Effect of exercise on bone structural traits, physical performance and body composition in breast cancer patients--a 12-month RCT

In this 12-month RCT, we examined whether aerobic impact exercise training (3x/week) could facilitate breast cancer survivors' recovery by enhancing their bone structural strength, physical performance and body composition. After the adjuvant chemo- and/ or radiotherapy, 86 patients were randomly assigned into the training or control group. Structural bone traits were assessed with pQCT at the tibia and with DXA at the femoral neck. Agility (figure-8 running), jump force and power (force platform), grip strength and cardiovascular fitness (2-km walk test) were also assessed. Training effects on outcome variables were estimated by two-way factorial ANCOVA using the study group and menopausal status as fixed factors. Bone structural strength was better maintained among the trainees. At the femoral neck, there was a small but significant 2% training effect in the bone mass distribution (p=0.05). At the tibial diaphysis, slight 1% to 2% training effects (p=0.03) in total cross-sectional area and bone structural strength were observed (p=0.03) among the postmenopausal trainees. Also, 3% to 4% training effects were observed in the figure-8 running time (p=0.03) and grip strength (p=0.01). In conclusion, vigorous aerobic impact exercise training has potential to maintain bone structural strength and improve physical performance among breast cancer survivors.

Effect of supervised and home exercise training on bone mineral density among breast cancer patients. A 12-month randomised controlled trial

The ability of combined step aerobic- and circuit-training to prevent bone loss after breast cancer treatments was related to skeletal site and patients' menopausal status. Among premenopausal breast cancer survivors, a 12-month exercise intervention completely prevented bone loss at the femoral neck, whereas no exercise effect was seen at lumbar spine or at neither site in postmenopausal women.

INTRODUCTION

The primary objective of this randomised clinical trial was to determine the preventive effect of supervised weight-bearing jumping exercises and circuit training on bone loss among breast cancer patients.

METHODS

Of 573 breast cancer survivors aged 35-68 years randomly allocated into exercise or control group after adjuvant treatments, 498 (87%) were included in the final analysis. The 12-month exercise intervention comprised weekly supervised step aerobic- and circuit-exercises and similar home training. Bone mineral density (BMD) at lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry. Physical performance was assessed by 2-km walking and figure-8 running tests, and the amount of physical activity was estimated in metabolic equivalent-hours/week.

RESULTS

In premenopausal women, bone loss at the femoral neck was prevented by exercise, the mean BMD changes being -0.2% among the trainees vs. -1.4% among the controls (p = 0.01). Lumbar bone loss could not be prevented (-1.9% vs. -2.2%). In postmenopausal women, no significant exercise-effect on BMD was found either at the lumbar spine (-1.6% vs. -2.1%) or femoral neck (-1.1% vs. -1.1%).

CONCLUSIONS

This 12-month aerobic jumping and circuit training intervention completely prevented femoral neck bone loss in premenopausal breast cancer patients, whereas no effect on BMD was seen in postmenopausal women.

Quality of life and physical performance and activity of breast cancer patients after adjuvant treatments

OBJECTIVE

The study aimed at investigating the quality of life (QoL) and physical performance and activity, and their interrelations, in Finnish female breast cancer patients shortly after adjuvant treatments.

METHODS

A total of 537 disease-free breast cancer survivors aged 35-68 years were surveyed at the beginning of a one year randomized exercise intervention. The patients were interviewed using EORTC QLQ-C30, FACIT-F, RBDI, and WHQ (for vasomotor symptoms) questionnaires. Physical performance was tested by a 2 km walking test. Physical activity was measured by a questionnaire and a prospective two-week diary. Multivariate analysis was used to study the factors associated with QoL.

RESULTS

About 26% of the patients were rated as depressed, 20.4% as fatigued, and 82% suffered from menopausal symptoms. The global QoL was lower than in general population (69.4 vs 74.7, p<0.001). About 62% of the walking test results were below the population average. Fatigue (p<0.001), depression (p<0.001), body mass index (p = 0.016) and comorbidity (p = 0.032) impaired, and physical activity (p = 0.003) improved QoL. Physical activity level correlated positively to physical performance (r = -0.274, p<0.0001).

CONCLUSIONS

The QoL of the patients shortly after adjuvant treatments was impaired and the physical performance poor as compared to general population. In particular, depression and fatigue were related to impaired QoL. Physical performance and activity level were the only factors that correlated positively to QoL. Thus, physical exercise could be useful in rehabilitation of cancer survivors, especially for depressed and fatigued patients.

Incidence of necrotizing enterocolitis in very-low-birth-weight infants related to the use of Lactobacillus GG

BACKGROUND

One of the five level III neonatal intensive care units (NICU) in Finland has used prophylactic Lactobacillus GG (LGG) for very-low-birth-weight (VLBW) infants since 1997.

AIM

To examine retrospectively the incidence of necrotizing enterocolitis (NEC) in all five university hospital NICUs in Finland in relation to the use of LGG during the years each unit has belonged to the Vermont Oxford Network (VON).

METHODS

The incidence of NEC was analysed from the national database and from the VON databases separately in all five level III NICUs and additionally in three groups according to the probiotic practice in the hospitals: prophylactic LGG group, probiotics 'on demand' group and no probiotics group.

RESULTS

The incidence of NEC was 4.6% vs. 3.3% vs. 1.8% in the prophylactic LGG group, the no probiotics group and the probiotics 'on demand' group [corrected] respectively; p = 0.0090, chi-square. LGG had no influence on the clinical course of NEC.

CONCLUSIONS

The results of this retrospective report failed to show that LGG prophylaxis protects VLBW infants from the occurrence of NEC, in contrast to previously published results. Our results call for more research regarding effective ways to administer probiotics, including data on appropriate bacteria, strain, dose and timing of administration to achieve clinically robust effects.

Health and life style among infertile men and women

OBJECTIVE

Lifetime prevalence of infertility among couples is approximately 10-15%, but studies addressing their health behavior are few. Our aim was to describe health and life style of Finnish men and women who had experienced infertility.

DESIGN

Cross-sectional survey.

SETTING

Finland.

POPULATION AND METHODS

Data from a population-based survey (n=7021) was utilized. Life style of infertile men (n=289) and women (n=155) were compared to other men and fertile women.

MAIN OUTCOME MEASURES

Life style (dietary factors, use of alcohol, physical activity), reproductive factors, other diseases and symptoms.

