Does the menopausal transition affect health-related quality of life?

The effect of oral capsules containing Ocimum basilicum leaf extract on menopausal symptoms in women: a triple-blind randomized clinical trial

BACKGROUND

Menopause, characterized by various physical and mental changes, is primarily caused by hormonal fluctuations, resulting in numerous complications. Recently, herbal treatments have gained significant attention for their minimal side effects compared to chemical drugs. This study aimed to investigate the effects of oral capsules containing Ocimum basilicum leaf extract (OBLE) on menopausal symptoms.

METHODS

This placebo-controlled clinical trial study was conducted in 2020. The research focused on 60 menopausal women referred to Mashhad health centers. Eligible participants were administered either an OBLE 500 mg capsule or a placebo daily for 1 month. Menopause symptoms were evaluated using the Menopause Rating Scale (MRS) before, two weeks, and one month after the intervention. Data were analyzed using SPSS21, independent t, Mann-Whitney, and Friedman tests. A significance level of p < 0.05 was considered significant.

RESULTS

The independent t-test indicated that the mean (SD) scores of menopausal symptoms in both the OBLE and placebo groups were initially similar before the intervention (P = 0.141). Two weeks after the intervention, the menopausal symptom scores were 9.5 ± 3.5 and 11.2 ± 5.6 in the OBLE and placebo groups, respectively (P = 0.163, df = 58, t = 1.4). After one month, the menopausal symptom scores were 6.9 ± 0.3 in the OBLE group and 11.26 ± 0.6 in the placebo group (P = 0.001, df = 58, t = 3.4). This indicates a significant difference between the two groups one month after the intervention, compared to before and two weeks after the intervention. Additionally, there was a significant difference in the scores of the physical and somato-vegetative dimension between the intervention and placebo groups two weeks and one month after the intervention (P < 0.05).

CONCLUSION

The study results suggested that taking OBLE capsules led to a decrease in the scores of menopausal symptoms. This indicates that OBLE can be considered as a safe and cost-effective medicinal plant for alleviating menopausal symptoms among women.

A cross-sectional study of symptoms and health-related quality of life in menopausal-aged women in China

OBJECTIVE

To measure symptoms and health-related quality of life in a cross-sectional cohort of menopausal-aged women in China.

METHOD

A cross-sectional survey was conducted in a general population cohort of 2,000 Chinese females over the age of 45 years. Patients completed the Chinese version of the EuroQol-5D five level (EQ5D5L) health-related quality of life instrument via Personal Digital Assistant. Raw scores were converted to utility tariffs using value sets for China. Statistical analysis included Pearson's chi-square test, z test for multiple comparisons with adjustment by the Bonferroni method, independent-sample t-test, ANOVA, and adjustment by the Tukey method for multiple comparison. Results were considered statistically significant when p < 0.05 and the study was reported according to the STROBE recommendations.

RESULTS

In a cohort of 2000 women, 732 (37%) were premenopausal, 798 (40%) were perimenopausal and 470 (23%) were postmenopausal. Perimenopausal women reported significantly more symptoms (91%) compared to premenopausal (77%) and postmenopausal (81%) women. Health-related quality of life was significantly lower in symptomatic perimenopausal women compared to premenopausal (0.919, p < 0.05) and postmenopausal (0.877, p < 0.05) women. Within each group there was a statistically significant difference between the health-related quality of life of women with symptoms compared to without symptoms.

CONCLUSION

The perimenopausal phase of menopause is associated with significantly more symptoms and significantly lower HRQoL compared to premenopausal and postmenopausal phases.

Effects of Omega-3 Polyunsaturated Fatty Acids Intake on Vasomotor Symptoms, Sleep Quality and Depression in Postmenopausal Women: A Systematic Review

The menopausal transition is often accompanied with distressing manifestations, such as vasomotor symptoms, sleep disruptions, and depressive syndrome. Omega-3 polyunsaturated fatty acids (n-3 PUFAs) have emerged as a potential intervention to alleviate these symptoms. This review aimed to comprehensively assess the impact of n-3 PUFAs supplementation on vasomotor symptoms, sleep quality, and depression among postmenopausal women. We conducted a systematic literature search of randomized controlled trials across the Cochrane Library, Web of Science, PubMed, CINAHL, EMBASE, and SCOPUS databases from inception to August 2023. Among the initial pool of 163 identified studies, nine studies met the inclusion criteria and were incorporated into this systematic review. Notably, four studies detected potential benefits of n-3 PUFAs in improving hot flashes and night sweats. On the contrary, sleep quality outcomes displayed heterogeneity across the studies. Incorporating diverse scales, such as the Hamilton Depression Rating Scale-21, the Patient Health Questionnaire depression scale, and Generalized Anxiety Disorder-7 for depression outcomes, we found inconclusive evidence of n-3 PUFA's impact on depression. Overall, the combined analysis of these studies did not provide substantial evidence to support the efficacy of n-3 PUFAs in improving vasomotor symptoms, sleep quality, and depression. Further well-designed randomized clinical trials with larger participant groups are crucial to validate and generalize these results. Review Registration: PROSPERO registration no: CRD42023421922.

Effects of concurrent exercise on health-related quality of life in middle-aged women

OBJECTIVE

This study aimed to evaluate the influence of a 16-week concurrent exercise program on health-related quality of life in middle-aged women.

METHODS

A total of 150 middle-aged women from the FLAMENCO project (age range 45-60 years) were randomized into a counseling (n = 75) or an exercise (n = 75) group. The exercise group followed a 16-week (3 days/week, 60 min/session) concurrent exercise program (aerobic + resistance training). The counseling group attended conferences on a healthy lifestyle. Participants' health-related quality of life was assessed with the EuroQol plus, a visual analog scale and the 36-item Short Form Health Survey (SF-36), where greater values indicate a better health-related quality of life.

