g. physical and mental exhaustion) subscale (p < 0.05) without a significant effect on the genito-urinary subscale. A positive impact of Salvia off. compared to placebo was furthermore seen on sleep quality, discontent and fatigue (p < 0.05) as evidenced by sleep and profile of mood state questionnaires.
Tolerability was uniformly rated as very good for Salvia off. extract and placebo, with an overall incidence of three adverse events in total, none of which treatment-related.
Conclusion
The results support the use of Salvia off. for the specific treatment of a wide range of somato-vegetative and psychological symptoms as experienced by menopausal women and correlate this effect to a restoration of associated dysbalanced brain waves.
The study was registered as EudraCT-No 2016-005033-77.
Los sofocos son el síntoma más frecuente y característico del climaterio. Se desencadenan con el estrés, altas temperaturas ambientales y alcohol. La etiología es la deprivación estrogénica, pero los mecanismos exactos que los producen se desconocen, pero se postula que se relacionan con un cambio en la vía noradrenérgica que modifica tanto la regulación de los centros hipotalámicos, que controlan la temperatura corporal, como las neuronas productoras de GnRH. Los sofocos hay que diferenciarlos de cuadros clínicos similares como el hipertiroidismo. carcinoide, feocromocitoma; y, de reacciones a fármacos como nifedipina, niacina o calcitonina. El tratamiento más efectivo son los estrógenos. Cuando hay contraindicaciones o rechazo a esta terapia pueden plantearse otras alternativas como tibolona, gestágenos y andrógenos; entre las alternativas no hormonales figuran veralipride, alfametildopa, clonidina, metoclorporpamida y la beta-alanina. Otra medida con cierta efectividad es el aumento de la actividad física. Las mujeres japonesas presentan menos bochornos que las occidentales, relacionándose este hecho a los fitoestrógenos que ingieren a través de la soya. Diferentes fitoestrógenos se han usado con éxito en el control de los bochornos. Conclusión: cuando no se puede o no se quiere usar estrógenos existen otras alternativas terapeutas efectivas.
La evaluación de la calidad de vida se debe centrar, principalmente, en la percepción de la paciente sobre su estado de
salud, siendo ella partícipe activa en este proceso. Los instrumentos para medir la calidad de vida relacionada con la salud
(CVRS) se pueden clasificar en instrumentos genéricos, que miden múltiples áreas o dominios y que son aplicables a todos
los individuos, independientemente de la patología que les afecte; y en instrumentos específicos, que son los que miden
el funcionamiento del paciente en una o varias áreas y se caracterizan por prestar especial atención a aquellos síntomas o
problemas propios de una enfermedad concreta y a aquellas áreas que se consideran más afectadas, siendo sólo aplicables
a pacientes específicas. En la práctica clínica diaria es útil para evaluar: mejoría del diagnóstico clínico, individualización
y priorización de los tratamientos, mejorar la relación médico-paciente, y monitorizar el cumplimiento de las terapias que
contribuyan en la mejora de la calidad de vida femenina.
Sleep disturbances are frequent at menopausal transition and substantially affect the quality of life in midlife women. Diagnosing and treating sleep disturbances are essential parts of the management of menopausal symptoms. Persistent insomnia in midlife is not a single entity, and is not always linked with menopause per se. Detailed patient history supplemented with appropriate physical examination and diagnostic tests is the basis for correct diagnosis. Insomnia in midlife women can be divided into four major categories: (1) menopausal insomnia (often related to climacteric vasomotor symptoms); (2) primary (psychophysiologic) insomnia; (3) secondary insomnia (associated with other sleep disorders (e.g., sleep-disordered breathing), mental (e.g., anxiety or depression) or medical (e.g., fibromyalgia) disorders or aging; and (4) insomnia induced by behavioral, environmental, or psychosocial factors. Careful evaluation of the nature of the menopausal insomnia will help choosing the best therapy for each individual. Treatment options for menopause-associated insomnia include hormone therapy, behavioral interventions as well as medication targeting the specific underlying medical condition (such as pain, anxiety, or depression). Conventional hypnotic agents rarely provide long-term benefit in chronic forms of insomnia. This chapter provides a practical approach to diagnosis and treatment of menopausal insomnia.
Sleeping problems are a severe public health problem, imposing a serious burden on the individual and society both medically and economically. Climacterium often causes or worsens sleep disturbances. Thus, effective management already at the acute phase will lead to the best outcome. According to women’s own judgment, HT significantly improves sleep quality, although studies using polysomnography have reported inconsistent results. HT can thus be considered as a first line therapy for menopausal sleeping problems, especially if other climacteric symptoms are also present. Part of the sleep disturbances may just coincide with the menopausal period and are thus not of endocrinological origin. Therefore, if no relief during HT has been achieved within a few months, or if symptoms and signs direct on other underlying causes, further medical examinations are warranted.
The North American population is aging rapidly. By 2020, more than 40% of the population will be over 40 and more than 25% will be over 55. There is no doubt that aging is associated with an important increase in sleep-wake cycle complaints, which has important individual, social, and economical consequences. Multiple factors including medical problems, side effects of medications, and specific sleep disorders account for this age-dependent increase in sleep difficulties. Notable modifications of the sleep-wake cycle are also observed in “optimal aging,” i.e., in people who do not suffer from medical, psychiatric, or specific sleep disorders. These age-dependent changes occur quite early and they may have important repercussions for older individuals, especially when their sleep-wake system faces challenges such as those related to stress, jet lag, and shift work.
Sleep complaints are common in today’s society, with 20-30% of the population experiencing sleep problems on several nights a week. Women are about 1.5 times more likely than men to report insomnia-related sleep problems, although this gender disparity is not reflected in studies using objective sleep parameters. Psychosocial stressors such as work conditions and work-family conflicts, which may have different relevance for men and women, contribute together with other factors to the occurrence of sleeping difficulties. Importantly, sleep problems are not only a cause of personal suffering per se, but are also closely linked to ill health. Insomnia-like sleep complaints, very short (<5-6 h) and very long sleep duration (>8-9 h), as well as sleep disorders, in particular sleep apnea (which is albeit a male predominance also a serious health problem in women), have been associated to e.g., hypertension and coronary heart events, and ultimately mortality. Apart from the direct link between sleep and health, sleep may also play a role in mediating the effect of stress on health. Given the high prevalence of sleep problems, and the adverse effects of inadequate sleep on health, the diagnosis and effective treatment of sleep problems and disorders should be a key component in health prevention. This may also include targeting preceding and co-occurring psychosocial stressors.
This thesis is about the social determinants of alcohol consumption. More specifically, the aims were to study how some circumstances of life, working and social environment may exert an influence on changes in drinking behaviours over time.The analyses were conducted within the Gazel cohort, including more than 20 000 subjects(15 000 men and 5 000 women) employees of EDF‐GDF, the French national utility company,aged 35‐50 at the inception of the cohort in 1989, which were followed‐up since that period.The main determinants that were studied are the working conditions, the marital status of women, and retirement. The main findings showed that the occupational, familial and social environment play a role in the changes in drinking behaviours over time, and that their effects are socially patterned
Objectives:
To evaluate the effectiveness of black cohosh extract 40 mg/day for relieving moderate to severe menopausal symptoms and improving quality of life in Thai women.
Methods:
A randomized, double-blind, placebo-controlled clinical trial was conducted in a menopause clinic of a tertiary-care university hospital during 2011-2013. Participants were peri- or postmenopausal Thai women aged at least 40 years, who have moderate to severe menopausal symptoms evaluated using the Kupperman index (KI). Outcome measures included KI, frequency of hot flushes, Menopause-Specific Quality of Life (MENQOL) score, participants' global satisfaction and safety outcomes.
