Attitudes Toward Menopause in Relation to Symptom Experience in Puebla, Mexico

Chronic stress, social support, and symptoms at midlife. Is there a buffering effect?

OBJECTIVES

This study was designed to examine associations among measures of stress, social support, and symptoms at midlife. Specifically, the study examined whether support buffered against the negative effects of stress on severity of symptoms grouped via factor analyses into emotional instability, vaso-somatic symptoms, mood disturbances, and aches and pains.

METHODS

We used cross-sectional data from n = 119 women aged 40-55 in Nagaland, India. Midlife symptoms were measured with the help of questionnaires, and factor analysis was used to identify latent factors. Stress and social support were measured by Perceived Stress Scale and Multidimensional Scale of Perceived Social Support, respectively. Chronic stress was measured by fingernail cortisol.

RESULTS

After adjusting for menopausal status, tobacco use, body mass index, and socioeconomic status, cortisol level was positively associated with emotional instability (p < 0.01), vaso-somatic symptom score (p < 0.05), and total symptoms at midlife (p < 0.05). Familial support was negatively associated with emotional instability (p < 0.05) and total symptoms at midlife (p < 0.05). However, no significant associations were observed with spousal or friend support. Although no significant interactions between stress, social support, and symptoms at midlife were observed, spousal support when stratified as high and low support using the means, perceived stress and vaso-somatic symptoms indicated an interaction.

CONCLUSION

Cortisol level and support from family were independently associated with symptoms at midlife. The study highlights the importance of family ties and support for navigating the stressors of everyday life among women in Nagaland.

Frequency of Phytoestrogen Consumption and Symptoms at Midlife among Bangladeshis in Bangladesh and London

There is a longstanding interest in the relationship between diet and hot flash symptoms during midlife, especially in whether phytoestrogens ease menopausal symptoms. The purpose of this study was to examine hot flashes, night sweats, trouble sleeping, and vaginal dryness in relation to the intake of foods rich in phytoestrogens among Bangladeshi women aged 35 to 59 years who were living either in Sylhet, Bangladesh (n = 157) or as migrants in London (n = 174). Consumption ranges for phytoestrogens were constructed from food frequencies. We hypothesized that diets rich in isoflavones, lignans, and coumestrol would be associated with lower symptom frequencies. However, adjusted logistic regression results showed that with each incremental increase in general phytoestrogen consumption (scale of 0 to 10), the likelihood of hot flashes increased by 1.4%. Each incremental increase in lignan consumption raised the likelihood of hot flashes by 1.6%. In contrast, the odds of vaginal dryness decreased by 2%, with each incremental increase in phytoestrogen and lignan consumption, and by 4%, with each incremental increase in isoflavone consumption. Night sweats and trouble sleeping were not associated with phytoestrogen intake in logistic regressions. Our findings add to the conflicting data on relationships between phytoestrogens and symptoms associated with menopause.

Individual Characteristics Associated with Menopausal Symptom Severity and Menopause-Specific Quality of Life: A Rural Perspective

This study aims to analyze the relationship/effect of a wide range of individual factors with/on menopausal symptom severity (MSS) and menopause-specific quality of life (MSQoL) in rural Turkish women. This cross-sectional study included rural perimenopausal/postmenopausal women. Demographic (age, marital status, and education and employment status), physical (body weight and height), medical (chronic disease status), obstetric (number of gravidas), and menopausal characteristics (menopausal nature, perception of menopause, and menopausal stage), physical activity level, anxiety and depressive symptom levels, MSS, and MSQoL of the participants were assessed. The relationships between MSS/MSQoL and all individual characteristics were examined by correlation analyses. In addition, MSS and MSQoL were compared between various categories using independent-groups t tests and variance analyses. Statistical significance level was set at p <0.05. A total of 245 women (mean age 56.64 ± 6.59 years) were included in the study. It was found that marital status, body mass index, presence of chronic disease, the number of gravidas, perception of menopause, and anxiety and depressive symptom levels were associated with MSS and MSQoL (p < 0.05). On the other hand, symptom severity and QoL did not change according to the level of education, employment status, menopausal nature, menopausal stage, and physical activity level (p > 0.05). MSS and MSQoL in rural women may be associated or affected by a wide range of individual characteristics, and this relationship or influence differs from the urban women literature at some points. Further studies are needed to illuminate the menopausal process in rural areas and compare rural and urban results.

