Menopause Int
· 2011 Dec · PMID 22120939
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The approach to menopause can be divided into the early (E) and late (L) menopausal transitions (MT) on the basis of menstrual irregularity (EMT) and subsequent observation of at least one episode of 60 or more days amen...The approach to menopause can be divided into the early (E) and late (L) menopausal transitions (MT) on the basis of menstrual irregularity (EMT) and subsequent observation of at least one episode of 60 or more days amenorrhoea (LMT). In total, 40-60% of cycles in the LMT are anovulatory, often with low oestradiol (E2) and high follicle-stimulating hormone concentrations. The ovulatory cycles have variable endocrine characteristics, none of which is specific to EMT or LMT. Hormonal measurements of FSH and E2 are thus of little diagnostic value because of their unpredictable variability. Symptoms during the transitions may result from high or low E2 and can often be satisfactorily managed with low-dose oral contraceptives, which suppress pituitary-ovarian function.
Menopause Int
· 2011 Dec · PMID 22120938
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BACKGROUND: Breast cancer survivors can be expected to suffer from menopause symptoms with estrogen deprivation due to cancer treatments, in addition to natural menopause-related estrogen loss. OBJECTIVE: To gain an unde...BACKGROUND: Breast cancer survivors can be expected to suffer from menopause symptoms with estrogen deprivation due to cancer treatments, in addition to natural menopause-related estrogen loss. OBJECTIVE: To gain an understanding of what support breast cancer patients have when they suffer from menopausal symptoms, and utilize findings to further inform National Health Service (NHS) care provision for breast cancer survivors. STUDY DESIGN: Qualitative study with focus group sessions targeting Caucasian and Asian women with breast cancer. METHODS: Patient stories, with women describing their breast cancer journey and speaking about support received for any menopausal symptoms. Thematic data analysis of transcription. RESULTS: Breast cancer patients were not sure if they had menopausal symptoms or whether this was due to their breast cancer condition or treatment. Patients had an attitude of acceptance of menopausal symptoms and reported trying to cope with these by themselves. CONCLUSIONS: This research identifies a need for more information that is culturally sensitive on managing menopause symptoms, both as side-effects of breast cancer treatments as well as for affect on quality of life during the survivorship phase. Our work also gives insight into cultural remedies used for hot flushes by Asian patients, which they consider as 'cooling' foods. Breast cancer patients want to know whether side-effects of cancer treatment persist long term and how these can be managed. There is a need for improved patient support within any new NHS service models that are developed along breast cancer patient pathways, and inclusion of personalized advice for menopause symptoms.
Menopause Int
· 2011 Dec · PMID 22101781
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The menopause is a time in a woman's life when it is recognized that biological and social changes can impact upon mental wellbeing. Several studies have investigated the relationship between menopause and psychological...The menopause is a time in a woman's life when it is recognized that biological and social changes can impact upon mental wellbeing. Several studies have investigated the relationship between menopause and psychological symptoms, especially depression, with mixed results. In part, this is due to a considerable overlap between depressive symptoms and those due to declining estrogen levels, causing challenges in assessment. However it appears that vulnerable women are at a higher risk of succumbing to depression during menopausal transition. Antidepressants remain the mainstay of treating depressive symptoms, with little conclusive evidence for hormone replacement therapy. Memory problems during menopause are a common complaint, but there is no demonstrated link to subsequent dementia. This paper also reviews considerations of diagnosis and treatment of postmenopausal depression.
