Do patients lie? An open interview vs. a blind questionnaire on sexuality.

INTRODUCTION: Postmenopausal women are often hesitant to discuss their sexual attitudes and experiences surrounding sexuality with her doctors. Sociocultural, ethnic, and medical background may affect the attitude towards menopause and the expectations regarding sexuality in these women. AIM: To describe communication about sex between patients and doctors and its relation to extrinsic limiting factors. METHODS: A total of 2,332 women between 45 and 64 years old were involved in this cross-sectional survey. The study used an ad hoc questionnaire covering the demographic and reproductive variables as well as the data related to sexual activity. The Cervantes questionnaire was administered to determine the impact of sexuality on health-related quality of life. MAIN OUTCOMES: Patients' responses to anonymous questionnaires or direct interviews. RESULTS: The percentage of women who recognized having occasional or unconventional partners was twofold higher in the anonymous questionnaire than in the clinical interview. In the medical interview only 15.2% of women recognized that sexuality was not very important compared with more than 40% in the anonymous questionnaire (P < 0.001). The highest concordance between the anonymous questionnaire and the clinical interview was in women who referred to not having any sexual relationship at all (88.07%) whereas in the other conditions concordance was significantly lower (P < 0.001). CONCLUSION: Self-reported data on sexuality diverge from those derived from a direct interview. The proportion of women with low interest in sexuality was higher in the blind questionnaires.

Differences in health related quality of life in a sample of Spanish menopausal women with and without obesity.

OBJECTIVE: To investigate whether body mass index, abdominal obesity or fat distribution in postmenopausal women influence their quality of Life. METHODS: A cross-sectional study was carried out on 250 postmenopausal women (age: 50-64 years), with intact uterus and ovaries, sexually active, and non-hormone therapy users. Various anthropometric measurements were considered and a specific health-related quality of life (HR-QoL) instrument, the Cervantes scale, was performed. RESULTS: Thirty-three women were not included as they refused to participate in the study, had chronic disease such as hypertension, diabetes type 2, depression or did not answer all the scale items, so 217 patients were evaluated. According with BMI values, 34% of women were obese, 46.1% were in overweight, 19.8% were in normal weight and there were not underweight women. Any consistent relation was found between BMI and global values of HR-QoL, but obese women were diagnosed with "high level of problems" in the "psychical domain" and in the "sexuality domain". This difference in "sexuality domain" was also appreciated in women with abdominal obesity. Fat or lean mass was not correlated with HR-QoL. CONCLUSION: In our study, obesity did not affect the global HR-QoL in Spanish postmenopausal women, but could have an influence on the psychical and sexual domains. Others anthropometric measurements are not associated with changes in HR-QoL. Additional research with HR-QoL specific and validated instruments and with a longitudinal design seems necessary to confirm our results.

[Health-related quality of life in the Spanish women through and beyond menopause. Development and validation of the Cervantes Scale]. / Calidad de vida relacionada con la salud en la mujer española durante la perimenopausia y posmenopausia. Desarrollo y validación de la Escala Cervantes.

BACKGROUND AND OBJECTIVE: There are numerous health-related quality of life questionnaires but only a few are specific for the menopause. The objective of this study was to develop and validate a specific scale, the Cervantes Scale, for menopause in Spanish women. SUBJECTS AND METHOD: This cross-sectional study included a pilot phase, construction of the questionnaire, validation, and test-retest reliability. A population-based sample of 2,274 women ponderated by age groups and education levels was used in the validation phase. Internal consistency was assessed with the Cronbach's alpha analysis. RESULTS: The final questionnaire included 31 items ("menopause and health" with 15 items made up of vasomotor symptoms, health and aging, "sexuality" with 4 items, "couple relationship" with 3 items and "psychical domain" with 9 items). The Cronbach's (coefficient of the scale was 0.9092. The correlation coefficient of the test-retest was r=0.847 (p<.001). The Cervantes Scale is short, easy to administer (about 7 minutes), has a minimal score of 0 and a maximal score of 155 (from better to worse quality of life) and scores can be compared to reference values in younger women and women of the same age. CONCLUSIONS: The Cervantes Scale is included in the new generation of instruments of health-related quality of life specific for the menopause and is intended to be used in Spanish women aged between 45 and 64 years.

