Elevated leptin levels in healthy climacteric women from Northeastern Brazil: an effect of age or adiposity?

OBJECTIVE: Climacterium is associated with elevated leptin levels and increased risk of cardiovascular disorders. Conflicting data diverge on whether high leptin levels in climacterium reflect increasing adipose mass or, at least partially, age-related hormonal changes. This study addresses this issue in women from a Brazilian state with a low human development index. SUBJECTS AND METHODS: A case-control study was conducted, enrolling 136 women from the state of Maranhão, 52 (38.2%) climacteric and 84 (61.8%) non-climacteric. Biometric, biochemical, hormonal and immunological parameters were analyzed. RESULTS: Climacteric women showed a moderately increased waist/hip ratio (0.894 versus 0.834, p < 0.05), sustained body mass index (27.46 versus 28.68, p > 0.05) increased leptin levels (9.59 versus 7.13, p < 0.05) and no evidence of metabolic syndrome. No other parameters were altered. The climacteric cohort didn't show significant body fat gains but displayed a typical age-related redistribution of adipose tissue. Even so, leptin levels were significantly elevated compared with non-climacteric women. CONCLUSIONS: Altogether, these data support the hypothesis that leptin is elevated, at least partially, as a function of age and climacterium and is not necessarily correlated with metabolic dysfunction and systemic inflammation. Further studies are needed to evaluate the impact of higher leptin levels on postmenopausal women. Arch Endocrinol Metab. 2020;64(3):276-81.

Elevated leptin levels in healthy climacteric women from Northeastern Brazil: an effect of age or adiposity?

ABSTRACT Objective Climacterium is associated with elevated leptin levels and increased risk of cardiovascular disorders. Conflicting data diverge on whether high leptin levels in climacterium reflect increasing adipose mass or, at least partially, age-related hormonal changes. This study addresses this issue in women from a Brazilian state with a low human development index. Subjects and methods A case-control study was conducted, enrolling 136 women from the state of Maranhão, 52 (38.2%) climacteric and 84 (61.8%) non-climacteric. Biometric, biochemical, hormonal and immunological parameters were analyzed. Results Climacteric women showed a moderately increased waist/hip ratio (0.894 versus 0.834, p < 0.05), sustained body mass index (27.46 versus 28.68, p > 0.05) increased leptin levels (9.59 versus 7.13, p < 0.05) and no evidence of metabolic syndrome. No other parameters were altered. The climacteric cohort didn't show significant body fat gains but displayed a typical age-related redistribution of adipose tissue. Even so, leptin levels were significantly elevated compared with non-climacteric women. Conclusions Altogether, these data support the hypothesis that leptin is elevated, at least partially, as a function of age and climacterium and is not necessarily correlated with metabolic dysfunction and systemic inflammation. Further studies are needed to evaluate the impact of higher leptin levels on postmenopausal women. Arch Endocrinol Metab. 2020;64(3):276-81

Effect of symptoms of climacteric syndrome, depression and insomnia on self-rated work ability in peri- and post-menopausal women in non-manual employment.

OBJECTIVE: The aim of the study was evaluation of the relationship between severity of symptoms of climacteric syndrome, depressive disorders and sleep problems, and the self-rated work ability of peri-menopausal and post-menopausal women in non-manual employment. MATERIAL AND METHODS: The study included 287 women aged 45-60 years, employed in various institutions as non-manual workers. Work Ability Index, Greene Climacteric Scale, Beck Depression Inventory, and Athens Insomnia Scale were used. RESULTS: The examined peri-menopausal and post-menopausal women in non-manual employment obtained good work ability on the Work Ability Index. The severity of menopausal syndrome, according to the Greene Climacteric Scale, was moderate, placing the examined women between results for the general population of women and the pattern for menopausal women. Depressive disorders ranked between low mood and moderate depression. No depression was observed in 59% of the women, whereas moderate depression was observed in 39%, and severe depression in only 2%. Sleep disorders were on the border of normal range. As many as 46% of the women had no sleep problems, which was on the border of normal range in 36%. Only 19% of the examined women suffered from insomnia. Work ability correlated negatively with depression and insomnia severity, as well as with psychological and vasomotor symptoms of climacteric syndrome, but not to its somatic symptoms. CONCLUSIONS: Preventing the occurrence and treatment of menopausal symptoms, sleep and mood disorders may contribute to maintaining the work ability of women in peri- and post-menopausal age.

