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Climacteric-like disorders in prostate cancer patients treated with LHRH agonists.

We assessed long-term side effects with characteristics of female climacteric disorders in prostate cancer patients treated with luteinizing hormone-releasing hormone (LHRH) agonists. Such side effects are not considered to be serious, though they can significantly affect patient quality of life. Sixty-four prostate cancer patients treated with LHRH agonists and 30 benign prostatic hyperplasia patients, as a control group, were surveyed by questionnaire. The median age of the cancer patients was 74.9 years old, ranging from 60 to 94 years, and the median LHRH agonist dosing period was 16.5 months, ranging from 1 to 64 months. The results of the questionnaires were compared between the patients and the controls, as well as between different variables. Sixty (93.8%) of 64 patients claimed symptoms similar to female climacteric disorders. Further, more than 50% of the symptoms included in the questionnaire were reported by 14 (21.9%) of the patients. Symptoms reported by the patients were more severe than those by the controls. Hot flashes, sleep disturbance, and fatigue recorded high scores in the patient questionnaires as compared with those of the controls. In addition, as the term of LHRH agonist use increased, complaints of sweating or coldness in hands and feet increased. Patients without bone metastasis frequently experienced heaviness in the head and headaches compared to those with bone metastasis. The results of our questionnaire-based outcome study showed that side effects similar to female climacteric disorders in prostate cancer patients treated with LHRH agonists were more severe than in the control group, which could be detrimental to quality of life and general well-being.

Aged↗

Climacteric symptoms and hormones.

Climacteric symptoms are so closely associated with the menopause to be practically considered its hallmark. However, symptoms can already appear before the onset of menopause. The frequency, extent and intensity of symptoms are dependent on social factors, body composition, race and geographical region. In about 20-25% of menopausal women they do not occur at all. These symptoms are most prominent in women who are suddenly deprived of their endogenous estrogen secretion, for instance by bilateral ovariectomy, particularly in younger women. Climacteric symptoms can to be subdivided into five categories: menstrual bleeding disorders; vegetative symptoms; psychosomatic symptoms; somatotrophic changes; and metabolic changes. For prevention and treatment of the various symptoms, estrogen/progestogen replacement therapy (HRT) or estrogen replacement therapy (ERT) in individualized dosages and various forms of applications are the most cost-effective modalities in order to control menopausal symptoms and restore organic function, or prevent all of this and improve women's quality of life. Recent publications indicate that gene polymorphisms may be associated with severe and persistent climacteric symptoms. This is also true for current and ever cigarette smokers.

Climacteric↗

Depressive symptoms, menopausal status, and climacteric symptoms in women at midlife.

OBJECTIVE: Previous studies have found increased rates of depression in women aged 45 to 54 years, but the factors that influence these rates are not understood. It was assessed whether higher rates of depressive symptoms were associated with menopausal status, climacteric symptoms, and use of hormone replacement therapy. DESIGN: Cross-sectional survey. SETTING: Community sample. METHODS: Data are from 581 women ages 45 to 54 years who were interviewed by telephone between October 1998 and February 1999. MEASURES: Depression was measured with the abbreviated CES-D, a depressive symptoms screening measure. Women's reported perception of menopausal stage, frequency of periods in the preceding 12 months, and history of oophorectomy were used to classify their menopausal status into four categories: (1) no indication of menopause; (2) close to menopause; (3) had begun menopause; and (4) had completed menopause. RESULTS: There were 168 women (28.9%) who reported a high level (> or = 10) of depressive symptoms when the abbreviated CES-D was used. In a logistic-regression analysis, significant factors associated with increased depressive symptoms included physical inactivity, inadequate income, use of estrogen/progesterone combination, and presence of climacteric symptoms (trouble sleeping, mood swings, or memory problems). Menopausal status was not associated with depressive symptoms. CONCLUSIONS: In this sample of women age 45 to 54 years, climacteric symptoms but not menopausal status were associated with higher rates of depressive symptoms.

Climacteric↗

Climacteric symptoms among indigenous Australian women and a model for the use of culturally relevant art in health promotion.

