The medicalization of menopause: implications for recruitment of study participants.

OBJECTIVE: Early studies of menopause recruited sample populations from clinical settings; however, in the 1970s, populations drawn from health care settings were characterized as nonrepresentative because of symptom overreporting. This pilot study was carried out to test whether this characterization still holds true: that women who are drawn from clinical settings report more symptoms compared with women who are recruited from community and work sites. DESIGN: Open-ended interviews were carried out with patients aged 40-60 years in a physician's office (n = 50), in a chiropractor's office (n = 24), at two Breast Health Project sites (n = 50), and in several non-health care sites in the community (n = 81). Interviews were supplemented by anthropometrics and standardized return-by-mail questionnaires. RESULTS: Women who experienced hot flashes and sweating were more likely to report having spoken with a physician about menopause. However, women who were drawn from the clinical setting were not significantly more likely to describe hot flashes, sweats, or mood changes and were significantly less likely to report headaches in relation to menopause compared with a community sample. Women who were drawn from the physician's office were more likely to use hormone replacement therapy and to have had a hysterectomy. CONCLUSIONS: This study suggests that because of the medicalization of menopause, we need to rethink our assumptions about the characteristics of populations drawn from health care settings. In western Massachusetts, place of recruitment did not predict symptom frequency.

Early age at menopause among left-handed women.

Associations have been suggested between handedness, autoimmune disorders, and reproductive hormonal changes. The purpose of this study was to test a proposed relationship between handedness and age at menopause. Two national survey data sets were used to compare recalled ages at menopause. Mexican-American women, ages 35-74, naturally postmenopausal for at least 1 year, were selected from the Hispanic Health and Nutrition Examination Survey (HHANES). White and black women were selected from the National Health and Nutrition Examination Survey (NHANES-I) using similar criteria. The mean age at menopause was found to be earlier among left-handed women than right-handed women from the NHANES-I data set. In the HHANES data set, the mean age at menopause was significantly earlier among left-handed women than in right-handed women (t = 2.35, P less than .05). Early age at menopause among left-handed women may result from misclassification of handedness among older women or differential mortality among left-handed individuals. Alternatively, the association may be related to possible correlations between left-handedness and autoimmune disorders, which may include reactions against hormone receptor sites and oocytes.

Is follicular atresia biphasic?

OBJECTIVE: To examine the rate of human follicular depletion and the interpretation of curved scatters on log-linear plots. DESIGN: Four mathematical models were tested with use of data drawn from published autopsy studies and histologic analyses of ovaries. SETTING: None. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): None. RESULT(S): Human oocyte depletion data do not support the inference of a biphasic follicular atresia. On original measurement scales there is no perturbation in the data between ages 37 and 40, and the instantaneous rate of follicle loss is lower after age 40 than ever before. CONCLUSION(S): There is no abrupt increase in the "rate" of follicular atresia that corresponds with a drop in fecundability or an increase in risk of chromosomal abnormalities at approximately age 38. The apparent abrupt increase in rate of follicular depletion is an artifact of log-linear transformation.

Symptoms of menopause in relation to the timing of reproductive events and past menstrual experience.

The framework of the lifespan approach is used to examine the frequency of symptoms associated with menopause. Symptom frequencies are examined in relation to past menstrual symptom experience and the timing of reproductive events. Data were drawn from a cross-sectional community survey carried out in Greene County, New York. The symptoms most often reported were hot flashes, irritability, mood changes, sweating, and headaches. Frequencies of vasomotor symptoms (hot flashes, sweating) were highly correlated. Frequencies of psychological symptoms (irritability, mood change) were also highly correlated. Neither vasomotor nor psychological symptoms were associated with parity, age at menarche, or ages at first and last childbirth. Frequency of hot flashes was significantly associated with post-menopause status, later age at natural menopause, and fewer years of education. In contrast, frequency of psychological symptoms was not related to menopause status, age at natural menopause, or years of education. Menstrual abdominal cramps and leg cramping were associated with hot flash frequency at menopause, but not frequency of menopausal mood change. In contrast, menstrual bloating and mood changes were associated with menopausal irritability and mood change. Self-reported vasomotor and psychological symptoms demonstrated dissimilar relationships to lifespan events. It is difficult to determine, however, which dimension of the lifespan (biological, sociocultural, or psychological) is involved in determining differences in menopansal symptom frequencies. © 1996 Wiley-Liss, Inc.

Timing of menopause in relation to body size and weight change.

Age at menopause was examined in relation to weight and body mass index (BMI) (kg/m2) in 105 women,. age 41 years and older, who recalled the date of their last menstrual period to be at least 12 months before the interview. Mean recalled age at menopause was 49.3 years (SD 4.8); median age at menopause, by probit analysis, was 49.96. Age at menopause was negatively correlated with weight (r = -0.252, p < 0.05) and BMI (r = -0.204, p < 0.05) at interview; however, weight at time of interview is not necessarily an accurate indicator of weight at the time of menopause. Among women who did not report a gain or loss of 50 pounds across adulthood (n = 59) there was no significant correlation between weight or BMI and age at menopause. Age at menopause was earlier among women who reported weight losses of 50 or more pounds across adulthood (p < 0.01). In addition, age at menopause was earlier among women who reported weight gains of 100 or more pounds, although this difference was not significant at p < 0.05. Further attention should be given to weight change in relation to the timing of menopause.

Biological aspects of menopause: across the lifespan.

"This review outlines the biological basics of menopause and then places menopause within the context of a dynamic lifespan. The basic tenets of the lifespan approach maintain that, for each individual, aging and development are lifelong processes from birth to death; biological, psychological, and sociocultural trajectories interweave across the life course; the entire lifespan serves as a frame of reference for understanding particular events or transitions; and the life course can be affected by environmental change.... This review also points to the gap between population-level studies of menopause and studies carried out at the biochemical, cellular, or organ systems level. Filling this gap...offers the most interesting directions for future anthropological research."