Mapping global prevalence of menopausal symptoms among middle-aged women: a systematic review and meta-analysis

BACKGROUND

Women at middle age are puzzled by a series of menopausal disturbances, can be distressing and considerably affect the personal, social and work lives. We aim to estimate the global prevalence of nineteen menopausal symptoms among middle-aged women by performing a systematic review and meta-analysis.

METHODS

Comprehensive search was performed in multiple databases from January, 2000 to March, 2023 for relevant studies. Random-effect model with double-arcsine transformation was used for data analysis.

RESULTS

A total of 321 studies comprised of 482,067 middle-aged women were included for further analysis. We found varied prevalence of menopausal symptoms, with the highest prevalence of joint and muscular discomfort (65.43%, 95% CI 62.51-68.29) and lowest of formication (20.5%, 95% CI 13.44-28.60). Notably, South America shared dramatically high prevalence in a sort of menopausal symptoms including depression and urogenital symptoms. Besides, countries with high incomes (49.72%) had a significantly lower prevalence of hot flashes than those with low (65.93%), lower-middle (54.17%), and upper-middle (54.72%, p < 0.01), while personal factors, such as menopausal stage, had an influence on most menopausal symptoms, particularly in vaginal dryness. Prevalence of vagina dryness in postmenopausal women (44.81%) was 2-fold higher than in premenopausal women (21.16%, p < 0.01). Furthermore, a remarkable distinction was observed between body mass index (BMI) and prevalence of sleep problems, depression, anxiety and urinary problems.

CONCLUSION

The prevalence of menopausal symptoms affected by both social and personal factors which calls for attention from general public.

Metabolic Syndrome and Its Association with Menopausal Symptoms among Postmenopausal Women: A Cross-sectional Study

Background

With increase in postmenopausal population, screening for MetS and its relationship with menopausal symptoms needs evaluation.

Objective

To identify the frequency of metabolic syndrome (MetS) and assess its relationship with menopausal symptoms in postmenopausal women.

Methods

This was a cross sectional study performed at a tertiary care centre in Uttarakhand India over a period of 18 months. All postmenopausal women >40 years with natural menopause included in the study sample. We used the Consensus Definition IDF and AHA/NHLBI (2009) criteria to classify subjects as having metabolic syndrome. Menopausal symptoms were assessed using Menopause Rating Scale (MRS) questionnaire.

Results

The frequency of metabolic syndrome in our study was 34.38% (55 out of 160 patients). We observed sleeping problems (36.88%) followed by physical & mental exhaustion (33.75%) and hot flushes (33.13%) to be the commonest menopausal symptoms. Significant association was seen for MRS along with its subscales in women with metabolic syndrome (P value <.05). Significant positive correlation was observed between total Menopause rating scale scores as well as all three subscales for triglycerides in patients with metabolic syndrome.

Conclusion

Hyper triglyceridemia was associated with severe menopausal symptoms among postmenopausal women with MetS in our study.

Urban-rural differences in epidemiology and risk factors of menopause syndrome in middle-aged Chinese women

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.

Limited evidence of a threshold effect for increasing adiposity on risk of symptoms at midlife

OBJECTIVE

To assess the nature of relationships between increasing body mass index (BMI) and the prevalence of midlife symptoms in a population with high adiposity.

METHODS

In the cross-sectional Study of Women's Health in Qatar, 841 participants aged 40 to 60 years were recruited from nine primary health centers in Doha. Face-to-face interviews collected demographic, menopause, and symptom information. BMI (kg/m 2 ) was categorized as healthy, overweight, or class I, II, or III obesity. Multivariate logistic regression models were used to examine aches/stiffness in joints, trouble sleeping, shortness of breath, urinary incontinence, and hot flashes with BMI categories. Restricted cubic splines (RCSs) were used to estimate relationships between continuous BMI and each symptom and to conduct formal tests of nonlinearity.

RESULTS

Mean BMI was 34.3 kg/m 2 (SD, 6.0 kg/m 2 ). Women with class II and III obesity had higher odds of reporting aches/stiffness than women with a healthy BMI, and the odds of reporting urinary incontinence were three times higher among women with class III obesity (odds ratio, 3.08; 95% confidence interval, 1.17-8.14). Using restricted cubic spline models, a significant nonlinear association ( P = 0.002) was observed between aches/stiffness and BMI with an apparent threshold of 38 kg/m 2 . Linear relationships were observed with BMI for urinary incontinence ( P < 0.001 for linear trend) and shortness of breath ( P = 0.005 for linear trend). Trouble sleeping and hot flashes were not associated with BMI.

CONCLUSIONS

Even at very high levels of BMI, likelihood of urinary incontinence and shortness of breath increases with BMI. In contrast, likelihood of aches/stiffness has a nonlinear relationship with BMI, increasing to a threshold level.

The association between mental health and obesity in postmenopausal women: A systematic review

Postmenopausal women are at great risk of mental health deterioration, which may lead to morbidity and mortality. The decrement of mental health with aging is attributed to hormonal changes, lowered physical activity, sleep disturbances, economic factors, as well as modifiable variables such as smoking and obesity. Studies have shown controversial results on the association between obesity and mental health in postmenopausal women. This study is a systematic review of the evidence available on the association between obesity and mental health in postmenopausal women with the aim to identify the most reliable obesity measure that has been shown in association with mental health as well as the effective measures that have been practiced for improving mental health in postmenopausal obese women. CINAHL, Scopus, Science Direct and PubMed including Medline databases were searched. Out of 3,766 articles, 23 studies of average to good quality were included, out of which 17 were cross-sectional and 6 interventional. Out of the 17 studies, 12 showed a positive association between obesity and deterioration of mental health, 3 showed a negative association and two showed no association. From the interventional studies, 4 showed positive and two not significant impact of the intervention used on obesity and mental health. In conclusion, more studies showed a positive association between obesity, especially visceral obesity, and mental health issues particularly depression, anxiety, and sleep disorders. Combination of caloric restriction and exercise seems to have a better impact on the mental health of the postmenopausal in comparison with other interventions.