OBJECTIVE: To evaluate climacteric symptoms among rural and remote, indigenous Australian women and to develop culturally relevant women's health midlife educational material. DESIGN: A cross-sectional pilot survey based on structured interviews of women older than 18 years of age who were available for interview and willing to participate. The study was conducted in the Kimberley region of Western Australia and southwestern Victoria between February and June 1999. Health issues central to the local community were identified by the structured survey. Development of culturally relevant information involved collaboration between indigenous women and indigenous artists, health workers, educators, and ourselves. Traditional health themes in art form were then linked with specific health issues to be addressed. Health messages were translated by Aboriginal women and health workers into both traditional language and vernacular, to target all women. RESULTS: Fifty-five women completed the survey. Thirty-eight were premenopausal, 4 were perimenopausal, and 13 were postmenopausal. The 4 perimenopausal women and 9 of the 13 postmenopausal women had climacteric symptoms, but none had been prescribed systemic or local hormonal therapy. Rates of obesity, diabetes mellitus, and hypertension were high. Midlife women's health booklets were produced in collaboration with Aboriginal elders and artists to communicate preventive health information in a visual context familiar to Aboriginal people of the Kimberley and surrounding communities. CONCLUSIONS: In contrast to the case in other non-Caucasian populations, climacteric symptoms seem to be common among Australian indigenous women and are apparently untreated. Aboriginal art and language has been employed in the development of culturally appropriate health promotion literature for Aboriginal communities in the Kimberley region of Western Australia. This process of collaboration provides a useful model for addressing women's health issues in other culturally diverse populations.

Adult↗

Effect of a combination of isoflavones and Actaea racemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study.

OBJECTIVE: To investigate the effects of a novel dietary supplement containing soy isoflavones and Actaea racemosa Linnaeus (formerly called Cimicifuga racemosa L.) on climacteric symptoms in healthy perimenopausal women. DESIGN: In a multicenter, randomized, placebo-controlled, double-blind study, 124 women experiencing at least five vasomotor symptoms every 24 hours were randomized to receive daily either a phytoestrogen-containing supplement (n = 60) or placebo (n = 64) for 12 weeks. The modified Kupperman Index and Greene Climacteric Scale, a visual analogue scale designed to measure quality of life and the daily number and severity of hot flushes, was used in the screening period and in weeks 6 and 12. Changes in these scores from baseline were calculated. RESULTS: At weeks 6 and 12, all scores in both groups had improved compared with baseline, though the overall difference in scores between the groups was not statistically significant. CONCLUSION: The supplement containing soy isoflavones and A racemosa L. had no statistically significant effect on climacteric symptoms in perimenopausal women experiencing at least five vasomotor symptoms per day.

Aged↗

Efficacy and safety of a special extract of Rheum rhaponticum (ERr 731) in perimenopausal women with climacteric complaints: a 12-week randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To investigate the efficacy and safety of the special extract ERr 731 from the roots of Rheum rhaponticum compared to placebo in perimenopausal women with climacteric complaints. DESIGN: A multicenter, prospective, randomized, double-blind, placebo-controlled, clinical trial in which 109 women with climacteric complaints received either one enteric-coated tablet of ERr 731 (n = 54) or placebo (n = 55) daily for 12 weeks. Primary outcome criterion for efficacy was the change in Menopause Rating Scale II (MRS II) total score after 12 weeks. Other efficacy assessments analyzed number and severity of hot flushes, menopause-specific quality of life, number of bleeding/spotting days, and treatment outcome. RESULTS: By 12 weeks, the MRS II total score and each MRS II symptom significantly decreased in the ERr 731 group compared to the placebo group (P < 0.0001). After 4 weeks, ERr 731 also significantly decreased the number and severity of hot flushes (P < 0.0001). After 12 weeks, the overall menopause-specific quality of life was significantly better in women treated with ERr 731 compared with placebo (P < 0.05). Treatment outcome assessed by investigators and participants was better in the ERr 731 group, and ERr 731 was better tolerated than placebo. There were no differences in gynecological findings including endometrial biopsies, bleeding, weight, blood pressure, pulse, and laboratory safety parameters between the treatment groups. No adverse events were classified as being related to the investigational medication. CONCLUSIONS: Compared to placebo, ERr 731 significantly reduces the occurrence and severity of climacteric complaints in perimenopause. It is also safe and well tolerated.

Body Mass Index↗

An exploration of the mother-child relationship between climacteric mothers and their adolescent daughters.