Results:
There were 54 participants assigned to treatment (black cohosh extract 40 mg/day, n = 27) or placebo group (n = 27). Both the treatment and placebo groups had comparable baseline KI scores (33.9 ± 7.9 vs. 31.3 ± 6.8), frequency of hot flushes (3.1 ± 2.0 vs. 2.8 ± 2.1), and MENQOL scores, all of which improved with time. Neither the improvements nor the global satisfaction were significantly different between the two groups; but the proportion of participants with moderate to severe symptoms seemed to be lower in the treatment group than in the placebo group (40% vs. 60%, p = 0.174). There was no serious adverse event or significant change in liver function tests.
Conclusions:
A black cohosh extract of 40 mg/day is not superior to a placebo for relieving moderate to severe menopausal symptoms or improving quality-of-life scores in Thai women.
Objectives:
The use of hormone therapy (HT) for hot flushes has changed dramatically over the past five decades. In this cross-sectional questionnaire study, the aim was to describe the use of HT and alternative treatments and to study the frequency of hot flushes. A further aim was to compare data from the present questionnaire with data from previous studies made in the same geographic area.
Method:
A questionnaire was sent to a random sample of 2000 women aged 47-56 years living in Östergötland County, Sweden. The results were compared with findings from previous studies regarding use of HT, alternative treatment and hot flushes, and the number of HT prescriptions dispensed during the corresponding time using data derived from the Swedish Prescribed Drug Registry.
Results:
The response rate was 66%. Six percent used HT, in line with prevalence data from the Swedish Prescribed Drug Registry. Alternative treatments were used by 10%. About 70% of postmenopausal women reported flushes and almost one-third of those with flushes stated that they would be positive to HT if therapy could be shown to be harmless, a view more often stated by women with severe complaints of hot flushes (67%).
Conclusion:
The use of HT and alternative treatments is low and many women suffer from flushes that could be treated. Women considered their knowledge of the climacteric period and treatment options as insufficient. Individualized information should be given and women with significant climacteric complaints, without contraindications, should be given the opportunity to try HT.
This study aims to obtain preliminary data on the efficacy of yoga for reducing self-reported menopausal hot flashes in a randomized study including an attention control group.
We randomized 54 late perimenopausal women (2-12 mo of amenorrhea) and postmenopausal women (>12 mo of amenorrhea)-aged 45 to 58 years and who experienced at least four hot flashes per day, on average, for at least 4 weeks-to one of three groups: yoga, health and wellness education (HW), and wait list (WL). Yoga and HW classes consisted of weekly 90-minute classes for 10 weeks. All women completed daily hot flash diaries throughout the trial (10 wk) to track the frequency and severity of hot flashes. The mean hot flash index score is based on the number of mild, moderate, severe, and very severe hot flashes.
Hot flash frequency declined significantly across time for all three groups, with the strongest decline occurring during the first week. There was no overall significant difference in hot flash frequency decrease over time by treatment groups, but the yoga and HW groups followed similar patterns and showed greater decreases than the WL group. On week 10, women in the yoga group reported an approximately 66% decrease in hot flash frequency, women in the HW group reported a 63% decrease, and women in the WL group reported a 36% decrease. The hot flash index showed a similar pattern.
Results suggest that yoga can serve as a behavioral option for reducing hot flashes but may not offer any advantage over other types of interventions.
Epidemiology faces many problems where time plays an important role at an individual or a population scale. The temporal sequence between exposure of subjects to putative risk factors and health outcomes must be taken into account to study the risk of developing diseases, the latency periods between exposure and the onset of disease, or to analyze the evolution of a disease after it occurred. Modeling the sequence and interactions between personal and environmental factors and the health status or the incidence of various health outcomes is often necessary to understand the complex pathways leading to disease. When analyzing evolutions in the pattern of diseases or mortality in populations, one has to disentangle the relationships between age and generation or period effects to have a clear understanding of the changes that occurred over time. The longitudinal cohort design, i.e. individual follow-up over time of subjects, is theoretically the best method for dealing with these methodological problems. It also allows for the prospective collection of adequate data at an individual level, thus avoiding some major biases (Szklo, 1998). In the domain of public health and medical research, two main types of epidemiological cohorts exist: large longitudinal representative samples and longitudinal cohorts of volunteers. Large longitudinal representative samples of the whole population allow for the description and quantification of health problems at the population level, and for the analysis of changes over time. The necessity of representativeness implies that subjects are anonymously included in these cohorts, and do notactively participate in the follow-up, which is usually performed through the linkage with national data bases, such as employment, taxes, or causes of death registers. On the other hand, cohorts of volunteers allow for the collection of more specific data directly from the subjects, such as lifestyle factors, working conditions, social activities and relationships, biological samples or various health scales. In a search for causality, such data are needed to understand the mechanisms linking different conditions and exposures and the occurrence of health problems. However, relying on the voluntary participation of the subjects always implies some amount of selection effects associated with socioeconomic, demographic, occupational and health factors (Goldberg et al, 2001), and cohorts of volunteers can not be
During the climacterium, which covers the menopausal transition through to postmenopause, women experience vasomotor symptoms (hot flashes and sweating) and sleep disturbances. Hormone therapy is generally acknowledged as the most effective therapy for reducing climacteric vasomotor symptoms and related secondary insomnia. This review describes the effects on sleep of the gradual cessation of hormonal secretion, specifically estrogen and progesterone, by the ovaries and evaluates different treatment options. Aging is briefly discussed with a focus on menopausal transition and related changes in biological functions.
Objectives:
To explore demographic and epidemiological characteristics surrounding menopause among women of Majorca, estimate their health related quality of life (QOL), and ascertain wheather they differ from those of the mainland population of menopausal women.
Methods:
A cross-sectional population-based study was conducted with a sample of 428 women. The Cervantes questionnaire for measuring QOL during menopause was used.
Results:
Among women in Majorca, the mean QOL is better than the national mean of the Spain reference population. It declines with age and levels off at menopause. In menopausal women, QOL improves slightly in tandem with educational level. 29% of menopausal women were on some form of therapy, most commonly a mix of estrogens and gestagens (36%). Only a weak association was detected between being menopausal and QOL.
Conclusion:
The Cervantes questionnaire allows periodic study sample cut-offs to determine whether changes in sociodemographic and disease-related variables are also accompanied by changes in self-perceived QOL. It is much better in menopausal women in Majorca than in those in the Spanish mainland.
Objective:
Because the experience of menopause varies by ethnic group, society, and social class, we sought to compare quality of life (QoL) at menopause between Tunisian and French women.
Methods:
This secondary analysis of existing data collected in two independent, cross-sectional surveys (the French GAZEL cohort and a representative sample of Tunisian women) compared both samples for six dimensions of the Women's Health Questionnaire while taking into account social and demographic characteristics and menopause status with multivariate logistic models.
Results:
Comparison of 1,040 Tunisian women aged 45 to 64 years with 774 French women aged 48 to 53 years showed that Tunisian women had a significantly lower QoL than the French women in every dimension (low QoL for Tunisian vs French, odds ratio [95% CI]: somatic symptoms, 2.1 [1.6-2.7]; depressed mood, 3.6 [2.8-4.7]; anxiety, 2.4 [1.8-3.3]; vasomotor symptoms, 1.7 [1.3-2.3]). QoL was also lower for working-class women, but associations were weaker than for country (low QoL for working class vs middle class, odds ratio [95% CI]: somatic symptoms: 1.9 [1.5-2.4]; depressed mood, 1.5 [1.2-1.8]; anxiety, 1.8 [1.5-2.3]; vasomotor symptoms, 1.7 [1.4-2.2]). Associations between country and QoL were stronger in the working class than in the middle class.
Conclusions:
This epidemiological study comparing France and a North African country sheds light on the major role of country of residence, social class, and their interaction in the experience of menopause. Levels of national wealth, human development, cultural constraints, and social and gender inequality are likely to explain how country and class affect QoL.
