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Pingarrón Santofímia C, Lafuente González P, Guitiérrez Vélez MDC, Calvente Aguilar V, Poyo Torcal S, Terol Sánchez P, Palacios S. Long-term use of ospemifene in clinical practice for vulvo-vaginal atrophy: end results at 12 months of follow-up. Gynecol Endocrinol 2022; 38:577-582. [PMID: 35670533 DOI: 10.1080/09513590.2022.2083103] [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] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To assess the improvement in vulvovaginal atrophy (VVA) of postmenopausal women treated with oral ospemifene 60 mg/day under conditions of routine clinical practice after 12 months of follow-up. METHODS The AYSEX study is a Spanish observational, prospective, and unicentric study in which five gynecologists recruited postmenopausal women with VVA in routine clinical practice treated with oral ospemifene 60 mg/day as an appropriate therapeutic option. Vaginal health, the most bothersome symptoms, sexual health, endometrial safety, bone resorption markers, bone densitometry, mammography, treatment satisfaction, and quality of life were assessed at baseline and after 12 months using appropriate scales. RESULTS A total of 100 postmenopausal women cytologically and clinically diagnosed with VVA were included in the study. After 3 months of treatment with ospemifene, a significant improvement was observed in all domains of Vaginal Health Index. This improvement was maintained at month 12 and only one patient remained with vaginal atrophy. In addition, a significant improvement was observed in the most bothersome symptoms, sexual function, and quality of life. There was no significant change in endometrial thickness, mammography, and bone health during the 12 months of treatment. CONCLUSIONS This study in routine clinical practice conditions confirms the results previously reported by randomized controlled trials, including a significant improvement in VVA, sexual function, quality of life, endometrial safety, and satisfaction with the treatment.
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Affiliation(s)
- Carmen Pingarrón Santofímia
- Servicio de Ginecología y Oncoginecología, Universidad Europea de Madrid. Hospital Quirónsalud San José, Madrid, Spain
| | | | | | | | - Silvia Poyo Torcal
- Servicio de Ginecología y Oncoginecología. Hospital Quirónsalud San José, Madrid, Spain
| | - Pablo Terol Sánchez
- Servicio de Ginecología y Oncoginecología. Hospital Quirónsalud San José, Madrid, Spain
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Zhou L, Wong KY, Poon CCW, Yu W, Xiao H, Chan CO, Mok DKW, Wong MS. Water Extract of Rhizoma Drynaria Selectively Exerts Estrogenic Activities in Ovariectomized Rats and Estrogen Receptor-Positive Cells. Front Endocrinol (Lausanne) 2022; 13:817146. [PMID: 35282447 PMCID: PMC8908013 DOI: 10.3389/fendo.2022.817146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/27/2022] [Indexed: 12/18/2022] Open
Abstract
Our previous study demonstrated that the bone protective actions of herbal medicine Rhizoma Drynariae (Gusuibu, RD) were mainly mediated by flavonoid phytoestrogens via estrogen receptors, raising concerns about the safety of using RD as it may induce estrogen-like risk-benefit profile and interact with other ER ligands, such as selective estrogen receptor modulators (SERMs), when coadministered. The present study evaluated the estrogenic activities of RD and its potential interaction with tamoxifen, a SERM, in estrogen-sensitive tissues by using mature ovariectomized (OVX) rats and ER-positive cells. Similar to but weaker than tamoxifen, RD at its clinical dose dramatically ameliorated OVX-induced changes in bone and dopamine metabolism-related markers in OVX rats. However, tamoxifen, but not RD, induced uterotrophic effects. No significant alteration in mammary gland was observed in OVX rats treated with RD, which was different from the inhibitory actions of tamoxifen. The two-way ANOVA results indicated the interactions between RD and tamoxifen in the bone, brain, and uterus of OVX rats while RD did not alter their responses to tamoxifen. Our results demonstrate that RD selectively exerts estrogenic actions in a different manner from tamoxifen. Moreover, RD interacts with tamoxifen without altering its effects in OVX rats.
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Affiliation(s)
- Liping Zhou
- Cell Therapy Center, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Ka-Ying Wong
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Christina Chui-Wa Poon
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Center for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Wenxuan Yu
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Huihui Xiao
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Center for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Chi-On Chan
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Chinese Medicine and Molecular Pharmacology (Incubation), The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Daniel Kam-Wah Mok
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Chinese Medicine and Molecular Pharmacology (Incubation), The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Man-Sau Wong
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Center for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- State Key Laboratory of Chinese Medicine and Molecular Pharmacology (Incubation), The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
- *Correspondence: Man-Sau Wong,
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Pingarron C, de Lafuente P, Ierullo AM, Poyo Torcal S, Maroto Díaz CJ, Palacios S. Ospemifene in clinical practice for vulvo-vaginal atrophy: results at 3 months of follow-up of use. Gynecol Endocrinol 2021; 37:562-566. [PMID: 33300371 DOI: 10.1080/09513590.2020.1853695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To assess the effect of ospemifene 60 mg/day in vulvovaginal atrophy (VVA) in postmenopausal women under conditions of routine clinical practice after 3 months of follow-up. METHODS The AYSEX study is a Spanish observational, prospective, and unicentric study in which 5 gynecologists recruited postmenopausal women with VVA in routine clinical practice treated with ospemifene 60 mg/day as an appropriate therapeutic option. Vaginal health, sexual health, dryness, dyspareunia, quality of life, and satisfaction with treatment were assessed at baseline and after three months using validated scales. RESULTS A total of 100 postmenopausal women cytologically and clinically diagnosed with VVA were included in the study. After 3 months of treatment with ospemifene, vaginal health index increased and vaginal pH, dryness, and dyspareunia decreased significantly (p < .0001). A significant improvement was observed in sexual function and quality of life. CONCLUSIONS This study in routine clinical practice conditions confirms the results previously reported by randomized controlled trials, including a significant improvement in VVA, sexual function, quality of life, and satisfaction with the treatment.