Does Obesity Aggravate Climacteric Symptoms in Postmenopausal Women?

OBJECTIVE

 To determine if there is a correlation between body mass index (BMI) and climacteric symptoms in postmenopausal women.

METHODS

 The study sample was composed of 109 postmenopausal women with a mean age of 57 ±  8 years, mean body mass index (BMI) of 30 ±  6 kg/m², and 8 ±  8 years after menopause. For the assessment of the climacteric symptoms, the Blatt-Kupperman Index (BKI), the Menopause Rating Scale (MRS), and the Cervantes Scale (CS) were used. Data analysis was performed through the Chi-squared test, analysis of variance (ANOVA) with the Bonferroni post hoc test, and multiple linear regression. The level of significance adopted was of p < 0.05. The statistical analyses were performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, United States) software, version 26.0.

RESULTS

 The multiple linear regression showed a positive association (p < 0.01) between BMI values and menopause symptoms when adjusted for age and time after menopause in the 3 questionnaires used (BKI: B = 0.432; CS: B = 304; and MRS: B = 302). Regarding symptom scores, the obese women had higher mean scores (p < 0.05) when compared to eutrophic women (BKI = 28 ±  10 and 20 ±  10; and MRS = 20 ±  10 and 13 ±  7, respectively). In the Chi-squared analysis, 28% of obese women had severe symptoms and 46% had moderate symptoms, while only 1% and 46% of eutrophic women had these same symptoms.

CONCLUSION

 There is an association between BMI and climacteric symptoms, and overweight or obese women have more intense and moderate symptoms than eutrophic women.

Association of depression, anxiety and menopausal-related symptoms with demographic, anthropometric and body composition indices in healthy postmenopausal women

Background

The termination of the menstrual cycle is correlated with a number of physiological alterations and symptoms that can negatively impact emotion and mood. We aimed to investigate the association of anxiety, depression, and menopausal related symptoms with demographic, anthropometric, and body composition indices in healthy postmenopausal women.

Methods

A total of 320 menopausal women were selected randomly from referrals of health centers between January and June 2018 in Tabriz/Iran. All participants completed a demographic questionnaire. Bioelectrical impedance analysis was applied to evaluate body fat mass (BFM), soft lean mass (SLM), and lean body mass (LBM) of participants. The modified Kupperman index, Beck's depression inventory-II, and Spielberger’s state-trait anxiety inventory were applied to measure the severity of menopausal-related symptoms, the frequency, and severity of the symptoms of depression and state (SA) and trait anxiety (TA), respectively.

Results

Finally, 245 postmenopausal women with age of 55.33 ± 4.48 years and body mass index (BMI) of 27.96 ± 3.22 kg/m² were studied. Women with the age of 55 years and older (OR 3.928, 95% CI 1.504–10.256) and also women with mild physical activity (OR 10.104, 95% CI 3.785–26.976) had a greater possibility of having mild and moderate depression in comparison with women less than 50 years old and women with moderate and severe physical activity. Moderate and severe physical activity was correlated with a lower possibility of having medium upward, relatively severe and severe TA in comparison with participants with mild physical activity in these women (OR 0.372, 95% CI 0.151–0.917). Women with higher BMI and BFM had and more severe menopause-related symptoms (r = 0.143, p = 0.025 and r = 0.139, p = 0.030, respectively) and more severe TA symptoms (r = 0.198, p = 0.018 and r = 0.151, p = 0.021, respectively). Women with lower LBM (r =  − 0.139, p = 0.031) and lower SLM (r =  − 0.128, p = 0.047) had more severe depressive symptoms.

Conclusion

Postmenopausal women with higher age and lower physical activity had a greater possibility of having mild and moderate depression. Lower physical activity was also correlated with a greater possibility of having medium upward to severe TA symptoms. Postmenopausal women with higher BMI and BFM had more severe menopause-related and TA symptoms. Women with lower LBM and SLM had more severe depressive symptoms.

[Investigation of Relationships among Health Literacy, Social Determinants of Health, Menopausal Symptoms, Lifestyle-related Diseases, and Depression in Menopausal Women]

OBJECTIVES

The aim of this study was to clearly identify the relationships among health literacy, social determinants of health, health behaviors, menopausal symptoms, lifestyle-related diseases, and depression in healthy menopausal women.

METHOD

A cross-sectional study was conducted using a questionnaire among menopausal women (45 to 60 years of age) who visited a facility offering various medical checkups to receive a specific medical checkup.Logistic regression was used to analyze the association of health literacy and social determinants of health with health behaviors for 162 subjects adjusted for age. Moreover, the association of several factors (health literacy, social determinants of health, and health behaviors) with menopausal symptoms, borderline zones for lifestyle-related diseases, and depression was also analyzed in the same way.

RESULTS

It was shown that educational history was associated with smoking habit with an age-adjusted odds ratio OR of 3.23 (95% confidence interval [CI]: 1.103-9.443). It was shown that health literacy was associated with smoking habit, age-adjusted OR 4.07 (95% CI: 1.337-12.388), menopausal symptoms, age-adjusted OR 2.48 (95% CI: 1.177-5.235), and depression, age-adjusted OR 6.24 (95% CI: 2.421-16.092).

CONCLUSION

It was found that poor health literacy was associated with smoking habit and the severity of menopausal symptoms and depression.

Using Best-Worst Scaling to Determine the Most Burdensome Menopausal Symptoms in Cambodian Women Living With HIV

ABSTRACT

As persons living with HIV live longer, it is important to understand the symptoms experienced by menopausal women living with HIV (WLWH). This study used best-worst scaling (BWS) to determine the menopausal symptoms that are most burdensome for Cambodian WLWH. Participants were asked to rate a list of menopausal symptoms in terms of the most and least burdensome in their lives via BWS. The final analysis included 183 participants, 67 of whom were premenopausal, 47 perimenopausal, and 69 postmenopausal women. Physical and mental exhaustion (mean best-worst score = 319) was rated as the most burdensome symptom, and hot flushes and sweating were the least burdensome (mean best-worst score = -181). The BWS provides information on priorities for the distribution of health care resources. Understanding how Cambodian WLWH prioritize burdensome menopausal symptoms is crucial for choosing the most contextually sensitive method to provide health care services and interventions.

