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Positve attitude to menopause and improved quality of life among Igbo women in Nigeria
International Journal of Gynecology & Obstetrics
... The most commonly reported symptoms among women in high-income countries are vasomotor symptoms including hot flushes, vaginal dryness, insomnia, fatigue, and joint pain [8][9][10]. Several studies conducted among Nigerian women reported menopausal symptoms of joint and bone pain, hot flush, insomnia, anxiety, urinary symptoms, fatigue, and dyspareunia [11][12][13]. A study conducted among menopausal Ghanaian women reported tiredness, sleeplessness, palpitations, weight gain, hot flushes, and irritability as their common symptoms [14]. ...
... Ethiopian menopausal women experienced somatic symptoms (65.9%) most prevalently, followed by psychological (46.0%), and least prevalently, urogenital symptoms (30.5%). The five most commonly reported specific symptoms were: hot flushes (65.9%), difficulty falling asleep (50.0%), depressive moods (46.0%), irritability (45.1%) and anxiety (39.8%), which is consistent with literature in other diverse populations [13,27,28]. When assessing current menopausal status and symptoms, we found that postmenopausal women experienced higher proportions of nearly every type of menopausal symptoms while perimenopausal women reported lower frequency of symptoms. ...
... The sub-Saharan population found to have menopausal articles focused in Nigeria. Our research, similar the Nigerian studies, found high proportions of self-reported bone and joint pain, hot flushes, and physical and mental exhaustion [11][12][13]27]. Nigerian women tended to report symptoms as mild with only 8.6% of participants rating symptoms as severe, which is also consistent with our severe prevalence rate [13]. ...
Background:
Menopause is a natural phenomenon occurring as women approach middle-age. It is characterized by declining of ovarian function and onset of the last menstrual period and subsequent 12-month cessation of menstruation. Due to a growing aging population and longer life expectancies, sub-Saharan African women will spend a significant portion of their lives in postmenopause. Menopausal symptom research has been primarily conducted on Caucasian women from high-income countries. Understanding menopause symptom prevalence and perceptions among diverse women in Ethiopia will better inform reproductive health care.
Methods:
We conducted a multi-stage, cross-sectional study on 226 perimenopausal and postmenopausal women aged 30-49 years in Gulele sub-city of Addis Ababa, Ethiopia. Data on socio-demographic characteristics, menopausal status and an 11-item Menopause Rating Scale (MRS) were collected using interviewer-administered questionnaire. Statistical analyses consisted of descriptive data and chi-squared analyses.
Results:
Study participants were 40.4 ± 5.9 years, on average, with the majority married, educated at secondary school level, and comprised different ethnicities and wealth tertiles. The most prevalent types of menopausal symptoms reported from the MRS were from somatic subscale (65.9%) while psychological (46.0%) and urogenital subscale symptoms (30.5%) were also prevalent. The most commonly reported individual symptoms were: hot flushes (65.9% (95% CI: 59.4%-72.1%)), difficulty falling asleep (49.6% (95% CI: 42.9%-56.3%)), depressive mood (46.0% (95% CI: 39.4%-52.8%)), irritability (45.1% (95% CI: 38.5%-51.9%)), and anxiety (39.8% (95% CI: 33.4%-46.5%)). Each of the somatic, psychological, and urogenital MRS subscale scores were higher among postmenopausal women compared to perimenopausal women. Women self-reported differing severity levels of symptoms with high severity reported in 8.4% of total MRS, 1.3% of somatic, 10.6% of psychological, and 8.4% of urogenital scales.
Conclusions:
Our study provides the first presentation of menopausal symptoms among perimenopausal and postmenopausal women in the Gulele sub-city of Addis Ababa, Ethiopia. We capture the prevalence of menopausal symptoms experienced as well as self-rated severity through the MRS. Our findings reflect menopausal symptoms in our specific study population and have been found to be consistent with previous international research.
... Until recently, researches on menopause had received little attention in the developing countries, including Nigeria. It has recently been reported that Nigerian women experience most of the common menopausal symptoms 16,17 . Although some socio-cultural factors have been reported to enable some Nigerian women with mild and moderate menopausal symptoms to cope without medical treatment, other women are also known to present with severe symptoms that require effective medical treatment 16 . ...