Soy isoflavones, diet and physical exercise modify serum cytokines in healthy obese postmenopausal women.

OBJECTIVES: Evaluate the effect of diet, physical exercise, and a daily oral intake of a soy isoflavones extract (Fisiogen(®)) contained 200 mg of Glycine max, which corresponded to 80 mg of isoflavone (60.8 mg of genistein, 16 mg of daidzein and 3.2 mg of glicitein) on leptin and other adipokines plasma levels in healthy obese postmenopausal women. METHODS: A multicentric randomized longitudinal prospective cohort study was conducted in a sample of 87 healthy obese postmenopausal women. Patients were randomly assigned to a 1200 kcal diet and exercise group (control group) or a group of 1200 kcal diet, exercise, and daily oral intake of daily oral intake of a soy isoflavones extract (Fisiogen(®)) contained 200 mg of Glycine max, which corresponded to 80 mg of isoflavone (60.8 mg of genistein, 16 mg of daidzein and 3.2 mg of glicitein) (soy isoflavones group) along 6 months. Main outcome measures were: anthropometric measures, body composition, leptin, adiponectin, TNF-alpha, homocysteine, C-reactive protein, glucose, insulin, lipid profile and oestradiol serum levels, Kupperman index and Cervantes Scale. RESULTS: Mean serum leptin and TNF-alpha levels declined after 6 months in both groups of the study, but only women in the soy isoflavones group showed a significant increase of mean serum levels of adiponectin. CONCLUSIONS: Diet, physical exercise and daily oral intake of a soy isoflavones extract (Fisiogen(®)) contained 200 mg of Glycine max, which corresponded to 80 mg of isoflavone (60.8 mg of genistein, 16 mg of daidzein and 3.2 mg of glicitein) have a beneficial effect on serum leptin, adiponectin and TNF-α in healthy obese postmenopausal women after 6 months of treatment.

Soy isoflavones, Mediterranean diet, and physical exercise in postmenopausal women with insulin resistance.

OBJECTIVE: The aim of this study was to evaluate whether a standard dose of 40 mg of soy isoflavones prescribed in routine clinical practice for treatment of menopausal symptoms has some influence on glucose homeostasis in postmenopausal women with insulin resistance (IR). METHODS: A total of 116 postmenopausal women with IR were randomly assigned to a group of Mediterranean diet and physical exercise (control group) or a group of Mediterranean diet, physical exercise, and daily oral ingestion of 40 mg of soy isoflavones (soy isoflavones group). Anthropometric measures, Kupperman Index values, Cervantes Scale score, and blood samples for glucose, insulin, lipid profile, creatinine, uric acid, homocysteine, folic acid, vitamin B12, selenium, and estradiol were determined at baseline and at intervals of 6, 12, 18, and 24 months. RESULTS: Mean homeostasis model assessment of IR (HOMA-IR) values remained unchanged from the baseline in the control group but steadily decreased in the soy isoflavones group at 6 months (P = 0.042). There were no statistically significant differences between both groups in mean HOMA-IR scores at baseline, but statistically significantly lower values were found in the soy isoflavones group at 6 months (P = 0.009), 12 months (P = 0.011), 18 months (P = 0.018), and 24 months (P = 0.012). Changes in HOMA-IR values were also clearly related to body mass index (P < 0.001), abdominal circumference (P < 0.001), and treatment (P = 0.044) when a linear regression analysis was carried out. CONCLUSIONS: Daily intake of 40 mg of soy isoflavones together with a Mediterranean diet and exercise reduced IR in postmenopausal women who had IR in the first place. It was significantly better than lifestyle changes alone. If corroborated, this may be a useful intervention for these women.

Impact of anthropometric parameters on quality of life during menopause.