Vitamin D, a hormone critical to the body's maintenance of serum calcium and phosphorus concentrations, is currently the subject of much scientific interest. Low levels of vitamin D have been observed in many populations...Vitamin D, a hormone critical to the body's maintenance of serum calcium and phosphorus concentrations, is currently the subject of much scientific interest. Low levels of vitamin D have been observed in many populations and epidemiological studies have suggested a link between this biochemical state and a range of diseases, such as cancer, diabetes and multiple sclerosis. While the consequence of vitamin D deficiency is well documented for bone (rickets and osteomalacia), with mixed findings relating to falls and fractures, a causal link between vitamin D deficiency and these wider health outcomes has not been established. If these relationships were found to be causal, the morbidity and mortality resulting from low levels of vitamin D could be substantial; the current evidence base, however, most robustly supports the assessment of serum 25(OH)-vitamin D in the context of specific symptoms, low bone mineral density or biochemical abnormalities, rather than as an entity to treat in its own right or as the basis for a population-wide screening programme.
OBJECTIVES: To determine patterns of premenstrual symptom experiences across the reproductive age range, and the effects of other factors on premenstrual symptoms. STUDY DESIGN: Global cross-sectional survey. Sample A to...OBJECTIVES: To determine patterns of premenstrual symptom experiences across the reproductive age range, and the effects of other factors on premenstrual symptoms. STUDY DESIGN: Global cross-sectional survey. Sample A total of 7226 women aged 15-49 recruited by random sampling with approximately 400 each from France, Germany, Hungary, Italy, Spain, UK, Brazil, Mexico, Hong Kong, Pakistan and Thailand. Approximately 1000 women in Japan and Korea and 500 Australian women were found using Internet panels. MAIN OUTCOME MEASURES: Questionnaire of 23 premenstrual symptoms, sociodemographic and lifestyle variables. RESULTS: Four different patterns of premenstrual symptoms were found with ageing: symptoms showing no change with age, symptoms decreasing with age, symptoms reaching a maximum just before or around age 35, and symptoms reaching a maximum around age 40-44. Smoking was associated with an increase in most of the premenstrual symptoms. Increasing parity was associated with a decrease in some of the symptoms. CONCLUSIONS: These results suggest that the premenstrual symptoms most associated with the years of regular ovulatory cycles are skin disorders, lack of energy, appetite problems, joint/muscle/back pain, anger, abdominal bloating, depressed mood and irritability. Other symptoms which peaked later (swelling of extremities, breast tenderness/pain, weight gain) may reflect exacerbation by hormonal changes of the late reproductive/early menopausal transition. Smokers report more problematic premenstrual symptoms.
OBJECTIVES: To determine cross-cultural and other effects on women's experiences of premenstrual symptoms and their impact on activities of daily life (ADL). STUDY DESIGN: Cross-sectional survey. Sample A total of 7226 w...OBJECTIVES: To determine cross-cultural and other effects on women's experiences of premenstrual symptoms and their impact on activities of daily life (ADL). STUDY DESIGN: Cross-sectional survey. Sample A total of 7226 women aged 15-49 recruited by random sampling with approximately 400 each from France, Germany, Hungary, Italy, Spain, UK, Brazil, Mexico, Hong Kong, Pakistan and Thailand. Approximately 1000 women in Japan and Korea and 500 Australian women were found using Internet panels. MAIN OUTCOME MEASURES: Questionnaire of 23 premenstrual symptoms, sociodemographic and lifestyle variables, ADL and women's knowledge of premenstrual terms. RESULTS: The most prevalent symptoms were abdominal bloating, cramps or abdominal pain, irritability, mastalgia and joint/muscle/back pains. Severity of symptoms was directly proportional to duration (number of affected cycles) (R = 0.78). A linear model found that symptom prevalence (duration × severity) was associated with age (linear and quadratic effects), parity, current smoking and country. Premenstrual physical and mental symptom domains had similar negative effects on ADL. Impact on ADL was affected by education and exercise participation. Women's knowledge of the terms premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) varied by symptom intensity, age, education and country. CONCLUSIONS: Four of the five most prevalent premenstrual symptoms were physical. There was a great deal of similarities of women's experiences of these symptoms across countries and regions. Women's knowledge of PMS terms is highly dependent on the country in which they live.
