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Ballot O, Ivers H, Ji X, Morin CM. Sleep Disturbances During the Menopausal Transition: The Role of Sleep Reactivity and Arousal Predisposition. Behav Sleep Med 2022; 20:500-512. [PMID: 34176385 DOI: 10.1080/15402002.2021.1937171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sleep disturbances are common during the menopausal transition and several factors can contribute to this increased incidence. This study examined the association between sleep reactivity, arousal predisposition, sleep disturbances, and menopause. METHODS Data for this study were derived from a longitudinal, population-based study on the natural history of insomnia. A total of 873 women (40-60 years) were divided into two groups according to their menopausal status at baseline: reproductive (n = 408) and postmenopausal (n = 465). Participants were evaluated annually throughout the five-year follow-up period. Four questionnaires were used to examine sleep quality, insomnia severity, sleep reactivity, and arousal predisposition. The data were analyzed using two approaches: cross-sectional with a multivariate analysis and binary regression, and longitudinal with a linear mixed models using menopausal groups (3) x time (5) design. RESULTS Cross-sectional analyses showed that postmenopausal women reported significantly more severe insomnia and poorer sleep quality than reproductive women. Sleep reactivity and arousal predisposition were significant predictors of sleep disturbances. Longitudinal analyses revealed increased sleep disturbances in the two years before and after the menopausal transition. Sleep reactivity and arousal predisposition did not moderate the temporal relationship between menopausal transition and sleep disturbances. CONCLUSION More sleep disturbances were reported during the menopausal transition, but those difficulties were not explained by sleep reactivity and arousal predisposition. These results suggest the involvement of other psychophysiological factors in the development of sleep disturbances during the menopause.
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Affiliation(s)
- O Ballot
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - H Ivers
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - X Ji
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - C M Morin
- École de Psychologie, Université Laval, Québec, QC, Canada
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Wilfried D, Nina CDG, Silvia B. Effectiveness of Menosan® Salvia officinalis in the treatment of a wide spectrum of menopausal complaints. A double-blind, randomized, placebo-controlled, clinical trial. Heliyon 2021; 7:e05910. [PMID: 33615001 PMCID: PMC7881233 DOI: 10.1016/j.heliyon.2021.e05910] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/04/2020] [Accepted: 01/04/2021] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate efficacy and safety of fresh Salvia officinalis extract tablets in relieving typical symptoms in menopausal women and to gain insight in the mode of action by measuring altered cerebral wave intensities. Methods Randomized 80 menopausal women from 48 - 65 years of age received Menosan® tablets [3'400 mg ethanolic extract of freshly harvested Salvia officinalis L.] or placebo under double-blind conditions for 4 weeks. An efficacy analysis evaluated the developments of the menopausal rating scale [MRS], hot flush severity score [HFS] and quantitative electroencephalography [qEEG] intensities in the per protocol population. Results were further corroborated by data from the intention to treat population including late postmenopausal women. Results Salvia off. distinctly reduced MRS by 39.2% from 15.3 ± 6.87 to 9.3 ± 5.75 and significantly in comparison to placebo (p = 0.002). The HFS score decreased by 55.3% from 15.9 ± 13.77 to 7.1 ± 7.41, reaching significance on week 3 onwards (p = 0.028). Clinical effects of Salvia off. correlated with relevant reduction of frontal lobe beta2 wave qEEG intensities at electrodes F3/4/7/8 and are underpinned by secondary parameters and ITT analysis. Salvia off. within 4 weeks significantly reduced the somato-vegetative (e.g. hot flushes) and psychological MRS subscale (e.g. physical and mental exhaustion) subscale (p < 0.05) without a significant effect on the genito-urinary subscale. A positive impact of Salvia off. compared to placebo was furthermore seen on sleep quality, discontent and fatigue (p < 0.05) as evidenced by sleep and profile of mood state questionnaires.Tolerability was uniformly rated as very good for Salvia off. extract and placebo, with an overall incidence of three adverse events in total, none of which treatment-related. Conclusion The results support the use of Salvia off. for the specific treatment of a wide range of somato-vegetative and psychological symptoms as experienced by menopausal women and correlate this effect to a restoration of associated dysbalanced brain waves.The study was registered as EudraCT-No 2016-005033-77.
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Affiliation(s)
- Dimpfel Wilfried
- Justus-Liebig-University Giessen c/o NeuroCode AG, Wetzlar, Germany
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Trajectories of response to acupuncture for menopausal vasomotor symptoms: the Acupuncture in Menopause study. Menopause 2018; 24:171-179. [PMID: 27676631 DOI: 10.1097/gme.0000000000000735] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the trajectories of responses to acupuncture treatment for menopausal vasomotor symptoms (VMS) and the characteristics of women in each trajectory. METHODS Two hundred nine perimenopausal and postmenopausal women aged 45 to 60 years experiencing at least four VMS per day were recruited and randomized to receive up to 20 acupuncture treatments within 6 months or to a waitlist control group. The primary outcome was percent change from baseline in the mean daily VMS frequency. Finite mixture modeling was used to identify patterns of percent change in weekly VMS frequencies over the first 8 weeks. The Freeman-Holton test and analysis of variance were used to compare characteristics of women in different trajectories. RESULTS Analyses revealed four distinct trajectories of change in VMS frequency by week 8 in the acupuncture group. A small group of women (11.6%, n = 19) had an 85% reduction in VMS. The largest group (47%, n = 79) reported a 47% reduction in VMS frequency, 37.3% (n = 65) of the sample showed only a 9.6% reduction in VMS frequency, and a very small group (4.1%, n = 7) had a 100% increase in VMS. Among women in the waitlist control group, 79.5% reported a 10% decrease in VMS frequency at week 8. Baseline number of VMS, number of acupuncture treatments in the first 8 weeks, and traditional Chinese medicine diagnosis were significantly related to trajectory group membership in the acupuncture group. CONCLUSIONS Approximately half of the treated sample reported a decline in VMS frequency, but identifying clear predictors of clinical response to acupuncture treatment of menopausal VMS remains challenging.
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Abstract
OBJECTIVE The aim of the study was to evaluate the short and long-term effects of acupuncture on vasomotor symptoms (VMS) and quality of life-related measures. METHODS A total of 209 perimenopausal and postmenopausal women aged 45 to 60 years, experiencing four or more VMS per day, were recruited from the community and randomized to receive up to 20 acupuncture treatments within the first 6 months (acupuncture group) or the second 6 months (waitlist control group) of the 12-month study period. The primary outcome was mean daily frequency of VMS. Secondary outcomes were VMS interference with daily life, sleep quality, depressive symptoms, somatic and other symptoms, anxiety, and quality of life. RESULTS The VMS frequency declined by 36.7% at 6 months in the acupuncture group and increased by 6.0% in the control group (P < 0.001 for between-group comparison). At 12 months, the reduction from baseline in the acupuncture group was 29.4% (P < 0.001 for within-group comparison from baseline to 12 months), suggesting that the reduction was largely maintained after treatment. Statistically significant clinical improvement was observed after three acupuncture treatments, and maximal clinical effects occurred after a median of eight treatments. Persistent improvements were seen in many quality of life-related outcomes in the acupuncture group relative to the control group. CONCLUSIONS We found that a course of acupuncture treatments was associated with significant reduction in VMS, and several quality-of-life measures, compared with no acupuncture, and that clinical benefit persisted for at least 6 months beyond the end of treatment.
