Biomedical subjects

L Dennerstein

Publications and source records attributed to L Dennerstein.

At least 55 records · Page 3Linked to original sources

PubMed1999

Factors affecting sexual functioning of women in the mid-life years.

OBJECTIVE: To model the interaction of hormones, symptoms and psychosocial factors on women's sexuality during the menopausal transition. DESIGN AND METHODS: A prospective, observational study was carried out of a community-based sample of 438 Australian-born women aged 45-55 years at baseline. The study comprised six annual assessments in the women's own homes utilizing a core questionnaire, with rating scales for well-being and daily hassles, and a Personal Experiences Questionnaire as a measure of sexual functioning. Levels of follicle stimulating hormone (FSH), estradiol and inhibin were measured annually. Statistical analysis was performed by structural equation modelling. RESULTS: The retention rate was 90% (final sample size after exclusions, n = 354). The normal fit index for the global model obtained was 0.92. There is a significant direct effect of menopausal status on vaginal dryness/dyspareunia, and an indirect effect on sexual responsivity via a direct effect of menopausal status on symptoms, which then affect well-being. Menopausal status reflects hormonal status. Feelings for the partner and the partner's sexual problems have direct effects on different aspects of sexual functioning. Other social variables such as paid work, interpersonal stress, daily hassles and educational level affect sexual functioning indirectly via effects on symptoms and well-being. CONCLUSIONS: Psychosocial factors, symptoms and the menopausal transition affect women's sexual functioning during the mid-life years.

Aging↗

PubMed1998

A prospective study of bone loss in menopausal Australian-born women.

Two hundred and twenty-four women (74 pre-, 90 peri-, 60 post-menopausal), aged 46-59 years, from a population-based cohort participated in a longitudinal study of bone mineral density (BMD). BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femoral neck and the time between bone scans was on average 25 (range 14-41) months. The aim of the study was to assess changes in BMD in relation to changes in normal menopausal status. During the study period women who were between 3 and 12 months past their last menstrual period (n = 22, late perimenopausal) at the time of the second bone scan had a mean (SE) annual change in BMD of -0.9% (0.4%) at the lumbar spine and -0.7% (0.6%) at the femoral neck (both p < 0.05 compared with women who remained premenopausal). In the women who became postmenopausal (n = 42) the mean annual changes in BMD were -2.5% (0.2%) at the lumbar spine and -1.7% (0.2%) at the femoral neck (both p < 0.0005), and in the women who remained post-menopausal (n = 60) they were -0.7% (0.2%) per year and -0.5% (0.3%) per year respectively (both p < 0.05), compared with women who remained premenopausal. In the 1-3 years after the final menstrual period (FMP) there was greater bone loss from the lumbar spine than the femoral neck (p < 0.05). In women who were menstruating at the time of the second bone scan and whose FMP could be dated prospectively (n = 35), higher baseline oestradiol levels were associated with less lumbar spine bone loss (p < 0.005). In the women who remained postmenopausal there was an association between baseline body mass index (BMI) and percentage change per year in femoral neck BMD (p < 0.05), such that women with higher BMI had less bone loss. In conclusion, during the time of transition from peri- to post-menopause, women had accelerated BMD loss at both the hip and spine.

Absorptiometry, Photon↗

PubMed1998

Relationship of endogenous sex hormones to lipids and blood pressure in mid-aged women.

PURPOSE: The relationship between endogenous sex hormones and blood lipids was examined in a representative sample of 438 Australian-born women 45 to 56 years of age taking part in a longitudinal study of the menopausal transition. Data from 363 women who were taking neither exogenous hormones nor lipid-altering medications, were not diabetic, and who had provided blood samples were available for analysis. METHODS: Multiple linear regression was used to examine the relationship between sex hormones and high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), triglycerides, and diastolic blood pressure (DBP), taking account of the effects of age, body mass index (BMI), smoking, alcohol intake, and exercise. RESULTS: There was no significant relationship between estradiol and HDL, LDL, triglyceride, or DBP levels. Free androgen index was positively associated with LDL. However, BMI was an important predictor of all three lipid measures and DBP. HDL was positively associated with age and was highest among women with lowest BMI, high alcohol intake, and in nonsmokers. LDL increased with BMI, free androgen index, and age, but was lower amongst women who exercised more than two or three times per week. Triglyceride also increased with BMI, and was higher among smokers. DBP increased with BMI only. CONCLUSIONS: The results do not support the view that endogenous sex hormones are strongly associated with cardiovascular risk factors around the time of menopause.

