Modified Kupperman Index Research Articles

The effect of Hypericum perforatum on postmenopausal symptoms and depression: A randomized controlled trial

ObjectivesHypericum perforatum (St John's wort) is an herbal plant that has antidepressant activity and contains ingredients such as flavonols derivatives, bioflavonoids, proanthocyanidins, xanthones, phloroglucinol, and naphthodianthrones. This study was aimed to test the effect of Hypericum perforatum on hot flashes, menopausal symptoms, and depression in postmenopausal women. Design & settingThis randomized controlled study was conducted on 80 postmenopausal women aged 45–60 in Izeh, Iran. InterventionTwo groups received 270–330 μg of H. perforatum (n = 40) or placebo (n = 40) tablets three times a day for two months. Main outcomesData were collected using a socio-demographic questionnaire, the modified Kupperman index before the intervention and 2, 4, 6 and 8 weeks after intervention. The Hamilton Depression Rating Scale was used to gather data before the intervention and in the 8th week of intervention. The data were analyzed using an independent t-test, chi-square test, and repeated measure test. ResultsSeventy women completed the study and five women from each group withdrew the study. The frequency and intensity of hot flashes and the score of Kupperman scale significantly decreased in the H. perforatum group compared to the control group (p < 0.001). In addition, the intensity of depression significantly decreased in the H. perforatum group compared to the control group. At the end of the study, 80% of women in the intervention group did not have depression compared to only 5.7% in the control group (p < 0.001). ConclusionTreatment with Hypericum perforatum is an efficient way of reducing hot flashes, menopausal symptoms, and depression in postmenopausal women.

Factors associated with the quality of life in women with perimenopausal and postmenopausal status: a cross-sectional questionnaire survey from China

Background: Many factors may influence the quality of life (QOL) of women with perimenopausal and postmenopausal status; however, systematic research is lacking. The purpose of the current study was to determine factors associated with specific dimensions of the QOL for perimenopausal and postmenopausal Chinese women. Materials and Methods: A cross-sectional study was performed and initially included 403 women aged 36-76 years who visited the menopause clinic at Peking University First Hospital between September 2012 and December 2013. Participants completed the modified Kupperman index (mKMI), overactive bladder symptom score (OABSS), and SF-36 (QOL) questionnaires. Single factor logistic regression and multiple binary logistic regression were performed to evaluate the risk factors for low QOL for perimenopausal and postmenopausal women. Results: A total of 320 women were included in the final study sample. The average age was 52.55±5.96 years, average height was 159.99±5.70 cm, the average weight was 61.37±8.47 kg, the average BMI was 23.91±3.14kg/m2, the average total score of QOL was 492.51±145.35, the average score of mKMI was 21.72±9.79, and the average score of OABSS was 2.13±2.313. Multiple logistic regression analysis showed current smoking [OR=10.132, 95%CI (1.142, 89.882), p = 0.038], mKMI [OR=9.151, 95%CI (1.996, 41.957), p = 0.004], passive attitude towards menopause [OR=3.465, 95%CI (1.878, 6.392), p = 0.000], and OABSS (OR=2.410, 95%CI (1.253, 4.636), p = 0.008] showed statistical significance towards total score of QOL. Multiple logistic regression analysis towards different dimension of QOL: factors associated with physical functioning (PF) are age, current smoking, mKMI, and OABSS. Factors associated with physical role (PR) are low frequency of sexual intercourse in the last six months, mKMI, passive attitude towards menopause, dancing, and OABSS. Factors associated with bodily pain (BP) are height, and traditional Chinese medicine (TCM) relieving menopause symptoms. Factors associated with general health (GH) are height, TCM relieving, mKMI, and passive attitude towards menopause. Factors associated with vitality (VT) are living with husband, mKMI, and passive attitude towards menopause. Factors associated with social functioning (SF) are mKMI, passive attitude towards menopause, and OABSS. Factors associated with emotional (ER) are passive smoking, low frequency of sexual intercourse in the last six months, mKMI, passive attitude towards menopause, and OABSS, Factors associated with mental health (MH) are mKMI, passive attitude, and OABSS. Linear-regression showed the different combination of relieving methods of perimenopausal symptoms, complications, relatives, and various exercises have different effects on the each dimension of QOL. Conclusion: Current smoking, mKMI, passive attitude towards menopause, and OABSS are risk factors towards the total QOL score for perimenopausal and postmenopausal Chinese women. Age, low frequency of sexual intercourse in the last six months, using TCM to relieve menopause symptoms, and passive smoking are risk factors towards some dimensions of the QOL for women during this period of life. Dancing, height, and living with husband are protective factors towards some dimensions of the QOL. Fully exploring the factors affecting women during this special period can help make more precise and effective treatments that may improve the QOL.

