Medication Use and Sexual Function: A Population-Based Study in Middle Aged Women.

INTRODUCTION: Medications used to treat chronic diseases have contributed to increasing longevity and improving quality of life. These medications are considered an indispensable resource in the management of most treatable diseases. However, they can affect sexual function through their effects on the central or the peripheral nervous system or due to hormonal effects. AIM: To evaluate the association between the use of medication for chronic diseases and sexual dysfunction in Brazilian women 45-60 years of age. METHODS: A secondary analysis of household survey data from a previous cross-sectional, population-based study conducted with a sample of 749 women of a population of 257,434 female urban residents in the age bracket of interest. Sexual function was evaluated using the Short Personal Experiences Questionnaire (SPEQ). Associations between the use of medication and sexual function were evaluated, as were correlations with other variables. MAIN OUTCOME MEASURE: We found associations of the individual SPEQ domains with the use of some medications. RESULTS: Mean age of participants was 52.5 ± 4.4 years. Mean age at menopause was 46.5 ± 5.8 years. The overall prevalence of medication use was 68.8%, with the drugs predominantly consisting of those used for cardiovascular diseases. In the Poisson regression analysis, sexual dysfunction, as based on the overall SPEQ score, was associated with sexual inactivity (prevalence ratio [PR] = 4.05; 95% CI 3.16-5.20; P < .001), a sedentary lifestyle (PR = 1.49; 95% CI 1.06-2.09; P = .021), and untreated anxiety (PR = 1.44; 95% CI 1.08-1.92; P = .014). Analysis of the individual SPEQ domains revealed that women who scored low in the desire domain were more likely to use antihypertensive agents (P = .019), whereas a lower score for the arousal domain was associated with the use of antidepressants, with treatment for osteoarticular diseases and with polypharmacy (P = .003). Women with lower scores in the satisfaction domain were more likely to use antidepressants, drugs for osteoarticular diseases, diabetes medication, and polypharmacy (P = .019). A lower score in the orgasm domain was associated with the use of antidepressants, the treatment of osteoarticular diseases, and diabetes (P < .001). Hormone therapy proved protective against loss of libido (P = .036). CLINICAL IMPLICATIONS: Some medications can interfere with sexual function negatively and, clinicians have to be aware of it to choose the treatment with fewer collateral effects. STRENGTH & LIMITATIONS: The strength of our study is the large, population-based sample of middle-aged women evaluated for sexual dysfunction with the SPEQ. However, it was a self-reported cross sectional study. CONCLUSION: This study found no association between the use of medication for chronic diseases and the overall SPEQ score, whereas untreated anxiety was 1 of the main factors associated with female sexual dysfunction. On the other hand, medical treatments were found to contribute to lower scores in the different sexual function domains. Common drug culprits included antihypertensives, antidepressants, treatment for osteoarticular disease, diabetes medications, and polypharmacy. Hormone therapy protected against loss of libido. Gueldini de Moraes AV, Ribeiro Valadares AL, Lui Filho JF, et al. Medication Use and Sexual Function: A Population-Based Study in Middle Aged Women. J Sex Med 2019;16:1371-1380.

Opinions and main sources of information about menopause among middle-aged Brazilian women.

OBJECTIVES: The aim of this study was to evaluate women's opinions about menopause and the sources of information they use to deepen their understanding of the topic. METHODS: Population-based study with 749 Brazilian women aged 45 to 60 years. The answers to the question "What is menopause?" were typed and coded, and categories that emerged from the interviewees' own speech were created. The answers to the question: "Where or from whom did you get information about menopause?" were also analyzed. RESULTS: The mean age of women was 52.5 (± 4.4) years. Of them, 68% were postmenopausal. According to 67.5% of the interviewees, the concept of menopause encompassed changes in the menstrual cycle and hormones. For 48%, menopause meant physical changes such as "hot flushes and vaginal dryness." For 22.7%, menopause represented psychological changes. The concept of menopause was associated with some change in sexuality for 7.6% of the interviewees. Approximately 18% could not explain what menopause meant. Regarding the sources of information, 44.5% of the women attributed this knowledge to friends and relatives. Doctors or health services were mentioned by 44.3% of women. Television or radio was cited by 22.0%; magazines, newspapers, or books were cited by 14.0%; and the Internet was cited by 6.8% of women. Fifty-two women (6.9%) reported having no source of information about menopause. CONCLUSIONS: Most of the interviewees relate the term "menopause" to physiological events. There seems to be a suppressed demand for information on the various aspects of the menopausal transition among middle-aged Brazilian women.

