Hormone replacement therapy and the Jamaican memopausal woman

A comparative study, on the benefits and disadvantages of hormone replacement therapy (HRT) was conducted from a survey of 120 menopausal women within the age range of 45-65 years. The participants, all menopausal women, were recruited from among those attending the Jamaica Menopausal Society monthly meetings in Mandeville and Kingston; and the Community Health and Psychiatry health clinic at the University of the West Indies, Mona. The quota sampling method was used, resulted in a non random selection. This resulted in a non-randlomly selected population. The aim of the study was to identify the benefits and disadvantages of hormone replacement therapy that were faced by the Jamaican menopausal women. Benefits, like not being depressed, no irritability, mood swings, and no vaginal dryness from taking hormone replacement therapy (HRT) whilst, disadvantages were headaches, nausea and vomiting, while taking hormone replacement therapy. Some women reported that they did not experience or observe any disadvantages of taking HRT. Trends reported showed that the educational level of the women plays a vital role in HRT awareness and use. Menopausal changes and symptoms reported are similar for women worldwide. The Caribbean or International regions, irrespective of race, color or climatic zones and benefits and disadvantages of hormone replacement therapy are overwhelmingly the same (AU)

Hormone replacement therapy - knowledge, attitudes and practices of women attending a gynaecology outpatient clinic in Trinidad

A questionnaire was used to assess the knowledge, attitudes and practices of a sample of 218 outpatients attending the Port of Spain General Hospital Gynaec Outpatient Clinic. The questionnaire investigated women's knowledge of menopause, risks and benefits of Hormone Replacement Therapy (HRT), their attitudes concerning HRT and menopause as well as practices of postmenopausal women with respect to HRT. Comparisons were made between women of differing menopausal status, educational background and ethnicity. The results showed that overall knowledge was lacking regardless of menopausal status, ethnicity or educational background. Less educated women were more inclined to believe that HRT was inappropriate prinicpally because they regarded the menopause as a natural process (p = 0.023). Only 24 percent of postmenopausal women were practicing some from of HRT. A minority (7 percent) had previously been undergoing the therapy but had stopped. Most postmenopausal women (69 percent) simply never considered treatment because the majority had never heard about HRT. The main source of patient information was from the clinic they were attending. This study reveals low awareness of menopausal information and therapeutic options in a Trinidadian population. A targeted education programme may substantially fill this void.(Au)

Diabetes in the peri-menopausal period - position statement

Menopause and oestrogen deficiency result in adverse changes in various lipoproteins and calcium metabolism, which may lead to increased risk of coronary artery disease, osteoporosis and Alzheimer's disease. Diabetic women are also at increased risk for cardiovascular disease, hypertension, stroke, endometrial cancer and Alzheimer's disease. Hormone replacement therapy has been shown to reduce the risk of cardiovascular disease, osteoporosis, endometrial cancer, and may even reduce the risk of Alzheimer's disease. The purpose of this review is to demonstrate that sufficient evidence now exists to confirm that hormone replacement therapy is both safe and beneficial for the perimenopausal and post-menopausal diabetic woman.(AU)

Diabetes in the peri-menopausal period - position statement

Interrelationship of one with the other includes the high prevalence of diabetes in peri-menopausal and menopausal women, and the adverse impact of the menopause on diabetes. MENOPAUSE AND DIABETES RISK: The risk increases for women predisposed to type 2 diabetes because of the loss of oestrogen, increased adipose tissue and increased insulin resistance. MENOPAUSE AND PRE-EXISTING DIABETES: There is a change in glycaemic control with an increase in marcovascular risk due to comorbidities such as hypertension and dyslipidaemia. DIABETES AND HORMONE REPLACEMENT THERAPY: This results in worsening of hyperlipidaemia with an increased risk of cardiovascular events and deterioration in glycaemic control. The management regime includes assessment and management of dyslipidaemia, renal problems, ophthalmic complications and neuropathy. The objectives are to achieve normal weight and blood pressure whilst maintaining tight glycaemic control as monitored by HbA measurement.(AU)

