Risk factors related to the presence and severity of hot flushes in mid-aged Ecuadorian women

Prevalencia y caracterización de los síntomas de la menopausia en mujeres climatéricas del Eje Cafetero (Colombia), 2018-2020

Objetivo: determinar la prevalencia y caracterizar los síntomas de la menopausia, en mujeres climatéricas del Eje Cafetero. Materiales y métodos:  estudio de corte transversal; incluyó mujeres mayores de 45 años, residentes en el Eje Cafetero (Colombia), en etapa de climaterio, sexualmente activas y no usuarias de terapia hormonal de la menopausia; entre 2018 y 2020. Se realizó en tres clínicas privadas, de alta complejidad, en las ciudades de Manizales, Pereira y Armenia. Se aplicaron como instrumentos el índice de Kupperman, y el Menopause-Specific Quality of Life questionnaire (MENQOL). Se realizó un muestreo no probabilístico por conveniencia. Resultados: 594 mujeres participaron, con edad promedio de 49,28 ± 6,17 años. Edad media de la menopausia 48,71 ± 4,93 años. La prevalencia de los síntomas de la menopausia fue 71,88 %. La mayoría de las mujeres presentaron sofocos (71,88 %), seguida de irritabilidad (63,13 %) e insomnio (54,88 %). La puntuación del índice de Kupperman en la población total fue 18,58 ± 7,61 puntos. Según el MENQOL los mayores promedios pertenecen a las dimensiones vasomotoras (7,13 ± 2,54) y psicosocial (6,48 ± 2,17); con afectación de la calidad de vida del 68,85 %. Conclusiones: las mujeres climatéricas del Eje Cafetero, presentaron una prevalencia de síntomas de la menopausia próxima a las tres cuartas partes de las participantes, caracterizados principalmente por sofocos e irritabilidad. La mala calidad de vida se atribuye a los síntomas vasomotores. Se hace necesario explorar el impacto del síndrome climatérico durante la atención médica, a fin de ofrecer oportunas soluciones.

Surgical Treatment of a Patient with Recurrent Bleb Leak and Glaucoma: Bleb Excision Combined with Gonioscopy-Assisted Transluminal Trabeculotomy

Here we present a case of intermittent bleb leakage with increased intraocular pressure (IOP) during recovery periods that was treated with gonioscopy-assisted transluminal trabeculotomy (GATT) combined with avascular bleb excision. A 60-year-old woman exhibiting simultaneous leaking bleb and glaucoma underwent GATT and bleb revision. At her final visit, the bleb leakage had resolved and IOP was under control without any further antiglaucoma medication. GATT may be useful for glaucoma patients exhibiting intermittent bleb leakage after failed trabeculectomy.

Cross-cultural analysis of determinants of hot flashes and night sweats: Latin-American immigrants to Madrid and their Spanish neighbors

OBJECTIVE

This study applies a biocultural perspective to better understand the determinants of hot flashes and night sweats within immigrant and local populations in Madrid, Spain.

METHODS

A combined sample of 575 women from Madrid, aged 45 to 55 years, was drawn from two studies. The Spanish sample (n = 274) participated in The Decisions At Menopause Study in 2000-2002. The Latin-American sample (n = 301) was drawn from immigrants to Madrid in 2010-2011. χ(2) analyses and logistic regression models were carried out on the combined sample, controlling for origin of provenance.

RESULTS

Forty-four percent of women reported hot flashes, 36% reported night sweats, and 26% reported both symptoms. Compared with Spanish women, Latin-American women were less likely to report hot flashes (odds ratio, 0.7; 95% CI, 0.4-0.9), after demographic variables and menopause status were controlled for. The same was not found for night sweats and for both symptoms combined. Determinants of hot flashes differed from determinants of night sweats.

CONCLUSIONS

Because their determinants differ, hot flashes and night sweats should be queried and analyzed separately. Latin-American women are less likely to report hot flashes, but not night sweats or both symptoms combined. More research is needed to clarify the differences in reported hot flashes, as the lesser reporting among immigrants could have been a cultural phenomenon rather than a biological phenomenon.

Assessment of insomnia and related risk factors in postmenopausal women screened for the metabolic syndrome

BACKGROUND

Sleep disturbances are common during female mid-life. Nevertheless, there is limited available information linking sleep characteristics to the menopause and the metabolic syndrome (METS).

OBJECTIVE

To assess insomnia prevalence and related risk factors in postmenopausal women screened for the METS.

METHODS

In this cross sectional study 204 natural postmenopausal women participating in a METS screening program filled out the Athens insomnia scale (AIS), the hospital anxiety and depression scale (HADS) and a general socio-demographic questionnaire. Criteria of the Adult Treatment Panel III (ATP-III) were used to define the METS.

RESULTS

Median age of the whole sample was 56 years. A 50.5% of women had the METS, 57.4% hot flushes, 58.3% were abdominally obese, 51.5% hypertension, 25.0% hyperglycemia, 15.7% depressed mood and 29.9% anxiety. A 33.8% presented insomnia according to the AIS (scores 6 or more). The AIS displayed a high internal consistency as computed Cronbach's alpha was determined to be 0.86. Multiple linear regression analysis determined that male premature ejaculation, female psychotropic drug use, hot flush intensity, mood morbidity (higher total HADS scores) and higher parity positively and significantly correlated to higher AIS scores (more insomnia).

CONCLUSION

In this postmenopausal sample insomnia was not related to the METS or its components yet to other psycho-somatic female and partner issues.