Prospective and retrospective study of weekly intermittent hormone (estrogen and progesterone) replacement therapy in hysterectomised women

Background: Estrogen therapy in younger postmenopausal women is associated with a decisive reduction in morbidity and mortality, but estrogen use in this population is low because of risk of side effects. Weekly intermittent therapy is a more patient friendly approach with reduced pill burden increasing compliance and adherence as well as reducing side effects. Therefore, authors wanted to study the effect of weekly intermittent fixed dose estrogen and progesterone (ultra-low dose) supplements in hysterectomised surgically menopaused women.Methods: The present study was prospective and retrospective study. For retrospective study authors records of 100 hysterectomised women up to 45years of age with severe post-menopausal symptoms treated in authors Medicine Department of Hospital with once weekly MALA-D tablets were studied. For prospective study, all consecutive hysterectomised patients with severe post-menopausal symptoms attending medicine OPD were given once weekly MALA-D which contains ethinylestradiol 0.03mg and levonorgestrel 0.15mg tablets and followed up monthly with outcomes measured by Modified Kuppermann Index, visual analogue scale, and women’s health questionnaires.Results: Present retrospective study showed moderate degree of postmenopausal symptoms as indicated by Modified Kuppermann index of 19.57. Prospective study showed significant improvement in postmenopausal symptoms with weekly intermittent hormone replacement therapy as indicated by outcomes measured by Modified Kupperman index and Visual analogue scale. Women’s health questionnaire also showed statistically significant improvement in 6 out of 8 dimensions.Conclusions: Authors concluded that weekly estrogen progesterone hormone replacement therapy with mala-D tablet (ultra-low dose therapy) was 100% effective in relieving vasomotor symptoms and it is very effective in improving psychosomatic symptoms, urinary symptoms and quality of life with no obvious side effects and greater adherence.

Effects of Ziyin Jianghuo Ningxin decoction plus dehydroepiandrosterone and femoston in treatment of patients with menopausal symptoms

OBJECTIVETo determine the therapeutic effect of Ziyin Jianghuo Ningxin Decoction (ZYJHNXD) plus dehydroepiandrosterone (DHEA) and menopausal hormone therapy (MHT) in patients suffering from menopausal symptoms identified as, in terms of Traditional Chinese Medicine, symptom pattern of Yin deficiency with hyperactive fire. METHODSTotally 180 postmenopausal women aged 40 to 60 years were assigned into four groups and accepted femoston, femoston with ZYJHNXD, femoston with DHEA, femoston with ZYJHNXD and DHEA therapies, respectively, for three months. Common questionnaire-based measure instruments included modified Kupperman index (MKI), Hamilton Rating Scale for Anxiety (HAMA), and Hamilton Rating Scale for Depression (HAMD). Follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), 5-hydroxyindole-3-acetic acid (5-HIAA), norepinephrine (NE), dopamine (DA), bone mineral density (BMD), and sleep quality were evaluated before and three months after the treatments. RESULTSIn all four groups, the scores of MKI, HAMA, HAMD and the levels of FSH, LH decreased significantly (P < 0.05) after the treatment, while the levels of E2, 5-HIAA, NE, and DA showed obvious elevation (P < 0.05). The group receiving ZYJHNXD and DHEA combined with femoston had superiority in the preservation of bone mineral density and improvement of total sleep time and nighttime sleep time over the other three groups. CONCLUSIONZYJHNXD and DHEA combined with MHT therapy have a favorable outcome in managing menopausal symptoms, restoring hormone levels, preventing skeletal rarefaction or osteoporosis, and improving sleep quality for postmenopausal women.

