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Climacteric symptoms were investigated among healthy women living in and around a small town in Tanzania. The incidence of symptoms was high and similar to that recorded in Western societies. Statistically significant associations were observed between some symptoms and the number of years since menopause. More attention needs to be paid to climacteric problems among African women.
Fifteen percent (20/130) of a group of climacteric women on diets of their choice had urinary calcium (Ca) levels exceeding 4 mg/kg per day. Most of these hypercalciuric subjects had a daily Ca intake of 0.4-0.5 g. Their bone turnover rates were raised and high Ca absorption was observed in 4 cases. Serum Ca and total protein and glomerular filtration rates were normal in all the hypercalciuric patients. The calcium/creatinine (Ca/Cr) ratio (mg l-1/mg l-1, fasting, 09:00-10:00 h) was measured in 72 climacteric women, 35 of whom (49%) had ratios > 0.1. The latter defines a relative hypercalciuria as compared with premenopausal Ca excretion levels. Only 5 of the 35 subjects had calciuria levels above 4 mg/kg per day. The Ca/Cr ratio cannot replace daily urinary Ca measurements for the screening of subjects in whom calciuria may exceed net Ca absorption. Urinary saturation measurements were carried out in 70 women. Supersaturation was observed only in the case of Ca oxalate (CaOx) among several calcium salts usually found in urinary stones. CaOx supersaturation was observed in 95% of the hypercalciuric subjects and in 48% of the rest of the women investigated. The relatively high frequency of CaOx supersaturation can be attributed in part to the decreased excretion of citrate associated with ovarian failure. Oestrogen replacement therapy increased citrate excretion and lowered the level of CaOx supersaturation. Ca supplementation (1 g Ca/day) reduced the degree of supersaturation as a result of the concurrent reduction in oxalate excretion.
OBJECTIVES: To determine more closely the relationship between vasomotor symptoms, well-being and climacteric status according to the last menstrual bleeding and according to the women themselves. METHODS: A population-based cross-sectional study was executed using a postal questionnaire. Well-being of women with and without vasomotor symptoms was compared, for the different menopausal statuses. All 2729 women living in a commuter suburb of Rotterdam aged 45-60 years were approached of whom 1947 (71.3%) responded. Well-being was measured by the Inventory of Subjective Health (ISH) and three subscales of the Sickness Impact Profile (SIP). RESULTS: The results showed that the relationship between vasomotor symptoms and well-being was dependent on climacteric status. Pre- and (middle and late) postmenopausal women with vasomotor symptoms more often experienced a relatively lower level of well-being compared to women without these symptoms. However, when the prevalence of vasomotor symptoms is as its peak, i.e. in late perimenopause, a difference in the level of well-being between women with and without vasomotor symptoms was absent. CONCLUSIONS: It is concluded that well-being and vasomotor symptoms were inversely related in all menopausal statuses except for the (late) perimenopausal phase. For this no somatic explanation seems plausible. A more social scientific explanation is suggested.
OBJECTIVES: This study examined women's opinions about the climacteric and hormone therapy (HT) after menopause and compared women's and physicians' opinions in a country of low-HT use. METHODS: In 1998, a postal questionnaire was sent to a random sample of 2000 Estonian 45-64-year-old women; 69% (n=1312) responded. In 1999, a postal questionnaire was sent to a random sample of 500 Estonian gynaecologists and general practitioners; 68% (n=342) responded. RESULTS: Mean age at menopause was 49.8 years (S.D. 4.0), and there was no difference by socioeconomic classes or by age in self-rated health. Ten percent of women reported having used HT, with 3% currently using it. Most women reported some symptoms, with vasomotor symptoms more frequently reported by 50-54 years old; women most often reported tiredness (48%). Half of the women but under a fifth of physicians considered the climacteric a normal phase of life. Women's awareness about HT was low and about half had no opinion on its health effects. Half of the women had visited a gynaecologist, older women less so. Women with contacts with health care were more aware of HT. CONCLUSIONS: Women reported symptoms by age-group as similarly found in high-HT use countries and it verifies that many symptoms experienced were not due to menopause. As in other low-HT use countries, women were unfamiliar with HT and their attitudes were traditional, although physicians' attitudes were more positive. Estonian women seemed to have escaped the period of the preventive use of HT.
OBJECTIVE: To obtain data on correlates of climacteric symptoms in women around menopause attending menopause clinics in Italy. METHODS: Since 1997 a large cross sectional study has been conducted on the characteristics of women around menopause attending a network of first level menopause outpatient's clinics in Italy. A total of 66,501 (mean age 54.4 years) women are considered in the present paper. RESULTS: The odds ratios of moderate and severe hot flashes/night sweats were lower in more educated women and (for severe symptoms only) in women reporting regular physical activity. Depression, difficulty to sleep, forgetfulness and irritability tended to be less frequent in more educated women and (depression only) in women reporting regular physical activity. Parous women reported more frequently these symptoms. CONCLUSIONS: This large study confirms in Southern European population that low education, body mass index and low physical activity are associated with climacteric symptoms. Parous women are at greater risk of psychological symptoms.
