Age at menopause in India: A systematic review

Age at natural menopause and its determinants in female population of Kharameh cohort study: Comparison of regression, conditional tree and forests

BACKGROUND

Natural menopause is defined as the permanent cessation of menstruation that occurs after 12 consecutive months of amenorrhea without any obvious pathological or physiological cause. The age of this phenomenon has been reported to be associated with several health outcomes.

OBJECTIVES

This study aimed to estimate the Age at Natural Menopause (ANM) and to identify reproductive and demographic factors affecting ANM.

METHODS

This cross-sectional, population-based study was conducted on 2517 post-menopausal women aged 40-70 years participating in the first phase of the PERSIAN cohort study of Kharameh, Iran, during 2014-2017. To more accurately detect the determinants of ANM, we applied multiple linear regression beside some machine learning algorithms including conditional tree, conditional forest, and random forest. Then, the fitness of these methods was compared using Mean Squared Error (MSE) and Pearson correlation coefficient.

RESULTS

The mean±SD of ANM was 48.95±6.13. Both applied forests provided more accurate results and identified more predictors. However, according to the final comparison, the conditional forest was the most accurate method which recognized that more pregnancies, longer breastfeeding, Fars ethnicity, and urbanization have the greatest impact on later ANM.

CONCLUSIONS

This study found a wide range of reproductive and demographic factors affecting ANM. Considering our findings in decision-making can reduce the complications related to this phenomenon and, consequently, improve the quality of life of post-menopausal women.

An empowerment model for managing menopause

Menopause eventually happens to all people with typically functioning ovaries, and almost one billion women worldwide are postmenopausal. Although the biology of typical menopause is ubiquitous, the experience varies substantially. Factors contributing to the experience include not only individual factors, such as the nature and severity of symptoms, but also psychological, social, and contextual considerations, many of which are modifiable. In this first paper in the Lancet Series on menopause, we argue for a new approach that goes beyond the treatment of specific symptoms, to encompass a broad model to support women transitioning this life stage, using the model of empowerment. WHO defines empowerment as an active process of gaining knowledge, confidence, and self-determination to self-manage health and make informed decisions about care. Rather than focusing on menopause as an endocrine deficiency, we propose an empowerment model that recognises factors modifying the experience, in which the patient is an expert in their own condition and the health-care worker supports the patient to become an equal and active partner in managing their own care.

Association of reproductive factors and exogenous hormone use with distal sensory polyneuropathy among postmenopausal women in the United States: results from 1999 to 2004 NHANES

Postmenopausal status is a risk factor for distal sensory polyneuropathy-the most common type of peripheral neuropathy. We aimed to investigate associations between reproductive factors and history of exogenous hormone use with distal sensory polyneuropathy among postmenopausal women in the United States using data from the National Health and Nutrition Examination Survey 1999-2004, and to explore the modifying effects of ethnicity on these associations. We conducted a cross-sectional study among postmenopausal women aged ≥ 40 years. Women with a history of diabetes, stroke, cancer, cardiovascular disease, thyroid disease, liver disease, weak or failing kidneys, or amputation were excluded. Distal sensory polyneuropathy was measured using a 10-g monofilament test, and a questionnaire was used to collect data on reproductive history. Multivariable survey logistic regression was used to test the association between reproductive history variables and distal sensory polyneuropathy. In total, 1144 postmenopausal women aged ≥ 40 years were included. The adjusted odds ratios were 8.13 [95% confidence interval (CI) 1.24-53.28] and 3.18 (95% CI 1.32-7.68) for age at menarche < 11 years and time since menopause > 20 years, respectively, which were positively associated with distal sensory polyneuropathy; adjusted odds ratios were 0.45 for the history of breastfeeding (95% CI 0.21-0.99) and 0.41 for exogenous hormone use (95% CI 0.19-0.87) were negatively associated. Subgroup analysis revealed ethnicity-based heterogeneity in these associations. Age at menarche, time since menopause, breastfeeding, and exogenous hormone use were associated with distal sensory polyneuropathy. Ethnicity significantly modified these associations.

Urban-rural differences in epidemiology and risk factors of menopause syndrome in middle-aged Chinese women

OBJECTIVE

To compare the prevalence and severity of menopausal symptoms and investigate their associated factors among rural and urban middle-aged Chinese women.