Neural Correlates of Mental Rotation Relate to Fluid Intelligence

To determine the therapeutic effect of Ziyin Jianghuo Ningxin Decoction (ZYJHNXD) plus dehydroepiandrosterone (DHEA) and menopausal hormone therapy (MHT) in patients suffering from menopausal symptoms identified as, in terms of Traditional Chinese Medicine, symptom pattern of Yin deficiency with hyperactive fire.Totally 180 postmenopausal women aged 40 to 60 years were assigned into four groups and accepted femoston, femoston with ZYJHNXD, femoston with DHEA, femoston with ZYJHNXD and DHEA therapies, respectively, for three months. Common questionnaire-based measure instruments included modified Kupperman index (MKI), Hamilton Rating Scale for Anxiety (HAMA), and Hamilton Rating Scale for Depression (HAMD). Follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), 5-hydroxyindole-3-acetic acid (5-HIAA), norepinephrine (NE), dopamine (DA), bone mineral density (BMD), and sleep quality were evaluated before and three months after the treatments.In all four groups, the scores of MKI, HAMA, HAMD and the levels of FSH, LH decreased significantly (P < 0.05) after the treatment, while the levels of E2, 5-HIAA, NE, and DA showed obvious elevation (P < 0.05). The group receiving ZYJHNXD and DHEA combined with femoston had superiority in the preservation of bone mineral density and improvement of total sleep time and nighttime sleep time over the other three groups.ZYJHNXD and DHEA combined with MHT therapy have a favorable outcome in managing menopausal symptoms, restoring hormone levels, preventing skeletal rarefaction or osteoporosis, and improving sleep quality for postmenopausal women.

Effect of Vitamin E Supplementation on Plasma Nitric Oxide in Menopausal Women with Hot Flashes: A Cross-Over, Randomized Clinical Trial

Background: Vitamin E serves a major role in increasing nitric oxide (NO) and reducing lipoperoxidation progression during the menopause transition. Objectives: This study aimed to determine the effect of Vitamin E on plasma nitric oxide in menopausal women with hot flashes (HFs). Methods: In this double-blind, randomized, cross-over clinical trial performed in a teaching hospital, 83 eligible menopausal women with HFs were randomly block allocated to Vitamin E (n = 42) and placebo (n = 41) groups. In phase I of the intervention, they were administered 400 IU per day of Vitamin E or placebo for 4- weeks. In the phase II, the group receiving Vitamin E was subsequently given placebo and vice versa after wash-out. Primary outcomes were the number and severity of hot flashes per day as determined by the recorded values by the women and using Modified Kupperman Index, respectively. The secondary outcome was plasma nitric oxide measured before and after the intervention in the two phases. Both outcomes were analyzed within and between placebo-vitamin E (P-E) and Vitamin E-placebo (E-P) groups, and in general by gathering Vitamin E and placebo groups in the two phases, separately. Data were analyzed using the Chi-Square test, independent t-test, Wilcoxon test, Mann-Whitney test, and Spearman’s correlation coefficient. Results: The mean number of HFs indicated a significant decreasing trend from week II of the phase I to the end of the phase II within P-E and E-P groups compared to before the intervention. Median (interquartile range [IQR]) of HFs number changes was 2.03 (2.57) in the P-E group and 1.21 (2.21) in the E-P group at the end of the first week of phase II (P = 0.043). There was a very low significant positive correlation between changes in HFs and plasma nitric oxide level in weeks I (r = 0.262, P = 0.029) and ΙΙ (r = 0.256, P = 0.034) in the Vitamin E group. Conclusions: Vitamin E and placebo were both effective in reducing HFs in menopausal women. It seems that the subjective effect of placebo contributed to this decline. Vitamin E had no effect on reducing HFs via increasing plasma level of nitric oxide. These results were not in line with our hypothesis. Further research is needed to understand this issue.

Impact of multidisciplinary collaborative pharmaceutical care on knowledge, adherence, and efficacy of hormone therapy in climacteric women.