Purpose:
This article reviews the pathophysiology of vasomotor symptoms (VMS) of menopause and current management options.
Data sources:
Current scientific literature.
Conclusions:
In most menopausal women, loss of ovarian function results in VMS, including hot flashes, night sweats, and mood and sleep disturbances. Hormone therapy (HT) has been the mainstay of VMS treatment for many years, but safety concerns raised by publication of the Women's Health Initiative (WHI) results have dramatically reduced the use of this treatment. Since the WHI published its findings, attention has focused on other novel treatments for menopausal symptoms, including low-dose oral or transdermal HT and agents such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, gabapentin, and clonidine. Many women also use complementary and alternative medications to manage VMS, but little evidence from controlled clinical trials supports their efficacy.
Implications for practice:
The increasing number of alternative treatments for VMS requires improvement in patient-provider communication about treatment risks and benefits, individualization of treatment to meet patient needs and attitudes, and careful follow-up to ensure adherence to potentially effective therapy. Nurse practitioners play a leading role in patient evaluation, discussions, and management to help women achieve control over bothersome VMS that dramatically impact their quality of life.
Gynecomastia, defined as a palpable disk of breast tissue in males, is a relatively common condition. It is usually benign
and self-resolving, especially in neonates and pubertal boys. An imbalance in the estrogen-to-androgen ratio is believed to
be the culprit in the pathophysiology of gynecomastia. An increase in estrogen or a decrease in androgen is found in most
pathologic entities associated with gynecomastia, such as hypogonadism, tumors, or enzymatic defects. A thorough history and
physical examination is essential in distinguishing between benign and pathologic gynecomastia, as well as in directing further
workup. Treatment of gynecomastia is usually for social and cosmetic reasons, and it is unnecessary in cases where it is mild
or transient. However, in persistent or severe cases, treatment may be advisable. Androgens, antiestrogens, and P450 aromatase
inhibitors have all been studied, with mixed results. Surgical treatment, while invasive and likely to leave scars in severe
cases, is a definitive and more effective treatment option.
From puberty to menopause, women are submitted to important hormonal fluctuations. Compared to men, women report poorer sleep quality and more frequent use of sedative-hypnotic drugs. Menopause, menstrual cycle, use of hormonal contraceptives or hormonal replacement therapy are factors that may influence sleep quality in women. Animal and human studies show that progesterone or estrogens administration influences sleep architecture. The effects of the menstrual cycle on sleep is still a matter of debate in the literature and only a few studies have evaluated the effects of hormonal contraceptives on sleep. Sleep problems and fatigue are important complaints in menopausal women. Night sweats and hot flashes seem to play a significant role in the deterioration of sleep quality in menopausal women. There are still very few studies on the effects of hormone replacement therapy on polysomnographic sleep. Most studies have indicated only small improvements in polysomnographic sleep on a number of different parameters. The design of effective preventive and therapeutic strategies for women throughout their reproductive life depends greatly on our understanding of the mechanisms underlying hormonal modulation of the sleep-wake cycle.
Sleep disturbance and hot flashes are common during menopause, but their association is not well understood. We sought to understand the associations among sleep disturbance and the frequency, bothersomeness, and interference of hot flashes in mid-life women.
STRIDE is a study of women ages 40-65 years at varied menopausal stages. We examined the cross-sectional associations of sleep disturbance with the frequency and bothersomeness of hot flashes, and interference of hot flashes with work, social, and leisure activities during the 2nd year of STRIDE.
Self-reported sleep disturbance.
Of the 623 women with complete data, 370 (59%) reported having hot flashes. Bivariate analyses showed that reporting hot flashes with bother, but not hot flashes alone, was associated with sleep disturbance (odds ratio [OR] [95% confidence interval (CI)]: 2.8 [2.0-4.0] and 1.3 [0.7-2.5], respectively). In multivariable models, women reporting bothersome hot flashes were more likely to report sleep disturbance (OR [95% CI]: 2.1 [1.4-3.2]) compared to women who reported no hot flashes. When the perceived interference of hot flashes with work, social activities, and leisure activities were included in the model, the relationships between bothersome hot flashes and sleep disturbance disappeared.
Hot flashes are not associated with sleep disturbance, unless they are bothersome. Mid-life patients should routinely be queried about the bothersomeness of their hot flashes.
This trial aimed to assess the tolerability and efficacy of a fresh sage preparation in treating hot flushes and other menopausal complaints. Sage (Salvia officinalis) has been traditionally used to treat sweating and menopausal hot flushes, as well as to alleviate associated menopausal symptoms and as a general tonic. However, no clinical studies substantiating the use of sage in menopause have been published previously.
In an open, multicenter clinical trial conducted in eight practices in Switzerland, 71 patients (intent-to-treat population [ITT], n=69; with a mean age of 56.4±4.7 years, menopausal for at least 12 months, and with at least five flushes daily) were recruited and treated with a once-daily tablet of fresh sage leaves for 8 weeks after an introductory baseline week. Parameters for the evaluation of efficacy were the change in intensity and frequency of hot flushes, and total score of the mean number of intensity-rated hot flushes (TSIRHF) as determined by diary protocol over the 2-month treatment period. Other variables included assessment of the Menopause Rating Scale (MRS) by the treating physician at baseline and after 2 months of therapy.
In the ITT population there was a significant decrease in the TSIRHF by 50% within 4 weeks and by 64% within 8 weeks (P<0.0001). The mean total number of hot flushes per day decreased significantly each week from week 1 to 8. The mean number of mild, moderate, severe, and very severe flushes decreased by 46%, 62%, 79%, and 100% over 8 weeks, respectively. The MRS and its somato-vegetative, psychological, and urogenital subscales decreased significantly by 43%, 43%, 47%, and 20% respectively. The treatment was very well tolerated.
A fresh sage preparation demonstrated clinical value in the treatment of hot flushes and associated menopausal symptoms.
Good sleep quality is important for good health, both physical and mental, and indeed for quality of life, performance and productivity. Sleep problems increase with age in both sexes, but women are more susceptible to them at all ages. Although menopause is considered an important milestone (the decrease in both oestrogen and progesterone has been shown to reduce sleep quality), an increase in sleep problems is already evident in midlife, as there is an increased incidence of other diseases as well as mood symptoms, which may exert an effect on sleep quality either directly or via the side-effects of the associated medications. Weight changes at midlife and the menopause may also affect sleep quality. In addition to reductions in sleep quality, specific sleep disorders, like sleep-disordered breathing and restless legs syndrome, become more prevalent in midlife and especially after menopause. Because sleep problems are commonly present in association with other conditions, rather than as isolated, independent disorders, treatment is often complex and patients generally need multiprofessional appraisal.
Most postmenopausal women have insomnia. Some of these women also have respiratory sleep disorders. Recent reports have documented that the phytohormones, isoflavones, are capable of reducing the symptoms of climacterium. The purpose of this investigation was to examine subjective and objective sleep parameters and to measure changes in these parameters during treatment with isoflavones in a controlled, double-blinded study in postmenopausal women with insomnia.
Two groups of postmenopausal women with insomnia participated in the study: the first received 80 mg isoflavones daily for 4 months, and the second received a placebo for the same period. Sleep analysis consisted of questionnaires and polysomnography. Student's t test and analysis of variance were applied for comparisons between groups, and correlations were tested with Pearson's correlation coefficient.
Thirty-eight women were enrolled in the study. Polysomnography revealed a significant increase in sleep efficiency in the isoflavone group (from 77.9% to 83.9%) when compared with the placebo group (from 77.6% to 81.2%). Isoflavones induced a decrease in the intensity and number of hot flashes and the frequency of insomnia: among the women in the placebo group, 94.7% had moderate or intense insomnia at the beginning of the study, compared with 63.2% at the end, whereas in the isoflavone group, these percentages were 89.5% and 36.9%, respectively.