RESULTS

After adjusting for age, area and education, infertile women under 50 years consumed more polyunsaturated fat (OR 1.23, 95% CI 1.03-1.46), less saturated fat (OR 0.83, 95% CI 0.74-0.92) and had experienced more hangovers during previous year (OR 1.02, 95% CI 1.00-1.05) than fertile women. Infertile men under 50 years consumed more total fat (OR 1.06, 95% CI 1.03-1.10), polyunsaturated fat (OR 1.20, 95% CI 1.05-1.37) and monounsaturated fat (OR 1.17, 95% CI 1.06-1.28) compared to other men. Infertile men did not consume more alcohol nor smoke more cigarettes but reported more often allergies than fertile men. Infertile women also had Chlamydia trachomatis infection, benign tumor in their uterus and intestinal disease more often than fertile women. Infertile women over 50 years were more often current smokers than fertile women, but the differences in other age-groups were not significant.

CONCLUSIONS

Women with infertility experience reported more diseases and less use of oral contraceptives than other women, possibly reflecting reasons to infertility. Since both infertility and unhealthy use of alcohol are an increasing public health issues in western societies, more attention should be paid towards life style, especially alcohol use of infertile women.

The impact of perinatal probiotic intervention on the development of overweight and obesity: follow-up study from birth to 10 years

BACKGROUND

The achievements in combating the increasing trend of overweight and obesity have thus far been inadequate. The recently discovered instrumental role of the gut microbiota in host metabolism may offer a novel target in the prevention and management of obesity.

OBJECTIVE

To evaluate the impact of perinatal probiotic intervention on childhood growth patterns and the development of overweight during a 10-year follow-up.

PATIENTS AND METHODS

Altogether 159 women were randomized and double-blinded to receive probiotics (1 × 10(10) colony-forming units of Lactobacillus rhamnosus GG, ATCC 53103) or placebo 4 weeks before expected delivery; the intervention extending for 6 months postnatally. Anthropometric measurements of the children were taken at the ages of 3, 6, 12 and 24 months and at 4, 7 and 10 years in 113 (72%) children.

RESULTS

The excessive weight gain was detected to be two-parted; the initial phase of excessive weight gain initiating during fetal period and continuing until 24-48 months of age and a second phase of excessive weight gain starting after the age of 24-48 months. The perinatal probiotic intervention appeared to moderate the initial phase of excessive weight gain, especially among children who later became overweight, but not the second phase of excessive weight gain, the impact being most pronounced at the age of 4 years (P=0.063, analysis of variance for repeated measures). The effect of intervention was also shown as a tendency to reduce the birth-weight-adjusted mean body mass index at the age of 4 years (P=0.080, analysis of covariance).

CONCLUSIONS

Early gut microbiota modulation with probiotics may modify the growth pattern of the child by restraining excessive weight gain during the first years of life. This novel observation calls for further epidemiological and clinical trials, with precise data on early growth patterns and on confounding factors influencing weight development.

Pre-eclampsia is a risk factor of carotid artery atherosclerosis

BACKGROUND

A history of pre-eclampsia has been shown to be associated with an increased risk of subsequent coronary artery disease. The intima-media thickness of carotid arteries and the detection of plaques are useful measures as regards preclinical atherosclerosis. The aim of this study was to examine whether women with a history of pre-eclampsia more often show signs of atherosclerosis compared with 2 control groups.

METHODS

We used data from a large Finnish cross-sectional health examination survey. We had women with previous pre-eclampsia (n = 35) or pregnancy-induced hypertension (n = 61) and 2 control groups. Laboratory tests and physical examination were performed. Information on reproductive and medical history was obtained at the home interview. Carotid atherosclerosis was assessed by ultrasonography.

RESULTS

The women with previous pre-eclampsia had significantly (p = 0.008) more atherosclerotic plaques than the healthy parous controls. The intima-media thickness in the women with previous pre-eclampsia also tended to be higher than in the other groups, although the differences did not reach statistical significance. In logistic regression analysis, advanced age (OR: 1.08; 95% CI: 1.04-1.13; p < 0.001) and pre-eclampsia (OR: 3.63; 95% CI: 1.50-8.79; p = 0.004) were independent risk factors as regards plaque, and in linear regression analysis advanced age (estimate: 0.012; 95% CI: 0.010-0.014; p < 0.001), HDL cholesterol (estimate: -0.049; 95% CI: -0.088 to -0.010; p = 0.013), systolic blood pressure, BMI (estimate: 0.005; 95% CI: 0.000-0.009; p = 0.043) and high-sensitivity C-reactive protein (estimate: -0.003; 95% CI: -0.007 to -0.000; p = 0.048) were independent risk factors with respect to intima-media thickness.

CONCLUSIONS

Our data suggest that pre-eclampsia is an independent risk factor as regards developing plaque later in life.

Success of infertility treatments in Finland in the period 1992-2005

OBJECTIVES

The objective was to study the success rates of infertility treatments in the period 1992-2005 in public and private clinics.

STUDY DESIGN

Aggregate IVF statistics (1992-2005) and nationally representative cross-sectional survey (2002).

RESULTS

The success rates of infertility treatments remained stable, despite a substantial increase in single-embryo transfers. In 2005, the clinical pregnancy rate was 23/100 initiated cycles and a live birth rate of 17/100 cycles. The proportions of term singletons and singletons weighing at least 2500g improved over time and both rates were 14/100 in 2005. Pregnancy rates improved most among older women during the study period. The success rate in the private sector was significantly better than that in the public sector among women younger than 35 years.

CONCLUSION

The single-embryo policy has not decreased pregnancy and birth rates. The proportions of term singletons per initiated cycle and singletons weighing at least 2500g per initiated cycle have improved over time. The higher success rate in the private sector may be because of different clientele.

Preventing excessive weight gain during pregnancy - a controlled trial in primary health care

OBJECTIVE

To investigate whether individual counselling on diet and physical activity during pregnancy can have positive effects on diet and leisure time physical activity (LTPA) and prevent excessive gestational weight gain.

DESIGN

A controlled trial.

SETTING

Six maternity clinics in primary health care in Finland. The clinics were selected into three intervention and three control clinics.

SUBJECTS

Of the 132 pregnant primiparas, recruited by 15 public health nurses (PHN), 105 completed the study.

INTERVENTIONS

The intervention included individual counselling on diet and LTPA during five routine visits to a PHN until 37 weeks' gestation; the controls received the standard maternity care.

