Natural Menopausal Women Research Articles

The relation of season of birth to severity of menopausal symptoms

Season of birth influences the rate of several psychiatric disorders. In this study, we investigated whether climacteric symptoms and, in particular, psychological and somatic symptoms of postmenopausal women were influenced by their season of birth. This retrospective multicenter study was performed on 2,541 women in natural menopause, free of hormone therapy. The score of the Greene Climacteric Scale and of its vasomotor, psychological (anxiety and depression), and somatization subscales were stratified by season of a woman's birth. Data were controlled for possible confounders, such as age, years since menopause, body mass index, education occupation, smoking habits, and season of evaluation. The Greene Climacteric Scale appeared to be associated with the season of birth, with the lowest scores being observed in women born in autumn and the highest scores in women born in spring (+2.11; 95% CI, 0.67-3.56; P = 0.01), and summer (+2.22; CI, 0.82-3.63; P = 0.01). Lowest scores in autumn and highest scores in spring were also observed for psychological symptoms subscaled as anxiety and depression (+1.43; CI, 0.54-2.32; P = 0.01) and somatic symptoms (+0.59; CI, 0.15-1.04; P = 0.01). In this study, we found a relationship between season of birth and some menopause-associated symptoms. Further study is needed to confirm these relationships and examine possible mechanisms.

Factors Modifying the Association Between Hormone-Replacement Therapy and Breast Cancer Risk

Hormone-replacement therapy (HRT) is an established risk factor for breast cancer. HRT users are different from non-users with respect to socio-economic and other characteristics. There may be women where the HRT-related risk could be modulated by other factors. We conducted a population-based case-control study with 688 breast cancer cases and 724 controls to characterize HRT users and to estimate odds ratios (OR) and 95% confidence intervals (CI) for HRT use and potentially risk modifying factors. In women aged 50 years and older, 58% of controls and 61% of cases ever used HRT. Among women in natural menopause, HRT use for 10 years and more years was associated with an increased breast cancer risk (OR 1.79, 95% CI, 1.12-2.87), but not among women in surgical menopause (OR 0.61, 95% CI, 0.09-4.17). In the subgroup of women with a positive family history of breast cancer, each year of HRT use increased the risk by 1.22 (95% CI, 1.02-1.47). Another subgroup comprised women with at least 10 diagnostic mammograms (OR 4.04, 95% CI, 1.10-14.81 for using HRT 10 or more years). Long-term HRT use was associated with a breast cancer risk in women with natural menopause. Our findings suggest that this risk may be increased in women with a positive family history of breast cancer and in women who received frequent diagnostic mammographic screens.

Bone density patterns after normal and premature menopause

Objectives: The investigation of the effect of time and type of menopause on bone mineral density (BMD) at different ages. Methods: Five hundred and fourteen women, who had never received any hormonal substitution were studied in a cross-sectional design: 177 with normal (NMP), 210 with surgical (SUMP) and 127 with premature natural (EMP) menopause. Age at menopause was 49.1±3.9, 38.3±4.7 and 38.1±4.2 years (mean±1 S.D.), respectively. BMD was measured at L2–L4 vertebrae and proximal femur by the DEXA method. Results: EMP women presented significantly lower vertebral BMD than NMP women in the 45–55-years segments ( P<0.001), but did not differ from SUMP women. This group exhibited lower vertebral BMD than NMP between 45 and 50 years ( P<0.001). Regarding femoral neck, EMP women exhibited lower values than SUMP in the 45–50 and 55–65 age segments ( P<0.001) whereas SUMP women presented significantly higher BMD values than NMP women after 55 years of age ( P<0.001). The percentages of women with vertebral BMD ( T-score values) in the osteoporotic range were significantly greater in EMP compared with either NMP or SUMP groups (both P<0.001) whereas in femoral neck lower in SUMP than the other two categories. Conclusions: Women with either natural or surgical premature menopause exhibit lower BMD of trabecular bone compared with normal menopause women at the age segments 45–55 and 45–50, respectively. However, surgical menopause women exceed normal menopause women in their mixed bone BMD values after 60 years as well as premature natural menopause women at almost all age segments.

Effects of lifestyle factors on stiffness index of calcaneus measured by quantitative ultrasound system among Japanese women aged 40 years and over: the Hizen-Oshima Study.