Demandas de mulheres no climatério na Estratégia Saúde da Família: estudo descritivo / Demands of women in the climaterium in the Family Health Strategy: descriptive study / Demandas de mujeres durante el climaterio en la Estrategia Salud de la Familia: estudio descriptivo

OBJETIVO: conhecer as principais demandas de mulheres no climatério, atendidas na Atenção Primária à Saúde, a partir dos relatos dos profissionais de saúde. MÉTODO: pesquisa de caráter descritivo com abordagem qualitativa desenvolvida em uma unidade de Estratégia Saúde da Família do município do Rio de Janeiro. Através de um roteiro de entrevista semiestruturado foram entrevistados 17 profissionais de saúde, entre médicos e enfermeiros, finalizando a coleta com a utilização da técnica de amostragem por saturação teórica. As entrevistas foram tratadas por meio da análise de conteúdo temático-categorial. RESULTADOS: as demandas foram: problemas conjugais, perda de libido, dispareunia, ressecamento e atrofia vaginal. CONCLUSÃO: recomenda-se atualização dos profissionais quanto aos conceitos e aos aspectos relacionados ao climatério, visando que suas ações atendam essas mulheres integralmente. IMPLICAÇÕES PRÁTICAS: a atenção à saúde deve considerar questões do âmbito da sexualidade para poder contribuir para a saúde sexual das mulheres na fase do climatério.

AIM: to know the main demands of women in the climaterium, attended in the Primary Health Care, from the reports of health professionals. METHOD: a descriptive research with a qualitative approach developed in a Family Health Strategy unit in the city of Rio de Janeiro. Through a semi-structured interview script, 17 health professionals were interviewed among physicians and nurses, finishing the collection using the technique of sampling by theoretical saturation. The interviews were treated through analysis of thematic-categorial content. RESULTS: the demands were: marital problems, loss of libido, dyspareunia, dryness, and vaginal atrophy. CONCLUSION: it is recommended to update the professionals regarding the concepts and aspects related to the climacteric, aiming that their actions attend these women integrally. PRACTICAL IMPLICATIONS: health care should consider issues of sexuality in order to contribute to the sexual health of women in the climacteric phase.

OBJETIVO: conocer las principales demandas de las mujeres durante el climaterio, atendidas en la Atención Primaria de Salud, a partir de los relatos de los profesionales de salud. MÉTODO: investigación de carácter descriptivo, con abordaje cualitativo, realizada en una unidad de Estrategia Salud de la Familia del municipio de Rio de Janeiro. A través de un programa de entrevista semiestructurada se entrevistaron a 17 profesionales de salud, entre médicos y enfermeros, finalizando el muestreo utilizándose la técnica de muestreo por saturación teórica. Las entrevistas se analizaron por medio del análisis de contenido temático-categorial. RESULTADOS: las demandas fueron: problemas conyugales, pérdida de libido, dispareunia, sequedad y atrofia vaginal. CONCLUSIÓN: se recomienda que los profesionales actualicen los conceptos y los aspectos relacionados al climaterio, para que sus acciones atiendan a esas mujeres integralmente. IMPLICACIONES PRÁCTICAS: la atención a la salud debe considerar cuestiones del ámbito de la sexualidad para poder contribuir a la salud sexual de las mujeres durante el climaterio.

Sexual life of women in the climacterium: A community-based study.

