Menopause, local biologies, and cultures of aging

Hot flashes and sleep in women

Sleep disturbances during menopause are often attributed to nocturnal hot flashes and 'sweats' associated with changing hormone patterns. This paper is a comprehensive critical review of the research on the relationship between sleep disturbance and hot flashes in women. Numerous studies have found a relationship between self-reported hot flashes and sleep complaints. However, hot flash studies using objective sleep assessment techniques such as polysomnography, actigraphy, or quantitative analysis of the sleep EEG are surprisingly scarce and have yielded somewhat mixed results. Much of this limited evidence suggests that hot flashes are associated with objectively identified sleep disruption in at least some women. At least some of the negative data may be due to methodological issues such as reliance upon problematic self-reports of nocturnal hot flashes and a lack of concurrent measures of hot flashes and sleep. The recent development of a reliable and non-intrusive method for objectively identifying hot flashes during the night should help address the need for substantial additional research in this area. Several areas of clinical relevance are described, including the effects of discontinuing combined hormone therapy (estrogen plus progesterone) or estrogen-only therapy, the possibility of hot flashes continuing for many years after menopause, and the link between hot flashes and depression.

Relation between climacteric symptoms and ovarian hypofunction in middle-aged and older Japanese women

OBJECTIVE

To gain insight into the characteristics and current status of climacteric symptoms reported by middle-aged and older women in Japan, we surveyed women presenting at our menopause clinic.

DESIGN

The participants included 1,069 women, ranging in age from 40 to less than 60 years (mean age, 50.2 y). Climacteric (indefinite) symptoms were objectively assessed with the use of the Keio questionnaire, which grades the severity of 40 types of symptoms classified into 20 subgroups. The total scores obtained for the 40 symptoms were used to calculate symptom prevalence and severity. To evaluate ovarian function, concentrations of estradiol and follicle-stimulating hormone (FSH) in sera were measured.

RESULTS

The most frequent symptom was general fatigue, reported by 88.2% of the women. Shoulder stiffness was the symptom rated to be severe by the highest percentage of women (38.1%). The prevalence and severity of hot flushes (and sweats) were slightly higher in perimenopausal and early postmenopausal women than in premenopausal and late postmenopausal women. The prevalence and severity of hot flushes and sweats were higher in women with estradiol < 25 pg/mL and FSH > 40 mIU/mL than in those with estradiol > or = 25 pg/mL and FSH < or = 40 mIU/mL.

CONCLUSION

General fatigue and shoulder stiffness, symptoms with low hormone dependence, are the two most frequent climacteric symptoms in our clinic. Hot flushes and sweats, symptoms with high hormone dependence, are also common symptoms.

Factors associated with intention to use hormone replacement therapy among Thai middle-aged women

OBJECTIVES

To examine the differences among those who express their intentions to use hormone replacement therapy (intenders), those who express their intentions not to use hormone replacement therapy (non-intenders), and those who are undecided, and to examine the factors associated with hormone replacement therapy (HRT) intention among Thai middle-aged women.

METHODS

A total of 420 women aged 40-59 years, recruited from one hospital in Bangkok were asked to complete a self-administered questionnaire.

RESULTS

Compared to intenders and non-intenders, the undecided were significantly less knowledgeable about menopause and HRT, and perceived the highest level of decisional uncertainty. Being inadequately informed was the most important factor that distinguished the undecided from intenders and non-intenders. When looking at intenders and non-intenders, no significant differences in perceived information inadequacy, level of knowledge, and perceived risks of HRT were found. However, it was found that intenders perceived higher benefit over risk of HRT (OR = 1.05, 95% CI = 1.02, 1.07), held more negative beliefs towards menopause (OR = 1.61, 95% CI = 1.03, 2.53), and were approximately two times more likely to have ever used oral contraceptives (OR = 1.99, 95% CI = 1.13, 3.47) than non-intenders.