... It has recently been reported that Nigerian women experience most of the common menopausal symptoms 16,17 . Although some socio-cultural factors have been reported to enable some Nigerian women with mild and moderate menopausal symptoms to cope without medical treatment, other women are also known to present with severe symptoms that require effective medical treatment 16 . Unfortunately, treatment of severe menopausal symptoms in most Nigerian hospitals often consists of 'psychotherapy', analgesia and anxiolytics and rarely includes the use of HRT 18 . ...
... They suggested that the ineffective hospital-based treatment of menopausal symptoms might be one of the reasons why many Nigerian women believe that menopausal symptoms are not amenable to orthodox medical treatment. In Enugu Nigeria, women rarely present to the Gynaecologist with menopausal symptoms despite the reported high prevalence of such symptoms amongst menopausal women in the city 16 . It is not known whether this is because the women are able to cope without treatment or because they seek treatment of their symptoms from other sources. ...
To determine treatment preferences and awareness of HRT amongst Nigerian Igbo women, a two-year cross-sectional study of consecutive eligible menopausal women seen by the author in Enugu South East Nigeria was undertaken .Data for the study were obtained with the aid of researcher-administered, semi-structured questionnaires which captured the socio-demographic-data, age at menopause, menopausal symptoms experienced, treatment received for menopausal symptoms, sources of the treatment and awareness of Hormone Replacement Therapy (HRT). The common menopausal symptoms were body and joint pains (58%), hot flushes (49.8%), urinary symptoms (28.7%), insomnia (16.7%), crawling sensation (14.8) and depression (14.4%). 176 respondents (84.2%) had received some form of treatment for the menopausal symptoms while 33 (15.8%) had not. Their sources of treatments were herbal medicine practitioners 156 (74.6%), patent medicine dealers and medicine vendors 125 (59.8%), priests, pastors and prayer houses 89 (42.6%), and health care facilities (hospitals and health centres) 39 (18.7%). Only 2 (0.96%) of the women were aware of HRT and none had ever receive HRT. It is concluded that although Nigerian Igbo women experienced most known menopausal symptoms, they prefer herbal therapies for these symptoms. They have very low awareness of HRT.
... Previous studies of Nigerian women, especially in urban centers, have shown that their experience of postmenopausal symptoms is similar to other cultures [3][4][5][6][7]. However, Nigerian women rarely seek help to alleviate their symptoms. ...
... The median age of the participants at menopause was 47 ± 4.2 years. This is similar to the age at menopause found in previous studies from urban centers in Nigeria [3][4][5][6]. Lower ages have also been reported in African Americans [8] and other low-resource countries in Africa and Asia [9,10]. The median age at menopause in white women has been reported as 50 years [1]. ...
... This suggests that the majority of women had a positive attitude toward menopause. This positive attitude has been documented in urban centers [3][4][5] and may account for the low presentation of postmenopausal women seeking consultation for menopausal-related symptoms in gynecological clinics in Nigeria [7]. ...
To document women's experience of menopause in rural communities in Orlu, Eastern Nigeria, and to compare this with urban centers in Nigeria and worldwide.
A total of 349 women who had not menstruated for at least 12 months were included in a questionnaire-based study. The questionnaire included questions on sociodemographic characteristics, age at menarche and menopause, attitude to menopause, and knowledge and use of hormone replacement therapy. Questionnaires were administered in 13 communities by medical students during the Annual Convention of Christian Women in August 2009.
The mean age at menopause of the women was 47 ± 4.2 years. Menopausal symptoms were prevalent, and bone and joint pain were the most prevalent symptoms. Knowledge and use of hormone replacement therapy were poor. Most of the women considered the menopause to be beneficial.
Age at menopause and associated postmenopausal symptoms were similar to those seen in urban centers in Nigeria, but age at menopause was lower than in studies of white women. Despite the apparent positive attitude of Nigerian women to menopause, a program of information and education, and use of hormone replacement therapy will improve quality of life for women in Eastern Nigeria.
... Hence, the average Nigeria-trained physician did not consider menopausal symptoms as important health problems. Recent community-based studies [17,18] have revealed that most menopausal symptoms are indeed prevalent amongst Nigerian women. Because of cultural practices that engender positive attitude to menopause in some Nigerian com- munities [17], women with mild menopausal symptoms are able to cope with the symptoms without seeking for treatment. ...