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Abstract
Sleeping problems are a serious public health problem, imposing a substantial burden on individuals and society. Although sleeping problems occur throughout the lifespan, and in both sexes, menopause can be considered as one important milestone of increasing occurrence in sleeping problems. However, to determine whether sleeping problems are caused by the menopause or merely occur by coincidence during the menopause is not always easy because several, particularly age-related, changes take place at the same time. The most important factors are general diseases, medications, weight changes and mood symptoms. According to women's own judgment, hormone therapy significantly improves sleep quality. Hormone therapy can thus be considered as a first-line treatment for climacteric sleeping problems. If sleeping problems are accompanied by other disorders, hormone therapy should be kept in mind as an adjuvant therapy. According to worldwide consensus on hormone therapy, the main indication of hormone therapy is alleviation of climacteric symptoms, including climacteric sleeping problems. However, when choosing hormone therapy for a patient, contraindications and possible long-term side effects should be individually considered. This review illustrates the effect of menopause on sleep and evaluates different treatment options, especially hormone therapy, in alleviation of symptoms.
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Affiliation(s)
- Päivi Polo-Kantola
- University of Turku, Department of Obstetrics and Gynecology, University Central Hospital of Turku and Sleep Research Center Dentalia, FIN-20520 Turku, Finland, Tel.: +358 2313 0000; Fax: +358 2313 2340
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Abstract
OBJECTIVE This study aims to obtain preliminary data on the efficacy of yoga for reducing self-reported menopausal hot flashes in a randomized study including an attention control group. METHODS We randomized 54 late perimenopausal women (2-12 mo of amenorrhea) and postmenopausal women (>12 mo of amenorrhea)--aged 45 to 58 years and who experienced at least four hot flashes per day, on average, for at least 4 weeks--to one of three groups: yoga, health and wellness education (HW), and wait list (WL). Yoga and HW classes consisted of weekly 90-minute classes for 10 weeks. All women completed daily hot flash diaries throughout the trial (10 wk) to track the frequency and severity of hot flashes. The mean hot flash index score is based on the number of mild, moderate, severe, and very severe hot flashes. RESULTS Hot flash frequency declined significantly across time for all three groups, with the strongest decline occurring during the first week. There was no overall significant difference in hot flash frequency decrease over time by treatment groups, but the yoga and HW groups followed similar patterns and showed greater decreases than the WL group. On week 10, women in the yoga group reported an approximately 66% decrease in hot flash frequency, women in the HW group reported a 63% decrease, and women in the WL group reported a 36% decrease. The hot flash index showed a similar pattern. CONCLUSIONS Results suggest that yoga can serve as a behavioral option for reducing hot flashes but may not offer any advantage over other types of interventions.
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Hachul H, Frange C, Bezerra AG, Hirotsu C, Pires GN, Andersen ML, Bittencourt L, Tufik S. The effect of menopause on objective sleep parameters: Data from an epidemiologic study in São Paulo, Brazil. Maturitas 2015; 80:170-8. [DOI: 10.1016/j.maturitas.2014.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/04/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
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Tanmahasamut P, Vichinsartvichai P, Rattanachaiyanont M, Techatraisak K, Dangrat C, Sardod P. Cimicifuga racemosaextract for relieving menopausal symptoms: a randomized controlled trial. Climacteric 2014; 18:79-85. [DOI: 10.3109/13697137.2014.933410] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lindh-Åstrand L, Hoffmann M, Hammar M, Spetz Holm AC. Hot flushes, hormone therapy and alternative treatments: 30 years of experience from Sweden. Climacteric 2014; 18:53-62. [DOI: 10.3109/13697137.2014.915516] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Calvo-Pérez A, Campillo-Artero C. Quality of life of menopausal women in the island of Majorca: a population based study. Gynecol Endocrinol 2013; 29:556-8. [PMID: 23480719 DOI: 10.3109/09513590.2013.774363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To explore demographic and epidemiological characteristics surrounding menopause among women of Majorca, estimate their health related quality of life (QOL), and ascertain wheather they differ from those of the mainland population of menopausal women. METHODS A cross-sectional population-based study was conducted with a sample of 428 women. The Cervantes questionnaire for measuring QOL during menopause was used. RESULTS Among women in Majorca, the mean QOL is better than the national mean of the Spain reference population. It declines with age and levels off at menopause. In menopausal women, QOL improves slightly in tandem with educational level. 29% of menopausal women were on some form of therapy, most commonly a mix of estrogens and gestagens (36%). Only a weak association was detected between being menopausal and QOL. CONCLUSION The Cervantes questionnaire allows periodic study sample cut-offs to determine whether changes in sociodemographic and disease-related variables are also accompanied by changes in self-perceived QOL. It is much better in menopausal women in Majorca than in those in the Spanish mainland.
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Ferrand F, Hajri S, Benzineb S, Draoui DM, Hassoun D, Delanoë D, Zins M, Ringa V. Comparative study of the quality of life associated with menopause in Tunisia and France. Menopause 2013; 20:609-22. [DOI: 10.1097/gme.0b013e318278b0ce] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Changes in self-reported hot flashes and their association with concurrent changes in insomnia symptoms among women with breast cancer. Menopause 2011; 18:985-93. [PMID: 21552166 DOI: 10.1097/gme.0b013e31820db6a1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to assess longitudinally the relationship between hot flashes and insomnia symptoms in women receiving adjuvant treatments for breast cancer. METHODS Fifty-eight participants completed a 7-day daily diary assessing hot flashes, the Menopause-Specific Quality of Life Questionnaire, and the Insomnia Severity Index, before and after chemotherapy or radiotherapy and at a 3-month follow-up evaluation. RESULTS A first canonical correlation analysis (n = 55) revealed a marginally significant relationship between pretreatment versus posttreatment change scores in hot flashes and sleep (R = 0.39), and a second analysis (n = 51) showed a significant relationship between posttreatment and follow-up changes in hot flash activity and sleep (R = 0.59). CONCLUSIONS These results show that increases in vasomotor symptoms occurring within the few months after the termination of initial adjuvant treatments for breast cancer are significantly associated with concurrent increases in insomnia symptoms and vice versa.