RESULTS

The visual analog scale increased by 9.0% in the exercise group, whereas it only increased by 3.5% in the counseling group (p = 0.040). The SF-36 physical function, physical role, bodily pain, vitality and emotional role increased by 5.5%, 11.3%, 10.8%, 9.6% and 8.9%, respectively, in the exercise group, whereas these only increased by 0.6%, decreased by 0.7% and increased by 1.4%, 3.8% and 0.6% in the counseling group (all p < 0.05).

CONCLUSIONS

Our results suggest that a 16-week concurrent exercise program adapted for midlife women improved their health-related quality of life.

CLINICALTRIALS.GOV IDENTIFIER

NCT02358109. Date of registration: 05/02/2015.

Low Corticosterone Response to Stress in a Perimenopausal Rat Model Is Associated with the Hypoactivation of PaMP Region of the Paraventricular Nucleus and Can Be Corrected by Exogenous Progesterone Supplementation

INTRODUCTION

The transition to menopause is characterized by mood, behavioral and metabolic changes. However, little is known about the changes in adrenal response to stress.

AIMS

The aim of the study was to evaluate, in an animal model of perimenopause induced by 4-vinylcyclohexene diepoxide (VCD), (1) the endocrine and neuronal stress system activity in response to acute restraint stress and (2) the effect of hormonal therapy in this response.

METHODS

Prepubertal female Wistar rats received daily injections (s.c) of oil or VCD (160 mg/kg) for 15 days. On 56th-66th days after treatment onset, the groups to be stressed received s.c implants containing placebo (PL), 17β-estradiol (E2), progesterone (P4), or E2P4. At 80 ± 5 days after VCD/oil injections, stress was applied for 30 min. Blood samples were collected immediately after and 60 min after the end of stress session from the tail tip followed by transcardial perfusion with PFA 4% for the assessment of c-Fos expression in the medial and posterior parvocellular (PaMP and PaPo) subdivisions of the paraventricular nucleus (PVN) and c-Fos/tyrosine hydroxylase in the locus coeruleus (LC) using immunohistochemistry. Control groups were not stressed nor received hormone therapy.

RESULTS

While basal corticosterone levels were similar between VCD-periestropausal and control rats, the secretion in response to stress in the VCD group was lower. This effect was prevented by P4 therapy. Inversely, basal levels of P4 were lower in VCD-periestropausal rats than in the controls, and no differences were found in response to stress between the groups. As expected, 30-min restraint stress increased c-Fos immunoreactivity in all brain areas studied in both control and VCD-periestropausal rats. However, the c-Fos increase in the PaMP region was attenuated. In all areas examined, there were no significant differences in the number of c-Fos-positive neurons across hormonal therapies.

DISCUSSION/CONCLUSION

This is the first study to demonstrate in a perimenopausal rat model that reproductive aging is accompanied by inadequate secretion of corticosterone in response to acute stress in association with the hypoactivation of the PaMP region of the PVN, while adrenal P4 response is preserved. Moreover, P4 therapy was shown to attenuate the effects of progressive ovarian failure on adrenal functioning during stress.

Limitations in functioning in climacteric syndrome: a systematic literature review using the ICF

INTRODUCTION

This study is the first of four preparatory studies in the process to develop an International Classification of Functioning, Disability and Health (ICF) Core Set for climacteric syndrome. The aim was to identify perimenopausal and postmenopausal limitations in functioning reported in the scientific literature.

METHODS

A systematic literature review was performed on MEDLINE, PsycInfo, Embase and CINAHL including publications from 2010 to 2020. Meaningful concepts were identified from the included studies and linked to the ICF using standardized linking rules.

RESULTS

From the 6935 unique publications found, 300 articles were randomly selected for abstract screening and 48 studies met the inclusion criteria. From these, 1836 meaningful concepts were identified and linked to 158 different ICF categories. Most of them could be linked to the ICF chapter 'Body Functions'. Emotional, sleep, energy and drive as well as thermoregulatory functions and sensation of pain were addressed in >80% of all publications.

CONCLUSION

Climacteric syndrome involves all four components of the ICF, but the focus of scientific research lies on limitations in body functioning. Limitations in body structures, activities and participation and environmental factors were less frequently assessed. The ICF is a valuable tool to describe the multidimensional phenotype of climacteric syndrome.

The role of cardiorespiratory fitness on quality of life in midlife women

OBJECTIVE

We aimed to characterize the relationship between cardiorespiratory fitness and quality of life in a sample of healthy midlife women aged 40 to 65 years.

METHODS

Cardiorespiratory fitness was measured with a VO2max test. Quality of life was assessed with the menopause-specific Utian Quality of Life scale (UQOL). The UQOL measures overall quality of life, which comprises health, emotional, occupational, and sexual domains. Simple and multiple linear regression models were built to analyze relationships between cardiorespiratory fitness and overall quality of life as well as the separate UQOL domains.

RESULTS

Forty-nine women with an average age of 52.5 years were included in the analysis. In simple linear models, cardiorespiratory fitness was related to overall (R2 = 0.34, P < 0.001), health (R2 = 0.55, P < 0.001), emotional (R2 = 0.08, P = 0.05), and occupational (R2 = 0.09, P = 0.03) quality of life. In multiple regression models, cardiorespiratory fitness was associated with overall (P < 0.01) and health (P < 0.001) quality of life, after controlling for physical activity, age, body mass index, and time sedentary.

CONCLUSIONS

Higher cardiorespiratory fitness is associated with better quality of life during midlife, particularly in the health domain. Increasing cardiorespiratory fitness may be a useful means to promote quality of life in this population.