Hormone replacement therapy: a survey of knowledge, attitudes, and practices of women attending gynaecological out-patient clinics of the General Hospital, Port-of-Spain, Trinidad

A questionnaire was used to assess the knowledge, attitudes and practices of a consecutive sample of 218 out-patients, aged 30 to 65 years, attending the Gynaecological Out-patient Clinic of the General Hospital, Port-of-Spain over 15 clinic days. Two-thirds of the sample were premenopausal and the rest were postmenopausal. A structured questionnaire was administered to collect data on demographics and menopausal status, knowledge of menopause, risks and benefits of hormone replacement therapy (HRT), attitudes concerning HRT and menopause and practices of postmenopausal women with respect to HRT. Data were analyzed by the F-test or X test. Comparisons were made between women of differing menopausal status, educational background and ethnicity, The results showed that 92 percent of the sample had "some" or "little" knowledge and this was true regardless of menopausal status, ethnicity or educational background. The less educated women, compared with women of higher education, were inclined to believe that natural methods were more appropriated than HRT for menopausal management (p=0.023). Only 24 percent of the postmenopausal women were practising some form of HRT while 7 percent who had previously received HRT had stopped. Most of the postmenopausal women (69 percent) had never replaced their hormones simply because they had never considered the treatment. Most women (>90 percent) had never heard about HRT.(AU)

Women's health: hormone replacement therapy - what women know and do about it

The aims of the study reported on in this paper were to determine the health status of a group of Trinidadian women age 40-64 years; to ascertain how informed they were about the "change of life", and determine the sources from which they had received their information. The study also sought to discover what women knew about hormone replacement therapy(HRT) and what had been their personal experience of it. Data for this study were obtained through self administered questionnaires to fifty (50) women. The women were chosen, half from a working class community and the others from a middle class commumnity in urban Trinidad. The women were chosen by simple quota sampling which sought to select women in the age group 40-64. The questionnaires were self administered. Additional data were gathered from discussions held in three focus groups, with approximately ten women in each group. Discussions were also held with two physicians and two pharmaceutical representatives to attempt to gain information on the role of professionals like themselves in the promotion of HRT in Trinidad. The research showed the majority of the women reporting themselves to be in good health. In relation to hormone replacement therapy, the middle-class women were significantly more informed than were the working-class. The women's knowledge of HRT though was not reflected in their patterns of usage (AU)

Health maintenance needs for perimenopausal women and their partners in a selected population

A survey was conducted among women attending a public gynaecological facility and a private medical facility. Their partners were included wherever possible. The aim was to compare health maintenance needs in the perimenopausal women and their partners (age 40-55) attending a private and a public facility for care. All patients attending both facilities and who were within the age range were invited to enroll. At the public facility 80 females and 27 partners were enrolled whilst at the private facility it was 40 females and 21 partners. It was found approximately one third of the respondents stated that they were unaware of the meanings of menopause and it was noted that, for the majority, menopause was not discussed with either the partner or anyone else. The access to care, especially at the public facility, was affected by long waiting time and lack of adequate transportation. Amongst respondents, both male and female, hypertension was the most common medical problem. Similar proportions of those attending either facility had a total abdominal hysterectomy. This study has identified some factors which affect health maintenance in the stated age group and recommendations are made to address the problem.(AU)

Health maintenance needs for perimenopausal women and their partners in a selected population

A survey was conducted among women attending a public gnaecological facility and a private medical facility. Their partners were included wherever possible. The aim was to compare health maintenance needs in the perimenopausal women and their partners (age 40 - 55) attending a private and a public facility for care. All patients attending both facilities and who were within the age range were invited to enroll. At the public facility 80 females and 27 partners were enrolled whilst at the private facility it was 40 females and 21 partners. It was found that approximately one third of the respondents stated that they were unaware of the meaning of menopause and it wad noted that for the majority, menopause was not discussed with either the partner or anyone else. The access to care, especially at the public facility, was affected by long waiting time and lack of adequate transportation. Amongst respondents, both male and female, hypertension was the most common medical problem. Similar proportions of those attending either facility had a total abdominal hysterectomy. This study has identified some factors which affect health maintenance in the stated age group and recommendations are made to address the problem. (AU)