Medication use and climacteric syndrome: a cross-sectional population-based study.

OBJECTIVE: The aim of this study was to evaluate medication use during the climacteric period and assess its association with sociodemographic factors, morbidities, and climacteric symptoms. METHODS: Secondary analysis of data from a previous exploratory cross-sectional population-based study, conducted with 749 women (45-60 y), with the help of home interviews. Associations between medication use and climacteric symptoms were analyzed, and their correlations with other variables were made. Univariate analysis was made using the χ test, followed by Bonferroni correction (multiple comparison method). Values were adjusted for age using the polytomic logistic multivariate regression analysis. Using Poisson regression analysis, simple and multiple, we identified the main factors for medication use, with forward stepwise variable selection criteria (95% CI). RESULTS: The mean age was 52.5 years and menopause occurred at 46.5 years (mean). The overall prevalence of medication use was 68.8%. The use of exclusive medications for relieving climacteric symptoms was associated with the absence of diseases (prevalence ratio [PR] = 8.2; 95% CI = 3.5-18.9; P<0.001) and menopause onset between 40 and 44 years (PR = 4.9; 95% CI = 2.0-11.9; P<0.001). Polypharmacy was associated with the highest number of diseases (PR = 10.6; 95% CI = 4.6-24.2; P<0.001) and somatic Menopause Rating Scale (MRS) score >3 (PR = 1.4; 95% CI = 1.01-1.96; P = 0.044). CONCLUSIONS: The prevalence of medication use among middle-aged women was high and was associated with the age of menopause onset, chronic diseases, and obesity/overweight status.

Risk factors associated with intensity of climacteric symptoms in Brazilian middle-aged women: a population-based household survey.

OBJECTIVE: To determine the factors associated with the intensity of climacteric somatovegetative, psychological, and urogenital symptoms among middle-aged women in the Metropolitan Region of Campinas, Brazil. METHODS: A cross-sectional population-based household survey was conducted with 749 women aged 45 to 60 years. The dependent variable was the intensity of menopausal symptoms assessed using the Menopause Rating Scale. The independent variables were sociodemographic data, health-related habits and problems, self-perception of health, and gynecological background. RESULTS: The mean age of the women was 52.5 ±â€Š4.4 years, and the mean age at onset of menopause was 46.5 ±â€Š5.8 years. The intensity of menopausal symptoms was defined using the subscale scores of the median Menopause Rating Scale. Poisson multiple regression for somatovegetative, psychological, and urogenital symptoms showed several associated factors of each subscale, though some factors were common. Factors associated with moderate to severe climacteric symptoms in all the subscales of the Menopause Rating Scale were self-perception of health as "fair"/"poor"/"very poor" (P < 0.01), depression/anxiety (P < 0.01), and osteoarticular diseases (P < 0.01). CONCLUSIONS: The severity of climacteric symptoms in the different Menopause Rating Scale domains was related to a broad set of factors. Each Menopause Rating Scale subscale had its own set of factors, but some were common. Presence of chronic diseases, depression or anxiety, and worst self-perception of health were highlighted. A better understanding of these factors may help to not only reduce the effect of climacteric symptoms on the quality of life of middle-aged women, but also identify groups of women who need multidisciplinary health care.

Does obesity increase the risk of hot flashes among midlife women?: a population-based study.

OBJECTIVE: To evaluate the association between vasomotor symptoms and obesity in climacteric women. METHODS: We conducted a cross-sectional population-based study of 749 women aged 45 to 60 years. The dependent variable was intensity of menopausal symptoms evaluated by the menopause rating scale questionnaire. Independent variables were sociodemographic and clinical characteristics, and obesity evaluated by body mass index. RESULTS: There was no significant difference in the majority of clinical and sociodemographic characteristics between the body mass index groups. Obese women had less physical activity (P = 0.019) and a higher prevalence of hypertension (P < 0.001), diabetes (P = 0.002), urinary incontinence (P < 0.001), and urge incontinence (P = 0.0006). The total mean menopause rating scale score was 9.7. Scores for hot flashes increased progressively and were higher for participants with body mass index greater than 30 kg/m (P = 0.027). Joint and muscle pain scores also increased with increased body mass index (P < 0.001). Regarding urogenital symptoms, there was a significant difference in urinary problems only, which were more intense in obese women (body mass index >30 kg/m) (P < 0.0001). There was no significant difference in any psychological symptoms on the menopause rating scale. Factors associated with hot flash scores were higher body mass index, presence of urinary urgency, and vaginal dryness. CONCLUSIONS: We found that menopausal symptoms, including vasomotor, joint, and urinary symptoms, were related to obesity. Hot flashes were associated with higher body mass index, urinary urgency, and vaginal dryness. Understanding this relationship may contribute to the development of healthcare strategies aimed at minimizing the impact of obesity on several health issues of climacteric women.