RESULTS

The counselling did not affect the proportion of primiparas exceeding the weight gain recommendations or total LTPA when adjusted for confounders. The adjusted proportion of high-fibre bread of the total weekly amount of bread decreased more in the control group than in the intervention group (difference 11.8%-units, 95% confidence interval (CI) 0.6-23.1, P=0.04). The adjusted intake of vegetables, fruit and berries increased by 0.8 portions/day (95% CI 0.3-1.4, P=0.004) and dietary fibre by 3.6 g/day (95% CI 1.0-6.1, P=0.007) more in the intervention group than in the control group. There were no high birth weight babies (>or=4000 g) in the intervention group, but eight (15%) of them in the control group (P=0.006).

CONCLUSIONS

The counselling helped pregnant women to maintain the proportion of high-fibre bread and to increase vegetable, fruit and fibre intakes, but was unable to prevent excessive gestational weight gain.

Diagnosis and treatment of menorrhagia

One-third of all women experience heavy menstrual bleeding at some point in their life. In western countries, about 5% of women of reproductive age will seek help for menorrhagia annually. Half of all women who consult for hypermenorrhea have some uterine abnormality, most often fibroids (among patients under 40 years of age) and endometrial polyps (above 40 years of age). Appropriate treatment considerably improves the quality of life of these patients, and it is important to make a rigorous assessment of the patient to provide the best treatment options. This guideline provides instructions on how to examine and treat women of fertile age who have menorrhagia. The subject's own assessment of the amount of menstrual blood loss does not generally reflect the true amount. All patients should undergo a pelvic examination and, if the menstrual pattern has changed substantially or if anaemia is present, a vaginal sonography should be carried out as the most important supplemental examination. Vaginal sonography combined with an endometrial biopsy is a reliable method for diagnosing endometrial hyperplasia or carcinoma, but it is insufficient for diagnosing endometrial polyps and fibroids; these can be diagnosed more reliably by sonohysterography or hysteroscopy. Non-steroidal anti-inflammatory drugs and tranexamic acid reduce menstrual blood loss by 20-60%, and the effectiveness of a hormonal intrauterine system (IUS) is comparable with that of endometrial ablation or hysterectomy. Cyclic progestogens do not significantly reduce menstrual bleeding of women who ovulate. Treatment should be started with one of the drug therapies, i.e. the IUS, tranexamic acid, anti-inflammatory drugs, or oral contraceptive. Drug treatment should be used and evaluated before surgical interventions are considered. With an effective training and feedback system, it is possible to organise the diagnostics, medical treatment and follow-up of heavy menstrual bleeding in the primary health care setting or in outpatient clinics, which reduces the burden on specialist health care.

Effect of hysterectomy on incidence trends of endometrial and cervical cancer in Finland 1953-2010

The hysterectomy-corrected age-adjusted incidence rate of endometrial cancer was 29%, and for cervical cancer 11% higher than the uncorrected rate. Correction factors for such cancer sites are recommended for regular use. The levelling-off of the incidence of endometrial cancer appears to be an artefact caused by the increasing prevalence of hysterectomy.

Pregnancy weight gain from 1960s to 2000 in Finland

OBJECTIVE

To study secular trends in average pregnancy weight gain between the 1960s and 2000 in Finland, and whether the changes were related to body mass index (BMI), age or parity.

DESIGN

Three cross-sectional population surveys in Finland from three different periods.

SUBJECTS

Women who were pregnant in Helsinki in the period 1954-1963 (N=2262), or in Tampere in the period 1985-1986 (N=1771) or in 2000-2001 (N=371).

MEASUREMENTS

Pregnancy weight gain was determined from self-reported prepregnancy weight and measured weights during pregnancy.

RESULTS

The mean age and prepregnancy BMI of all pregnant women increased between the 1960s and 2000 (from 26.5 to 29.6 y, from 21.9 to 23.7 kg/m(2)). The mean pregnancy weight gain, adjusted for mother's age, BMI and parity, increased from the 1960s to the mid-1980s from 13.2 to 14.3 kg. The increase was observed in all BMI categories. Compared to the 1960 cohort, the proportion of women with a pregnancy weight gain of less than 10 kg decreased and the proportion of women with a weight gain of 15 kg or more increased in the 1980 cohort. After the mid-1980s, the average pregnancy weight gain remained the same. In all cohorts, overweight women gained least weight during pregnancy, but age and parity were not associated with BMI and parity-/age-adjusted pregnancy weight gain. Higher pregnancy weight gain was associated with higher mean child's birthweight and higher proportion of high birthweight babies in all cohorts.

CONCLUSIONS

The mean pregnancy weight gain has increased since the 1960s, which may be of importance with regard to the development of later obesity. Factors other than changes in prepregnancy BMI, age and parity must explain the increased pregnancy weight gain over time.

Associations between health-related behaviors: a 7-year follow-up of adults

BACKGROUND

The study examines pairwise associations between smoking, alcohol use, physical activity, dietary behavior and body mass index using long-term follow-up data of Finnish adults.

METHODS

Respondents to large nationwide health behavior surveys conducted in 1989/1990 were recontacted in 1997. First, we examined whether each health behavior predicted other behaviors 7 years later. Second, we examined whether changes in each health behavior were accompanied by changes in other behaviors.

RESULTS

Smoking at baseline predicted all other health behaviors except body mass index in men. On the other hand, other behaviors tended to predict smoking. Physical inactivity and unhealthy diet were predictive of each other in men. Those with an unhealthy diet at baseline were less likely to be high alcohol users in the follow-up. Baseline body mass index did not predict any of the other behaviors. Concurrent changes in health behaviors involved either smoking or body mass index. Changes in diet and alcohol use were differently related to changes in body mass index in men than in women.

CONCLUSIONS

Overall, smoking seemed to play a central role in the associations between health behaviors. Smoking was predictive of most other health behaviors. Concurrent changes in health behaviors related either to smoking or to body weight. The associations between health behaviors were fairly similar for men and women, but the variation in the associations between body mass index and some other health behaviors suggests gender differences in the behavioral response to body weight.