Androgens↗

PubMed1998

Serum inhibins A and B fall differentially as FSH rises in perimenopausal women.

BACKGROUND: Serum FSH levels rise with increasing age in normal women, particularly as they enter the menopausal transition and progress to the postmenopausal state. The contributions of decreasing levels of inhibin-A (INH-A) and inhibin-B (INH-B) to this rise are presently unclear, as there are no reports of dimeric INH levels in relation to menopausal status. The present study was undertaken in order to provide preliminary data on relationships amongst the dimeric inhibins, oestradiol (E2) and FSH in normal subjects of defined menopausal status. METHODS: Single serum samples were obtained between cycle days 3 and 8 in regularly cycling women, or at random in those with irregular cycles or amenorrhoea, in 110 women, aged 48-59 years, in the third year of a prospective longitudinal study of the menopausal transition, 'The Melbourne Women's Mid-Life Health Project'. Samples were assayed for FSH, E2, INH-A, INH-B and immunoreactive inhibin (IR-INH) and results were analysed following logarithmic transformation. Undetectable values were assigned the limit of sensitivity of the respective assays. The relationships between hormones were evaluated as a function of menopausal stage. The latter was assigned as Stage 1, premenopausal (no reported change in menstrual cycle pattern), Stage 2, early peri-menopausal (reported change in menstrual cycle frequency in the preceding year with a bleed in the preceding 3 months), Stage 3, late peri-menopausal (no menses in the preceding 3-11 months) and Stage 4, postmenopausal (no menses in the preceding 12 months). RESULTS: The hormone concentrations in premenopausal subjects (geometric means, FSH 13.5 IU/l, E2 306 pmol/l, IR-INH 217 U/l, INH-A 96 ng/l, and INH-B 48 ng/l) were used as reference points for the other stages of menopausal status. Early peri-menopausal subjects had significantly lower levels of IR-INH (147 U/l) and INH-B (13.5 ng/l) in the presence of a small, statistically nonsignificant rise in FSH (to 21.4 U/l) and no significant change in E2 or INH-A. In late peri-menopausal subjects, IR-INH fell to 76 U/l, INH-A fell to 4.2 ng/l, whilst INH-B was not significantly different at 14 ng/l. FSH had risen significantly to 72.21 U/l. Oestradiol also fell significantly to 89 pmol/l. In the postmenopausal subjects there were no further significant changes in the peptide hormones or FSH, but E2 fell further to 41 pmol/l. There was a significant (P < 0.05) inverse correlation between FSH and E2 (R = -0.78), FSH and IR-INH (R = -0.66), FSH and INH-A (R = -0.53), FSH and INH-B (R = -0.29) while IR-INH and either INH-A or INH-B were positively correlated (R = +0.57 and +0.35, respectively). The data are consistent with negative feedback roles for both dimeric inhibins and E2 as contributors to the regulation of FSH secretion as menopausal status changes. CONCLUSIONS: The major significant endocrine event in women in the early peri-menopausal phase of the menopausal transition is a substantial fall in the circulating levels of inhibin-B with no significant change in inhibin-A or oestradiol. Progression to late peri-menopausal status is accompanied by a marked fall in inhibin-A and oestradiol and a rise in FSH without further change in inhibin-B. Inhibin-B, a marker of follicle number, is a significant factor in the endocrinology of the menopausal transition.

Cross-Sectional Studies↗

PubMed1998

Menopausal status: subjectively and objectively defined.