Posttraumatic Stress Disorder and Likelihood of Hormone Therapy Use among Women in the Nurses' Health Study II: A 26-Year Prospective Analysis

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with higher risk of certain chronic diseases, including ovarian cancer, but underlying mechanisms remain unclear. Although prior work has linked menopausal hormone therapy (MHT) use with elevated ovarian cancer risk, little research considers PTSD to likelihood of MHT use. We examined whether PTSD was prospectively associated with greater likelihood of initiating MHT use over 26 years.

METHODS

Using data from the Nurses' Health Study II, with trauma and PTSD (symptoms and onset date) assessed by screener in 2008 and MHT assessed via biennial survey (from 1989), we performed Cox proportional regression models with women contributing person-years from age 36 years. Relevant covariates were assessed at biennial surveys. We considered potential effect modification by race/ethnicity, age at baseline, and period (1989-2002 vs. 2003-2015).

RESULTS

Over follow-up, 22,352 of 43,025 women reported initiating MHT use. For example, compared with women with no trauma, the HR for initiating MHT was 1.18 for those with trauma/1-3 PTSD symptoms [95% confidence interval (CI), 1.13-1.22] and 1.31 for those with trauma/4-7 PTSD symptoms (95% CI, 1.25-1.36; P trend < 0.001), adjusting for sociodemographic factors. Associations were maintained when adjusting for reproductive factors and health conditions. We found evidence of effect modification by age at baseline.

CONCLUSIONS

Trauma and number of PTSD symptoms were associated with greater likelihood of initiating MHT use in a dose-response manner.

IMPACT

MHT may be a pathway linking PTSD to altered chronic disease risk. It is important to understand why women with PTSD initiate MHT use.

Symptom clusters predict risk of metabolic-syndrome and diabetes in midlife: the Study of Women's Health Across the Nation

PURPOSE

Women's cardio-metabolic risk increases in midlife. Previous work relating menopause symptoms to diabetes/Metabolic Syndrome (MetS) does not consider the adverse impact of multiple concurrent physical and psychological symptoms in midlife.

METHODS

Data are from 3097 participants in the Study of Women's Health Across the Nation, a cohort of midlife women followed for over 20 years. Baseline latent symptom classes (LSC) were derived from 58 questions assessing physical, psychological and menopausal symptoms. Six identified LSCs ranged from 1 (most symptoms present at high severity) to 6 (few symptoms present at low severity). Accelerated failure time models estimated time to onset of type 2 diabetes and MetS for each LSC.

RESULTS

Women with multiple high/moderate severity symptoms had an earlier onset of diabetes (13.2%, 14.1% and 20.8% earlier onset in LSCs 1, 2, 3, respectively) and MetS (15.5%, 13.0% and 19.7% earlier onset in LSCs 1, 2, 3, respectively) than women with few/low severity symptoms.

CONCLUSIONS

Having multiple concurrent moderate to high intensity physical and psychological symptoms in midlife are associated with early onset of diabetes and MetS. Monitoring and subsequent intervention on a broad range of symptoms in midlife may significantly mitigate cardio-metabolic risk during this critical life stage.

Serum Metabolic Profiles of Chinese Women With Perimenopausal Obesity Explored by the Untargeted Metabolomics Approach

By far, no study has focused on observing the metabolomic profiles in perimenopause-related obesity. This study attempted to identify the metabolic characteristics of subjects with perimenopause obesity (PO). Thirty-nine perimenopausal Chinese women, 21 with PO and 18 without obesity (PN), were recruited in this study. A conventional ultra-high-performance liquid chromatography-quadrupole time-of-flight/mass spectrometry (UHPLC-QTOF/MS) followed by principal component analysis (PCA) and orthogonal partial least-squares discriminant analysis (OPLS-DA) were used as untargeted metabolomics approaches to explore the serum metabolic profiles. Kyoto Encyclopedia of Genes and Genomes (KEGG) and MetaboAnalyst were used to identify the related metabolic pathways. A total of 46 differential metabolites, along with seven metabolic pathways relevant to PO were identified, which belonged to lipid, amino acids, carbohydrates, and organic acids. As for amino acids, we found a significant increase in l-arginine and d-ornithine in the positive ion (POS) mode and l-leucine, l-valine, l-tyrosine, and N-acetyl-l-tyrosine in the negative ion (NEG) mode and a significant decrease in l-proline in the POS mode of the PO group. We also found phosphatidylcholine (PC) (16:0/16:0), palmitic acid, and myristic acid, which are associated with the significant upregulation of lipid metabolism. Moreover, the serum indole lactic acid and indoleacetic acid were upregulated in the NEG mode. With respect to the metabolic pathways, the d-arginine and d-ornithine metabolisms and the arginine and proline metabolism pathways in POS mode were the most dominant PO-related pathways. The changes of metabolisms of lipid, amino acids, and indoleacetic acid provided a pathophysiological scenario for Chinese women with PO. We believe that the findings of this study are helpful for clinicians to take measures to prevent the women with PO from developing severe incurable obesity-related complications, such as cardiovascular disease and stroke.

Influence of dietary habits and Mediterranean diet adherence on menopausal symptoms. The FLAMENCO project

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.

Association of Menopausal Symptoms with Overweight and Obesity among Rural Middle Aged Women in North India: A Population Based Study

Background:

Overweight and obesity are important determinant of increasing morbidity among all age groups, including menopausal women. The symptoms of menopause have a negative impact on the quality of life.

Objectives:

The aim of this study is to assess the prevalence of overweight and obesity in menopausal women and also to find its association with menopausal symptoms and sociodemographic variables.

Materials and Methods:

The study was conducted among middle-aged women (40–60 years) from April 2018 to March 2019. The Menopausal Rating Scale was used to assess the severity of menopausal symptoms in 400 women, and data were collected for sociodemographic factors, menstrual history in the past month, and personal history.