Our purpose of conducting this community-based study was to determine sexual functions of women in climacterium and effects of menopausal symptoms on sexual functions. It was descriptive, cross-sectional, and community-based. The study sample consisted of 282 climacteric women. Menopause Rating Scale (MRS), Female Sexual Function Index (FSFI), and Sexual Satisfaction Scale for Women (SSS-W) were used for data collection. The total score was 13.42 ± 8.82 for MRS, 18.73 ± 9.79 for FSFI, and 82.56 ± 18.07 for SSS-W. Seventy-nine-point four percent of the women had sexual dysfunction. While complaints typical of the climacteric period increased, sexual functions and satisfaction decreased.

Climacteric symptoms in Quechua and Mestizo women from the Andean region of Cusco, Peru: effects of altitude and ethnicity.

BACKGROUND: Latin-American women present a greater severity of climacteric symptoms than women from other parts of the world. Previous studies suggest that this could be due to either its Amerindian crossbreeding or the altitude in which a huge proportion of the Latin-American population lives. OBJECTIVE: To answer this question, climacteric symptoms between Peruvian women ("Hispanic-Mestizas" and "Quechuas") living in similar altitude (around 3000 MASL) were compared. METHOD: This is a cross sectional descriptive study of healthy women of 40-59 years of age living in Departamento de El Cusco, Peru. Using the MRS questionnaire climacteric symptoms were assessed in 395 "Hispanic-Mestizas" (Quechua-Spaniard breeding) and 376 pure "Quechuas". RESULTS: The "Quechuas" compared with "Hispanic-Mestizas" have comparable similar age, but less: obesity, schooling years, cigarette smoking, use of hormonal therapy, diabetes and hypertension; and a greater: proportion of postmenopausal women and number of children. "Quechuas" showed a greater prevalence in ten of the eleven symptoms evaluated by the MRS scale, except for insomnia. The total MRS score was 14.54±7.51 vs. 9.87±6.26 (p<0.0001), respectively. As a consequence of this, 46.5% of the "Quechuas" had a deteriorated quality of life due to severe climacteric symptomatology, compared to only 14.2% of "Hispanic-Mestizas" women (p<0.0001). After adjusting for confounding variables menopause was associated with increased risk of severe menopausal symptoms (OR: 5.86, 95% CI: 3.93-8.75), followed by lack of partner (OR: 3.52, 95% CI: 1.91-6.48), arterial hypertension (OR: 2.62, 95% CI: 1.28-5.39) and Quechua being (OR: 2.38, 95% CI: 1.27-4.45). CONCLUSIONS: Peruvian "Quechuas" women have severer climacteric symptoms than the Peruvian "Hispanic-Mestizas" who live in a comparable altitude. This could suggest that the ethnicity could be one of the factors that could explain the augmented symptoms in Latin-American climacteric woman.

Respuesta sexual en mujeres de edad mediana trabajadoras de la salud / Sexual response in mean age health workers women

Introducción: la incorporación al trabajo insertado y el escenario laboral son factores sociales implicados en la función sexual de la mujer en etapa reproductiva, sin embargo, sus significados no están bien establecidos en la mujer en etapa de climaterio.Objetivo: identificar algunos aspectos relativos a la respuesta sexual en mujeres de edad mediana que laboran en centros de salud de Ciudad de la Habana. Métodos: estudio descriptivo transversal que consistió en entrevistar a las 59 mujeres de edad mediana que respondieron a la convocatoria de participar en el estudio, todas trabajadoras de 2 centros asistenciales del sector salud del municipio San Miguel del Padrón, en Ciudad de La Habana, y todas con edades entre 38 y 59 años y con pareja sexual estable. Se empleó una encuesta autoadministrada para explorar aspectos sociodemográficos, y cambios en la respuesta sexual (deseo, excitación y orgasmo) en los últimos 6 meses. Como variables a controlar se utilizaron: la edad actual, la etapa de climaterio, las características de las relaciones de pareja y la sobrecarga de género. Se emplearon estadígrafos descriptivos y ANOVA para establecer diferencias entre grupos (valor de p< 0,05 para significación estadística).Resultados: la mayoría de las encuestadas refirió no experimentar cambios en las características de la respuesta sexual. La disminución de cualquiera de las fases de la respuesta sexual estuvo relacionada con las características de las relaciones de pareja, con una mayor edad de la mujer y con etapa de posmenopausia, resultados similares a otros reportes realizados en mujeres con iguales características sociodemográficas que no trabajaran en el sector salud. No se identificó influencia de la sobrecarga de género sobre la respuesta sexual.Conclusiones: los aspectos relativos a la respuesta sexual identificados en el grupo de mujeres de edad mediana fueron similares a los de otros reportes nacionales e internacionales. No se confirma que el escenario laboral escogido tuviera influencia (negativa o positiva) sobre la respuesta sexual de las mujeres evaluadas(AU)

