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Xia XY, Liu ST, Song ZC, Chen PL, Hu JJ, Zhao W. Current investigation of the high prevalence of sexual dysfunction in female patients with systemic lupus erythematosus: a cross-sectional study. Rheumatol Int 2024:10.1007/s00296-024-05690-6. [PMID: 39153077 DOI: 10.1007/s00296-024-05690-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 08/08/2024] [Indexed: 08/19/2024]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects women of childbearing age and has been reported to cause sexual dysfunction in women. Although there are articles on sexual function in women with SLE, the number of articles is small, and the factors affecting sexual function in women with SLE are controversial. Based on this, this study aimed to investigate the prevalence of sexual dysfunction in Chinese female SLE patients and to explore the factors that influence it. The study design was a cross-sectional study conducted from December 2023 to April 2024 in the Department of Rheumatology and Immunology of a tertiary hospital in Hefei, Anhui Province. A total of 293 female patients diagnosed with SLE were enrolled using face-to-face questionnaires and online questionnaires. The questionnaire consisted of four parts: general information questionnaire, fatigue severity scale (FSS), depression-anxiety-stress scale (DASS-21), and female sexual functioning index (FSFI) scale. A total of 173 (59.04%) patients had sexual dysfunction, including 251 (85.67%) with decreased libido and 186 (63.46%) with difficulty in sexual arousal. There was a correlation between the patients' total FSFI scores and age (p = 0.028), marital satisfaction (p < 0.001), own education level (p = 0.008), partner's education level (p = 0.003), place of residence (p = 0.039), monthly household income (p < 0.001), family financial satisfaction(p < 0.001), menstrual status (p = 0.003), hormone use (p = 0.021),immunosuppressant use (p = 0.042), disease activity (p = 0.016), FSS score (p < 0.001), stress score (p < 0.001), anxiety score (p < 0.001) and depression score (p < 0.001)were correlated. The results of stepwise regression analysis showed that marital satisfaction (b = 2.011, t = 3.797, p < 0.001), monthly household income (b = 0.854, t = 2.316, p = 0.021), menstrual status (b = 1.218, t = 2.350, p = 0.019), fatigue scale score (b = - 0.069, t = - 2.302, p = 0.022), and depression score (b = - 0.117, t = - 2.910, p = 0.004) were the influencing factors of FSFI total score, and the difference was statistically significant. The incidence of sexual dysfunction in Chinese female SLE patients is high, and medical personnel should pay more attention to patients' sexual problems, to provide theoretical and practical bases for further prevention, treatment, and care of sexual dysfunction in female SLE patients.
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Affiliation(s)
- Xue-Ying Xia
- School of Nursing, Anhui Medical University, Hefei, 230601, Anhui, China
| | - Shu-Ting Liu
- School of Nursing, Anhui Medical University, Hefei, 230601, Anhui, China
| | - Zi-Cheng Song
- School of Nursing, Anhui Medical University, Hefei, 230601, Anhui, China
| | - Pei-Ling Chen
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Jia-Jia Hu
- Blood Purification Center, The Second People's Hospital of Hefei, Hefei, 230011, Anhui, China
| | - Wei Zhao
- School of Nursing, Anhui Medical University, Hefei, 230601, Anhui, China.
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Huang F, Fan Y, Tang R, Xie Z, Yang L, Ma X, Liang J, Chen R. Musculoskeletal pain among Chinese women during the menopausal transition: findings from a longitudinal cohort study. Pain 2024:00006396-990000000-00608. [PMID: 38787639 DOI: 10.1097/j.pain.0000000000003283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/28/2024] [Indexed: 05/26/2024]
Abstract
ABSTRACT The profiles of muscle and joint pain throughout the menopausal transition and the factors associated with these symptoms have not been determined. A total of 609 participants from a longitudinal cohort study conducted in an urban Chinese community were enrolled in this study. We assessed the prevalence of musculoskeletal symptoms at different menopausal stages and explored the factors associated with these symptoms. The prevalence and severity of muscle and joint pain increase as menopausal stages progress, and late menopausal transition may be a crucial timepoint that triggers the onset of musculoskeletal pain. The results of the multivariate analysis revealed that poor health status (OR = 2.245, 95% CI = 1.714-2.94, P < 0.001), body mass index (BMI) (OR = 1.046, 95% CI = 1.01-1.084, P = 0.011), the presence of anxiety (OR = 1.601, 95% CI = 1.211-2.117, P < 0.001), and depression (OR = 1.368, 95% CI = 1.143-1.639, P < 0.001) were independently associated with muscle and joint pain. In addition, the severity of musculoskeletal pain was related to poor health status (OR = 2.738, 95% CI = 1.91-3.924, P < 0.001) and depression (OR = 1.371, 95% CI = 1.095-1.718, P = 0.006). Musculoskeletal symptoms are frequent somatic symptoms experienced by Chinese middle-aged women. Women with poor health status, high BMI, anxiety, and depression were at heightened risk of experiencing musculoskeletal pain. The severity of pain increased over time.
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Affiliation(s)
- Feiling Huang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
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Li Z, Guo JP, Huang L. Perimenopausal syndrome and hypertension during perimenopause in South China: prevalence, relationships and risk factors. BMC Womens Health 2024; 24:215. [PMID: 38570811 PMCID: PMC10988979 DOI: 10.1186/s12905-024-03056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/27/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND More than 2 billion women are experiencing the menopausal transition in China, and some of these women have hypertension. Limited studies has focused on perimenopausal syndrome and hypertension in a specific population, so we aimed to investigate the prevalence of perimenopausal syndrome and hypertension and to analyse their relationships and risk factors in perimenopausal women in South China. METHODS This cross-sectional study included 3553 women aged 40 to 60 years from South China. We collected medical report, lifestyle, blood sample, general condition questionnaire, and modified Kupperman index (mKMI) data. Multivariate logistic regression analysis was performed to identify risk factors for perimenopausal syndrome and hypertension during perimenopause. RESULTS The prevalence of hypertension in perimenopause patients was 16.58%, and the prevalence of perimenopausal syndrome was 9.9%. Compared with women without hypertension during perimenopause, women with HTN during perimenopause had an increased risk of perimenopausal syndrome (26.4% vs. 8.7%, P < 0.001). Lipid levels and urinary tract infections were risk factors for hypertension and perimenopausal syndrome, in addition to the presence of breast nodules, the intake of snacks at night, high-salt diets, red meat and sugar-sweetened beverages, and a history of smoking and drinking for perimenopausal syndrome and the presence of gestational hypertension and diabetes for hypertension. CONCLUSION We concluded that perimenopausal syndrome and HTN are common in perimenopausal women in South China, and the associations between them are strong and positive. Perimenopausal syndrome shares some common risk factors with HTN during perimenopause, such as BMI and dyslipidaemia. Therefore, gynaecological endocrinologists in China should consider screening for perimenopausal syndrome in hypertensive perimenopausal women, and appropriate management of perimenopause is needed to alleviate these conditions.
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Affiliation(s)
- Zheng Li
- Obstetrics and Gynecology, Wuyunshan Hospital of Hangzhou, Hangzhou, 310000, China
| | - Jun-Ping Guo
- Obstetrics and Gynecology, Wuyunshan Hospital of Hangzhou, Hangzhou, 310000, China.
| | - Liu Huang
- Medical School, Hangzhou Normal University, Hangzhou, 310000, China
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Li Z, Zhou G, Jiang L, Wang M. Analysis of related factors for pathological upgrading of cervical biopsy from CIN3 to cancer after conical resection. BMC Cancer 2024; 24:401. [PMID: 38561685 PMCID: PMC10985929 DOI: 10.1186/s12885-024-12186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND To investigate related factors for postoperative pathological upgrading of cervical biopsy to cervical cancer (CC) in patients with cervical intraepithelial neoplasia (CIN)3 after conical resection. METHODS This retrospective study collected data from patients diagnosed with CIN3 by cervical biopsies at the author's Hospital between January 2012 and December 2022. The primary outcome was the pathological results of patients after conical resection. The pathological findings were categorized into the pathological upgrading group if postoperative pathology indicated CC, while those with normal, inflammatory, or cervical precancerous lesions were classified into the pathological non-upgrading group. The factors associated with upgrading were identified using multivariable logistic regression analysis. RESULTS Among 511 patients, there were 125 patients in the pathological upgrading group (24.46%). The patients in the upgrading group were younger (47.68 ± 9.46 vs. 52.11 ± 7.02, P < 0.001), showed a lower proportion of menopausal women (38.40% vs. 53.02%, P = 0.0111), a lower proportion of HSIL (40.00% vs. 57.77%, P = 0.001), a higher rate of HPV-16/18 positive (25.60% vs. 17.36%, P = 0.011), a higher rate of contact bleeding (54.40% vs. 21.50%, P < 0.001), lower HDL levels (1.31 ± 0.29 vs. 1.37 ± 0.34 mmol/L, P = 0.002), higher neutrophil counts (median, 3.50 vs. 3.10 × 109/L, P = 0.001), higher red blood cell counts (4.01 ± 0.43 vs. 3.97 ± 0.47 × 1012/L, P = 0.002), higher platelet counts (204.84 ± 61.24 vs. 187.06 ± 73.66 × 109/L, P = 0.012), and a smaller platelet volume (median, 11.50 vs. 11.90 fL, P = 0.002).The multivariable logistic regression analysis showed that age (OR = 0.90, 95% CI: 0.86-0.94, P < 0.001), menopausal (OR = 2.68, 95% CI: 1.38-5.22, P = 0.004), contact bleeding (OR = 4.80, 95% CI: 2.91-7.91, P < 0.001), and mean platelet volume (OR = 0.83, 95% CI: 0.69-0.99, P = 0.038) were independently associated with pathological upgrading from CIN3 to CC after conical resection. CONCLUSION Age, menopausal, contact bleeding, and mean platelet volume are risk factors of pathological upgrading from CIN3 to CC after conical resection, which could help identify high risk and susceptible patients of pathological upgrading to CC.