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Xu H, Thurston RC, Matthews KA, Bryce CL, Hays RD, Kapoor WN, Ness RB, Hess R. Are hot flashes associated with sleep disturbance during midlife? Results from the STRIDE cohort study. Maturitas 2011; 71:34-8. [PMID: 22051577 DOI: 10.1016/j.maturitas.2011.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 10/01/2011] [Accepted: 10/07/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Sleep disturbance and hot flashes are common during menopause, but their association is not well understood. We sought to understand the associations among sleep disturbance and the frequency, bothersomeness, and interference of hot flashes in mid-life women. STUDY DESIGN STRIDE is a study of women ages 40-65 years at varied menopausal stages. We examined the cross-sectional associations of sleep disturbance with the frequency and bothersomeness of hot flashes, and interference of hot flashes with work, social, and leisure activities during the 2nd year of STRIDE. MAIN OUTCOME MEASURE Self-reported sleep disturbance. RESULTS Of the 623 women with complete data, 370 (59%) reported having hot flashes. Bivariate analyses showed that reporting hot flashes with bother, but not hot flashes alone, was associated with sleep disturbance (odds ratio [OR] [95% confidence interval (CI)]: 2.8 [2.0-4.0] and 1.3 [0.7-2.5], respectively). In multivariable models, women reporting bothersome hot flashes were more likely to report sleep disturbance (OR [95% CI]: 2.1 [1.4-3.2]) compared to women who reported no hot flashes. When the perceived interference of hot flashes with work, social activities, and leisure activities were included in the model, the relationships between bothersome hot flashes and sleep disturbance disappeared. CONCLUSIONS Hot flashes are not associated with sleep disturbance, unless they are bothersome. Mid-life patients should routinely be queried about the bothersomeness of their hot flashes.
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Affiliation(s)
- Hanna Xu
- Temple University School of Medicine, Philadelphia, PA, USA
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Abstract
OBJECTIVE Most postmenopausal women have insomnia. Some of these women also have respiratory sleep disorders. Recent reports have documented that the phytohormones, isoflavones, are capable of reducing the symptoms of climacterium. The purpose of this investigation was to examine subjective and objective sleep parameters and to measure changes in these parameters during treatment with isoflavones in a controlled, double-blinded study in postmenopausal women with insomnia. METHODS Two groups of postmenopausal women with insomnia participated in the study: the first received 80 mg isoflavones daily for 4 months, and the second received a placebo for the same period. Sleep analysis consisted of questionnaires and polysomnography. Student's t test and analysis of variance were applied for comparisons between groups, and correlations were tested with Pearson's correlation coefficient. RESULTS Thirty-eight women were enrolled in the study. Polysomnography revealed a significant increase in sleep efficiency in the isoflavone group (from 77.9% to 83.9%) when compared with the placebo group (from 77.6% to 81.2%). Isoflavones induced a decrease in the intensity and number of hot flashes and the frequency of insomnia: among the women in the placebo group, 94.7% had moderate or intense insomnia at the beginning of the study, compared with 63.2% at the end, whereas in the isoflavone group, these percentages were 89.5% and 36.9%, respectively. CONCLUSIONS In postmenopausal women with insomnia, isoflavone treatment was effective in reducing insomnia symptoms, which was confirmed by increased sleep efficiency as observed by polysomnographic analysis.
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Arakane M, Castillo C, Rosero MF, Peñafiel R, Pérez-López FR, Chedraui P. Factors relating to insomnia during the menopausal transition as evaluated by the Insomnia Severity Index. Maturitas 2011; 69:157-61. [DOI: 10.1016/j.maturitas.2011.02.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 02/09/2011] [Accepted: 02/22/2011] [Indexed: 11/24/2022]
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Bommer S, Klein P, Suter A. First time proof of sage's tolerability and efficacy in menopausal women with hot flushes. Adv Ther 2011; 28:490-500. [PMID: 21630133 DOI: 10.1007/s12325-011-0027-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND This trial aimed to assess the tolerability and efficacy of a fresh sage preparation in treating hot flushes and other menopausal complaints. Sage (Salvia officinalis) has been traditionally used to treat sweating and menopausal hot flushes, as well as to alleviate associated menopausal symptoms and as a general tonic. However, no clinical studies substantiating the use of sage in menopause have been published previously. METHODS In an open, multicenter clinical trial conducted in eight practices in Switzerland, 71 patients (intent-to-treat population [ITT], n=69; with a mean age of 56.4±4.7 years, menopausal for at least 12 months, and with at least five flushes daily) were recruited and treated with a once-daily tablet of fresh sage leaves for 8 weeks after an introductory baseline week. Parameters for the evaluation of efficacy were the change in intensity and frequency of hot flushes, and total score of the mean number of intensity-rated hot flushes (TSIRHF) as determined by diary protocol over the 2-month treatment period. Other variables included assessment of the Menopause Rating Scale (MRS) by the treating physician at baseline and after 2 months of therapy. RESULTS In the ITT population there was a significant decrease in the TSIRHF by 50% within 4 weeks and by 64% within 8 weeks (P<0.0001). The mean total number of hot flushes per day decreased significantly each week from week 1 to 8. The mean number of mild, moderate, severe, and very severe flushes decreased by 46%, 62%, 79%, and 100% over 8 weeks, respectively. The MRS and its somato-vegetative, psychological, and urogenital subscales decreased significantly by 43%, 43%, 47%, and 20% respectively. The treatment was very well tolerated. CONCLUSION A fresh sage preparation demonstrated clinical value in the treatment of hot flushes and associated menopausal symptoms.
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Affiliation(s)
- S Bommer
- A. Vogel Bioforce AG, Roggwil, Switzerland.
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Polo-Kantola P. Sleep problems in midlife and beyond. Maturitas 2011; 68:224-32. [DOI: 10.1016/j.maturitas.2010.12.009] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 12/16/2010] [Indexed: 12/20/2022]
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Impact of walking on eating behaviors and quality of life of premenopausal and early postmenopausal obese women. Menopause 2010; 17:529-38. [DOI: 10.1097/gme.0b013e3181d12361] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms. Menopause 2010; 17:72-9. [DOI: 10.1097/gme.0b013e3181b397c7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Change in health-related quality of life over the menopausal transition in a multiethnic cohort of middle-aged women: Study of Women's Health Across the Nation. Menopause 2009; 16:860-9. [PMID: 19436224 DOI: 10.1097/gme.0b013e3181a3cdaf] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine changes in health-related quality of life (HRQL) during the menopausal transition, controlling for chronological aging, symptoms, and other covariates. METHODS This was a prospective, longitudinal study of women aged 42 to 52 years at baseline recruited at seven US sites (N = 3,302) in the multiethnic Study of Women's Health Across the Nation. Women eligible for the cohort had an intact uterus, had at least one ovary, were not currently using exogenous hormones, were either premenopausal or early perimenopausal, and were self-identified as one of the study's designated racial/ethnic groups. Data from the baseline interview and six annual follow-up visits are reported. HRQL was assessed with five subscales from the Medical Outcomes Study Short-Form Health Survey, with reduced functioning defined as being in the lowest 25% on a subscale. Covariates included symptoms, medical conditions, sociodemographics variables, physical activity, and psychological factors. RESULTS With adjustment for baseline age, chronological aging, and relevant covariates, the odds of reduced role-physical functioning were significantly greater at late perimenopause (odds ratio, 1.46; 95% CI, 1.08-1.99) and postmenopause (odds ratio, 1.49; 95% CI, 1.09-2.04) compared with premenopause. Menopause status was unrelated to bodily pain, vitality, role-emotional, or social functioning. Hormone therapy users were more likely to report reduced functioning. Other variables significantly related to HRQL across all domains included vasomotor symptoms, urine leakage, poor sleep, arthritis, depressed mood, perceived stress, and stressful life events. CONCLUSIONS The menopausal transition showed little impact on HRQL when adjusted for symptoms, medical conditions, and stress.