Developing an ICF Core Set for Climacteric Syndrome based on the International Classification of Functioning, Disability and Health (ICF)

BACKGROUND

The International Classification of Functioning, Disability and Health (ICF) provides a globally accepted framework for the assessment of problems in functioning in relation to health conditions. ICF Core Sets are internationally accepted shortlists of the most relevant and essential ICF categories that can be used to assess and document the functioning of patients living with specific health conditions.

OBJECTIVES

The objective of this paper is to outline the process of developing an ICF Core Set for Climacteric Syndrome.

STUDY DESIGN

The development of an ICF Core Set follows an established, evidence-based process and will produce a comprehensive and a brief version of the ICF Core Set. The process includes four preliminary studies: 1) a systematic literature review; 2) a multi-center, cross-sectional study in a clinical setting with women 40+ years old; 3) an online expert survey with health professionals involved in caring for the health of women with climacteric syndrome; and 4) a qualitative study with focus groups of women 40+ years old. The results will be integrated at an international consensus conference, where it will be decided which ICF categories will be included in the ICF Core Set for Climacteric Syndrome.

CONCLUSION

An ICF Core Set for Climacteric Syndrome could provide a holistic assessment of limitations in peri- and post-menopausal women and integrate the psycho-social perspective into health care practice. It could further facilitate communication between health care providers, be useful for research and teaching, and support both the transparency and the comparability of information.

Quality of Life among Iranian Postmenopausal Women: A Systematic Review and Meta-Analysis

Menopause can cause mental, physical, vasomotor, and sexual symptoms and problems, which negatively affect the quality of life (QOL). The aim of this study was to systematically evaluate QOL among Iranian postmenopausal women. This systematic review was conducted on cross-sectional studies that were published between 2000 and 2018. An online search to find studies published in English or Persian was conducted in the databases of Web of Science, PubMed, ScienceDirect, Scopus, Google Scholar, Scientific Information Database, Magiran, and IranMedex. Search key terms were "quality of life", "menopause", and "Iran". Fourteen studies were eligible for this study. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used for quality appraisal. The mean and standard deviation of QOL and its domains were extracted from the selected studies. Study data were analyzed using the Review Manager (v. 5.0) and the STATA (v. 12.0) software. The mean of total QOL among 3413 postmenopausal women was 57.89±12.8 (in the possible range of 0–174). The means of its vasomotor, psychosocial, physical, and sexual domains were 7.86±2.14, 19.43±2.05, 40.58±3.33, and 6.71±1.77, respectively. The QOL among Iranian postmenopausal women is nearly higher than the moderate level. The lowest and the highest levels of QOL are related to the physical and sexual domains, respectively. Health authorities need to develop educational interventions to promote postmenopausal women’s QOL, particularly in the physical domain.

Depression during the menopause transition: impact on quality of life, social adjustment, and disability

The impact of depression on quality of life (QOL) and social support has neither been well characterized in clinical samples of women with perimenopausal depression (PMD) nor have the relative contributions of depression and other menopausal symptoms (e.g., hot flushes) to declining QOL been clarified. In this study, we compared QOL measures, social support, and functional disability in PMD and non-depressed perimenopausal women. We evaluated women aged 40-60 years who presented with menstrual cycle irregularity, elevated plasma FSH levels, and met criteria for perimenopause. A structured clinical interview was administered to determine the presence or absence of major and minor depression. Outcome measures included the Quality of Life Enjoyment Scale Questionnaire, the Sheehan Disability Scale, the Global Assessment of Functioning, the Social Adjustment Scale, and the Duke Social Support Index. Kruskal-Wallis tests and ANOVAs were used to compare outcome measures. Ninety women with PMD and 51 control women participated in this study. Women with PMD reported significantly decreased QOL, social support, and adjustment and increased disability compared with non-depressed perimenopausal women. Neither perimenopausal reproductive status alone nor the presence of hot flushes had a significant negative impact on QOL measures. PMD is accompanied by significant reductions in QOL, social support, and disability similar to depression in women at other stages of life. PMD may also contribute to decreased QOL in community- or clinic-based samples of perimenopausal women. It remains unclear whether the clinical characteristics we identified reflect pre-existing risk factors for depression during the perimenopause or the effects of a current depression. Future clinical and treatment studies in perimenopausal women should distinguish depressed women when outcome measures include QOL.

Effects of imparting planned health education on hot flush beliefs and quality of life of climacteric women

OBJECTIVE

The aim of the present study was to determine the effect of imparting planned health education to climacteric women on their beliefs related to hot flushes and on their quality of life.

METHODS

The research was conducted using pretest and post-test semi-experimental models along with a control group. Of 450 women, 255 were randomly selected and invited to participate in the study. Five people did not agree to participate in the study. Three people were also excluded from the study because they did not complete training. The research sample was comprised of 247 climacteric women (121 women in the experimental group and 126 women in the control group) who were <65 years (the average ages of the participants in the experimental group were 50.61 ± 5.54 years and in the control group 50.94 ± 6.03 years), had experienced hot flushes within the past month, were going through the menopause and postmenopause, were not using hormone replacement therapy, and had agreed to participate in the study. Participants were asked to complete a Sociodemographic Questionnaire, the Hot Flush Beliefs Scale, and The Menopause-Specific Quality of Life Questionnaire. Three educational sessions at 2-week intervals were given to the women in the experimental group. The research was supported with an educational booklet prepared by the researchers. Training was not given to the women in the control group. After the education of the experimental group (after about 6 months), women in both groups recompleted the data collection forms, and post-test data were collected.