Middle-aged female sexual dysfunction and multimorbidity: a population-based study.

OBJECTIVES: The aim of the study was to evaluate the association between multimorbidity and sexual dysfunction in women aged 45 to 60 years in a cross-sectional population-based study in a specific Brazilian city. It was also to evaluate the main factors associated with sexual dysfunction in the group with multimorbidity. METHODS: Cross-sectional population-based study conducted with 736 women (household survey), representative of a population of 257,434 women, to obtain data on multimorbidity and sexual dysfunction, as part of a broader study on women's health. The instrument used to evaluate sexual dysfunction was the Short Personal Experiences Questionnaire. Associations were determined between multimorbidity and sexual dysfunction and sexual dysfunction and demographic, behavioral, and medical characteristics. RESULTS: 53% of the women reported multimorbidity and 49.6% of them reported sexual dysfunction. Multiple regression analysis showed no association between sexual dysfunction and multimorbidity. Sexual dysfunction in the whole sample (with and without multimorbidity) was associated with sexual activity in the last month (prevalence ratio [PR] = 0.27, 95% CI 0.22-0.33, P < 0.001), having physical activity greater than or equal to 2 times a week (PR = 0.70, 95% CI 0.58-0.84, P < 0.001), menopause rating symptoms greater than 8 (PR = 1.25, 95% CI 1.09-1.43, P = 0.002), perimenopausal or postmenopausal status (PR = 1.57, 95% CI 1.13-2.17, P = 0.007), alcohol use greater than or equal to 1 drink/week (PR = 0.81, 95% CI 0.67-0.97, P = 0.025), and anxiety (PR = 1.15, 95% CI 1.01-1.31, P = 0.039). In the group with multimorbidity, the main factors associated with sexual dysfunction were sexual activity in the last month (PR = 0.31, 95% CI 0.25-0.39, P < 0.001), anxiety (PR = 1.33, 95% CI 1.15-1.53, P < 0.001), and physical activity (PR = 0.70, 95% CI 0.56-0.87, P = 0.002). CONCLUSIONS: There was no evidence that multimorbidity was associated with sexual dysfunction in this sample of middle-aged women. The main factors associated with sexual dysfunction in women with multimorbidity in this sample were lack of sexual activity in the last month, physical inactivity, and anxiety. This highlights the importance of sexual activity, psychological health, and physical activity for a satisfactory sexual life in the case of women with multimorbidity.

[Factors associated with menopausal symptoms in women from a metropolitan region in Southeastern Brazil: a population-based household survey]. / Epidemiologia da menopausa e dos sintomas climatéricos em mulheres de uma região metropolitana no sudeste do Brasil: inquérito populacional domiciliar.

PURPOSE: To determine the average age at the onset of menopause and to investigate menopausal symptoms in women in a metropolitan region in Southeastern Brazil. METHODS: A descriptive, exploratory, cross-sectional study was conducted with 749 women (a population-based household survey). The dependent variable was the intensity of menopausal symptoms assessed by th Menopause Rating Scale (MRS). The independent variables were sociodemographic data, health-related habits and problems, self-perception of health, and gynecological background. Statistical analysis was carried out by the χ2 test and Poisson regression using the backward selection criteria. RESULTS: The mean age of the women was 52.5 (± 4.4) years. With regard to menopausal status, 16% were premenopausal, 16% perimenopausal and 68% postmenopausal. The mean age at the onset of menopause was 46.5 (± 5.8) years. The intensity of menopausal symptoms was defined according to the median MRS score and was considered severe for values ​​above 8. Depression/anxiety (PR = 1.8; 95%CI 1.5-2.2; p < 0.01), rheumatic diseases (PR 1.5; 95%CI 1.2-1.7; p < 0.01), self-perception of health as fair/poor/very poor (PR 1.4; 95% CI 1.2-1.7; p < 0.01), history of abortion (PR 1.3; 95%CI 1.1-1.4; p < 0.01), current or previous treatment for menopausal symptoms (PR 1.2; 95%CI 1.1-1.4; p < 0.01), peri- or postmenopausal status (PR 1.4; 95%CI 1.1-1.7; p < 0.01), number of normal deliveries > 1 (PR 1.2; 95%CI 1.02-1.4; p < 0.01) and asthma (PR 1.2; 95%CI 1.01-1.4; p < 0.01) were associated with more severe menopausal symptoms. Older age (PR 0.96; 95%CI 0.96-0.97; p < 0.01) was associated with less severe symptoms. CONCLUSION: The severity of menopausal symptoms was related to a wild range of factors, especially presence of chronic diseases, a larger number of pregnancies, use of hormone therapy, and worse self-rated health. A better understanding of these factors can help to reduce the impact of symptoms on quality of life, and to identify groups of women who are likely to need more care during and beyond menopause.