Climacteric women face multidimensional changes including physical, psychological, social changes and changes in family structure. However, there have been few studies about the related family structure changes for climacteric women. The purpose of this study was to explore the parent-child relations between climacteric women and their adolescent daughters. Data was collected by interview, using Parent-Child Relations Scale questionnaires with purposive sampling of 70 female (mothers) who were in perimenopausal or post-menopause and 70 current nursing students (daughters) who were studying at a junior nursing college. A total of 140 subjects were recruited from residents of the Chiayi-Tainan area of Taiwan. SPSS for Windows 10.0 was used. The results indicated that the most of the women had positive parent-child relationships, and demonstrated that the women' s sense of attachment was quite strong. Significant differentiation was found for the dimensions "sense of attachment", "without sense of autonomy", "sense of indebtedness", "sense of respect" and "instrumental valence" between perimenopausal mothers and their daughters (p < .01). In addition, the teenage girls ' perception of the parent-child relationship was higher than the mothers' (p < .01). It is therefore suggested that nursing care should go beyond the scope of disease treatment and include related socio-psychological priorities, such as the parent-child relationship, in evaluation and nursing procedures, and encourage middle-aged women to include their parent-child relationships in their life planning.

Adaptation, Psychological↗

Status of climacteric symptoms among middle-aged to elderly Japanese women: comparison of general healthy women with women presenting at a menopausal clinic.

AIM: To examine the status and characteristics of climacteric symptoms reported by generally healthy middle-aged to elderly women in Japan, those living in Saitama Prefecture were surveyed . METHODS: The subjects comprised 398 women ranging in age from 40 to <60 years (mean age, 50.5 years). Climacteric symptoms were objectively assessed using the Keio questionnaire. The total scores obtained for the 40 symptoms were used to calculate symptom prevalence and severity. RESULTS: (i) The most frequent symptom was poor memory, reported by 88.7% of the women. (ii) Lumbar-sacral back pain was rated as a severe symptom by the highest percentage of women (15.3%). (iii) The prevalence and severity of poor memory and lumbar-sacral back pain did not differ with menopausal status. (iv) Hot flashes and sweats were slightly higher in peri- and early postmenopausal women than in premenopausal women. CONCLUSIONS: The present study showed that healthy women who do not consult physicians because of climacteric symptoms are primarily concerned with age-related symptoms, such as poor memory, loss of hair, and forgetfulness.

Adult↗

A comparison of 25 mg and 50 mg oestradiol implants in the control of climacteric symptoms following hysterectomy and bilateral salpingo-oophorectomy.

OBJECTIVES: 1. To compare the effects of 25 mg and 50 mg oestradiol implants on serum follicle stimulating hormone and oestradiol levels; and 2. to assess the relationship of the dose of oestradiol implant and serum oestradiol on the effectiveness and duration of climacteric symptom control. DESIGN: Randomised, double-blind investigation. PARTICIPANTS: Forty-four women, who had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy. METHODS: The women were randomised to receive either 25 mg (n = 20) or 50 mg (n = 24) oestradiol implants. Follow up consisted of prospective symptom enquiry and hormone assays. MAIN OUTCOME MEASURES: Primary: climacteric symptom control: duration and effectiveness; secondary: serum oestradiol and follicle stimulating hormone levels. RESULTS: Serum oestradiol was significantly higher and serum follicle stimulating hormone significantly lower after the fourth month of treatment in women receiving 50 mg implants. No significant difference in symptom control was noted in the two groups. The mean duration of symptom control was similar in the two groups: 5.9 months (SD 2.4) in those receiving 50 mg oestradiol and 5.6 months (SD 2.3) in those receiving 25 mg. CONCLUSION: The higher level, 50 mg oestradiol implants does not result in better control of symptoms nor in longer periods of symptom control compared with 25 mg oestradiol implants. In order to maximise compliance, 25 mg oestradiol implants should therefore be the treatment of choice for women with normal bone density seeking relief of climacteric symptoms.

Climacteric↗

Skin climacteric aging and hormone replacement therapy.

A gender perspective is indispensable for a full understanding of aging. Menopause is a turning point in women's lives. In addition to the effects of chronological aging, sunlight exposure, and other environmental and endogenous stimuli, the climacteric appears to exert some dramatic consequences on skin biology and aspect. The epidermis may become xerotic and exhibit altered functions. The dermis thins out and its elasticity decreases in concert with the decline in bone mass. The skin microcirculation is impaired. These aspects are some of the better worked-out changes of the climacteric, which in turn seem to be stabilized or in part reversible with hormone replacement therapy (HRT). The HRT effect on menopause consequences on hair growth and sebum production is less impressive. This review summarizes some important impacts of the climacteric on skin, and highlights the benefits of HRT that may influence cosmetic dermatology.