RESULTS

On all the subscales, the total of the Hot Flush Beliefs Scale, and the average post-test score, the women in the experimental group scored lower than the women in the control group (the average post-test total score in the experimental group was 26.22 ± 10.09 and in control group it was 52.25 ± 15.04; p < 0.001). While the women in the experimental group developed positive beliefs about their hot flushes, the beliefs of the women in the control group remained unchanged. The average post-test score on all the subscales of the Menopause-Specific Quality of Life Questionnaire for the women in the experimental group was lower than that for the women in the control group (p < 0.001; the average post-test score in the experimental group for the vasomotor subscale was 1.78 ± 0.88, for the psychosocial subscale 1.50 ± 0.75, for the physical subscale 1.69 ± 0.63, and for the sexual subscale 2.91 ± 2.06; the average post-test score in the control group for the the vasomotor subscale was 3.80 ± 1.88, for the psychosocial subscale 2.79 ± 1.08, for the physical subscale 3.10 ± 1.04, and for the sexual subscale 2.25 ± 2.11). While the quality of life of the women in the experimental group showed an upward trend, that of the women in the control group remained the same.

CONCLUSION

It was found that planned health education about the climacteric period reduced women's negative beliefs about hot flushes and enhanced their quality of life.

Validation and reliability of the Turkish Utian Quality-of-Life Scale in postmenopausal women

OBJECTIVE

There are a limited number of menopause-specific quality-of-life scales for the Turkish population. This study was conducted to evaluate the validity and reliability of the Turkish Utian Quality-of-Life Scale in postmenopausal women.

METHODS

The study group was comprised of 250 postmenopausal women who applied to a training and research hospital's menopause clinic in Turkey. A survey form and the Turkish Utian quality-of-Life Scale were used to collect data, and the Turkish version of Short Form-36 was used to evaluate reliability with an equivalent form. Language-validity, content-validity, and construct-validity methods were used to assess the validity of the scale, and Cronbach's α coefficient calculation and the equivalent-form reliability methods were used to assess the reliability of the scale.

RESULTS

The Turkish Utian Quality-of-Life Scale was determined to be a valid and reliable instrument for measuring the quality of life of postmenopausal women. Confirmatory factor analysis demonstrates that the instrument fits well with 23 items and a four-factor model. The Cronbach's α coefficient for the quality-of-life domains were as follows: 0.88 overall, 0.79 health, 0.78 emotional, 0.76 sexual, and 0.75 occupational. Reliability of the instrument was confirmed through significant correlations between scores on the Turkish version of the Utian Quality-of-Life Scale and the Turkish version of the Short Form-36 (r = 0.745, P < 0.001).

CONCLUSIONS

This research emphasizes that the Turkish Utian Quality-of-Life Scale is reliable and valid in postmenopausal women-it is a useful instrument for measuring quality of life during menopause.

Serbian version of the Women's Health Questionnaire: psychometric properties

OBJECTIVE

The aim of this study was to translate the Women's Health Questionnaire (WHQ) into the Serbian language and assess its validity and reliability in a population of Serbian menopausal women.

METHODS

The study included peri- and postmenopausal women from two Community Health Centers in Belgrade. Women filled out the WHQ, the Short Form-36 questionnaire (SF-36) and Beck's Depression Inventory (BDI). The WHQ was translated according to recommended methodology for cultural adaptation of questionnaires and its psychometric characteristics (internal consistency, inter-rater reliability, factor analysis, sensitivity, discriminant, construct and criterion validity) were tested.

RESULTS

In the Serbian population, the mean values of the WHQ domains were mostly comparable with reference Mediterranean countries. Whole-scale Cronbach's α was 0.838. Moreover, five WHQ domains had a value of Cronbach's α above the acceptable limit. There were no significant differences in WHQ scores between our two investigators. On exploratory factor analysis, we obtained ten factors (two items formed a new factor - 'Menstrual pathology'). Almost all SF-36 domains were significantly associated with WHQ domains, while the BDI was associated with domains: depressive mood, anxiety and sleep problems. Based on ROC analysis, WHQ is slightly more reliable for perimenopausal than postmenopausal Serbian women.

CONCLUSION

The Serbian version of the WHQ showed very good reliability and validity in assessment of quality of life among menopausal women. The WHQ is applicable for both peri- and postmenopausal women.

Menopause and age-driven changes in blood level of fat- and water-soluble vitamins

OBJECTIVE

The purpose of this cross-sectional study was to assess the association of the menopausal transition with changes in vitamins.

METHODS

The study group comprised women aged 17-85 years from the Third National Health and Nutrition Examination Survey (NHANES), which was conducted between 1988 and 1994, and from the NHANES surveys conducted between 1999 and 2006. Menopausal status was defined using the time since the last period, < 2, 2-12, and > 12 months, for the pre-, peri-, and postmenopause, respectively. The data-cleaning technique employing serum follicle stimulating hormone activity resulted in pre-, peri- and postmenopausal samples encompassing the following age brackets: 17-50, 42-51, and 46-85 years. Statistical inferences were analyzed using non-parametric techniques.

RESULTS

Significant increases in vitamin A and vitamin E concentrations across all phases of the menopausal transition were observed. There was a gradual decrease in the vitamin C concentration across all stages of the menopause but a fairly stable concentration of vitamin B12. There was a statistically significant increase in vitamin D between the pre- and postmenopause. Body mass index correlated negatively with serum vitamin concentration in the pre- and postmenopause.

CONCLUSIONS

Vitamin A should be supplemented in postmenopausal women to decrease the risk of bone fracture. The daily diet should be supplemented with vitamin B12, to avoid possible neurological symptoms due to vitamin B12 deficiency, and with vitamin D to decrease the risk of developing secondary hyperparathyroidism. Due to an adverse influence on serum vitamin concentration, body mass index should be monitored in pre- and postmenopausal women.

Physical activity and change in quality of life during menopause--an 8-year follow-up study

Background and objectives

The aim of this study was to study the role of menopausal status and physical activity on quality of life.

Methods

A total of 1,165 Finnish women aged 45-64 years from a national representative population-based study were followed up for 8 years. Study participants completed the Health 2000 study questionnaire and follow-up questionnaire in 2008. Ordinal logistic regression analysis was used to measure the effect of menopausal status on global quality of life (QoL). Other variables included in the analyses were age, education, change of physical activity as assessed with metabolic equivalents, change of weight and hormone therapy (HRT) use.