Epidemiologia da menopausa e dos sintomas climatéricos em mulheres de uma região metropolitana no sudeste do Brasil: inquérito populacional domiciliar / Factors associated with menopausal symptoms in women from a metropolitan region in Southeastern Brazil: a population-based household survey

OBJETIVOS: Avaliar a idade da menopausa e os fatores associados aos sintomas menopausais em mulheres de uma região metropolitana do sudeste do Brasil. MÉTODOS: Um estudo exploratório de corte-transversal foi realizado com 749 mulheres entre 45 e 60 anos (pesquisa de base populacional). A variável dependente foi a intensidade dos sintomas menopausais avaliada através do escore total do questionário Menopause Rating Scale (MRS). As variáveis independentes foram características sociodemográficas, problemas e hábitos de saúde, auto-percepção de saúde e antecedentes ginecológicos. A análise estatística foi realizada com o teste do χ2 e regressão de Poisson. RESULTADOS: A média etária das mulheres entrevistadas foi 52,5 (±4,4) anos. Com relação ao estado menopausal, 16% das mulheres encontravam-se na pré-menopausa, o mesmo número na perimenopausa e 68% estavam na pós-menopausa. A média de idade de ocorrência da menopausa foi 46,5±5,8 anos. A intensidade dos sintomas menopausais foi definida de acordo com a mediana do escore total do MRS e foi considerada severa para valores acima de 8. Depressão/ansiedade (RP=1,8; IC95% 1,5-2,2; p<0,01), doenças osteoarticulares (RP=1,5; IC95% 1,2-1,7; p<0,01), auto-percepção do estado geral de saúde regular, ruim ou péssimo (RP=1,4; IC95% 1,2-1,7; p<0,01), antecedente de algum aborto (RP=1,3; IC95% 1,1-1,5; p<0,01), tratamento para menopausa atual ou prévio (RP=1,2; IC95% 1,1-1,4; p<0,01), estar na perimenopausa ou pós-menopausa (RP=1,4; IC95% 1,1-1,8; p=0,01), número de partos normais >1 (RP=1,2; IC95% 1,02-1,4; p=0,02) e asma (RP=1,2; IC95% 1,01-1,4; p=0,03) se associaram a maior severidade de sintomas menopausais. Apresentar maior idade (RP=0,96; IC95% 0,96-0,97; p<0,01) se associou a menor intensidade de sintomas da menopausa. CONCLUSÃO: A intensidade dos sintomas menopausais está relacionada a um amplo conjunto de fatores. Entender e controlar estes fatores pode auxiliar na ...

PURPOSE: To determine the average age at the onset of menopause and to investigate menopausal symptoms in women in a metropolitan region in Southeastern Brazil. METHODS: A descriptive, exploratory, cross-sectional study was conducted with 749 women (a population-based household survey). The dependent variable was the intensity of menopausal symptoms assessed by th Menopause Rating Scale (MRS). The independent variables were sociodemographic data, health-related habits and problems, self-perception of health, and gynecological background. Statistical analysis was carried out by the χ2 test and Poisson regression using the backward selection criteria. RESULTS: The mean age of the women was 52.5 (±4.4) years. With regard to menopausal status, 16% were premenopausal, 16% perimenopausal and 68% postmenopausal. The mean age at the onset of menopause was 46.5 (±5.8) years. The intensity of menopausal symptoms was defined according to the median MRS score and was considered severe for values ​​above 8. Depression/anxiety (PR=1.8; 95%CI 1.5-2.2; p<0.01), rheumatic diseases (PR 1.5; 95%CI 1.2-1.7; p<0.01), self-perception of health as fair/poor/very poor (PR 1.4; 95% CI 1.2-1.7; p<0.01), history of abortion (PR 1.3; 95%CI 1.1-1.4; p<0.01), current or previous treatment for menopausal symptoms (PR 1.2; 95%CI 1.1-1.4; p<0.01), peri- or postmenopausal status (PR 1.4; 95%CI 1.1-1.7; p<0.01), number of normal deliveries >1 (PR 1.2; 95%CI 1.02-1.4; p<0.01) and asthma (PR 1.2; 95%CI 1.01-1.4; p<0.01) were associated with more severe menopausal symptoms. Older age (PR 0.96; 95%CI 0.96-0.97; p<0.01) was associated with less severe symptoms. CONCLUSION: The severity of menopausal symptoms was related to a wild range of factors, especially presence of chronic diseases, a larger number of pregnancies, use of hormone therapy, and worse self-rated health. A better understanding of these factors can help to reduce ...

