Attitudes towards the menopause and hormone therapy over the turn of the century

Prevalence of menopausal symptoms and attitudes towards menopausal hormone therapy in women aged 40-60 years: a cross-sectional study

BACKGROUND

Menopause is a specific physical and psychological transition period for women, during which they experience a series of menopausal symptoms. Menopausal hormone therapy is an important treatment for improving menopausal symptoms. Helping women correctly understand menopausal hormone therapy is a prerequisite for increasing the acceptance and utilization of menopausal hormone therapy by women. Physical examinations are an important method for women to master their own health status and detect potential health problems, and in recent years, an increasing number of women have actively participated in physical examinations. Therefore, this study aims to comprehend the prevalence of menopausal symptoms and attitudes towards menopausal hormone therapy among women aged 40-60 who underwent physical examinations, which would provide a useful reference to reduce the prevalence of menopausal symptoms and improve acceptance of menopausal hormone therapy.

METHODS

This cross-sectional study was conducted at the Health Management Centre of the Affiliated Hospital of Southwest Medical University in Luzhou City, Sichuan Province. The data were collected from 295 women aged between 40 and 60 using convenience sampling. Information on all participants was collected through face-to-face interviews. Participants completed a demographic questionnaire and an attitude towards menopausal hormone therapy questionnaire, and the modified Kupperman index was used to assess the prevalence and severity of participants' menopausal symptoms. The collected data were processed using SPSS and Excel software and analysed using descriptive statistics and logistic regression.

RESULTS

The top 5 menopausal symptoms were insomnia, fatigue, bone and joint pain, sexual dysfunction and emotional instability. Multiple linear regression analysis showed that residence, sexual intercourse frequency, mentality, and physical exercise were the influencing factors of menopausal symptoms. The study showed that 77% of women said they were still reluctant to receive menopausal hormone therapy after experiencing menopause-related symptoms. The main source of menopausal hormone therapy-related knowledge among women was from surrounding menopausal women (62%), and 54% wanted to gain menopausal hormone therapy-related knowledge through a web-based approach.

CONCLUSION

The incidence of menopausal symptoms is higher in women aged 40-60 years, which is related to women's mentality, exercise, and sexual intercourse frequency. In addition, the results of this study indicate that women's knowledge of menopausal hormone therapy is insufficient, which suggests that we need to strengthen health education to improve the acceptance rate of menopausal hormone therapy.

Is menopausal status related to women's attitudes toward menopause and aging?

The objective of this study was to explore the relationship between menopausal status and attitudes toward menopause and aging. We identified 1,400 Bengali Hindu women aged 40-55 years (early perimenopausal n = 445; late perimenopausal n = 240; early postmenopausal n = 285; late postmenopausal n = 430) from West Bengal, India. Information on attitudes toward menopause and aging was collected from March 2009 to July 2012 using ten agree/disagree statements, of which three were positive, four were negative, and the rest were neutral. We used only the positive and negative statements in the analyses. The participants were given three response options for each statement: (1) agreed, (2) disagreed, and (3) felt neutral. Agreement with positive statements and disagreement with negative statements were scored as 3. The converse responses were scored as 1. Neutral responses were not scored. Thus, the total attitude score for each participant ranged from 7 to 21. Additionally, data on sociodemographic and reproductive variables, menopausal symptoms, and perceptions toward menopause were also collected. Multivariable analyses (ANCOVA) showed that postmenopausal women had more positive attitudes toward menopause and aging than perimenopausal women. Providing balanced information about menopause and aging might help to foster positive attitudes toward menopause.

A Turkish study on menarche and menstrual experiences and their effects on attitudes towards menopause

The purpose of this study was to investigate women's menarche and menstrual experiences and their effects on attitudes towards menopause. This research was planned as cross-sectional. A total of 300 women who had applied for a physical examination at the Maternity and Gynecology and Children's Hospital of Ordu province of Turkey were recruited for the study using the convenience sampling method. The study was conducted between 16 April and 28 May 2008. The research data were gathered using the Menopause Attitude Scale and a questionnaire. The average score for women on the Menopause Attitude Scale was 37.85 ± 10.34. Significant differences were found between attitudes of women towards menopause and the information they had received before menarche about menstruation (P = 0.024), the meaning of menstruation (P = 0.014), the interval time between menstrual periods (P = 0.017), problems experienced before menstruation (P = 0.035) and the desire of some women to continue menstruating and delay menopause (P = 0.005). Results of this study showed that more than half of the women had negative attitudes towards menopause. In order to help girls and women develop positive attitudes about menarche, menstruation and menopause, they need to have access to information during all phases of these important physical changes.