Results

Peri- and postmenopausal women increased their physical activity (28% and 27%) during the eight-year follow up period slightly more often than premenopausal (18%) women (p = 0.070). Menopausal status was not significantly correlated with change of QoL. QoL of the most highly educated women was more likely to improve than among the less educated (e^b = 1.28, 95%CI 1.08 to 1.51 p = 0.002). Women whose physical activity increased or remained stable had greater chances for improved QoL than women whose physical activity decreased (e^b = 1.49, 95%CI 1.23 p < 0.001 to 1.80, e^b = 1.46, 95%CI 1.24 to 1.73 p < 0.001 respectively). Women whose weight remained stable during follow-up also improved their QoL compared to women who gained weight (e^b = 1.26, 95%CI 1.07 to 1.50 p > 0.01). Women who had never used HRT had 1.26 greater odds for improved QoL (95%CI 1.02 to 1.56 p = < 0.05).

Conclusion

Improvement of global QoL is correlated with stable or increased physical activity, stable weight and high education, but not with change in menopausal status.

Influence of habitual physical activity on the symptoms of climacterium/menopause and the quality of life of middle-aged women

AIM

To analyze the influence of the duration of habitual physical activity (PA) on the symptoms of climacterium/menopause and on several domains of the health-related quality of life (QOL) in middle-aged women.

METHODS

One hundred and four 45- to 59-year-old women were placed into three groups: group A, subjects who maintained PA less than 30 minutes/day; group B, subjects who maintained or began to perform PA 30-60 minutes/day; and group C, subjects who maintained or increased PA to more than 60 minutes/day. Symptoms of menopause, QOL (physical, psychological, and social), and PA were assessed through the Kupperman Menopausal Index, World Health Organization Quality of Life Brief Version questionnaire, and International Physical Activity Questionnaire, respectively.

RESULTS

The analysis of covariance (ANCOVA) results, adjusted for age, initial body mass index, schooling years, hormonal replacement therapy, and the number of diseases, indicated that the women who maintained or increased their total habitual PA to more than 60 minutes/day had reduced symptoms of climacterium/menopause (-5.4 ± 0.5; P = 0.001) and improved QOL in the psychological (4.4% ± 0.8%; P = 0.001) and social domains (2.0% ± 0.9%; P = 0.035). ANCOVA revealed a further improvement of approximately 5% in the psychological domain of QOL in group C, who also experienced decreased menopause symptoms (P = 0.001) and lost weight (P = 0.009).

CONCLUSION

The habitual practice of at least moderate-intensity PA for 60 minutes/day has a favorable effect on climacterium/menopause symptoms and on QOL, particularly on its psychological and social domains. The influence of habitual PA at the psychological level seems to be at least partially associated with a decrease in menopause symptoms and/or weight loss.

Atividade física habitual e qualidade de vida de mulheres na meia-idade

OBJETIVO: Analisar a relação entre a atividade física habitual (AF) e a qualidade de vida (QV) de mulheres na meia-idade. MÉTODOS: Participaram do estudo 1.011 mulheres dos 45 aos 59 anos de idade, das quais 370 eram perimenopausadas e 641 pós-menopausadas, com índice de massa corporal (IMC) de 25 ± 4kg/m² e escolaridade entre um e 13 anos. A QV foi avaliada pelo WHOQOL-bref da WHO e a AF através do International Physical Activity Questionnaire. RESULTADOS: Após a divisão da amostra em três grupos, de acordo com a prática de AF total (A: < 30 min/dia; B: 30-60 min/dia; C: > 60 min/dia), a análise da variância ajustada para o IMC e menopausa (peri vs. pós), mostrou diferenças de QV entre os grupos A e B e o grupo C no domínio físico, e entre o grupo A e os grupos B e C nos domínios psicológico, social e ambiental (p ≤ 0,001). CONCLUSÃO: A prática de 30 min/dia de AF de intensidade pelo menos moderada parece estar associada a efeitos mais favoráveis aos níveis psicológico, social e ambiental, mas parecem ser necessários pelo menos 60 min/dia para influenciar o domínio físico. Estas associações podem, no entanto, refletir o impacto da QV na quantidade total de AF. Assim, a prática de 30 min/dia pode ser mais condicionada pelos domínios psicológico, social e ambiental, enquanto os 60 min/dia pelo domínio físico.

Effect of exercise combined with phytoestrogens on quality of life in postmenopausal women

BACKGROUND

Postmenopausal women seem to favor alternative therapies such as exercise and phytoestrogens as a substitute for potentially harmful hormone replacement therapy. Based on previous research, we hypothesized that phytoestrogens combined with exercise could have a synergic effect on women's health.

OBJECTIVE

To verify whether phytoestrogens enhance the response to mixed training regarding menopausal symptoms and quality of life in postmenopausal women.

METHODS

From a pool of women participating in a 6-month randomized, controlled exercise study, 21 received a placebo (mean age 58.3 ± 5.4 years, body mass index 29.8 ± 5.1 kg/m(2)) and 19 received phytoestrogen supplements (mean age 60.1 ± 3.4 years; body mass index 30.3 ± 4.6 kg/m(2)). Body weight, fat mass and lean body mass (dual-energy X-ray absorptiometry) were assessed. Quality of life was estimated by the Short Form-36 (SF-36) and Perceived Stress Scale-10 (PSS-10) questionnaires, and menopausal symptoms by the Kupperman index. All measurements were performed before and after the intervention.

RESULTS

Although the Kupperman index and PSS-10 remained unchanged in both groups, the SF-36 Physical Component Summary and almost all the SF-36 subscales (except for role-emotional and mental health) increased only in the exercise group taking phytoestrogens (0.001 < p < 0.04).