BackgroundThe objective of this study was to evaluate the impact of pharmaceutical care on the knowledge, adherence, and efficacy of hormone therapy in climacteric women participated in multidisciplinary collaborative clinic, launched by Peking University First Hospital (Beijing, People’s Republic of China) in 2012.MethodsA total of 296 patients were recruited (intervention group n=150, control group n=146). The patients in the intervention group visited the multidisciplinary collaborative clinic for their initial hormone therapy, receiving individualized pharmaceutical care (PC), whereas the control group visited only the general clinic without PC. The pill count method, knowledge assessment questionnaire (Cronbach’s α=0.80), and the modified Kupperman Index were used to assess the knowledge, adherence, and efficacy at months 3, 6, and 12.ResultsThe intervention group, which received PC, showed significantly higher and better knowledge, adherence, and efficacy than the control group, demonstrating the effectiveness of the PC provided. The knowledge scores of the intervention and control groups at months 3, 6, and 12 were (73.12 vs 59.28), (77.63 vs 66.19), and (80.81 vs 66.64); the data for adherence were (90.97% vs 82.17%), (93.21% vs 87.79%), and (95.81% vs 93.38%); and the values of the modified Kupperman Index were (17.15 vs 24.05), (13.22 vs 22.01), and (12.21 vs 23.15), respectively.ConclusionPC improved the knowledge, adherence, and efficacy of hormone therapy in climacteric women. Therefore, the multidisciplinary collaborative model investigated in our study should be advocated in other health care institutions for the benefit of more patients. Further large-sample and long-term studies should be conducted to evaluate the effects of PC on patient clinical outcomes, including its impact on the safety and efficacy of long-term use of hormone therapy, as well as the economic benefits.

Treatment of Menopausal Syndrome by Combined Electroacupuncture, Acupoint-injection and Fire-needle Therapies

To observe the clinical efficacy of joint application of electroacupuncture (EA), acupointinjection and fire-needle in the treatment of menopausal syndrome (MS) women. One hundred MS patients were randomized into control group and combined treatment group (n=50 patients in each). The combined treatment group was treated by joint application of EA, acupoint-injection and fire-needle stimulation, and the control group treated by EA stimulation alone. EA was applied to Shenshu (BL 23), Xinshu (BL15), Taixi (KI 3), Sanyinjiao (SP 6), Laogong (PC 8), Pishu (BL 20), etc., for 30 min, once daily for 10 days. Point-injection of red ginseng-ophiopogon root injection (0.5 mL) or red-hot needle stimulation was applied to bilateral BL15, BL 20, SP 6 and BL 23 once daily for 10 days and once every other day for 5 times, respectively. The modified Kupperman index scale was used to evaluate symptoms (hot flashes and night sweats: 4 points; paresthesia, insomnia, dyspareunia, irritability and problems of urinary system: 2 point each; depression, dizziness, fatigue, joint pain or muscular pain, headache, palpitation, skin formication: 1 point each) of the perimenopausal syndrome, and 3 months' follow-up survey was conducted after the treatment. Each symptom score was calculated as the product of the symptom severity score (0, no; 1, mild; 2, moderate; 3, severe) multiplied by the points of symptom index. The total Kupperman score was the sum of the scores of all the items. The therapeutic effect was also evaluated according to the "Guiding Principles for Clinical Trials of New Drugs of Chinese Materia Medica" (2002). The Kupperman scores were significantly decreased following the 10 days' treatment and 3 months thereafter in both control and combined treatment groups in comparison with their individual pretreatment (P<0.05), and were obviously lower in the combined treatment group than in the control group after treatment (P<0.05). Of the both 50 patients in the control and combined treatment groups, 22(44%) and 35 (70%) experienced a remarkably improvement, 18(36%) and 12(24%) were effective, and 10(20%) and 3 (6%) ineffective, with the total effective rates being 80% and 94%, respectively. The therapeutic effect of the combined treatment group was notably superior to that of the control group (P<0.05). The joint application of electroacupuncture (EA), acupoint-injection and fire needle is significantly superior to that of simple EA in improving the symptoms of patients with menopausal syndrome.

Randomized, Double-Blind, Placebo-Controlled Study of Modified Erzhi Granules in the Treatment of Menopause-Related Vulvovaginal Atrophy.

Objective To evaluate the clinical therapeutic efficacy and safety of modified Erzhi granules (MEG) in patients with menopause-related vulvovaginal atrophy (VVA). Methods This randomized, double-blind, placebo-controlled study comprised two groups, including the treatment and control groups. Patients receive MEG and placebo for 12 weeks, respectively. Vaginal health score (VHS), vaginitis score, vaginal maturation index (VMI), female sexual function index (FSFI), and modified Kupperman Index (modified KI) were used as efficacy endpoints and assessed at baseline, 4, 8, and 12 weeks during administration, and 4 weeks after drug withdrawal. At baseline and 12 weeks, serum estradiol (E2), follicle stimulating hormone (FSH), pelvic ultrasound, breast ultrasound, and other safety parameters were measured, recording adverse events. Results At 12 weeks, VHS, percentage of superficial cells in the vaginal epithelium and FSFI were significantly increased, while vaginitis score, percentage of basal cells in the vaginal epithelium, and modified KI were significantly decreased in comparison with baseline and control group (all P<0.05); these differences persisted for up to 4 weeks after drug withdrawal. The placebo group showed no significant change during treatment compared with baseline values (p>0.05). Serum E2 and FSH levels, endometrial thickness, and breast thickness in all patients were within the normal ranges before and after treatment, with no serious adverse reactions observed. Conclusion MEG significantly alleviates menopause-related vulvovaginal atrophy, with no overt adverse effects on the endometrium, breast, hepatic, and renal functions.