This study aims to assess the relationship between self-rated and menstrually defined menopausal status, assesses criteria women use in perceiving their own menopausal status and compares symptom reporting and hormonal levels for self-rated and menstrually defined menopausal status. Women in the third year of the longitudinal phase of the Melbourne Women's Midlife Health Project (n = 332) were asked to assess their own menopausal status and the basis for this assessment. They were also specifically questioned on current menstrual cycle characteristics and levels of follicle-stimulating hormone (FSH), estradiol and inhibin were measured. For 67% of the women, the two definitions of menopausal status were in agreement. In women menstrually defined as premenopausal, self-rated menopausal status of peri- or postmenopausal appeared to be based on the occurrence of symptoms. In women menstrually defined as postmenopausal, persistence of hot flushes was taken to mean that 'the menopause was still in progress' despite absence of menses for more than 12 months. In women menstrually defined as perimenopausal yet who self-rated as premenopausal, FSH was lower (p < 0.01) and inhibin higher (p = 0.05) than women who self-rated as peri- or postmenopausal. Women's perceptions of the menopause are based on symptoms. Self-rated menopausal status appears to relate more closely to a women's endocrine status than definitions based on purely menstrual cycle characteristics.

Attitude to Health↗

PubMed1998

Relationships between premenstrual complaints and perimenopausal experiences.

This study evaluates whether a history of menstrually-related problems, termed premenstrual complaints (PMCs), is a significant predictive marker for a more symptomatic perimenopausal experience. Two hundred and ninety-one randomly selected urban women, aged between 45 and 55 years were interviewed yearly for three consecutive years to record their individual experiences and changes as they progressed through the menopause transition. Repeated measures were obtained on a range of physical, psychological and social indicators. The experiences of women who reported a self-defined history of premenstrual complaints (n = 104) were compared with those women with no prior premenstrual problems (n = 187) and predictors of perimenopausal symptoms were assessed. Relationships were found between a prior history of both physical and psychological premenstrual complaints and a more symptomatic perimenopause characterised by dysphoria, skeletal, digestive and respiratory symptoms (all ps < 0.05). The more symptomatic women also reported pronounced interpersonal stress (p < 0.001), significant 'hassles', current smoking and low exercise (ps < 0.05). The findings support predictive relationships between a prior history of premenstrual problems and a more problematic menopause transition. The issues of vulnerability and help-seeking behaviors are discussed.

Cross-Sectional Studies↗

PubMed1998

Using longitudinal data to define the perimenopause by menstrual cycle characteristics.

OBJECTIVES: To determine which aspects of menstrual change best predict time to postmenopause. METHODS: A total of 250 Australian-born women aged 45-55 years were divided into five menstrual status categories: Group I reported no change in menstrual flow or frequency; Group II reported change in flow; Group III reported change in frequency; Group IV reported change in both frequency and flow; and Group V reported between 3 and 11 months of amenorrhea. Menstrual status groups were compared on baseline data for age, hormone levels, hot flushes and self-rated menopausal status. The proportion of women moving to postmenopause in subsequent years was compared using 4 years of follow-up data. RESULTS: Women in Group V were older, had lower estradiol and inhibin levels, higher follicle stimulating hormone levels, and were more likely to report hot flushes, and to self-rate themselves as having started the menopausal transition, compared with the women who had menstruated in the last 3 months (Groups I-IV). Groups I and II were similar in age and hormonal status, as were Groups III and IV. The proportion of women who had moved to postmenopausal status in the 4 years after baseline were 12%, 14%, 58%, 53% and 94% for Groups I-V, respectively. CONCLUSIONS: Amenorrhea is the best predictor of future menopause followed by changes in menstrual frequency. Change in flow only was not predictive of future menopause. A two-stage classification scheme is suggested for defining the perimenopause. 'Early perimenopause' is defined as the self-reporting of changes in menstrual frequency over the last year, and 'late perimenopause' is defined as the self-report of 3-11 months of amenorrhea.

Amenorrhea↗

PubMed1997

Menopausal experiences of Thai women. Part 1: Symptoms and their correlates.

This study was a cross-sectional survey of mid-aged Thai women with the following aims: to describe their experience of symptoms and attitudes to menopause and to examine the relationships between symptoms, attitudes to menopause, sociodemographic variables and menopausal status. The sample was 268 women aged between 40 and 59 y who had accompanied patients to the outpatients department of the Royal Irrigation Hospital. Mean age at menopause was 50.13 (SD 4.67) y. Fifty-one percent were premenopausal. 9% perimenopausal and 40% postmenopausal. The symptoms which showed strongest associations (P < 0.001) with menopausal status were: joint aches/pain, hot flushes, depression and insomnia. Women most likely to experience symptoms were: older than 50 years of age, had more children, peri- or post-menopausal, of little education, housewives or landowners and reported their health was not so good and required treatment.

