Parsing the ageing Asian woman: Symptom results from the China Study of Midlife Women

Acupuncture for hot flashes in hormone receptor-positive breast cancer, a coordinated multinational study: Rationale and design of the study protocol

BACKGROUND

Acupuncture has been reported to reduce hot flashes in patients with breast cancer undergoing adjuvant hormonal therapy. Although hot flashes are common, the prevalence varies among cultures, races, and ethnicities; the efficacy of acupuncture across cultures has not been investigated.

METHODS

This is a coordinated multinational study, including three parallel randomized trials with a planned analysis of individual patient data, to test the effectiveness of acupuncture on hot flash-related symptoms in hormone receptor-positive breast cancer patients on adjuvant endocrine therapy. Using a standardized acupuncture protocol (total across all three studies of n = 80) versus usual care (total n = 80), symptoms are assessed using changes in the Endocrine Symptom Subscale of Functional Assessment of Cancer Therapy-Endocrine Symptoms. Secondary outcomes include hot flash severity, quality of life, and sleep quality. Differences in response to acupuncture between participants in the three countries will also be explored.

DISCUSSION

Here we describe the design of a protocol for a coordinated multinational study, with attention to the complex considerations in developing a multinational research effort testing a non-pharmacologic intervention. This protocol and approach provide guidance for future efforts to evaluate and test non-pharmacologic interventions across multinational populations.

TRIAL REGISTRATION

clinicaltrials.gov (Identifier: NCT00797732, registered on December 21, 2018), Chinese Clinical Trial Registry (ChiCTR2100045888), and The Clinical Research Information Service (CRIS) of Korea (Registration number: KCT0003618).

Effect of isoflavone supplementation on menopausal symptoms: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND/OBJECTIVES

Complementary and alternative medicines can be used to alleviate climacteric symptoms that significantly affect the quality of life of postmenopausal women. Isoflavones are the most common plant-based therapies for postmenopausal changes, but the results of previous studies have been controversial.

MATERIALS/METHODS

To investigate whether isoflavones would affect menopausal symptoms as well as ovarian hormones, we performed a systematic review and meta-analysis. The PubMed and EMBASE databases were used to perform the systematic search. Included studies were limited to randomized controlled trials (RCTs) assessing the impact of isoflavone supplementation on menopausal symptoms.

RESULTS

Eleven studies were included for the final quantitative assessment. Isoflavone intervention was varied between 49.3 and 135 mg of isoflavones per day for 12 wk-2 yrs. The meta-analysis showed that supplementation of isoflavones significantly increased the estradiol levels (standardized mean difference [SMD] = 0.615, P = 0.035) and Kupperman index (SMD = 3.121, P = 0.003) but had no significant effect on hot flashes, follicle-stimulating hormone, and luteinizing hormone. However, both estradiol and the Kupperman index showed significant heterogeneity among studies (I2 = 94.7%, P < 0.001 and I2 = 98.1%, P < 0.001, respectively).

CONCLUSIONS

Although the results showed a significant SMD in estradiol and the Kupperman index, the results should be interpreted with caution due to the high heterogeneity. Further validation with a larger RCT will be necessary. Overall, isoflavone supplementation has distinct effects on the climacteric symptoms and hormonal changes in postmenopausal women.

Menopause and Midlife Aging in Cross-Cultural Perspective: Findings from Ethnographic Research in China

Based on longitudinal mixed methods ethnographic research conducted in China from the mid-1990s to 2018, this article argues that Chinese lay language use divides what Americans and Canadians refer to as "menopause" into two distinct though overlapping concepts of the narrow juejing or end of menstruation and the broader non-gender-specific gengnianqi or "transition between middle and old age." While comparison with research done by Lock in Japan shows that Japanese language uses a similar set of two overlapping yet distinct terms called heikei and könenki, there are important differences between Chinese and Japanese views and experiences of female midlife amidst the similarities. While views and experiences of juejing in China are very similar to notions of heikei in Japan, gengnianqi is quite different from könenki. Like in Japan, the end of menstruation tends to be welcomed by women in China. Also like in Japan, midlife women in China had a lower prevalence of hot flashes than that found in the US and Canada. Also similar to Japan, Chinese women rarely associate hot flashes with embarrassment. However, unlike in the Japanese sample, the Chinese women reported a higher rate of irritability than even the American and Canadian samples. Contrasting with könenki, which is primarly associated with bodily aches and self-restraint in Japan, gengnianqi is commonly viewed as a time of vulnerability to irritable outbursts which must be allowed, though managed carefully. Overall, I show how menopause and midlife aging as concepts and as lived experiences are subject to variation related to differences in language, cultural ideas and practices, local biologies, and culturally-mediated generational experiences of historical change.