The relationship between menopausal symptoms and burnout. A cross-sectional study among nurses

Background

Despite the growing presence of menopausal women in workplaces, studies aimed at exploring the link between menopausal symptoms and job well-being are scarce. In the interest of addressing this gap, the present study aimed to explore whether menopausal symptoms might contribute to increased levels of burnout and whether this relationship can be moderated by social or personal resources.

Method

The study design was cross-sectional and non-randomized. Ninety-four menopausal nurses completed a self-report questionnaire including scales aimed at measuring menopausal symptoms, burnout, social (i.e., support from superiors and colleagues) and personal (i.e., self-efficacy, resilience, and optimism) resources. Moderated regression analyses were performed to test study hypotheses.

Results

Whereas menopausal symptoms were associated significantly with emotional exhaustion, no social or personal resources were found to moderate this relationship. Regarding depersonalization, our study indicated that it was affected by menopausal symptoms only among nurses who reported low social support (from superiors and colleagues), optimism, and resilience.

Conclusion

The present study highlights the importance of organizations that employ a growing number of menopausal women to seek solutions at the individual and social levels that help these women deal with their menopausal transition while working.

Stress and the menopausal transition in Campeche, Mexico

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.

Attitudes toward menopause, sexual function and depressive symptoms in Mexican women

The objective of this study was to explore the beliefs and attitudes toward menopause, depressive symptoms and sexual function in both premenopausal and postmenopausal Mexican women. The Beliefs about and Attitudes toward Menopause Questionnaire, the Female Sexual Function Index and the Center for Epidemiologic Studies Depression Scale were answered by 253 women between the ages of 46 and 59 years. Negative attitudes toward menopause were associated with a more depressive symptomatology, but there was no association between positive attitudes and depressive symptomatology. Among sexually active women (92% premenopausal and 70% postmenopausal), positive attitudes were associated with better sexual function, while negative attitudes were associated with worse sexual function. Our findings suggest that besides biological factors, psychosocial factors may also play an important role in middle-aged women's sexual functioning and in their psychological adjustment.

Attitudes toward menopause among middle-aged women in Semnan, Iran

BACKGROUND AND OBJECTIVE

The menopause marks a major biological transition in the lives of all women. Understanding the attitude of women about menopause facilitates the implementation of public health policies that focus on improving women's health. This study was designed to determine the attitude of a group of Iranian women toward menopause with respect to sociodemographic variables and menopausal status.

MATERIALS AND METHODS

A cross-sectional study was conducted at Primary Health Centers of Semnan during 2012. A total of 747 women aged 45-60 years were interviewed. Sociodemographic characteristics and attitude toward menopause were collected through a structured pretested questionnaire. The attitude scale consisted of 17 questions, each rated on a five-point Likert scale with a total score of 85 points.

RESULTS

The mean (±SD) age of women was 51.3 (±4.5) years. Women were classified as premenopausal (38.4%), perimenopausal (16.9%), and postmenopausal (44.8%). The majority of respondents (63.5%) were illiterate or have had low level of education (<9 years), and 86.3% were unemployed. The mean (±SD) attitude score was 53.3 (±6.8). Most of the women (71%) had neutral attitude, 22.8% had positive, and only 6.3% had negative attitude toward menopause. Menopausal status, educational level, marital status, place of residency, and employment were not associated with women's attitude.

CONCLUSION

In general, women's attitude toward menopause ranged from neutral to positive. The attitude did not differ significantly on the basis of menopausal status, educational level, marital status, place of residency, and employment.

Ethnomedical research and review of Q'eqchi Maya women's reproductive health in the Lake Izabal region of Guatemala: Past, present and future prospects

ETHNOPHARMACOLOGICAL RELEVANCE

In Central America, most Maya women use ethnomedicines for all aspects of their reproductive cycle including menstruation, pregnancy and menopause. However, very few of these plants have been documented, collected and tested in appropriate pharmacological assays to determine possible safety and efficacy. The aim of this work was to provide an overview of information on the ethnomedical uses, ethnopharmacology, chemistry and pharmacological research for medicinal plants used for women's reproductive health in Guatemala, with a special emphasis on the Q'eqchi Maya of the Lake Izabal region, to demonstrate therapeutic potential and support future research in the field.