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Affiliation(s)
| | - Pilar de Lafuente
- Instituto Palacios de Salud y Medicina de la Mujer, Instituto Palacios de Salud y Medicina de la Mujer, Madrid, Spain
| | | | | | | | - Santiago Palacios
- Instituto Palacios de Salud y Medicina de la Mujer, Instituto Palacios de Salud y Medicina de la Mujer, Madrid, Spain
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Sievert LL, Huicochea-Gómez L, Cahuich-Campos D, Ko'omoa-Lange DL, Brown DE. Stress and the menopausal transition in Campeche, Mexico. Womens Midlife Health 2019; 4:9. [PMID: 30766719 PMCID: PMC6298015 DOI: 10.1186/s40695-018-0038-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/29/2018] [Indexed: 11/16/2022] Open
Abstract
Background Stress has been implicated as a factor in the presence and severity of symptoms during the menopausal transition. Our primary aim was to test the hypothesis that stress-sensitive biological measures and self-reported stress would be positively associated with a greater likelihood and intensity of hot flashes. Our secondary aim was to examine measures of stress in relation to the most often reported symptoms in Campeche, Mexico. We also hypothesized ethnic differences (Maya versus non-Maya) in relation to measures of stress and symptom reports. Methods Participants aged 40–60 (n = 305) were drawn from multiple sites across the city of San Francisco de Campeche to achieve a generally representative sample. Measures included C-reactive protein (CRP), an indicator of inflammation; Epstein-Barr virus antibodies (EBV-Ab), an indicator of immune function; the Perceived Stress Scale (PSS); a symptom checklist; anthropometric measures; and a questionnaire that elicited symptoms, ethnicity (based on language, birthplace, and last names of the woman, her parents, and her grandparents) and ten dimensions of socioeconomic status (SES). The relationships between symptoms and stress-sensitive biological and self-reported measures were examined in bivariate analyses, and with logistic and linear regressions. Results The twelve most common symptoms reported, in descending order of frequency, were tiredness, muscle and joint pain, nervous tension, problems concentrating, feeling depressed, difficulty sleeping, headaches, feeling of ants crawling on the skin, loss of interest in sex, urinary stress incontinence, hot flashes, and night sweats. PSS scores were significantly associated with the likelihood of seven symptoms (yes/no), and with the intensity of ten symptoms after controlling for ethnicity, SES, education, cohabitation status, parity, smoking, body mass index, and menopausal status. The stress-sensitive biological measures of immune function (EBV-Ab and CRP) were not significantly associated with midlife symptoms. The PSS was associated with more symptoms among the Maya (e.g., feeling nervous/tense and having difficulty concentrating) than non-Maya. Conclusion PSS scores were associated with the intensity, but not the likelihood, of hot flashes. Other symptoms were also associated with self-reported stress but not with physiological measures. Maya/non-Maya differences may indicate that either symptoms or stress were experienced and/or reported in culture-specific ways.
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Affiliation(s)
- Lynnette Leidy Sievert
- Department of Anthropology, Machmer Hall, 240 Hicks Way, UMass Amherst, Amherst, MA 01003-9278 USA
| | - Laura Huicochea-Gómez
- 2Departamento de Sociedad y Cultura, El Colegio de la Frontera, ECOSUR, Campeche, México
| | - Diana Cahuich-Campos
- 2Departamento de Sociedad y Cultura, El Colegio de la Frontera, ECOSUR, Campeche, México
| | | | - Daniel E Brown
- 4Department of Anthropology, University of Hawai'i at Hilo, Hilo, HI USA
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Gerber LM, Sievert LL. Neighborhood disorder, exposure to violence, and perceived discrimination in relation to symptoms in midlife women. Womens Midlife Health 2018; 4:14. [PMID: 30766724 PMCID: PMC6297945 DOI: 10.1186/s40695-018-0043-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 09/21/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Some symptoms at midlife are associated with stress, such as hot flashes, trouble sleeping, headaches, or depressed mood. Hot flashes have been studied in relation to laboratory stressors, physiological biomarkers, and self-reported stress, but less is known about hot flashes in relation to the larger context of women's lives. This study examined the risk of symptoms in relation to neighborhood disorder, exposure to neighborhood violence, social cohesion and perceived discrimination. We hypothesized that women exposed to more negative neighborhood characteristics and discrimination would be more likely to report hot flashes and other midlife symptoms. METHODS Participants were black and white women, aged 40 to 60, drawn from a cross-sectional investigation of race/ethnicity, socioeconomic status, and blood pressure in New York City (n = 139). Demographic information, medical history, menopausal status, and symptoms were measured by questionnaire. Likert scales were used to measure neighborhood characteristics, specifically, the Neighborhood Disorder Scale, the Exposure to Violence Scale, the Perceived Violence Subscale, the Neighborhood Social Cohesion and Trust Scale, and the Everyday Discrimination Scale. Ten symptoms were included in analyses: lack of energy, feeling blue/depressed, backaches, headaches, aches/stiffness in joints, shortness of breath, hot flashes, trouble sleeping, nervous tension, and pins/needles in hands/feet. Each scale with each symptom outcome was examined using logistic regression analyses adjusting for significant covariates. RESULTS Black women reported higher scores on all negative neighborhood characteristics and discrimination, and a lower score on the positive Neighborhood Social Cohesion and Trust. Neighborhood Disorder was associated with feeling blue/depressed, aches/stiffness in joints, and hot flashes, and Perceived Violence was associated with aches/stiffness in joints, after controlling for model-specific covariates. There was a lower risk of backaches with increasing Neighborhood Social Cohesion and Trust score. The Everyday Discrimination Scale was associated with lack of energy. Lack of energy, feeling blue/depressed, aches/stiffness in joints, and hot flashes appeared to be most vulnerable to negative neighborhood context and discrimination. CONCLUSIONS This study adds to the literature linking neighborhood environments to health outcomes. The associations between negative neighborhood contexts and discrimination with diverse symptoms, and the association between social cohesion and back pain, point to the need to expand analyses of stress to multiple physiological systems.