To explore how the stiffness index of the calcaneus is related to lifestyle factors, we examined the associations of lifestyle factors, age, and years since menopause, with stiffness index of the calcaneus among 573 community-dwelling Japanese women aged 40-89 years. Stiffness index of the calcaneus was obtained from quantitative ultrasound measurement. Body height and weight were measured, from which body mass index (BMI) was calculated. Physical activity index was calculated using a validated questionnaire. Dietary calcium intake and amount of ingested alcohol were estimated by a semiquantitative food frequency questionnaire. Current smoking status was obtained by questionnaire. In univariate analysis, stiffness index was positively related to physical activity index and BMI, and inversely to age and years since menopause, but not to dietary calcium intake. Stiffness index of drinkers and current smokers was not significantly different from that of non-drinkers and non-smokers, respectively. Among the natural menopausal women, multiple regression analysis showed that advancing age and years since menopause were associated with lower stiffness index, while higher physical activity index and greater BMI were associated with higher stiffness index. In conclusion, higher physical activity, in combination with adequate nutrition for weight maintenance, should be emphasized as a part of a healthy lifestyle in order to maintain bone health among middle-aged and elderly Japanese women.

The effects of body mass index on age at menopause.

We examined which of body mass index (BMI, kg/m(2)), serum cholesterol (mg/dl), or systolic blood pressure (SBP, mm Hg) affected age at natural menopause. A population-based follow-up program. We determined the age at natural menopause in 1136 women followed biennially since their first examination in 1958-1959 through the 16th examination in 1988-1989. Four-hundred and ninety-three naturally menopausal women were classified into three groups by BMI, serum cholesterol and SBP measurement levels at age 40 or 41 y: the upper 25%, middle 50%, and lower 25%. We then studied whether there was a difference in age at menopause among the three groups thus classified. The 1136 natural menopausal women were also classified as early (n=454; 45-49 y at menopause (48.3+/-1.2 y)) or late (n=682; >or=50 y at menopause (52.3+/-1.6 y)) menopausal and compared for premenopausal trends in BMI, serum cholesterol and SBP in the early and late menopausal women by means of a longitudinal data analysis model. When women were classified into the three groups based on a BMI that was measured at 40 or 41 y, age at menopause in the upper 25% (50.4+/-2.8 y) was significantly higher (P<0.05) than that in the lower 25% (49.7+/-2.8 y). The entire premenopausal trend in BMI in late menopausal women shifted upward compared to that in early menopausal women. On the other hand, the premenopausal trend more than 4 y before menopause in serum cholesterol and the entire premenopausal trend in SBP in late menopausal women were identical to those in early menopausal women. Among the variables studied, only BMI is related to age at menopause, and the greater the BMI, the later the age at menopause.

Carotid pulsatility indices in surgical menopause.

A large body of literature is available concerning association of hormone replacement therapy (HRT) and postmenopausal women; to our knowledge, only few publications in purely surgical menopausal women. The aim of this study was to evaluate pulsatility indices (PI) of internal carotid arteries in two groups of surgical menopausal women who underwent HRT vs who did not. Measurements of the PIs of internal carotid arteries in both Groups were performed with color Doppler ultrasound. Measurements of the untreated group (n = 38, mean age = 47.10 +/- 2.45, group 1) were compared to those of treated group (n = 42, mean age = 47.35 +/- 2.37, group 2). A statistically significant increase in PIs of the carotid arteries were observed in Group 1 as compared to Group 2 in post-operative follow-up (p < 0.001). Pre- and post-operative PIs in Group 1 measured at significantly different values pre- and post-operatively (right, 0.73 +/- 0.031 vs 0.80 +/- 0.049; left, 0.73 +/- 0.030 vs 0.80 +/- 0.052) (p < 0.001). No such pre- and post-operative difference in PIs were noted among patients in Group 2 (right, 0.74 +/- 0.046 vs 0.73 +/- 0.044, p = 0.200; left, 0.73 +/- 0.04 vs 0.73 +/- 0.04, p = 0.504). When comparing both groups, no statistical difference was noted pre-operatively (right, p = 0.501; left p = 0.625); however, postoperative PIs did reveal a statistically significant difference (p < 0.05). Pre- and post-operative side-to-side differences in the PIs of internal carotid arteries were not statistically significant (group 1, 0.158 vs 0.211; group 2, 0.152 vs 0.356). In surgical menopausal women, the beneficial effects of HRT are in concordance with previous studies in terms of PI, which were performed with natural menopausal women.

Carotid intima-media thickness in surgical menopause: women who received HRT versus who did not

Objective: The effects of hormone replacement therapy (HRT) in the natural menopausal period have been extensively studied. However, these effects have almost none been studied in purely surgical menopause. The aim of this study was to measure intima-media thickness (IMT) of carotid arteries bilaterally in two groups of surgical menopausal women who received HRT versus who did not. Methods: A B-mode ultrasound unit was used for the measurements of the IMTs of carotid arteries in two groups. Measurements of Group 1 ( n=65, untreated group) were compared with those of Group 2 ( n=70, treated group), in 2-years of follow-up. Patients in Group 2 received daily doses of 0.625 mg of oral conjugated estrogen preparates. Serum estradiol levels, lipid profiles, and blood pressures were measured, pre and postoperatively. For the statistical analyses in terms of differences of IMTs between two groups, general factorial analysis of variation was used. Results: Among preoperative values of low-density lipoprotein (LDL), high-density lipoprotein (HDL), cholesterol, systolic and diastolic blood pressures, estradiol, and age, only the estradiol values showed significant difference between both groups. The statistical results concerning the postoperative IMT differences for both groups showed that there was a statistically significant difference when comparing both groups, showing an increase in IMT in Group 1. Conclusion: In surgical menopausal women, the direction of the HRT effect is in agreement with evidence from earlier studies on the effects of HRT in natural menopausal women.