Results:

About 35.5% of menopausal women were overweight/obese (26% overweight and 9.5% obese) with average body mass index of 23.9 ± 4.84 and mean age of 53.65 ± 5.11 years Joint and muscular discomfort (P = 0.001), hypertension (P = 0.014), literacy level (P = 0.009), and socioeconomic status (P = 0.01) were significantly associated with overweight/obesity. With reference to women with no/little somatic and urogenital complaints, the odds of developing obesity was more (adjusted odds) in patients with mild (odds ratio [OR] - 2.8), moderate (OR - 2.1), and severe (2.19) somatic complaints and also higher risk in patients with mild (OR-3.2), moderate (OR - 1.1), and severe (OR - 1.74) urogenital symptoms. The age of menopause was significantly more among overweight than normal-weight women (P = 0.033).

Conclusion:

Overweight and obesity associated with menopause require increased attention and a multidisciplinary approach to women's health to prevent morbidity in this population group.

Changes in hot flash experiences and related factors in women with breast cancer

OBJECTIVE

Taiwanese women are younger than women in western countries when diagnosed with breast cancer, and many of them are still menstruating. One of many distressing side effects reported by premenopausal women treated for breast cancer are hot flashes (HFs). The purposes of this study were to identify: (1) the trajectories of hot flash (HF) occurrence, frequency, and interference and (2) potential factors associated with HF changes.

METHODS

Peri- or premenopausal women newly diagnosed with breast cancer scheduled to receive chemotherapy and hormonal therapy were enrolled. HF frequency, HF interference, and other symptoms were measured six times from prechemotherapy to 24 months after chemotherapy. Data were analyzed using hierarchical linear modeling.

RESULTS

A total of 90 women were eligible for the study. The prechemotherapy occurrence rate of HFs was 7.9%, but rapidly increased to 42.5% immediately after chemotherapy. The change curve of HF frequency and interference appeared quadratic, increasing first and slightly decreasing later. At any time point, increased body mass index (BMI) was associated with both higher HF frequency (P = 0.020) and HF interference (P = 0.002), whereas anxiety (P < 0.001) and loss of sexual desire (P = 0.038) were associated with higher HF interference. Six months after completing chemotherapy, premenopausal women reported significantly higher HF frequency than perimenopausal women (P = 0.041).

CONCLUSION

A significant proportion of pre- and perimenopausal women experienced HFs after receiving breast cancer treatment. Our findings on HF trajectories can educate patients newly diagnosed with breast cancer. Special attention should be paid to those with increased body mass index changes and those still regularly menstruating.

Association between physical activity, cardiorespiratory fitness, and body composition with menopausal symptoms in early postmenopausal women

OBJECTIVE

The aim of this study was to investigate the relationship between daily physical activity (daily activities, exercise, and sitting time), cardiorespiratory fitness (CRF), and body composition (body mass index [BMI], waist to hip ratio [WHR)] with menopausal symptoms and to determine the strongest predictor(s) of menopausal symptoms.

METHODS

The Menopause Rating Scale questionnaire was used to examine somatic, psychological, urogenital, and total symptoms of menopause. The energy expenditure of daily physical activity, exercise, and sitting time was measured by the International Physical Activity Questionnaire, and CRF was measured by estimating the maximal oxygen intake (VO2max) through the Rockport test. Statistical methods of the Pearson correlation coefficient and hierarchical multiple linear regression were used for data analysis.

RESULTS

Fifty-six women, aged 50 to 65 years, voluntarily participated in the study. Exercise energy expenditure was inversely correlated with total (r = -0.403, P = 0.002), somatic (r = -0.293, P = 0.023), and urogenital (r = -0.343, P = 0.009) symptoms of menopause. VO2max was inversely correlated with urogenital symptoms of menopause (r = -0.414, P = 0.002). WHR was positively correlated with somatic symptoms of menopause (r = 0.286, P = 0.032); sitting was correlated with total (r = 0.40, P = 0.002), somatic (r = 0.325, P = 0.015), and psychological (r = 0.274, P = 0.015) symptoms of menopause. Among the study variables, sitting (β=0.365, P = 0.004) and VO2max (β=-0.286, P = 0.030) were the most important predictors of total symptoms of menopause; sitting was the predictor of somatic symptoms (β=0.265, P = 0.045), and VO2max was the predictor of urogenital symptoms of menopause (β=-0.332, P = 0.014). The inclusion of age, BMI, WHR, and duration of menopause as confounding variables in regression analysis did not change the findings related to the predictions of menopausal symptoms.

CONCLUSION

Reducing sitting time, improving VO2max, decreasing WHR, and exercise can be recommended by priority to alleviate menopausal symptoms. Considering the small number of participants in this investigation, future studies are, however, recommended.

Genistein as Potential Therapeutic Candidate for Menopausal Symptoms and Other Related Diseases

Plant-derived compounds have recently attracted greater interest in the field of new therapeutic agent development. These compounds have been widely screened for their pharmacological effects. Polyphenols, such as soy-derived isoflavones, also called phytoestrogens, have been extensively studied due to their ability to inhibit carcinogenesis. These compounds are chemically similar to 17β-estradiol, and mimic the binding of estrogens to its receptors, exerting estrogenic effects in target organs. Genistein is an isoflavone derived from soy-rich products and accounts for about 60% of total isoflavones found in soybeans. Genistein has been reported to exhibit several biological effects, such as anti-tumor activity (inhibition of cell proliferation, regulation of the cell cycle, induction of apoptosis), improvement of glucose metabolism, impairment of angiogenesis in both hormone-related and hormone-unrelated cancer cells, reduction of peri-menopausal and postmenopausal hot flashes, and modulation of antioxidant effects. Additionally, epidemiological and clinical studies have reported health benefits of genistein in many chronic diseases, such as cardiovascular disease, diabetes, and osteoporosis, and aid in the amelioration of typical menopausal symptoms, such as anxiety and depression. Although the biological effects are promising, certain limitations, such as low bioavailability, biological estrogenic activity, and effects on target organs, have limited the clinical applications of genistein to some extent. Moreover, studies report that modification of its molecular structure may eliminate the biological estrogenic activity and its effects on target organs. In this review, we summarize the potential benefits of genistein on menopause symptoms and menopause-related diseases like cardiovascular, osteoporosis, obesity, diabetes, anxiety, depression, and breast cancer.

