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Beshyah SA, Alwatban L, Ekhzaimy A, Mustafa HE, Abdelmannan DK, Merheb M, Bashir M. Management of menopause: a survey of physicians from the Middle East and Africa. Climacteric 2023; 26:455-464. [PMID: 36999573 DOI: 10.1080/13697137.2023.2190509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/14/2023] [Accepted: 03/04/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE This study evaluated physicians' perceptions, practices, confidence, comfort level and prior training in managing menopause. METHODS A survey was conducted of a convenience sample of physicians from the Middle East and Africa (MEA) in 2019. We covered knowledge of symptoms, menopausal hormone therapy (MHT), other menopause management strategies and prior training in menopause medicine. RESULTS Of the 254 participants, 64.2% were seniors in family medicine (36.4%), endocrinology (36.0%), gynecology (15.8%) and internal medicine (13.8%). Fewer than one-third (28.8%) correctly identified the diagnostic criteria of menopause. Almost all recognized vasomotor symptoms (99.5%), vaginal dryness (96.2%) and mood disturbance (94.3%), but to a lesser extent other symptoms. Inconsistency and critical gaps were identified in responses to competence questions on six case studies. They recalled having occasional (43.2%) or no training (19.4%) in menopause medicine and rated their preparedness to treat menopause widely. A total of 66.2% agreed that training is very important. Variation between specialties was identified. CONCLUSION Many physicians recognize the importance of education in menopause management, but their responses revealed critical knowledge gaps that underscored the need for comprehensive, evidence-based menopause management.
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Affiliation(s)
- S A Beshyah
- Department of Medicine, Dubai Medical College, Dubai, UAE
- Department of Endocrinology, Yas Clinic Khalifa City, Abu Dhabi, UAE
- Department of Medicine, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE
| | - L Alwatban
- Department of Family and Community Medicine, King Saud University, Medical City, Riyadh, Saudi Arabia
| | - A Ekhzaimy
- Department of Medicine, Endocrinology Division, King Saud University, Medical City, Riyadh, Saudi Arabia
- Health Plus, Center for Diabetes and Endocrinology, Abu Dhabi, UAE
| | - H E Mustafa
- Health Plus, Center for Diabetes and Endocrinology, Abu Dhabi, UAE
| | - D K Abdelmannan
- Department of PostGraduate Medical Education, Dubai Academic Health Corporation, Dubai, UAE
- Dubai Diabetes Center, Dubai Health Authority, Dubai, UAE
| | - M Merheb
- Department of Endocrinology, Mount Lebanon Hospital, Beirut, Lebanon
| | - M Bashir
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
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Baquedano L, Coronado P, De la Viuda E, Sánchez S, Otero B, Ramírez I, Llaneza P, Mendoza N. Population-based survey on menopausal symptoms and treatment use. Climacteric 2023; 26:47-54. [PMID: 36351874 DOI: 10.1080/13697137.2022.2139598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This article aimed to study the use of menopausal hormone therapy (MHT) among Spanish perimenopausal and postmenopausal women, the presence of menopausal symptoms and the sources of information. METHODS The epidemiological study using a survey included Spanish perimenopausal or postmenopausal women aged between 40 and 70 years in August 2021. RESULTS A total of 1254 women were included. In the postmenopausal group, 86% reported one or more menopausal symptoms; the most frequent was vulvovaginal dryness (57%). Among the symptomatic women, 15.2% used some treatment. Vasomotor symptoms (p = 0.001), vulvovaginal atrophy (p < 0.001) and symptoms related to sexuality (p < 0.001) were associated with greater use of treatments; 2.5% of postmenopausal women used MHT. In the perimenopausal group, 75.1% were symptomatic, hot flashes being the most frequent. Only insomnia was related to greater use of some treatment (p = 0.021); 1.6% of perimenopausal women used MHT. The most common reason for women's rejection of MHT was the fear of side effects, especially cancer. The gynecologist was the most frequently used source of information. CONCLUSIONS Although there is a high prevalence of symptoms, the use of MHT in Spanish perimenopausal and postmenopausal women is very low.