OBJECTIVE: To survey women who stopped hormone replacement therapy (HRT) after 2002, including those who later restarted. STUDY DESIGN: A questionnaire on the UK-based menopause website www.menopausematters.co.uk evaluat...OBJECTIVE: To survey women who stopped hormone replacement therapy (HRT) after 2002, including those who later restarted. STUDY DESIGN: A questionnaire on the UK-based menopause website www.menopausematters.co.uk evaluating how women are influenced by HRT advice. Main outcome measures Answers to questions regarding stopping/restarting HRT in response to the advice in the early 2000s and advice given today. RESULTS: A total of 1100 responses were obtained. Of those who made the decision to stop HRT themselves, 56.4% (n = 425/754) said that they were influenced by the media. In those who would potentially most benefit from HRT, 72.8% (n = 220/302) stopped without medical advice. Overall, women aged under 50 years were significantly more likely to stop HRT themselves than women over 50 (P < 0.001). In women in whom symptoms returned, 37.5% (n = 362/966) said these affected their ability to work, 45.1% (n = 436) had problems with decision-making, 53.6% (n = 518) admitted to relationships being negatively affected and 29.2% (n = 286) said that symptoms affected their social relationships. Overall 46.5% of women (n = 485/1044) would not have stopped HRT given the current understanding of risk. Compared with women over 50, significantly more women under the age of 50 said that they would not have previously stopped their HRT based on their current understanding of risk (P < 0.001). CONCLUSIONS: The negative impact of published research and its reporting from the early 2000s are being mitigated by current press coverage. Media reports appear to influence the younger woman more than the older woman. Health professionals and media must learn the lessons from the past.
OBJECTIVES: To observe the effect of yoga on menopausal symptoms using a prospective, randomized, controlled and interventional study. Main outcome measures Total Menopause Rating Scale (MRS) score and three subscale sco...OBJECTIVES: To observe the effect of yoga on menopausal symptoms using a prospective, randomized, controlled and interventional study. Main outcome measures Total Menopause Rating Scale (MRS) score and three subscale scores (somatovegetative, psychological and urogenital) were measured on day 1 and day 90 in the study group which performed yoga (asana, pranayam and meditation) under supervision for three months, and were compared with the control group that did not perform yoga. MRS has been designed to measure health-related quality of life of ageing women. It consists of 11 symptoms and three subscales. RESULTS: It was observed that on day 1 the scores in both the groups were comparable. On day 90, the scores in the yoga group showed a reduction in score on all the subscales, which was statistically significant. No significant difference was noted in the control group. CONCLUSION: Yoga is effective in reducing menopausal symptoms and should be considered as alternative therapy for the management of menopausal symptoms.
Menopause Int
· 2011 Jun · PMID 21693503
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Following their introduction in the 1990s, bisphosphonates have become the mainstay of treatment in the management of postmenopausal osteoporosis, and their use continues to rise. Commonly noted adverse effects in clinic...Following their introduction in the 1990s, bisphosphonates have become the mainstay of treatment in the management of postmenopausal osteoporosis, and their use continues to rise. Commonly noted adverse effects in clinical practice include gastrointestinal side-effects, acute phase reactions (predominately seen with intravenous preparations) cutaneous reactions and more rarely, ocular side-effects. However, recent reports of potentially serious adverse effects of bisphosphonate therapy, including atypical subtrochanteric and femoral shaft fractures, atrial fibrillation, oesophageal carcinoma and osteonecrosis of the jaw, have prompted concerns regarding the long-term safety of this class of drugs. This review summarizes the benefits and potential adverse effects of bisphosphonates used in the treatment of postmenopausal osteoporosis. Although evidence of a definitive casual relationship between bisphosphonate therapy and serious adverse effects is lacking, concern remains particularly in relation to atypical subtrochanteric and femoral shaft fractures. This has important consequences in terms of determining optimum duration of therapy and how best to target therapy at those most at risk. Recently, attention has focused on individual fracture risk assessment in order to optimize the risk-benefit ratio of treatment for individual patients. A review of the role of hormone replacement therapy in younger women with significant risk of osteoporotic fractures may be timely in these circumstances.