Introduction: to be incorporated into work and the working environment are social factors involved in sexual function of woman in reproductive stage, however, its meanings are not well established in the woman in climateric stage. Objective: our objective was to identify some features related to sexual response in mean age women working in health centers of Ciudad de La Habana. Methods: a cross-sectional and descriptive study was conducted to interview 59 mean age women participant in such study working in two assistance centers of health sector from the San Miguel del Padrón municipality in Ciudad de La Habana aged between 38 and 59 and with a stable sexual partner. A self-administered opinion poll was used to explore the sociodemographic features and the changes in sexual response (desire, excitation and orgasm) during the past months. The variables to be controlled were: present age, climateric stage, features of partner relationships and genre overload. Descriptive stadigraphs were used and ANOVA to establish differences among groups (value of p < 0,05 for statistical significance). Results: most of polled persons expressed no change in sexual response features. Decrease of any of the sexual response phases was related to the partner relationships features, with a older age of woman and to the menopause stage, results similar to other reports made in women with similar sociodemographic features no workers of health sector. Influence of genre overload over sexual response was not identified. Conclusions: features related to sexual response identified in the mean age women group were similar to those of other national and international reports. It is not confirmed that the working scenario selected had influence (negative or positive) on the sexual response of study women(AU)

Climacteric complaints among very low-income women from a tropical region of Brazil.

CONTEXT AND OBJECTIVE: Climacteric symptoms may vary between different countries and cultures. Socioeconomic factors and climate may be implicated. The aim of this study was to identify climacteric symptomatology among very low-income Brazilian women, living in a hot and humid region. DESIGN AND SETTING: This cross-sectional population-based study was conducted in Cuiabá, at Júlio Müller University Hospital, a tertiary institution. METHODS: The study enrolled 354 climacteric women. The variables analyzed were social class, symptomatology and abnormal concurrent conditions. The study was approved by the hospital's research ethics committee. RESULTS: Sixty-five percent of the participants (232/354) were very poor and had had little schooling. The number of symptoms per woman was 8.0 +/- 5.7. Hot flushes, nervousness, forgetfulness and fatigue were each found in nearly 60.0%. Tearfulness, depression, melancholy and insomnia were also frequent. Sexual problems were reported by 25%. The most relevant concurrent abnormal conditions reported were hypertension (33.9%), obesity (26.5%), arthritis/arthrosis (15.0%) and diabetes mellitus (9.6%). Hot flushes were associated with tearfulness, nervousness and forgetfulness. CONCLUSION: Brazilian climacteric women of low income and low schooling present multiple symptoms. Vasomotor and psychosexual symptoms were the most prevalent disorders. Hot flushes were associated with nervousness, forgetfulness and tearfulness.