Biomechanical Phenomena↗

Confrontation in the climacteric.

Why is an increasing number of women dissatisfied with their doctors' help in their climacteric? Why do so many object to hormone replacement therapy (HRT)? Why do they generally feel it is not 'natural'? Though many object to getting old, want to continue flaunting their 'eternal youth', many more, women and men, embrace retirement, wish to rest and slow down. There is no mistaking these extremes, for while the first grasp at every possible treatment, the last are but seldom medically seen. It is the middle majority, their demands, censure, disapproval, even open confrontation with those who try to help them which is difficult to understand. This paper briefly reviews the manner in which Western climacteric women have, during two hundred, but mainly last fifty, years confronted their world: their protests at societal attitudes, their private marital conflicts, their demands of doctors and, finally, their present criticism of them. It also pays detailed attention to the key concept of 'natural' treatment. Finally it suggests that much of present climacteric confrontation is a displacement activity, born of concurrent conflicting desires for both youth and retirement, rather than aimed specifically at doctors.

Climacteric↗

Cyto-histologic evaluation of the endometrium in climacteric women at risk for endometrial carcinoma.

The authors evaluated the diagnostic effectiveness of a triple specimen technique (cyto-histologic) performed by the Perma device. The incidence of endometrial hyperplasia (according to Dallenbach-Hellweg's classification) was estimated in 254 climacteric women selected from outpatients who come spontaneously to the Menopause Clinic of the Obstetrics and Gynecology Department (Bologna University). The selection criterion was the evidence of risk factors for endometrial carcinoma, climacteric bleedings (obesity, late menopause, high blood pressure, diabetes), or endometriotropic estrogen therapy in the postmenopause. Results showed that the cyto-histologic sampling is most useful for diagnosing endometrial hyperplasia and early carcinoma (diagnostic effectiveness: 89.0-93.8%). Also, endometrial hyperplasia was found to have a significant incidence in the group we examined. This incidence was highest in women with climacteric bleedings, secondly in women using high-dose estrogens, and thirdly in women with risk factors for endometrial carcinoma. When evaluating the different kinds of endometrial hyperplasia, we never found adenomatous hyperplasia in women on estrogen therapy. Affinity between histologic and cytologic classes was around 50% in endometrial hyperplasia and 100% in early carcinoma. This emphasizes that both samplings are needed to perform an accurate diagnosis.

Adult↗

[Climacteric women seeking medical care, Brazil].

OBJECTIVE: To study the causes and factors associated with climacteric women seeking medical care. METHODS: A descriptive exploratory cross-sectional population-based study was carried out. Subjects were 456 women aged 45 to 60 years resident in a metropolitan area of Southeastern, Brazil, selected through area cluster sampling. Data were collected through home interviews using a structured, pre-tested questionnaire. Statistical analysis were performed using Chi-square test, Cramer's coefficient and logistic multiple regression. RESULTS: About 80% sought medical care due to menstrual irregularities and climacteric symptoms. The main factors associated with women seeking medical care were hormone replacement therapy, marital status, and stronger psychological symptoms. The main reason for not seeking medical care was women's thought that their complaint did not justify medical attention. CONCLUSIONS: There was a high demand for medical care by climacteric women, but a significant percentage did not seek medical attention because they believed their symptoms were ordinary.

Climacteric↗

Bowel habits before and during menses in Japanese women of climacteric age: a population based study.

A good deal of data are available on the bowel habits of pre-climacteric females during menstruation. Few studies have examined the same subject in females of climacteric age but who are still menstruating, so the present study was undertaken to examine the bowel habits in menstruating females in this age group. Subjects (n = 246) were residents of a city in northern Japan, aged from 45 to 55 years old and who were still menstruating. Their every-day state of defecation and fecal characteristics were assessed with regard to four parameters: bowel movement frequency, defecation state, fecal appearance and fecal consistency. Based on a perfect match to these four criteria, the subjects were assigned to two groups, the normal group and the constipation group, and changes were assessed by enquiring how their bowel habits differed immediately before and during menses compared with their usual state. Immediately before menstruation, in the constipation group feces became harder and looser in 22.1% and 13.7%, respectively, compared with 8.7% and 9.5% in the normal group. On the other hand, during menstruation in the constipation group, feces became harder and looser in 11.6% and 16.8%, respectively, compared with 5.7% and 8.9% in the normal group. In other words, the constipation group showed a greater change immediately before and during menstruation compared with the normal group, though the differences were not significant. Our data thus suggest that the changes in the bowel habits of women of climacteric age at menstruation are greater for those suffering from constipation than those who are not.