Tallness and overweight during childhood have opposing effects on breast cancer risk

Using birth and school health records we studied how weight and height during childhood affect breast cancer risk among 3447 women born during 1924-33 at the University Hospital of Helsinki, Finland. Through linkages with the National Hospital Discharge Registry and the Cause of Death Registry we identified 177 women who during 1971-1995 had been admitted to hospital with breast cancer, of whom 49 had died from the disease. Of these, 135 (76%) were aged 50 years or more at the time of diagnosis, and therefore likely to have been post-menopausal. Hazard ratios for breast cancer rose with increasing weight and length at birth, though neither trend was statistically significant. At each age, from 7 to 15 years, the girls who later developed breast cancer were on average taller and had lower body mass than the other girls. Unadjusted hazard ratios rose across the range of height (P = 0.01 at age 7 years) and fell across the range of body mass index (P = 0.009 at age 7 years). In a simultaneous analysis the hazard ratio for breast cancer was 1.27 (95% CI 0.97-1.78, P = 0.08) for every kilogram increase in birth weight and 1.21 (95% CI 1.06-1.38, P = 0.004) for every kg/m(2) decrease in body mass index at 7. Our findings indicate that tallness in childhood is associated with increased risk of developing breast cancer. One possible explanation is persisting high plasma concentrations of insulin-like growth factors in tall women. In contrast, we found that being overweight in childhood reduces breast cancer risk. The increased adipose tissue-derived oestrogen levels in overweight children could induce early breast differentiation and eliminate some targets for malignant transformation.

The effect of physical activity on breast cancer risk: a cohort study of 30,548 women

BACKGROUND

In epidemiological studies abundant physical activity has been related to decreased breast cancer risk, though the results have been inconsistent. The purpose of this paper was to study the association of physical activity at leisure and commuting to work and incidence of breast cancer.

METHODS

The study cohort consisted of 30,548 female participants of the Finnish adult health behaviour survey, based on annual random samples of Finns aged 15-64, collected in 1978-1993. By the end of 1995, 332 breast cancer cases had been diagnosed in the cohort. Relative risks of breast cancer were adjusted for age at survey, body mass index (BMI), education, length of follow-up, parity and age at first birth using Poisson regression models.

RESULTS

Compared to women exercising less than once a week, the adjusted relative risk of breast cancer for women exercising once a week was 0.80 (95% confidence interval (CI): 0.58-1.10), for women exercising 2-3 times per week 0.92 (95% CI: 0.78-1.22) and for women exercising daily 1.01 (95% CI: 0.72-1.42). Women who reported commuting, walking or bicycling to work 30 min or more daily had slightly lower adjusted risk of breast cancer (RR: 0.87, 95% CI: 0.62-1.24) than women working at home, being unemployed or driving a car to working place.

CONCLUSION

Although a small protective effect of regular physical activity for breast cancer incidence was found in physical activity when commuting to work, the role of the physical activity in breast cancer prevention is still an open question.

Fibroids and hypertension. A cross-sectional study of women undergoing hysterectomy

OBJECTIVE

To determine whether uterine fibroids are associated with hypertension.

STUDY DESIGN

A total of 543 consecutive women, 41-89 years of age, who underwent hysterectomy in 1984 and 1994 for benign indications at Helsinki University Central Hospital were included in the study. Preoperative information on indications for the procedure, current use of hormone replacement therapy (HRT) or other medication, parity, body mass index and blood pressure (BP) was obtained from medical records. The presence of fibroids was confirmed from the pathology report. Women were classified as hypertensive if they currently used antihypertensive medication, had a history of hypertension without current medication or had a preoperatively measured BP > 140/90 mm Hg.

RESULTS

Women with fibroids were significantly younger and more likely to use HRT than the other women. Uterine fibroids were more frequent among hypertensive (42%) than normotensive (37%) women. In logistic regression analysis, fibroids were statistically significantly associated with hypertension (OR 1.8, 95% CI 1.2-2.7). The association between myomas and hypertension was strongest (OR 3.6, 95% CI 1.2-10.9) among women with hysterectomies for benign adnexal tumors.

CONCLUSION

Uterine fibroids and/or adnexal tumors may share pathogenic features with the development of hypertension.

Sixty thousand woman-years of experience on the levonorgestrel intrauterine system: an epidemiological survey in Finland

OBJECTIVE

An epidemiological survey was carried out in Finland to establish the performance of the levonorgestrel intrauterine system (LNG-IUS) in a large population of women regularly using the system for contraception.

STUDY DESIGN

All women who had LNG-IUS inserted between 1990 and 1993 were sent a questionnaire with questions about general health status, reproductive and contraceptive history and gynecological problems and a set of questions about their experience on the LNG-IUS.

RESULTS

The women who had a LNG-IUS inserted between April 1990 and December 1993 were asked to participate in an epidemiological survey. At the insertion visit, the women were asked to fill in a questionnaire, to consent to further use of the information by signing their initials and to return the questionnaire to the manufacturer. The number of returned forms was 23,885. The names and addresses of these women were acquired from the National Register and a questionnaire with 75 questions was sent to them. Of the questionnaires, 75% were returned. Experience covered 58,600 woman-years. The mean age of the users of the LNG-IUS was 40 years. Most of them (99.3%) were parous, most often with two or three children. The cumulative 5-year Pearl index was 0.18 and there were 108 pregnancies in the study population during the use of the LNG-IUS. The continuation rates for 1, 2, 3, 4 and 5 years were 0.94, 0.87, 0.82, 0.76 and 0.65, respectively. Removal before the full 5 years was most common among the youngest age group. Bleeding disorders, infections and pain during LNG-IUS use were associated with the highest risk for discontinuation. The risk of premature removal was markedly diminished among women with totally or occasionally missed periods.

CONCLUSIONS

The response rate to the survey was high and the sample studied was exceptionally large. The continuation rate of LNG-IUS was high up to 5 years. The symptoms associated with premature removal agreed with results from earlier randomized studies of the LNG-IUS.

Heritability and risk factors of uterine fibroids--the Finnish Twin Cohort study

OBJECTIVES

Our aim was to study heritability, risk factors and hospitalization for uterine fibroids.

METHODS

A random sample of 80 MZ and 80 DZ twins from the Finnish Twin Cohort were invited and 51% of the eligible women (n=82, 17 MZ and 16 DZ pairs, 40-47 years, mean age 43.0), underwent a transvaginal ultrasound. The entire cohort of 13872 women was linked to the national hospital discharge registry 1972-1990.

RESULTS

Prevalence of fibroids was 66% and the average number of fibroids 1.7. The casewise concordance for being hospitalized for uterine fibroids was higher in MZ (0.31, 95% CI 0.24-0.37) than in DZ pairs (0.18, 95% CI 0.14-0.22). The proportion of variance in liability to fibroid hospitalization accounted for by genetic factors was 54.8% (95% CI 46.2-62.7%). Women with fibroids had higher body mass index (23.7 vs 21.7, P=0.0086), lower age at first birth (25.7 vs 29.3, P=0.012) and higher parity (3+ children 48.2 vs 29.6%, P=0.009) than women without fibroids. Risk ratio (RR) for fibroids in a MZ twin whose sister had been diagnosed with fibroids was 1.1 (95% CI 0.08;15), for a DZ twin 1.1 (95% CI 0.16;8.8) and for all twins 1.3 (95% CI 0.3; 6.1). Intraclass correlation for the number of fibroids was 0.24 for MZ and 0.11 for DZ twins, yielding an heritability estimate of 0.26.