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Affiliation(s)
- L Baquedano
- IIS Aragon, Hospital Universitario Miguel Servet, Zaragoza University, Madrid, Spain
| | - P Coronado
- Instituto de Salud de la Mujer, Hospital Clinico San Carlos, IdISSC, Complutense University, Madrid, Spain
| | - E De la Viuda
- Department of Obstetrics and Gynecology, Hospital Universitario de Guadalajara, Guadalajara, Spain.,Universidad de Alcalá de Henares, Madrid, Spain
| | - S Sánchez
- Department of Obstetrics and Gynecology, Quiron Salud Hospital Universitari General de Catalunya, Barcelona, Spain
| | - B Otero
- Department of Obstetrics and Gynecology, Hospital de Cruces, University of the Basque Country, Bilbao, Spain
| | - I Ramírez
- Salud Sexual y Reproductiva, Unidad de Gestión Clínica Cayetano Roldan, San Fernando, Cadiz, Spain
| | - P Llaneza
- Department of Obstetrics and Gynecology, Hospital Central de Asturias, Faculty of Medicine, Oviedo University, Spain
| | - N Mendoza
- Department of Obstetrics and Gynecology, Faculty of Medicine, Granada University, Spain
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Abstract
OBJECTIVE The use of some forms of hormone therapy (HT) is associated with an increase in mammographic density-a major risk factor for breast cancer. The role of isoflavones, however, is unclear. Here, we quantify the prevalence of HT and isoflavone use among postmenopausal Spanish women, determine associated risk factors, and explore the relationship between these therapies and mammographic density. METHODS This cross-sectional study included 2,754 postmenopausal women who underwent breast cancer screening in seven geographical areas. Mammographic density was evaluated using Boyd's semiquantitative scale. Multinomial logistic regression models were adjusted to assess risk factors associated with both therapies. Ordinal regression models were fitted to study the association between HT and isoflavone consumption with mammographic density. RESULTS The prevalence of ever-use of HT was 12%, whereas that of the current use was 2.3%. Isoflavone lifetime prevalence was 3.7%, and current use was 1.7%. The most common HT types were tibolone and estrogens. Surgical menopause, oral contraceptive use, educational level, population density, and years since menopause were positively associated with HT, whereas body mass index and parity were inversely associated. Mammographic density was not associated with current or past HT use. However, women who reported having consumed isoflavones in the past and those who started their use after menopause had a higher mammographic density when compared with never-users (odds ratio 1.98, 95% CI 1.21-3.25, P = 0.007; and odds ratio 1.60, 95% CI 1.01-2.53, P = 0.045 respectively). CONCLUSIONS Our results show a low prevalence of HT and isoflavone use in postmenopausal Spanish women. In this population, HT use was not associated with mammographic density, whereas some categories of isoflavone users had higher density.
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Cornellana MJ, Harvey X, Carballo A, Khartchenko E, Llaneza P, Palacios S, Mendoza N. Sexual health in Spanish postmenopausal women presenting at outpatient clinics. Climacteric 2017; 20:164-170. [PMID: 28140692 DOI: 10.1080/13697137.2017.1282453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE One of the most common complaints among postmenopausal women is a change in sexual drive. The aim of this study was to assess the current state of sexual health in Spanish postmenopausal women who present at outpatient gynecology clinics. METHOD In this multicenter, observational, cross-sectional, questionnaire-based study, a survey was conducted that included 3026 Spanish postmenopausal women in a routine clinical setting in outpatient gynecology clinics at public and private institutions throughout Spain. We used the Women's Sexual Function questionnaire, which has been validated in Spain. RESULTS In the multivariate analysis, we found that the best indicators of sexual health in postmenopausal women were a higher education (p < 0.001), working or previously worked (p < 0.001), a stable partner (p < 0.001), living in an urban area (p < 0.01), healthy habits and received information about menopause (p < 0.001). CONCLUSION These results indicate that it is important to provide health education and information about menopause and the complaints associated with this period in a woman's life.