CONCLUSION

While phytoestrogens combined with mixed exercise were not sufficient to improve menopausal symptoms, it seemed to be a better strategy than exercise alone to improve the general quality of life in postmenopausal women.

Measurement of Quality of Life in Menopausal Women

Use of a wide variety of quality of life (QoL) instruments, each measuring a different aspect of menopause with a different type of underlying scale, has been a major problem in menopause research. The aim of this review was to identify instruments developed for menopausal women and evaluate the psychometric properties and appropriateness of instruments for the study of QoL in menopausal women. Seven measures from 16 papers were chosen for the review. The psychometric evaluations were conducted based on quality judgment criteria. Of the seven measures reviewed in this study, the psychometric quality scores of Women’s Health Questionnaire (WHQ) was the highest. However, the result indicates that most instruments of menopause-specific QoL need further testing and evaluation of the various aspects of their psychometric properties. In addition, future research assessing psychometric properties with cross-cultural samples may be beneficial in adapting measures to specific context and study populations.

Psychometric evaluation of the Midlife Women's Symptom Index in multiethnic groups

The Midlife Women's Symptom Index (MSI) was designed to measure menopausal symptoms specifically in a multiethnic sample of midlife women. This study involved a psychometric property test to evaluate MSI among 512 multiethnic groups of midlife women (White, Hispanic, African American, and Asian American). Across the ethnic groups, the MSI had an adequate internal consistency in all subdomains except psychosomatic symptoms. The item-total correlation coefficients of lost weight and nosebleeds were lower than .20 among all ethnic groups. The discriminant validity was confirmed among all ethnic groups except Asian Americans. Overall, the MSI may work better for Whites compared with other ethnic groups. Additional studies with diverse groups of multiethnic midlife women are needed, however, to confirm the psychometric properties of the MSI because the samples tended to be a select group.

Severity of menopausal symptoms of Jordanian women

INTRODUCTION

Menopause is a transitional period that every woman goes through if she lives beyond the age of 52 years. The health care of women during this stage requires special attention to the identification of their health needs in order to provide competent care. The aim of the study was to assess severity of symptoms related to the menopausal period and to describe the differences in severity of menopausal symptoms according to menopausal status.

METHODS AND DESIGN

A descriptive cross-sectional design was used. Data were collected from 350 Jordanian women using a self-administered questionnaire consisting of a sociodemographic, medical and obstetrical history form and the Greene Climacteric Scale.

RESULTS

Results on the severity of menopausal symptoms showed that 15.7%, 66.9% and 17.4% were experiencing severe, moderate and mild menopausal symptoms, respectively. Vasomotor signs were reported to have the highest scores for severity as manifested by hot flushes and night sweating. In addition, women in the perimenopausal period complained more frequently of menopausal symptoms compared to premenopausal and postmenopausal women, except for vasomotor and sexuality symptoms for which postmenopausal women reported higher scores. There was a significant relationship between the severity and occurrence of menopausal symptoms and age, family income, level of education, number of children, perceived health status and menopausal status.

IMPLICATIONS

The study has implications for research, practice and education. Health-care providers need to play a more visible and instrumental role in continuously assessing menopausal women's needs as well as to implement appropriate health educational programs. Further research addressing women's health needs is also essential for improving the quality of life of menopausal women in Jordan.

Correlates and predictors of self-rated health and ambulatory status among elderly women - Cross-sectional and 10 years population-based cohort study

AIM

To investigate the correlates and predictors of self-rated health (SRH) and self-reported ambulatory status (AMB) among elderly women.

SUBJECTS AND METHODS

A random sample of 1620 postmenopausal women aged 53-66 years in 1994 was selected from Osteoporosis Risk Factor and Prevention (OSTPRE) - study cohort in Finland. SRH and AMB were assessed in baseline (1994) and after 10-year follow-up (2004). A prognostic model was developed to predict the probability of good 10-year SRH and AMB.

RESULTS

Full AMB was correlated with and predicted by good SRH (OR=4.3, p<0.001). Good quality of life (QoL) was both correlate and predictor of good 10-year SRH (OR=2.0, p<0.001) and full AMB (OR=2.6, p<0.001). Low BMI was associated with good SRH (OR=0.97, p<0.049) and full AMB (OR=0.92, p<0.001), good grip strength with good SRH (OR=2.7, p<0.001) and ability to squat down with full AMB (OR=1.7, p=0.002). Cardiovascular diseases, arthritis and back pain were common significant negative correlates (p<0.001) of baseline AMB and SRH out of variety of chronic diseases with significant association with either one. The significant (p<0.05) baseline predictors in final prognostic model for good 10-year SRH included baseline AMB and SRH, QoL, age, BMI, grip strength and psychiatric diseases (C-index=0.81) and for full 10-year AMB ability to squat, baseline AMB and SRH, QoL, BMI, hypertension and arthritis (C-index=0.81). These risk scores had better predictive power in comparison to that of baseline SRH and AMB alone (p<0.001 in univariate Z-score test).

CONCLUSIONS

Among elderly women AMB is strongly linked to SRH. SRH and AMB are affected mostly by musculoskeletal, cardiovascular and psychiatric diseases as well as body anthropometry, muscle strength and subjective QoL. The present study provides a novel algorithm for predicting probability of full AMB and good SRH in postmenopausal women.

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

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.

Effects of ethyl-eicosapentaenoic acid omega-3 fatty acid supplementation on hot flashes and quality of life among middle-aged women: a double-blind, placebo-controlled, randomized clinical trial

OBJECTIVE

To compare the effects of enriched ethyl-eicosapentaenoic acid (E-EPA) omega-3 fatty acid supplementation with those of placebo on hot flashes (HFs) and quality of life among middle-aged women.