OBJECTIVES: To evaluate the level of knowledge about the menopause of Andalusian women between 30 and 60 years old; and to determine their knowledge's relationship with social and demographic variables, health service use and their position as regards the climacteric. DESIGN: Cross-sectional study. PARTICIPANTS: A sample of 770 Andalusian women between 30 and 60 was chosen, for a sample error of +/- 5% and 95% confidence interval, chosen through multi-stage sampling: at random with proportionality for province and size of habitat, and sampling by age quotas and educational background. MEASUREMENTS: The principal study variable was women's level of knowledge about the menopause, evaluated through a validated test of 56 dichotomous questions. In the descriptive analysis, the mean, standard deviation and 95% CIs were obtained; in the analysis of relationships, the test of homogeneity of means, and variance and regression analysis were used. RESULTS: On a scale of 0-56, the mean on the sample was 18.17 with a standard deviation of 14.37 (95% CI: 17.15-19.17). 57.9% of the sample polled had values of low or very low level of knowledge. In the analysis of relationships, and according to the variance analysis data, we found that the level of understanding is related (p < 0.001) to age (F = 64.21), educational background (F = 131.19), type of menopause (F = 8.94), and having received information on the menopause (F = 7.57). Of these four variables it is educational background which most explains the variability in knowledge (r = 0.52, p < 0.001). However, experience of the menopause or use of the health services for the menopause do not seem to affect knowledge about the climacteric period and its treatment. CONCLUSIONS: The lack of knowledge of the menopause shown by the population studied demonstrates the need for Health Education on this stage of life. The relationships analysis leads us to conclude that the profile of women studied who knew most was someone with middle/high educational background, aged 30-40, who had had a surgical menopause, and had received information about the menopause.
OBJECTIVE: Our purpose was to compare the effects of a new estradiol-releasing vaginal ring with progesterone given as a vaginal suppository, versus the efficacy, safety and acceptability of an intrauterine device releasing levonorgestrel combined with estradiol, delivered transdermally from a patch. Climacteric symptoms, bleeding pattern and endometrial histologic features were studied. METHODS: Fifty six parous, postmenopausal women with urogenital symptoms were allocated in two groups for one year: 28 women receiving estradiol by a vaginal ring and a 100 mg vaginal progesterone suppository 7 days every month and 28 women receiving a continuous transdermal daily dose of 50 micrograms of estradiol with a levonorgestrel-releasing intrauterine device inserted. All the patients were subjected to vaginosonographic examination followed by thorough pathological examination of the uterine curetting samples. RESULTS: A mean endometrial thickness (double layer) of 2.9 and 3.0 mm, respectively, was found to be predictive of normal endometrium. Both treatment regiments effectively relieved climacteric symptoms. Endometrial proliferation was not observed. Spotting was more common in the intrauterine device group than in the vaginal ring group. CONCLUSIONS: Treatment of urogenital symptoms in postmenopausal women with these two forms of hormone replacement therapy is shown to be an effective and safe method, exhibiting advantages over other methods of treatment.
OBJECTIVES: The aim of this study was to compare a new sequential estradiol-desogestrel (E2-DSG) hormone replacement regimen (Liseta) with one of the standard treatments i.e. estradiol valerate-medroxyprogesterone acetate (E2V-MPA) combination (Klimalet) regarding the alleviation of climacteric symptoms, vaginal bleeding pattern and the occurrence of adverse experiences. METHODS: In a multicenter study performed in Denmark, a total of 376 perimenopausal women with climacteric symptoms were randomly allocated to oral sequential treatment with either E2-DSG (1.5 mg E2 for 24 days with 0.15 mg DSG for the last 12 days followed by a placebo tablet for 4 days) (n = 186) or with E2V-MPA (2 mg E2V for 21 days with 10 mg MPA for the last 10 days) (n = 190). Treatments were administered, using a double-blind, double-dummy technique for 6 cycles of 28 days. RESULTS: Three hundred and seventeen women, 158 in the E2-DSG and 159 in the E2V-MPA group, completed six treatment cycles. Both treatments reduced menopausal symptoms rapidly and to a similar extent. Hot flushes were present in 88% of the women in both groups. After six treatment cycles, hot flushes were no longer present in 71 and 62% of the women in the E2-DSG and E2V-MPA group, respectively. Perspiration decreased from 80 to 65% in the E2-DSG group and from 82 to 63% in the E2V-MPA group. Mood disturbances were present in 82% of the women in the E2-DSG at baseline, and in 52% after six cycles. In the E2V-MPA group the corresponding figures were 68 and 42%, respectively. The bleeding pattern was comparable in both treatment groups. Regular withdrawal (expected) bleeding appeared in 90-92% and in 85-90% of the women in cycles 1-5 with E2-DSG and E2V-MPA, respectively. Irregular bleeding (including spotting) occurred in 15.2% of the women receiving E2-DSG and in 20.1% of the women treated with E2V-MPA in cycle 6. In both treatment groups there was a tendency of a slight decrease in blood pressure. Adverse events were in less than 10% in each group the reason to discontinue treatment. CONCLUSIONS: Both treatments effectively alleviated menopausal complaints and presented good cycle control. Bleeding pattern and mood disturbances appeared to be more favorable influenced by E2-DSG.