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Affiliation(s)
- Zhifang Li
- Department of Gynaecology, Anqing Municipal Hospital, Anhui Medical University, Anqing, Anhui Province, P.R. China.
| | - Guiju Zhou
- The Second Affiliated Hospital of Anhui Medical University, Anqing, Anhui Province, P.R. China
| | - Longfan Jiang
- Department of Gynaecology, Anqing Municipal Hospital, Anhui Medical University, Anqing, Anhui Province, P.R. China
| | - Mengjie Wang
- Department of Gynaecology, Anqing Municipal Hospital, Anhui Medical University, Anqing, Anhui Province, P.R. China
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Assaf EA, Gharaibeh MK, Abuhammad S, AbuRuz M. Quality of life of Jordanian menopausal working and retired women and its associated factors: a cross-sectional study. F1000Res 2024; 11:1189. [PMID: 38807918 PMCID: PMC11130584 DOI: 10.12688/f1000research.125887.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 08/13/2024] Open
Abstract
OBJECTIVE Life expectancy of Jordanian women has increased, indicating that the number of women entering menopause age, during the prime of their working life, will also increase. Therefore, assessments of the quality of life (QoL) of working and retired women and factors associated with overall wellbeing, are essential for the provision of quality services and care. METHOD A cross-sectional study was conducted with 200 Jordanian women between the ages of 45 to 60 years old. The Utian QOL tool was used to assess the quality of life among menopausal women. Multiple regressions were used to determine predictors for QoL for the whole sample and for each group of working and retired women. RESULTS The study shows that the total QoL for women was 77.5 ±14.4, with a significant difference (p=.023) in total QoL and the occupational domain (p=.003) between working and retired women. Employed women with fewer chronic diseases and using frequent preventive measures had a higher QoL compared to others. CONCLUSION Working itself might be an important indicator for better a quality of life among menopausal women. Better working conditions and more attention from the health care providers for the menopausal changes and the preventive measures could enhance women's perceived QoL in addition to increasing their productivity.
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Affiliation(s)
- Enas A. Assaf
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Muntaha K. Gharaibeh
- Maternal and Child Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
- Faculty of Nursing, Al Ahliyya Amman University, Amman, Jordan
| | - Sawsan Abuhammad
- Maternal and Child Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohannad AbuRuz
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
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Assaf EA, Gharaibeh MK, Abuhammad S, AbuRuz M. Quality of life of Jordanian menopausal working and retired women and its associated factors: a cross-sectional study. F1000Res 2024; 11:1189. [PMID: 38807918 PMCID: PMC11130584 DOI: 10.12688/f1000research.125887.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 05/30/2024] Open
Abstract
Objective Life expectancy of Jordanian women has increased, indicating that the number of women entering menopause age, during the prime of their working life, will also increase. Therefore, assessments of the quality of life (QoL) of working and retired women and factors associated with overall wellbeing, are essential for the provision of quality services and care. Method A cross-sectional study was conducted with 200 Jordanian women between the ages of 45 to 60 years old. The Utian QOL tool was used to assess the quality of life among menopausal women. Multiple regressions were used to determine predictors for QoL for the whole sample and for each group of working and retired women. Results The study shows that the total QoL for women was 77.5 ±14.4, with a significant difference (p=.023) in total QoL and the occupational domain (p=.003) between working and retired women. Employed women with fewer chronic diseases and using frequent preventive measures had a higher QoL compared to others. Conclusion Working itself might be an important indicator for better a quality of life among menopausal women. Better working conditions and more attention from the health care providers for the menopausal changes and the preventive measures could enhance women's perceived QoL in addition to increasing their productivity.
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Affiliation(s)
- Enas A. Assaf
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Muntaha K. Gharaibeh
- Maternal and Child Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
- Faculty of Nursing, Al Ahliyya Amman University, Amman, Jordan
| | - Sawsan Abuhammad
- Maternal and Child Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohannad AbuRuz
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
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Carter E, Bruinvels G, Timmins K, Pedlar C, Martin D. Menopausal symptoms, exercise practices, and advice received in active women: a multi-country survey of strava app users. Women Health 2024; 64:23-31. [PMID: 37996389 DOI: 10.1080/03630242.2023.2284730] [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: 04/28/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
The study aimed to identify the prevalence of symptoms, changes in exercise levels, and exercise advice received during the menopausal transition in a large multi-country sample. Using total population sampling, 2.5 percent of female Strava app users (n = 970) from 7 countries completed an online survey between 14 February 2019 and 11 March 2019. The survey discussed menopause status (perimenopausal or postmenopausal), menopausal symptoms, changes to exercise behaviors, and advice received concerning exercise during menopause. Frequencies, chi-square statistics, and linear regressions were used to analyze data. The most commonly reported menopausal symptoms were sexual (18-83 percent) and cognitive/psychological (77-78 percent). 41 percent of women reported no change in exercise behavior since menopause began (46 percent increased and 11 percent decreased behaviors). The majority (88 percent) of women did not receive advice regarding exercise during menopause. Women who received advice were more likely to report an increase in their exercise than those not receiving advice (60 percent vs 46 percent; X2 (df 2, n = 927) = 7.1, p = .03). Exercise behaviors increased the longer it had been since the menopausal onset (X2 (df 8, n = 937) = 77.42, p < .001). The results suggested high menopausal symptom prevalence in active women and a general lack of exercise advice. More women reported higher symptom prevalence and an increase in exercise participation, the longer it had been since menopause onset. Future research should determine whether these increased exercise behaviors are being used as a coping mechanism.
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Affiliation(s)
- Esther Carter
- School of Sport, Exercise and Rehabilitation Sciences, University of Hull, Hull, UK
| | - Georgie Bruinvels
- Orreco Ltd, Business Innovation Unit, NUI Galway, Galway, Ireland
- Institute of Sport, Exercise and Health, University College London, London, UK
- Faculty of Sport, Allied Health and Performance Science, St Mary's University, Twickenham, UK
| | - Kate Timmins
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Charles Pedlar
- Orreco Ltd, Business Innovation Unit, NUI Galway, Galway, Ireland
- Institute of Sport, Exercise and Health, University College London, London, UK
- Faculty of Sport, Allied Health and Performance Science, St Mary's University, Twickenham, UK
| | - Daniel Martin
- School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
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Logan S, Wong BWX, Tan JHI, Kramer MS, Yong EL. Menopausal symptoms in midlife Singaporean women: Prevalence rates and associated factors from the Integrated Women's Health Programme (IWHP). Maturitas 2023; 178:107853. [PMID: 37806008 DOI: 10.1016/j.maturitas.2023.107853] [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: 04/13/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Menopausal symptoms can substantially impact quality of life. We studied somatic, psychological, and urogenital symptoms and their associated factors. DESIGN Cross-sectional study of healthy midlife Singaporean women from three major Asian ethnic groups. METHODS In 2014-16, women aged 45 to 69 attending well-woman clinics at the National University Hospital Singapore completed the Menopause Rating Scale (MRS). Sociodemographic, reproductive, medical, anthropometric, body composition, and physical performance characteristics were assessed using validated questionnaires and strict protocols. We analysed sub-scales and total scores by median split, and adjusted odds ratios using multivariable logistic regression. RESULTS Of the 1054 eligible women, 62.6 % reported at least one moderate to extremely severe symptom. The top five menopausal symptoms were joint and muscle discomfort, sleep problems, vaginal dryness, physical and mental exhaustion, and hot flushes. Higher total scores on the MRS were associated with moderate disability (adjusted odds ratio: 9.80, 95 % confidence interval: 2.88-33.34), poorer self-rated health status (2.18, 1.60-2.97), menstrual irregularity at 25 years (1.63, 1.07-2.49), and slower chair stands (1.49, 1.09-2.03). Age ≥65 (0.54, 0.30-0.94) and a lower level of education (0.45, 0.26-0.76) had significant inverse associations with total MRS score. CONCLUSIONS Menopausal symptoms were associated with disability, poorer health status, and weaker lower-body muscle strength. These data add to the limited Asian evidence and raise the profile of this important area of health.