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Lai JN, Chen HJ, Chen CM, Chen PC, Wang JD. Quality of life and climacteric complaints amongst women seeking medical advice in Taiwan: assessment using the WHOQOL-BREF questionnaire. Climacteric 2009; 9:119-28. [PMID: 16698658 DOI: 10.1080/13697130600635292] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the impact of the climacteric transition on health-related quality of life amongst women, between the ages of 45 and 55 years, seeking medical advice in Taiwan. METHOD A total of 203 women seeking medical advice (SMA) were drawn from a special integrated clinic, with a further 349 healthy referents of the same age, range and gender, with no history of hormone replacement therapy and living in the same municipality, also being recruited from a national health survey sample for comparison. Each one was asked to fill out the brief questionnaire of the Taiwan version of the World Health Organization Quality of Life (WHOQOL-BREF), assessing quality of life on 26 items in four domains (physical, psychological, social and environmental). SMA subjects were also questioned about the 21 most frequent symptoms. Multiple regression analyses were conducted to control variables such as age, marital status, religion and educational attainment. RESULTS The mean scores for the physical, psychological and social domains were significantly lower than those of the healthy referents, as was the overall quality of life for SMA women. Although usual vasomotor symptoms did not significantly predict quality of life in the SMA subjects, after controlling for demographic factors, insomnia and emotional disturbance were found to be major determinants of the scores in the different domains. CONCLUSION Insomnia and emotional disturbance should be taken into consideration in the management of climacteric women seeking medical advice.
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Affiliation(s)
- J-N Lai
- Department of Obstetrics and Gynecology, Taipei Municipal Yang Ming Hospital, Taipei, Taiwan
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Peeyananjarassri K, Cheewadhanaraks S, Hubbard M, Zoa Manga R, Manocha R, Eden J. Menopausal symptoms in a hospital-based sample of women in southern Thailand. Climacteric 2009; 9:23-9. [PMID: 16428122 DOI: 10.1080/13697130500487422] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate menopausal symptoms and quality of life in middle-aged women. STUDY DESIGN Hospital-based, cross-sectional study. METHODS A survey was conducted among 270 women aged 45-65 years who attended the gynecological and menopause clinic, Songklanagarind Hospital. We used the MENQOL questionnaire as the instrument. RESULTS The average age at menopause of the postmenopausal women was 48.7 years (range 40-57 years). The prevalences of the classical menopausal symptoms--hot flushes, night sweats, and vaginal dryness--in the women aged 45-65 years were 36.8%, 20.8 and 55.3%, respectively. The three most prevalent symptoms in perimenopause were aching in muscles and joints, experiencing poor memory, and change in sexual desire. Within the four domains (vasomotor, psychological, physical, and sexual symptoms), more suffering was reported in the perimenopausal and postmenopausal subjects than in the premenopausal subjects (p < 0.001). CONCLUSIONS Peri- and postmenopausal women had a significant decrease in quality of life compared to premenopausal women.
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Affiliation(s)
- K Peeyananjarassri
- Department of Obstetrics & Gynecology, Faculty of Medicine, Songklanagarind Hospital, Hat-Yai, Songkhla, Thailand
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Abstract
OBJECTIVE To investigate the feasibility of conducting a randomized trial of the effect of acupuncture in decreasing hot flashes in peri- and postmenopausal women. DESIGN Fifty-six women ages 44 to 55 with no menses in the past 3 months and at least four hot flashes per day were recruited from two clinical centers and randomized to one of three treatment groups: usual care (n = 19), sham acupuncture (n = 18), or Traditional Chinese Medicine acupuncture (n = 19). Acupuncture treatments were scheduled twice weekly for 8 consecutive weeks. The sham acupuncture group received shallow needling in nontherapeutic sites. The Traditional Chinese Medicine acupuncture group received one of four treatments based on a Traditional Chinese Medicine diagnosis. Usual care participants were instructed to not initiate any new treatments for hot flashes during the study. Daily diaries were used to track frequency and severity of hot flashes. The mean daily index score was based on the number of mild, moderate, and severe hot flashes. Follow-up analyses were adjusted for baseline values, clinical center, age, and body mass index. RESULTS There was a significant decrease in mean frequency of hot flashes between weeks 1 and 8 across all groups (P = 0.01), although the differences between the three study groups were not significant. However, the two acupuncture groups showed a significantly greater decrease than the usual care group (P < 0.05), but did not differ from each other. Results followed a similar pattern for the hot flash index score. There were no significant effects for changes in hot flash interference, sleep, mood, health-related quality of life, or psychological well-being. CONCLUSIONS These results suggest either that there is a strong placebo effect or that both traditional and sham acupuncture significantly reduce hot flash frequency.
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Gallicchio L, Miller S, Zacur H, Flaws JA. Race and health-related quality of life in midlife women in Baltimore, Maryland. Maturitas 2009; 63:67-72. [PMID: 19264431 DOI: 10.1016/j.maturitas.2009.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 01/20/2009] [Accepted: 02/03/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Only a few studies have examined the association between race/ethnicity and health-related quality of life (HRQOL) during midlife. Thus, the purpose of this study was to examine this association in the context of a population-based study of Caucasian and African-American women aged 45-54 years. METHODS Data from 626 pre- and peri-menopausal African-American and Caucasian women aged 45-54 years were analyzed. HRQOL was measured using Cantril's Self-Anchoring Ladder of Life, a validated measure of overall life satisfaction. Body mass index was determined using measured height and weight. Information on race and other variables such as education was based on self-report. Logistic regression models were constructed to examine the unadjusted and adjusted associations between race and low present HRQOL (< or =6 on Cantril's Ladder of Life). RESULTS In both the unadjusted and adjusted analyses, race was not significantly associated with low present HRQOL (unadjusted OR 1.57; 95% CI 0.93, 2.65; adjusted OR 0.82; 95% CI 0.42, 1.61). In the fully adjusted model, only the number of menopausal symptoms and self-rated health were significantly associated with present HRQOL. CONCLUSIONS Findings from this population-based study suggest that race is not a statistically significant determinant of present HRQOL among midlife women.