METHODS

Women were considered for participation if they were between 40 and 55 years of age and had moderate to severe psychological distress. A total of 120 women were randomly assigned to E-EPA or placebo for 8 weeks. Only women with HFs were included in this analysis (E-EPA, n = 45; placebo, n = 46). Outcomes were changes from baseline to week 8 postintervention regarding hot flash (HF) frequency (number of HFs per day), intensity and score (frequency x intensity), and Menopause-specific Quality of Life questionnaire scores.

RESULTS

At baseline, the average number of HFs was 2.8 per day. After 8 weeks, HF frequency and score decreased significantly in the E-EPA group compared with the placebo group. There was no difference in the change in HF intensity between groups. Frequency of HFs declined by a mean of 1.58 per day (95% CI, -2.18 to -0.98) in the E-EPA group and by 0.50 per day (95% CI, -1.20 to 0.20) in the placebo group. The odds of being a responder among those taking E-EPA were about three times greater than among those taking placebo (odds ratio, 2.70; 95% CI, 1.03-7.03; P = 0.04). Menopause-Specific Quality of Life scores improved significantly over time in both groups but no significant differences were noted between them.

CONCLUSIONS

Supplementation with E-EPA omega-3 fatty acid reduced HF frequency and improved the HF score relative to placebo. These results need to be confirmed by a clinical trial specifically designed to evaluate HFs in more symptomatic women.

Menopausal symptoms and ethnicity: the Study of Women's Health Across the Nation

A number of studies have suggested that ethnic background influences a woman's perception of her symptoms. The Study of Women's Health Across the Nation (SWAN) is a multiethnic, longitudinal, cohort study of US women that includes non-Hispanic Caucasian, African-American, Chinese, Japanese and Hispanic women. The initial strategy for this seven-site study involved community-based recruitment of non-Hispanic Caucasians at each site, plus one minority ethnic group. Since ethnicity varies with many other factors, measures of education, acculturation, social status, psychological wellbeing and financial strain were all taken into account in interpreting symptom onset, frequency and severity of the common menopausal symptoms. Biological and physical measures were also assessed and related to symptoms. Most symptoms varied by ethnicity. Vasomotor symptoms were more prevalent in African-American and Hispanic women and were also more common in women with greater BMI, challenging the widely held belief that obesity is protective against vasomotor symptoms. Vaginal dryness was present in 30-40% of SWAN participants at baseline, and was most prevalent in Hispanic women. Among Hispanic women, symptoms varied by country of origin. Acculturation appears to play a complex role in menopausal symptomatology. We conclude that ethnicity should be taken into account when interpreting menopausal symptom presentation in women.

Gender differences in gastrointestinal, psychological, and somatic symptoms in irritable bowel syndrome

In the United States, more women than men seek health-care services for symptoms of irritable bowel syndrome (IBS). A number of explanations are given for this gender difference including the higher rates of somatic non-gastrointestinal symptoms and increased psychological distress reported by women with IBS. However, these gender differences are found in studies that rely on retrospective recall with little attention to age or reproductive status. The purpose of the current analysis was to prospectively compare the frequency (days/month of moderate to severe based on a daily diary) of somatic, gastrointestinal (GI), and psychological distress symptoms, in menstruating women (N = 89) and postmenopausal women (N = 66) to men (N = 32) with IBS. In addition, the correlation between daily symptoms and daily report of overall health was evaluated. Postmenopausal women reported significantly more GI pain/discomfort symptoms, especially bloating and abdominal distension, than men, however these differences are greatly attenuated when age is controlled for. Both postmenopausal and menstruating women reported significantly more somatic symptoms (especially joint pain and muscle pain) than men with IBS. The effect was stronger in postmenopausal women, whose somatic symptoms were also higher than menstruating women (P = 0.014). Fatigue and stress were higher in women than men but anxiety and depression were not. All three types of symptoms were strongly correlated with self-rating of health, both across and within-person. Gender-related differences in GI and somatic symptoms are apparent in persons with IBS, more strongly in postmenopausal women. The presence of somatic symptoms in postmenopausal women with IBS may challenge clinicians to find suitable therapeutic options.

Sensitivity and specificity of recalled vasomotor symptoms in a multiethnic cohort

Many epidemiologic studies include symptom checklists assessing recall of symptoms over a specified time period. Little research exists regarding the congruence of short-term symptom recall with daily self-reporting. The authors assessed the sensitivity and specificity of retrospective reporting of vasomotor symptoms using data from 567 participants in the Study of Women's Health Across the Nation (1997-2002). Daily assessments were considered the "gold standard" for comparison with retrospective vasomotor symptom reporting. Logistic regression was used to identify predictors of sensitivity and specificity for retrospective reporting of any vasomotor symptoms versus none in the past 2 weeks. Sensitivity and specificity were relatively constant over a 3-year period. Sensitivity ranged from 78% to 84% and specificity from 85% to 89%. Sensitivity was lower among women with fewer symptomatic days in the daily assessments and higher among women reporting vasomotor symptoms in the daily assessment on the day of retrospective reporting. Specificity was negatively associated with general symptom awareness and past smoking and was positively associated with routine physical activity and Japanese ethnicity. Because many investigators rely on symptom recall, it is important to evaluate reporting accuracy, which was relatively high for vasomotor symptoms in this study. The approach presented here would be useful for examining other symptoms or behaviors.

Weight regain and health-related quality of life in postmenopausal women

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.

Validation of a menopause quality of life scale: the MENCAV scale

OBJECTIVE

To assess the criterion validity, construct validity and test-retest reliability of the MENCAV menopause quality of life scale.