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Affiliation(s)
- Linda M Gerber
- Department of Healthcare Policy & Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, 402 E. 67th St., LA-231, New York, NY 10065 USA
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medical College, New York City, NY USA
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Yeom HE. Gender differences in climacteric symptoms and associated factors in Korean men and women. Appl Nurs Res 2018; 41:21-28. [PMID: 29853209 DOI: 10.1016/j.apnr.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/09/2018] [Accepted: 03/02/2018] [Indexed: 12/19/2022]
Abstract
Both men and women may experience multifaceted symptoms that are part of natural aging throughout the climacteric period. This study compared the prevalence and severity of climacteric symptoms between genders and identified the underlying clusters of climacteric symptoms and associated factors in midlife men and women. A cross-sectional study was done with 254 middle-aged Korean men (n = 129, M = 50.4) and women (n = 125, M = 49.5). Data were collected by self-administered surveys and analyzed using t-tests, chi-square tests, exploratory factor analysis, and regression analysis. Significant gender differences in overall climacteric symptoms were not detected except for muscle weakness, weight gain, and hot flashes. Climacteric symptoms were clustered as physical, vasomotor-genital, psychological, and metabolic dimensions, with the physical dimension being the most explanatory cluster. A significant gender effect was found only in the metabolic dimension after adjusting for the relevant covariates, and regular eating was significantly associated with all symptom clusters. This study offers evidence that most climacteric symptoms are shared by both men and women and emphasizes the importance of healthier lifestyles in the climacteric transition period. The findings highlight the critical need for integrated assessments of the multifactorial symptoms and of modifying poor lifestyles in both genders throughout the climacteric transition period.
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Affiliation(s)
- Hyun-E Yeom
- College of Nursing, Chungnam National University, Munhwaro 266, Jung-gu, Daejeon, South Korea.
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Im EO, Hu Y, Cheng CY, Ko Y, Chee E, Chee W. Clusters of midlife women identified by cognitive symptoms. Maturitas 2018; 110:33-40. [PMID: 29563033 DOI: 10.1016/j.maturitas.2018.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/23/2017] [Accepted: 01/12/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The study aimed to identify clusters of midlife women by their cognitive symptoms and to examine racial/ethnic differences in the clusters. STUDY DESIGN This secondary analysis was conducted on the data from 1054 midlife women of multi-ethnic groups in two Internet studies (conducted from 2005 to 2013). MAIN OUTCOME MEASURES Only the data from the questions on background characteristics, health status, and menopausal status and the Cognitive Symptom Index for Midlife Women were used for this secondary analysis. The data were analyzed using factor analyses, hierarchical cluster analyses, chi-square tests, multinomial logistic analyses, and analyses of covariance. RESULTS Four clusters were extracted: the low total symptom group (Cluster 1; 49.9%), the low-moderate total symptom group with high tertiary symptoms (Cluster 2; 17.3%), the high-moderate total symptom group with low tertiary symptoms (Cluster 3; 21.2%); and the high total symptom group (Cluster 4; 11.7%). There were significant differences in the level of education, employment status, family income, marital status, social support, the country of birth, race/ethnicity, body mass index, perceived general health, diagnosed disease(s), access to health care, and menopausal status among the clusters (p < .01). There were significant racial/ethnic differences in the total numbers and total severity scores of tertiary symptoms in Cluster 1. Also, there were significant racial/ethnic differences in individual symptoms in each cluster. CONCLUSIONS Racial/ethnic differences in midlife women's cognitive symptoms and multiple factors that might differently influence their cognitive symptoms need to be considered in health care for midlife women in menopausal transition.