Assessment of menopausal symptoms in different transition phases using the Greene Climacteric Scale among rural women of North India

BACKGROUND

Menopause is the universal physiological process of women's midlife and exhibits a wide variety of symptoms. However, there is little data on the menopausal symptoms and factors associated with their severity among rural Indian women.

AIM

To evaluate the prevalence of menopausal symptoms during the different transition phases of menopause among rural women of North India.

SUBJECTS AND METHODS

This cross-sectional study consisted of 351 women aged 35-55 years (mean age 44.6 years) residing in rural areas of North India. A structured questionnaire was used to collect data regarding menopausal status, demographic profile and reproductive history of the participants. Frequency and severity of menopausal symptoms were evaluated using the Greene Climacteric Scale in different stages of menopause. All statistical procedures were accomplished using SPSS version 19.0.

RESULTS

In the present study the mean ages of attainment of menarche and menopause were 14.3 years and 47.2 years, respectively. Mean score of total Greene Climacteric Scale was highest among perimenopausal women (16.12 ± 8.1) over post-menopausal (14.78 ± 7.3) and pre-menopausal women (11.08 ± 6.1). Logistic regression analysis revealed that advancing age, low educational attainment, low socioeconomic status, menopausal status, later age at menarche and higher BMI were all associated with more severe menopausal symptoms.

CONCLUSION

The climacteric symptoms were more prevalent among women who were perimenopausal followed by post-menopausal women and were the lowest in pre-menopausal women. Age, menopausal status, socio-economic status, and reproductive factors significantly influenced the severity of menopausal symptoms.

Association of body composition with menopausal symptoms in (peri-)menopausal women

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.

Obesity associates with vasomotor symptoms in postmenopause but with physical symptoms in perimenopause: a cross-sectional study

BACKGROUND

Middle-aged women experience various menopausal symptoms during the menopause. These symptoms can affect their quality of life and health. Several epidemiological studies reported that obesity associates with menopausal symptoms. The aim of this cross-sectional study was to examine the associations between obesity and multiple menopausal symptoms at different stages of menopause in middle-aged Korean women.

METHODS

The study population included women aged 44-56 years who visited a tertiary referral hospital for medical check-ups between November 2012 and March 2013 and were free from serious illness, could comprehend a questionnaire. The Menopause-Specific Quality of Life (MENQOL) questionnaire was used to assess the prevalence of menopausal symptoms. Overweight and obesity were defined as body mass index (BMI) of 23-24.9 and ≥25 kg/m2, respectively.

RESULTS

Of the 2204 middle-aged women, 929 met the eligibility criteria. Of these, 533 (57.4%) and 396 (42.6%) were in perimenopause and postmenopause, respectively. In perimenopause, obese women were significantly more likely to have moderate/severe physical symptoms (MENQOL domain score ≥ 5) than normal or overweight women. In postmenopause, obese women were significantly more likely to have moderate/severe vasomotor symptoms. Multiple linear regression with adjustment for confounders showed that relative to normal weight, obesity in perimenopause and postmenopause associated independently with physical symptoms (beta coefficient = 0.35; P = 0.023) and vasomotor symptoms (beta coefficient = 0.68; P = 0.003), respectively. Overweight did not associate with menopausal symptoms. BMI did not associate significantly with psychosocial or sexual symptoms at either stage of menopause.

CONCLUSIONS

Obese women had more frequent menopausal symptoms than normal or overweight women but the associated menopausal symptom differed depending on the menopausal stage. Further studies are required to confirm this result and identify the underlying mechanisms.

Association of Mid-Life Changes in Body Size, Body Composition and Obesity Status with the Menopausal Transition

The mid-life period is a critical window for increases in body weight and changes in body composition. In this review, we summarize the clinical experience of the menopausal transition by obesity status, and examine the evidence regarding the menopausal transition and reproductive hormones effects on body weight, body composition, or fat distribution. Mid-life obesity is associated with a different menopausal experience including associations with menstrual cycle length prior to the final menstrual period (FMP), age at the FMP, and higher prevalence of vasomotor symptoms. The menopausal transition is associated with weight gain and increased central body fat distribution; the majority of evidence suggests that changes in weight are due to chronological aging whereas changes in body composition and fat distribution are primarily due to ovarian aging. Continuous and regular physical activity during mid-life may be an efficacious strategy to counteract the age-related and menopause-related changes in resting energy expenditure and to prevent weight gain and abdominal adiposity deposition.

Severity and clustering of menopausal symptoms among obese and nonobese postmenopausal women in India

Background:

The symptoms of menopause have a negative impact on quality of life, especially in women transitioning to menopause and earlier transitions. This study was conducted with the objective of assessing the effect of obesity on the severity of menopausal symptoms and the clustering of symptoms in postmenopausal women in India.

Methodology:

The Menopausal Rating Scale (MRS) was used to assess the severity of menopausal symptoms of postmenopausal women of Chennai, visiting Saveetha Medical College, Chennai, India. This cross-sectional study was conducted from August to November 2013 in Chennai, India. Sociodemographic characteristics, anthropometric measurements, blood pressure level, menopausal history, personal health history, and hormonal disorder issues were investigated.

Results:

The results have shown that 24% of the participants had complaint of mild to severe hot flushes, half of them had reported heart ailments (49%; n = 74), and disturbed sleep (48%; n = 72). The proportion of overweight/obese participants was higher in married (64%) than widows (41%), and this difference was found statistically significant (P = 0.005). There were no significant differences in MRS scores of obese and nonobese postmenopausal participants.

Conclusion:

There is a need of developing interactive, user friendly, technology based education module for addressing the chronic ailments of postmenopausal women.

Assessment of hot flushes and vaginal dryness among obese women undergoing bariatric surgery

OBJECTIVE

Menopausal symptoms are associated with a negative impact on the quality of life, leading women to seek medical treatment. Obesity has been linked to higher levels of menopausal symptoms such as hot flushes. This assessment will explore whether the prevalence and bother of hot flushes and vaginal dryness change from pre- to post-bariatric surgery among obese midlife women.