Comparison of biochemical markers of bone turnover and bone mineral density in different groups of climacteric women

In the present study we evaluated plasma levels of two markers of bone turnover (osteocalcin (OC) and urinary pyridinium cross-links) in association with bone mineral density (BMI) in different groups ofclimacteric women. We have investigated 158 women in pre- ,peri- and postmenopause. Blood and urine samples for assay of hormones and markers were collected and bone mineral density (BMD) was measured byDEXA densitometry in the distal tenth of the non-dominant forearm. There was a significant increase in mean absolute levels of both markers in perimenopause and women in natural and surgical menopause,with respect to women in premenopause. There was a significant correlation between OC and deoxypyridoline (DPYR) in peri- and postmenopause groups. In peri- and postmenopause groups ,BMD was correlatedwith an increase in the biochemical markers of bone remodeling. In the present study ,OC and DPYR were found to have good sensitivity for identifying perimenopausal women with pathological BMD. The presentresults reveal a positive and significant correlation between DPYR and OC ,inversely proportional to BMD ,during hormone replacement therapy. These markers therefore turn out to be sensitive not only formonitoring severe pathology of bone turnover ,but also for monitoring slight physiological deficits in bone equilibrium beginning in perimenopause.

Efficacy and safety of oral estriol for managing postmenopausal symptoms

Objective: to assess the therapeutic efficacy and safety of oral estriol for the treatment of climacteric symptoms in postmenopausal women. Methods: 68 postmenopausal women with climacteric symptoms received oral estriol, 2 mg/day, daily for 12 months. We evaluated the degree of climacteric complaints with estriol therapy; serum levels of gonadotropins, estradiol (E 2) and lipids; biochemical markers of bone metabolism; blood pressure; and side effects both at baseline and during treatment. Climacteric symptoms were assessed according to the menopausal index (MI), a version of the Kupperman index that had been modified for Japanese women. Results: oral estriol therapy significantly reduced total MI scores. The greatest relief was noted for hot flushes, night sweats, and insomnia. Estriol treatment significantly lowered serum follicle stimulating hormone (FSH) and luteinizing hormone (LH) concentrations but did not affect any of the other parameters (lipids, bone, liver and blood pressure) during the study period. Slightly vaginal bleeding occurred in 14.3% of those who underwent natural menopausal women. Histologic evaluation of the endometrium and ultrasound assessment of the breasts following 12 months of estriol treatment found normal results in all women. Conclusion: Estriol is a safe and effective alternative for relieving climacteric symptoms in postmenopausal Japanese women.

The Changes in Serum Insulin-like Growth Factors and Their Relationship With Changes in Bone Mineral Density After Hormone Replacement Therapy in Natural Menopausal Women: A One-Year Prospective Study

Kim, J G1; Suh, C S1; Shin, C S2; Kim, S H1; Choi, Y M1; Moon, S Y1; Kim, S Y2; Lee, J Y1 Author Information

Determinants of self rated menopause status

This study, based on a population survey, examines the self ratings of progress through the menopausal transition of women in natural menopause, women using hormone therapy and women who have undergone hysterectomy. The latter two groups are usually excluded from discussions of menopausal transition, since the accepted menstrually defined criteria do not apply to them. Hysterectomised women do not differ in their self rating profile from non-hysterectomised women, after hormone therapy status is taken into account. This is surprising, since they may have been expected to see themselves as in the main postmenopausal. Use of hormone therapy is tantamount to self perception as at least perimenopausal. Among women in natural menopause there is 29% disagreement between self ratings and menstrually defined categories. On the basis of these observations it is hypothesised that experience of symptoms associated with menopause is important in determining self ratings. The good fit of logistic regression predictions of self ratings from hysterectomy status, hormone therapy status and experience of hot flushes is consistent with this hypothesis. This research indicates that it is important to take women's subjective evaluations into account in assessing progress through the menopausal transition.