MATERIALS AND METHODS

Reviews of the ethnobotanical, ethnomedical and ethnopharmacological literature were performed for 30 plants collected in the Lake Izabal region of Guatemala and used by the Q'eqchi Maya for treatment of reproductive health issues were performed up to and including July 2015 using multiple databases, library searches for abstracts, books, dissertations, and websites.

RESULTS AND CONCLUSIONS

Review of the published research confirms that many of the plants used by Q'eqchi Maya women for the management of reproductive health issues have pharmacological activities, including analgesic, anti-inflammatory, estrogenic, progestagenic and/or serotonergic effects, that support the use of these plants and provide plausible mechanisms of action for their traditional uses. Furthermore, a new serotonin agonist, 9, 10-methylenedioxy-5, 6-Z-fadyenolide was isolated, thereby demonstrating an untapped potential for drug discovery. However, to date much of the pharmacological assays have been in vitro only, and few in vivo studies have been performed. Considering the large percentage of the Maya population in Guatemala that use traditional medicines, there remains a significant lack of pharmacological and toxicological data for these plants. Future research should focus on the safety and efficacy of medicinal plants using in vivo preclinical studies and clinical trials, as well as chemical analysis. Since medicinal plants from the Piperaceae are most commonly used as traditional medicines by the Q'eqchi Maya women, and new bioactive compounds have been identified from Piper species, investigations of commonly used plants from this family would be an appropriate place to start. Data generated from such studies would contribute to Guatemala's national effort to promote a complementary relationship between traditional Maya medicine and public health services.

Ambivalent sexism and attitudes toward women in different stages of reproductive life: a semantic, cross-cultural approach

College students in southeastern Mexico (n = 185) and the northeastern United States (n = 96) utilized a semantic differential scale to rate subtypes of women: a menstruating woman, a menopausal woman, a pregnant woman, a premenstrual woman, a woman with a hysterectomy, a teenage girl, a woman in love, and a woman with a young baby. Americans reported significantly more negative attitudes than Mexicans did toward a menstruating woman, a premenstrual woman, a teenage girl, and a pregnant woman. Participants chose more positive words to describe a teenage girl, a woman in love, a pregnant woman, and a woman with a young baby, which is suggestive of a pronatal bias. Participants also completed the Ambivalent Sexism Inventory (ASI). Men scored significantly higher than women on hostile sexism. Mexicans scored significantly higher than Americans on both hostile and benevolent sexism. Sexism scores are related to attitudes toward premenstrual, menstruating, and menopausal women; women with a hysterectomy; and women with a young baby.

Mexican beliefs and attitudes toward menopause and menopausal-related symptoms

The objective of this study was to explore the beliefs and attitudes toward menopause among young and middle-aged Mexican women and men, as well as the menopausal-related symptoms that middle-aged women report or expect and that other participants think a menopausal woman experiences. The beliefs about and attitudes toward Menopause Questionnaire and the Greene Climacteric Scale were answered by 395 Mexicans between the ages of 20 and 60 years. Comparing middle-aged participants, the most negative attitudes toward menopause were held by surgically menopausal women, and the most positive attitudes by naturally postmenopausal women. Younger participants showed more negative attitudes when compared to those in middle age (with exception of surgically menopausal women). There was a positive correlation between negative attitudes and menopausal-related symptoms either experienced by perimenopausal and naturally postmenopausal women, or expected by young and premenopausal women. No significant correlation was found between attitudes and symptoms in the groups of surgically menopausal women or the men. These findings are discussed in light of differences between genders and age cohorts.

Factors associated with reporting classic menopausal symptoms differ

OBJECTIVES

To investigate how symptoms experienced in midlife cluster and to identify factors independently associated with hot flushes, night sweats, and vaginal dryness.

METHODS

A questionnaire was sent to 8206 women aged 45-54 years, recruited from family practices in north-east Scotland, UK. Using data collected about 23 symptoms, we conducted factor analysis for premenopausal, perimenopausal, postmenopausal and surgically menopausal women. Forward stepwise logistic regression was used to identify sociodemographic, lifestyle and psychological variables independently associated with the classic menopausal symptoms.