In postmenopausal women with insomnia, isoflavone treatment was effective in reducing insomnia symptoms, which was confirmed by increased sleep efficiency as observed by polysomnographic analysis.
The aim of this study was to investigate whether tapering down of combined estrogen plus progestogen therapy (EPT) reduced the recurrence of hot flashes and resumption of therapy compared with abrupt discontinuation. A secondary aim was to evaluate whether health-related quality of life (HRQoL) was affected after discontinuation of EPT and to investigate the possible factors predicting resumption of EPT.
Eighty-one postmenopausal women undergoing EPT because of hot flashes were randomized to tapering down or abrupt discontinuation of EPT. Vasomotor symptoms were recorded in self-registered diaries, and resumption of hormone therapy (HT) was asked for at every follow-up. The Psychological General Well-being Index was used to assess HRQoL.
Neither the number nor the severity of hot flashes or HRQoL or frequency of resumption of HT differed between the two modes of discontinuation of EPT during up to 12 months of follow-up. About every other woman had resumed HT within 1 year. Women who resumed HT after 4 or 12 months reported more deteriorated HRQoL and more severe hot flashes after discontinuation of therapy than did women who did not resume HT.
Women who initiate EPT because of hot flashes may experience recurrence of vasomotor symptoms and impaired HRQoL after discontinuation of EPT regardless of the discontinuation method used, abrupt or taper down. Because, in addition to severity of flashes, decreased well-being was the main predictor of the risk to resume HT, it seems important to also discuss quality of life in parallel with efforts to discontinue HT.
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.
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.
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 < or =25kg/m(2) (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%).
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.
This study describes the development of the Menopause Representations Questionnaire (MRQ), which, based on Leventhal's self-regulation model (Leventhal et al., 1984), samples a range of cognitions about menopause, including identity, consequences, time frame and perceptions of control and cure. Items were derived from a qualitative interview study of 45 women aged 49-51. Identity included attributions of general symptoms as well as hot flushes and menstrual changes; positive and negative consequences were evident, as were both short and long time lines. The MRQ was given to a sample of 80 women aged 49-56 years. Internal consistency and test-retest reliability were reasonable. Perceptions of control/cure were negatively associated with depressed mood (Women's Health Questionnaire, WHQ; Hunter, 1992), and perceptions of negative consequences were associated with medical help-seeking.
When assessing mood and general health of mid-aged women, the effects of hormonal changes (and resulting symptoms such as hot flushes) and changes associated with age (such as in sleep patterns) can confound the results. A questionnaire was specifically developed to measure subjective reports of emotional and physical well-being of women aged 45 to 65 years. The relationships between symptoms was explored using factor analysis and a range of subscales was derived. Depressed mood and anxiety formed separate scales, as did sleep problems, somatic symptoms, menstrual problems and sexual behaviour. Vasomotor symptoms (hot flushes and night sweats) made up an additional scale. The full scale, with scoring information and norms for two samples ((i) 682 women aged 45-65, and (ii) 55 women aged 23-38) is provided. Test-retest reliability was found to be high (range 0.69-0.96) and concurrent validity for the depressed mood scale was confirmed by comparison with the General Health Questionnaire (Goldberg, 1972), which measures mood disturbance in community samples.
Each menopausal body is the product of decades of physiological responses to an environment composed of cultural and biological factors. Anthropologists have documented population differences in reproductive endocrinology and developmental trajectories, and ethnic differences in hormones and symptoms at menopause demonstrate that this stage of life history is not exempt from this pattern. Antagonistic pleiotropy, in the form of constraints on the reproductive system, may explain the phenomenon of menopause in humans, optimizing the hormonal environment for reproduction earlier in the life course. Some menopausal symptoms may be side effects of modernizing lifestyle changes, representing discordance between our current lifestyles and genetic heritage. Further exploration of women's experience of menopause, as opposed to researcher-imposed definitions; macro- and microenvironmental factors, including diet and intestinal ecology; and folk etiologies involving the autonomic nervous system may lead to a deeper understanding of the complex biocultural mechanisms of menopause.
Menopause is an important life event that may have a negative influence on quality of life. Work ability, a concept widely used in occupational health, can predict both future impairment and duration of sickness absence. The aim of this study was to examine the impact of menopausal symptoms on work ability.
This was a cross-sectional study that used a sample of healthy working Dutch women aged 44 to 60 years. Work ability was measured using the Work Ability Index, and menopausal symptoms were measured using the Greene Climacteric Scale. Stepwise multiple linear regression models were used to examine the relationship between menopausal symptoms and work ability.
A total of 208 women were included in this study. There was a significant negative correlation between total Greene Climacteric Scale score and Work Ability Index score. Total Greene Climacteric Scale score predicted 33.8% of the total variance in the Work Ability Index score. Only the psychological and somatic subscales of the Greene Climacteric Scale were significant predictors in multiple linear regression analysis. Together, they accounted for 36.5% of total variance in Work Ability Index score.
Menopausal symptoms are negatively associated with work ability and may increase the risk of sickness absence.
The aim of the study was to evaluate factors influencing quality of life (QOL) in Moroccan postmenopausal women with osteoporotic vertebral fracture assessed by the Arabic version of ECOS 16 questionnaire.
357 postmenopausal women were included in this study. The participants underwent bone mineral density (BMD) measurements by DXA of the lumbar spine and the total hip as well as X-ray examination of the thoraco-lumbar spine to identify subclinical vertebral fractures. Patients were asked to complete a questionnaire on clinical and sociodemographic parameters, and osteoporosis risk factors. The Arabic version of the ECOS16 (Assessment of health related quality of life in osteoporosis questionnaire) was used to assess quality of life.
The mean age was 58 +/- 7.8 years, and the mean BMI was 28.3 +/- 4.8 kg/m2. One hundred and eight women (30.1%) were osteoporotic and 46.7% had vertebral fractures. Most were categorized as Grade1 (75%). Three independent factors were associated with a poor quality of life: low educational level (p = 0,01), vertebral fracture (p = 0,03), and history of peripheral fracture (p = 0,006). Worse QOL was observed in the group with vertebral fracture in all domains except "pain": Physical functioning (p = 0,002); Fear of illness (p = 0,001); and Psychosocial functioning (p = 0,007). The number of fractures was a determinant of a low QOL, as indicated by an increased score in physical functioning (p = 0,01), fear of illness (p = 0,007), and total score (p = 0,01) after adjusting on age and educational level. Patients with higher Genant score had low QOL in these two domains too (p = 0,002; p = 0,001 respectively), and in the total score (p = 0,01) after adjusting on age and educational level.
Our current data showed that the quality of life assessed by the Arabic version of the ECOS 16 questionnaire is decreased in post menopausal women with prevalent vertebral fractures, with the increasing number and the severity of vertebral fractures.
The purpose of this descriptive qualitative study was to describe the perceptions of Jordanian midlife women about making the menopausal transition.
Audio taped interviews were conducted with 25 peri-menopausal Jordanian women. Interviews were analysed as appropriate for descriptive qualitative inquiry.
The major theme generated was 'A Life Transition', which included: a time of no more reproductive obligations, changing from the burdens and obligations of reproductive roles and responsibilities to freedom, relief and rest; a time for managing peri-menopausal symptoms; and a time for growing into a wise woman and accepting aging as a part of life.
These data can assist healthcare providers to provide culturally competent health care to midlife Jordanian women. Support groups may be helpful to facilitate connections between midlife women, increase self-awareness, assist women to come to value their menopausal experiences, to manage their symptoms appropriately through self-care measures and healthcare interventions and to more fully embrace being 'wise women'.