Aging↗

alpha-Methyldopa for climacteric hot flushes. A double-blind, randomized, cross-over study.

The effects of single evening doses of alpha-methyldopa and placebo have been compared in 40 women with climacteric hot flushes. The study was designed as a double-blind, randomized and cross-over investigation. Of the 24 patients who completed the study, 15 reported that they preferred the alpha-methyldopa treatment (p greater than 0.05). alpha-methyldopa seemed to affect both the severity (p less than 0.05) and the frequency of climacteric hot flushes (p greater than 0.05). It is concluded that alpha-methyldopa is efficacious against climacteric hot flushes when given as single evening doses, but further study is required to answer whether this dosage is as effective as a twice daily regimen.

Climacteric↗

Climacteric symptoms and estrogen replacement therapy in women with endometrial carcinoma.

A case-control study was undertaken to investigate the influence of exogenous estrogens and climacteric symptoms on the risk of developing endometrial carcinoma. The study comprised 254 women with newly diagnosed endometrial carcinoma, resident in a defined geographical area, and 254 age-matched population controls. Treatment with estrogens for 4 years or longer was significantly more common among patients than among controls (odds ratio = 4.5; 95% confidence limit (CL) = 1.2-17.3). A history of climacteric symptoms was reported by significantly fewer patients than controls (odds ratio = 0.5; 95% CL = 0.3-0.7) and this difference was shown to be independent of weight. The decrease in risk associated with climacteric symptoms was limited to women younger than 70 years.

Adult↗

The climacteric and well-being.

The climacteric is accompanied by many changes in life, which may give cause to a variety of complaints. Thus, it may be difficult to discern to what extent the climacteric is related to well-being. The association between menopausal status and well-being was determined in a population of 2729 women aged 45-60 years. A self-administered questionnaire was filled out and returned by 1947 women (response 71.3%). Well-being was measured by the Inventory of Subjective Health (ISH) and the three subscales of the Sickness Impact Profile (SIP): social functioning; emotions, feelings and sensations; and intellectual functioning. The relationship between menopausal status and well-being was estimated using linear regression analysis, while adjusting for age and other potential confounding variables, including body mass index, smoking behavior, education, work outside the home, parity, way of cohabitation, difference in age with the partner and partner's employment. The results show that early perimenopausal women report a lower level of well-being as compared to premenopausal women on all three SIP scales. Early postmenopausal women report a lower level of well-being on the SIP emotions, feelings and sensations. Intermediate postmenopausal women have a lower level of well-being on the ISH only. Finally, late postmenopausal women have a lower level of well-being on the SIP social functioning and SIP emotions, feelings and sensations. We tentatively conclude that the influence of the climacteric on well-being independent of confounders is primarily found in behavioral functioning in the daily life of a woman.

Activities of Daily Living↗

Coping style and climacteric symptoms in a clinical sample of postmenopausal women.

Hormonal changes as well as sociocultural and personal factors account for climacteric symptoms. The aim of this study is to investigate in a clinical population the correlation between the severity of hot flashes and vaginal dryness and the 'coping-ineffectiveness of coping' construct. Out of 120 women consecutively referring to the University Menopause Clinic, 85 subjects were evaluated for their climacteric complaints including anxiety and depression and for their coping style assessed with the Italian version of the Utrechtse Coping Lijst. Daily hot flashes and severe vaginal dryness were reported by almost half of the studied population, regression analyses were performed in order to investigate how much of the variance in such symptoms was explained by the psychosocial variables and by the coping mechanisms. A more recent menopause, a lower educational level and an active coping predict a higher severity of hot flashes; a longer time since last menstrual period and a coping of avoidance predict a higher severity of vaginal dryness. The present study suggests that the severity of hot flashes and vaginal dryness among a clinical sample of postmenopausal women is not only determined by biological and social variables, but personal resources also explain part of the variance of such climacteric complaints.

Adaptation, Psychological↗