CONCLUSION

Reproductive and anthropometric factors may have at least as large role in pathogenesis of fibroids than genetic factors.

Occasional smoking increases total and cardiovascular mortality among men

The aim was to study whether occasional smoking increases mortality risk. The mortality of random samples of the Finnish Adult Health Behavior surveys from 1978 to 1991 were followed for 18 years from 1978 to 1995. Poisson models were used to determine the risk of total and cardiovascular mortality. It was found that occasional smokers were less often sedentary and had less often unhealthy diet than other smoking status groups. Occasional smoking among men was significantly related to the risk of both total (age-adjusted relative risk, RR, 1.6, 95% confidence interval, CI, 1.3-2.1) and cardiovascular mortality (age-adjusted RR 1.5, 95% CI 1.0-2.3). Controlling for education, period and chronic morbidity did not change results. Among women no significant associations could be established; when adjusted for age, period, education and morbidity the RR for cardiovascular mortality was 1.4 (95% CI 0.6-3.4) and total mortality 1.0 (95% CI 0.6-1.6). Occasional smoking is associated with increased risk of premature death, at least among men. Although occasional smoking is a less dangerous practice than regular smoking, it is not a safe alternative for daily smoking.

Estrogen replacement therapy and MRI-demonstrated cerebral infarcts, white matter changes, and brain atrophy in older women: the Cardiovascular Health Study

OBJECTIVE

We studied the relationship between the use of estrogen replacement therapy (ERT) and cerebral magnetic resonance imaging (MRI) abnormalities among older women.

DESIGN

A population-based prospective study (Cardiovascular Health Study).

SETTING

Four regions in the United States.

PARTICIPANTS

A total of 2133 (62.9% of the eligible) women aged 65 to 95 years (mean age 74.8), on whom MRI was performed in 1992-1994.

MEASUREMENTS

Presence of global brain atrophy, white matter changes, small infarct-like lesion (ILL) (<3 mm), MRI infarcts (> or =3 mm, mostly small and asymptomatic), and cognitive function as measured by Mini-Mental State Exam (MMSE), and by ERT use (current/past/never), adjusted for a number of socioeconomic, lifestyle, and reproductive covariates.

RESULTS

Current use of ERT was reported by 15% and past use by another 23% of participants; 35% of all women had MRI infarcts. The prevalence of MRI infarcts did not differ in current or past users from those who had never used ERT (nonusers). Bifrontal distance, the largest distance between frontal horns, and the size of ventricles were larger among current ERT users compared to past users or nonusers (P (trend) = .01), adjusted for all other covariates, but no dose-response relationship to current or past ERT use was found. Duration of estrogen use was not associated with any atrophy measure. Cortical atrophy measure, sulcal widening, or white matter disease did not differ significantly by ERT use or duration of use. Central measures of atrophy, bifrontal distance, and ventricular size were significantly associated with cognition as measured by MMSE.

CONCLUSIONS

Current ERT users had much more clinically significant central atrophy than nonusers, but the implications remained unclear.

Length of use and symptoms associated with premature removal of the levonorgestrel intrauterine system: a nation-wide study of 17,360 users

OBJECTIVE

To establish the continuation rates of the levonorgestrel intrauterine system (LNG IUS) and symptoms associated with its premature removal.

SAMPLE AND SETTING

All women in Finland who had a LNG IUS inserted between April 1990 and December 1993 and whose doctor had filled in and returned a form at the insertion visit. This study population consists of 46% of all the LNG IUSs sold in Finland between 1990 and 1993.

DESIGN

A questionnaire on reproductive and contraceptive history, gynaecological problems and symptoms experienced during the use of the LNG IUS was sent to 23,885 LNG IUS users. A total of 17,914 questionnaires were returned (response rate 75%). The results cover experience from 58,600 woman years. A log-rank-test was used to test differences in continuation rates. Multivariate analyse were performed using Cox's proportional hazard model.

RESULTS

The LNG IUS was prematurely removed from 5175 women. The one, two, three, four and five year continuation rates were 93%, 87%, 81%, 75% and 65%, respectively. The symptoms during the use of the LNG IUS most strongly associated with its premature removal were excessive bleeding and spotting, and infections and pain. The risk of premature removal was markedly lower among women who had occasional or total absence of menstruation. Premature removal was less likely in the oldest age group.

CONCLUSIONS

The continuation rate of the LNG IUS compares favourably with other long-acting contraceptive systems. Totally or occasionally absent menstruation was strongly associated with prolonged continuation.

Blood pressure and menopausal transition: the Atherosclerosis Risk in Communities study (1987-95)

OBJECTIVE

Blood pressure changes during menopausal transition have not been studied previously using a biracial sample. We investigated whether menopausal transition was associated with change in blood pressure in African-American or white women.

DESIGN, SETTING AND PARTICIPANTS

The prospective multicenter study, the Atherosclerosis Risk In Communities (ARIC) Study (1987-95) was utilized. Included were never-users of hormone replacement therapy (3,800 women, 44% of the original sample).

MAIN OUTCOME MEASURE

Changes in blood pressure were adjusted for baseline age and body mass index, baseline blood pressure, antihypertensive use, ARIC field center and weight change. The menopausal transition group was compared to the non-transition group, separately, by ethnicity.

RESULTS

Women undergoing the menopausal transition did not differ significantly in regard to systolic blood pressure change [5.2, 95% confidence interval (CI) 4.0-6.4] from non-transitional women (4.6, 95% CI 4.0-5.2); adjustment for age, baseline systolic blood pressure and other factors did not alter this finding. Transitional women had significantly less diastolic blood pressure change (-0.5, 95% CI -1.1 to 0.2) than non-transitional women (-2.0, 95% CI -2.4 to -1.7, P= 0.000) but, after adjustment for other covariates, the result was not significant African-American women had significantly (P= 0.003) higher systolic blood pressure change compared to white women, but this difference became non-significant (P= 0.21) after restricting the sample to women younger than 55 years of age. Interactions between menopausal transition and ethnicity were not significant, either in systolic blood pressure or diastolic blood pressure change.