Knowledge, perceptions and information about hormone therapy (HT) among menopausal women: a systematic review and meta-synthesis

Background

The use of hormone therapy (HT) by menopausal women has declined since the Women's Health Initiative randomized trial (WHI) in 2002 demonstrated important harms associated with long-term use. However, how this information has influenced women's knowledge and attitudes is uncertain. We aimed to evaluate the attitudes and perceptions towards HT use, as well as specific concerns and information sources on HT since the WHI trial.

Method/Results

We did a systematic review to assess the attitudes and knowledge towards HT in women, and estimate the magnitude of the issue by pooling across the studies. Using meta-synthesis methods, we reviewed qualitative studies and surveys and performed content analysis on the study reports. We pooled quantitative studies using a random-effects meta-analysis. We analyzed 11 qualitative studies (n = 566) and 27 quantitative studies (n = 39251). Positive views on HT included climacteric symptom control, prevention of osteoporosis and a perceived improvement in quality of life. Negative factors reported included concerns about potential harmful effects, particularly cancer risks. Sources of information included health providers, media, and social contact. By applying a meta-synthesis approach we demonstrate that these findings are broadly applicable across large groups of patients.

Conclusions

Although there are clear hazards associated with long-term HT use, many women view HT favorably for climacteric symptom relief. Media, as a source of information, is often valued as equivalent to health providers.

Treatment for the menopause in Central America: use, knowledge, perceptions and attitudes among urban living middle-aged women

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.

Relationships between menstrual and menopausal attitudes and associated demographic and health characteristics: the Hilo Women's Health Study

The objective of this study was to examine the relation of menstrual attitudes to menopausal attitudes and the demographic and health characteristics associated with each. This cross-sectional study consisted of a randomly selected sample of 1,824 respondents aged 16 to 100 years in multi-ethnic Hilo, Hawai'i. Women completed questionnaires for demographic and health information, such as age, ethnicity, education, residency in Hawai'i, menopausal status, exercise, and attitudes toward menstruation and menopause. Women more often chose positive terms, such as "natural," to describe menstruation (60.8%) and menopause (59.4%). In bivariate analyses, post-menopausal women were significantly more likely to have positive menstrual and menopausal attitudes than pre-menopausal women. Factor analyses were used to cluster attitudes followed by linear regression to identify demographic characteristics associated with factor scores. Asian-American ethnicity, higher education, reporting more exercise, and growing up outside of Hawai'i were associated with positive menstrual attitudes. Higher education, older age, post-menopausal status, growing up outside of Hawai'i and having hot flashes were associated with positive menopausal attitudes. Bivariate correlation analyses suggested significant associations between factor scores for menstrual and menopausal attitudes. Both negative and positive menstrual attitudes were positively correlated with the anticipation of menopause, although negative attitudes toward menstruation were negatively correlated with menopause as a positive, natural life event. Demographic variables, specifically education and where one grows up, influenced women's attitudes toward menstruation and menopause and should be considered for inclusion in subsequent multi-ethnic studies. Further research is also warranted in assessing the relationship between menstrual and menopausal attitudes.

Hormone therapy for the management of the menopause in Ecuador: perception, use and knowledge among middle-aged women

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.

Women are periodontally healthier than men, but why don't they have more teeth than men?

OBJECTIVE

Periodontal diseases are more prevalent in men than in women. However, in a population-based epidemiological study, we found that, on average, women have fewer teeth than men. The aim of this study was to test different hypotheses that could explain this obvious paradox.

DESIGN

In 4,290 randomly selected participants from the normal population (Study of Health in Pomerania), we determined diagnostic periodontal parameters, attachment loss, and number of teeth. Behavioral and environmental risk factors were assessed by interviews and questionnaires. Use of estrogens was assessed, and urinary excretion of collagen cross-links was determined.

RESULTS

Multiple regression analyses adjusted for caries and periodontitis revealed that in the women of this population, there is an inverse association between the number of children born and the number of teeth (P < 0.01). This relationship depends on socioeconomic status, bone metabolism, and the use of estrogens. In the group of the youngest (20-40 years), the bone turnover rate is positively related to the number of children born (P < 0.01). In postmenopausal women treated with estrogens, the number of teeth was higher than in men of the same age group. Only in women without hormone treatment were there fewer teeth.

CONCLUSION

The apparent paradox of having fewer teeth despite better periodontal health in women compared with men is related to an increased bone turnover rate and socioeconomic conditions such as low education and low social status. Periodontal health is even worse if these factors are combined.