Menopause Int
· 2011 Jun · PMID 21693502
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Hormone replacement therapy (HRT) has been shown to increase bone density, reduce the risk of fracture and can successfully relieve menopausal symptoms. From a time when HRT was the major therapeutic option for the manag...Hormone replacement therapy (HRT) has been shown to increase bone density, reduce the risk of fracture and can successfully relieve menopausal symptoms. From a time when HRT was the major therapeutic option for the management of osteoporosis, women and their clinicians now have a range of treatments available. Following the publication of the Women's Health Initiative (WHI) and the Million Women Study highlighting potential side-effects, such as breast cancer, heart disease and stroke, many doctors and women are now reluctant to use HRT. The National Osteoporosis Society felt that the role of HRT in the management of osteoporosis needed to be clarified. Using the Charity's expert clinical and scientific advisers, and through public consultation with members and key stakeholders, a Position Statement has been published. We conclude that HRT has a role to play in the management of osteoporosis in postmenopausal women below the age of 60 years. The key recommendations of the Position Statement are presented in this paper.
Menopause Int
· 2011 Jun · PMID 21693501
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A retrospective case-note study was undertaken to look at recorded details relating to information/advice given to women prior to or at the time of their gynaecological surgery with regard to possible effects of menopaus...A retrospective case-note study was undertaken to look at recorded details relating to information/advice given to women prior to or at the time of their gynaecological surgery with regard to possible effects of menopause/menopausal symptoms or advice given about hormone replacement therapy.
Menopause Int
· 2011 Jun · PMID 21693500
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Standards are an important way of demonstrating quality of care in any given setting. The British Menopause Society (BMS) has produced guidelines as to what should be recorded at the initial menopause consultation. A ret...Standards are an important way of demonstrating quality of care in any given setting. The British Menopause Society (BMS) has produced guidelines as to what should be recorded at the initial menopause consultation. A retrospective audit of case-notes of women attending Poole Menopause Centre was undertaken using these criteria as audit standards. Although areas of good practice were highlighted, the published criteria were met for only five of the 23 standards. An action plan to improve the documentation to achieve these standards has been formulated.
Menopause Int
· 2011 Jun · PMID 21693499
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Management of the menopausal woman has become controversial since publication of the results of the Women's Health Initiative and the Million Women Study from 2002 onwards. This health-care pathway summarizes the role of...Management of the menopausal woman has become controversial since publication of the results of the Women's Health Initiative and the Million Women Study from 2002 onwards. This health-care pathway summarizes the role of hormone replacement therapy and non-estrogen-based treatments as well as alternative and complementary therapies. It is based on the fifth edition of Management of the Menopause and was updated on 5 April 2011.
Menopause Int
· 2011 Jun · PMID 21693498
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An ongoing need for safe and effective pharmacological therapies exists for postmenopausal osteoporosis, which imposes a significant burden on both women and the health-care system. Bazedoxifene is a novel selective estr...An ongoing need for safe and effective pharmacological therapies exists for postmenopausal osteoporosis, which imposes a significant burden on both women and the health-care system. Bazedoxifene is a novel selective estrogen receptor modulator with a unique tissue-selectivity profile. In phase 3 clinical trials of nearly 10,000 postmenopausal women, bazedoxifene was shown to significantly reduce the risk of new vertebral fracture versus placebo, with favourable effects on bone mineral density, bone turnover markers and the lipid profile. Moreover, in a subgroup of women at increased risk of fracture, bazedoxifene significantly decreased non-vertebral fracture risk versus both placebo and raloxifene. Bazedoxifene has been shown to be safe and well tolerated, with no evidence of endometrial or breast stimulation. These data suggest that bazedoxifene may offer significant clinical benefit for postmenopausal women with or at risk of developing osteoporosis, which may subsequently lessen the medical and economic burden of this disease.