Adult↗

PubMed1997

Menopausal experiences of Thai women. Part 2: The cultural context.

This paper describes the cultural context of middle-aged Thai women who took part in a survey of symptoms and attitudes to menopause. The women lived in Nonthaburi province, adjacent to Bangkok, which has undergone a transition from rural to urban. Household structure often includes three generations. There have been changing opportunities for women in areas of education, occupation and family size and women's power increases with age. Thai women perceive menstruation as an indicator of health and take special care during menstruation. There is a special idiom in Thai 'leod cha pai-lom cha ma' (the blood will go--the wind will come) used to describe changes in a woman's behaviour, emotions and well-being during the menopause. These changes are expected to happen occasionally, not in every woman. Some women looked forward to menopause, while others were found to be ambivalent towards it.

Adult↗

PubMed1997

Sexuality, hormones and the menopausal transition.

OBJECTIVES: To assess the validity and reliability of a sexuality questionnaire, and to assess the relationship of sexual functioning to age, menopausal status and hormone levels. METHODS: Cross-sectional analysis of a population-based cohort of 201 women aged 48-58 years in the fourth year of a longitudinal study. Sexual functioning was measured by self-completed questionnaire. E2, FSH. Inhibin, total T and SHBG were sampled on cycle days 4-8 or after 3 months of amenorrhoea. RESULTS: Internal consistency, as measured by Cronbach's alpha, was 0.71. Six factors were found on principal components factor analysis: (1) Feelings for Partner, (2) Sexual Responsivity, (3) Sexual Frequency, (4) Libido, (5) Partner Problems and (6) Vaginal Dryness/Dyspareunia. Sexual Responsivity decreased with age (beta = -0.060, P = 0.05), and Vaginal Dryness/Dyspareunia decreased with log E2 (beta = -0.181. P < 0.001). Testosterone was not associated with the aspects of female sexual functioning measured in this study. CONCLUSIONS: This longitudinal study found that most aspects of female sexual functioning were not affected by age, menopausal functioning or hormone levels.

Age Factors↗

PubMed1997

Determinants of self rated menopause status.

This study, based on a population survey, examines the self ratings of progress through the menopausal transition of women in natural menopause, women using hormone therapy and women who have undergone hysterectomy. The latter two groups are usually excluded from discussions of menopausal transition, since the accepted menstrually defined criteria do not apply to them. Hysterectomised women do not differ in their self rating profile from non-hysterectomised women, after hormone therapy status is taken into account. This is surprising, since they may have been expected to see themselves as in the main postmenopausal. Use of hormone therapy is tantamount to self perception as at least perimenopausal. Among women in natural menopause there is 29% disagreement between self ratings and menstrually defined categories. On the basis of these observations it is hypothesised that experience of symptoms associated with menopause is important in determining self ratings. The good fit of logistic regression predictions of self ratings from hysterectomy status, hormone therapy status and experience of hot flushes is consistent with this hypothesis. This research indicates that it is important to take women's subjective evaluations into account in assessing progress through the menopausal transition.

Attitude to Health↗

PubMed1997

Changes in physical activity and health outcomes in a population-based cohort of mid-life Australian-born women.