Attitudes of Bahraini women towards the menopause: implications for health care policy

OBJECTIVES

To assess the attitudes of Bahraini women aged 30-64 years towards the menopause and to examine the relationship between attitudes of Bahraini women towards menopause and their sociodemographic data and reproductive characteristics.

MATERIALS AND METHODS

A cross-sectional study of 260 Bahraini women attending primary health care centers was conducted. A multistage stratified and clustered random sampling technique was used. The women were interviewed using a questionnaire composed of Attitude Towards Menopause scale and sociodemographics.

RESULTS

The mean+/-S.D. of women's age and age at menopause were 45.04+/-9.43 and 48.67+/-2.92 years, respectively. Respondents' median age and median age at menopause were 45.5 and 48.0 years, respectively. Almost half of the women (48.5%) had completed high school or diploma, and 41.5% were currently employed outside home. Over half of the women (53.5%) were premenopausal, 19.6% perimenopausal and 26.9% were postmenopausal. The Mean Average Attitude Score (MAAS)+/-S.D. was 2.4+/-0.26 where the minimum score is 1 indicating very negative attitudes and the maximum is 4 indicating very positive attitudes. Statistically significant differences in means were noted among categories of educational level, menopausal status, and marital status. Moreover, MAAS was positively correlated with age of respondents. Premenopausal women had more negative attitudes towards menopause than peri- or postmenopausal women.

CONCLUSIONS

Bahraini women display a considerable range of attitudes towards the menopause, with their general attitudes ranging from neutral to positive. Postmenopausal women had more positive attitudes towards menopause than premenopausal women. Implications for health care policy were explored in this study.

Knowledge of reproductive physiology and hormone therapy in 53- to 54-year-old Swedish women: a population-based study

OBJECTIVE

To investigate knowledge of hormone therapy (HT), reproductive physiology, and menopause in a population of 53- to 54-year-old women. Further aims were to determine whether the knowledge differed between users and nonusers of HT and between groups with different levels of education.

DESIGN

In 2003, all 53- and 54-year-old women (N = 1,733) in Linköping, Sweden, were sent a questionnaire containing questions about reproductive physiology related to menopause and HT. Answers from 73% of the women were analyzed.

RESULTS

Swedish women had limited knowledge of HT, reproductive physiology, and menopause irrespective of HT use or educational level. Most of the women knew that hot flashes are common around menopause and decreasing estrogen production causes the menopause. They knew little about the effects of progestagens and the effects of HT on fertility. Women with low educational level were more likely to answer the questions by stating that they were unsure than did women with high educational level. Ever-users of HT knew more than never-users about risks and benefits of HT in relation to breast cancer and osteoporosis, and ever-users thought that the risks of thrombosis and myocardial infarction were lower than did never-users.

CONCLUSIONS

Women need improved knowledge of the risks and benefits of HT as well as education about the reproductive system around menopause. This would probably better support and empower women to manage an important period of their lives.

Perceptions and attitudes toward the menopause among middle aged women from Guayaquil, Ecuador

BACKGROUND

Studies reporting the perspective of Latin American women, Ecuador, included, regarding the menopausal phenomena are scarce or lacking.

OBJECTIVES

Obtain information regarding the perception and attitudes toward the menopause among middle aged women of Guayaquil, Ecuador.

METHODS

Women aged 40 or more, nursing staff members of two major associated teaching hospitals of the Universidad Católica de Santiago de Guayaquil, Ecuador, were surveyed with a structured questionnaire containing items intended to assess women's perception and attitudes toward the menopause. Secondarily level of information related to the menopause was explored.

RESULTS

During the study period, 349 women were surveyed of which mean age was 48+/-6.8 years. A 41.3% were postmenopausal, 55% premenopausal and 3.7% had a history of hysterectomy with conserved ovaries. Women more frequently perceived the menopause as a positive event as they agreed that it is a normal (93.7%) and important event (73.6%), that it gives more confidence and maturity (78.8%), that they may fully enjoy sexual relations (74.8%), that there is a relief as the risk of becoming pregnant is null (65.3%) and that life becomes easier and calmer (60.7%). A relatively high rate demonstrated a preoccupying attitude toward the menopause as 79.4% responded to be concerned about it indicating that seeking medical attention was important, moreover, 77.9% responded that health during this phase be taken care of and life styles changed. Less than 50% of surveyed women considered having enough information regarding the menopause whereas a high rate indicated wanting to receive educational sessions related to the menopause. Married and lower educated women were not concerned about the menopause in a higher rate than their counterparts.

CONCLUSIONS

Despite the fact that women perceived the menopause as a positive event, displaying a concerned attitude toward it, their related knowledge was low.