Climacteric complaints among very low-income women from a tropical region of Brazil / Sintomas climatéricos em mulheres com baixa renda de uma região tropical do Brasil

CONTEXT AND OBJECTIVE: Climacteric symptoms may vary between different countries and cultures. Socioeconomic factors and climate may be implicated. The aim of this study was to identify climacteric symptomatology among very low-income Brazilian women, living in a hot and humid region. DESIGN AND SETTING: This cross-sectional population-based study was conducted in Cuiabá, at Júlio Müller University Hospital, a tertiary institution. METHODS: The study enrolled 354 climacteric women. The variables analyzed were social class, symptomatology and abnormal concurrent conditions. The study was approved by the hospital's research ethics committee. RESULTS: Sixty-five percent of the participants (232/354) were very poor and had had little schooling. The number of symptoms per woman was 8.0 ± 5.7. Hot flushes, nervousness, forgetfulness and fatigue were each found in nearly 60.0 percent. Tearfulness, depression, melancholy and insomnia were also frequent. Sexual problems were reported by 25 percent. The most relevant concurrent abnormal conditions reported were hypertension (33.9 percent), obesity (26.5 percent), arthritis/arthrosis (15.0 percent) and diabetes mellitus (9.6 percent). Hot flushes were associated with tearfulness, nervousness and forgetfulness. CONCLUSION: Brazilian climacteric women of low income and low schooling present multiple symptoms. Vasomotor and psychosexual symptoms were the most prevalent disorders. Hot flushes were associated with nervousness, forgetfulness and tearfulness.

CONTEXTO E OBJETIVO: Sintomas climatérios podem mudar em diferentes culturas e países. Aspectos sócio-econômicos e clima podem estar envolvidos. Este estudo tem como proposta identificar os sintomas em mulheres climatéricas brasileiras de baixa renda de uma região quente e úmida do Brasil. TIPO DE ESTUDO E LOCAL: Estudo de coorte transversal, realizado no Hospital Universitário Julio Muller em Cuiabá. MÉTODOS: Este estudo incluiu todas as 354 mulheres climatéricas do Distrito Oeste de Cuiabá. Incluiu-se na análise as variáveis classe social, sintomas e doenças coexistentes. Possíveis associações foram examinadas pelo teste chi2 e regressão logística. RESULTADOS: 65 por cento das pacientes eram muito pobres e de baixa escolaridade. O número médio de sintomas referidos por mulher foi de 8.0 ± 5.7. Fogachos, nervosismo, esquecimento e fadiga foram encontrados em quase 60 por cento das mulheres. Choro imotivado, melancolia, depressão e insônia também foram freqüentes. Disfunções sexuais foram relatadas por cerca de 25 por cento das mulheres. Fogachos foram associados com esquecimento, nervosismo e choro imotivado. As doenças coexistentes mais freqüentes foram hipertensão arterial (33,9 por cento), obesidade (26,5 por cento), artrite/artrose (15,0 por cento) e diabetes mellitus (9,6 por cento). CONCLUSÃO: Mulheres climatéricas brasileiras de baixa renda e baixa escolaridade são plurisintomáticas. Os sintomas vasomotores e psicosexuais foram os mais prevalentes. Fogachos foram associados a nervosismo, esquecimento e choro imotivado.

Climacteric symptoms and hormones.

Climacteric symptoms are so closely associated with the menopause to be practically considered its hallmark. However, symptoms can already appear before the onset of menopause. The frequency, extent and intensity of symptoms are dependent on social factors, body composition, race and geographical region. In about 20-25% of menopausal women they do not occur at all. These symptoms are most prominent in women who are suddenly deprived of their endogenous estrogen secretion, for instance by bilateral ovariectomy, particularly in younger women. Climacteric symptoms can to be subdivided into five categories: menstrual bleeding disorders; vegetative symptoms; psychosomatic symptoms; somatotrophic changes; and metabolic changes. For prevention and treatment of the various symptoms, estrogen/progestogen replacement therapy (HRT) or estrogen replacement therapy (ERT) in individualized dosages and various forms of applications are the most cost-effective modalities in order to control menopausal symptoms and restore organic function, or prevent all of this and improve women's quality of life. Recent publications indicate that gene polymorphisms may be associated with severe and persistent climacteric symptoms. This is also true for current and ever cigarette smokers.