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Affiliation(s)
- Eun-Ok Im
- Duke University, School of Nursing, 307 Trent Dr., Durham, NC, 27710.
| | - Yun Hu
- Duke University, School of Nursing, 307 Trent Dr., Durham, NC, 27710; Shanghai Jia Tong University, South Chongqing Road, NO. 227, Building 1, 209, Shanghai.
| | - Ching-Yu Cheng
- Duke University, School of Nursing, 307 Trent Dr., Durham, NC, 27710; Chang Gung University of Science and Technology, 261 We-hua 1st Road, Kwei-shan, Tao-yuan, Taiwan.
| | - Young Ko
- Gachon University, School of Nursing, Incheon, South Korea.
| | - Eunice Chee
- North Carolina State University, School of Engineering, Biomedical Engineering Department, Engineering Building III, 911 Oval Drive, Campus Box 7115, Raleigh, NC 27695.
| | - Wonshik Chee
- Duke University, School of Nursing, 307 Trent Dr., Durham, NC, 27710.
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Abstract
Background Patterns of symptom clustering in midlife women may suggest common underlying mechanisms or may identify women at risk of adverse health outcomes or, conversely, likely to experience healthy aging. This paper assesses symptom clustering in the Study of Women’s Health Across the Nation (SWAN) longitudinally by stage of reproductive aging and estimates the probability of women experiencing specific symptom clusters. We also evaluate factors that influence the likelihood of specific symptom clusters and assess whether symptom clustering is associated with women’s self-reported health status. Methods This analysis includes 3289 participants in the multiethnic SWAN cohort who provided information on 58 symptoms reflecting a broad range of physical, psychological and menopausal symptoms at baseline and 7 follow-up visits over 16 years. We conducted latent transition analyses to assess symptom clustering and to model symptomatology across the menopausal transition (pre, early peri-, late peri- and post-menopausal). Joint multinomial logistic regression models were used to identify demographic characteristics associated with premenopausal latent class membership. A partial proportional odds regression model was used to assess the association between latent class membership and self-reported health status. Results We identified six latent classes that ranged from highly symptomatic (LC1) across most measured symptoms, to moderately symptomatic across most measured symptoms (LC2), to moderately symptomatic for a subset of symptoms (vasomotor symptoms, pain, fatigue, sleep disturbances and physical health symptoms) (LC3 and LC5) with one class (LC3) including interference in life activities because of physical health symptoms, to numerous milder symptoms, dominated by fatigue and psychological symptoms (LC4), to relatively asymptomatic (LC6). In pre-menopause, 10% of women were classified in LC1, 16% in LC2, 14% in LC3 and LC4, 26% in LC5, and 20% in LC6. Intensity of vasomotor and urogenital symptoms as well as sexual desire) differed minimally by latent class. Classification into the two most symptomatic classes was strongly associated with financial strain, White race/ethnicity, obesity and smoking status. Over time, women were most likely to remain within the same latent class as they transitioned through menopause stages (range 39–76%), although some women worsened or improved. The probability of moving between classes did not differ substantially by menopausal stage. Women in the highly symptomatic classes more frequently rated their health as fair to poor compared to women in the least symptomatic class. Conclusion Clear patterns of symptom clustering were present early in midlife, tended to be stable over time, and were strongly associated with self-perceived health. Notably, vasomotor symptoms tended to cluster with sleep disturbances and fatigue, were present in each of the moderate to highly symptomatic classes, but were not a defining characteristic of the symptom clusters. Clustering of midlife women by symptoms may suggest common underlying mechanisms amenable to interventions. Given that one-quarter of midlife women were highly or moderately symptomatic across all domains in the pre-menopause, addressing symptom burden in early midlife is likely critical to ameliorating risk in the most vulnerable populations. Electronic supplementary material The online version of this article (doi:10.1186/s40695-017-0021-y) contains supplementary material, which is available to authorized users.
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Gerber LM, Sievert LL, Schwartz JE. Hot flashes and midlife symptoms in relation to levels of salivary cortisol. Maturitas 2017; 96:26-32. [PMID: 28041591 PMCID: PMC5215844 DOI: 10.1016/j.maturitas.2016.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/21/2016] [Accepted: 11/01/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study examined the relationship between salivary cortisol levels and hot flashes during midlife. Previous studies have shown that cortisol levels increase with hot flashes in the laboratory, and higher cortisol levels have been associated with more severe hot flashes. Salivary cortisol levels were also examined in relation to total number of midlife symptoms. METHODS Women aged 40-60 years (n=109) reported the presence or absence of 23 symptoms, including hot flashes, during the previous 2 weeks. Salivary samples were collected at waking, 30min after waking, 1h before bedtime, and at bedtime. The cortisol awakening response (CAR), cortisol daily decline (CDD), log transformed salivary cortisol levels at each time point, and mean cortisol levels were compared by hot flash report using t-tests. Logistic regression analyses were performed to assess the association between each cortisol measure and the presence or absence of hot flashes, after controlling for potential covariates. RESULTS Salivary cortisol levels were not significantly associated with hot flashes or sum of symptoms. Hot flash report did not differentiate women who had a positive CAR from those who did not, or women who showed strong CDD from those who did not. CONCLUSION Symptomatic women - defined by hot flash report or symptom total - were not found to have higher salivary cortisol levels.