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Affiliation(s)
| | - X Harvey
- b Obstetrics and Gynecology , University of Granada , Granada , Spain
| | - A Carballo
- c Complejo Hospitalario de Jaen , Jaen , Spain
| | | | - P Llaneza
- e Obstetrics & Gynecologic , University of Asturias , Oviedo , Spain
| | | | - N Mendoza
- b Obstetrics and Gynecology , University of Granada , Granada , Spain
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Mendoza N, Hernández C, Cornellana MJ, Carballo A, Llaneza P, Harvey X, Palacios S. Factors determining the use of hormonal therapy and phytotherapy in Spanish postmenopausal women. Climacteric 2016; 19:375-80. [DOI: 10.1080/13697137.2016.1183625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- N. Mendoza
- University of Granada, Obstetric & Gynaecology, Granada, Spain
| | - C. Hernández
- University of Granada, Obstetric & Gynaecology, Granada, Spain
| | | | | | - P. Llaneza
- University of Asturias, Obstetrics & Gynecologogy, Oviedo, Spain
| | - X. Harvey
- University of Granada, Obstetric & Gynaecology, Granada, Spain
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Constantine GD, Graham S, Clerinx C, Bernick BA, Krassan M, Mirkin S, Currie H. Behaviours and attitudes influencing treatment decisions for menopausal symptoms in five European countries. Post Reprod Health 2016; 22:112-22. [PMID: 26895640 PMCID: PMC5019289 DOI: 10.1177/2053369116632439] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objective To assess women’s behaviours and attitudes regarding the treatment of menopausal symptoms in five European countries. Study design Women aged ≥45 years in France, Germany, Italy, Spain, and the United Kingdom participated in an internet survey. Completers were those who reported menopausal symptoms and had treated their symptoms. Women were equally stratified by age (45–54 years, 55–64 years, ≥65 years). Main outcome measures Behaviours, attitudes, and experiences regarding treatment of menopausal symptoms. Results Of 3890 peri- to postmenopausal women screened, 67% experienced symptoms and 54% sought either medical input or some treatment concerning their symptoms. Hot flushes, the most common symptom, decreased with age but remained prevalent after age 64. Roughly 75% of women who sought relief consulted a physician, mostly a gynaecologist or a general practitioner (GP) as in the United Kingdom. The decision to seek treatment was influenced by age, number, and severity of symptoms. Approximately 79% visiting a physician received prescription therapy. Of the women who received non-hormone therapy (HT) treatment instead of HT: patients refused HT (20–44%), physicians did not discuss HT (32–46%), or advised against HT (24–43%). Women in the United Kingdom were most familiar with and favorable to HT. Interest in a new HT (34–50%) was higher than use (19–28%). Conclusions Menopausal symptoms are common, persistent, and bothersome, but many fail to seek treatment. Sources and types of treatment vary among age groups and countries. Education regarding women’s attitudes toward treatment should be provided to those physicians who treat menopausal symptoms in each country.
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Affiliation(s)
| | | | | | | | | | | | - Heather Currie
- Department of Obstetrics and Gynecology, Dumfries & Galloway Royal Infirmary, Dumfries, UK
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Tserotas K, Hernandez L, Morera F, Pineda R, Chedraui P. Treatment for the menopause in Central America: use, knowledge, perceptions and attitudes among urban living middle-aged women. Gynecol Endocrinol 2011; 27:504-11. [PMID: 20626238 DOI: 10.3109/09513590.2010.495798] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Data on social and personal aspects of Central America are lacking in relation to hormone therapy (HT) and other treatments for the menopause. OBJECTIVE To gain information regarding the treatment of the menopause (HT/alternative): use, knowledge, perceptions and attitudes among middle-aged Central American women. METHODS A total of 720 urban living women (35-65 years) from six Central American countries (Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica and Panama) were surveyed with a structured questionnaire that included socio-demographic data and information regarding the menopause and its treatment. RESULTS Participating countries displayed significant socio-demographic differences. Forty-one percent of all women were postmenopausal and 5.8% had no education at all. Knowledge regarding menopausal treatment options varied; while 27.2% (196/720) indicated HT as an option a higher rate (36.3%) either did not respond or answered not knowing anything. HT use for the whole sample was rather low 2.7% with differences seen among countries. 13.8% (27/196) indicated to have been on HT but abandoned treatment because of medical indication (51.9%), undesired side effects (29.6%) and costs (11.1%). While more than 50% considered HT served to replace hormones a smaller percentage (<14%) referred HT as bad for health, reduces cancer risk or has many side effects. 9.3% (67/720) acknowledged the existence of phytoestrogens as a menopausal treatment option, considering them as natural estrogens and good for health in 38.8% and 25.4%, respectively. CONCLUSIONS HT use in this mid-aged series was rather low in which the demography of Central America may be related factors. Education to women and physicians should be encouraged.