... Recent community-based studies [17,18] have revealed that most menopausal symptoms are indeed prevalent amongst Nigerian women. Because of cultural practices that engender positive attitude to menopause in some Nigerian com- munities [17], women with mild menopausal symptoms are able to cope with the symptoms without seeking for treatment. However, women with moderate and severe menopausal symptoms consider them important health concerns and seek treatment for these symptoms. ...
... These symptoms are usually presented to the clergy, spiritualists and traditional medicine men rather than to the hospitals [18]. Nkwo et.al [17] recorded The common use of reassurance and anxiolytics for treating menopausal symptoms was probably influenced by the high prevalence of psychosomatic symptoms. It is however more likely that such treatments resulted from a common but wrong opinion held by many Nigerian doctors in the past that the typical Nigerian women do not manifest severe menopausal symptoms, hence reassurance evolved as the first line management of menopausal symptoms. ...
Effective management of menopause is an important way to improve the quality of life of the increasing number of older women. The study sought to find out if Nigerian Gynaecologists offer effective treatment for severe menopausal symptoms.
126 Nigerian Gynaecologists representing the six health zones of Nigeria were interviewed to determine the menopausal symptoms they had ever encountered in their practices, frequency of the symptoms, treatments ever offered for severe symptoms including their attitude to, and practice of hormone replacement therapy.
A Nigerian Gynaecologist encountered an average of one patient with menopausal symptoms every three months (range: 0-3 patients per month). The commoner symptoms they encountered were hot flushes (88%), insomnia (75.4%), depression (58.0%), irritability (56.3%), night sweats (55.6%) and muscle pains (54.8%) while urinary symptoms (16.7%) and fracture (1.6%) were less common. Treatments ever offered for severe symptoms were reassurance (90.5%), anxiolytics (68.3%), analgesics (14.3), HRT (7.9%), Vitamins (4%), Beta-blockers (3.2%) and Danazol (2.4%). These treatments were offered as a matter of institutional traditions rather than being based on any evidence of their efficacy.
The result revealed that most Nigerian Gynaecologists prefer reassurance and anxiolytics for managing severe menopausal symptoms instead of evidence-based effective therapies. A policy of mandatory continuing medical education for Nigerian physicians is recommended to ensure evidence-based management of gynaecological problems, including menopause.
... This brutal drop in circulating estrogen results in the development of associated pathophysiological conditions such as vasomotor instability (hot insomnia, loss of libido, depression and vagina dryness [2], genito-urinary atrophy, osteoporosis. These troubles may be so severe that they require a therapy [3]. ...
... This suggests the presence in these plants, , can induce cell proliferation and correct oophorectomy oestrogénopénia in the Wistar rats and therefore menopausal , uterotrophic effect, phytoestrogens, hot urinary atrophy, osteoporosis. These troubles may be so severe that they require a therapy [3]. Vasomotor instabilities for instance are the hallmark of estrogen nd greatly affect women's quality of life. ...
Tragia benthamii Baker (Euphorbiaceae) and Graptophyllum pictum Linn (Acanthaceae) are two Cameroonian medicinal plants traditionally used against female reproductive tract disorders, during and after the reproductive period, and as an abortifacient. Since there were no scientific data supporting the above claims and pharmacological studies characterizing their estrogenic properties, we therefore aimed to evaluate their ability to induce estrogen-like effects on primary estrogens targets, uterine, vagina and mammary gland; as well as their ability to alleviate hot flushes in ovariectomized adult rats. For this purpose, we applied a 3-day uterotrophic assay to determine the estrogenic effects of each extract and the mixture of both plants as used by traditional practitioners. The extracts were administered orally for 3 days to the 10 to 12 weeks aged ovariectomized rats. The results obtained showed that the aqueous extract of T. benthamii at the dose of 500 mg / kg BW, the aqueous extract of G. pictum at all the tested doses as well as the aqueous extract of the mixture at 275 mg / kg body weight induced a significant increase (p ˂ 0.01) of the uterine epithelium thickness. In addition, the aqueous extract of T. benthamii at the dose of 500 mg / kg BW, as well as the aqueous extract of the mixture at the doses of 50 and 275 mg / kg induced acinar development and eosinophil secretions. These results are proof of estrogen-like effects of T. benthamii and G. pictum and therefore justify the traditional use of these plants. This suggests the presence in these plants, of secondary metabolites with estrogenic properties, can induce cell proliferation, and to correct disorders of post-oophorectomy œstrogénopénia in the Wistar rats and therefore menopausal disorders.