A Cross-Cultural Comparison of Climacteric Symptoms, Health-Seeking Behavior, and Attitudes towards Menopause Among Mosuo Women and Han Chinese Women in Yunnan, China

Cultural *YZ and XZ contributed equally. background has been shown to influence climacteric symptoms of women. This study compares various characteristics of climacteric symptoms, illness conception, health-seeking behavior, and attitude towards menopause of Mosuo women, a Chinese ethnic minority with a matriarchal structure, and Han Chinese women, the majority ethnic group of China with a patriarchal structure. Through convenience sampling, 51 Mosuo and 47 Han women ages 40 to 60 completed a sociodemographic questionnaire, the modified Kupperman Menopause Index (KMI), the Self-Rating Scale of Illness Conception and Health Seeking Behavior (SSICHSB) and the Menopause Attitude Questionnaire (MAQ). The Mosuo and Han Chinese women are comparable with regard to their age, educational levels and menstrual status. During climacteric, Mosuo women showed less severe melancholia ( p = .009), reported less health-seeking behavior ( p = .009), and displayed more positive attitudes towards menopause than their Han Chinese counterparts ( p < .001). One predictive variable of the melancholia severity in Mosuo was "menarche age", while that in the Han group was "social view on the menopause". Future research with a larger sample is needed to deepen our understanding about the interaction between culture and climacteric symptoms.

Cross-cultural study: experience, understanding of menopause, and related therapies in Australian and Laotian women

OBJECTIVE

The aim of this study was to investigate and compare symptom experiences, beliefs, attitudes, and understanding of menopause and menopausal therapies in Australian and Laotian women.

METHODS

This was a cross-cultural, questionnaire-based study involving 108 women (56 Australian women and 52 Laotian women aged 40-65 y) attending outpatient clinics in Australia and Laos. Descriptive statistics and univariate analysis were conducted using Student's t test or Mann-Whitney U test, where appropriate.

RESULTS

Psychological symptoms, depression, vasomotor symptoms, and sexual dysfunction were significantly higher in Australian women compared with Laotian women (P < 0.05). Australian women perceived the meaning of menopause as aging (57%), whereas most Laotian women reported not knowing what menopause meant to them (81%). Australian women's fears about menopause included weight gain (43%), aging (41%), and breast cancer (38%), whereas Laotian women reported not knowing about potential menopausal problems (85%). Exercise (55%), education and awareness (46%), and improving lifestyle (41%) were reported by Australian women as being effective in alleviating menopausal symptoms, with only 21% reporting not knowing what was effective compared with 83% of Laotian women. Many women reported not knowing the risks/benefits of hormonal therapies (50% of Australian women and 87% of Laotian women) and herbal therapies (79% of Australian women and 92% of Laotian women). General practitioners were the most common source of menopause information for both Australians (73%) and Laotians (67%).

CONCLUSIONS

Sociocultural factors influence women's perception of menopause. Psychological symptoms, sexual dysfunction, and vasomotor symptoms are more commonly reported by Australian women than by Laotian women. Women have a limited understanding of the risks/benefits of menopausal therapies, and culturally appropriate education is needed.

Subethnic differences in the menopausal symptom experience of Asian American midlife women

PURPOSE

To compare the menopausal symptom experiences of subethnic groups of Asian American midlife women.

DESIGN

A cross-sectional study among 91 Asian American women online. Questions about background characteristics, ethnic identity, and health and menopausal status, and the Midlife Women's Symptom Index were used. The data were analyzed using descriptive and inferential statistics.