OBJECTIVE: To investigate whether body mass index (BMI), abdominal obesity, and fat distribution in postmenopausal women influence quality of life. DESIGN: Cross-sectional survey. SETTING: Outpatient clinics in the hospital setting and private practices. PATIENT(S): 274 postmenopausal Spanish women, distributed by body phenotype, fat distribution (android or gynoid), and BMI. INTERVENTION(S): The Cervantes scale, a specific health-related quality of life (HRQOL) questionnaire. MAIN OUTCOME MEASURE(S): The quality of life of the obese and overweight patients was compared by age, sex, education, marriage, and municipality with matched healthy normal-weight controls. RESULT(S): Women of the pyknoid phenotype have worse general HRQOL, menopausal symptoms, and psychological and sexuality scores than athletic or lean women. Android fat distribution is also related to low global Cervantes scale scores. All scores on the Cervantes scale worsened with increasing BMI (>or=25). CONCLUSION(S): Pyknoid phenotype, android fat distribution, and a higher BMI are related to poor HRQOL.

Insulin resistence and health-related quality of life in postmenopausal women.

Health-related quality of life (HR-QOL) was similar between the menopausal women with and without Insulin Resistance (IR). However, when IR women with Metabolic Syndrome were considered, a higher level of problems on the HR-QOL global score was found and the difference was mainly due to Health and Sexuality domains.

Selenium and health-related quality of life in menopausal women.

OBJECTIVES: The objective of this study was to evaluate whether there is a relation between serum selenium levels and health-related quality of life (HRQoL) in overweight and obese postmenopausal women. STUDY DESIGN: A cross-sectional study was carried out in 104 overweight and obese postmenopausal women attending a gynaecological clinic for their annual gynaecological examination. MAIN OUTCOME MEASURES: Age, anthropometric parameters, educational level, smoking habits, serum glucose, insulin, lipid profile, C-reactive protein, folic acid, vitamin B12, homocysteine and selenium levels were determined, and the Cervantes Scale was used to evaluate HRQoL. RESULTS: Serum selenium mean value levels were similar in the different groups of HRQoL and there were no differences in the four domains of the Cervantes Scale. When women were classified according to serum selenium tertiles, higher levels of serum cholesterol, low-density lipoprotein cholesterol (LDLc) and triglycerides were found in women in the lowest serum selenium tertile. CONCLUSIONS: In overweight and obese postmenopausal women, serum selenium level is not related to HRQoL but higher levels of cholesterol, LDLc and triglyceride values were detected in women in the lowest serum selenium tertile.

Understanding how personality factors may influence quality of life: development and validation of the Cervantes Personality Scale.

OBJECTIVE: To develop and validate a simple personality scale to be used as a complementary tool for menopause-specific quality-of-life instruments. DESIGN: A population-based random sample of 2,274 Spanish women stratified by age groups and education level was used in the validation phase. The initial 94-item questionnaire was reduced to 20 items by examining the frequency and variability with which women were responding to each of the items. The measurement properties were tested by conducting reliability (internal consistency and test-retest) and validation analyses (correlations, and factor analysis). RESULTS: The final 20-item scale consisted of three domains: introversion (seven items), emotional instability (seven items), and insincerity (control subscale, six items). Cronbach's alpha coefficients for the subscales of emotional instability, introversion, and insincerity were 0.7966, 0.7135, and 0.7042, respectively. The test-retest correlation was r = 0.763 for introversion, r = 0.720 for emotional instability, and r = 0.680 for insincerity (P < 0.001). The Cervantes Personality Scale is short and easy to administer. Scores range from 0 (the most extraverted personality) to 35 (the most introverted personality) for the introversion domain, from 0 (the most emotionally stable personality) to 35 (the most emotionally unstable personality) for the emotional instability domain, and from 0 (the most sincere response) to 30 (the most insincere response) for the insincerity domain. CONCLUSIONS: A novel self-report 20-item scale for assessing three stable personality traits (introversion, emotional instability, and insincerity) in peri- and postmenopausal women is presented. We provide preliminary evidence that the Cervantes Personality Scale is a useful psychometric tool for studying personality in women going through the menopausal transition.