... 18.8% of the participants adjusted well to menopause and none of the women studied revealed any serious maladjustment to the events of menopause. However, in another study by Nkwo and Onah (2008) on positive attitude to menopause and improved quality of life among Igbo women in Nigeria, reported that, some societal privileges enjoyed by menopausal women in some communities tend to modulate the expression of menopausal symptoms, they do not however eliminate them. Research examining cross-cultural symptoms suggests that menopausal experiences vary among societies and groups (Anderson et al., 2004;Dennerstein et al., 2000). ...
... Nkwo (2009), observed that in Nigeria, the widespread social inhibition and secrecy about female sexual and genital matters in most communities may be responsible for the low reporting of genital symptoms. Also, Nkwo and Onah (2008) reported that some societal privileges enjoyed by menopausal women in some communities tend to modulate the expression of these symptoms. ...
Menopause is a period of natural physiologic adaptation which occurs in women when the finite numbers of ovarian follicles are depleted due to decreased levels of reproductive hormones. This decrease in reproductive hormone levels may be mild and present with no obvious disturbances in some women while in others, severe and unbearable health and psychological challenges may demand medical intervention. This study is aimed to explore the psychological effects and health challenges of menopausal symptoms in middle aged women in a rural community of Nigeria. Utilizing a random sampling technique, one hundred and twenty middle aged women (n=120) age 40 to 55 years were recruited for the study. The descriptive survey used a semi structured questionnaire to obtain data from consenting participants. Result shows that women experience various psychological challenges: 77 (64.2%) expressed feelings of sadness and 68 (56.7%) felt easily irritated. Health challenges were hot flushes, night sweats, fatigue, low libido, dizziness, weight gain, irregular menstrual period, arthritis and heart problems. There is need for women to be educated prior to this period and health care providers should communicate optimally, support and empower middle-aged women through this period of transition.
... Our study resonates with [20], [21], reporting prevalent menopausal symptoms among participants aged 50-54. Discrepancies with [22] are acknowledged, ...
Menopause represents a pivotal developmental juncture in a woman’s life, characterized by a spectrum of physiological alterations and the potential emergence of depressive symptomatology. The manifestation of anxiety and depression during the menopausal phase is intricate and influenced by a confluence of biological, social, and psychological determinants. This study aims to assess depression and anxiety among menopausal women while elucidating their associations with various sociodemographic attributes. A cross-sectional study was executed at the Ali Kamal Consultation Center, encompassing 126 menopausal women. Data compilation utilized a structured questionnaire encompassing sections on sociodemographic particulars, menopausal symptoms, and the Hospital Anxiety and Depression Scale. Statistical analysis employing SPSS version 25 encompassed frequency and percentage along with Chi-square tests. A substantial proportion of women (72.5%) reported prevalent anxiety, with a noteworthy 74.2% exhibiting discernible signs of depression. Sociodemographic determinants, including age and age at marriage, body mass index, and marital status, exhibited robust associations with anxiety and depression. The prevalence of depression and anxiety symptoms in menopausal women underscores the imperative for targeted interventions. Sociodemographic variables emerged as pivotal determinants influencing the likelihood of developing these psychological symptoms. Notably, occupation and place of residence exhibited no statistically significant correlations.
... Tamoxifen, the most popular inhibitor, is acclaimed for significantly decreasing breast cancer recurrence and mortality rates (Davies, Pan & Godwin, 2017), though can never qualify as a cure since cancers tend to develop resistance to it overtime (Mashimo et al., 2018;Tsubaki et al., 2012). Moreover, it is reported to harm fertility (Assi et al., 2020;Nicosia, Matusridley & Meadows, 1985) and exacerbate symptoms of menopause, including hot flashes, insomnia, loss of libido, depression, and vaginal dryness (Alipour et al., 2015;Nkwo & Onah, 2008;Pinkerton, Stovall & Kightlinger, 2009). Hormone replacement therapy (HRT) has often been prescribed to address these complaints, despite being known to elevate the risk of endometrial cancer (Rossouw et al., 2002). ...