RESULTS

Overall, 4407 women responded. Hot flushes were experienced by 46.7% (95% confidence interval (CI) 45.2-48.2) of women, night sweats by 46.4% (95% CI 44.9-47.9) and vaginal dryness by 28.2% (95% CI 26.9-29.6). Seven factors including 20 symptoms emerged from factor analysis. Hot flushes were associated with: being perimenopausal or postmenopausal; low education; obesity; low social support; reporting night sweats, musculoskeletal, bloating, menstrual and sexual symptoms; using complementary alternative medicines, lifestyle (e.g. exercising) or psychological management strategies (e.g. talking to family or friends) for menopausal symptoms. Night sweats were associated with: lower body weight; smoking; possible depression; reporting sleep difficulties, hot flushes and sexual symptoms; using lifestyle strategies for menopausal symptoms. Vaginal dryness was associated with: being postmenopausal; high education; high social support; below average physical health, reporting hot flushes, somatic symptoms and decreased sexual interest; using psychological or lifestyle strategies for menopausal symptoms.

CONCLUSION

It is important to investigate each classic menopausal symptom separately. Combining menopausal symptoms into categories such as vasomotor symptoms may lead to inaccurate conclusions about variables associated with these symptoms.

Perimenstrual symptoms and symptoms at midlife in Puebla, Mexico

OBJECTIVES

To examine perimenstrual symptoms in relation to hot flushes and depressive symptoms among 755 pre- and postmenopausal women aged 40-60 years drawn from a general population in Puebla, Mexico.

METHODS

Hot flushes and depressed mood during the past 2 weeks were queried, along with cramps and other symptoms experienced during or before menstruation. Relationships among perimenstrual symptoms were examined by factor analyses. Logistic regression was used to assess determinants of hot flushes and determinants of depressed mood at midlife.

RESULTS

Fifty-four percent of the women reported abdominal cramping (cólicos) during menstruation; fewer reported irritability (8%) and depressed mood (9%). Gastrointestinal complaints were most frequently volunteered (12%), followed by breast tenderness (10%) and mid-back pain (9%). Emotional symptoms clustered separately from perimenstrual symptoms. In bivariate analyses, abdominal cramping and waist pain were associated with hot flushes at midlife (p <0.01) and remained significant determinants after controlling for potential confounders. Depressed mood with menstruation was associated with depressed mood at midlife (p <0.05). After controlling for education, socioeconomic status and parity, perimenstrual irritability and depressed mood raised the risk of midlife depressed mood, although significance was lost after adding current hot flushes and trouble sleeping.

CONCLUSIONS

The relationship between abdominal cramps and hot flushes may be hormonal or sociocultural. The lack of association between depressed mood with menstruation and depressed mood at midlife after controlling for current hot flushes and trouble sleeping suggests that concurrent difficulties were more important than past history of depression in this population.

Relationship between women's attitude towards menopause and quality of life

OBJECTIVES

The aim of the study was to assess the symptoms of women and to describe the relationship between women's attitude towards menopause and quality of life.

METHODS

This study was conducted from November 2010 to April 2011 at Celal Bayar University Faculty of Medicine and 494 women agreed to participate in the study. Women's attitudes towards menopause and quality of life were evaluated by Menopause-specific Quality of Life (MENQOL) questionnaires.

RESULTS

Women with no education had the highest scores for vasomotor, psychosocial and physical cluster symptoms (4.1 ± 2.0, 3.1 ± 1.6, 3.2 ± 1.4, respectively). Vasomotor (4.0 ± 1.9) and physical quality-of-life scores (3.2 ± 1.40) were significantly higher among housewives. Psychosocial (3.6 ± 1.8) and physical scores (3.5 ± 1.5) of women who had no health insurance were found to be higher. The highest scores reported by the women were as follows: vasomotor, physical, psychosocial and sexual cluster (3.8 ± 1.9, 3.1 ± 1.4, 2.9 ± 1.6, 2.7 ± 1.8, respectively). Women with a negative attitude towards menopause were associated with more frequently reported symptoms compared to women with a positive attitude. The women whose relationships with their husband were negatively affected had higher vasomotor, psychosocial, physical, and sexual symptom scores (4.2 ± 1.7, 3.7 ± 1.7, 3.5 ± 1.5, 3.5 ± 1.8). Similarly, the vasomotor, psychosocial, physical, and sexual symptom scores were high in women who declared an unfavorable relationship with their children (4.5 ± 1.8, 3.8 ± 1.6, 3.7 ± 1.4, 3.2 ± 1.9).

CONCLUSION

Health-care professionals should understand women's attitudes towards menopause, in order to give optimal information and help the women create positive attitudes and healthy perceptions of this period of life.