Sintomas climatéricos e fatores associados em mulheres HIV soropositivas / Menopausal symptoms and associated factors in HIV-positive women

Introdução: Com o surgimento da terapia antirretroviral ocorreu significativa queda da mortalidade por doenças relacionadas ao HIV, transformando assim esta infecção em uma doença crônica. Com o envelhecimento, maior sobrevida da população infectada e, também, pelo surgimento de novos casos na faixa etária climatérica, tem havido aumento significativo na prevalência de mulheres portadoras desse vírus em idade mais avançada. Estudos atuais sugerem que estas mulheres experimentam a menopausa e o climatério de forma diferente das mulheres soronegativas, tanto pela idade mais precoce da menopausa, quanto por sintomas mais intensos. Objetivo: Em mulheres HIV soropositivas avaliar os sintomas climatéricos e fatores associados. Sujeitos e métodos: Realizou-se um estudo de corte transversal em 537 mulheres, entre 40 e 60 anos, sendo 273 HIV soropositivas e 264 soronegativas. Todas foram submetidas à entrevista para avaliação das características sociodemográficas e sintomas climatéricos. Resultados: A média etária foi 47,7±5,8 anos nas mulheres HIV soropositivas e 49,8±5,3 anos nas soronegativas (p<0,001). Análise bivariada mostrou menor prevalência de sintomas vasomotores no grupo soropositivo (p=0,009), especificamente fogachos (p<0,002) e sudorese (p=0,049). Ressecamento vaginal também foi menos prevalente no grupo soropositivo (p<0,005). Depressão e insônia não apresentaram diferença estatística. Análise múltipla mostrou que os fogachos estiveram associados a estar na peri ou pós-menopausa (RP=2,12, IC95% 1,52-2,94). Ressecamento vaginal foi menos frequente em mulheres sem companheiro (RP=0,67, IC95% 0,49-0,90), e esteve associado à maior idade (RP=1,03, IC95% 1,01-1,06) e a estar na peri e pós-menopausa (RP=1,69, IC95% 1,10-2,60). Depressão esteve inversamente associada com realizar trabalho (RP=0,74, IC95% 0,58-0,96) e diretamente associada à presença de doenças crônicas (RP=1,30, IC95% 1,01-1,067).

The advent of antiretroviral therapy (ART) significantly decreased the mortality caused by HIV-related diseases, transforming this condition into a chronic disease. With the aging of the infected population, the prevalence of HIV in older women increased significantly, a fact that is attributed both to the greater survival of those infected and to the appearance of new cases of the disease in climacteric individuals. Current studies suggest that these women experience menopause differently than seronegative women, trying earlier age of menopause and larger symptomatology. Objective: To evaluate menopausal symptoms and their associated factors in HIV-positive women. Methods: A cross-sectional study was conducted with 537 women of 40-60 years of age, 273 of whom were HIV-positive and 264 HIV-negative. The women were interviewed to obtain data on their sociodemographic characteristics and menopausal symptoms. Results: The mean age of the seropositive women was 47.7 ± 5.8 years compared to 49.8 ± 5.3 for the seronegative women (p<0.001). Bivariate analysis showed a lower prevalence of vasomotor symptoms in the seropositive group (p=0.009), specifically hot flashes (p<0.002) and sweating (p=0.049). Vaginal dryness was also less prevalent in this group (p<0.005). There were no statistically significant differences between the groups with respect to depression or insomnia. Multiple analyses showed that hot flashes were associated with being peri- or postmenopausal (PR=2.12; 95%CI: 1.52-2.94). Vaginal dryness was less common in women without a partner (PR=0.67; 95%CI: 0.49-0.90) and was associated with older age (PR=1.03; 95%CI: 1.01-1.06) and being in the peri- or post menopause (PR=1.69; 95%CI: 1.10-2.60). Depression was inversely associated with being employed (PR=0.74; 95%CI: 0.58-0.96) and directly associated with the presence of chronic diseases (PR=1.30; 95%CI: 1.01-1.067).