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Affiliation(s)
- Susan Logan
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Level 3, 119074, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, 119228, Singapore
| | - Beverly Wen Xin Wong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, 119228, Singapore
| | - Joelle Hwee Inn Tan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, 119228, Singapore
| | - Michael S Kramer
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, 119228, Singapore; Department of Epidemiology, Biostatistics & Occupational Health, McGill University Faculty of Medicine, 3605 Rue de la Montagne Montréal, Quebec H3G 2M1, Canada; Department of Pediatrics, McGill University Faculty of Medicine, 3605 Rue de la Montagne Montréal, Quebec H3G 2M1, Canada
| | - Eu-Leong Yong
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Level 3, 119074, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, 119228, Singapore.
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Chen J, Zhai H, Jin H, Li X, Zhang P, Chen R. Sexual experiences of postmenopausal women in China: a qualitative study. Sex Med 2023; 11:qfad062. [PMID: 38058407 PMCID: PMC10696166 DOI: 10.1093/sexmed/qfad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 10/09/2023] [Accepted: 10/23/2023] [Indexed: 12/08/2023] Open
Abstract
Background Sexual dysfunction is common among postmenopausal women and can have a significant negative impact on quality of life. Aim This study aimed to explore perceptions, experiences, and coping strategies related to sex among postmenopausal women in China. Methods We used phenomenologic qualitative methods in this study. On the basis of purposive sampling and the data saturation principle, 21 volunteers from a community cohort study were selected for semistructured interviews. The data were analyzed and themes were extracted. Outcomes Thematic codes pertaining to sexual experiences and coping strategies were defined and assessed in this study. Results Four themes and 12 subthemes were extracted from the interview data. The sexual concepts were relatively conservative for most of the Chinese women; the majority experienced physical and psychological distress with respect to sex, although negative and positive psychological experiences were described. The women often passively accepted and adapted to negative changes to their sex lives during the postmenopause period. Clinical Implications This study highlights the importance of and need for effective dissemination of sexual health-related knowledge and the opening of appropriate communication channels. Strengths and Limitations By using a qualitative approach, this study provides individuals with the opportunity to describe their cognition and attitudes toward sexuality. Limitations include limited generalizability, as is true for most qualitative research. Additionally, the study is based solely on the female perspective and cannot fully reflect the sex life of couples. Conclusion The sexual experiences of our respondents exhibited distinct Chinese cultural characteristics. The interviews show the importance of paying attention to postmenopausal women's sexual health and providing relevant professional support and guidance to improve women's overall health-related quality of life.
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Affiliation(s)
- Jie Chen
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing,100730, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Haina Zhai
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing,100730, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Hongyun Jin
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing,100730, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xiang Li
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing,100730, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Pan Zhang
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing,100730, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Rong Chen
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing,100730, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
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Lu J, Li K, Zheng X, Liu R, Chen M, Xian J, Tu S, Xie L. Prevalence of menopausal symptoms and attitudes towards menopausal hormone therapy in women aged 40-60 years: a cross-sectional study. BMC Womens Health 2023; 23:472. [PMID: 37667324 PMCID: PMC10476428 DOI: 10.1186/s12905-023-02621-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023] Open
Abstract
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.
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Affiliation(s)
- Jie Lu
- School of Nursing, Southwest Medical University, Sichuan, China
| | - Kangfen Li
- School of Nursing, Southwest Medical University, Sichuan, China
| | - Xinlie Zheng
- School of Nursing, Southwest Medical University, Sichuan, China
| | - Ran Liu
- School of Nursing, Southwest Medical University, Sichuan, China
| | - Min Chen
- Department of Gynecology, Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Jingyun Xian
- Department of Gynecology, Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Suhua Tu
- Nursing Department, Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Lingling Xie
- Department of Gynecology, Affiliated Hospital of Southwest Medical University, Sichuan, China.
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An J, Li L. Urban-rural differences in epidemiology and risk factors of menopause syndrome in middle-aged Chinese women. Menopause 2023; 30:306-316. [PMID: 36728551 DOI: 10.1097/gme.0000000000002135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Junxia An
- From the College of Life Sciences, Northwest Normal University, Anning, Lanzhou, Gansu, People's Republic of China
| | - Lifei Li
- The Reproductive Medicine Special Hospital of The First Hospital of Lanzhou University, Chengguan, Lanzhou, Gansu, People's Republic of China
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Lian IB, Sie JJ, Chang CC, Fann CS, Huang CH. Effects of insomnia and non-vasomotor menopausal symptoms on coronary heart disease risk: a mendelian randomization study. Heliyon 2023; 9:e13569. [PMID: 36846681 PMCID: PMC9950832 DOI: 10.1016/j.heliyon.2023.e13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
Background Previous studies suggested that vasomotor symptoms were associated with an increasing risk of coronary heart diseases (CHD) but not clear with menopausal symptoms other than vasomotor symptoms. Given the heterogeneity and interrelationship among menopausal symptoms, it is not easy to make causal inferences based on observational studies. We performed a Mendelian randomization (MR) to investigate the association of individual non-vasomotor menopausal symptoms and the risk of CHDs. Methods A sample of 177,497 British women aged ≥51 years old (average age at menopause) without related cardiovascular diseases from the UK biobank is selected as our study population. Non-vasomotor menopausal symptoms, including anxiety, nervous, insomnia, urinary tract infection, fatigue, and vertigo, were selected as exposures based on the modified Kupperman index. Outcome variable is CHD. Results In total, 54, 47, 24, 33, 22, and 81 instrumental variables were selected for anxiety, insomnia, fatigue, vertigo, urinary tract infection and nervous respectively. We conducted MR analyses of menopausal symptoms and CHD. Only insomnia symptoms increased the lifetime risk of CHD with OR 1.394 (p = 0.0003). There were no significant causal relationships with CHD and other menopausal symptoms. Insomnia near menopause age (45-50 years) does not increase the risk of CHD. However, postmenopausal (over 51) insomnia increases the risk of CHD. Conclusion MR analyses support that among non-vasomotor menopausal symptoms, only insomnia symptoms may increase the lifetime risk of CHD. Insomnia at different ages near menopause has differential impacts on CHD risk.
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Affiliation(s)
- Ie-Bin Lian
- Institute of Statistics and Information Science, National Changhua University of Education, Taiwan
| | - Jia Jyun Sie
- Department of Mathematics, National Changhua University of Education, Taiwan
| | - Chia-Chu Chang
- Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan,Department of Nutrition, Hungkuang University, Taichung, Taiwan
| | - Cathy S.J. Fann
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan,Corresponding author.
| | - Ching-Hui Huang
- Department of Mathematics, National Changhua University of Education, Taiwan,Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Beauty Science and Graduate Institute of Beauty Science Technology, Chienkuo Technology University, Changhua, Taiwan,Corresponding author. Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
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Jia M, Lan C, Niu J, Liang Y. Risk factors for pathological upgrading in perimenopausal women with cervical intraepithelial neoplasia grade 2/3 following conization. Medicine (Baltimore) 2022; 101:e31368. [PMID: 36316892 PMCID: PMC9622652 DOI: 10.1097/md.0000000000031368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Postmenopausal women have a high risk for pathological upgrading in conization specimens due to pathological changes of the cervix. This study aimed to investigate the risk factors for pathological upgrading in conization specimens in Chinese women with cervical intraepithelial neoplasia grade 2/3 (Cervical intraepithelial neoplasia 2/3) ≥ 50 years of age. From January 2015 to December 2019, 443 CIN2/3 patients ≥ 50 years of age were retrospectively included and divided into the upgrade group (n = 47) and the non-upgrade group (n = 396) according to the presence or absence of pathological upgrading in the conization specimens. Multivariate logistic regression model was performed to analyze risk factors associated with pathological upgrading. The upgrade group was more likely to have gravidity < 2 times, postmenopausal period ≥ 5 years, higher incidences of endocervical glandular involvement (EGI) and human papillomavirus (HPV) 16/18 infection, as well as a lower incidence of cervical contactive bleeding and fewer cases undergoing endocervical curettage (all P < .05) than the non-upgrade group. Multivariate model showed that factors associated with pathological upgrading were postmenopausal period ≥ 5 years (OR = 2.55), EGI (OR = 17.71), endocervical curettage (OR = 0.33), and HPV type 16/18 (OR = 3.41) (all P < .05). The receiver operating characteristic analysis showed an area under curve of 0.782 (P < .001). Pathological upgrading in conization specimens is not uncommon in Chinese CIN2/3 patients ≥ 50 years of age. For those with high-risk factors of pathological upgrading (postmenopausal period ≥ 5 years, EGI, and HPV 16/18 infection), the follow-up interval can be appropriately shortened, and active intervention could be considered.