FINDINGS

The most frequently reported and the most severe symptoms differed by subethnicity. The total number of symptoms differed by subethnicity, as did total severity scores for the symptoms.

DISCUSSION

Researchers and clinicians should be aware of subethnic differences.

Comparing TCM textbook descriptions of menopausal syndrome with the lived experience of London women at midlife and the implications for Chinese medicine research

Almost without exception clinical research seeking to evaluate the effectiveness of Chinese medicine relies on TCM textbook knowledge - accessed directly or via practitioners' clinical usage - in order to frame its hypotheses. Recent historical research shows that these textbooks, products of a politically directed process of modernisation, constitute complex hybrids of western and Chinese knowledge that are designed to facilitate the integration of Chinese medicine into biomedically dominated contexts of practice. As such they produce a number of unresolved and generally unacknowledged tensions, such as between the emphasis on local illness experience in the Chinese medical tradition and the universality aspired to by biomedical knowledge. To examine the effect of these tensions we have carried out a study that compares local symptom patterns experienced by post-menopausal women in London with the universal patterns described in TCM textbooks. The results of this study confirm our proposition, namely that the TCM textbook descriptions of disease are not always grounded in clinical experience even if that is what textbooks claim. This raises questions about the relation of textbooks to clinical practice, and about the validity of clinical research based on textbooks and textbook derived normative practice. We argue that only a multidisciplinary approach that includes an understanding of the historical construction of contemporary Chinese medical knowledge and its relation to clinical practice can overcome these problems and enable a meaningful evaluation and utilisation of Chinese medicine in the context of 21st century evidence-based healthcare.

Racial and ethnic disparities in reproductive endocrinology and infertility

This review examines racial and ethnic disparities in reproductive health focusing on 3 key topical areas: (1) infertility, (2) polycystic ovarian syndrome, and (3) reproductive aging. We report that an increasing body of knowledge points toward reduced infertility access and in vitro fertilization outcomes in Asian, black, and Hispanic women compared with white women. There are differences in the reproductive and metabolic phenotypes of Asian, black, and Hispanic women presenting with the polycystic ovarian syndrome compared with white women. Reproductive aging differences appear to exist in all racial and ethnic groups. Awareness of racial and ethnic disparities is critical to a complete understanding of the health issues facing women of reproductive age.

A situation-specific theory of Asian immigrant women's menopausal symptom experience in the United States

In this article, a situation-specific theory that explains the menopausal symptom experiences of Asian immigrant women in the United States is presented. Using an integrative approach, the theory was developed on the basis of the transitions theory, a review of the relevant literature, and a study on Asian immigrant women's menopausal symptom experience in the United States. The proposed theory includes transition conditions, patterns of response, and nursing therapeutics as major concepts and explains the relationships among these major concepts. This theory should be further validated and developed in intervention studies and nursing practice with this specific population.

The treatment of menopausal symptoms by traditional East Asian medicines: review and perspectives

This article provides an overview and critical evaluation of the management of menopausal symptoms by traditional East Asian medicines (TEAMs). For this purpose we utilise an interdisciplinary perspective that draws on social history, medical anthropology, and clinical research. Our goal is threefold. First, we examine the research literature regarding evidence for the effectiveness of TEAMs in the management of menopausal symptoms. The failure of all studies reviewed to address the problematic articulation between tradition and modernity in the case of menopausal syndrome leads us to examine more closely how this connection has been constructed. In the second part of this review we explain how during the late 20th century various TEAMs currents such as traditional Chinese medicine (TCM), Japanese Kampō, and Korean medicine, explored different responses to a biomedically defined disorder, namely menopause, that was until then not discussed in these traditions. Third, based on the findings of the previous sections we make a number of recommendations as to how research in this field might be improved. We argue that while robust evidence for the efficacy of TEAMs in treating menopausal symptoms is currently lacking, existing studies provide sufficient evidence to warrant further research. A new interdisciplinary research framework that takes account of the actual realities of TEAMs practice will be required however for meaningful answers regarding the two most urgent problems in the field to emerge. These are, first the issue of actual treatment effects, and second the more general problem of how TEAMs might be integrated into personalised health care.