METHODS

This study is a longitudinal analysis of data from 69 women (ages 35-72 years) undergoing bariatric surgery with reported reproductive histories and menopausal symptoms at preoperative and 6-month postoperative visits. Prevalence of and degree of bother of hot flushes and vaginal dryness at pre- and post-surgery were compared using McNemar's test and Wilcoxon signed-rank test.

RESULTS

The reported degree of bother of symptoms associated with hot flushes decreased from pre- to post-surgery (p < 0.01). There was no significant change in the prevalence of hot flushes or vaginal dryness in the overall study sample.

CONCLUSIONS

The degree of bother of symptoms associated with hot flushes among midlife women may decrease after bariatric surgery. These results highlight important secondary gains, including less bothersome menopausal symptoms, for women who choose bariatric surgery for weight loss.

Obesity and its relation to depressive symptoms and sedentary lifestyle in middle-aged women

BACKGROUND

The prevalence of obesity increases during female mid-life and although many factors have been identified, data from Latin America is lacking.

OBJECTIVE

To assess factors related to obesity among middle-aged women and determine the association with depressive symptoms, sedentary lifestyle and other factors.

METHODS

A total of 6079 women aged 40-59 years of 11 Latin American countries were asked to fill out the Goldberg Anxiety and Depression Scale, the Menopause Rating Scale, the Athens Insomnia Scale, the Pittsburgh Sleep Quality Index and a general questionnaire containing personal socio-demographic data, anthropometric measures and lifestyle information. Obesity was defined as a body mass index (BMI) ≥30 kg/m(2).

RESULTS

Obesity was observed in 18.5% and sedentary lifestyle in 63.9%. A 55.5% presented vasomotor symptoms, 12.2% had severe menopausal symptoms and 13.2% used hormone therapy for the menopause. Prevalence of depressive symptoms was 46.5% and anxiety 59.7%. Our logistic regression model found that significant factors associated to obesity included: arterial hypertension (OR: 1.87), depressive symptoms (OR: 1.57), sedentary lifestyle (OR: 1.50) diabetes mellitus (OR: 1.34), higher number of individuals living at home (OR: 1.31), sleep problems (OR:1.22), anxiety (OR: 1.21), having a stable partner (OR: 1.20), parity (OR: 1.16) and vasomotor symptoms (OR:1.14). A lower risk for obesity was found among women using hormonal contraceptives (OR: 0.69).

CONCLUSION

Obesity in middle-aged women is the consequence of the interaction of multiple factors. It was associated to hypertension, depressive symptoms, sedentary lifestyle, climacteric symptoms and other factors.

How to evaluate quality of life in overweight and obese women during climacterium?

Objective: identifying the instruments used to measure quality of life during menopausal transition and post-menopause in women with obesity or overweight. Methods: a systematic search using the Embase, Pubmed and Cochrane databases, and the following key-words: menopause/climacteric, quality of life, overweight/obesity. Nineteen papers that fulfilled the including criteria were found. Results: eighteen studies using generic health questionnaires (global quality of life) were identified, six of them were specific for menopause and one specific for obesity. Eleven studies used generic questionnaires, while only eight questionnaires were specific for menopause. Conclusion: there was no consensus in the literature about the use of quality of life questionnaires in women with overweight and obesity in climacterium, which makes de comparison and reproducibility of the results difficult. This is an alert about the need for standardization to better evaluate this specific population.

Application of the 10-item Cervantes Scale among mid-aged Ecuadorian women for the assessment of menopausal symptoms

BACKGROUND

The majority of instruments used to evaluate menopausal symptoms are long and complex. In this sense, more simple tests are being designed to rapidly obtain a snapshot of the global clinical picture.

OBJECTIVE

To assess menopausal symptoms in mid-aged women using the short 10 item version of the original menopause Cervantes Scale (CS-10).

METHOD

This was a cross sectional study in which a total of 451 Ecuadorian women (40-59 years) were surveyed with the CS-10 and a general socio-demographic questionnaire containing personal and partner data.

RESULTS

Median age of the whole sample was 48 years. A 41.2% were postmenopausal, 44.3% abdominally obese (waist circumference >88cm), 6% diabetic, 16.9% hypertense, 11.5% smoked, 6.9% currently used hormone therapy, 9.5% phytoestrogens and 6.7% psychotropic drugs. For the entire sample, median [interquartile range] CS-10 global scores were 10.0 [9.5], and for pre-, peri- and postmenopausal women: 5.0 [7.0], 11.0 [9.0] and 13.5 [8.0], respectively. The CS-10 displayed good internal consistency (Cronbach's alpha 0.87). According to the CS-10, the three most prevalent menopausal symptoms were: muscle and joint pains (88.5%), hot flushes (77.6%) and skin dryness (71.4%). Multiple linear regression analysis found that postmenopausal status, parity, unhealthy perceived status, psychotropic drug use, partner erectile dysfunction, lower coital frequency and living at high altitude were related to higher CS-10 global scores.

CONCLUSION

In this mid-aged Ecuadorian female sample severity of menopausal symptoms, as determined by the CS-10, were related to environmental and female/partner personal and socio-demographical aspects.

Evaluation of the presence and severity of menopausal symptoms among postmenopausal women screened for the metabolic syndrome

BACKGROUND

The prevalence of the metabolic syndrome (METS) increases after the menopause. Reports indicate that the METS and its components, especially obesity, enhance the intensity of menopausal symptoms.

OBJECTIVE

Assess the frequency and severity of menopausal symptoms in postmenopausal women. Factors related to the symptom severity were also analyzed including depressive and metabolic status.

METHODS

A total of 204 natural postmenopausal women (40-65 years) participating in a METS screening program were asked to fill out the Menopause Rating Scale (MRS), the Hospital Anxiety and Depression Scale (HADS), and a general socio-demographic questionnaire containing personal and partner data. Criteria of the American Heart Association were used to define the METS.