Cross-sectional studies and intervention programs have suggested that physical activity is a potential contributor to the health and wellbeing of mid-life and older women. This prospective longitudinal study investigates whether natural changes in physical activity are associated with changes in health outcomes in a population-based cohort of Australian-born women aged 45-55 years living in Melbourne. Of the 352 women from the Melbourne Women's Midlife Health Project who filled in a base-line physical activity questionnaire, 292 (83 per cent) were evaluated around three years later with regard to physical activity, psychological wellbeing, self-rated health, symptoms experienced, body mass index (BMI), blood pressure and serum lipids. Mean (SD) physical activity measured at base-line was 5.9 (5.7) hours/week, or 1496 (1449) kcal/week; mean (SD) change in physical activity per week was 0.05 (5.24) hours, or 44 (1347) kcal, indicating that although mean change was small there was substantial variation in change. There were significant increases in BMI (P < 0.001), wellbeing (P < 0.05), the number of reported menopause-related symptoms, and high-density lipoprotein cholesterol (HDL-C) levels (P < 0.001), and a decrease in low-density lipoprotein cholesterol (LDL-C) levels (P < 0.05). Change in level of physical activity was positively associated with change in HDL-C (P < 0.01) and change in wellbeing (P = 0.08) and negatively associated with change in coronary heart disease risk score. By increasing physical activity in mid-life, women may reduce at least one risk factor (HDL-C) associated with coronary heart disease.

Australia↗

PubMed1997

Well-being and the menopausal transition.

This paper examines the relationship between well-being, age, menopausal status, hormone levels and hot flashes. Data from the first 4 years of longitudinal observation from the Melbourne Women's Midlife Health project was utilized. This study involved a population-based sample of 405 women interviewed annually. Blood was taken during the follicular phase (if still menstruating) for estradiol, sex hormone binding globulin, follicle stimulating hormone and testosterone. A validated well-being scale was used. Positive affect increased with age while negative affect decreased with age but only in the postmenopausal category. Positive affect was significantly lower in the 2 years postmenopausal group but this effect of menopausal status did not remain when hot flashes were included in the analysis. Negative affect was highest in the 1-2 years postmenopausal group. Although hot flashes adversely affected negative moods, a significant effect of menopausal status remained. No direct association between any of the hormone levels and positive or negative affect scores was evident. In conclusion, this study found that well-being was decreased in the first 2 years after the first menstrual period but began to improve spontaneously after this time.

Adaptation, Psychological↗

PubMed1997

Effects of age and non-hormonal contraception on menstrual cycle characteristics.

The objective of this study was to investigate the effects of age and non-hormonal contraceptive method on menstrual cycle parameters. The menstrual cycle data were collected prospectively, and the study was cross-sectional with regard to age. The subjects were 142 women, including 14 asymptomatic volunteers and 128 women who presented to a premenstrual tension (PMT) clinic. The age range was 20-45 years. Contraceptive methods used were intrauterine device (IUD) (n = 12), tubal ligation (n = 61) and non-intensive methods (n = 69). Daily menstrual cycle diaries were used to calculate cycle length and number of days of menstruation. Daily 24-h urine collections were used to calculate the day of the preovulatory estrogen peak. Pearson correlations found significant relationships between age and preovulatory estrogen peak day (p < 0.001) and length of cycle (p < 0.002), but not between age and length of menstruation or luteal phase. Analysis of variance was highly significant for age and contraceptive method, for both cycle length and preovulatory estrogen peak day. Non-intrusive contraception users aged 30 years and younger had significantly longer follicular phases than did women with tubal ligation (p < 0.05). It was concluded that cycle length decreases with age due to shortening of the follicular phase. Further research on whether tubal ligation affects ovulation and follicular phase length in young women is needed.

Adult↗

PubMed1996

Physical, sexual and emotional violence against women: a general practice-based prevalence study.

OBJECTIVE: To determine the prevalence of domestic violence, childhood abuse and sexual assault experienced by women attending general practitioners. DESIGN: A cross-sectional, questionnaire-based prevalence survey. SETTING: 15 general practices in metropolitan Melbourne between November 1993 and February 1994. SUBJECTS: 3026 women over the age of 18 attending for a consultation. RESULTS: The response rate was 72%. Over a quarter of women in relationships had been victims of physical or emotional partner abuse in the previous year, one in 10 having experienced severe physical violence. Thirteen percent of women had experienced rape or attempted rape, 10% had been severely beaten during childhood and 28% had experienced childhood sexual abuse involving physical contact. The abuse had been disclosed to the woman's doctor by only 27% of those who had experienced partner or childhood physical abuse (mostly because the doctor had never asked) and 9% of those who had experienced sexual abuse (mostly because the woman did not see it as relevant to the consultation). CONCLUSION: There is a high prevalence of physical, sexual and emotional violence against women as well as poor communication about this violence to their general practitioners. RECOMMENDATION: Medical practitioners should be more proactive in questioning women about violence.