METHODS

Observational, cross-sectional study covering a random sample of 470 women aged 40-60 years. Two questionnaires were administered, namely, the MENCAV, made up of 37 items in 5 dimensions, and the SF-36. A confirmatory factorial analysis was performed, leaving a final scale with 35 items. To evaluate criterion validity, the relationship between the physical and mental health dimensions of both instruments was estimated. Two experts assessed 40 menopausal women and recorded the correlations with the MENCAV. Construct validity was evaluated by comparing the mean scores of menopausal and non-menopausal women for each of the MENCAV dimensions. To assess test-retest reliability, we estimated the correlation between MENCAV scores when the questionnaire was administered on two separate occasions, 2 weeks apart.

RESULTS

The final questionnaire comprised 35 items divided into 5 dimensions. All dimensions displayed high levels of reliability, with Cronbach's alpha values ranging from 0.71 to 0.91, and Cronbach's alpha for the total scale being 0.89. The intraclass correlation was 0.77 (95% CI: 0.61-0.87). Correlations between the questionnaire and the SF-36 were significant; and those with the experts were significant for the physical, mental and sexual dimensions.

CONCLUSIONS

The MENCAV is a valid and reliable questionnaire for assessing quality of life in menopausal women.

Differences in health related quality of life in a sample of Spanish menopausal women with and without obesity

OBJECTIVE

To investigate whether body mass index, abdominal obesity or fat distribution in postmenopausal women influence their quality of Life.

METHODS

A cross-sectional study was carried out on 250 postmenopausal women (age: 50-64 years), with intact uterus and ovaries, sexually active, and non-hormone therapy users. Various anthropometric measurements were considered and a specific health-related quality of life (HR-QoL) instrument, the Cervantes scale, was performed.

RESULTS

Thirty-three women were not included as they refused to participate in the study, had chronic disease such as hypertension, diabetes type 2, depression or did not answer all the scale items, so 217 patients were evaluated. According with BMI values, 34% of women were obese, 46.1% were in overweight, 19.8% were in normal weight and there were not underweight women. Any consistent relation was found between BMI and global values of HR-QoL, but obese women were diagnosed with "high level of problems" in the "psychical domain" and in the "sexuality domain". This difference in "sexuality domain" was also appreciated in women with abdominal obesity. Fat or lean mass was not correlated with HR-QoL.

CONCLUSION

In our study, obesity did not affect the global HR-QoL in Spanish postmenopausal women, but could have an influence on the psychical and sexual domains. Others anthropometric measurements are not associated with changes in HR-QoL. Additional research with HR-QoL specific and validated instruments and with a longitudinal design seems necessary to confirm our results.

Does menopausal transition affect the quality of life? A longitudinal study of middle-aged women in Kinmen

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.

Effect of weight reduction on quality of life and eating behaviors in obese women

OBJECTIVE

To examine the impact of a 3-week weight-reducing program on body composition, physical condition, health-related quality of life, and eating behaviors of sedentary, obese (body mass index, 29-35 kg/m) women, according to menopausal status and menopause duration (<5, >or=5, and >or=10 y).

DESIGN

Thirteen premenopausal and 27 postmenopausal women received a dietary plan of 1,400 +/- 200 kcal/day and completed 110-minute endurance exercise 6 days per week. Body mass index, fat mass, lean mass, distance walked in the Six-Minute Walk Test, health-related quality of life estimated by the 36-item Short Form Health Survey (SF-36), and eating behaviors (restriction, disinhibition, and susceptibility to hunger) assessed by the Three-Factor Eating Questionnaire were determined before and after weight reduction.

RESULTS

Body mass index and fat mass decreased (P < 0.0001), whereas distance walked increased in both groups after weight reduction (P < 0.001). Although the SF-36 mental component score increased after weight loss in both groups (P < 0.0001), the SF-36 physical component score increased in postmenopausal women only (P < 0.001). Restriction increased (P < 0.0001), whereas disinhibition and susceptibility to hunger decreased after weight reduction (P < 0.001 and P < 0.01, respectively) in both groups. Distance walked and SF-36 physical component score after weight loss were higher in women whose menopause ranged between 5 and 9 years and exceeded 10 years, respectively (P < 0.01).

CONCLUSIONS

Our study shows that a short-term weight-reducing program combining caloric restriction and physical activity has a favorable impact on women's body composition, physical condition, health-related quality of life, and eating behaviors irrespective of their menopausal status.

Menopause and determinants of quality of life in women at midlife and beyond

OBJECTIVE

Determinants of quality of life (QoL) in pre- and postmenopausal women including nonhormonal modulators of QoL in adult women are not well understood; there is an ongoing controversy about the impact of menopause on health-related QoL. We investigated the extent to which diverse mental and physical symptoms are associated with (a) menopausal status; (b) sociodemographic, psychosocial, and lifestyle factors; and (c) menopausal hormone therapy (MHT) in adult women after the German reunification in a region of the former German Democratic Republic.

DESIGN

The Study of Health in Pomerania is a cross-sectional, population-based survey. Computer-based structured interviews and self-administered questionnaires were used to capture QoL (Zerssen Symptom List) and sociodemographic parameters, psychosocial, and lifestyle indicators (age, socioeconomic status, abuse, social support, nutrition, body mass index, self-rated health, chronic diseases, and use of MHT) in 1,119 pre- and postmenopausal women with an intact uterus.

RESULTS

Analyses suggest that menopausal status was not associated with QoL. MHT was associated with physical, mental, and gastrointestinal symptoms. Age was a significant predictor for cardiopulmonary symptoms and sensory impairment. The relationship between age and both physical and mental complaints was inverse as was the relationship between age and both mood and gastrointestinal symptoms. Age, socioeconomic status, physical and sexual abuse, perceived social support, nutrition, body mass index, self-rated health, chronic diseases, and MHT modulated QoL.

CONCLUSIONS

Our findings do not support the hypothesis that QoL is reduced after menopause. Differences between pre- and postmenopausal women can be explained by sociodemographic, psychosocial, and lifestyle factors.