RESULTS

Median age of the whole sample was 56 years. A 52.9% presented the METS, with 37.3% presenting hyperglycemia, 51.5% hypertension, 58.3% abdominal obesity, 45.6% high triglyceride and 56.4% low HDL-C levels. Total and subscale MRS scores did not differ in accordance to the presence or not of the METS. The three top prevalent menopausal symptoms were muscle and joint problems (87.2%), physical and mental exhaustion (72%) and depressive mood (64.7%). A 19.6% of women presented total MRS scores above 16 defined as severe. Multivariate linear regression analysis determined that anxiety (higher HADS anxiety subscale scores) was significantly and positively correlated with all components of the MRS (Total and subscale scores). Higher total MRS scores correlated positively with abdominal perimeter and higher parity. Somatic scores correlated inversely with female education and positively with psychotropic drug use; and psychological MRS scores positively correlated depressed mood (higher HADS depressive subscale scores) and abdominal perimeter.

CONCLUSION

In this postmenopausal sample, severity of menopausal symptoms correlated to abdominal obesity, mood and other personal aspects.

Effects of the body mass index on menopausal symptoms among Asian American midlife women using two different classification systems

OBJECTIVE

To explore the effects of the body mass index (BMI) on menopausal symptoms among Asian American midlife women using two different classification systems: the international classification and the BMI classification for public health action among Asian populations.

DESIGN

Secondary analysis using data from two large Internet survey studies.

SETTING

Communities and groups of midlife women on the Internet.

PARTICIPANTS

A total of 223 Asian American midlife women who were recruited over the Internet.

METHODS

The Midlife Women's Symptom Index and self-reports of height and weight were used to collect data. The data were analyzed using multiple analyses of covariance.

RESULTS

No significant differences in the prevalence and severity scores among three subscales and total menopausal symptoms according to the international classification were found. When the BMI classification for public health action among Asian populations was used as an independent variable, significant differences were found in the severity scores of three subscales and total menopausal symptoms. Results of the post-hoc analyses showed that Asian American midlife women who were in the BMI classification for high risk had significantly more severe menopausal symptoms than those who were in the BMI classification for increased risk.

CONCLUSION

For Asian American women, BMI categorized using the BMI classification for Asian populations is more closely related to the severity of menopausal symptoms than BMI categorized using the international classification. Nurses need to consider the BMI classification for Asian populations when they develop interventions to prevent and alleviate menopausal symptoms among Asian American midlife women.

Menopause negatively impacts sexual lives of middle-aged Iranian women: a cross-sectional study

The study aimed to explore associations between sexual function, demographic variables, health and menopausal status among middle-aged Iranian women. Participants were 200 Iranian middle-aged women (40-65 years). All women completed the Female Sexual Function Index and the Brief Profile of Female Sexual Function. Data were analyzed using a Pearson correlation statistical test, a one-way analysis of variance, an independent t test, and a linear regression analysis. Advanced age, lower education, and socioeconomic status were significantly correlated with the lower scores on the Female Sexual Function Index. Lower scores on the Female Sexual Function Index were associated with being retired; having a hysterectomy or oophorectomy; and presence of hot flashes, vaginal dryness, health problems, prescription drug use, and cold sweats. There were no significant associations between middle-aged women's sexual function and ethnicity, body mass index, alcohol consumption, severity of hot flashes, and hot flash frequency. Sexual desire was decreased or absent in 94.5% of the postmenopausal respondents. Our findings appear that sexual function is associated with sociodemographic characteristics of Iranian middle-aged women. Gender-sensitive counseling and medical services for aging Iranian women can improve the quality of women's sexual lives.

Assessment of serum leptin and resistin levels in association with the metabolic risk factors of pre- and post-menopausal rural women in South India

OBJECTIVES

Menopausal status is related with weight gain, abnormal lipid and glucose metabolism leading to metabolic syndrome susceptibility. The aim of this study is to determine circulating serum leptin and resistin levels and to correlate these levels in relationship with the metabolic factors in pre- and post-menopausal women.

METHODS

A cross-sectional study has been carried out for 34 subjects who were in post-menopause and 31 subjects who had regular menstruation in south Indian rural women. Anthropometric indices, blood pressure, fasting blood sugar (FBS), fasting lipid profile, fasting leptin and resistin levels were measured.

RESULTS

In a total of 65 subjects, the mean age of pre-menopausal group was 38.65±6.21 and that of post-menopausal group was 55.32±6.32. Fasting serum leptin level was increased considerably in post-menopausal women when compared to pre-menopausal women (P=0.018). Resistin has no significant relationship with metabolic factors except Body Mass Index (BMI) in both the groups. Triglycerides and FBS were lower in pre-menopausal group when compared to post-menopausal group (P<0.001). Leptin was well correlated with BMI in pre-menopausal women (r(2)=0.7120, P<0.0001) as well as post-menopausal women (r(2)=0.2470, P=0.0028). Leptin also had significant correlation with FBS in both pre (r(2)=0.1373, P=0.0402) and post-menopausal women (r(2)=0.2141, P=0.0401). Systolic blood pressure was positively associated with the leptin levels in post-menopausal women (P<0.001).

CONCLUSION

Leptin was found to have significant association with metabolic factors when compared to resistin in pre- and post-menopausal women and there is no doubt that association of BMI and FBS elevates the level of leptin in both the category.

Determinants of severity of menopausal symptoms among Saudi women in Riyadh city

OBJECTIVE

To determine the relationship between sociodemographic, reproductive and lifestyle factors and the severity of menopausal symptoms among Saudi women attending a university hospital in Riyadh city.

METHODS

A cross-sectional survey was carried out during 2010 in Riyadh city. Women aged > 40 years attending or accompanying their relatives in outpatient clinics in King Khalid University Hospital were invited to participate in the study. The English version of the Menopause Rating Scale (MRS) was used to assess the severity of menopausal symptoms after translation and validation on a sample of 30 women.