Adult↗

PubMed1996

Hot flushes, menstrual status, and hormone levels in a population-based sample of midlife women.

OBJECTIVE: To determine the frequency of hot flushes in a population sample of 453 pre-, peri-, and postmenopausal women (aged 48-59 years), and to investigate the relationship of hot-flush reporting with menstrual status, serum levels of estradiol (E2), inhibin, and FSH, history of premenstrual complaints, and physical and life-style factors. METHODS: We used a population-based sample. Interviews were conducted in the women's homes. RESULTS: Frequency of hot-flush reporting was associated with menstrual status (P < .001). Twenty-nine percent of women who had more than 3 and less than 12 months of amenorrhea, and 37% of postmenopausal women experienced hot flushes several times a day. In total, 13% of premenopausal women, 37% of perimenopausal women, 62% of postmenopausal women, and 15% of women on hormone therapy reported having had at least one hot flush in the previous 2 weeks. Follicle-stimulating hormone levels were higher in women who experienced hot flushes at least once a day or more (P < .001); E2 levels were higher in women experiencing one or no hot flushes per week (P < .001). The women in the perimenopausal group who experienced hot flushes had higher FSH levels (P = .008) and were more likely to have reported premenstrual complaints at the first interview 3 years earlier (P = .03). In the postmenopausal group, there was no significant difference with any of the variables studied between the women who were experiencing hot flushes and those who were not. CONCLUSION: Reporting of hot flushes is greatest 3 months or more after the final menstrual period. The frequency of hot flushes is associated with increasing FSH, decreasing E2, and a history of premenstrual complaints.

Body Mass Index↗

PubMed1996

Well-being, symptoms and the menopausal transition.

OBJECTIVES: This paper reviews the knowledge accumulated from published population studies of health and ill-health experiences during the menopausal transition. RESULTS: Well-being: mid-aged women are more likely to report positive moods than negative moods. Well-being is not associated with menopausal status but is associated with current health status, psychosocial and lifestyle variables. SYMPTOMS: SYMPTOMS vary greatly across cultures, with North American and European samples reporting higher rates of symptoms than Asian women. The most symptomatic women in the North American samples and Australian studies are those whose menstrual cycles have changed. Vasomotor symptoms increase through the menopausal transition. Other variables such as socio-demographic, health status, stress, premenstrual complaints, attitudes to ageing and menopause, and health behaviors are associated with the occurrence of symptoms. Psychological complaints: There is no increase in the incidence of major depression with the menopause. Negative moods are not associated with the natural menopausal transition. Factors associated with negative moods include surgical menopause, prior depression, health status, menstrual problems, social and family stressors and negative attitudes to menopause. Sexuality: Several studies suggest a decline in sexual functioning associated with menopausal status rather than ageing. Social factors and health status factors are also associated with sexual outcomes. RECOMMENDATIONS: Future research should bring together biomedical and sociological aspects. Positive aspects of health should be assessed as well as troubling symptoms. Longitudinal studies are needed with measures of hormonal change. Promoting positive attitudes to ageing and menopause, health lifestyles and stress reduction can be used as community interventions and as part of individual care.

Adult↗

PubMed1996

Candida albicans: is it associated with nipple pain in lactating women?

Persistent nipple pain in lactating women, burning in nature, and associated with radiating breast pain, has been claimed by some authorities to be due to 'thrush' (candida) infection. Yet, scientific proof has been lacking. This study compared microbiological assessment of 61 women with nipple pain, 64 women without nipple pain, and 31 non-lactating women. Swabs of the nipple and baby's mouth, and expressed breast milk were collected for culture. Growth of Candida albicans (nipple and milk) was found more often in the women with nipple pain (19%) than in the control group (3%, p < 0.01). In addition, Staphylococcus aureus was also associated with nipple pain (p < 0.0001), and independently associated with nipple fissures (p < 0.0001). Neither C. albicans nor S. aureus was found on the nipples of the non-lactating group.

Adult↗