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Affiliation(s)
- Linda M Gerber
- Department of Healthcare Policy & Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, United States; Department of Medicine, Division of Nephrology & Hypertension, Weill Cornell Medical College, United States.
| | - Lynnette L Sievert
- Department of Anthropology, University of Massachusetts Amherst, United States
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University, United States; Department of Psychiatry, Stony Brook University, United States
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Guidozzi F, Thomas C, Smith T, Nappi RE. CLarifying vaginal atrophy’s impact On SEx and Relationships (CLOSER) survey in South Africa. Climacteric 2017; 20:49-54. [DOI: 10.1080/13697137.2016.1262838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- F. Guidozzi
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C. Thomas
- Claremont, Cape Town, Western Cape, South Africa
| | - T. Smith
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - R. E. Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Abstract
OBJECTIVE The purpose of this study was to identify clusters of midlife women by sleep-related symptoms in multiethnic groups and to examine racial/ethnic differences in the clusters. METHODS This secondary analysis was conducted on data from 1,054 midlife women who participated in two cross-sectional descriptive national Internet surveys. The instruments included questions on background characteristics, health, and menopause status, and the Sleep Index for Midlife Women. The data were analyzed using hierarchical clustering methods, χ2 test, analysis of variance, and multinomial logistic regression analyses. RESULTS A four-cluster solution was adopted: cluster 1 (low total symptoms group), cluster 2 (moderate physical and psychosomatic symptoms group), cluster 3 (moderate psychological symptoms group), and cluster 4 (high total symptoms group). There were significant differences in education, employment status, family income, social support, country of birth, race/ethnicity, body mass index, perceived general health, diagnosed disease, access to health care, and menopause status among clusters (P < 0.05). In cluster 1 only, there were significant racial/ethnic differences in the total number of total severity scores for physical symptoms (P < 0.01). When racial/ethnic differences in individual symptoms in each cluster were determined, there were no consistent racial/ethnic differences. CONCLUSIONS Researchers need to consider that racial/ethnic differences could be prominent in midlife women with low sleep-related symptoms.
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Constantine GD, Graham S, Clerinx C, Bernick BA, Krassan M, Mirkin S, Currie H. Behaviours and attitudes influencing treatment decisions for menopausal symptoms in five European countries. Post Reprod Health 2016; 22:112-22. [PMID: 26895640 PMCID: PMC5019289 DOI: 10.1177/2053369116632439] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objective To assess women’s behaviours and attitudes regarding the treatment of menopausal symptoms in five European countries. Study design Women aged ≥45 years in France, Germany, Italy, Spain, and the United Kingdom participated in an internet survey. Completers were those who reported menopausal symptoms and had treated their symptoms. Women were equally stratified by age (45–54 years, 55–64 years, ≥65 years). Main outcome measures Behaviours, attitudes, and experiences regarding treatment of menopausal symptoms. Results Of 3890 peri- to postmenopausal women screened, 67% experienced symptoms and 54% sought either medical input or some treatment concerning their symptoms. Hot flushes, the most common symptom, decreased with age but remained prevalent after age 64. Roughly 75% of women who sought relief consulted a physician, mostly a gynaecologist or a general practitioner (GP) as in the United Kingdom. The decision to seek treatment was influenced by age, number, and severity of symptoms. Approximately 79% visiting a physician received prescription therapy. Of the women who received non-hormone therapy (HT) treatment instead of HT: patients refused HT (20–44%), physicians did not discuss HT (32–46%), or advised against HT (24–43%). Women in the United Kingdom were most familiar with and favorable to HT. Interest in a new HT (34–50%) was higher than use (19–28%). Conclusions Menopausal symptoms are common, persistent, and bothersome, but many fail to seek treatment. Sources and types of treatment vary among age groups and countries. Education regarding women’s attitudes toward treatment should be provided to those physicians who treat menopausal symptoms in each country.
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Affiliation(s)
| | | | | | | | | | | | - Heather Currie
- Department of Obstetrics and Gynecology, Dumfries & Galloway Royal Infirmary, Dumfries, UK
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Hakimi S, Simbar M, Ramezani Tehrani F, Zaiery F, Khatami S. Women's perspectives toward menopause: A phenomenological study in Iran. J Women Aging 2016; 28:80-9. [PMID: 26735699 DOI: 10.1080/08952841.2014.954502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study explores the attitude and feelings toward menopause among Azeri menopausal women using hermeneutic phenomenology based on Van Manen's approach. A total of 18 menopausal women who were attended in urban health centers of Tabriz, Iran, were recruited using a purposive sampling method. Data were gathered through semistructured interviews. Each interview was transcribed verbatim and analyzed simultaneously. Data analysis led to the emergence of five main themes: positive attitude, neutral attitude, negative attitude, positive feelings, and negative feelings. Participants had different feelings and attitude. Acceptance of menopause as a natural process helps women to have a neutral attitude toward menopause.