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Affiliation(s)
- Lisa Gallicchio
- The Prevention and Research Center, Weinberg Center for Women's Health and Medicine, Mercy Medical Center, Baltimore, MD 21202, United States
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Menopause-specific questionnaire assessment in US population-based study shows negative impact on health-related quality of life. Maturitas 2009; 62:153-9. [PMID: 19157732 DOI: 10.1016/j.maturitas.2008.12.006] [Citation(s) in RCA: 212] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 12/08/2008] [Accepted: 12/09/2008] [Indexed: 11/27/2022]
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Riesco E, Roussel M, Lemoine S, Garnier S, Sanguignol F, Mauriège P. What is the influence of menopausal status on metabolic profile, eating behaviors, and perceived health of obese women after weight reduction? Appl Physiol Nutr Metab 2008; 33:957-65. [PMID: 18923571 DOI: 10.1139/h08-063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The duration of the numerous weight-loss studies that combine physical activity and diet varies from 3 to 14 months, and these studies have often considered pre- and postmenopausal women separately. The purpose of this study was to compare the effects of a 3-week weight-reducing program that combines caloric restriction and exercise on the metabolic profile, eating behaviors, and perceived health of sedentary obese pre- and postmenopausal women, after adjustment for age. In 10 pre- and 22 postmenopausal women, before and after weight loss, body composition, fasting lipid-lipoprotein profile, glucose and insulin levels, eating behaviors, and perceived health state were assessed. Body mass index, fat mass, and waist girth decreased after weight reduction in both groups (p < 0.0001). Reductions in fasting serum cholesterol and low-density lipoprotein-cholesterol levels were greater in pre- than in postmenopausal women (p < 0.0001), whereas triacylglycerol, glucose, and high-density lipoprotein-cholesterol levels decreased similarly in both groups (p < 0.05). Neither fasting insulin nor free fatty-acid concentrations were modified after weight loss in either group. Disinhibition (p < 0.005) and hunger scores on the three-factor eating questionnaire (TFEQ) (p < 0.05) and the state-anxiety score on the state-trait anxiety inventory (STAI) questionnaire (p < 0.0005) decreased in both groups, but restriction (TFEQ) increased (p < 0.01) and trait anxiety (STAI) decreased (p < 0.001) after weight reduction only in premenopausal women. Improvements in selected lipid-lipoprotein indices, eating behaviors, and perceived health-state components were better in pre- than in postmenopausal women, suggesting that menopausal status has an influence on some metabolic and behavioral responses to weight loss.
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Affiliation(s)
- Eléonor Riesco
- UFR STAPS, Universite Paul Sabatier, 118, Route de Narbonne, Toulouse 31062, France
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Yankura DJ, Conroy MB, Hess R, Pettee KK, Kuller LH, Kriska AM. Weight regain and health-related quality of life in postmenopausal women. Obesity (Silver Spring) 2008; 16:2259-65. [PMID: 18719654 DOI: 10.1038/oby.2008.345] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Weight loss improves health-related quality of life (HRQoL). However, regain after loss is common; little is known about the impact of weight regain on HRQoL in postmenopausal women. Woman on the Move through Activity and Nutrition (WOMAN) is a randomized lifestyle intervention trial of diet, physical activity, and weight loss in 508 postmenopausal women aged 52-62 years. This analysis focused on the women who lost > or =5 lb during the initial phase of the study, baseline to 6 months (n = 248). This cohort was divided into three groups based on subsequent weight change between 6 and 18 months: weight loss (WL; > or =5 lb loss), weight stable (WS; <+/-5 lb change), and weight regain (WR; > or =5 lb gain). HRQoL was measured at baseline, 6, and 18 months using the Short Form-36. Of the 248 women studied, 51 (21%) continued to lose weight after initial weight loss, while 127 (51%) maintained a stable weight, and 70 (28%) regained weight. Between baseline and 6 months, women in WR group had decreased mental health and social-functioning scores, while the WL and WS groups improved in these subscales. Between baseline and 18 months, energy improved most significantly in those with continued weight loss (P = 0.0003). Weight loss was correlated with a small to moderate improvement in perceived general health and energy, which was reversed by weight gain. Further study is needed to investigate the impact of a decline in mental health and social functioning on future weight regain.
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Affiliation(s)
- David J Yankura
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Qader SS, Shakir YA, Samsioe G. Could Quality of Life Impact the Prevalence of Metabolic Syndrome? Results from a Population-Based Study of Swedish Women: The Women's Health in the Lund Area Study. Metab Syndr Relat Disord 2008; 6:203-7. [DOI: 10.1089/met.2008.0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Saleem S. Qader
- Department of Clinical Science, CRC (UMAS), University of Lund, Malmö, Sweden
- Department of Surgery, Sunderby Hospital, SE 97180 Luleå, Sweden
| | | | - Göran Samsioe
- Department of Clinical Sciences, Lund University, Malmö, Sweden
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Alexander IM, Moore A. Treating vasomotor symptoms of menopause: the nurse practitioner's perspective. ACTA ACUST UNITED AC 2008; 19:152-63. [PMID: 17341283 DOI: 10.1111/j.1745-7599.2006.00206.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This article reviews the pathophysiology of vasomotor symptoms (VMS) of menopause and current management options. DATA SOURCES Current scientific literature. CONCLUSIONS In most menopausal women, loss of ovarian function results in VMS, including hot flashes, night sweats, and mood and sleep disturbances. Hormone therapy (HT) has been the mainstay of VMS treatment for many years, but safety concerns raised by publication of the Women's Health Initiative (WHI) results have dramatically reduced the use of this treatment. Since the WHI published its findings, attention has focused on other novel treatments for menopausal symptoms, including low-dose oral or transdermal HT and agents such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, gabapentin, and clonidine. Many women also use complementary and alternative medications to manage VMS, but little evidence from controlled clinical trials supports their efficacy. IMPLICATIONS FOR PRACTICE The increasing number of alternative treatments for VMS requires improvement in patient-provider communication about treatment risks and benefits, individualization of treatment to meet patient needs and attitudes, and careful follow-up to ensure adherence to potentially effective therapy. Nurse practitioners play a leading role in patient evaluation, discussions, and management to help women achieve control over bothersome VMS that dramatically impact their quality of life.
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Affiliation(s)
- Ivy M Alexander
- Yale University School of Nursing, New Haven, Connecticut 06536-0740, USA.
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A randomized, placebo-controlled trial of the effects of physical exercises and estrogen therapy on health-related quality of life in postmenopausal women. Menopause 2008; 15:613-8. [DOI: 10.1097/gme.0b013e3181605494] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cheng MH, Lee SJ, Wang SJ, Wang PH, Fuh JL. Does menopausal transition affect the quality of life? A longitudinal study of middle-aged women in Kinmen. Menopause 2007; 14:885-90. [PMID: 17429333 DOI: 10.1097/gme.0b013e3180333a58] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the role of menopausal transition and menopausal symptoms in relation to quality of life in a cohort of middle-aged women in Kinmen. DESIGN A total of 734 premenopausal women participated in the baseline study, and 579 women (78.9%) completed a follow-up 2 years later. Quality of life was assessed by the Medical Outcomes Study Short Form-36. Participating women were asked for demographic data, about vasomotor symptoms, and to complete the Medical Outcomes Study Short Form-36 and the Hospital Anxiety and Depression Scale. RESULTS There was no demographic difference between women who remained premenopausal and those who entered perimenopause except for age. Vitality deteriorated no matter whether the women stayed in premenopause or entered perimenopause. In multivariate analysis, only vasomotor symptoms had an adverse influence on role limitation of emotion after adjusting for age, education, menopausal status, baseline cognitive score, and Hospital Anxiety and Depression Scale score. The menopausal transition did not influence the eight domains of the Short Form-36 in the multivariate regression model. CONCLUSION This longitudinal study found no significant effect of menopausal transition on quality of life among Taiwanese women. The decline in the role limitations due to emotional problems was related to vasomotor symptoms.