CONCLUSION

The findings reveal the importance of being informed about menopause and HRT in making decision about HRT use. Changes in knowledge, and beliefs are promising avenues to study to see how these impacts HRT use.

Distribution of distress in post-socialist Mongolia: a cultural epidemiology of yadargaa

This study discusses quality of life in post-socialist Mongolia. Yadargaa, a fatigue-related illness in traditional Mongolian medicine, results from lifestyle imbalance. We examine the distribution of yadargaa and its association to socioeconomic changes under capitalism. Ethnographic interviews concerning yadargaa were conducted with health professionals, yadargaa patients, and laypersons. Epidemiological methods were used to identify risk groups, to estimate the point prevalence, and to assess the distribution of meanings and interpretations of yadargaa. The epidemiological sample included 194 individuals, half urban and half rural. Nearly half of the epidemiological sample suffered from yadargaa (49%). These yadargaa sufferers felt that they benefited less than non-yadargaa subjects from the current socioeconomic changes. Among these, perceived change in employment opportunities was one of the best predictors of yadargaa. Additionally, yadargaa sufferers were predominantly women, the elderly, and urban residents. Yadargaa varies greatly in presentation; Western psychiatric categories are only able to explain half of yadargaa cases. In conclusion, yadargaa strongly associates with disenfranchised groups in the capitalist economy. As a culturally constructed indicator of quality of life, yadargaa is a window into the lives of women and men in post-socialist Mongolia.

Breaking--bad news: women's experiences of fractures at midlife

OBJECTIVE

To gain understanding of the experiences and sequelae of fractures in women aged 40-65 years and to assess whether it is linked to overall bone health assessment.

METHOD

A qualitative study using face-to-face indepth interviews.

FINDINGS

Contrary to the common belief that fractures are benign, for middle-aged women, fractures have a significant impact on their well-being in both the short and long-term. Women report significant pain as well as an immediate need for help from family and professional caregivers. They experience interruptions to daily and leisure activities, employment, daily life and mobility. Only a minority of women and/or their family physicians initiated follow up to investigate bone health subsequent to the fracture.

CONCLUSIONS

Bone health is often examined in the context of already established bone disease. This study suggests a need for a closer examination of fracture treatment in the context of preventive care, and early detection of osteoporosis.

Biocultural aspects of obesity in young Mexican schoolchildren

Obesity related to over-nutrition is investigated in a sample of 219 Mexican children from affluent families, ages 6-12 years. Defined as weight-for-age at or above the 95(th) percentile, obesity rates in middle childhood are very high in this population, being 24.2% of children (29.4% of boys and 19.1% of girls). Binary logistic regression shows that children are more likely to be obese if they are boys, from small households with few or no other children, and have more permissive, less authoritarian parents. Diet at school and activity patterns, including television viewing, are not different for boys and girls and so do not explain this gender variation. The value placed on children, especially sons, in smaller middle-class families, can result in indulgent feeding because food treats are a cultural index of parental caring. Parents also value child fatness as a sign of health. These obese Mexican children have no greater social problems (peer rejection or stigma) or psychological problems (anxiety, depression, or low self esteem) than their non-obese peers. More study specifically focused on feeding practices in the home environment is required to explain very high rates of child obesity. The differences in obesity risk related to specific aspects of children's developmental microniche emphasize the importance of including a focus on gender as a socio-ecological construct in human biological studies of child growth, development, and nutrition.

Menopause in highland Guatemala Mayan women

OBJECTIVES

To explore any feelings and symptoms surrounding menopause among Mayan women in three ethnolinguistic groups in highland Guatemala and compare these with previous reports from Mexico.

METHODS

This was a qualitative exploratory study of the experiences around menopause of eight middle aged women and one local key informant in each of three villages in western highland Guatemala (n=27). Individual interviews were conducted in women with irregular menses or whose menses has ceased in the last 3 years. Field notes were kept and then an analysis undertaken by the author.