A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
Interview-based measures of functional health status may pkay a significant role in the evaluation of health policies and treatments. This paper focuses on the interday reliability of information obtained by the Quality of Well-Being (QWB) scale. The QWB scale combines measures of symptoms and functioning to provide a numeric point-in-time expression of well-being, which ranges from zero (0) for death to one (1.0) for asymptomatic optimum functioning. The QWB also includes three scales of function: Mobility (MOB), Physical Activity (PAC), and Social Activity (SAC).
The Nottingham Health Profile (NHP) is easy to use with stroke patients and may be used with those who cannot manage more complicated mood questionnaires, such as the General Health Questionnaire (GHQ). Stroke patients rate their health, and especially emotions and feelings of social isolation, as much worse than that of people of similar age. NHP emotion scores correlate with objective measures of disability, length of hospital stay, and GHQ scores. The NHP is a valid indicator of depressed mood, and combining its components into a total score gives the greatest accuracy in detecting depression. Patients with high scores at one month continued to report large numbers of problems at six months after their stroke. Many patients experienced pain, disturbed sleep, and social isolation, which are important, potentially treatable problems not usually considered in the management of stroke patients. Many patients with problems did not see their general practitioner or any other source of help, and additional follow up was needed.
The development and validation of a short and simple measure of perceived health problems is described. Extensive testing with selected groups, including the elderly, the chronically ill, pregnant women, fracture victims, and a random sample of the community has established the face, content and criterion validity, and the reliability of the instrument. The Nottingham Health Profile is intended as a standardized tool for the survey of health problems in a population, but is equally valid and useful as a means of evaluating the outcome of medical and/or social interventions and as an adjunct to the clinical interview.
The current recognition of the importance of perceived health status as a predictor of need for, and utilisation of, health services has led to attempts to produce indicators which assess subjective rather than objective health problems. The development of the Nottingham Health Profile is described, together with a study which tested the validity of the instrument on four groups of elderly people differing in health status. The results showed that the profile was capable of discriminating between groups differing in terms of diagnosed chronic illness, number of consultations at primary care level, and physiological fitness. Age, sex, and marital status were not significant overall in affecting scores. In these elderly subjects, perceived health status accorded well with objective health status. Further tests of the profile are now taking place on younger groups of subjects.
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
The prevalence of 24 complaints was surveyed in eight menopausal age groups in a representative sample of 1886 women, 45-55 years of age, drawn from the population register of Oslo, Norway. Although more than one-third had experienced frequent hot flushes, excessive sweating, muscle and joint pains, and sleeping problems, complaints during the climacteric were reported more rarely than in previous studies. The highest prevalences appeared among the 2-3 years postmenopausal women: 45% hot flushes, 33% excessive sweating, 22% vaginal dryness and 10% mood swings. When prevalence among regularly menstruating subjects was used to adjust for the premenopausal level of complaints, the adjusted prevalences were 34% hot flushes, 25% excessive sweating and 18% vaginal dryness. Mood-related complaints showed no relationship with menopausal age. Among the premenopausal women, however, 57% and 55% reported occasional irritability and moodswings respectively. A short literature review indicates that size of prevalence figures in this area is inversely related to representativity of the sample used. A detailed methodological discussion concludes that the previous prevalences of menopausal complaints have been overestimated because of methodological weaknesses. The menopause does not involve such a large health problem as originally assumed when large-scale hormonal prevention among healthy women was launched.
Objectives:
The Women's Health Questionnaire has been developed for the assessment of symptom perception in mid-aged women. It explores a range of psychological and physical symptoms and is one of the most used health-related quality of life measures. It was developed in the English language and is available in several other languages. The aim of this study was to evaluate the psychometric properties of the Tunisian-Arabic version of the questionnaire.
Methods:
A Tunisian-Arabic translation of the original version of the Women's Health Questionnaire (36-item WHQ) was produced using the forward-backward translation method recommended by the designers. A total of 1231 women were anonymously recruited from the general population using the quota method of sampling. All women were administered the WHQ as part of a broader questionnaire; 1150 records were finally retained for analysis. Psychometric evaluation was performed for the original version of the WHQ (36 items) and then for the 23-item revised version proposed by the MAPI Research Institute.
Results:
The acceptability and comprehensibility of the scale were good. The 36-item version showed overall good reliability, but some subscales lacked internal consistency. The validity was explored by principal component analysis and showed significant differences with the original English instrument and some deficiencies in its dimensional structure. The validity of the 23-item revised version was better. Finally, we suggest some adjustments to improve the reliability and validity of the instrument.
Conclusion:
The Tunisian-Arabic version of the WHQ is globally reliable and valid, but we recommend the use of an improved shortened version, more specific to mid-aged women.
Menopause symptoms result from the interaction of estrogen deprivation, psychosocial influences, and genetic factors. We examined the influence of stress and of estrogen receptor-α (ER-α; PvuII and XbaI) and serotonin transporter (5-HTT) polymorphisms on symptoms at postmenopause.
We studied 290 urban women from three cities in Mexico. General characteristics, menopause symptoms, and scores of perceived stress, effort-reward imbalance, dominance, and submission were collected. A fasting blood sample was obtained for hormone measurements and genotypification.
Women had a mean ± SD age of 54.4 ± 4.5 years and BMI of 29.5 ± 4.9 kg/m. The frequency of hot flashes was 75.5%; vaginal dryness, 57.8%; and diminished sexual interest, 78.7%. Follicle-stimulating hormone and estradiol levels were 59 ± 27 mIU/mL and 22 ± 29 pg/mL, respectively. Women from Torreón had higher schooling and less parity but higher scores for depression and lower submission. Hot flashes were more frequent in women from León. Genotype distribution was similar among cities. Lower scores for dominance were found in women with the pp and xx ER-α genotypes. Increased smoking habit was found for the SS genotype of 5-HTT. Factors significantly associated with symptoms were years since menopause, with hot flashes (negative), and with diminished sexual interest (positive); dominance was negatively associated with depression, perceived stress, and vaginal dryness; submission was positively associated with depression, perceived stress, anxiety, and hot flashes; and effort-reward imbalance was positively associated with anxiety, hot flashes, and perceived stress.
Symptoms at postmenopause were associated mainly with dominance, submission, and effort-reward imbalance. The pp genotype of ER-α showed lower scores of dominance.
The experience of menopause can vary strongly from one society to another: frequency of hot flushes, other somatic and psychological symptoms, and changes in family and social relations. Several studies have shown that country of residence, country of birth, ethnicity, and social class all play roles in these variations. But few comparative anthropological studies have analysed the social processes that construct the experience of menopause or considered menopausal women's social and financial autonomy. To study the impact of the social status accorded to menopausal women and their social resources, during 2007 and 2008 we conducted a series of 75 in-depth interviews with women in different sociocultural settings: Tunisian women in Tunisia, Tunisian women in France, and French women in France, all aged from 45 to 70 years. Our methodological approach to the data included content analysis, typology development and socio-demographic analysis. Quite substantial differences appeared, as a function of social class and cultural environment. We identified three principal experiences of menopause. Tunisian working class women, in Tunisia and France, experience menopause with intense symptoms and strong feelings of social degradation. Among Tunisian middle-class women in both countries, menopause was most often accompanied by a severe decline in aesthetic and social value but few symptoms. For most of the French women, menopause involved few symptoms and little change in their social value. The distribution of types of experiences according to social but not geographic or national factors indicates that, in the populations studied here, the differences in symptoms are not biologically determined. Different experiences of menopause are linked to social class and to the degree of male domination. A given level of independence and emancipation allows women an identity beyond their reproductive function and a status unimpaired by menopause.