It is widely known that breast cancer cells eventually develop resistance to hormonal drugs and chemotherapies, which often compromise fertility. This study aimed to investigate the effect of the flavonoid, kaempferol‐3‐O‐apiofuranosyl‐7‐O‐rhamnopyranosyl (KARP), on 1) the viability of MCF‐7 breast cancer cells and 2) ovarian function in rats. A dose‐dependent decrease in MCF‐7 cell survival was observed, and the IC50 value was found to be 48 μg/ml. Cells in the control group or those exposed to increasing concentrations of KARP experienced a similar generation of reactive oxygen species and induction of apoptosis. For the rats, estradiol levels correlated negatively to KARP dosages, although a recovery was obtained at administration of 30 mg/kg per day. Noteworthily, when compared against the control, this dosage led to significant increases in mRNA levels for CYP19, CYP17a, CCND2, GDF9, and INSL3 among the treatment groups, and ER1 and ER2 mRNA levels decreased in a dose‐dependent manner. KARP shows great promise as an ideal therapy for breast cancer patients since it induced apoptosis and autophagy in cancerous cells without harming fertility in our animal model. Future investigations on humans are necessary to substantiate these findings and determine its efficacy as a general line of treatment.
... Menopause marks the end of the reproductive life span of women and is often associated with a variety of physiological disorders like hot flushes, depressions and body weight increase. Although such disorders are not life threatening; the social life, as well as, the productivity of the women affected might be negatively impacted [3]. In the long term, estrogen deficiency affects bone density [4] and the cardiovascular system [5]. ...
Background
Ficus umbellata is a medicinal plant previously shown to endow estrogenic properties. Its major component was isolated and characterized as 7-methoxycoumarin (MC). Noteworthy, coumarins and the respective active metabolite 7-hydroxycoumarin analogs have shown aromatase inhibitory activity, which is of particular interest in the treatment of estrogen-dependent cancers. The present work aimed at evaluating the estrogenic/antiestrogenic effects of MC in vitro and in vivo.
Methods
To do so, in vitro assays using E-screen and reporter gene were done. In vivo, a 3-day uterotrophic assay followed by a postmenopausal-like rat model to characterize MC as well as F. umbellata aqueous extract in ovariectomized Wistar rats was performed. The investigations focused on histological (vaginal and uterine epithelial height) and morphological (uterine wet weight, vagina stratification and cornification) endpoints, bone mass, biochemical parameters and lipid profile.
Results
MC induced a significant (p < 0.05) MCF-7 cell proliferation at a concentration of 0.1 μM, but did not inhibit the effect induced by estradiol in both E-screen and reporter gene assays. In vivo, MC treatment did not show an uterotrophic effect in both rat models used. However, MC (1 mg/kg) induced a significant increase (p < 0.01) of vaginal epithelial height. No significant change was observed with MC in abdominal fat weight, serum lipid levels and bone weight.
Conclusion
These results suggest that MC has a weak estrogenic activity in vitro and in vivo that accounts only in part to the estrogenicity of the whole plant extract. MC could be beneficial with regard to vagina dryness as it showed a tissue specific effect without exposing the uterus to a potential tumorigenic growth.
Electronic supplementary material
The online version of this article (doi:10.1186/s12906-017-1895-9) contains supplementary material, which is available to authorized users.
... Ande et al (2011) also stated that while menopause was considered a normal event in 97.4% of women, another 2.6% believed it was a disease condition. Also Nkwo and Onah (2008) stated that some societal privileges enjoyed by menopausal women in some communities actually helped to modulate the symptoms of menopause though not totally eliminating them. Several strategies have been employed to cope with menopause and these are under two broad headings of hormonal and non-hormonal therapy (Ewuzie, 2007 andNnodum, 2004). ...
... Because of their adverse impact on the quality of life, hot flushes are the first reason that drives menopausal women to seek medical attention (Nkwo and Onah, 2008). Given that F. umbellata extracts showed preliminary estrogenic activity, it was found necessary to test their ability to alleviate hot flushes. ...
... After menopause they were free to conduct religious duties completely, and they reported that they felt elated. Other studies on Muslim women and menopause have demonstrated that they associate menopause with cleanliness and believe that menstruation is a barrier to performing religious duties, including praying, fasting, and so forth ( Cifcili et al., 2009;Mahadeen et al., 2008;Nkwo & Onah, 2008). This highlights the pivotal role that religion occupies in the culture and life of the participants in this study. ...