Association between pulse wave velocity and hot flashes/sweats in middle-aged women

As women age and go through menopause, they suffer a higher incidence of cardiovascular morbidity and mortality. Previous studies have shown that a relationship exists between hot flashes/sweats and an increased risk of cardiovascular disease. However, the association between hot flashes/sweats and arterial stiffness is unclear. We aim to explore the relationship between hot flashes/sweats and arterial stiffness using the modified Kupperman index (KMI) questionnaire and measure the brachial-ankle pulse wave velocity (baPWV). The prevalence of hot flashes in our research was reported to be 41.77%. There was a statistically significant difference between the mean baPWV among groups that experienced different severities of hot flashes/sweats according to one-way ANOVA test (p < 0.001). The baPWV values were positively associated with the severity of hot flashes/sweats based on linear regression after adjusting for established cardiovascular confounders (95% CI: (5.86, 43.23), p = 0.01). To the best of our knowledge, this study is the first investigation to propose that baPWV may serve both as an objective index for evaluating the severity of hot flashes/sweats and as a predictor of arterial stiffness beyond Cardiac Vascular Disease (CVD) risk factors in middle-aged women.

Effect of Gua sha therapy on perimenopausal syndrome: a randomized controlled trial.

This study aims to evaluate the effectiveness and safety of Gua sha therapy on perimenopausal symptoms, quality of life, and serum female hormones in participants with perimenopausal syndrome. A prospective, randomized, controlled clinical trial was conducted at the First Affiliated Hospital of Nanjing University of Chinese Medicine in China. Eighty women with perimenopausal syndrome were recruited and randomized into an intervention group or a control group. Participants in the intervention group received 15-minute Gua sha treatment sessions once a week plus conventional treatment for 8 weeks, whereas participants in the control group received conventional treatment alone. The primary outcome was the change in perimenopausal symptoms and quality of life as obtained through the modified Kupperman Index (KI) and the Menopause-Specific Quality of Life. The secondary outcome was the change of serum female hormones including estrogen, follicle-stimulating hormone, and luteinizing hormone. Seventy-five out of 80 participants (93.8%) completed the study-38 in the intervention group and 37 in the control group. The baseline levels of demographic and outcome measurements were comparable between the two groups. After eight sessions of intervention, the reduction in the total modified KI score was, however, 16.32 ± 4.38 in the intervention group and 11.46 ± 5.96 in the control group, with a difference of 4.86 ± 6.15 (P < 0.01) between the two groups. Also the reductions of hot flash/sweating, paresthesia, insomnia, nervousness, melancholia, fatigue, and headache were greater in the intervention group than in the control group (P < 0.05). The reduction in the total Menopause-Specific Quality of Life score was 17.87 ± 3.84 in the intervention group and 13.62 ± 7.40 in the control group, with a difference of 4.46 ± 7.52 (P < 0.01) between the two groups. And the scores for vasomotor, psychosocial, and physical domains in the intervention group were significantly lower than those in the control group (P < 0.05). There were no significant differences in serum estrogen, follicle-stimulating hormone, and luteinizing hormone between the two groups. The results of this study suggest that Gua sha therapy was effective and safe in relieving perimenopausal symptoms and improving the quality of life in participants with perimenopausal syndrome. The therapy may serve as a promising, effective, nondrug treatment for perimenopausal syndrome in clinical work. Additional research is needed to better understand its effectiveness and examine its mechanism for treating perimenopausal syndrome.

Effects of nutraceuticals on quality of life and sexual function of perimenopausal women.