A large multinational study of vasomotor symptom prevalence, duration, and impact on quality of life in middle-aged women

OBJECTIVE

The aim of this study was to determine vasomotor symptom (VMS) prevalence, duration, and impact on quality of life in middle-aged women using a validated menopausal tool.

METHODS

The Menopause Rating Scale (MRS) and an itemized questionnaire containing personal sociodemographic data were used to examine 8,373 women aged 40 to 59 years from 22 healthcare centers in 12 Latin American countries.

RESULTS

Less than half (48.8%) of all women studied were postmenopausal, 14.7% used hormone therapy (HT), 54.5% presented VMS of any degree, and 9.6% presented severe/bothersome symptoms. The rate of VMS (any degree) significantly increased from one menopausal stage to the next. HT users presented more VMS (any degree) than did nonusers (58.6% vs 53.8%, P = 0.001). When surgical postmenopausal women were compared, non-HT users displayed a higher prevalence of severe VMS (16.1% vs 9.0%, P = 0.0001). The presence of VMS of any degree was related to a more impaired quality of life (higher total MRS score; odds ratio, 4.7; 95% CI, 4.1-5.3). This effect was even higher among women presenting severe VMS. Logistic regression analysis determined that the presence of severe psychological/urogenital symptoms (MRS), lower educational level, natural perimenopause-postmenopause status, nulliparity, surgical menopause, and living at high altitude were significant risk factors for severe VMS. HT use was related to a lower risk. A second regression model determined that surgical menopause, intense psychological/urogenital symptoms, and a history of psychiatric consultation were factors related to severe VMS persisting into the late postmenopausal stage (5 or more years).

CONCLUSIONS

In this Latin American middle-aged series, VMS prevalence was high, persisting into the late postmenopausal phase in a high rate and severely impairing quality of life. HT use was related to a lower risk of severe VMS.

Prevalence, frequency and problem rating of hot flushes persist in older postmenopausal women: impact of age, body mass index, hysterectomy, hormone therapy use, lifestyle and mood in a cross-sectional cohort study of 10,418 British women aged 54-65

OBJECTIVE

Hot flushes and night sweats (HFs/NSs) are the main menopausal symptoms, but few studies have been adequately powered to examine the dimensions or predictors of experiencing HFs/NSs. We report on these variables in a large UK cohort of postmenopausal women.

DESIGN

Cross-sectional cohort study.

SETTING

UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) cohort.

POPULATION

A cohort of 202,638 postmenopausal women, aged 50-74 years, without oophorectomy, recruited to UKCTOCS between 2001 and 2005.

METHODS

Women completed a follow-up questionnaire, and those aged 54-65 years were mailed a survey in July 2008.

MAIN OUTCOME MEASURES

  Hot flush prevalence and hot flush rating scale.

RESULTS

Of the 15,000 women mailed, 10,418 returned completed questionnaires; 90% had previously had HFs/NSs. Despite being on average 10 years postmenopausal, 54% experienced HFs/NSs (frequency of 33 per week with mean problem rating 4/10) that persisted across the age range. Past hysterectomy (OR 1.50, 95% CI 1.19-1.86), ever having smoked (OR 1.27, 95% CI 1.11-1.46) and alcohol consumption (current units) (OR 1.05, 95% CI 1.01-1.09) predicted ever having had HFs/NSs. Anxiety (OR 3.09, 95% CI 2.57-3.72), hysterectomy (OR 2.74, 95% CI 2.32-3.25), depressed mood (OR 1.57, 95% CI 1.24-1.99), years since last menstrual period (OR 0.95, 95% CI 0.94-0.96) and education (above and below 18 years) (OR 0.98, 95% CI 0.97-0.99) predicted the current prevalence of HFs/NSs. Few predictors of frequency were identified, but problem rating was associated with depressed mood, hysterectomy, skirt size increase and frequency of HFs/NSs. Past hormone therapy users who had discontinued treatment were more likely to have HFs/NSs that were more frequent and problematic.

CONCLUSIONS

To date, this is the largest UK study of the experience of HFs/NSs amongst older postmenopausal women. HFs/NSs are more prevalent in this age band than has previously been assumed. These findings and the associations of smoking, hysterectomy, anxiety, depressed mood and hormone therapy use with the experience of HFs/NSs have implications for prevention and symptom management.

Assessment of self-esteem in mid-aged women

OBJECTIVE

To assess self-esteem and affecting factors in a middle-aged Ecuadorian female population using the Rosenberg Self-Esteem Scale (RSES).

STUDY DESIGN

This was a cross-sectional study in which 149 women (40-59 years) were requested to fill out the RSES and a general socio-demographic form containing personal and partner data.

RESULTS

Mean age of sample was 47.6+/-5.5 years, a 67.8% had less than 12 years of schooling and 33.6% were postmenopausal. At the moment of the survey 2.7% were on hormone therapy, and 2% were taking psychotropic drugs. Mean total RSES score was 26.6+/-3.1 (median 26, range 17-35). A 35.6% and 18.1% of women respectively presented total RSES scores below 26 (median) and 25 (25th percentile) suggesting lower self-esteem. Total scores did not differ when comparing older age, menopausal phases or time since the menopause. Logistic regression analysis determined that women with lower parity and an unhealthy partner were related to lower total RSES scores (below the 25th percentile) suggesting lower self-esteem.

CONCLUSIONS

In this mid-aged series lower self-esteem was not related to the aging process per se yet to socio-demographic female/male aspects. More research is needed in this regard that incorporates other sociological aspects.