Risk factors and treatment of endometrial carcinoma

A twelve-year retrospective study of 54 consecutive cases of endometial carcinoma revealed that post-menopausal bleeding was the commonest symptom, and the major associated risk factors were obesity and hypertension. Panhysterectomy was the corner-stone of treatment while adjunctive therapy was based on certain prognostic factors and the operator's preference (AU)

Carcinoma of the vulva in Trinidad: its clinical presentation and outcome - abstract

Carcinoma of the vulva comprises less than 3 percent of all gynaecological cancers. A review of the status of this relatively rare carcinoma in 24 Trinidadian women found 75 percent to be menopausal and 96 percent to be symptomatic with a mean duration of symptoms of 18 months. An advanced stage of disease was found in 70.7 percent and this, together with co-existing medical problems, accounted for the low operability rate of 68.4 percent. All 14 surgical cases suffered varying degrees of morbidity and there were 2 deaths. The 6 women who were deemed unsuitable for surgery died within months of presentation. Four of the 5 women with carcinoma in-situ benefited from excision-biopsy and remain disease free. Late diagnosis mainly due to a delay in clinical presentation adversely affected management. Improved health education concerning vulval diseases as well as closer clinical scrutiny of the vulva in symptomatic menopausal women would allow for earlier diagnosis and so reduce the unfavourable sentiments which surround this carcinoma (AU)

Factors affecting the onset of the menopause in Trinidadian women - abstract

There are many factors that may affect the onset of the menopause, particularly cigarette smoking. The purpose of this study was to determine which factors may influence the onset of the menopause in Trinidadian women. A consecutive sample of 384 post-menopausal women attending Chronic Disease Clinics in 12 randomly selected Health Centres in North Trinidad comprised the study population. A pretested interview-type questionnaire was the instrument used to collect the data. Our findings from 379 (98.7 per cent) respondents aged 45 - 81 (mean = 61.5) years showed a mean age at menopause of 49.3 years. There were more women of African (56.3 per cent) than East Indian (28.3 per cent) origin; 84.9 per cent of women were non-smokers, 40 (10.6 per cent) and 17 (4.5 per cent) were smokers and ex-smokers, respectively. The mean age of menopause in Trinidadian women who smoke was reduced by as much as 5 years (49.7 vs 44.6 years), while women who were ex-smokers showed a reduction in the age of onset of the menopause by 3 years (49.7 vs 46.5 years). Chi-squared test showed these differences to be significant (p = 0.00312). However, there were no relationships with nutritional status, parity, chronic disease status or the use of hormonal contraception. It was interesting to note that all the hypertensive women in this sample acquired the disease post-menopause and 95 per cent acquired diabetes mellitus similarly (AU)

The menopause in a Caribbean setting: does it differ? - abstract

The aim of this study was to assess the menopause, the climacteric syndrome and its management by local practitioners. The long-term implications of the menopause were assessed by comparison of osteoporotic fractures in the local population against a North American population. Seven hundred and seventy women between the ages of 40 and 60 years were asked to respond to a mailed questionnaire to assess the menopause, the climacteric syndrome complex and its treatment. The long-term implications of the menopause were assessed by observing the incidence of lower limb fractures (neck of femur, etc.) in females (cases) and males (controls) over the age of 50 years, in Trinidad. This local incidence was then compared with a similar age and sex distribution in a North American population. One hundred and fifty-four or 20 per cent of the 770 women over age 40 years responded to the questionnaire. The mean age of the natural and surgical menopause was 47 years and 43 years respectively. The climacteric syndrome complex occurred as shown (table given). This syndrome occurred in 62 per cent of patients before the menopause and in 38 per cent after the menopause. Irritability (80 per cent) and decreased libido (64 per cent) were the most common psychological and psychosexual symptoms, respectively. Menstrual irregularities occurred in 35 per cent of women. Fifty-four per cent of patients recognised the `change of life' and sought treatment while 46 per cent did not. The treatments offered locally were: hormonal tablets (88 per cent), intramuscular hormonal injections (12 per cent) and psychotropic drugs (12 per cent). Osteoporosis as measured by fractures of the lower limbs and hip, occurred more commonly in females than in males. Fractures did not increase with age in a linear fashion as occurred in the North American population. This study suggests that women in Trinidad do not fully recognize the short- and long-term medical implications of the menopause and the climacteric syndrome. It suggests that family practitioners should ask about sypmtoms in the perimenopausal years and treat them with modern methods to possibly decrease the long-term sequelae. It suggests that the Caribbean female is possibly less prone to osteoporosis than her North American counterpart (AU)