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Affiliation(s)
- Konstantino Tserotas
- Department of Gynecology and Obstetrics, Complejo Hospitalario Dr. Arnulfo Arias Madrid, Caja del Seguro Social, Panamá, Panamá
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Palacios S, Henderson VW, Siseles N, Tan D, Villaseca P. Age of menopause and impact of climacteric symptoms by geographical region. Climacteric 2010; 13:419-28. [PMID: 20690868 DOI: 10.3109/13697137.2010.507886] [Citation(s) in RCA: 190] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To describe differences in the age of onset of menopause and in the prevalence of climacteric symptoms in different geographical areas. DESIGN Systematic review of published data on onset of menopause and symptoms in Europe, North America, Latin America and Asia. METHODS We identified publications by searching electronic databases, including MEDLINE (1966-October 2009) and EMBASE (1975-October 2009). Primary search criteria were age of menopause and climacteric symptoms. A sensitive analysis that excluded papers without full data was performed. RESULTS The median age at menopause in Europe ranges from 50.1 to 52.8 years, in North America from 50.5 to 51.4 years, in Latin America from 43.8 to 53 years, and in Asia from 42.1 to 49.5 years. The frequency of vasomotor symptoms varies widely depending on the geographical region, selection of criteria, and method of symptom identification. The prevalence of such symptoms ranges from 74% of women in Europe, 36-50% in North America, 45-69% in Latin America and 22-63% in Asia, as reported in different, large, epidemiological studies. CONCLUSION There are wide geographical differences in the prevalence of menopausal symptomatology and some differences in the age of onset of menopause. Both in Asia and Latin America, women of poorer socioeconomic status have significantly earlier onset of menopause. Within a geographical region, there are ethnic differences in menopause symptoms. Given differences in study methodologies, firm conclusions are not possible. However, regional differences in age at menopause and in climacteric symptoms are important to acknowledge and lay the foundation for an informed approach to the management of menopause and an understanding of its impact on women's health in the different regions of the world.
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Affiliation(s)
- S Palacios
- Palacios Institute of Women's Health, Madrid, Spain
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Alwi SARS, Rubiah ZS, Lee PY, Mallika PS, Haizal MNM. Experience of hormone replacement therapy among women of Sarawak, Malaysia. Climacteric 2009; 13:553-60. [DOI: 10.3109/13697130903470319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Castelo-Branco C, Palacios S, Combalia J, Ferrer M, Traveria G. Risk of hypoactive sexual desire disorder and associated factors in a cohort of oophorectomized women. Climacteric 2009; 12:525-32. [DOI: 10.3109/13697130903075345] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Heier M, Moebus S, Meisinger C, Jöckel KH, Völzke H, Döring A, Alte D. Menopausal hormone therapy in Germany. Results of three national surveys from 1997 to 2003. Maturitas 2008; 62:9-15. [PMID: 19028032 DOI: 10.1016/j.maturitas.2008.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 09/25/2008] [Accepted: 10/02/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine regional variations in the prevalence and applied therapy regimes of current menopausal hormone therapy (HT) in Germany. METHODS Three population-based surveys, analysing data of 45-74 years old women, were compared: The Study of Health in Pomerania (SHIP; 1123 participants; northeast Germany, October 1997-May 2001), Cooperative Health Research in the Augsburg Region Survey 2000 (KORA; 1253 participants; south Germany, October 1999-April 2001) and Heinz Nixdorf Recall Study (HNR; 2257 participants; west Germany, December 2000-August 2003). A standardized interview technique provided data on current medication. RESULTS The age-standardized prevalence of HT was 17.0% (95% confidence interval (CI): 14.9-19.1) in SHIP, 25.9% (95% CI: 23.6-28.3) in KORA and 24.7% (95% CI: 22.9-26.4) in HNR. Mean average time of intake of HT was 5.1 (SHIP), 7.5 (KORA) and 10.1 years (HNR). The use of estrogen plus progestogen combinations was equally common in all three surveys with proportions of about 15%, the use of unopposed estrogen in KORA and HNR was twice as high as in SHIP. In all three surveys oral estradiol was taken most often. Transdermal estradiol was preferred by KORA women whereas conjugated estrogens were taken most frequently by HNR women. CONCLUSIONS Compared to northeast Germany HT was more often applied in the south and west of Germany. HT as long-term therapy was more common in West than in East Germany. In each study region there was a specific pattern of used HT components.
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Affiliation(s)
- Margit Heier
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology, Neuherberg, Germany.
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Mfenyana C, DeBeer D, Joubert E, Louw A. Selective extraction of Cyclopia for enhanced in vitro phytoestrogenicity and benchmarking against commercial phytoestrogen extracts. J Steroid Biochem Mol Biol 2008; 112:74-86. [PMID: 18793725 DOI: 10.1016/j.jsbmb.2008.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 08/08/2008] [Accepted: 08/19/2008] [Indexed: 11/23/2022]
Abstract
Previous work established the phytoestrogenicity of "unfermented"Cyclopia (honeybush) extracts. The current study investigated the phytoestrogenicity of four Cyclopia harvestings (M6-9) for preparation of extracts with enhanced phytoestrogenicity for benchmarking against commercial preparations. Two extracts, from M6 (C. subternata) and M7 (C. genistoides), were identified as most phytoestrogenic using estrogen receptor binding, an estrogen receptor response element containing promoter reporter assay, alkaline phosphatase activity, and E-screen. M6 and M7 were sequentially and non-sequentially extracted with five solvents of differing polarities. Additionally, two extracts were prepared in the traditional way of preparing a cup of honeybush tea. The resultant 22 extracts were evaluated for estrogenicity. Select extracts were analysed by high-pressure liquid chromatography (HPLC) and liquid chromatography mass spectrometry (LC-MS). The sequentially extracted M6 methanol extract (SM6Met) had the highest potency and the sequentially extracted M6 ethyl acetate extract (SM6EAc) had the highest efficacy of all the extracts. The HPLC results suggested enrichment of luteolin in SM6EAc and enrichment of an unidentified polyphenol in SM6Met. Benchmarking against four commercial phytoestrogenic preparations suggest that in terms of the assays used, Cyclopia extracts have comparable potency and efficacy to the commercial extracts and thus have potential as marketable phytoestrogenic nutraceuticals.