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Affiliation(s)
- Ming-Huei Cheng
- Department of Obstetrics and Gynecology, Neurological Institute, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan
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Freeman EW, Sherif K. Prevalence of hot flushes and night sweats around the world: a systematic review. Climacteric 2007; 10:197-214. [PMID: 17487647 DOI: 10.1080/13697130601181486] [Citation(s) in RCA: 213] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Many studies have evaluated the relationships between ethnicity and culture, prevalence of menopausal symptoms, and attitudes toward them, but few have assessed menopausal symptoms across cultures world-wide. This paper aims to systematically review the prevalence of hot flushes and night sweats, two prevalent symptoms of menopause, across the menopausal stages in different cultures and considers potential explanations for differences in prevalence rates. DESIGN Sixty-six papers formed the basis for this review. Studies were organized by geographic region, and results are presented for North America, Europe, East Asia, Southeast Asia, Australia, Latin America, South Asia, Middle East, and Africa. Studies were included if they provided quantitative information on the occurrence of hot flushes. This report focuses on hot flushes and night sweats, the most common menopausal symptoms reported in epidemiologic studies. RESULTS Studies reviewed indicate that vasomotor symptoms are highly prevalent in most societies. The prevalence of these symptoms varies widely and may be influenced by a range of factors, including climate, diet, lifestyle, women's roles, and attitudes regarding the end of reproductive life and aging. Patterns in hot flush prevalence were apparent for menopausal stages and, to a lesser degree, for regional variation. CONCLUSIONS Caregivers should recognize that variations exist and ask patients specific questions about symptoms and their impact on usual functioning.
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Affiliation(s)
- E W Freeman
- Department of Obstetrics and Gynecology, University of Pennsylvania 19104, USA
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Chedraui P, Hidalgo L, Chavez D, Morocho N, Alvarado M, Huc A. Quality of life among postmenopausal Ecuadorian women participating in a metabolic syndrome screening program. Maturitas 2007; 56:45-53. [PMID: 16797890 DOI: 10.1016/j.maturitas.2006.05.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 05/16/2006] [Accepted: 05/17/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Quality of life decreases after the menopause as it has been assessed by several designed tools. Despite this, few studies have reported correlations between quality of life and the metabolic syndrome and its determinants. OBJECTIVE Evaluate quality of life and determine factors related to its impairment among postmenopausal Ecuadorian women. METHODS Postmenopausal women that participated in a metabolic syndrome screening and educational program at the Institute of Biomedicine of the Universidad Católica of Guayaquil, Ecuador were interviewed using the Menopause-Specific Quality of Life Questionnaire (MENQOL). Mean domain scores as well as factors associated to higher scores within each of the domains of the questionnaire (vasomotor, psycho-social, physical and sexual) were determined. RESULTS Three hundred twenty-five postmenopausal women (n=325) were surveyed. Mean age of participants was 55.9+/-8.1 years (median: 54 years). Women presented metabolic syndrome, hypertension, hyperglycemia, hypertriglyceridemia and abdominal obesity in 41.5%, 38.8%, 16.6%, 56.9% and 54.2% respectively. Mean scores obtained for each domain were: vasomotor: 3.5+/-2.5 (median 3); psycho-social: 3.7+/-1.5 (median 3.6); physical: 3.8+/-1.2 (median 3.8); sexual: 4.9+/-2.3 (median 5.3). More than 50% of women had scores above the median for each domain of the questionnaire. Logistic regression determined that vasomotor score decreased with age. Abdominal obesity increased the risk of having vasomotor, psycho-social and physical scores above the median. Hypertension and hyperglycemia increased the risk for higher scores within the psycho-social and sexual domain respectively. CONCLUSION In this postmenopausal Ecuadorian population, impairment of quality of life was found to be associated to age and related conditions such as abdominal obesity, hypertension and hyperglycemia.
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Affiliation(s)
- Peter Chedraui
- Institute of Biomedicine, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, PO Box 09-01-4671, Guayaquil, Ecuador.
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Thurston RC, Blumenthal JA, Babyak MA, Sherwood A. Association between hot flashes, sleep complaints, and psychological functioning among healthy menopausal women. Int J Behav Med 2006; 13:163-72. [PMID: 16712434 DOI: 10.1207/s15327558ijbm1302_8] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Self-report data suggest that sleep hot flashes among menopausal women are associated with sleep problems and in turn impaired psychological functioning. However, few studies have examined these relations with physiologic hot flash measures. A total of 41 perimenopausal and postmenopausal women with daily hot flashes underwent nighttime sternal skin conductance monitoring to quantify hot flashes. Participants completed sleep diaries; the Sleep-Wake Experience List (van Diest, 1990); and depression, anxiety, and daily stress measures. Participants experienced a median of 2 physiologically monitored and 1 reported sleep hot flash nightly. Although sleep complaints were significantly and positively associated with psychological functioning, neither sleep complaints nor psychological functioning was significantly related to frequency of physiologically monitored sleep hot flashes. Conversely, results indicate an association between reported sleep hot flashes and acute sleep problems. The frequency of physiologically monitored sleep hot flashes, as opposed to reported sleep hot flashes, may be independent of problems with sleep and mood among menopausal women.
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Affiliation(s)
- Rebecca C Thurston
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina, USA.
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Saadoun K, Ringa V, Fritel X, Varnoux N, Zins M, Bréart G. Negative impact of urinary incontinence on quality of life, a cross-sectional study among women aged 49-61 years enrolled in the GAZEL cohort. Neurourol Urodyn 2006; 25:696-702. [PMID: 16917934 DOI: 10.1002/nau.20245] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS The aim of the study was to analyze the relations between severity of urinary incontinence (UI), defined as involuntary loss of urine considered to be a hygienic or social problem, and quality of life (QoL) among middle-aged French working women enrolled in a cohort study, while taking into account characteristics that may affect this relation. METHODS Data came from self-administered mail questionnaires completed by 2,640 women aged 49-61 years in the GAZEL cohort of utility company employees. The analysis considered social and demographic characteristics, lifestyle, hormone status, and body mass index. We used bivariate and multivariate analysis to study the associations between UI severity (measured by SANDVIK's index) and QoL scales (Contilife, specific for UI, and the generic Nottingham Health Profile). RESULTS The sample included 556 women (21%) with UI. QoL alterations associated with UI severity were observed for all six Contilife dimensions (daily and effort activities, self-image, emotional impact, sexuality, and well-being) and two dimensions of the NHP (pain and physical mobility). These results remain after adjustment for age, BMI, and living arrangements. CONCLUSIONS UI affects QoL even among women from a nonclinical population, and the more severe the UI, the more harmful the effect. These results raise the question of whether UI in its severe forms should be considered a disability because of its negative effects on mobility in daily life.