The paper draws attention to the increased incidence of clinical depression reported during the climacteric period of the female life continuum. It seeks to identify factors which may be responsible for this phenomenon, drawing upon research and anecdotal evidence from both the biological and social sciences. With this aim, changes during the climacteric period for women are examined within a bio-psycho-social framework. Nursing care and treatment of those suffering depression within this stage of the middle years are discussed briefly and the influence of personal beliefs, held by both the patient and clinician, emphasized. The relevance and importance of these factors when employing the Roy Adaptation model in the care of such clients is also considered. In conclusion, the author stresses the need for a holistic approach and highlights the value of Roy's model in care provision for this patient group.
Climacteric complaints are caused by a decrease in estrogen production and are characterized by neurovegetative and psychic complaints. Hot flushes represent the leading symptom, in addition excitability, irritability and sleep disturbances are reported. These complaints are usually treated with estrogens, but extracts of Cimicifuga racemosa are used for this indication, too. Clinical studies gave evidence for the efficacy of Cimicifuga extracts in patients with climacteric symptoms. In pharmacological experiments Cimicifuga extracts exhibited organ specific estrogenic effects and were characterised as selective estrogen-receptor-modulators. In addition pronounced effects on the central nervous system were shown. Taking these relevant therapeutic properties into account further experimental and clinical studies seem to be necessary and promising.
In a prospective study 911 patients were treated over a period of 5 years (M = 2.2) or a total of 2007 treatment years with estriol succinate oral (Synapause, 2-12 mg per day). The treatment was very effective in the removal of all typical climacteric complaints and of the atrophic genital changes caused by estrogen deficiency. Subjective side effects were seldom seen and without practical importance for the treatment. Objective, grave side effects were only few: one superficial phlebo-thrombosis, 2 cases of thrombophlebitis, one carcinoma in situ of the portio vaginalis uteri and 2 mammary cancers were seen. The carcinoma had probably no causal relationship to the treatment. Embolies, myocardial infarctions, cerebrovascular and liver-gall bladder complications did not occur during treatment. The rate of uterine bleedings was low. The incidence of all complications was not increased by estriol succinate; but was even lower than expected. Endometrial and ovarian cancers were not seen. Estriol succinate is accordingly a very effective and well tolerated preparation against climacteric complaints, exerting no significant side effects. It is remarkable that it does not proliferate the endometrium when given in one dose a day. Estriol succinate can therefore be characterized as the estrogen to be favoured for the treatment of postclimacteric women, who do not want to have uterine bleedings any longer.(ABSTRACT TRUNCATED AT 250 WORDS)
The duration of symptoms occurring in vegetative climacteric syndrome in 97 women who refused hormone treatment and served as the control group was 4.5 years. A mean duration of 5.4 years was determined in 85 women treated with oral estrogens, 6.4 years in 20 women treated with a combination of estradiol and prasterone and 12.9 years in 28 women receiving a combination of estradiol and testosterone. All these groups were practically identical as to initiation of therapy and age, as well as to 17 further case history, sociological and clinical characteristics. Hormonal treatment of the climacteric syndrome can therefore lengthen symptomatic problems. This applies particularly to estradiol-testosterone combinations, in which the testosterone assumes decisive significance for the extent of the lengthening. Adjustment to the symptomatic timespan experienced by the control group depends largely on a relatively quick reduction of dosage.
The object of this study was to evaluate the effect of different doses of a compound containing isoflavones 60 mg, primrose oil 440 mg and vitamin E 10 mg. (IOVE) on menopausal complaints. This was an open, multicentre, randomised, group comparative, efficacy and safety trial. A total of 1,080 postmenopausal women, with climacteric symptoms, were allocated into one of two treatment groups to receive one (Group 1; n = 562) or two IOVE capsules (Group 2; n = 518) per day. The Blatt - Kupperman scale and safety parameters including weight, body mass index, blood pressure and adverse effects were assessed at the first visit before initiating the treatment, and 3 - 6 months thereafter. In addition, cholesterol, high density lipoprotein (HDL), low-density lipoprotein (LDL) and triglyceride levels were measured at baseline and at the 6th month visit. Finally, at the end of follow-up, the patient's satisfaction was assessed. No differences between groups at the beginning of the study and during the follow-up were observed. A significant reduction in Blatt - Kupperman scores were observed in the two groups. In addition, the reduction of the symptoms was more intense in the first 3 months. Increasing doses of IOVE add no beneficial effects since both studied doses were equally effective in the reduction of climacteric complaints.