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Affiliation(s)
- Sevil Hakimi
- a Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran; Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Masoumeh Simbar
- b The Research Center for Safe Motherhood, Department of Midwifery and Reproductive Health , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Fahimeh Ramezani Tehrani
- c Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Farid Zaiery
- d Department of Biostatistics , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Shiva Khatami
- e Department of Education , Colorado State University , Fort Collins , Colorado, USA
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Terauchi M, Hirose A, Akiyoshi M, Owa Y, Kato K, Kubota T. Subgrouping of Japanese middle-aged women attending a menopause clinic using physical and psychological symptom profiles: a cross-sectional study. BMC WOMENS HEALTH 2014; 14:148. [PMID: 25420911 PMCID: PMC4247616 DOI: 10.1186/s12905-014-0148-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 11/10/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Women in the menopausal transition and the postmenopausal period are affected with vasomotor symptoms, urogenital atrophy, sexual dysfunction, somatic symptoms, cognitive difficulty, sleep disturbance, and psychological problems. It is important to gain a better understanding of the complexity and diversity of climacteric disturbance in order to optimize treatments for individual patients. The aim of this study was to identify subgroups of Japanese perimenopausal and postmenopausal women attending a menopause clinic based on their physical and psychological symptom profiles. METHODS We administered the Menopausal Health-Related Quality of Life questionnaire to 491 Japanese women aged 40-64 years who had enrolled in the Systematic Health and Nutrition Education Program at the Menopause Clinic of the Tokyo Medical and Dental University Hospital between 2005 and 2012. We performed a principal component analysis followed by a hierarchical cluster analysis of the responses to 9 physical and 12 psychological items on the questionnaire. RESULTS The first analysis extracted 3 principal components that defined the variance of physical and psychological symptom profiles: depression, somatic, and vasomotor/sleep. A subsequent cluster analysis was performed based on the 3 principal components to generate 4 clusters, CL8 (N = 162; 33.0%), CL6 (N = 111; 22.6%), CL5 (N = 102; 20.8%), and CL4 (N = 116; 23.6%). CL8 included women who only had mild-to-moderate musculoskeletal pains and tiredness. All women in CL6, CL5, and CL4 described their musculoskeletal pains and tiredness as moderate to severe. The women in CL5 also had moderate-to-severe vasomotor symptoms, while the women in CL4 also suffered from moderate-to-severe psychological symptoms, such as depression, anxiety, and insomnia. CONCLUSIONS Distinct subgroups of Japanese perimenopausal and postmenopausal women were identified based on their symptom profiles. Menopausal symptoms were shown to accumulate in this population in the order of musculoskeletal pains and tiredness, vasomotor symptoms, and psychological symptoms.
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Affiliation(s)
- Masakazu Terauchi
- Department of Women's Health, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8510, Japan.
| | - Asuka Hirose
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8510, Japan.
| | - Mihoko Akiyoshi
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8510, Japan.
| | - Yoko Owa
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8510, Japan.
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8510, Japan.
| | - Toshiro Kubota
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8510, Japan.
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15
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Abstract
Our purpose for this study was to identify clusters of midlife women by menopausal symptoms in a multiethnic sample, and to determine ethnic differences in the clusters. This was a secondary analysis of data from 501 women in a larger Internet study on menopausal symptom experiences. The data were analyzed using factor analysis, hierarchical cluster analysis, and multinominal logistic analysis. A three cluster solution was adopted (F = 575.71, p <.01). The clusters differed significantly in the country of birth and ethnicity (p <.05). Only in the low symptomatic cluster were there significant ethnic differences in menopausal symptoms.
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Affiliation(s)
- Eun-Ok Im
- a School of Nursing, University of Pennsylvania , Philadelphia , Pennsylvania , USA
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The CLOSER survey: Impact of postmenopausal vaginal discomfort on relationships between women and their partners in Northern and Southern Europe. Maturitas 2013; 75:373-9. [DOI: 10.1016/j.maturitas.2013.05.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 05/03/2013] [Indexed: 11/18/2022]
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17
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Ferrand F, Hajri S, Benzineb S, Draoui DM, Hassoun D, Delanoë D, Zins M, Ringa V. Comparative study of the quality of life associated with menopause in Tunisia and France. Menopause 2013; 20:609-22. [DOI: 10.1097/gme.0b013e318278b0ce] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Cray LA, Woods NF, Mitchell ES. Identifying symptom clusters during the menopausal transition: observations from the Seattle Midlife Women's Health Study. Climacteric 2012; 16:539-49. [PMID: 23153001 DOI: 10.3109/13697137.2012.746657] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES First, to explore the variability in how symptoms clustered together over the late reproductive stage, early and late menopausal transition (MT) stages, and early postmenopause; second, to determine whether the symptom factor structure of the preceding MT stage would predict the symptom factor structure of the MT stage immediately following. METHODS The sample consisted of a subset of Seattle Midlife Women's Health Study participants who were in late reproductive or early or late menopausal transition stages or early postmenopause and provided self-reported data on symptoms experienced between 1990 and 2005. Principal components analysis was used to determine how symptoms clustered together across the stages. Variables predicting the symptom factor structure were analyzed by multiple regression. RESULTS Principal components analysis with varimax rotation revealed different factor structures for each of the four stages. The three-factor solution in the late reproductive stage explained a total of 54.9% of the variance. The four-factor solutions in the early and late menopausal transition stages and postmenopause explained a total of 56.5%, 59.3%, and 60.7%, respectively. CONCLUSIONS This analysis revealed similar factor structures across the four stages in that each stage revealed a mood component, a vasomotor component, and a pain component. However, the symptoms differed somewhat in how they grouped from stage to stage. Regression analysis demonstrated that a relationship exists between the symptom factor structures across stages. Controlling for demographic and lifestyle variables, it was revealed that the symptom clusters at the early and late menopausal transition stages and early postmenopause were best predicted by the symptom factor structure of the previous stage.