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Affiliation(s)
- Karim Saadoun
- INSERM, UMR S149, IFR 69, Epidemiological Research on Perinatal Health and Women's Health, Villejuif, France
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Abstract
We address whether the menopausal transition affects health-related quality of life (HRQOL). To do this, we review how HRQOL is defined and measured, present HRQOL findings from the large, population-based studies of menopause, and identify key gaps in knowledge. HRQOL is defined as the value assigned to duration of life as modified by impairments, functional states, perceptions, and social opportunities that are influenced by disease, injury, treatment, or policy. The specific domains of HRQOL include resilience or the capacity to respond to stress, health perceptions, physical functioning, and symptoms. The majority of menopause studies have operationalized HRQOL as frequency and severity of symptoms. Taken together, the findings from 12 cross-sectional reports and 3 longitudinal studies suggest that the perimenopause is associated with higher levels of somatic symptoms. It is unclear whether the perimenopause is related to other domains of HRQOL. Only 1 longitudinal study reported an association between reduced physical functioning and perimenopause. Studies typically compare premenopausal women with women of other menopausal transition status separately, thereby not addressing the question of further change in HRQOL after the cessation of menses. There is a clear need for understanding the effects of the menopause beyond the domain of symptoms and to consider whether some domains of HRQOL may improve.
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Affiliation(s)
- Karen A Matthews
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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Utian WH. Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: a comprehensive review. Health Qual Life Outcomes 2005; 3:47. [PMID: 16083502 PMCID: PMC1190205 DOI: 10.1186/1477-7525-3-47] [Citation(s) in RCA: 264] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 08/05/2005] [Indexed: 01/30/2023] Open
Abstract
Many women experience vasomotor symptoms at or around the time of menopause. Hot flushes and night sweats are considered primary menopausal symptoms that may also be associated with sleep and mood disturbances, as well as decreased cognitive function. All of these symptoms may lead to social impairment and work-related difficulties that significantly decrease overall quality of life. Hot flushes have shown a great deal of variability in their frequency and severity in women. In some women, hot flushes persist for several months; in others, they may last for more than 10 years. Traditionally vasomotor symptoms were reported to begin 5 to 10 years prior to the cessation of the final menstrual cycle, corresponding with the initial decline in circulating gonadal hormones; however, night sweats in particular most often begin in perimenopause. The pathogenesis of hot flushes has not yet been fully elucidated, but the circuitry involving estrogen and neurotransmitters, norepinephrine and serotonin specifically, are hypothesized to play a major role in the altered homeostatic thermoregulatory mechanisms underlying these events. Menopause-associated vasomotor symptoms are associated with significant direct and indirect costs. Overall costs of traditional pharmacotherapy or complementary and alternative medicine modalities, including over-the-counter treatments and dietary supplements, for managing menopause-related vasomotor symptoms are substantial and include initial and follow-up physician visits and telephone calls. Additional costs include laboratory testing, management of adverse events, loss of productivity at work, and personal and miscellaneous costs. Pharmacoeconomic analyses, including those that consider risks identified by the Women's Health Initiative, generally support the cost-effectiveness of hormonal therapy for menopause-associated vasomotor symptoms, which have been the mainstay for the management of these symptoms for more than 50 years. However, because many women now want to avoid hormone therapy, there is a need for additional targeted therapies, validated by results from controlled clinical trials that are safe, efficacious, cost-effective, and well tolerated by symptomatic menopausal women.
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Affiliation(s)
- Wulf H Utian
- North American Menopause Society, 5900 Lander Brook Drive, Mayfield Heights, OH 44124, USA.
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Abstract
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.
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Affiliation(s)
- Karen E Moe
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356560, Seattle, WA 98195-6560, USA.
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Avis NE, Assmann SF, Kravitz HM, Ganz PA, Ory M. Quality of life in diverse groups of midlife women: assessing the influence of menopause, health status and psychosocial and demographic factors. Qual Life Res 2004; 13:933-46. [PMID: 15233507 DOI: 10.1023/b:qure.0000025582.91310.9f] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper examines whether menopausal status is associated with global quality of life (QOL) among women aged 40-55 and whether this association varies by race/ethnicity. We further examine the contributions of other health-related and psychosocial factors to QOL and whether these associations vary by racial/ethnic group. Analyses are based on 13,874 women who participated in the multi-ethnic, multi-race study of mid-aged women called the Study of Women's Health Across the Nation (SWAN). Study participants completed a 15-min telephone or in-person interview that contained questions on a variety of health-related topics. Items of interest for these analyses include global QOL, menstrual history (to assess menopausal status), sociodemographics, health status, lifestyle, and psychosocial variables. Results showed that in unadjusted analyses, early perimenopausal women reported lower QOL compared with premenopausal women, but menopausal status was no longer associated with QOL when analyses were adjusted for other variables. In multivariable models, being married and having low levels of perceived stress were associated with better QOL across all racial/ethnic groups. While there were many consistencies across racial/ethnic groups, we also found that the nature of the associations between QOL and education, marital status, perceived stress and social support varied across racial/ethnic groups.
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Affiliation(s)
- N E Avis
- Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA.
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Avis NE, Ory M, Matthews KA, Schocken M, Bromberger J, Colvin A. Health-related quality of life in a multiethnic sample of middle-aged women: Study of Women's Health Across the Nation (SWAN). Med Care 2003; 41:1262-76. [PMID: 14583689 DOI: 10.1097/01.mlr.0000093479.39115.af] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Relatively little is known about the association between menopause and health-related quality of life (HRQL) across ethnic groups. OBJECTIVES To examine the association between HRQL and early perimenopause and ethnicity, adjusting for health, lifestyle, psychosocial, and sociodemographic factors. RESEARCH DESIGN Questionnaires were administered to pre- and early perimenopausal women. SUBJECTS We studied a cohort of 3302 black, Chinese, Hispanic, Japanese, and white women aged 42 to 52 years from the multisite Study of Women's Health Across the Nation (SWAN). MEASURES We measured HRQL, menstrual regularity, and a variety of covariates. HRQL was assessed with 5 subscales from the Short Form-36; impaired functioning was defined as being in the 25% most impaired on a subscale. RESULTS In unadjusted, but not adjusted, analyses, significantly more early perimenopausal women, as compared with premenopausal women, were classified as having impaired functioning on each of the 5 subscales. For 4 of the subscales, the effect of menopausal status was explained by menopause-related symptoms. There were significant ethnic group differences across all 5 subscales in unadjusted analyses. Ethnicity was no longer significant for the Vitality or Role-Emotional subscales when adjusted for health variables or for the Role-Physical subscale when analyses were adjusted for socioeconomic status, health, lifestyle, or social circumstances. Ethnicity remained significant for the Bodily Pain and Social Functioning subscales, even in adjusted analyses. CONCLUSIONS Early perimenopause is not associated with impaired functioning when adjusted for symptoms. Significant ethnic differences in HRQL exist. Some, but not all, differences can be explained by differences in health, lifestyle, and social circumstances.
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Affiliation(s)
- Nancy E Avis
- Wake Forest University School of Medicine, Department of Public Health Sciences, Winston-Salem, North Carolina 27157-1063, USA.