BACKGROUND: Predictive factors of women who are unable to quit prolonged hormonal therapy (HT) are largely unknown. We sought to identify predictors for the resumption of HT after the discontinuation of treatment. METHODS: A cohort prospective study was conducted allocating menopausal women treated with HT for over 3 years. Menopausal symptoms were monitored periodically after HT cessation by the Greene climacteric scale. RESULTS: Eighty-two women participated in the study. Age, the age of menopause, BMI, HT duration, the type of regimen, reasons cited to discontinue HT and the method of discontinuation did not differ between the subjects who successfully discontinued HT and those who failed to quit HT. Only the prevalence of vasomotor symptoms when HT was first prescribed significantly differed between the groups (P = 0.03). Comparable maximal Greene score was recorded in both groups. Over time, the subjects who returned to HT had higher Greene score [Hazard ratio 1.25, confidence interval (CI) 95% (1-1.07)] and significantly higher vasomotor score [Hazard score 1.22, CI 95% (1.02-1.46)]. CONCLUSIONS: The history of hot flashes and the duration of menopausal symptoms upon HT discontinuation predict the resumption of HT. Thus, the return to HT is expected in individuals who are intolerant of prolonged climacteric syndrome.
A questionnaire study conducted in a cohort of women who had been prescribed oestrogen treatment for climacteric symptoms provided a unique opportunity to assess the concordance between their histories of oestrogen use and the exposure data derived from the prescription forms that had been collected for recruitment of the cohort. The questionnaire information, which was gathered within three years after the registration of prescription forms, was found to be highly concordant with the prescription data with respect to name of brand (85%), dosage (88%), treatment schedule--cyclic versus continuous--(88%), total duration of drug intake (months of treatment; correlation coefficient 0.98) and time of start of medication (correct month in 85%). A method for estimating the true exposure on the basis of prescription data--taking into account non-compliance and non-registered forms--was developed and found to be reproducible. It was concluded that information on climacteric oestrogen intake could be reliably obtained through a questionnaire within a period of less than three years after the exposure.
Two cases of sleep disordered-breathing in climacteric were reported. Polysomnography including esophageal pressure (Pes) measurement was performed. Case 1 was diagnosed as upper airway resistance syndrome. Case 2 was diagnosed as obstructive sleep apnea syndrome, while many episodes of upper airway resistance also existed. Hormone replacement therapy improved clinical symptoms, and in case 1, Pes nadir was improved but incidence of arousals which was induced by breathing disturbances was not significantly changed. Sleep disordered-breathing should be suspected as a cause of sleep disorder even in females, especially in climacteric age. Pes measurement and evaluation of arousals is required. Hormone replacement therapy may release the upper airway resistance.
OBJECTIVES: We objectively assessed the effects of counseling on climacteric symptoms in Japanese postmenopausal women. METHODS: Symptoms in 44 women (age, 51.4 +/- 3.4 years; period after menopause, 3.6 +/- 3.4 years) treated with counseling were evaluated according to the Keio modified menopause index. The response to counseling was compared with that to hormone replacement therapy (HRT). RESULTS: Forty cases (90.9%) showed an improvement in index score. There were no significant relationships between improvement and age, the period after menopause, or the severity or type of symptoms before counseling. The most improved symptom was headache, followed by palpitation and insomnia. Physical symptoms accounted for most of the common symptoms. The pattern of improvement with counseling was markedly different from that with HRT. CONCLUSIONS: We suggest that counseling is effective for treating climacteric symptoms, since it improves not only psychological symptoms, but also physical ones. Counseling may deserve evaluation as a complementary treatment to HRT.
A randomized double-blind cross-over study into the effect of northisterone on climacteric symptoms was performed on 23 postmenopausal women. Active therapy resulted in a significant reduction in the number and severity of hot flushes and night sweats. There was also a slight improvement in memory, insomnia and lack of energy but the other climacteric symptoms were not consistently altered. Side effects were minimal. There was a significant reduction in serum calcium, alkaline phosphatase, cholesterol, triglycerides, follicle-stimulating hormone and luteinizing hormone levels. There was a variable effect on serum creatinine and urea but there was no significant alteration in the other biochemical profiles, liver-function tests, weight or blood pressure.