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Affiliation(s)
- Mingyu Jia
- Graduate School, Dalian Medical University, Dalian, Liaoning, China
| | - Chong Lan
- Department of Gynecology, Shenyang Women and Children’s Hospital, Shenhe District, Shenyang, Liaoning, China
| | - Jumin Niu
- Department of Gynecology, Shenyang Women and Children’s Hospital, Shenhe District, Shenyang, Liaoning, China
- * Correspondence: Jumin Niu, Department of Gynecology, Shenyang Women and Children’s Hospital, No. 87, Danan Street, Shenhe District, Shenyang 110011, Liaoning, China (e-mail: )
| | - Yin Liang
- Department of Gynecology, Shenyang Women and Children’s Hospital, Shenhe District, Shenyang, Liaoning, China
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Mínguez-Alarcón L, Rifas-Shiman SL, Soria-Contreras DC, Hivert MF, Shifren J, Oken E, Chavarro JE. Self-reported menstrual cycle length during reproductive years in relation to menopausal symptoms at midlife in Project Viva. Menopause 2022; 29:1130-1136. [PMID: 36150115 PMCID: PMC10008511 DOI: 10.1097/gme.0000000000002042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the extent to which self-reported menstrual cycle length during reproductive years is associated with menopausal symptoms and age at natural menopause at midlife. METHODS This analysis includes 634 women who enrolled in Project Viva during pregnancy (1999-2002) and completed the midlife visit approximately 18 years later. Women self-reported menstrual cycle length at enrollment (early pregnancy) and at midlife reported total and specific menopausal symptoms using the Menopause Rating Scale as well as age at natural menopause. We used linear and regression models to evaluate associations of cycle length with total and specific menopausal symptoms. We also applied a time-to-event Cox proportional hazards model to investigate the relationship between menstrual cycle length and onset of natural menopause. We adjusted models for age at midlife visit, prepregnancy body mass index, race/ethnicity, education, and parity. RESULTS At enrollment (median age, 33.3 years), 90 (14%) women reported having short (≤25 days) and 39 (6%) reported long (≥35 days) menstrual cycles. Compared with women with a normal menstrual cycle length of 26 to 34 days, women whose cycles were short had a higher total Menopause Rating Scale at midlife ( β = 2.05; 95% confidence interval [CI], 0.73-3.38). Specifically, women with short menstrual cycles during their reproductive years had higher odds of midlife sleep problems (odds ratio [OR], 1.92; 95% CI, 1.10-3.37), heart discomfort (OR, 1.68; 95% CI, 1.03-2.73), and depressive symptoms (OR, 1.85; 95% CI, 1.16-2.96). In addition, compared with women with a normal cycle length of 26 to 34 days, women reporting short cycles had an earlier onset of natural menopause (hazard ratio, 1.67; 95% CI, 1.11-2.51). CONCLUSIONS Compared with women with normal menstrual cycle length, those with short menstrual cycles during their reproductive years had a higher frequency of total and certain menopausal symptoms at midlife and reached menopause earlier.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Sheryl L. Rifas-Shiman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | | | - Marie-France Hivert
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jan Shifren
- Department of Obstetrics and Gynecology, Midlife Women’s Health Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Emily Oken
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Jorge E. Chavarro
- Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
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Menopausal Symptoms and Sleep Quality in Women Aged 40–65 Years. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2560053. [PMID: 35983252 PMCID: PMC9381266 DOI: 10.1155/2022/2560053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/20/2022]
Abstract
The study examined the relationship between menopausal symptoms and sleep disturbances and the related influencing factors. Methods. We recruited women aged 40-65 years who attended the menopause clinic at Shanghai Jiao Tong University's Sixth People's Hospital from February 2011 to November 2019. The Menopause Rating Scale (MRS) was used to collect women's menopausal symptoms, and the Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the subjects' sleep condition. We used logistic regression models to identify the relationship between menopausal symptoms and sleep quality. Results. A total of 1341 participants were recruited in this study. The most frequent three symptoms assessed by MRS were fatigue (72.9%), sleep disturbance (67%), and hot flashes with night sweats (65%). Participants' age was significantly associated with the severity of menopausal syndrome (P < 0.01). According to the PSQI sleep evaluation, 66.9 percent of participants had sleep disturbances (PSQI > 5). Logistic regression analysis revealed that women with mild, moderate, or severe menopausal syndrome had a 3-, 7-, and 17-fold increased chance of having sleep disturbances compared to women without menopausal syndrome. Conclusion. Women aged 40–65 years were found to have a significantly higher risk of menopausal syndrome and sleep disturbances.
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Efficacy and Safety of Moxibustion for Menopausal Obesity: A Multicentre, Randomized, Controlled Trial Protocol. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:9255017. [PMID: 35966744 PMCID: PMC9371829 DOI: 10.1155/2022/9255017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/06/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
Background. In the past, moxibustion has been widely used to treat endocrine system disorders, but evidence of its effectiveness is scarce at this point. The aim of this multicenter, randomized, controlled trial is to evaluate the efficacy and safety of treating menopausal obesity with moxibustion. Methods/Design. There are six centers taking part in this randomized, controlled, parallel trial. A total of 216 patients with menopausal obesity will be randomly divided into two equal groups: the “moxibustion for harmonization of Yin and Yang” group and the gentle moxibustion group. A 12-week study period with moxibustion will be preceded by a 1-week baseline, followed by a 12-week follow-up. We will conduct an interim analysis to determine whether or not the treatment is efficacious and safe after 216 participants have completed a 12-week treatment period. Evaluations will be conducted at weeks 0, 4, 8, 12, 18, and 24. The main outcome is waist circumference (WC), and the rate of WC reduction will be compared to the baseline. An intention-to-treat analysis will be performed with a two-sided P value of <0.05 considered significant. Participants who withdraw from the trial will be analyzed according to the intention-to-treat formula (ITT). Discussion. These results will be used to support selecting the right moxibustion prescription and guiding the improvement of clinical efficacy. This trial will provide convincing evidence of moxibustion's effectiveness and safety in the treatment of obesity by “moxibustion for harmonization of Yin and Yang,” which will be conducive to the promotion and clinical application of the theory of “moxibustion for harmonization of Yin and Yang.” Trial Registration. This trial is registered with Clinical Trials.gov: NCT04943705 (registered on June 27, 2021).
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Does temporomandibular disorder correlate with menopausal symptoms? Menopause 2022; 29:728-733. [PMID: 35544600 DOI: 10.1097/gme.0000000000001962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the correlation between menopausal symptoms and pain caused by temporomandibular disorder (TMD) and the impact of sociodemographic factors on the association. METHODS In this cross-sectional study, a total of 74 women with TMD symptoms were enrolled and divided into three groups according to the Stages of Reproductive Aging Workshop + 10 (STRAW + 10) criteria: G1 (n = 25, late menopausal transition), G2 (n = 30, early postmenopause), and G3 (n = 19, late postmenopause). Sociodemo-graphic data were collected, along with data on menopausal symptoms (Blatt-Kupperman menopausal index) and TMD-induced pain (craniomandibular index). Statistical analysis was performed using a chi-squared test and linear correlation tests (Spearman and Pearson). RESULTS Analysis of the three groups showed that TMD-induced pain was more intense in G1 than in G3 (P = 0.0426, r = 0.2364, r2 = 0.05589), and menopausal symptoms correlated with the intensity of TMD-induced pain (P = 0.0004, r = 0.4020). This correlation was more significant during the late menopausal transition (G1: P = 0.0267, r = 0.4427, r2 = 0.1960). In G2, women with fewer than 4 years of schooling had a higher total Blatt-Kupperman menopausal index score (17.0 ± 85.0) and craniomandibular index (0.29 ± 0.23) than women with more than 4 years of schooling (P = 0.02 for both indices). CONCLUSIONS Our results suggest that TMD-induced pain and menopausal symptoms are correlated, and more strongly so in the late menopausal transition. Additionally, sociodemographic factors, such as schooling, have a major influence on symptoms in early postmenopause. Performing the TMD evaluation during the climacteric period may be important.
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Yu Q, Chae HD, Hsiao SM, Xie J, Blogg M, Sumarsono B, Kim S. Prevalence, severity, and associated factors in women in East Asia with moderate-to-severe vasomotor symptoms associated with menopause. Menopause 2022; 29:553-563. [PMID: 35231007 PMCID: PMC9060817 DOI: 10.1097/gme.0000000000001949] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To understand prevalence, severity, impact, and treatment of vasomotor symptoms associated with menopause, using cross-sectional survey data. METHODS This online, two-part survey was conducted in East Asia among women 40-65 years recruited from established online panels (Edelman, Beijing; Hankook Research, Seoul; Rakuten Insight, Taipei) using stratified sampling. Part I collected demographics/disease characteristics, including menopausal status and vasomotor symptom severity. Women with moderate-to-severe vasomotor symptoms completed Part II, including clinical characteristics, health-related quality of life, and healthcare-seeking behavior. Primary endpoints included vasomotor symptom prevalence and severity and proportions of women eligible and willing to take hormone therapy. Results are presented for each of the three online panels separately and as a pooled total. All analyses are descriptive with no formal hypothesis testing across groups. RESULTS Numbers of peri- versus postmenopausal women completing Part I were Edelman, 1,588 (55.1% vs 44.9%); Hankook Research, 1,000 (43.6% vs 56.4%); Rakuten Insight, 773 (61.7% vs 38.3%). Vasomotor symptom prevalence was =80% in each region; overall moderate-to-severe vasomotor symptom prevalence was 55%; >50% of women were untreated. Most of those treated used non-prescription treatments. Menopausal hormone therapy use was reported by 11.6% of peri- and 7.2% of postmenopausal women. In peri- and postmenopausal women with moderate-to-severe vasomotor symptoms, 8.6% and 3.4%, respectively, were hormone therapy-willing, 19.3% and 16.8% hormone therapy-contraindicated, 25.4% and 23.0% hormone therapy-cautious, and 10.2% and 8.3% hormone therapy-averse. Women experienced significant burden on health-related quality of life and substantial impairment of work productivity and daily activities. CONCLUSIONS Vasomotor symptoms associated with menopause affected =80% of women aged 40 to 65 years. A substantial proportion of women are unsuitable for, or choose not to take, menopausal hormone therapy, resulting in an unmet need for nonhormonal treatment options.