This study explores the attitude and feelings toward menopause among Azeri menopausal women using hermeneutic phenomenology based on Van Manen's approach. A total of 18 menopausal women who were attended in urban health centers of Tabriz, Iran, were recruited using a purposive sampling method. Data were gathered through semistructured interviews. Each interview was transcribed verbatim and analyzed simultaneously. Data analysis led to the emergence of five main themes: positive attitude, neutral attitude, negative attitude, positive feelings, and negative feelings. Participants had different feelings and attitude. Acceptance of menopause as a natural process helps women to have a neutral attitude toward menopause.
... Menopause signals the end of reproductive activity of women. [1,2] The way this inevitable status is perceived differs in many settings and it is usually influenced by sociocultural factors, quality of information at their disposal as well as economic factors. [3] Studies have shown a wide range of opinion of women on the interpretation of menopause, associated morbidities and possible intervention to cope with the state. ...
Menopause represents the end of women reproductive career and it is at this time they begin to manifest morbidities such as urinary incontinence.
To document proximate determinants of sexual activity and urological morbidities of menopausal women.
This was a community survey conducted among 254 menopausal women Mokola in Ibadan, Nigeria in 2008. Respondents were selected using cluster sampling technique. Interviewer administered questionnaires were used to obtain information on their characteristics, pattern of urological and sexual activities. Descriptive, bivariate and multivariable tests were performed with Statistical Package for the Social Sciences 15.0 (Chicago, IL USA) and statistical significance was set at P value less than 0.05.
The mean age of subjects was 60.3 (standard deviation = 10.2 years). About 33.5% (85/254) was still sexually active. About 68% (173/254) reported a reduction in sexual frequency since menopause while 31.5% (80/254) reported no change. The mean self-rated sexual performance score was 4.3 based on a numerical scale where 10 is the maximum obtainable. Significant predictors of reduction in sexual activity were age at menopause and education. Those between 45 and 49 years were less likely than those at 55 years or more (odds ratio [OR] = 0.21; 95% confidence interval OR = 0.05-0.87) while women with at least secondary education were thrice less likely than those with none to report a reduction in sexual activity after menopause. Less than a tenth reported urinary incontinence as a complaint. Urge incontinence was the most commonly reported followed by dysuria and stress incontinence. Less than a quarter of them had requested for a form of treatment.
Sexual performance of Nigerian menopausal women is associated with age at menopause and education. Non-fistulous urinary incontinence is now being mentioned as a complaint contrary to the widely held view that it is part of the aging process. Therefore, awareness creation on management opportunities should be shared with them.
Background: The Office of National Statistics 2011 census reported 8,585600 women living in the United Kingdom (UK) between the ages of 45 and 59 years old. The natural menopause affects midlife women who have not experienced surgical or chemical interventions with the average age for menopause in the UK being 51 years. Menopause related changes are suggested to occur for
some women before their final menstrual period and can continue for a significant time after the cessation of menses. The aim of this study was to explore women's lived experience of menopause, how they made sense of their experience and to what extent experiences and perspectives were shared.
Methodology and methods: interpretative phenomenological analysis (IPA) was applied to explore the lived experiences of nine women aged 45-60 years old. Data were collected via semi structured interviews and analysis guided by the idiographic, phenomenological and hermeneutic principles of IPA.
Findings: data analysis generated eight super-ordinate themes: Physical losses, emotional losses, loss of traditional notions of feminine identity, liberation from biological restrictions, liberation from social expectations, "sisterhood": a shared female experience, making social comparisons with other women and women's knowledge. Three higher order concepts were developed encapsulating the super-ordinate themes and capturing the bio psychosocial experiences of the
women who participated in this study: Losses: “I kind of assumed that it was something that lasted for a year or two and then it went and you went back to normal” (Kate:36), Liberation: Freedom from “cultural baggage...to feel that you’re becoming yourself finally” (Kate:486) and Women’s Business: The “stuff of legend” that only can be experienced and shared by women (Rose:278).