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Affiliation(s)
- L A Cray
- Seattle University, College of Nursing, Seattle, WA
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19
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Delanoë D, Hajri S, Bachelot A, Mahfoudh Draoui D, Hassoun D, Marsicano E, Ringa V. Class, gender and culture in the experience of menopause. A comparative survey in Tunisia and France. Soc Sci Med 2012; 75:401-9. [DOI: 10.1016/j.socscimed.2012.02.051] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 02/22/2012] [Accepted: 02/29/2012] [Indexed: 11/27/2022]
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20
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Symptom clusters at midlife: a four-country comparison of checklist and qualitative responses. Menopause 2012; 19:133-44. [PMID: 22042326 DOI: 10.1097/gme.0b013e3182292af3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the frequency and clustering of somatic symptoms as reported by women aged 45 to 55 years in four countries, to compare women's responses to open-ended questions with those derived from structured checklists, and to assess the extent to which bodily symptoms grouped with emotional complaints. METHODS The Decisions at Menopause Study recruited 1,193 women from the general population in Beirut, Lebanon; Rabat, Morocco; Madrid, Spain; and central Massachusetts. Women participated in semistructured interviews on health, menopause, and bodily changes at midlife. The women's responses to symptom checklists and their statements in response to open-ended questions were analyzed through factor and textual analyses. RESULTS There was considerable consistency between the frequencies of quantitative and qualitative responses, and analyses of qualitative data illustrate the extent to which women associate somatic and emotional complaints. As shown in their responses to the open-ended questions, the women in Massachusetts and Spain did not often cluster somatic with emotional symptoms. In Morocco, dizziness, fatigue, and headaches were clustered with emotional symptoms. Women in Lebanon explicitly associated shortness of breath, chest pain, palpitations, dizziness, fatigue, gastrointestinal complaints, headaches, and, to a lesser extent, joint pain and numbness with emotional symptoms. CONCLUSIONS The number of volunteered symptom responses was small because the respondents were relatively healthy; however, the extent and pattern of association between somatic and emotional symptoms varied across sites. Certain somatic symptoms may be more likely to communicate psychosocial distress in particular cultures. These results have implications for patterns of healthcare utilization.
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Lerner-Geva L, Boyko V, Blumstein T, Benyamini Y. The impact of education, cultural background, and lifestyle on symptoms of the menopausal transition: the Women's Health at Midlife Study. J Womens Health (Larchmt) 2012; 19:975-85. [PMID: 20380577 DOI: 10.1089/jwh.2009.1381] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS This study aimed to examine differences in symptom clusters among women in midlife from different cultural origins and to identify sociodemographic, lifestyle, and health characteristics that could account for the differences between the cultural groups in symptom reporting. METHODS Israeli women aged 45-64 were randomly selected according to age and population strata of three groups: long-term Jewish residents (LTR), Jewish immigrants from the former Soviet Union, and Arab women (mostly Israeli-born). Interviews were conducted with 540 LTR, 151 immigrants, and 123 Arab women. The survey instrument included the occurrence and rating of how bothersome to everyday function were 16 symptoms. Three outcome variables included hot flashes and two scales for mental and somatic symptoms extracted from exploratory factor analysis. RESULTS Multivariate logistic regressions showed that immigrants and Arab women (compared to LTR) had a significantly lower risk of reporting hot flashes and mental and somatic symptoms. Menopausal status was related only to hot flashes. Low education and depression were associated with the three symptom scales, whereas nonhealthy lifestyle was related only to somatic symptoms. CONCLUSIONS Our main finding is that cultural group is an independent predictor of each of the three menopausal symptom scales. A possible explanation for the lower reporting of symptoms among Arab and immigrant groups is that they differ from the LTR in level of acculturation and attitudes toward menopause. These findings support the proposition of a cultural factor in menopausal symptomatology that needs to be addressed by clinicians caring for women at midlife.