The Prevalence of Psychological Distress Among Postmenopausal Women Attending a Menopausal Clinic and the Effect of Hormone Replacement Therapy on Their Mental State

Abstract: Forty-eight women in natural or surgical menopause, who attended a menopausal-gynecological clinic, were examined before starting any treatment by a psychiatrist using the General Health Questionnaire-28 and the Hamilton scales for anxiety and depression, to measure the degree of their psychological distress. This degree was relatively high, especially for women in surgical menopause. After 6 months, in which 36 of the attendees received hormone replacement therapy, the psychiatric assessment was repeated and much lower levels of distress were found, so that in no case was psychiatric treatment needed. This improvement in psychological state could perhaps partly be attributed to the attention of the special setting, but is probably a result of the hormone replacement therapy

Postmenopausal Sexuality in Thai Women*

We evaluate sexuality in 100 natural menopausal women as pertains to hormones, symptoms related to intercourse, and marital relationship with sexual desire, orgasm and coital frequency. The mean age was 56.8 years while menopausal age was 50.3 years. The postmenopausal syndrome presented 55.0% occurring 1 to 7 years after menopause (mean 3.4 years). The common sexual problems after menopause were loss of libido, orgasmic dysfunction, and dyspareunia. Both sexual desire and activity decreased when compared with premenopausal period. Ninety percent of the subjects had sexual desire less than once a month. Only 14% of the subjects occasionally reached orgasm while the other 86% never had orgasm after menopause. The levels of FSH, LH, estradiol and testosterone were also reported. There was no correlation of hormone estradiol and testosterone, symptoms related to intercourse and marital relationship with sexual desire, orgasm, or coital frequency.

Osteoporosis in Surgical Menopause

Background: Osteoporosis in both surgical and natural menopausal women are common health hazards all over the world. And the surgical menopausal women may have the greater chance of this disorder than those of natural menopausal women. Objective: To observe osteoporotic changes in both surgical and natural menopausal women in Bangladesh. Method: This Cross sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College, Dhaka between 1st January 2010 to 31st December 2010. A total number of 60 female subjects were included in this study. Among them 30 surgical menopausal women age ranged from 45-55 years were included in the study group (Group B) and 30 natural menopausal women age ranged from 50-60 years were taken as control (Group A). All the menopausal women were selected from Out Patient Department (OPD) of Gynaecology and Obstetrics, Sir Salimullah Medical College and Mitford Hospital. Estimation of serum estrogen level by microparticle enzyme immunoassay (MEIA) method and T- score was obtained by Dual energy X-ray absorptiometry of both natural and surgical menopausal women were done. The statistical analysis was done by using appropriate method as applicable. Results: In this study T- score of both spinal and femoral neck bone were significantly (p&lt;0.001) lower in surgical menopausal women than those of natural menopausal women. Again, mean serum estrogen level was significantly (p&lt;0.001) lower in surgical menopausal women than that of natural menopausal women. Conclusion: The present study revealed that surgical menopausal women have greater chance of osteoporosis than those of natural menopausal women. Key words: Menopause; Bone mineral density; Osteoporosis. DOI: http://dx.doi.org/10.3329/jbsp.v6i1.8083 J Bangladesh Soc Physiol. 2011 June; 6(1): 39-44

Lipid Profile Status In Surgical Menopause

Background: Dyslipidaemia in both surgical and natural menopausal women is a common health hazard all over the world. Moreover, the surgical menopausal women may have greater chance of this disorder than those of natural menopausal women. Objective: To observe lipid profile level in surgical menopausal women in Bangladesh. Methods: This cross sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College, Dhaka from 1st January 2010 to 31st December 2010. A total number of 90 female subjects were included in this study. They were divided into control and study groups. Among them 6o women were taken as control (30 premenopausal women- group A and 30 natural menopausal women -group B) and 30 were taken as study (surgical menopausal-group C).However, age range of premanopausal women were from 30-35 years, natural menopausal women from 50-60 years and surgical menopausal women from 45-55 years. All the menopausal women were selected from Out Patient Department (OPD) of Gynaecology and Obstetrics of Sir Salimullah Medical College and Mitford Hospital. Premenopausal women were selected by personal contact. Serum lipid profile and serum estrogen levels of all participants were estimated by enzymatic method and by AxSYM method respectively. The statistical analysis was done by using appropriate method as applicable. Results: In this study, mean serum triglyceride (TG) level was significantly (p&lt;0.05) higher and serum high density lipoprotein cholesterol (HDL-C) level was significantly (p&lt;0.001) lower in surgical menopausal women than those of natural menopausal women. . Again, mean serum estrogen level was significantly (p&lt;0.001) lower in surgical menopausal women than that of natural menopausal women. Conclusion: The present study revealed that surgical menopausal women have greater chance of dyslipidaemia than those of natural menopausal women. DOI: http://dx.doi.org/10.3329/jbsp.v6i2.9763 JBSP 2011 6(2): 127-133