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Fuh JL, Wang SJ, Lee SJ, Lu SR, Juang KD. Quality of life and menopausal transition for middle-aged women on Kinmen island. Qual Life Res 2003; 12:53-61. [PMID: 12625518 DOI: 10.1023/a:1022074602928] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Although it seems reasonable to suggest that most women experience significant changes in quality of life (QOL) during the menopausal period, few researchers have quantified these changes. A total of 1497 women, aged 40-54 years and living on the island of Kinmen, were recruited for this survey. However, 137 were eliminated leaving 1360 for analysis. Women who used hormonal therapy or who had undergone surgically induced menopause were excluded. The subjects with incomplete data or who exhibited mental retardation or severe psychiatric disease were also eliminated. Univariate analysis demonstrated that, in general, QOL scores were poorer for perimenopausal and postmenopausal status. Comparing pre- and postmenopausal women, significant statistical differences were demonstrated for role limitations due to physical and emotional problems, even after adjusting for age, education level, body mass index, menarche, and chronic illness. A strong association was demonstrated between menopausal symptoms and premenstrual syndrome (PMS). Women with menopausal symptoms and PMS had significantly lower scores on all SF-36 dimensions. The results of this study suggest that poorer health status is experienced by peri- and postmenopausal women compared to premenopausal women.
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Affiliation(s)
- J L Fuh
- The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
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Kravitz HM, Ganz PA, Bromberger J, Powell LH, Sutton-Tyrrell K, Meyer PM. Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition. Menopause 2003; 10:19-28. [PMID: 12544673 DOI: 10.1097/00042192-200310010-00005] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare age-adjusted and ethnic differences in prevalences of sleep difficulty at various stages of the menopausal transition and to determine the relative contribution of other factors, including vasomotor symptoms, sociodemographics, and psychological and physical health factors, to self-reported sleep difficulty in middle-aged women. DESIGN A community-based survey of women's health and menopausal symptoms was conducted between November 1995 and October 1997 at each of the seven US sites participating in the Study of Women's Health Across the Nation. A multiethnic sample of 12,603 Caucasian, African American, Chinese, Japanese, and Hispanic women aged 40 to 55 years was categorized into six groups: premenopausal, early perimenopausal, late perimenopausal, naturally postmenopausal, surgically postmenopausal, and postmenopausal receiving hormone replacement therapy. The women were asked whether they had experienced difficulty sleeping in the past 2 weeks. RESULTS Difficulty sleeping was reported by 38%. Age-adjusted rates were highest in the late perimenopausal (45.4%) and surgically postmenopausal (47.6%) groups. Among ethnic groups, rates ranged from 28% in Japanese women to 40% in Caucasian women. In the multivariate analysis, menopausal status was significantly associated with difficulty sleeping. Ethnicity, vasomotor and psychological symptoms, self-perceived health and health behaviors, arthritis, and education also were significantly associated with difficulty sleeping. CONCLUSIONS These results suggest that stage of the menopausal transition, independent of other potential explanatory factors, is associated with self-reported sleep difficulty. Older age per se was not significantly associated with difficulty sleeping.
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Affiliation(s)
- Howard M Kravitz
- Department of Psychiatry, Rush Medical College, Chicago, IL, USA.
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Laferrère B, Zhu S, Clarkson JR, Yoshioka MRM, Krauskopf K, Thornton JC, Pi-Sunyer FX. Race, menopause, health-related quality of life, and psychological well-being in obese women. OBESITY RESEARCH 2002; 10:1270-5. [PMID: 12490671 DOI: 10.1038/oby.2002.172] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the health-related quality of life (HR-QOL) in African-American (AA) and white (W) obese women. RESEARCH METHODS AND PROCEDURES Participants were 145 obese women (80 AA and 65 W; 87 premenopausal and 58 postmenopausal) who completed the Medical Outcomes Study short form, the Brief Symptom Inventory, the Life Distress Inventory, the Satisfaction With Life Scale, and the Rosenberg Self-Esteem Scale before entering a weight-loss study. The mean age of the subjects was 46.3 +/- 11.1 years and the mean body mass index was 35.2 +/- 4.2 kg/m(2). RESULTS Although AA women were slightly heavier (95.3 +/- 10.3 kg vs. 91.5 +/- 11.6 kg, p < 0.05) and less educated (14.2 +/- 3.7 years vs. 15.7 +/- 3.7 years, p < 0.05) than the W women in the sample, there was no difference between the two ethnic groups in any of the reported HR-QOL variables. Menopausal status had a significant effect on HR-QOL, with premenopausal women being more distressed (p = 0.002), having more limitations in social activity (p = 0.007), and having less vitality (p < 0.001) than the postmenopausal women. This was especially true in the AA women. DISCUSSION These data show no difference in HR-QOL between AA and W obese women and suggest that menopausal status may have an impact on HR-QOL, especially in AA women.
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Affiliation(s)
- Blandine Laferrère
- New York Obesity Research Center, St. Luke's/Roosevelt Hospital Center, New York 10025, USA.
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Tsuritani I, Honda R, Noborisaka Y, Ishida M, Ishizaki M, Yamada Y. Impact of obesity on musculoskeletal pain and difficulty of daily movements in Japanese middle-aged women. Maturitas 2002; 42:23-30. [PMID: 12020976 DOI: 10.1016/s0378-5122(02)00025-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the impact of obesity on musculoskeletal pain and disability, which impairs well-being, associations between body mass index (BMI), frequency of musculoskeletal pain and difficulty of daily movements were assessed in middle-aged women. METHODS Subjects were 709 Japanese women in a community, aged 40-69. Measured BMI, current smoking habits, frequency of pain (pain score)(rarely (0), occasionally (1) or frequently (2)) during the last 1 month at shoulders, neck, upper back, lower back and legs, difficulty of three daily movements: walking continually for more than a half hour, climbing stairs and sitting on the floor with one's legs bent beneath one another, (score for each movement) (rarely (0), occasionally (1) or frequently (2)) by a questionnaire. The summed score was defined as the difficulty score of daily movements (DS) (0-6). RESULTS BMI increased significantly with age. Lower back pain (occasionally or frequently) was the most common symptom (40.3%) in the subjects. There was a peak in prevalence of frequent pain of shoulders at age 50. Pain score for legs and DS increased significantly with age. Higher BMI was related to increased prevalence of frequent leg pain and DS (>or=3), but there were no significant associations between age or BMI, and scores of back pain. DS was correlated significantly with pain scores at shoulders, upper back, lower back and legs. After adjustment for age and smoking habit using a logistic regression analysis, odds ratios for frequent pain at legs and DS (>or=3) were 4.02 (CI: 1.83-8.80) and 2.92 (CI: 1.56-5.47), respectively, in the obese women (BMI>or=26.4, n=61), compared with 401 women with normal BMI (20-24). CONCLUSION Obesity tended to impair well-being through musculoskeletal pain at legs and difficulty of daily movements in Japanese middle-aged women.
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Affiliation(s)
- Ikiko Tsuritani
- Department of Hygiene, Kanazawa Medical University, 1-1 Daigaku, Uchinada, 920-0293, Ishikawa, Japan.
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