The aim of the study was to evaluate the effects of nutraceuticals containing Equol, Resveratrol, Quecitine and Passiflora (Zemiar®, Avantgarde, Pomezia, Rome, Italy) on quality of life (QoL) and sexual function in perimenopausal women. Sixty perimenopausal women having vasomotor symptoms and being in the -1, +1a of the STRAW system (amenorrhea for longer than 60days and FSH<20 UI/L) were enrolled. The modified Kupperman Index (KI) was used to evaluate menopause symptoms. The Short Form-36 (SF-36), Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) were used to assess QoL, sexual function and sexual distress, respectively. The study had two follow-ups at 3 and 6months. The women reported an improvement in the KI total score from the baseline (35±4) to the 1st (21±3, p<0.05) and the 2nd (18±2, p<0.01) follow-ups. At the 1st follow-up, the women reported QoL improvements in some functions (p<0.05); at the 2nd follow-up, they reported improvements in all categories (p<0.001). At baseline, the total FSFI score was 23.1±1.2 and the FSDS score was 18.1±1.4, both indicating sexual dysfunction with sexual distress. FSFI and FSDS total scores did not change at the 1st follow-up (p=NS). On the contrary, at the 2nd follow-up, the FSFI score had risen to (27.6±1.5) (p<0.001) and the FSDS score had dropped to (11.3±1.2) (p<0.001). Nutraceuticals can be effective in modulating the perimenopausal symptoms in women. The progressive reduction of the vasomotor symptoms reported by women over the nutraceutical usage could contribute to improve their QoL and sexual life.

Menopausal Symptoms and Sleep Quality During Menopausal Transition and Postmenopause.

Background:Menopausal symptoms and sleep difficulty were physiological processes that were affected by genetic and other factors. This study was to investigate the prevalence of menopausal symptoms and sleep quality in menopausal transition (MT) and postmenopause (PM) women in Taiyuan, Shanxi.Methods:A community-based survey of women's menopausal symptoms and sleep quality was conducted between July 2012 and May 2013 at six municipal districts of Taiyuan, Shanxi. A sample of 2429 women aged 40–59 years was divided into four groups: early MT, late MT, early PM, and late PM. Sleep quality in the past 2 weeks before the interview was recorded. The data were analyzed using SPSS 16.0.Results:The prevalence of menopausal symptoms was 49.8%. Mild, moderate, and severe symptoms were observed in 28.9%, 18.5%, and 2.5% of participants, respectively. The highest prevalence of menopausal symptoms occurred in the early postmenopausal stage; the subsequences were the late postmenopausal stage and the early MT stage. Interestingly, among the 13 items of modified Kupperman index, the five most common symptoms were fatigue, arthralgia and myalgia, decreased libido, insomnia, and nervousness. Meanwhile, 55% perimenopausal women had poor sleep.Conclusions:Menopausal symptoms are common but mild among women in Taiyuan, Shanxi during MT and PM. In these stages, the prevalence of poor sleep is high.

Poor sleep in middle-aged women is not associated with menopause per se.

Whether sleep problems of menopausal women are associated with vasomotor symptoms and/or changes in estrogen levels associated with menopause or age-related changes in sleep architecture is unclear. This study aimed to determine if poor sleep in middle-aged women is correlated with menopause. This study recruited women seeking care for the first time at the menopause outpatient department of our hospital. Inclusion criteria were an age ≥40 years, not taking any medications for menopausal symptoms, and no sleeping problems or depression. Patients were assessed with the Pittsburgh Sleep Quality Index (PSQI), modified Kupperman Index (KI), and Menopause Rating Scale (MRS). A PSQI score of <7 indicated no sleep disorder and ≥7 indicated a sleep disorder. Blood specimens were analyzed for follicle-stimulating hormone and estradiol levels. A total of 244 women were included in the study; 103 (42.2%) were identified as having a sleep disorder and 141 as not having one. In addition, 156 (64%) women were postmenopausal and 88 (36%) were not menopausal. Follicle-stimulating hormone and estradiol levels were similar between the groups. Patients with a sleep disorder had a significantly higher total modified KI score and total MRS score (both, P<0.001) compared with those without a sleep disorder. Correlations of the PSQI total score with the KI and MRS were similar in menopausal and non-menopausal women. These results do not support that menopause per se specifically contributes to sleep problems.