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Affiliation(s)
- Ciko Mfenyana
- Department of Biochemistry, University of Stellenbosch, Stellenbosch, South Africa
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Leon-Leon P, Chedraui P, Hidalgo L, Ortiz F, Castelo-Branco C. Hormone therapy for the management of the menopause in Ecuador: perception, use and knowledge among middle-aged women. Gynecol Endocrinol 2008; 24:580-5. [PMID: 19012102 DOI: 10.1080/09513590802288234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND There is scant data on social and personal aspects related to the use of menopausal hormone therapy (HT) in Latin America. OBJECTIVES To obtain information regarding menopausal HT, i.e. use, perception, level and sources of knowledge, and to determine factors affecting several of these issues among middle-aged women of Guayaquil, Ecuador. DESIGN A total of 349 women (nursing staff), aged 40 years or more, were included in the present cross-sectional study. Participants completed a structured questionnaire including details related to HT and the reasons for not using it, as well as demographic and psychosocial data. RESULTS Only 50.1% of women considered HT beneficial. Current and former HT use was low (1.7% and 14.3%, respectively) and mean HT duration among former users was short (mean +/- standard deviation: 1.0 +/- 1.4 years). Women responded that the main reasons for not using HT were being asymptomatic (49.0%), non-established menopause (30.4%) and physician's advice (27.2%). Only 28.9% of women considered having enough information regarding HT, whereas a high percentage (93.1%) indicated willingness to participate in educational sessions addressing this issue. For most of the women the main sources of information were physicians, educational sessions and television. Logistic regression analysis determined that women with lower income and HT information did not consider HT beneficial at a higher rate than their counterparts. Premenopausal women and those with lower income were more prone to never HT use. Age and professional level were found to be confounding factors. CONCLUSIONS HT use in this population was low; hormonal status, economic income and level of HT information determined its use and benefit awareness.
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Affiliation(s)
- Patricia Leon-Leon
- Ecuadorian Climacteric & Menopause Society (SECLIM-Nucleo-Guayas), Guayaquil, Ecuador
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Sievert LL, Saliba M, Reher D, Sahel A, Hoyer D, Deeb M, Obermeyer CM. The medical management of menopause: a four-country comparison care in urban areas. Maturitas 2008; 59:7-21. [PMID: 18178044 DOI: 10.1016/j.maturitas.2007.11.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 11/19/2007] [Accepted: 11/21/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the medical management of menopause across urban areas in four countries which differ by level of income and degree of medicalization. METHODS Surveys of health providers who advise women on the menopausal transition were carried out in Beirut, Lebanon (n=100), Madrid, Spain (n=60), Worcester, MA, U.S. (n=59), and Rabat, Morocco (n=50) between 2002 and 2004. Physician characteristics, hormone therapy (HT) prescribing practices, and concerns about the management of menopause were compared across countries using chi(2) and logistic regression analyses. RESULTS Across sites, physicians were generally well informed about HT and thought that symptom alleviation and disease prevention were equally important. They had concerns about risks associated with HT, particularly breast cancer, and in 3 sites where the survey was conducted after the WHI (Beirut, Rabat, and Madrid) physicians changed their practices to prescribe HT less frequently, for shorter durations, or shifted to other medications. There were significant differences across sites in the recommended duration of HT, time spent talking with patients, perceived benefits of HT, tests recommended before prescribing HT, and concern about the risks associated with HT. Physicians in Madrid and Massachusetts were more likely to report that decisions about the management of menopause were difficult, but in all sites the main reason for difficulties was concerns about risks. The results also suggest discrepancies between physicians' perceptions and women's reports about the reasons why women consult at menopause. CONCLUSIONS Prescription patterns and perceived benefits of HT appear to reflect local medical culture rather than simply physician characteristics. The impact of the WHI study was seen in prescribing patterns and concerns about HT. Physicians in all four countries were generally well informed. Financial support: NIH 5 900 000196.
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