RESULTS

Twenty-four Mayan women, aged 38-55, and three Mayan key informants (all women over age 50) were interviewed. Most women reported some symptoms, including hot flashes, night sweats, changes in libido, irritability, moodiness, abdominal cramps and menstrual clots occurring at some stage during the last 3 years. Although women reported symptoms, they mostly accepted them with equanimity; and rejoiced at the cessation of their periods.

CONCLUSIONS

Highland Guatemalan Mayan women reported symptoms that were not reported in Mayan women in Yucatan, Mexico in the years surrounding menopause. The reasons for this disparity are unclear but may reflect differences in body weight and diet. Despite these symptoms, Mayan women looked forward to menopause and their newfound freedom and status. Symptoms in women in the years around menopause must be interpreted in geographical, nutritional, biological, psychological and cultural context.

Menopausal transition and psychological development

OBJECTIVE

To study women's psychological development during menopause and to examine the relationship between women's appraisal of menopause and symptom reporting.

DESIGN

A population-based sample of 130 healthy women was assessed annually for 5 consecutive years using semistructured interviews, a menopausal symptom rating scale, and the Symptom Checklist-90 rating scale.

RESULTS

Qualitative analyses of the interviews showed that the majority of the women (57%) had neutral beliefs about menopause, whereas 31% were pessimistic and 12% were optimistic. Optimistic and neutral expectations were associated with low levels of symptom reporting, whereas the pessimistic appraisal was significantly related to elevated symptom scores. The majority of the neutral and pessimistic women reappraised menopause during the study period, and at the last follow-up, 67% appraised menopause positively. A positive reappraisal among the initially pessimistic women was associated with more frequent statements about personal growth compared with the other subgroups.

CONCLUSIONS

Menopause has a developmental potential and is a positive period for most women.

The tempering of medical anthropology: troubling natural categories

This article reviews an approach in medical anthropology that commenced in the early 1980s and that continues to the present day in which biomedical knowledge and practices are systematically incorporated into anthropological analyses. Discussion then focuses on contributions made by feminists and medical anthropologists to the literature on medicalization and resistance, illustrating how the ethnographic approach has been crucial in critically reconceptualizing and situating these concepts historically and cross-culturally. The concept of local biologies is introduced in the third section of the article in creating the argument that the coproduction of biologies and cultures contributes to embodied experience, which, in turn, shapes discourse about the body. Subjective reporting at menopause provides an illustrative case study of local biologies in action. The final part of the article takes up the question of the moral economy of scientific knowledge. Comparative ethnographic work in intensive care units in Japan and North America reveals how a moral economy is put into practice in connection with brain-dead bodies and the procurement of organs from them. Medical anthropological contributions to policy making about biomedical technologies is briefly considered in closing.

Age at menopause and reproductive determinants in Polish women

Selected reproductive determinants of age at menopause were analyzed using data from a representative sample of 4354 women aged 35-65 years. The data were collected in cross-sectional surveys carried out in Wielkopolska and Western part of Poland in the years 1998 to 2001. Menopausal status and median and mean ages at menopause were estimated with the use of retrospective and status-quo methods. It was found that the median age at natural menopause, estimated by probit analysis, was 50.1 years. Women, who had been treated with HRT (Hormonal Replacement Therapy) in the period of perimenopause, underwent menopause significantly later – their median age at menopause was 52.9 years. Results of ANOVA revealed that of all characteristics of female reproduction taken into consideration, age at menarche and length of menstruation cycle had significant influence on age at menopause. Menopause occurred markedly later in women who began to menstruate after 15 years of age and whose menstrual cycles lasted longer than 32 days. Reproductive determinants were considered as a complex factor. Stepwise multiple regression analysis with backward elimination revealed that the reproductive determinants including the length of menstruation cycle, age at menarche, age at first and last pregnancies and length of lactation in combination affected age at menopause.