Examination of midlife women's attitudes toward menopause in Turkey

This study used a cross-sectional descriptive design to examine the attitudes of 154 Turkish women aged ≥ 40 years towards menopause. A questionnaire and the Menopause Attitudes scale were used. The mean score of the attitudes was determined as 34.70 ± 8.56. Most women in the study had negative attitudes towards menopause. The majority of women with positive attitudes were older, well educated and had used hormone replacement therapy (P < 0.05). Using multiple linear regression analysis, age and education level were found to be statistically significant (P < 0.001). A statistically significant difference was found between the women in the premenopausal and menopausal years in terms of sexuality after menopause (P < 0.05). This study suggests that Turkish women 40 years and older have negative attitudes towards menopause and their primary concern in the premenopausal period is sexuality after menopause. Counseling of women on menopause-related issues in gynecology clinics is recommended.

Toward healthy aging through empowering self-care during the climacteric stage

BACKGROUND

While they progress through the climacteric stage, women often develop physical and psychological health needs, calling for innovative health-care services that can be translated into preventive programs and empowerment towards self-care.

OBJECTIVE

To identify the changes in women's discourse regarding their concerns and needs about the climacteric stage and self-care after they had participated in an integrative women-centered health-care model with empowerment for self-care.

METHODS

Women's narratives during counseling group sessions were analyzed using qualitative inductive thematic analysis.

RESULTS

A total of 121 women between 45 and 59 years of age participated. At the beginning of the counseling group sessions, we identified the following themes: (1) Lack of information about changes during the climacteric stage and self-care; (2) Tradition: the climacteric stage as a taboo subject; (3) Life's changes and transitions: the complexity of the climacteric experience; (4) Stigma of menopause; (5) Relationship between the traditional gender role and the lack of self-care. At the end of the counseling group sessions, the themes were: (1) The climacteric as a natural stage; (2) Expectations for old age; (3) Empowerment and the change of awareness for self-care; (3) De-medicalization of the climacteric; (4) The richness of group work; (5) Empowerment as motivation to convey acquired knowledge.

CONCLUSION

Women in the climacteric stage require more information about their physical, psychological and social needs, as well as the potential impact on their health during old age. Empowerment during the climacteric can contribute to improving the perception about this stage as well as the importance of self-care.

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

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

Factors influencing the severity of menopause symptoms in Korean post-menopausal women

We have relatively limited knowledge of symptomatic aspects of the postmenopause, rather than perimenopause. We tried to determine the factors associated with experiencing menopausal symptoms by Korean postmenopausal women. A total of 657 Korean women who underwent a natural menopause completed multiple questionnaires, which included questions regarding their attitudes to menopause, depressive symptoms, state anxiety, self-esteem, dyadic relationships, sociodemographic variables, and 11-item Menopause Rating Scale (MRS). Multiple regression analyses were performed to collectively examine the relative impact of each independent variable on the quality of life, as determined by the MRS. Decreased severity of menopausal symptoms was associated with more time spent in education, an employed status, a history of pregnancy, longer postmenopausal duration, positive attitudes to menopause, higher state anxiety, heightened self-esteem, and higher dyadic consensus. Increased severity of menopausal symptoms was also associated with absence of a partner, alcohol consumption, a history of hormone replacement therapy, a history of probable premenstrual dysphoric disorder, and increased severity of depressive symptoms. Sociodemographic characteristics, lifestyle factors, premenstrual dysphoric disorder, attitudes to menopause, a dyadic relationship with a partner, and the inner psychological status can be associated with the severity of menopause symptoms specifically in Korean postmenopausal women.

Determinants of hot flashes and night sweats

PRIMARY OBJECTIVE

The purpose of this study was to identify determinants of hot flashes and night sweats, two vasomotor symptoms associated with the hormonal changes of the menopause transition.

METHODS

Participants were 293 women, aged 45 to 55, randomly selected from automated demographic and membership records of a health maintenance organization in the northeast USA. Letters were mailed to eligible women, followed by face-to-face interviews.

RESULTS

Hot flashes during the month before interview were reported by 57% of the participants, although only 9% of the entire sample reported hot flashes to be "bothersome". Night sweats were reported by 36% of all participants, with 6% reporting night sweats to be "bothersome". Fifty-four percent of women reporting hot flashes also reported night sweats. In logistic regression analyses that controlled for menopause status and use of hormone therapy (HT), daily alcohol consumption significantly increased the risk of hot flashes, night sweats, and bothersome night sweats. Higher education and an excellent self-rating of health decreased the risk of night sweats, but not hot flashes. Smoking increased the risk of bothersome hot flashes, but not bothersome night sweats.