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Affiliation(s)
- Qi Yu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Hee-Dong Chae
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine
| | - Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital
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Tang R, Luo M, Fan Y, Peng Y, Wang Y, Liu G, Wang Y, Lin S, Chen R. Menopause-specific quality of life during ovarian aging among Chinese women: A prospective cohort study. Maturitas 2022; 157:7-15. [DOI: 10.1016/j.maturitas.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
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Wang L, Zhang R, Yang Y, Sun X, Zhang B, Zhu H, Luo X, Ma X, Zhang X. Severity and factors of menopausal symptoms in middle-aged women in Gansu Province of China: a cross-sectional study. BMC Womens Health 2021; 21:405. [PMID: 34879847 PMCID: PMC8653527 DOI: 10.1186/s12905-021-01531-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/15/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate the severity and risk factors of menopausal symptoms in the middle-aged women in Gansu Province of China. METHODS In this cross-sectional study, a total of 7319 women (aged 40-55 years) attended the health survey in Gansu Province in China were enrolled. Information on demographics, menopausal status, reproductive history, and history of chronic diseases was collected via a structured questionnaire. Severity of menopausal symptom was evaluated by the Modified Kupperman Menopausal Index. Ordinal logistic regression model was applied to explore its risk factors. RESULTS A total of 7319 participants were included in present study, among them, 3606 (49.27%) had moderate or severe menopausal symptom. Compared with premenopausal women, perimenopausal and postmenopausal women have a higher mKMI score. We observed that older age, higher BMI, non-married status, longer duration of menstruation (≥ 7 days), number of pregnancy (> 3 times), longer duration of breastfeeding (> 12 months), peri- or post-menopausal status, and menopause hormone therapy was positively associated with menopausal symptom score, while higher level of family income, educational and physical activity, and history of gynecological, breast or chronic disease were negatively associated with the score. CONCLUSIONS Numerous factors were associated with the severity of menopausal symptom among the Chinese women. Because it was gradually increased with aging, more attention is warranted to manage the menopausal symptom.
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Affiliation(s)
- LiRong Wang
- The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, China
| | - Rui Zhang
- The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, China
| | - Ye Yang
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, Gansu, China
| | - XiaoYan Sun
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, Gansu, China
| | - BaoLi Zhang
- The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, China
| | - HaiYing Zhu
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, Gansu, China
| | - XiaoRong Luo
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, Gansu, China
| | - XiaoLing Ma
- The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, China
| | - XueHong Zhang
- The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, China.
- The First Hospital of Lanzhou University, Key Laboratory for Reproductive Medicine and Embryo of Gansu Province, No. 1, Donggangxi Rd, Chengguan District, Lanzhou City, 730000, Gansu Province, China.
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21
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Su J, Jogamoto A, Yoshimura H, Yang LJ. Menopausal symptoms among Chinese and Japanese women: differences and similarities. Menopause 2021; 29:73-81. [PMID: 34812777 DOI: 10.1097/gme.0000000000001874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study aimed to identify the characteristics of menopausal symptoms among Japanese and Chinese women and to determine the correlation between menopausal symptoms and self-efficacy. METHODS We surveyed 40- to 59-year-old women, 329 of whom were from an urban area in Northwest China (Xi'an) and 310 were from an urban area in Western Japan (Ehime), using a menopausal symptoms inventory and a self-efficacy scale. Comparison analysis was conducted among pre-, peri-, and postmenopausal status, within and between the two cultural groups. Following a two-way ANOVA, multiple comparisons were performed using the Tukey-Kramer test. The correlation between severity of menopause symptoms and self-efficacy scores was evaluated using canonical correlation analysis. RESULTS The most frequently reported symptoms were fatigue (93.6%) among Japanese women and memory loss (76.6%) among Chinese women. Japanese women showed significantly higher severity scores across all factors than Chinese, sexual function: 19.58 (SE = 0.73) versus 15.04 (SE = 0.67); mental health condition: 35.44 (SE = 1.15) versus 27.12 (SE = 0.95); interpersonal anxiety: 27.45 (SE = 0.95) versus 21.92 (SE = 0.86); autonomic balance: 42.76 (SE = 1.27) versus 35.75 (SE = 1.17); other subjective symptoms: 39.68 (SE = 1.20) versus 33.07 (SE = 1.12) in the premenopausal group (P < 0.01); and mental health conditions 35.14 (SE = 1.41) versus 29.60 (SE = 1.25), interpersonal anxiety: 27.34 (SE = 1.18) versus 20.79 (SE = 1.02), autonomic balance factors: 45.81 (SE = 1.79) versus 38.05 (SE = 1.67) in the postmenopausal group (P < 0.01). No significant differences of the factors among menopausal stages within Japanese women were found. Among Chinese women, peri- and postmenopausal women showed significantly higher severity scores on sexual function, while perimenopausal women scored higher on mental health conditions and autonomic balance factors (P < 0.01). A negative correlation was found between menopausal symptoms and self-efficacy among both Japanese and Chinese women (P < 0.01). CONCLUSIONS Japanese women reported more severe symptoms compared with their Chinese counterparts, and for Chinese women, symptoms might be specifically associated with menopausal status. Menopausal experience is associated with self-efficacy and vice versa.
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Affiliation(s)
- Jing Su
- Department of Nursing, Shantou University Medical College, Shantou, Guangdong Province, China
| | - Akiko Jogamoto
- Department of Fundamental and Clinical Nursing Program for Nursing and Health Science, Ehime University, Shitsukawa, Toon, Ehime, Japan
| | - Hiroyuki Yoshimura
- University of Human Environments, Hanazonomachi, Matsuyama, Ehime, Japan
| | - Lu Jun Yang
- Research Center for Translational Medicine, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
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Ak Sözer G, Güdül Öz H, Yangın H. Relationship between menopausal symptoms and perceived stress during the COVID-19 pandemic. J Women Aging 2021; 34:675-686. [PMID: 34661513 DOI: 10.1080/08952841.2021.1985374] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This study aimed to examine the relationship between menopausal symptoms and perceived stress in middle-aged women during the COVID-19 pandemic. In this cross-sectional study, data were collected online from 239 middle-aged women using the Personal Information Form, Menopause Rating Scale (MRS) and Perceived Stress Scale-14 (PSS-14). A positive correlation was found between the total MRS score and the total PSS-14 score. The COVID-19 pandemic usually restrict access to healthcare visit. The COVID-19 pandemic has created an urgent need to implement specific menopausal programs to promote the psychological health of middle-aged women and reduce stress during this or similar crises.
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Affiliation(s)
- Gülşen Ak Sözer
- Department of Maternity and Gynecological Nursing, Akdeniz University Nursing Faculty, Antalya, Turkey
| | - Hatice Güdül Öz
- Department of Maternity and Gynecological Nursing, Akdeniz University Nursing Faculty, Antalya, Turkey
| | - Hatice Yangın
- Department of Maternity and Gynecological Nursing, Akdeniz University Nursing Faculty, Antalya, Turkey
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Wang X, Wang L, Di J, Zhang X, Zhao G. Prevalence and risk factors for menopausal symptoms in middle-aged Chinese women: a community-based cross-sectional study. Menopause 2021; 28:1271-1278. [PMID: 34469934 PMCID: PMC8547757 DOI: 10.1097/gme.0000000000001850] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the prevalence and risk factors of menopausal symptoms in middle-aged Chinese women. METHODS A cross-sectional, community-based study recruited 6,745 women aged 40 to 55 years in the eastern, central, and western regions of China during 2018. Menopausal status was categorized into reproductive stage (defined as regular menstruation or subtle changes in menstrual cycle characteristics), menopausal transition (the beginning of a persistent difference of 7 d in the length of consecutive cycles, or the last menstruation having occurred no more than 12 mo), or postmenpause (the end of the 12 mo period of amenorrhea) according to the Stages of Reproductive Aging Workshop classification. Menopausal symptoms were determined by the modified Kupperman Menopausal Index (KMI) questionnaire and considered nonmenopausal symptoms (total KMI score<15) and menopausal symptoms (total KMI score≥15). Demographic, lifestyle, physical, and menopausal characteristics were collected by face-to-face interviews. Logistic regression models were used to identify factors associated with the risk of menopausal symptoms. RESULTS Among all participants, the mean age was 46.9 years, and 15.7% (1,001/6,364) of participants reported experiencing menopausal symptoms. The prevalence of menopausal symptoms was 9.3% (303/3,256), 23.9% (293/1,227), and 21.5% (405/1,881) in the reproductive stage, menopausal transition, and postmenopausal stage, respectively. Overall, the three most prevalent menopausal symptoms were insomnia (44.7%), fatigue (40.4%), and mood swings (37.2%). The multivariable logistic regression model showed that menopausal status, residence, nulliparity, and chronic diseases were associated with the risk of menopausal symptoms (all P < 0.05). Women during menopausal transition (OR = 2.66, 95% CI: 2.21-3.20) or postmenopause (OR = 2.26, 95% CI: 1.82-2.80) had significantly increased risk of menopausal symptoms compared with those in the reproductive stage. CONCLUSIONS Menopausal status, residence, nulliparity, and chronic diseases were associated with menopausal symptoms in middle-aged Chinese women.