Conclusion: findings challenge the dominant Western cultural narrative which explains menopause in terms of a transition. The language of menopause with its focus on 'symptoms', encouraged women to view and experience menopause in a negative way perpetuating Western cultural ideals situating youth as desirable and rendering older women invisible. This study offers an in-depth nuanced understanding of the complex, individualised nature of the natural
menopause for a specific group of women and how their lived experience results in a new 'normal' and an acceptance of the changing me: “You just get on with it” (Rose:347).
<br/
Introduction:
with the increase in life expectancy, women will live longer during their postmenopausal period. To improve their quality of life, they should be aware of what challenges they will be facing. This study aimed to evaluate the knowledge, attitudes and practices of middle-aged women towards menopause.
Methods:
in this cross-sectional study, data collected using a multistage clustered random sampling from 54 health centres in the Democratic Republic of Congo were used. Participants filled a questionnaire derived from the menopause rating scale and from local beliefs. The knowledge, attitudes and practices towards menopause were evaluated among pre- and postmenopausal women.
Results:
of the 353 women, both pre- and postmenopausal women knew the definition of menopause but for the symptoms, postmenopausal women were more informed than premenopausal. For the attitudes and practices towards menopause, while both had equally positive attitudes, the premenopausal women did not know which practice to adopt.
Conclusion:
Congolese women had limited knowledge, positive attitudes and unconventional practices towards menopause. Health-care providers, therefore, need to dispense appropriate advice to middle-aged women before the advent of menopause.
The role of augmented aldosterone production in pregnancy is poorly understood. Whereas some consider aldosterone secretion in pregnancy excessive, others suggest that this is a compensatory phenomenon. According to yet another view, mechanisms other than the renin-angiotensin-aldosterone system control sodium homeostasis in pregnancy. Metabolic balance studies were performed on 14 3rd trimester women. Mineralocorticoid activity was experimentally increased by administering desoxycorticosterone acetate, 9alpha-fluorocortisol acetate, or ACTH for 4-12 days. Administration of mineralocorticoid or ACTH consistently caused sodium retention. During this mineralocorticoid-induced volume expansion, aldosterone excretion decreased markedly. Natriuresis, which followed discontinuance of the drug, continued while aldosterone excretion, although greatly diminished compared to control values, was greater than that found in normal, nonpregnant individuals. This saline diuresis did not subside until aldosterone excretion returned to its previously high control values. These observations support the concept of the physiological role of increased aldosterone production in pregnancy. Results further revealed a marked dissociation between antinatriuretic and kaliuretic effects of corticoids. Potassium balance was virtually unaltered during continued mineralocorticoid or ACTH administration, despite initially high or abruptly increased sodium intakes. Finally, mineralocorticoid escape was induced by continued desoxycorticosterone acetate therapy in two male volunteers. Kaliuresis occurred which was subsequently abolished when progresterone was administered. Sodium excretion, however, was virtually unaltered. These data, mimicking results observed in gravidas, suggest that progesterone is an important determinant of potassium homeostasis in pregnant women.
In recent years, research on menopausal symptomalogy has focused on identifying symptom groupings experienced by women as they progress from premenopausal to postmenopausal status. However, most of these studies have been conducted among Caucasian women from western cultures. This leaves open the question of whether the findings from these studies can be extended to women of other racial/ethnic groups or cultures. Furthermore, many of the previous studies have been conducted on relatively small samples. This paper addresses the diversity of the menopause experience by comparing symptom reporting in a large cross-sectional survey of women aged 40–55 years among racial/ethnic groups of women in the United States (Caucasian, African-American, Chinese, Japanese, and Hispanic). Evaluation of the extent to which symptoms group together and consistently relate to menopausal status across these five samples provides evidence for or against a universal menopausal syndrome. The specific research questions addressed in this paper are: (1) How does the factor structure of symptoms among mid-aged women compare across racial/ethnic groups? (2) Is symptom reporting related to race/ethnicity or menopausal status? and (3) Does the relation between menopausal status and symptoms vary across racial/ethnic groups?
The relationship of reproductive hormones to vasomotor symptoms (VMS) has been incompletely explored, although an increase in such symptoms at midlife and their reduction with hormone therapy suggest a strong and direct relationship. Vasomotor symptoms are reported by 65-76% of women traversing the menopausal transition and are a primary reason for medical intervention during this life stage.