CONCLUSION

Menopausal transition is not associated with significant blood pressure change in African-American or white women.

The effect of breakfast cereal on diet and serum cholesterol: a randomized trial in North Karelia, Finland

OBJECTIVE

To test the hypothesis that a high carbohydrate breakfast with breakfast cereal leads to a meaningful reduction in dietary energy intake from fat, especially from saturated fat, and thus lower serum cholesterol levels.

DESIGN

An open randomized controlled cross-over trial. The subjects were randomized into intervention breakfast cereal or usual breakfast (control) groups.

SETTING

Free-living subjects aged 29-71 y in Eastern Finland

SUBJECTS

224 enrolled, 209 completed the study. The subjects were recruited from a survey of a random population sample and from other sources, and their serum cholesterol was not lower than 5.0 mmol/l. Recruited persons did not have any chronic disease or very low saturated fat intake.

INTERVENTION

The cereal group consumed 80 g (men) or 60 g (women) cereal at breakfast and the control group continued their usual dietary habits for six weeks. After a wash out of six weeks, a cross-over with another six week trial period took place. Measurements (including serum samples and a 3 d food record) took place before and after the two trial periods.

RESULTS

The intervention period led to 2.5 en% (energy percent units) reduction in saturated fatty acids intake. The reduction in total fat intake was 5.5 en%. This was compensated for by increased intake of carbohydrates. The reduction in saturated fatty acids intake led to modest (but in group 1 significant) 0.15 mmol/l (2.5%) reduction in total serum cholesterol level.

CONCLUSIONS

The trial showed that regular cereal breakfast can lead to reduced intake of total and saturated fatty acids of the daily diet and consequently to reduction in serum cholesterol level.

Declining socioeconomic differences in the use of menopausal and postmenopausal hormone therapy in Finland

OBJECTIVE

Sales figures for the use of menopausal and postmenopausal hormone therapy in Finland show a rapid increase during the 1980s continued into the first half of the 1990s. Hormone therapy use became very common in Finland compared to many other Western countries. The aim of our study was to investigate the sociodemographic distribution of hormone therapy among Finnish women aged 45-64 years.

METHODS

The study is based on population-based surveys conducted in 1989 and 1996 (response rates 87% and 78%).

RESULTS

Between 1989 and 1996 the current use of hormone therapy increased from 22% to 27%; in 1989 it was most common in the age group 50-54 years, but in 1996 among 55-59-year-olds. In 1989 it was significantly more common among women with longer education than other women in every age group, but in 1996 this difference was significant only in those 55 years and older. In 1989 the use was more common in the capital area than elsewhere and this difference decreased but remained significant in 1996.

CONCLUSION

Our results suggest that hormone therapy has become a routine treatment during the menopause in all educational groups and throughout the country. The lack of socioeconomic differences indicates that among women under 55 year of age the saturation point in short-term hormone use was reached in 1996. However, the persistence of socioeconomic differences among older women suggests that the use of long-term postmenopausal hormone therapy will continue to increase for some time.

Unemployment, sociodemographic background and consumption of alcohol before and during the economic recession of the 1990s in Finland

BACKGROUND

Some studies suggest that people's alcohol consumption increases during unemployment whereas others suggest the opposite. All studies, however, deal with situations marked by relatively low national unemployment rates. We studied alcohol use among individuals in relation to unemployment, education, marital status and sex during times of both low and high unemployment in Finland.

METHODS

A group of 44391 respondents, aged 18-64 years, from nationally representative, consecutive annual samples of 5000 people from 1982 to 1995 was utilized. Overall response rate for men was 77% and for women 80%.

RESULTS

Univariate analyses indicated that unemployment was associated with the amount of reported alcohol use. However, when logistic regression was used to analyse interactions between alcohol consumption, unemployment, education and marital status, the picture changed. During a low unemployment period (e.g. 1982-1990), being unemployed was not associated with the upper consumption level of alcohol use (defined as > or = 8 drinks/week for men, > or = 5 for women); nor was it during a high unemployment period (1991-1995), except among single people. During a high unemployment period poorly educated, single, unemployed men (odds ratio [OR] = 1.6, 95% confidence interval [CI] : 1.1-2.4), showed a significantly higher risk of upper level of alcohol consumption than otherwise similar but employed men (OR = 0.8, 95% CI: 0.6-1.0). The reference group consisted of highly educated, married, employed men who did not exceed the upper drinking limit. Similarly, the risk of upper consumption level drinking was significantly higher among highly educated, unemployed single women (OR = 2.4, 95% CI: 1.388-4.3) than among otherwise similar but employed women (OR = 1.1, 95% CI: 1.0-1.386).

CONCLUSION

Thus, unemployment was weakly but significantly related to the upper consumption level of alcohol use among single people during the recession but not in the preceding period of economic growth.

Impact of unhealthy behaviors on cardiovascular mortality in Finland, 1978-1993

BACKGROUND

Our aim was to study how combinations of three unhealthy behaviors (smoking, physical inactivity, and use of dairy fat) and an index describing their number were associated with the risk of cardiovascular mortality in a society showing remarkable improvement in health behaviors.

METHODS

The material consisted of random samples of annual adult health behavior surveys from 1978 to 1991; included were 8,869 men and 10,105 women ages 45 to 64 years. The mortality follow-up covered Years 1978 to 1993. The study period was divided into four phases on the basis of number of deaths and timing of health behavior changes. Poisson multivariate models were used to determine the risk of cardiovascular mortality by all combinations of unhealthy behaviors and the index. In the models age, education, chronic morbidity, and body mass index were adjusted for.

RESULTS

Each unhealthy behavior was found to be a risk factor for cardiovascular mortality when the whole study period was examined. Among men, daily smoking was a significant predictor of cardiovascular mortality in the first three phases, among women in the first and third phase. Among men physical inactivity became significant only in the last phase, among women in all except the last phase. The combinations of physical inactivity with use of dairy fat or with smoking were more significant for women than for men. The combination of smoking and use of dairy fat was significant only for men. The association of the index with cardiovascular mortality was slightly stronger among women than among men.

CONCLUSIONS

The predictive values of unhealthy behaviors on cardiovascular mortality changed by period depending on their frequency. The combinations of unhealthy behaviors are to be preferred over the index in description of lifestyle determinants of cardiovascular mortality.

Hormone replacement therapy and body size: how much does lifestyle explain?