METHODS

A descriptive, cross-sectional study of 4,580 urban and 2,729 rural randomly sampled participants aged 40 to 55 years in Gansu Province, China, was conducted. Questionnaires assessing the sociodemographic information and menstrual and reproductive histories of the participants were administered. The modified Kupperman scale was used to assess the presence and severity of menopausal symptoms. Binary and ordinal logistic regression analyses were performed to identify factors associated with the occurrence and severity of menopausal syndrome, respectively, according to the modified Kupperman Menopausal Index score rank.

RESULTS

The natural menopausal age of the rural women was significantly lower than that of the urban women (rural: 47.22, urban: 47.98; P < 0.05). Furthermore, rural women had a higher prevalence (rural: 56.35%, urban: 43.47%) and severity (rural: 11.40%, urban: 6.61%) of menopausal syndrome than the urban women ( P < 0.05). For both the urban and rural women, the prevalence and severity of most menopausal symptoms increased as menopause progressed. The three most prevalent symptoms in both the urban and rural women were fatigue (rural: 70.43%, urban: 68.19%), muscle/joint pain (rural: 62.84%, urban: 59.32%), and vertigo (rural: 57.42%, urban: 47.44%). Positive associations between menopausal symptoms and age, residence, body mass index, level of education, time of pregnancy, menstrual cycle, and presence of chronic diseases were observed.

CONCLUSIONS

Rural women experience more frequent and severe menopausal syndrome than do urban women.

A Multi-centric retrospective study into the epidemiological distribution of breast cancer patients in India

BACKGROUND

A multicentric private hospital-based retrospective study was conducted to understand the epidemiology of breast cancer in terms of demographics and clinical characteristics (staging and hormone receptor status) at the time of diagnosis.

METHODS

The data for 5,688 female breast cancer patients were collected from the hospital and clinical records of four study centres. All statistical analysis was performed using Microsoft Excel 2016 and R software. Survival was estimated by the Kaplan-Meier method and compared by the log-rank test. A P value of <.05 was considered statistically significant.

RESULTS

The mean and median age of the study population was 52.6 (± 12.4) years and 53.0 (range 51-54 across the four centers) years, respectively. About 68% of patients were in the age category of 41 65 years, 17.6% were <40 years old among whom 23.4% of patients reported a positive family history. Most of the patients (66.3%) were diagnosed at an early stage (Stage I and II). The 3-year OS probability was 100%, 97.5%, 94.1%, and 74.7% for TNM Stages I, II, III, and IV, respectively. The 3-year RFS was 95.7%, 95.5%, 84.5%, and 49% for TNM Stages I, II, III, and IV, respectively.

CONCLUSION

The present study highlights the epidemiological distribution of breast cancer patients. It emphasizes the importance of disease awareness among the urban and educated female population as most patients were diagnosed at earlier stages and demonstrated higher OS and RFS than reported in government registries.

Thyroid Dysfunction: An Alternate Plausibility in Perimenopausal Women!

Introduction

Perimenopause phase of a woman's life is featured by decline in the ovarian activity, predisposing her to several health consequences. The signs and symptoms of thyroid disorders simulate those of menopausal features which may go unnoticed and can cause untoward complications in these women.

Aims and Objective

The primary objective is to screen women of perimenopausal age for thyroid disorders. The secondary objective is to examine the variations in thyroid hormone levels in these women with advancing age.

Materials and Methods

One hundred and forty-eight apparently healthy women between the age group of 46 and 55 years were study subjects. They were divided into, Group I which constituted women between 46 and 50 years and Group II consisted of women between 51 and 55 years. Thyroid profile comprising serum thyroid-stimulating hormone (TSH), serum total triiodothyronine (T3), and serum total thyroxine (T4) were estimated for all the women recruited in the study.

Results

Subclinical hypothyroidism (SCH) and overt hypothyroidism (OH) were detected in 22 and 8 women who constituted 14.9% and 5.4%, respectively, of the total women populace. In Group I, it was noted that 17.1% and 1.8% of women were suffering from SCH and OH, respectively. In Group II, while 8.1% of the women had SCH, 16.2% of women had progressed to OH. TSH levels were significantly higher (P = 0.002) in women of Group II than in Group I, suggesting increase in TSH levels with advancing age.

Conclusion

Screening of perimenopausal women for thyroid disorders will assure timely detection and proper management which will aid in reducing the morbidity and associated complications.