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Affiliation(s)
- Xueyin Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Linhong Wang
- National Centre for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangli Di
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaosong Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Gengli Zhao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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Bai J, Cheng C. The relationship between health-promoting behaviors, menopause syndrome, and sleep quality in Chinese middle-aged nurses: A cross-sectional study. Jpn J Nurs Sci 2021; 19:e12443. [PMID: 34235867 DOI: 10.1111/jjns.12443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/26/2021] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nursing staff are on the front line of providing healthcare that addresses patients' needs. Sleep quality is highly related to work performance and quality of life among nurses. AIMS This study aimed to examine the influence of sociodemographic variables, menopause syndrome, and health-promoting behaviors on sleep quality in a sample of middle-aged nurses in China. METHODS A cross-sectional design was employed. A consecutive sample of 424 nurses was recruited from a university-affiliated hospital in Bengbu, China. Self-reported, structured questionnaires, including sociodemographic surveys, the Kupperman Menopausal Index, the Health Promoting Lifestyle Profile II, and the Pittsburgh Sleep Quality Index, were administered between October 2018 and July 2019. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. RESULTS Study participants had a mean sleep quality level of 5.30 points (SD = 3.16), indicating potential sleep problems. The results of regression models showed that menopause syndrome and spiritual growth were important predictors of sleep quality for premenopause, perimenopause, and postmenopause groups. CONCLUSION Middle-aged nurses with more severe menopause syndrome and less spiritual growth might experience worse sleep quality. RELEVANCE TO CLINICAL PRACTICE This study highlights important factors influencing the level of sleep quality in Chinese middle-aged nurses. Identifying the factors that are associated with sleep quality may help with the development of proper interventions.
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Affiliation(s)
- Jie Bai
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Cheng Cheng
- School of Nursing, Shanghai Medical College, Fudan University, Shanghai, China
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Chiu HH, Tsao LI, Liu CY, Lu YY, Shih WM, Wang PH. Using a short questionnaire of the perimenopausal fatigue scale to evaluate perimenopausal women prone to fatigue syndrome. Taiwan J Obstet Gynecol 2021; 60:734-738. [PMID: 34247816 DOI: 10.1016/j.tjog.2021.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Fatigue, a painful and unpleasant subjective experience, is common in perimenopausal women. Therefore, an effective tool to evaluate the fatigue-precipitating factor is important for perimenopausal women prone to fatigue syndrome. MATERIALS AND METHODS This study was surveyed by short-term perimenopausal fatigue scale. The enrollment period was from November 2019 to January 2020. The subjects were perimenopausal women prone to perimenopausal fatigue. The differences between the fatigue-precipitating factors and the degrees of fatigue and disturbance were determined by one-way ANOVA and t test. RESULTS A total of 220 perimenopausal women with mean age of 51.3 years were included. Among these, 64.1% did not have a habit of regular exercise and 55.5% had chronic diseases. Fatigue syndrome was found in 64.1% of subjects, who were mainly presented by shoulder and neck pain and sleep problems. There were significant differences between "perimenopausal fatigue" and "duration" (p < 0.001); "with and without regular exercise" (p = 0.05); and "with and without chronic diseases" (p = 0.03). CONCLUSIONS Our study showed the perimenopausal fatigue syndrome is more frequently found in perimenopausal women who have a co-morbidity (chronic illness) and do not have a habit of regular exercise. An early identification and prompt intervention may help perimenopausal women to deal with their fatigue syndrome. The short questionnaire perimenopausal fatigue scale seems to be useful for screening perimenopausal women prone to fatigue syndrome.
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Affiliation(s)
- Hsiao-Hui Chiu
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan; Graduate Institute of Gerontology and Heath Care Management, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
| | - Lee-Ing Tsao
- Graduate Institute of Gerontology and Heath Care Management, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
| | - Chieh-Yu Liu
- Graduate Institute of Gerontology and Heath Care Management, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
| | - Yu-Ying Lu
- Graduate Institute of Gerontology and Heath Care Management, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
| | - Whei-Mei Shih
- Graduate Institute of Gerontology and Heath Care Management, Chang Gung University of Science and Technology, Taoyuan City 333, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan; Female Cancer Foundation, Taipei 112, Taiwan.
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Kang HK, Kaur A, Dhiman A. Menopause-Specific Quality of Life of Rural Women. Indian J Community Med 2021; 46:273-276. [PMID: 34321740 PMCID: PMC8281871 DOI: 10.4103/ijcm.ijcm_665_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background: Menopause is a natural process, but it causes hormonal and biological changes in the body, which can result in drastic effects on quality of life (QOL) of women. Objective: The study was conducted to assess the menopause-specific QOL (MENQOL) of rural women. Subjects and Methods: A descriptive cross-sectional design was used to assess MENQOL of rural women of the selected villages of Punjab. A total of 150 menopausal women were selected using simple random sampling technique. The MENQOL questionnaire was administered to assess the QOL in relation to menopausal symptoms. Results: The mean score of overall QOL was 3.4274 ± 0.99, which revealed a moderate impact of menopausal symptoms on the QOL. Stepwise linear regression revealed the significant impact of 16 out of 29 menopausal symptoms on QOL. Furthermore, MENQOL was found to be significantly associated with education, marital status, and sleep pattern of women. Conclusions: There is a significant effect of menopausal symptoms on QOL of women which emphasizes the need to create awareness among menopausal women regarding menopausal symptoms and management to improve their QOL.
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Affiliation(s)
- Harmeet Kaur Kang
- Chitkara School of Health Sciences, Chitkara University, Punjab, India
| | - Arshdeep Kaur
- Chitkara School of Health Sciences, Chitkara University, Punjab, India
| | - Aarti Dhiman
- Chitkara School of Health Sciences, Chitkara University, Punjab, India
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Prevalence of symptoms and associated factors across menopause status in Taiwanese women. ACTA ACUST UNITED AC 2021; 28:182-188. [DOI: 10.1097/gme.0000000000001662] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Menopausal symptoms in women with premature ovarian insufficiency: prevalence, severity, and associated factors. ACTA ACUST UNITED AC 2021; 28:529-537. [PMID: 33470756 DOI: 10.1097/gme.0000000000001733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To comprehensively investigate and evaluate the prevalence, severity, and associated factors of menopausal symptoms in women with premature ovarian insufficiency (POI). In this study, the specific symptomatology experienced by women with POI and women with natural menopause was also compared. METHODS In this cross-sectional study, 293 Chinese women with POI from an outpatient clinic were recruited between June 2014 and January 2019. The prevalence and severity of menopausal symptoms were assessed with modified Kupperman Menopausal Index. Participants completed a structured questionnaire, including medical history, menstrual characteristics, and sociodemographic data. Serum levels of reproductive hormones were measured. RESULTS Among 293 women with POI (33.76 ± 5.47 y), the most prevalent symptoms were mood swings (73.4%), insomnia (58.7%), sexual problems (58.7%), and fatigue (57.3%). Moderate-to-severe mood swings were most frequently reported (23.9%), followed by formication (17.4%) and hot flashes/sweating (17.1%). Compared with women with natural menopause, women with POI exhibited significantly higher risks for fatigue (odds ratio = 1.42; 95% confidence interval, 1.04-1.94), melancholia (3.12; 1.94-5.01), mood swings (3.57; 2.33-5.45), insomnia (1.41; 1.02-1.96), and significantly lower risks for moderate-to-severe sexual problems (0.40; 0.23-0.69), any and moderate-to-severe muscle/joint pain (0.41; 0.27-0.62 and 0.45; 0.25-0.78, respectively). Living in urban areas and higher gravidity were independently associated with menopausal symptoms in women with POI. CONCLUSIONS Women with POI experienced a high prevalence of menopausal symptoms, particularly related to psychological and sexual domains. Furthermore, women with POI tended to have more distressing menopausal symptoms compared with women with natural menopause.