[Quality of sleep of climacteric women in São Paulo: some significant aspects]. / Qualidade do sono em mulheres paulistanas no climatério.

OBJECTIVE: To subjectively evaluate the quality of sleep in menopausal women (35 to 65 years of age) METHOD: A questionnaire about personal information, habits/health, sexuality and sleep was administered to 271 women. RESULTS: The sample under study included mostly married women, professionally active with a higher education and financial status, not using menopause hormone therapy, (MHT) habitual coffee drinkers and limited users of alcohol/tobacco. Most participants habitually had dinner and practiced physical exercises. Subjective evaluation of the quality of sleep was considered poor by 29% of the women in this sample. Menopause and self- awareness of health were the only variables that had a statistically significant relation with the quality of sleep. Perimenopausal women (that is to say from 45 years until one year after menopause) and those after surgical menopause stated the worst quality of sleep, while women at pre-menopause disclosed the best quality of sleep. Women who deemed themselves healthy reported a better quality of sleep than those that mentioned health problems. CONCLUSION: quality of sleep worsens during the climacterium and in women that consider themselves sick. Furthermore, there is a considerable lack of knowledge about the basic rules of sleep hygiene among women.

[On clinical application and assessment of Menopause-Specific Quality of Life (Chinese Version)].

OBJECTIVE: To introduce Menopause-Specific Quality of Life (MENQOL) into China, and to evaluate the quality of its Chinese Version. METHODS: MENQOL was translated into Chinese language and the reverse translation was done by several specialists. After retest study on 30 cases, validity, reliability and responsiveness were implemented in 409 cases with menopause syndrome in the multicenter study. RESULTS: 7 components were extracted in factor analysis, and the total cumulative contribution was 59.476%. By correlation analysis, 7 components were divided into four domains: vasomotor, psychosocial, physical and sexual items, same as in the English Version. The test-retest reliability of four domains were 0.806, 0.804, 0.941, 0.940 respectively. Cronbach alpha of four domains were 0.7258, 0.8234, 0.8475, 0.8641 respectively. There had been significant changes after treatment noticed. CONCLUSION: The measurement properties of MENQOL-Chinese Version including effectueness, reliability were met with satisfaction and seemed to be adaptable to Chinese menopause women.

Qualidade do sono em mulheres paulistanas no climatério / Quality of sleep of climacteric women in São Paulo: some significant aspects

OBJETIVO: O climatério é um período de grandes transformações em que a qualidade do sono usualmente se deteriora. O objetivo foi avaliar subjetivamente a qualidade do sono em mulheres no climatério (35 a 65 anos). MÉTODOS: Um questionário contendo informações pessoais, hábitos/saúde, sexualidade e sono foi aplicado a 271 mulheres. RESULTADOS: A amostra estudada constituiu-se principalmente de mulheres casadas, ativas profissionalmente, de alta condição econômica e escolaridade, não usuárias de terapêutica hormonal da menopausa (THM), com hábito freqüente de ingerir café e com pouco consumo de álcool/tabaco. A maioria das participantes tinha hábito de jantar e de praticar atividade física. A avaliação subjetiva da qualidade do sono foi considerada ruim por 29 por cento das mulheres da amostra. A menopausa e a autopercepção de saúde foram as únicas variáveis que exibiram relação estatisticamente significante com a qualidade do sono. Mulheres na perimenopausa (ou seja, entre 45 anos e até um ano após a menopausa) e após menopausa cirúrgica declararam a pior qualidade de sono, enquanto mulheres na pré-menopausa revelaram a melhor qualidade de sono. Mulheres que se consideravam saudáveis informaram melhor qualidade de sono do que as que declararam problemas de saúde. CONCLUSÃO: A qualidade do sono piora durante o climatério e nas mulheres que se percebem doentes; ademais, há um grande desconhecimento de regras básicas de higiene do sono entre as mulheres.