RESULTS

A total of 490 women were included. Severe urogenital symptoms were more common among housewives compared to working women (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.12-4.68) and women living in apartments or small houses compared to women living in villas (OR 1.70, 95% CI 1.90-2.64). Nulliparous women had more severe somatic symptoms compared to those who had been pregnant (OR 2.83, 95% CI 1.10-7.69). Women who exercised regularly were less likely to experience severe somatic and urogenital symptoms (OR 0.57, 95% CI 0.37-0.86; OR 0.65, 95% CI 0.44-0.98, respectively). Obese women experienced more severe psychosomatic symptoms compared to those of normal body mass index (OR 2.01, 95% CI 0.96-4.93).

CONCLUSION

Women who are housewives, living in apartments, not exercising regularly and obese are more likely to suffer from severe symptoms of menopause.

Impact of age and body mass on the intensity of menopausal symptoms in 5968 Brazilian women

OBJECTIVE

To assess the relationship of onset of menopause and body mass on the menopausal symptoms in post-menopausal Brazilian women.

DESIGN

Observational study conducted by the selection and inclusion of 5968 Brazilian women after menopause. The following variables were analyzed in this study: time at menopause; the relationship between age at menarche and age at menopause; vasomotor symptoms compared with age at the time of menopause and the time of menopause; Kupperman menopausal index (KMI) versus total time of menopause; body mass index (BMI) compared to the time of menopause, vasomotor symptoms, and KMI total score. We used the Chi-square test, and the significance level was set at 5%.

RESULTS

The age at natural menopause ranged from 41 to 62 years (mean 48.1 ± 4.07 years). A younger age at menopause was associated with a high intensity of vasomotor symptoms. These symptoms were more intense in the first 5 years of menopause and decreased with time. The KMI total also decreased with time after menopause, with the exception of arthralgia, myalgia, and insomnia, which did not tend to improve over time. In addition, the vasomotor symptoms and total KMI were more frequent with increasing BMI.

CONCLUSIONS

Our results suggested that the age of menopause and BMI may influence the intensity of vasomotor symptoms.

Understanding weight gain at menopause

OBJECTIVE

The aim of this review was to summarize the literature regarding the impact of the menopause transition on body weight and body composition.

METHODS

We conducted a search of the literature using Medline (Ovid, 1946-present) and PubMed (1966-2012) for English-language studies that included the following search terms: 'menopause', 'midlife', 'hormone therapy' or 'estrogen' combined with 'obesity', 'body weight' or 'body composition'.

RESULTS

Whereas weight gain per se cannot be attributed to the menopause transition, the change in the hormonal milieu at menopause is associated with an increase in total body fat and an increase in abdominal fat. Weight excess at midlife is not only associated with a heightened risk of cardiovascular and metabolic disease, but also impacts adversely on health-related quality of life and sexual function. Animal and human studies indicate that this tendency towards central abdominal fat accumulation is ameliorated by estrogen therapy. Studies mostly indicate a reduction in overall fat mass with estrogen and estrogen-progestin therapy, improved insulin sensitivity and a lower rate of development of type 2 diabetes.

CONCLUSION

The hormonal changes across the perimenopause substantially contribute to increased abdominal obesity which leads to additional physical and psychological morbidity. There is strong evidence that estrogen therapy may partly prevent this menopause-related change in body composition and the associated metabolic sequelae. However, further studies are required to identify the women most likely to gain metabolic benefit from menopausal hormone therapy in order to develop evidence-based clinical recommendations.

Life-course origins of the ages at menarche and menopause

A woman's age at menarche (first menstrual period) and her age at menopause are the alpha and omega of her reproductive years. The timing of these milestones is critical for a woman's health trajectory over her lifespan, as they are indicators of ovarian function and aging. Both early and late timing of either event are associated with risk for adverse health and psychosocial outcomes. Thus, the search for a relationship between age at menarche and menopause has consequences for chronic disease prevention and implications for public health. This article is a review of evidence from the fields of developmental biology, epidemiology, nutrition, demography, sociology, and psychology that examine the menarche-menopause connection. Trends in ages at menarche and menopause worldwide and in subpopulations are presented; however, challenges exist in constructing trends. Among 36 studies that examine the association between the two sentinel events, ten reported a significant direct association, two an inverse association, and the remainder had null findings. Multiple factors, including hormonal and environmental exposures, socioeconomic status, and stress throughout the life course are hypothesized to influence the tempo of growth, including body size and height, development, menarche, menopause, and the aging process in women. The complexity of these factors and the pathways related to their effects on each sentinel event complicate evaluation of the relationship between menarche and menopause. Limitations of past investigations are discussed, including lack of comparability of socioeconomic status indicators and biomarker use across studies, while minority group differences have received scant attention. Suggestions for future directions are proposed. As research across endocrinology, epidemiology, and the social sciences becomes more integrated, the confluence of perspectives will yield a richer understanding of the influences on the tempo of a woman's reproductive life cycle as well as accelerate progress toward more sophisticated preventive strategies for chronic disease.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Menopausal Symptoms according to Sasang Constitution and Menopausal Status among Perimenopause Women

PURPOSE

The purpose of this study was to address the difference menopausal symptoms according to sasang constitution and menopausal status among perimenopausal women.

METHODS

Data for this cross-sectional study was collected by administering questionnaires that elicited general information. The menopause rating scale (MRS) and Questionnaire for the Sasang Constitution Classification II (QSCC II) was given to 284 perimenopausal women who met the eligibility criteria and agreed to participate in the study.

RESULTS

The study subjects were composed of 27.5% so-yangin, 24.6% so-eumin, 18.7% tae-eumin, and 29.6% undefined category. The total MRS and all subscales were significantly higher for postmenopausal women in comparison to premenopausal women. Especially, so-eumin and tae-eumin displayed significantly higher scores in urogenital symptoms. The MRS score in postmenopausal women who belonged to the group of tae-eumin and so-eumin was significantly higher than those for premenopausal women. However, so-yangin displayed higher scores in psychological and urogenital symptoms than tae-eumin for premenopausal women. So-eumin presented significantly higher scores in urogenital symptoms in comparison to the undefined category for postmenopausal women.

CONCLUSION

These findings suggest that sasang constitution could be an important factor in understanding the woman's menopausal symptoms and identify the best treatment.