ZHI-BAI-DI-HUANG-WAN, A CLASSIC CHINESE MEDICINAL FORMULA IN RELIEVING MENOPAUSAL SYMPTOMS: A MULTI-CENTRE AND CONTROLLED TRIAL FROM UK AND CHINA

Objective: To explore the effects of Zhi-Bai-Di-Huang-Wan (ZBDHW), a classic formula of Chinese medicinal herbs in relieving menopausal symptoms in British and Chinese women.&#x0D; Patients and Methods: Between May 2011 and May 2013, 224 Chinese and British women were divided into a ZBDHW group with 115 cases and a control group with 109 cases. The clinical menopausal symptoms were assessed by the modified Kupperman Index Scale. The serum levels of follicle stimulating hormone (FSH) and estradiol (E2) were respectively detected before and after the treatment. &#x0D; Results: After 12 weeks of treatment, both groups’ Kupperman index scores markedly decreased (P0.05). The serum levels of FSH did not change significantly after the treatment (P&gt;0.05) and no significant difference existed between them (P&gt;0.05). The serum levels of E2 significantly increased in both of the two groups (P

Association between Menopausal Symptoms and Overactive Bladder: A Cross-Sectional Questionnaire Survey in China.

PurposeThe association between menopause and overactive bladder is controversial. The purpose of this study was to determine the association between menopausal symptoms and overactive bladder, and identify the risk factors for overactive bladder.MethodsA cross-sectional study was performed. The study included 403 women aged 36–76 years who visited the menopause clinic at Peking University First Hospital between September 2012 and December 2013. The overactive bladder symptom score and modified Kupperman index questionnaires were used. Differences were assessed using descriptive statistics to determine any association between the overactive bladder symptom score and modified Kupperman index score, and to evaluate the risk factors for overactive bladder.ResultsA total of 304 women were finally enrolled. The prevalence of overactive bladder was 9.43%, and the modified Kupperman index score; number of sexual problems; and frequency of urinary tract infections, vertigo, melancholia, and mood swings were significantly higher in patients with overactive bladder than in the patients without overactive bladder (p < 0.05). Menopausal symptoms (modified Kupperman index score ≥ 15) (odds ratio: 1.049, 95% confidence interval: 1.006–1.095, p = 0.025) and a low frequency of sexual intercourse in the last 6 months (odds ratio: 2.580, 95% confidence interval: 1.228–5.422, p = 0.012) were identified as independent risk factors for overactive bladder. The frequency of sexual intercourse was found to decrease with an increase in the severity of overactive bladder (p = 0.004, linear-by-linear association = 0.001).ConclusionMenopausal symptoms may be closely associated with overactive bladder, and sexual activity may be associated with the severity of overactive bladder. Moreover, sexual problems, urinary tract infections, vertigo, melancholia, and mood swings may be associated with overactive bladder.

An analysis of the main reasons that perimenopausal and postmenopausal women in China have for seeking outpatient treatment and factors influencing their symptoms: a single-center survey

To explore the main reasons that perimenopausal and postmenopausal women have for seeking treatment and factors influencing their symptoms in order to provide (peri-) menopausal women with better healthcare treatments.Interviews were conducted with 357 (peri-) menopausal women who sought outpatient treatment at The Sixth People's Hospital, Shanghai Jiaotong University from July 1, 2010 to March 31, 2012. The survey includes general questions and an evaluation of (peri-) menopausal symptoms using the modified Kupperman index score.The average age of the women who took part in the study was 51.47 years old (standard deviation = 5.18). Of the women, 47.6% were perimenopausal, 34.7% were early postmenopausal, and 17.7% were late postmenopausal. The age of natural menopause was between 39 and 56 years, and the average natural menopause age was 49.3 years (standard deviation = 4.0). The incidence of (peri-) menopausal symptoms was 91%. Age, education level, and chronic diseases were associated with menopausal symptoms. The main reasons for seeking treatment were hot flushes, insomnia, bone and joint pains, mood swings, and palpitations.The main reasons for Chinese (peri-) menopausal women seeking treatment were hot flushes, insomnia, bone and joint pains, mood swings, and palpitations; age, education level, and chronic diseases are the main factors that influencing the (peri-) menopausal symptoms.