OBJECTIVE

Our purpose was to assess the association of hormone replacement therapy with body size.

STUDY DESIGN

A total of 1658 randomly selected women aged 45 to 64 years in four regions (two provinces in eastern Finland, one southwestern province, and the capital area) were studied in a 1992 population survey. Linear regression analysis was used to assess the use of hormone replacement therapy as a determinant of body size, measured with the body mass index, the waist/hip ratio, and the body fat percentage and adjusted by sociodemographic (area and education) and lifestyle (diet, smoking, physical activity, and alcohol use) factors. The regression coefficients of hormone replacement therapy use obtained from the model when including sociodemographic and lifestyle variables (beta 1a[Hormone replacement therapy use] = -0.98) were compared with the coefficients obtained when these variables were excluded (beta 1b[Hormone replacement therapy use] = -1.36). The percentage of change (beta 1b-beta 1a/beta 1b%) in the regression coefficients denoted the variability explained by sociodemographic and lifestyle characteristics.

RESULTS

Hormone replacement therapy users (28%, n = 463) had higher education, were more often from the capital area, had a significantly higher healthy diet factor score, and were leaner than nonusers. Use of hormone replacement therapy remained a significant determinant of body mass index, waist/hip ratio, and body fat percentage after adjusting for sociodemographic and lifestyle factors. Of the difference in body mass index between hormone replacement therapy users and non-users, 28% were explained by lifestyle and sociodemographic risk factors, respectively, 31% of the difference by use of the waist/hip ratio and 42% by use of the body fat percentage.

CONCLUSIONS

The difference in body size between hormone replacement users and nonusers may not be the result of self-selection. The use of hormone replacement therapy was inversely associated with body size in menopause.

Hysterectomy and subsequent risk of cancer

BACKGROUND

The objective of this retrospective cohort study was to assess the effect of hysterectomy on subsequent risk of cancer among 25,382 hysterectomized and a similar number of non-hysterectomized control women, registered in 1963-1976 in the Mass Screening Registry (MSR).

METHODS

Cancer cases were obtained from the Finnish Cancer Registry (FCR) and standardized incidence ratio (SIR); the expected number of cases based on cancer incidence rates of the Finnish female population in 1967-1993, was used. Relative risk (RR) was calculated as SIR among the hysterectomized relative to non-hysterectomized women, adjusted for follow-up, education and parity.

RESULTS

The RR estimates of non-genital cancers among women with any hysterectomy were approximately 5% higher than in the non-hysterectomized cohort. Relative risks of rectal cancer (RR = 1.4, 95% confidence interval [CI]: 1.0-1.8) and thyroid cancer (RR = 2.1, 95% CI; 1.5-3.1) were significant and largest among women who had undergone total hysterectomy pre- or perimenopausally. Relative risk estimates of breast cancer were close to unity.

CONCLUSIONS

Hysterectomy is not associated with any substantial protective or promoting effect on cancers in general. Elevated risk of papillary thyroid cancer following hysterectomy is biologically plausible, as there are reproductive and endocrinological causes of thyroid cancer.

Socioeconomic variations in hysterectomy: evidence from a linkage study of the Finnish hospital discharge register and population census

STUDY OBJECTIVE

To explore variations in rates for hysterectomy in relation to social class, education, and family income.

DESIGN

Retrospective analysis of the 1988 Finnish hospital discharge register linked individually to the 1987 population census.

SETTING

Finland.

PARTICIPANTS

All women living in Finland aged 35 and over were the denominator population. The numerators were the 8663 women who underwent hysterectomy in 1988.

MAIN RESULTS

The overall rate for hysterectomy was 63.5/10,000 women aged 35 and over. There was a marked positive correlation between disposable family income and hysterectomy rates even after age, hospital catchment area, education, and occupational status were adjusted for. However, no linear trend for overall hysterectomy rates was observed in relation to social class or education. Procedures due to myomas, accounting for 48% of all hysterectomies, were more frequent among women of high socioeconomic status according to all socioeconomic indicators. Larger proportions of hysterectomies for myoma were also performed in patients in private hospitals and in pay beds in public hospitals than in women in worse off groups.

CONCLUSIONS

Unlike the findings in earlier studies from other countries, there was a positive correlation between income and hysterectomy rates as a result of the high numbers of hysterectomies performed to treat myoma in the well off women. The findings are discussed in terms of socioeconomic differences in the use of private gynaecological services, and factors, such as parity and use of hormonal replacement therapy, that affect the growth of myomas.

Cardiovascular morbidity in relation to ovarian function after hysterectomy

OBJECTIVE

To determine if removal of the uterus with ovarian preservation is associated with cardiovascular morbidity and risk factors.

METHODS

Self-reported histories of gynecologic surgery of 3895 women from 40 regions in Finland, 30-95 years old, were collected in 1977-1980, and 78% of hysterectomies were confirmed from the hospital records. Cardiovascular risk factors (total- and high-density lipoprotein cholesterol, education, body mass index [BMI], blood glucose, and triglycerides), parity, and current use of hormone replacement therapy were used to adjust the risk of hypertension (less than 60 years old and diastolic blood pressure [BP] at least 95 mmHg, or 60 years older and diastolic BP at least 100 mmHg), coronary heart disease, and heart failure. The women with unconfirmed hysterectomies and missing information on cardiovascular risk factors were excluded. Thereafter, the final number of subjects included in the analysis was 3780.

RESULTS

One or no ovary was removed in 163 hysterectomies, and in 55 cases, both ovaries were removed. Women with hysterectomy and preservation of at least one ovary had significantly higher diastolic BP and higher BMI than those who had not undergone hysterectomy. Women with hysterectomy and ovarian preservation also had a significantly increased risk of hypertension (odds ratio 2.2, 95% confidence interval 1.5-3.1). The risks of other heart diseases (angina pectoris, myocardial infarction, and heart failure) were not significantly increased.

CONCLUSION

Hysterectomy with ovarian preservation is associated with increased risk of high diastolic BP, diagnosis of hypertension, and increased BMI, but not with other heart diseases. Either hysterectomy increases the risk of hypertension or the increase of BP and the development of myomas, which often lead to hysterectomy, are explained by a common pathogenetic mechanism.