Physicians and the prescription of hormone replacement therapy in Spain.

OBJECTIVES: The purpose of this study was to determine the frequency of hormone replacement therapy (HRT) prescription and identify women's sociodemographic and climacteric factors, as well as variables related to healthcare, associated with the treatment's prescription in women aged 45-65 years in the reference population of a primary healthcare centre in the city of Granada (Spain). METHODS: A descriptive cross-sectional telephone survey was conducted in July 2002 with women aged 45-65 years from the reference population of a primary healthcare centre. The information was gathered using a semi-structured questionnaire specifically developed to gather information on the prescription of HRT. RESULTS: 22.3% of the sample had ever been prescribed with HRT. Regarding compliance with the treatment, 44.2% of the women prescribed with this therapy took it partially, and 8.1% did not begin with the treatment. The variables independently associated with HRT prescription were having the menopause (OR=2.81; IC 95%: 1.08-7.28), having psychological symptoms (OR=2.77; IC 95%: 1.19-6.46), going to see the gynaecologist (OR=4.41; IC 95%: 1.87-10.36), and the fact that the doctor worked in the private healthcare sector (OR=3.55; IC 95%: 0.92-13.65). CONCLUSIONS: The frequency of HRT prescription in Spain is high, as well as the non-compliance rate. Reaching the menopause and going to the gynaecologist are determinant in HRT prescription. It would be desirable to use similar methodological approaches in studies of this controversial therapy, in order to obtain consensus on the real impact on the female population, particularly in view of the results of the latest clinical trials.

Assessment of women in midlife.

BACKGROUND: Midlife is much more than menopause. At the time of their life when women may be experiencing symptoms relating to decreased ovarian function, they are also confronted with a range of physical and psychosocial issues that may affect their wellbeing. OBJECTIVE: This article outlines the range of clinical presentations of women in midlife and discusses assessment of these presentations in the context of the individual woman's life. DISCUSSION: Women in midlife present to doctors for a variety of reasons including information and preventive health, vasomotor or other symptoms of oestrogen deficiency, menstrual disorders, breast disorders, sexual difficulty, relationship and family issues, or mood disorders. Forming an effective doctor-patient partnership to address these issues requires time, empathy, good interpersonal skills, comprehensive and sensitive history taking and examination skills, and a good knowledge of relevant research.

[Survey of health status and healthcare service demand of perimenopausal women in Guangdong].

OBJECTIVE: To understand the health status and healthcare service demand of perimenopausal women in Guangdong Province so as to explore the mode and methods for implementing climacteric and senectitude healthcare. METHOD: Using the method of stratified and cluster sampling and according to the geographical features of Guangdong Province, we selected 4 500 perimenopausal women aged 40-65 years from 5 relatively small cities (representatives of the urban areas) and 4 counties (representatives of the rural areas) for this survey. RESULTS: The average age of natural menopause was 48.6 years in this cohort of women, and was 48.9 years in women from the urban areas and 48.3 years in those from the rural areas. The total incidence of diseases was similar in the urban and rural areas (38.5% vs 39.5%), accounting for an incidence of 39% in the total subjects. The 6 most prevalent diseases were bone and joint disease (12.5%), hypertension (9.2%), myoma of the uterus (6.8%), gastric or duodenal ulcer (5.2%), cardiac disease (2.7%) and diabetes mellitus (2.2%). In bone and joint disease, knee joint disease and lumbar vertebrae disease were the commonest (34.3% vs 32.8%), and the incidence of bone fracture was 2.5%. Perimenopausal syndrome had a prevalence rate of 68.1%, and the most distressful symptoms were sleeplessness, muscular, bone and joint pain, fidgety, dizziness, of which 86.8% were mental symptoms and 86.0% body symptoms. Women(71.2%) with perimenopausal symptoms received no medical treatment, and only 20.5% had ever sought medical care in the department of obstetrics and gynecology, often taking traditional Chinese medicines (53.9%). Only 1.4% of the symptomatic women received hormone therapy, the rate varied from 1.0% in the rural areas to 1.8% in the urban areas. CONCLUSION: Perimenopausal syndrome and its related diseases severely affect the physical and mental health of perimenopausal women, who demand extensive healthcare services.