Frequency-risk and duration-risk relations between second-hand smoke exposure and menopausal symptoms among middle-aged women in Guangzhou, China

Objective Tobacco smoking and menopausal symptoms are strongly associated, but the possible effects of second-hand smoke (SHS) have not been evaluated. This study aimed to explore the possible frequency-risk and duration-risk relations between SHS exposure and menopausal symptoms among non-smoking, middle-aged women.Methods A cross-sectional survey was conducted in Guangzhou, China using a stratified three-stage sampling method. Menopausal symptoms were measured by the modified Kupperman Index with a cut-off point of 7. The frequency-risk and duration-risk relations between SHS exposure and menopausal symptoms were examined using logistic regression models.Results Compared with non-exposure, SHS exposure was associated with increased menopausal symptoms (odds ratio (OR) = 1.69, 95% confidence interval (CI) 1.22–2.33 for exposure in any of the venues). The trend analysis showed that there were frequency-risk (OR = 1.43 for occasional exposure; OR = 2.30 for regular exposure; p for linear trend < 0.001) and duration-risk (OR = 1.09 for 1–15 years; OR = 1.99 for > 15 years; p for linear trend < 0.001) relations. When examining the frequency-risk and duration-risk relations by source of exposure (in homes or in workplaces), there was still evidence of increasing trend for risk of menopausal symptoms.Conclusions Findings from the present study suggest that SHS exposure is positively associated with menopausal symptoms in middle-aged women in a dose–response manner and highlight the need for further research to establish the mechanisms of the association.

Sleep disturbance and correlates in menopausal women in Shanghai

ObjectiveThe aim of this study was to investigate the sleep disturbance and its correlates in Chinese middle-aged women. MethodsA total of 2046 Chinese women 40–60years of age were recruited in this cross-sectional descriptive study. The subjects were surveyed using the Pittsburgh Sleep Quality Index (PSQI), the modified Kupperman Index (KI), and a general questionnaire to obtain sociodemographic data. Data were analyzed using SPSS 20.0 software. ResultsIn this study, the mean (standard deviation) age of the participants was 51.69 (6.54) years and the mean PSQI score was 6.88 (3.20). The prevalence of sleep disturbance was 33.2% (a PSQI global score ≥8). The prevalence of sleep disturbance was higher in women with a menopausal status (from 34.8% in premenopausal women to 40.9% in postmenopausal women, P<.001) and in women with an increased age (from 21.7% in women 40–44years of age to 41.8% in women 55–60years of age, P<.001). Vasomotor symptoms (classical menopausal symptoms, VMS) were associated with sleep disturbance. An increase in the severity of menopausal symptoms (higher total KI scores) was observed in women who experienced sleep disturbance. A logistic regression analysis revealed that menopausal status, vasomotor symptoms, modified KI scores, a history of disease, and older age (≥50years) were significant risk factors for sleep disturbance. ConclusionsSleep disturbance was highly prevalent in this large sample of middle-aged Chinese women. Therefore, clinicians should pay more attention to sleep problems in middle-aged Chinese women and measures should be taken to improve the quality of sleep in these women.

Survey on characteristics of menopause of Chinese women with the age of 40-60 years at gynecological clinic from 14 hospitals

To investigate the characteristics of menopause of Chinese women with the age of 40-60 years concerning gynecologic clinics in China. From Mar.2008 to Sept.2008, a face-to-face questionnaire was conducted in gynecological clinic in perimenopausal and postmenopausal women in 14 hospitals in China, which included general demographic data, menstrual change process, climacteric symptoms and knowledge about menopause. Modified Kupperman index were used to evaluate climacteric symptoms during the recent week and awareness of hormonal replacement therapy were studied. A total of 1641 women were investigated. The ages of onset of menopause transition, climacteric symptoms and natural menopause were (47 ± 4), (46 ± 4), (49 ± 3) years old respectively. Climacteric symptoms could be found in 78.43% (1287/1641) women during menopausal transition, which were mainly mild to moderate symptoms. The top 5 symptoms were fatigue and weakness (71.48%, 1173/1641), irritability (68.68%, 1127/1641), insomnia (67.65%, 1110/1641), muscle and joint pain (64.11%, 1052/1641) and hot flush (57.90%, 950/1641). The climacteric symptoms were not constant during menopausal transition, usually more severe in late transition and postmenopausal periods, during which the moderate and severe symptoms were 59.1% (189/320) and 51.1% (291/570) respectively. Although most symptoms primarily appeared along with menstruation change, there are about 17.5% (172/981) patients experienced climacteric symptoms before menstruation change occurrence. There were 56.39% (733/1300) women had ever heard (mostly from gynecologist) about hormone replacement therapy from Obstetrician and Gynecologist. Most of the women during menopausal transition had climacteric symptoms, usually mild and moderate ones. Although most symptoms primarily appeared along with menstruation change, there are other patients' experienced climacteric symptoms before menstruation change occurrence.