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Affiliation(s)
- Liat Lerner-Geva
- Women and Children's Health Research Unit, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
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22
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Methods used in cross-cultural comparisons of vasomotor symptoms and their determinants. Maturitas 2011; 70:110-9. [DOI: 10.1016/j.maturitas.2011.07.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 07/13/2011] [Accepted: 07/14/2011] [Indexed: 11/23/2022]
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Anderson D, Melby MK, Sievert LL, Obermeyer CM. Methods used in cross-cultural comparisons of psychological symptoms and their determinants. Maturitas 2011; 70:120-6. [DOI: 10.1016/j.maturitas.2011.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 07/15/2011] [Accepted: 07/15/2011] [Indexed: 10/17/2022]
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Melby MK, Sievert LL, Anderson D, Obermeyer CM. Overview of methods used in cross-cultural comparisons of menopausal symptoms and their determinants: Guidelines for Strengthening the Reporting of Menopause and Aging (STROMA) studies. Maturitas 2011; 70:99-109. [DOI: 10.1016/j.maturitas.2011.07.011] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 07/13/2011] [Accepted: 07/14/2011] [Indexed: 11/27/2022]
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25
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Nappi RE, Kokot-Kierepa M. Women's voices in the menopause: Results from an international survey on vaginal atrophy. Maturitas 2010; 67:233-8. [DOI: 10.1016/j.maturitas.2010.08.001] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 08/08/2010] [Accepted: 08/08/2010] [Indexed: 10/19/2022]
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26
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Fernández-Alonso AM, Cuadros JL, Chedraui P, Mendoza M, Cuadros ÁM, Pérez-López FR. Obesity is Related to Increased Menopausal Symptoms among Spanish Women. ACTA ACUST UNITED AC 2010; 16:105-10. [DOI: 10.1258/mi.2010.010029] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective. To assess the metabolic syndrome (METS) and its components in postmenopausal women using updated diagnostic criteria and explore their relation to menopausal symptom severity. Method. Medical records of the first visit of 574 postmenopausal Caucasian Spanish women attending a menopause clinic were retrospectively reviewed. Recorded information included general demographic data, type of menopause, menopausal symptom intensity (Kupperman index) and baseline hormonal and metabolic parameters. METS was established if three or more of the following criteria were met: body mass index (BMI) >28.8 kg/m2, fasting glycaemia >100 mg/dL, high-density lipoprotein cholesterol (HDL-C) <50 mg/dL, triglycerides ≥150 mg/dL and blood pressure ≥130/85 mmHg. Results Mean ± SD age of the whole cohort was 49.9 ± 6.1 years, 66% had natural menopause and 38.9% were obese. In all, 23.1% met diagnostic criteria for METS who were significantly older and displayed higher rates of being married, obesity and abnormal glucose, triglyceride, HDL-C, low-density lipoprotein cholesterol and blood pressure values, when compared with those without the syndrome. The mean Kupperman index score for the whole sample was 26.4 ± 10.6, with 73.8% displaying moderate to severe scores (20 or more). Logistic regression analysis determined that obesity and marriage status were independent risk factors related to more severe menopausal symptoms (Kupperman index scores of 20 or more). Conclusion. Although METS was observed in a lower frequency than previous reports, obesity was associated with more severe menopausal symptoms among postmenopausal Spanish women.
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Affiliation(s)
- Ana M Fernández-Alonso
- Department of Obstetrics and Gynaecology, Hospital Clínico San Cecilio, Facultad de Medicina, Universidad de Granada, Granada, Spain
| | - José l Cuadros
- Department of Obstetrics and Gynaecology, Hospital Clínico San Cecilio, Facultad de Medicina, Universidad de Granada, Granada, Spain
| | - Peter Chedraui
- Instituto de Biomedicina, Facultad de Medicina, Universidad Cató lica de Guayaquil, Ecuador
| | - Marcela Mendoza
- Instituto de Biomedicina, Facultad de Medicina, Universidad Cató lica de Guayaquil, Ecuador
| | - Ángela M Cuadros
- Department of Obstetrics and Gynaecology, Hospital Clínico San Cecilio, Facultad de Medicina, Universidad de Granada, Granada, Spain
| | - Faustino R Pérez-López
- Department of Obstetrics and Gynaecology, University of Zaragoza Hospital Clínico, Zaragoza, Spain
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27
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Abstract
This summary of the 3-day "Cross-Cultural Comparisons, Midlife, and Aging" workshop introduces 15 papers that examine menopause from biological, cultural, and health perspectives. The workshop was designed to critically examine the conceptual and methodological bases of cross-cultural studies and to make recommendations regarding future research on midlife and aging. This summary first reviews the comparative method with an emphasis on cross-cultural studies of menopause. Then the difference between etic and emic data is introduced. Etic data are collected by standardized instruments according to the interests of the investigator, whereas emic data reflect the concerns of individuals in the community studied. A brief review of cross-country studies concludes that there is a set of "core" menopausal symptoms but that the nuances of those symptoms seem to be culture-specific. The workshop concluded with a unanimous plea for the collection of similar information, both emic and etic data, to improve cross-cultural comparisons. This multidisciplinary collection of papers is an impressive commentary on what has been done in cross-cultural research and a compendium of suggestions for the future.
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Obermeyer CM, Reher D, Saliba M. Symptoms, menopause status, and country differences: a comparative analysis from DAMES. Menopause 2007; 14:788-97. [PMID: 17507832 DOI: 10.1097/gme.0b013e318046eb4a] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate reported frequencies of menopausal symptoms among women in four countries, namely Lebanon, Morocco, Spain, and the United States, and to assess the relative role of menopause status, country of residence, and other factors in explaining differences in symptomatology. DESIGN Surveys of representative samples of approximately 300 women aged 45 to 55 years in each site were conducted, using an instrument that includes demographic, health, and menopausal variables, in addition to perceptions and attitudes toward menopause. Statistical and textual analyses are used to examine differentials and the factors that influence them. RESULTS The burden of symptoms and the frequencies of symptoms differ across sites, but hot flashes are reported everywhere by just under one half of the respondents. The most frequent symptoms are joint pain, fatigue, impatience/nervousness, sleep disturbances, memory loss, and one or more emotional symptoms. Menopause status is significantly associated with hot flashes and vasomotor symptoms and to a lesser extent with emotional and sexual symptoms. Smoking, schooling, employment, and age are also associated with the frequency of selected symptoms. Country of residence influences reported symptoms over and above other factors. CONCLUSIONS Similarities among core symptoms and differences in the expression of symptoms were found across sites. Both biological (menopause status) and cultural (country of residence) variables influence symptomatology.
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