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Influence of dietary habits and Mediterranean diet adherence on menopausal symptoms. The FLAMENCO project. ACTA ACUST UNITED AC 2020; 27:1015-1021. [PMID: 32852453 DOI: 10.1097/gme.0000000000001574] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore the association of dietary habits and Mediterranean diet adherence with menopausal symptoms. METHODS The present study included 172 women recruited from the FLAMENCO project. Menopausal symptoms were assessed with the Kupperman Menopausal Index and the Cervantes Menopause and Health Subscale from the validated Cervantes Scale. A food frequency questionnaire was employed to evaluate dietary habits. Adherence to the Mediterranean diet was assessed with the Mediterranean diet score. RESULTS Intake of poultry and skimmed dairy products was associated with a worse Kupperman Menopausal Index score (β: 0.17, P = 0.03 and β: 0.18, P = 0.01, respectively). On the contrary, soy milk consumption was associated with a better Kupperman Menopausal Index score (β: -0.17, P = 0.02). Poultry and skimmed dairy were associated with worse scores in the total Cervantes Menopause and Health Subscale score (β: 0.22, P = <0.01 and β: 0.19, P = 0.01, respectively), whereas soy milk and vegetables were associated with a better total Cervantes Menopause and Health Subscale score (β: -0.20, P = 0.01 and β: -0.17, P = 0.03, respectively). Regarding vasomotor symptoms, a greater consumption of poultry was associated with worse symptomatology (β: 0.18, P = 0.02), and soy milk consumption was associated with fewer vasomotor symptoms (β: -0.15, P = 0.04). In addition, women with numerous or severe vasomotor symptoms showed a greater consumption of skimmed dairy products (P < 0.05). CONCLUSIONS This study seems to indicate that some women with mild menopausal symptoms may derive benefit from lower consumption of poultry and skimmed dairy products and a greater consumption of vegetables and soy milk.
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Ryu KJ, Park H, Kim YJ, Yi KW, Shin JH, Hur JY, Kim T. Comparison of various menopausal symptoms and risk factor analysis in Korean women according to stage of menopause. Maturitas 2020; 140:41-48. [PMID: 32972634 DOI: 10.1016/j.maturitas.2020.05.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/09/2020] [Accepted: 05/29/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the prevalence and severity of menopausal symptoms and their related risk factors among middle-aged Korean women according to their reproductive stages. METHODS This cross-sectional study included 3039 Korean women, aged 45-65 years, who attended their routine health checkup. Their scores from the Menopause Rating Scale (MRS) were compared and participants were categorized into four groups according to stage of menopause: premenopause, early menopause (≤2 years from their last menstruation), mid-menopause (2-8 years), and late menopause (>8 years). RESULTS The mean age of the participants was 52.81 ± 5.39 years, and 98.5 % of them reported one or more symptoms included in the MRS. The most common symptom was physical/mental exhaustion, experienced by 86.7 % of participants. The prevalence of moderate to severe symptoms, including vasomotor symptoms, heart discomfort, sleep problems, sexual problems, vaginal dryness, and joint/muscular discomfort, increased in the early menopausal period. This increased in the late menopausal period compared with its prevalence at premenopause. The prevalence of moderate to severe psychological symptoms, heart discomfort, and sleep problems followed a U-shaped trend after menopause: high at early menopause, low at mid-menopause, and high again at late menopause. A low level of physical exercise was an independent risk factor for a high total MRS score; however, the menopausal stages, age, and weight were also variously associated with menopausal symptoms. CONCLUSIONS Several menopausal symptoms remain severe, or are aggravated, until the late menopausal period among Korean women. More attention is warranted to manage these symptoms in postmenopausal women.
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Affiliation(s)
- Ki-Jin Ryu
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 126-1, 5-ga Anam-dong, Seongbuk-gu, Seoul 02841, South Korea
| | - Hyuntae Park
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 126-1, 5-ga Anam-dong, Seongbuk-gu, Seoul 02841, South Korea.
| | - Yong Jin Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 126-1, 5-ga Anam-dong, Seongbuk-gu, Seoul 02841, South Korea
| | - Kyong Wook Yi
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 126-1, 5-ga Anam-dong, Seongbuk-gu, Seoul 02841, South Korea
| | - Jung Ho Shin
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 126-1, 5-ga Anam-dong, Seongbuk-gu, Seoul 02841, South Korea
| | - Jun Young Hur
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 126-1, 5-ga Anam-dong, Seongbuk-gu, Seoul 02841, South Korea
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 126-1, 5-ga Anam-dong, Seongbuk-gu, Seoul 02841, South Korea
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Menopausal Symptoms and Perimenopausal Healthcare-Seeking Behavior in Women Aged 40-60 Years: A Community-Based Cross-Sectional Survey in Shanghai, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082640. [PMID: 32290565 PMCID: PMC7215590 DOI: 10.3390/ijerph17082640] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 11/20/2022]
Abstract
The aim of the study was to specify prevalence and severity of menopausal symptoms among middle-aged women and to understand the factors associated with women’s perimenopausal healthcare-seeking behavior in Shanghai, China. A community-based cross-sectional study was carried out involving 3147 participants aged 40–60 years. A combination of stratified sampling and quota sampling was used. Out of the total 16 districts in Shanghai, 7 were purposefully selected in consideration of covering both central and suburban areas, population distribution, and willingness to participate. Two communities were randomly selected in each of six districts. Four communities were randomly selected in the 7th district considering the relatively low coverage of central population in the sampling frame. Eligible women were recruited continuously according to the house number and invited to participate in the study until 200 participants were recruited in each community. A structured questionnaire was designed to collect information including sociodemographic data, menopausal symptoms, and experiences in seeking perimenopausal healthcare. The severity of menopausal symptoms was assessed with the modified Kupperman menopausal index (mKMI). The mean age of all the participants was 51 years. 33.13% of the participants were premenopausal, 14.52% were perimenopausal, and 52.35% were postmenopausal. The total prevalence of menopausal symptoms was 73.8%, while among the perimenopausal women, the symptoms were the most common (81.70%). The top three reported symptoms were fatigue (38.08%), hot flushes and sweating (33.65%), and joint ache (28.81%). Perimenopausal and postmenopausal participants had a higher score of the mKMI than premenopausal women (p < 0.01). Of the women who had symptoms, 25.97% had sought healthcare. A logistic regression model revealed that employment, menstruation status, and the mKMI were significantly associated with healthcare-seeking behaviors (p < 0.01). We concluded that prevalence of menopausal symptoms was relatively high among middle-aged women, with perimenopausal women showing the highest level. However, only a small percentage of the participants sought healthcare. Carrying out health education may be a measure to improve the healthcare-seeking behavior.
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Neutzling AL, Leite HM, Paniz VMV, de Bairros FS, Dias da Costa JS, Olinto MTA. Association between common mental disorders, sleep quality, and menopausal symptoms: a population-based study in Southern Brazil. ACTA ACUST UNITED AC 2020; 27:463-472. [DOI: 10.1097/gme.0000000000001524] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Song Y, Xu W, Chatooah ND, Chen J, Huang Y, Chen P, Lan Y, Li C, Ying Q, Ma L, Zhou J. Comparison of low dose versus ultra-low dose hormone therapy in menopausal symptoms and quality of life in perimenopause women. Gynecol Endocrinol 2020; 36:252-256. [PMID: 31538509 DOI: 10.1080/09513590.2019.1666815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The study was to compare the efficacy, safety, and tolerability of low dose versus ultra-low dose hormone therapy (HT) in the management of perimenopause symptoms and quality of life. Retrospective analysis of perimenopause patients prescribed for 25 weeks HT in the outpatient clinic of menopause. A total of 132 perimenopause women were included in two treatment regimens: one with low dose HT (LD-HT) and one with ultra-low dose HT (ULD-HT). Changes in serum levels of follicle-stimulating hormone, estradiol as well as transvaginal ultrasound (TVUS), the 36-item Short Form Health Survey (SF-36), the Kupperman Index (KI), and adverse effects were assessed at baseline, 4, 13, and 25 weeks. By the end of 25 weeks of treatment, each score of SF-36 domains for both LD-HT and ULD-HT groups were increased, the KI decreased, and the endometrial thickness increased in both groups and there was no statistical difference between two groups. Both groups have negligible differences in incidence of adverse effects. Low dose and ultra-low dose HT both can serve in improving symptoms of perimenopause, thereby offering a better quality of life with decreased incidence of side effects. Ultra-low dose treatment may have a better advantage on safety and tolerance.