A knowledge, experience and attitude study of menopause among public health nurses and women without health training in Jamaica and Trinidad and Tobago

This study compares the knowledge and attitudes of four groups of women within the menopausal phase, 40 to 60 years of age. Public health nurses (PHNs) and women without health training (WWHTs) were studied in both Trinidad and Tobago and Jamaica. The study was done during December 1989 and March 1990 using an original questionnaire to collect the data. The findings, based on the data collected from 88 respondents in Jamaica and 90 in Trinidad, showed that women were well aware of the term "menopause" but were not fully knowledgeable of its cause and effects. It also showed that both groups of women in both countries knew most of the symptoms of menopause and were conscious that certain conditions arising at the onset of menopause presented problems to the well being and health of women. The study further showed that while PHNs knew more of the technical facts of menopause, their general knowledge and understanding of the condition was not greater than that of WWHTs. In both groups, actual experience of menopause indicated more knowledge and a better understanding of the conditions. The study suggests the need for:- (a) special attention to be given to the menopause as an important aspect of the development of women; (b) the training and retraining of medical personnel; (c) the organization of clinics and further research in specific areas that have an impact on the lives of those experiencing menopause. The propagation of counselling programmes, and educational activities aimed to raise consciousness and alleviate problems, have been identified (AU)

Re-evaluation of diagnostic uterine dilatation and curettage: a review of 203 patients

Two hundred and three patients were reviewed to assess the efficacy of diagnostic uterine dilatation and curettage. Thirteen (6.4 percent) had define pathological changes of the endometrium; of the four patients with endometrial carcinoma, 3 presented with post-menopausal bleeding. Anaemia was present in 11.3 percent of those with menorrhagia. The complication rate was 3.4 percent and the mean hospital stay, 3 days. It is suggested that in pre-menopausal women with annormal uterine bleeding, medical management and outpatient endometrial biopsy should be the preferred diagnostic approach. For post-menopausal women, curettage under general anaesthesia remains the diagnostic method of choice (AU)

Benign epithelial mesothelioma of the corpus uteri

A case of epithelial mesothelioma of the myometrium in a 55-year-old post-menopausal patient is reported. The tumour occurred as an incidental finding in the uterus which was removed for fibroids. The histogenesis, differential diagnosis and prognosis of this rare uterine tumour are discussed (AU)

Some factors influencing the development of atherosclerosis: A survey in Jamaica, West Indies

Using a quantitative method of assay the degree of atherosclerosis of the aorta, coronary arteries and cerebral arteries has been determined in a large, predominantly Negro, autopsy series in Jamaica, West Indies. There is a progressive worsening of the disease with age but there are considerable individual variations at all ages. The aorta, coronary and cerebral arteries are affected in that order in time and severity. Atherosclerosis is generally more severe in men and hypertension accentuates the disease, especially in women after the menopause. Hypertension is more important than atherosclerosis in causing cerebrovascular disease in Jamaica. Diabetes alone does not seem to influence adversely the development of atherosclerosis except in combination with hypertension. Evidence for the effect of malignant disease was inconclusive. Severe degrees of atherosclerosis are encountered in the Jamaican Negro but the supposed complications are relatively uncommon. This supports the view that factors other than initial disease, principally those connected with thrombosis, are concerned in the pathogenesis of ischaemic vascular disease. (AU)