The psychometric properties of two menopause-specific quality of life (QoL) measures, the Menopausal Quality of Life (MQOL), and the Women's Health Questionnaire (WHQ), were evaluated and compared in a convenience sample of 304 Korean women in menopausal transition. Data were collected with a self-report questionnaire. Evaluation of validity included factor analysis, convergent and discriminant validity, and known-groups validity. Evaluation of reliability included internal consistency reliability and item analysis. The results indicated that both QoL instruments were valid, but the WHQ was more internally consistent in measuring QoL although with a factor structure different from previous research. Replication studies to identify factor structures are needed for both measures.
Menopause, according to contemporary American and European understanding, signifies the end of menstruation, a universal experience among human females. This definition of menopause is recent in origin, and is not one which is widely accepted, comparatively speaking. Research has shown that meanings and subjective experience, including symptoms, associated with menopause vary cross-culturally. Menopause may not be recognized as a concept, or alternatively is not closely associated with the end of menstruation, nor is it usually considered a difficult time. This anthropological research is briefly summarized followed by a discussion of the results of survey research conducted in Japan, comparable with Canadian and American surveys. Symptom reporting in Japan among a nonclinical, naturally menopausal population is significantly lower and different from the North American samples. In addition Japanese women have a longer life-expectancy and lower rates of heart disease, osteoporosis, and breast cancer than do North American women. These findings will be contextualized in light of cultural differences with respect to diet, exercise, and attitudes towards this part of the female life cycle. The significance of these findings are considered with respect to research questions to be posed in the future.
There is a global trend of increasing numbers of older women in the workforce. However, limited information is available regarding the relationship between the menopause transition and work, especially in developing countries. The objectives of this study were to investigate the relationship between experience of the menopause transition and work and to examine the factors affecting how women cope, including the extent to which women disclosed their menopausal status.
Using a cross-sectional single group design, 131 middle-aged female medical teaching staff working in Zagazig Faculty of Medicine completed questionnaires and semi-structured interviews.
Participants, particularly those who were postmenopausal, reported high average scores on depressed mood, memory/concentration, sleep problems, vasomotor symptoms, and sexual behavior subscales of the Women's Health Questionnaire (WHQ). Women reported that poor working environment and work policies and conditions, functioning as sources of work stress, aggravated their menopausal symptoms. Disclosure of their menopausal status was uncommon; limited time and socio-cultural barriers were the most commonly reported reasons for non-disclosure.
It could be concluded that the menopause transition is an important occupational health issue especially for women in developing countries. Implementing health promotion programs, improving working environment and work policies, and raising awareness of menopause are recommended to help women to cope with the menopause transition and to maintain well-being and productivity at work.
This paper is the third in a series of reviews of cross-cultural studies of symptoms at midlife. The goal of this review is to examine methods used previously in cross-cultural studies of menopause and women's health at midlife to (1) identify challenges in the measurement of somatic symptoms across cultures and (2) recommend questions and tools that can be used in future research. This review also aims to examine the determinants of somatic symptoms. The review concludes that methods used for assessing somatic symptoms differ across studies. Somatic symptoms, particularly, aches, pain, and fatigue have a high prevalence. Statistically significant differences were seen in the prevalence of somatic symptoms across cultures. Based on the number of studies that demonstrated cross-cultural differences in symptom prevalence, we recommend that the following symptoms be included in future studies of symptoms at midlife: headaches, aches/pain, palpitations, dizziness, fatigue, breathing difficulties, numbness or tingling, and gastrointestinal difficulties. We also recommend that objective measures of physical function be administered when possible to supplement subjective self-evaluation.
The aim of this study was to describe the evolution of hormone therapy (HT) initiation among newly postmenopausal women after the release of the first results from the Women's Health Initiative trial (July 2002).
We used data from two French prospective cohorts, E3N and GAZEL. We identified 3,364 women with natural menopause onset occurring before 2002 and 1,880 women with menopause onset occurring after 2002.
After 2002, the age-standardized rate of HT initiation (no later than 1 y after menopause onset) in newly postmenopausal women fell by 69.9% (67.9% and 74.8% in the E3N and GAZEL cohorts, respectively). There were also changes in the distribution of both the route of administration of estrogen and the type of associated progestogen, which made transdermal estrogen plus progesterone the predominant HT type initiated after 2002 (43.6% of the initiated HT, 44.0% and 42.2% in the Étude Épidémiologique auprès de femmes de l'Éducation Nationale and GAZEL cohorts, respectively).
The evolution of HT initiation was similar in these two French cohorts, with a substantial drop in HT initiation rate accompanied by changes in the types of HT used.
OBJECTIVE: To analyze changes in hormone therapy (HT) use after the publication of the Women's Health Initiative (WHI) results, in a country (France) where HT is different from that assessed in the WHI. DESIGN: Longitudinal study. SETTING: Women in the GAZEL cohort of employees of the French national power company. PARTICIPANT(S): One thousand six hundred five postmenopausal women ever-users of HT. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Discontinuation of HT. RESULT(S): Rates of discontinuation were higher after 2002: 65% of users who began HT in 1998 were still using it after 5 years. In contrast, >90% of those who began before 1994 were still using it after 5 years. Discontinuation was associated with women's social and medical characteristics and with factors related to side effects and expectations concerning HT. After adjustment for these factors, women were twice as likely to stop HT after publication of the WHI. CONCLUSION(S): Even in France, publication of the WHI has led to a decline in HT use.
Objectives:
The aim of the study was to explore the effects of country of residence on menopausal status and menopausal symptoms in Australian and Japanese women. The study objectives included exploring the impact of country of residence (Australia and Japan) and menopausal status on menopausal symptoms, and identifying whether country of residence (Australia and Japan) moderates the relationship between menopausal status and menopausal symptoms.
Methods:
Analyses are based on 1743 women aged between 40 and 60 years who participated in the multi-race, multi-site, cross-sectional study of mid-aged women called the Australian and Japanese Midlife Women’s Health Study (AJMWHS) in 2001– 002. Study participants completed a mailed questionnaire that contained questions on a variety of health-related topics.
Results:
In both cultures there was a similar increase in prevalence of depression (p50.001), somatic symptoms (p50.001) and vasomotor symptoms (p50.001) at perimenopause. Australian women experienced more night sweats than Japanese women but the prevalence of hot flushes was not statistically different. Postmenopausal Japanese women had more somatic, psychological and sexual symptoms. The main effect for menopausal status and the interaction effect of country of residence was significant in the somatic symptoms (p50.001), but not in any of the other areas.
Conclusions:
Vasomotor, psychological and somatic symptoms decrease after menopause in Australian women, with only sexual symptoms continuing. In Japanese women, somatic, psychological and sexual symptoms remain high after menopause. It is possible that westernization may be having a significant impact on the aging of women in Japan and it is, therefore important to capture through research just what this impact may be.
We previously found differences in experience of menopausal symptoms between a migrated Asian sample of women from the Indian subcontinent living in the UK (UKA), and matched samples of UK Caucasian women (UKC) and Asian women living in Delhi, India (DEL). This study aims to explain these differences using quantitative and qualitative methods.
A total of 153 peri- and postmenopausal women aged 45-55 years (52 UKA, 51 UKC and 50 DEL) were interviewed about their experience of menopause, lifestyle and health. The current study combines a quantitative analysis of potential predictors (sociodemographic variables, mood, lifestyle, ethnicity, country of residence and religion) of vasomotor symptoms and a qualitative thematic content analysis of descriptions of experience of menopause.
Country of residence and anxiety best predicted vasomotor symptoms, while religion, ethnicity, age of menopause and lifestyle factors did not. Within the UK Asian sample, poor general health, anxiety and less acculturation were predictors of vasomotor symptoms. Qualitative analyses revealed cultural differences in symptoms and beliefs about the menopause.
These results challenge assumptions about migrated Asian populations living in western cultures and the qualitative data provides information that might increase understanding of the experience and meanings of menopause amongst migrated Asian communities.