The purpose of this report was to relate longitudinal serum concentrations of the reproductive hormones estradiol (E2), FSH, testosterone (T), dehydroepiandrosterone sulfate (DHEAS), and SHBG and the free hormone indices free E2 index (FEI) and free T index (FTI) with the occurrence of VMS in women traversing the menopausal transition. Design and Setting: The Study of Women's Health Across the Nation is a multisite, longitudinal, cohort study of the menopausal transition being conducted in community-based groups of women.
At baseline, 3302 menstruating women who belonged to one of five ethnic/racial groups were recruited and followed up with annual visits. Frequencies of symptoms (hot flashes, night sweats) for the prior 2 wk and measures of other covariates as well as potentially confounding variables were self-reported in the annual interview. Serum was obtained annually, on d 2-5 of a spontaneous cycle in cycling women or within 90 d of the anniversary of the baseline study visit in noncycling women and assayed for FSH, E2, T, SHBG, and DHEAS. FTI and FEI were calculated. This analysis incorporated available longitudinal data from 3293 women, excluding information collected at or after first report of hormone therapy use or hysterectomy. Data were analyzed using longitudinal marginal logistic regression models and a partial proportional odds model.
After adjusting for age, body mass index, and other related covariates, VMS prevalence increased with higher (log)FSH concentrations, and the increase was greater when blood was drawn more than 5 d after menses began. FSH concentrations were positively associated with the frequency of either hot flashes or night sweats, and higher FSH concentrations were associated with greater odds of reporting more frequent symptoms. Vasomotor symptom prevalence decreased with higher (log)E2, (sqrt)SHBG, and (log)FEI but only when these hormone values were modeled independently of (log)FSH values and the specimens were obtained outside the d 2-5 window. When modeled simultaneously with (log)FSH, (log)E2, (sqrt)SHBG, and (log)FEI were no longer significantly associated with symptom prevalence. (Cubic root)T and (sqrt)DHEAS concentrations and (log)FTI were not associated with the prevalence of VMS.
Annual serum FSH concentrations, but not E2, T, DHEAS, FTI, or FEI when collectively modeled longitudinally, are associated with both the prevalence and frequency of VMS in women at midlife.
metabolic alkalosis, hyperprostaglandin E syndrome, hypokalemia, hypomagnesemia, hypocalciuria, nephrocalcinosis
A number of recent epidemiological findings have implicated magnesium as being essential to fetal well-being. Few studies, however, have examined the relationship between maternal requirements for dietary magnesium and subsequent mortality and morbidity in offspring. The present study uses a rodent model of dietary-induced hypomagnesemia to investigate the effects of magnesium deficiency prior to and during gestation on neonatal morbidity and mortality. Magnesium deficiency during gestation significantly increased neonatal mortality and morbidity. Such increases were associated with a reduced free magnesium concentration in both maternal and offspring blood and an increased incidence of periventricular hemorrhage and edema in newborn pups as observed by magnetic resonance imaging and histology. Animals fed a magnesium-deficient diet before mating but given magnesium supplementation during gestation did not demonstrate a significant change in neonatal mortality and morbidity when compared to control animals. The significant improvement in fetal outcome with dietary magnesium supports the concept of magnesium supplementation during pregnancy.
Attitudes have a potential role to play in the experience of menopause. The objective of this study was to examine the degree to which attitudes toward menopause and aging vary across ethnic groups and menopausal status (ie, premenopausal through postmenopausal).
More than 16,000 women were interviewed by telephone as part of the Study of Women's Health Across the Nation. They represented five ethnic/racial groups (African American, white, Chinese American, Japanese American, and Hispanic) from seven geographical sites (Boston, MA; Pittsburgh, PA; Chicago, IL; Michigan; New Jersey; and northern and southern California).
African American women were significantly more positive in attitude. The least positive groups were the less acculturated Chinese American and Japanese American women. Menopausal status was not a consistent predictor of attitude across ethnic groups.
In general, women's attitudes toward menopause range from neutral to positive. Ethnic groups within the United States vary slightly, but reliably, in their attitudes toward menopause and aging. Factors other than those directly associated with menopausal status seem to play a role in attitude.
/$ -see front matter © 2008 International Federation of Gynecology and Obstetrics
/$ -see front matter © 2008 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ijgo.2008.05.006