CONCLUSIONS

In logistic regression analyses, alcohol consumption was a significant predictor of vasomotor symptoms. A slightly different set of variables were associated with hot flashes compared to night sweats.

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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Variation in sweating patterns: implications for studies of hot flashes through skin conductance

OBJECTIVE

The literature of sweat physiology and population variation in response to heat stress suggests that variation in sweating patterns may affect the measurement of hot flashes. This study examined variation in sweating patterns in Puebla, Mexico, and Amherst, MA, and compared the levels of concordance between subjective and objective measures of hot flashes.

DESIGN

Thirteen women in Puebla, Mexico, and 15 women in Amherst, MA, aged 45 to 61, completed surveys, body diagrams of heat flow during a hot flash, anthropometric measures, and the measurement of hot flashes through skin conductance monitoring. Hot flashes were measured through sternal (Mexico and Massachusetts) and nuchal (Mexico only) skin conductance.

RESULTS

Mexican women were significantly more likely to describe the heat of hot flashes on the back of their neck (100% vs 40%) and on their arms and/or hands (85% vs 40%) compared with women in Massachusetts. Hot flashes in the midback were associated with concordance between nuchal, but not sternal, measures of skin conductance and subjective report in Mexico. In comparing average scores for concordance between subjective and sternal measures of hot flashes, there was a higher mean score for true positives in Mexico (61% vs 29%, P=0.06) and a significantly higher mean score for false-negative measures in Massachusetts (57% vs 21%, P=0.04).

CONCLUSIONS

Variation in rates of concordance between subjective and objective measures were not adequately explained by sweating patterns. Future studies should consider population variation in acclimatization and assess variation in the amount of sweat produced during a hot flash.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Prevalence of hot flushes and night sweats around the world: a systematic review

OBJECTIVE

Many studies have evaluated the relationships between ethnicity and culture, prevalence of menopausal symptoms, and attitudes toward them, but few have assessed menopausal symptoms across cultures world-wide. This paper aims to systematically review the prevalence of hot flushes and night sweats, two prevalent symptoms of menopause, across the menopausal stages in different cultures and considers potential explanations for differences in prevalence rates.

DESIGN

Sixty-six papers formed the basis for this review. Studies were organized by geographic region, and results are presented for North America, Europe, East Asia, Southeast Asia, Australia, Latin America, South Asia, Middle East, and Africa. Studies were included if they provided quantitative information on the occurrence of hot flushes. This report focuses on hot flushes and night sweats, the most common menopausal symptoms reported in epidemiologic studies.

RESULTS

Studies reviewed indicate that vasomotor symptoms are highly prevalent in most societies. The prevalence of these symptoms varies widely and may be influenced by a range of factors, including climate, diet, lifestyle, women's roles, and attitudes regarding the end of reproductive life and aging. Patterns in hot flush prevalence were apparent for menopausal stages and, to a lesser degree, for regional variation.

CONCLUSIONS

Caregivers should recognize that variations exist and ask patients specific questions about symptoms and their impact on usual functioning.

Hot flashes are associated with increased ambulatory systolic blood pressure

OBJECTIVE

To determine the association between ambulatory blood pressure (BP) and hot flash experience.

DESIGN

The participants in the study were 154 women (mean age=46 years, range=18-65 years), who were evaluated as part of a cross-sectional study on ethnicity, socioeconomic status, and diurnal BP patterns. Participants could be either normotensive or mildly hypertensive. Participants wore an ambulatory BP monitor for 24 hours and recorded their awake and sleep times. Hot flashes were assessed using an everyday complaint questionnaire that embeds symptoms associated with menopause into a list of everyday complaints.

RESULTS

Thirty-three percent of participants reported having had hot flashes during the 2 weeks before they completed the questionnaire. Compared with women who did not report hot flashes, mean awake and sleep systolic BP values were significantly higher (P<0.004 and P=0.007, respectively) in women who reported having had hot flashes. Hot flashes continued to independently predict average awake and sleep systolic BP (both P=0.03) after controlling for age, race/ethnicity, body mass index, and menopausal status. Hot flashes were not associated with diastolic BP or nocturnal dipping of BP.