SYNOPSIS
This study reports the factor structure of the symptoms comprising the General Health Questionnaire when it is completed in a primary care setting. A shorter, 28-item GHQ is proposed consisting of 4 subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Preliminary data concerning the validity of these scales are presented, and the performance of the whole 28-item questionnaire as a screening test is evaluated. The factor structure of the symptomatology is found to be very similar for 3 independent sets of data.
Comparisons were made between menopausal women and nonmenopausal controls among Caucasians and Japanese living in Honolulu, to investigate the extent of physical changes and clinical symptoms associated with menopause. The analysis was conducted using the multiphasic screening records of 170 menopausal cases and 162 nonmenopausal controls in Caucasians, and of 159 menopausal women and 187 nonmenopausal controls in Japanese. Discriminant function analysis was employed with relevant anthropometric, medical, and physiological variables. After adjusting for the linear and non-linear effects of age, only surgery and medication were retained as significant discriminant variables. Discriminant functions for Caucasian and Japanese groups were not found to be significantly heterogeneous. With regard to the discrimination of the menopausal and nonmenopausal groups, the data suggested that, while no clinical conditions other than those attributable to the effects of aging were significantly associated with the menopausal state, medication and surgical procedures for female disorders were significantly related to menopause.
The long-term effect on aspects of quality of life (QoL) of treatment with transdermal oestrogen for 2 weeks followed by transdermal oestrogen/progestogen norethisterone acetate/oestradiol TTS 0.25/0.05 mg/day for the next 2 weeks was investigated in postmenopausal women within the framework of a 1-year seven-centre trial. Of the 136 women who were included (mean age 53 +/- 4.8 years), 110 completed the study. Aspects of QoL that are of relevance in the perimenopause and postmenopause were evaluated using the Psychological General Well-Being (PGWB) index, the Women's Health Questionnaire (WHQ) and the Sleep Dysfunction Scale before and after 3 and 9 months of therapy in the oestrogen phase. Climacteric complaints were also assessed by means of the Kupperman Index. Improved well-being, i.e. less anxiety and depression, increased vitality and better self-control (P less than 0.0001) were observed, as well as reduced sleep disturbance (P less than 0.0001). The WHQ showed decreased vasomotor and somatic symptoms, and improved sex life, emotions and cognitive function (P less than 0.0001). Improvement was the same at 3 and 9 months. According to the Kupperman Index, climacteric symptoms were alleviated (P less than 0.0001). Relief of vasomotor symptoms was correlated with improvement in the WHQ (r = 0.82), the PGWB index (r = 0.58, P less than 0.0001) and sleep (r = 0.51, P less than 0.0001). Because of the absence of a placebo control group, the results must be regarded with caution until confirmed in a placebo-controlled trial.
An approach employing a range of standardized questionnaires, which included the Nottingham Health Profile (NHP), the Psychological General Well-Being (PGWB) index and the Mood Adjective Check List (MACL), was used to assess health-related quality of life (QoL) in conjunction with a study comparing two doses of transdermal oestrogen (50 or 100 micrograms/24 h) combined with an oral progestogen (5 mg medroxyprogesterone acetate for 14 days each cycle). In addition to the QoL measures, climacteric symptoms were self-rated and also summarized by means of the Kupperman index. In all, 59 women, median age 52 (39-71) years, who completed 4 months of therapy were evaluated. The use of a battery of standardized questionnaires enabled a comprehensive evaluation to be made of perceived health, well-being and day-to-day functioning. Not only was symptomatic relief, e.g. reduced frequency of sweating episodes, sleep disturbance and hot flushes, observed during treatment, but there were also improvements in terms of sleep, energy and emotions. The frequency of health-related problems associated with paid employment, housework, social life, home life and sex life decreased, indicating enhanced ability to take part in daily activities. The PGWB index showed improvement in the subscales representing well-being, anxiety, depression, vitality, health and self-control, while the mood scales indicated that the women experienced less tension and more satisfaction. Although the results of this study need to be further documented on the basis of a placebo-controlled trial, the findings nevertheless imply that the use of a battery of standardized questionnaires optimizes the possibility of evaluating climacteric complaints reliably before and after treatment.
This paper re-examines the association between menopause and depression using data from a study in which 477 women were interviewed 6 times over a 3-year period. Menopause is examined as one of a series of factors which may increase the risk of depression for women in middle age, such as children leaving home, the death and illness of family members, the stresses of daily living, health and the onset of chronic disease. Rather than hormonal changes, it seems to be her health coupled with the shifts and stresses of family life in a woman's menopausal years which may trigger her depression.
Fifty-six premenopausal women were drawn from a cross-sectional survey of 850 women living in South-East England. They were recontacted 3 years later when 36 met the criterion of being naturally peri- or postmenopausal. Somatic, vasomotor and emotional symptoms, as well as general health, use of medical services and beliefs about the menopause, were assessed on both occasions using the Women's Health Questionnaire (a symptom scale standardized for use with this age group). In general, the cross-sectional findings were confirmed--vasomotor symptoms, sleep problems and to a lesser extent depressed mood increased during the peri- and postmenopause. However, ratings of general health and use of medical services remained unchanged. A stepwise regression analysis was used to predict depressed mood and hot flushes in peri- and postmenopausal women. The results illustrate the importance of previously existing symptoms, stereotyped beliefs and social factors in explanations of climacteric symptoms.
As medical care is directed increasingly toward management of chronic diseases, measuring the quality of life as an outcome becomes more important. Therapeutic trials traditionally have focused on physiologic outcomes, but these outcomes may be only modestly associated with symptoms or functional ability. Although quality-of-life measures may be regarded as 'soft' and inferior to laboratory measures, newer instruments achieve high levels of reproducibility and validity. These newer questionnaire measures appear to offer important advantages over older and simpler scales, some dating from the 1940s. Despite conceptual and methodologic challenges, several quality-of-life instruments are ready for wider incorporation into clinical trials. Research is needed to improve existing measures, to provide head-to-head comparisons, and to assess the feasibility of incorporating these instruments into routinely maintained databases.
The efficient and reliable assessment of general community health requires the development of comprehensive and parsimonious measures of proven validity. The Nottingham Health Profile (NHP) has been demonstrated to be a reliable indicator of common expressions of discomfort and stress in the general population. The present paper describes its linguistic adaptation into French, the derivation of item weights by Thurstone's method of paired comparisons and the comparison of item weights across various sociodemographic groups. There is more similarity than variation on the valuation of the state of health explored by the NHP between the French and the British population as little inter-cultural or inter-linguistic variations were found. The differences in judgement of severity elicited across sociodemographic groups in the French sample cast some doubts on the relevance of general weights for use in population surveys.
Jenkinson C and Fitzpatrick R. Measurement of health status in patients with chronic illness: comparison of the Nottingham health profile and the general health questionnaire. Family Practice 1990; 7:121–124.
The results of two commonly used instruments for measuring health status were compared in patients with chronic illness. The Nottingham health profile (NHP) is a measure of perceived health, while the general health questionnaire (GHQ) is a measure of non-psychotic psychiatric disturbance. The questionnaires were completed by patients suffering either rheumatoid arthritis or migraine. The results provide evidence that, despite some specific problems in the measurement of pain and emotional reactions, the NHP and GHQ may be used to assess the impact of illness upon sufferers' lives, not only in severely disabling disorders such as rheumatoid arthritis, but in health problems such as migraine which have often been considered as relatively minor ailments.
Three groups of indications exist for postmenopausal estrogen use: relief of symptoms related to estrogen deficiency, osteoporosis prophylaxis and treatment, and cardioprotection. Estrogen replacement therapy enhances a woman's sense of well-being and reduces the morbidity, mortality, and health care costs associated with osteoporosis and atherosclerotic heart disease. There are a few absolute contraindications to estrogen replacement therapy. Many estrogen preparations are currently available in the United States. Establishing equivalencies among the different preparations is complicated by the many physiologic and pharmacologic effects of estrogens and the variety of treatment end points used. Most estrogens have the same biologic effect provided equivalent blood levels are achieved. Estrogen replacement therapy has proved beneficial to selected postmenopausal women.