Longitudinal changes in weight in perimenopausal and early postmenopausal women: effects of dietary energy intake, energy expenditure, dietary calcium intake and hormone replacement therapy.

OBJECTIVE: To investigate whether energy intake or energy expenditure affects 5-7 y weight gain in perimenopausal and early postmenopausal women, and whether hormone replacement therapy (HRT) use or dietary calcium (Ca) intake are contributory factors. DESIGN: Longitudinal, observational study of healthy women around the menopause. SUBJECTS: A total of 1064 initially premenopausal women, selected from a random population of 5119 women aged 45-54 y at baseline. In all, 907 women (85.2%) returned 6.3+/-0.6 y later for repeat measurements. Of these, 36% were postmenopausal (no HRT) and 45% had taken HRT, and 898 women completed the questionnaires. MEASUREMENTS: Weight, height, estimation of energy intake by food frequency questionnaire and physical activity level (PAL) by questionnaire. RESULTS: Change in PAL influenced weight change explaining 4.4% (P=0.001) of the variation. Alterations in dietary energy intake also had a small but significant effect (0.6% P=0.013). Dietary Ca intake had no effect on weight or weight change. CONCLUSION: Mean weight had increased and was influenced more by reduced energy expenditure rather than increased energy intake. HRT and dietary Ca intake did not influence weight gain.

Association of complementary and alternative medicine use, demographic factors, and perimenopausal symptoms in a multiethnic sample of women: the ENDOW study.

Complementary and alternative medicine (CAM) use is common in the United States, particularly among middle-aged women for symptoms commonly reported during perimenopause. The study examined the relationship between women's report of perimenopausal symptoms and the use of CAM and socioeconomic or cultural factors. The prevalence of CAM use was 33%; approximately 94% reported use of CAM therapies and 23% used CAM practitioners. Those who used CAM were younger and better educated; more often they reported pelvic pain and painful intercourse. The only demographic factor to predict use of alternative medicine was education.

Vasomotor symptoms are associated with depression in perimenopausal women seeking primary care.

OBJECTIVE: To compare the relationship between vasomotor symptoms (hot flushes and night sweats) and depression in perimenopausal women with that in postmenopausal and older premenopausal women. DESIGN: Questionnaire data assessing current depressive symptoms (Center for Epidemiologic Studies Depression Scale), hot flushes, night sweats, menopausal status, depression history, hormonal therapy use, and demographic characteristics were collected from women aged 40 to 60 years seeking primary care. Multivariable logistic regression models were used to examine the relationship between vasomotor symptoms and depression. RESULTS: Depression (defined by a Center for Epidemiologic Studies Depression Scale score >/= 25) was observed in 14.9% of 141 perimenopausal women, 13.9% of 151 postmenopausal women, and 7.6% of 184 older premenopausal women. Recent vasomotor symptoms were reported by 53.9% of perimenopausal women, 43.7% of postmenopausal women, and 20.7% of older premenopausal women. Perimenopausal women with vasomotor symptoms were 4.39 times more likely to be depressed than those without vasomotor symptoms (95% CI, 1.40-13.83), an association that did not change after controlling for depression history. In contrast with perimenopausal women, postmenopausal and older premenopausal women with vasomotor symptoms did not have a significantly greater risk for depression than women of the same menopausal status without vasomotor symptoms (adjusted odds ratios, 1.28 and 1.77; 95% CI, 0.47-3.46 and 0.53-5.89, respectively). CONCLUSIONS: Hot flushes and night sweats are associated with depression in perimenopausal women. Further investigation is warranted to elucidate the mechanism by which hot flushes may be associated with depression in perimenopausal women and not in postmenopausal or older premenopausal women.