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Affiliation(s)
- Yang Song
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Wenxian Xu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Namratta Devi Chatooah
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Jianfang Chen
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yizhou Huang
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Peiqiong Chen
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yibing Lan
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Chunming Li
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Qian Ying
- Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Linjuan Ma
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Jianhong Zhou
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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Association of menopausal symptoms with sociodemographic factors and personality traits. MENOPAUSE REVIEW 2020; 18:191-197. [PMID: 32132882 PMCID: PMC7045358 DOI: 10.5114/pm.2019.93117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022]
Abstract
Aim of the study To investigate the association of personality traits with the severity of vasomotor symptoms (VMS) in a predominantly Greek population. Material and methods A questionnaire-based study of women from the Menopause Clinic of a University Hospital in Athens, Greece. Sociodemographic parameters were documented through a structured interview. All women completed the Menopause Rating Scale (MRS) for the assessment of severity of menopausal symptoms, the Hot Flush Beliefs Scale (HFBS) for the assessment of how women were coping with their symptoms and the Big Five Inventory questionnaires for the assessment of personality traits. Associations between baseline parameters and menopausal symptoms were assessed with univariate and multivariate regression analyses. Results One hundred women were included. Employed women had lower MRS sub-scores (psychological p< 0.001, somatic p< 0.047, urogenital p< 0.008). Married women scored higher in the psychological and somatic domains. Women of university educational level coped significantly better with hot flushes (β coefficient [SE]: 0.72 [0.25], p< 0.01) and night sweats (0.57 [0.19], p< 0.01) than women of primary education, although the significance of these findings was not replicated when taking into account confounders. Regarding personality traits, women with low openness (-0.33 [0.11], p< 0.01) and empathy (-0.83 [0.37], p = 0.03) and high agreeableness (1.13 [0.21], p< 0.001) had more severe menopausal symptoms. In contrast, women with high agreeableness could better cope with their menopausal symptoms (-0.75 [0.36], p = 0.04). These associations were independent of sociodemographic factors. Conclusions Personality traits, especially agreeableness, openness and empathy are associated with menopausal symptoms and functionality in postmenopausal women. These associations might serve as indicators of women at risk of experiencing more severe VMS.
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Ong DSP, Chua MT, Shorey S. Experiences and Needs of Perimenopausal Women With Climacteric Symptoms in Singapore: A Qualitative Study. J Transcult Nurs 2019; 31:369-377. [PMID: 31434542 DOI: 10.1177/1043659619870569] [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: 11/15/2022] Open
Abstract
Introduction: Women in the perimenopause stage may face climacteric symptoms where physical and mental challenges are experienced. The purpose of this study was to increase the understanding of the experiences and needs of perimenopausal women with climacteric symptoms in Singapore. Method: This is a descriptive qualitative study. Purposive sampling was used to recruit 20 perimenopausal women with climacteric symptoms from a tertiary public hospital in Singapore. Semistructured face-to-face interviews and thematic analysis were used for data collection and analysis, respectively. Results: Participants lacked knowledge resulting in misconceptions of the condition. Experiencing climacteric symptoms led to mixed feelings. The availability of support varied in different sources and forms. Participants seek for more information, understanding, compassion, and empathy from family members and health care professionals. Discussion: Health care professionals should provide adequate support to cater to the diverse experiences and needs of multiracial perimenopausal women with climacteric symptoms. Future research should include the perspectives of health care professionals and family members.
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Demands for perimenopausal health care in women aged 40 to 60 years—a hospital-based cross-sectional study in Shanghai, China. Menopause 2019; 26:189-196. [DOI: 10.1097/gme.0000000000001172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kong F, Wang J, Zhang C, Feng X, Zhang L, Zang H. Assessment of sexual activity and menopausal symptoms in middle-aged Chinese women using the Menopause Rating Scale. Climacteric 2019; 22:370-376. [PMID: 30612483 DOI: 10.1080/13697137.2018.1547702] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- F. Kong
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Dalian Medical University, Dalian, P.R. of China
| | - J. Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Dalian Medical University, Dalian, P.R. of China
| | - C. Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Dalian Medical University, Dalian, P.R. of China
- Department of Obstetrics and Gynecology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, P.R. of China
| | - X. Feng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Dalian Medical University, Dalian, P.R. of China
| | - L. Zhang
- Department of Pathology, The First Affiliated Hospital of Dalian Medical University, Dalian, P.R. of China
| | - H. Zang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Dalian Medical University, Dalian, P.R. of China
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Huang Y, Chatooah ND, Qi T, Wang G, Ma L, Ying Q, Lan Y, Song Y, Li C, Chu K, Chen P, Xu W, Wan H, Cai Y, Zhou J. Health-related quality of life and its associated factors in Chinese middle-aged women. Climacteric 2018; 21:483-490. [PMID: 29856658 DOI: 10.1080/13697137.2018.1476133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Y. Huang
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - N. D. Chatooah
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - T. Qi
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - G. Wang
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - L. Ma
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Q. Ying
- Zhejiang Cancer Institute, Zhejiang Cancer Hospital, Hangzhou, People’s Republic of China
| | - Y. Lan
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Y. Song
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - C. Li
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - K. Chu
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - P. Chen
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - W. Xu
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - H. Wan
- Maternal and Child Health & Family Planning Service Center, Gongshu District, Hangzhou, People’s Republic of China
| | - Y. Cai
- Maternal and Child Health & Family Planning Service Center, Gongshu District, Hangzhou, People’s Republic of China
| | - J. Zhou
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
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Zhou Y, Zheng Y, Li C, Hu J, Zhou Y, Geng L, Tao M. Association of body composition with menopausal symptoms in (peri-)menopausal women. Climacteric 2018; 21:179-183. [PMID: 29390893 DOI: 10.1080/13697137.2018.1428295] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To explore the correlation of body composition with the severity of menopausal symptoms, as well as each classic menopausal symptom. METHODS A total of 758 (peri-)menopausal women were recruited (aged from 40 to 67 years) from the Menopause Clinic in the Shanghai Sixth People's Hospital. Different regions of fat mass, lean mass and fat-free mass were measured by bioelectrical impedance analysis, while menopausal symptoms were evaluated by valid modified Kupperman's index (KMI) in the Chinese version. RESULTS After adjusting for potential confounders, logistic regression revealed that trunk lean mass (odds ratio 0.29, 95% confidence interval 0.09-0.99) was the independent determinant of moderate to severe menopausal symptoms (KMI ≥ 16). In multiple regression analysis, significant relationships were found between body mass index and hot flushes/sweating and diabetes (p < 0.05). There was a significant relationship between lean mass and muscle/joint pain and sexual problems (p < 0.05). We also observed significant relationships between fat mass and hot flushes/sweating and muscle/joint pain. CONCLUSIONS Our findings indicated that trunk lean mass was an independent protective factor for moderate to severe menopausal symptoms. Strengthening the trunk lean mass may alleviate menopausal symptoms.
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Affiliation(s)
- Y Zhou
- a Department of Gynecology and Obstetrics , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , People's Republic of China
| | - Y Zheng
- a Department of Gynecology and Obstetrics , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , People's Republic of China
| | - C Li
- a Department of Gynecology and Obstetrics , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , People's Republic of China
| | - J Hu
- a Department of Gynecology and Obstetrics , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , People's Republic of China
| | - Y Zhou
- a Department of Gynecology and Obstetrics , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , People's Republic of China
| | - L Geng
- a Department of Gynecology and Obstetrics , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , People's Republic of China
| | - M Tao
- a Department of Gynecology and Obstetrics , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , People's Republic of China
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Chu K, Song Y, Chatooah ND, Weng Q, Ying Q, Ma L, Qu F, Zhou J. The use and discontinuation of hormone replacement therapy in women in South China. Climacteric 2017; 21:47-52. [PMID: 29166793 DOI: 10.1080/13697137.2017.1397622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The use of hormone replacement therapy (HRT) started later in China than in European countries. The purpose of the present study was to investigate HRT patterns and reasons for the initiation and discontinuation of HRT among women in South China. METHODS A telephone survey about menopausal status, the use of HRT, reasons for HRT discontinuation and duration of HRT treatment was conducted in 2014. RESULTS A total of 825 telephone surveys were carried out, and 217 previous HRT users and 390 current users were recruited for this study. Among these 607 subjects, 50.7% of the women sought out HRT for hot flushes, 41.6% for fatigue and 41.5% for sleeplessness. Approximately one-third (35.9%) of the patients abandoned HRT during the following year. The reasons for stopping HRT were mainly fear of breast and uterine cancer (28.4%), reduced menopausal symptoms (22.9%) and the inconvenience of taking pills or seeing a doctor (17.9%). The factors related to HRT discontinuation were the age when HRT was initiated (odds ratio 1.59, 95% confidence interval 1.19-2.13) and education level (odds ratio 0.78, 95% confidence interval 0.62-0.98). CONCLUSIONS The duration of HRT use in women in south China was short, and a high proportion of the women discontinued HRT. Given the high discontinuation rate and the low medical compliance, Chinese health-care providers still have much to do to let women know about the advantages and disadvantages of HRT and to encourage the use of HRT appropriately.
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Affiliation(s)
- K Chu
- a School of Medicine , Women's Hospital, Zhejiang University , Hangzhou , PR China
| | - Y Song
- a School of Medicine , Women's Hospital, Zhejiang University , Hangzhou , PR China
| | - N D Chatooah
- a School of Medicine , Women's Hospital, Zhejiang University , Hangzhou , PR China
| | - Q Weng
- b Yuhang First Hospital , Hangzhou , PR China
| | - Q Ying
- c Zhejiang Cancer Hospital , Hangzhou , PR China
| | - L Ma
- a School of Medicine , Women's Hospital, Zhejiang University , Hangzhou , PR China
| | - F Qu
- a School of Medicine , Women's Hospital, Zhejiang University , Hangzhou , PR China
| | - J Zhou
- a School of Medicine , Women's Hospital, Zhejiang University , Hangzhou , PR China
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