A comparison of the studies investigating the impact of medical care on quality of life over a recent 5-year period (1980-1984) with those appearing during the preceding 5 years from 1975 to 1979 [1]reveals; that (a) 3 times as many (69 as compared to 23) appeared during the time span, that (b) almost two-thirds (60%) of the recent studies included a subjective measure of quality of life as compared to only 1 in 10 for the previous 5-year period, but that (c) one-shot, case studies designs still predominate. On the other hand, (d) the use of control groups doubled from 1981 to the present, although (c) the majority of studies continues to use samples of convenience (e.g. consecutive patients or treatment survivors) rather than employing random assignments or random sampling. Nevertheless, (f) the average size of samples has doubled from 90 to 178, and (g) whereas almost all of the studies in the earlier review concluded that the intervention being studied improved quality of life, now approx. 1 in 5 report negative outcomes with another 30% reporting mixed results. It is concluded that in spite of increasing methodological sophistication, investigation of the impact of medical care on quality of life will be hindered until there is better agreement as to what constitutes adequate assessment of the construct. Suggestions for how a consensus might be attained are discussed.
As part of the trial for assessing the value of breast screening, all women in the Edinburgh area who became eligible for screening over a nine-month period were sent a standard questionnaire of perceived health status. Results were analysed in the light of subsequent attendance or non-attendance at the clinic. Of those women who replied to the questionnaire, attenders at the clinic, those who did not respond to the questionnaire and those who declined the questionnaire were found to have a similar perceived health status, close to the population norm for this age and sex; those who accepted the invitation but failed to attend reported more health problems overall and these were statistically significant for emotional distress, social isolation and sleep problems. These differences were independent of postal code sector. It is suggested that more attention be paid to the heterogeneity of non-attenders for screening and the social and emotional context within which an invitation for screening is received and accepted.
The importance of distinguishing climacteric symptoms from other psychological and somatic complaints has been repeatedly stressed, but as yet no detailed guidelines are available to assist the clinician in the day-to-day management of patients. Previous epidemiological surveys of climacteric symptoms have been criticised because of inadequate methodology. We have attempted to overcome most of these problems and to provide a more detailed analysis of the relationships between menopausal status and psychological and somatic symptoms. Eight hundred and fifty pre-, peri- and post-menopausal women, aged 45-65 yr, took part in a cross-sectional survey of general health, psychosocial factors and current symptomatology. They were a non-menopause clinic sample and were blind to the purpose of the study. Using a principal components analysis, the relationships between symptoms were examined. Certain psychological and somatic symptoms occurred together in specific clusters. Some of these symptom clusters, e.g., vasomotor symptoms and sexual difficulties, were best predicted solely by menopausal status, while others, such as psychological and somatic symptoms, were more clearly associated with psychosocial factors. On the basis of these results, guidelines for the assessment of climacteric and post-menopausal women can be suggested.
A simple and standardised measure of perceived health status, the Nottingham Health Profile, was used to assess the effect on perceived health status of surgical intervention in a variety of non-acute medical disorders. Patients were assessed a few days before their operation and again two months later and were compared with a control group who had not undergone surgery. Results showed very little change in subjective health from before to after surgical intervention. The experimental group had similar perceived health scores to the control group on the pre- and post-tests. It is suggested that the period allowed to elapse after surgical intervention was too short, or that the level of problems experienced by patients prior to surgery was too low to show significant change. It is also possible that the particular presenting disorders were only one possible somatic representation of general feelings of minor ill-health in the group. The findings of this study point to the need to look at the differences between doctors and patients expectations of the outcome of surgery, the decision to seek care and the factors that govern wellbeing.
The concept, "quality of life" (QOL), offers a broad perspective for assessing the needs and outcomes of chronic mental patients. In this survey of Los Angeles board-and-care homes, 278 randomly selected, mentally disabled residents evaluated their QOL in structured interviews based on a general QOL model. Life areas studied included living situation, family, social relations, leisure, work, safety, finances, and health. The model performed as well among these residents as among the general population, explaining 48% to 58% of the variance in global well-being. Adding patients' subjective QOL evaluations doubled the explanatory power of a model based only on personal characteristics and objective life conditions. Global well-being was most consistently associated with personal safety, social relations, finances, leisure, and health care variables. The study identifies methodological and service issues in need of further examination.
The decision to consult a doctor for medical reasons may be assumed to be indicative of the perception of a health problem by the patient. A study was carried out to compare the scores of consulters and non-consulters of a general practice, on the Nottingham Health Profile, which is designed to be a standardized and simple measure of subjective health status in the physical, social and emotional domains. Data on physical activity, absence from work and overall self-rated health were also collected. Each section of the Profile showed significant differences in score between consulters and non-consulters. Significant associations were also found between scores on the Profile and both self-rated health and absence from work. The association between scores and amount of physical activity was less clear cut.Females had a lower subjective health status than did males on all sections except those reflecting pain and physical mobility problems. The age-group 40–49 had a lower subjective health status than younger and older groups and for this age group males scored higher than females on sections representing emotional, social and sleep problems.The study indicates that the Nottingham Health Profile is a valid and sensitive measure of subjective health, which may well be a better predictor of need for and utilization of health services than “hard” data such as mortality and morbidity statistics.
Although the efficacy of hormonal replacement therapy (HRT) regarding numerous consequences of menopause is proven, its prevalence of use is low, as is compliance with the prescribed treatment. The aim of this work was to study the factors influencing a woman's decision to take HRT by analyzing the determinants of HRT use of at least 6 months' duration among post-menopausal women working for a French company and enrolled in a cohort study. Special attention was paid to the women's expectations of HRT. We compared two groups of women: 113 current HRT users who had been users for at least 6 months and 101 never users. Among the 113 current users, the most frequent treatment was a combination of oestrogen and progestin (86%). The determinants of HRT use for at least 6 months included a prior spinal radiograph, which showed a significant relationship with the use of hormone treatment (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.2-4.7), a current marriage (OR 2.5; 95% CI 1.3-5.1) and previous hot flushes (OR 2.4; 95% CI 1.2-4.9). The strongest determinant was an expectation that HRT would prevent osteoporosis (OR 5.0; 95% CI 2.2-11.6). In this population concern about osteoporosis appears to be an important determinant of HRT use. Our results underline the importance of the diffusion of information among physicians and women about HRT's benefits, especially its efficacy in preventing osteoporosis.
Our purpose was to determine the characteristics of menopause among Mayan women who did not have menopausal symptoms.
A cross-sectional study of Mayan women from Chichimila, Mexico, was performed. Demographic information, history and physical examination, hormone concentrations, and radial bone density measurement were obtained.
Fifty-two postmenopausal women were compared with 26 premenopausal women. Menopause occurred at 44.3 +/- 4.4 years. None of the women admitted to hot flushes and did not recall significant menopausal symptoms. Hormone levels included elevated follicle-stimulating hormone (66.6 +/- 29 mlU/ml), low estradiol and estrone (9.4 +/- 8.3 and 13.3 +/- 7.8 pg/ml), estrone greater than estradiol levels, normal levels of testosterone and androstenedione (0.17 +/- 0.14 and 0.31 +/- 0.17 ng/ml). Bone mineral density declined with age, but height did not. Clinical evidence of osteoporosis was not detected.
Lack of symptoms during the menopausal transition is not attributable to a difference in endocrinology. Postmenopausal Mayan women are estrogen deprived and experience age-related bone demineralization but do not have a high incidence of osteoporotic fractures.