Five gynecologic diagnoses associated with hysterectomy--trends in incidence of hospitalizations in Finland, 1971-1986

Trends in hospitalizations for selected gynecologic diagnoses per 100,000 women/year associated with hysterectomy were analyzed using the Finnish hospital discharge register data, including each inpatient episode in all Finnish hospitals, from 1971 to 1986. The diagnoses selected were uterine leiomyoma, genital prolapse, the group 'other disorders of the uterus' including endometriosis, and bleeding disorders. These were the most common indications for hysterectomy in Finland from 1987 to 1989, when national data on surgical procedures were included in the hospital discharge register. Trends in the incidence of hospitalizations for malignant neoplasms were also analyzed, although < 10% of hysterectomies are due to gynecological malignancies. Hospitalizations for leiomyoma, endometriosis and bleeding disorders have statistically increased, significantly, among women aged 45 years or more between 1971 and 1986, whereas hospitalizations for prolapse and malignant neoplasms did not show a significant change. Probable incidence of hysterectomy before 1986 was estimated on the basis of the annual incidence of hospitalization for leiomyoma, and hysterectomy for leiomyomas was estimated from the hospital discharge register data of 1988. According to hospital discharge data in 1988, 90% of the hospitalized women with leiomyoma underwent hysterectomy and half of the hysterectomies were performed for leiomyoma. The estimated incidence of hysterectomy increased from 311/100,000 women to approximately 400/100,000 from 1971 to 1986 (slope = 6.5 hysterectomies/100,000/year; 95% C.I. for slope (4.8:8.2)). As the epidemiology of most of the underlying disorders for indications leading to hysterectomy is poorly known, epidemiological studies should consider the determinants of the occurrence of indications independently whether hysterectomy has been performed or not.

Cardiovascular risks and socioeconomic status: differences between men and women in Finland

STUDY OBJECTIVE

The study aimed to assess the association of different indicators of socioeconomic status with levels of cardiovascular disease risk factors in men and women aged 25-64 years.

DESIGN

This was a cross sectional survey, using a community based random sample.

SETTING

The provinces of North Karelia and Kuopio in eastern Finland and the cities of Turku and Loimaa and surrounding communities in southwestern Finland in 1987.

PARTICIPANTS

Altogether 2164 men and 2182 women aged 25-64 years took part.

MEASUREMENTS AND MAIN RESULTS

Data were collected using self administered questionnaires and the measurement of height, body weight, and blood pressure and blood sampling for lipid determinations were done at the survey site. The risk of cardiovascular disease was determined by calculating a simple risk factor score based on the observed values of HDL and total cholesterol, leisure time, physical activity, blood pressure, medication for hypertension, body mass index, and smoking. Indicators of socioeconomic position used were years of education, family income, marital status, and the person's occupation. Lower levels of education, occupation, and income were all significantly associated with an unfavorable risk factor profile in men and women. Education and occupation showed the strongest associations with the risk factor score in both men and women. The results changed little when adjusting for income and marital status. Family income was more strongly associated with the risk factor score in women than men. When adjusting for occupation and education, income was no longer significantly associated with the risk factor score in men. Marital status was not significantly associated with the risk factor score in either sex.

CONCLUSIONS

Using the strength of the association with the cardiovascular risk factor score as the criterion for a good socioeconomic indicator, the present study suggests that education and occupation may be equally good indicators in both men and women. Family income may have some additional importance, especially in women.

Incidence, causes and surgical methods for hysterectomy in Finland, 1987-1989

BACKGROUND

The objective of our study was to investigate the incidence of hysterectomy by age, indication and surgical method employed during 1987-1989 in Finland, corrected by 'uteri or cervix at risk' population.

METHODS

Three years (1987-1989) of patient discharges from the Finnish Hospital Discharge Register, which covers all Finnish hospitals including the few private ones, was used. Patients represented all Finnish adult women (approximately 2,000,000).

RESULTS

Approximately 9000 hysterectomies are performed annually in Finland. The annual incidence of hysterectomy was 348/100,000 women (most among women aged 45-49), and after correction for 'uteri or cervix at risk' this rose by 11% to 390/100,000. The most frequent indications were leiomyoma (50%) and endometriosis (11%). Prolapse, menstrual disorders and cancer each accounted for 7-8% of all hysterectomies. The most common surgical approach was total abdominal hysterectomy (36%), while hysterectomy with bilateral oophorectomy and partial hysterectomy each accounted for 20% of operations. Differences in the rates by indication or surgical approach between 'uteri or cervix at risk' corrected and uncorrected estimates varied between 0% and 22%.

CONCLUSIONS

The incidence of, and indications for hysterectomy in Finland are approximately the same as in other European countries, but partial hysterectomy is more common in Finland. Because the correction for the 'uteri or cervix at risk' population produced changes in the rates of hysterectomy, correction should be considered when calculating hysterectomy rates or incidences of cervical or endometrial cancer.

Age at natural menopause and sociodemographic status in Finland

Differences in age at natural menopause by occupation, education, and place of residence were examined using a cross-sectional population sample of Finnish women aged 45-64 years (n = 1,713, response rate 86%). The sample was selected at random from the Finnish Population Register in 1989 (final n = 1,505, 75%). Kaplan-Meier estimates showed the median age at natural menopause to be 51 years for all women (95% confidence interval (CI) 50.6-51.4). The median menopausal age of smokers and nulliparous women was 50 years; that of nonsmokers and women whose first full-term pregnancy occurred before the age of 25 years was 52 years. Differences between occupational and educational groups were statistically significant (Mantel-Cox test for occupation, p < 0.02; for education, p < 0.03). In the Cox proportional hazards model, the odds ratio of the occurrence of natural menopause among upper white-collar women was 0.74 (95% CI 0.57-0.96) and among the most educated women (education > 11 years) it was 0.75 (95% CI 0.59-0.96), adjusted to reflect smoking, use of hormones, body mass index, and age at first full-term pregnancy. Sociodemographic variables appear to be associated with age at natural menopause in a representative sample of Finnish women.

Hysterectomy among Finnish women: prevalence and women's own opinions

This article describes the prevalence of hysterectomy, women's own opinions of it, and socioeconomic characteristics of hysterectomized women compared to non-hysterectomized ones. The questionnaire was sent in spring 1989 to 2000 45 to 64-year-old Finnish women picked randomly from the Population Census. After two reminders, 1713 (86%) had responded. One fifth of the women had had a hysterectomy and 5% had also had both ovaries removed. Among the highest educated there were less hysterectomized women than among the less educated. The largest differences in the prevalence of hysterectomy were between counties, not between socioeconomic groups. Fourty-one percent of the hysterectomized women had themselves wished hysterectomy, 25% did not have any specific opinion about the operation. Results raise further questions about clinical decision making and regional variation of hysterectomy.