CONCLUSIONS

Hot flashes are associated with increased awake and sleep systolic BP independent of menopausal status. Further investigation is warranted to elucidate the mechanisms by which hot flashes are associated with BP.

Symptoms, attitudes and treatment choices surrounding menopause among the Q'eqchi Maya of Livingston, Guatemala

The present study explored symptoms, attitudes and treatments surrounding women's health and menopause among the Q'eqchi Maya of the eastern tropical lowlands of Guatemala. Data were obtained through participant observation, semi-structured interviews, focus groups and plant walks with 50 Q'eqchi community members from the state of Izabal, Municipality of Livingston, including five midwives, five traditional male healers and eight postmenopausal women. Results indicate that the Q'eqchi Maya of Livingston possess their own cultural perceptions of women's health which affect attitudes, symptoms and treatment choices during the menopausal transition. Since discussions of menstruation and menopause are considered cultural taboos among the Q'eqchi, many women mentioned experiencing excessive preoccupation when unanticipated and unfamiliar symptoms occurred. Furthermore, many women suffered from additional hardship when their spouse misinterpreted menopausal symptoms (vaginal dryness, sexual disinterest) as infidelity. Seven of the eight postmenopausal women interviewed indicated experiencing one or more symptoms during the menopausal transition, including headaches, anxiety, muscular pain, depression, and hot flashes. These results differ from the lack of symptomatology reported in previous studies in Mexico, but are in line with the result of menopausal research conducted among other Maya groups from the highlands of Guatemala. Although the Q'eqchi did not use a specific term for "hot flash", three Q'eqchi women used the expression "baja presion" or a "lowering of blood pressure" to explain symptoms of profuse sweating followed by chills, heart palpitations, and emotional instability. The Q'eqchi Maya mentioned a number of herbal remedies to treat menopausal symptoms. Further research on these botanical treatments is needed in order to ascertain their safety and efficacy for continued use.

Musculoskeletal pain among women of menopausal age in Puebla, Mexico

Worldwide, complaints of musculoskeletal pain are more frequent than complaints of hot flashes amongst women of menopausal age. The purpose of this study was to examine musculoskeletal pain among women of menopausal age in the city of Puebla, Mexico. An opportunity sample was recruited from public parks and markets, with representation from all social classes (n=755). Mean age was 50.1 years, and the majority were employed as saleswomen in small businesses. Symptom frequencies were collected by open-ended interviews and with a structured symptom list that queried symptom experience during the two weeks prior to interview. In response to open-ended questions, "dolores de huesos" (bone pain) was volunteered by 47% of respondents as a symptom associated with menopause, second only to hot flashes (53%). From the structured symptom list, 55.8% and 55.6% reported back pain and joint stiffness during the two weeks prior to interview. Women with back pain and joint stiffness were less likely to report being active during their leisure time (p<.01). The results of backwards stepwise logistic regressions indicate that women with back pain were more likely to be older, with less education, a higher BMI, and ate less meat. Women with joint pain were more likely to be post-menopausal, with less education, more children, a higher BMI, and were likely to drink milk and coffee more than once/week but less than once/day. While menopause is not necessarily a risk factor for musculoskeletal pain, it is important to recognize the pervasiveness of this complaint among women of menopausal age.

A Psycho-Educational Program for Improving Women’s Attitudes and Coping With Menopause Symptoms

OBJECTIVE

To examine the impact of participation in a psycho-educational program on women's attitudes toward menopause, the perceived severity of their symptoms, and the association between the two.

DESIGN

Quasi-experimental. Data were gathered at baseline and 3 months after termination of the program.

SETTING

Two health maintenance organization clinics.

PARTICIPANTS

Eighty-two healthy 40- to 60-year-old women who chose to participate in the study. Thirty-six women participated in the program, and 46 women comprised the control group.

INTERVENTION

Program participants met for 10 weekly sessions to receive information from a professional team on subjects related to menopause and to share and discuss their experiences.

MAIN OUTCOME MEASURES

Attitudes toward menopause and severity of menopause symptoms.

RESULTS

The more negative the attitudes, the higher was the severity of symptoms. Participants reported significant improvements in attitudes and reductions in symptom severity compared to their own baseline scores and compared with the control group.

CONCLUSIONS

Participation in a program that combines delivery of information and processing of experiences on the cognitive, emotional, and social levels may improve women's attitudes toward menopause and ease the perceived severity of their symptoms, thereby increasing quality of life.