Can cognitive behavioral therapy improve vasomotor symptoms and recurrent depression in postmenopausal women?

OBJECTIVE: The aim of this study was to evaluate the effectiveness of cognitive behavioral therapy in the treatment of vasomotor, sexual dysfunction, and recurrent depression in postmenopausal women. METHODS: This prospective, open study evaluated 112 postmenopausal women with vasomotor symptoms. Sexual dysfunction has cultural, social, biological, and emotional issues and divided into two groups: G1, without depression (n=65) and G2, with recurrent depression (n=47). The subjects underwent 12 sessions of in-person cognitive behavioral therapy and 12 sessions of home-based activity over a period of 6 months. They were evaluated at 3 months following the completion of therapy. Depression, memory, and attention-related functions, as well as climactic symptoms, were assessed using a questionnaire. RESULTS: In the depression questionnaire, the G1 group had a lower initial score than the G2 group (p<0.01). Following 6 months of therapy, both groups had similar improved scores. In the depression questionnaire, the women in group G1 had higher baseline values. In the assessment of vasomotor symptoms, the values in both groups were similar and showed an improvement in vasomotor symptoms after 24 weeks of treatment, but these effects disappeared after the follow-up of 48 weeks in the G2 group. Both groups improved the sexual dysfunction after 24 weeks. CONCLUSION: Cognitive behavioral therapy may be effective in reducing vasomotor symptoms and ameliorate the sexual dysfunction and recurrent depression in postmenopausal women after 24 weeks of treatment.

The menopause transition and women's health at midlife: a progress report from the Study of Women's Health Across the Nation (SWAN).

OBJECTIVE: Our initial understanding of the menopause transition (MT) has been framed by clinical samples of women seeking treatment rather than by population-based studies. The Study of Women's Health Across the Nation (SWAN) initiated in 1996 with an overall goal to define the MT, to characterize its biological and psychosocial antecedents and sequelae in an ethnically and racially diverse sample of midlife women. METHODS: This review summarizes the central findings of SWAN to date that can inform women and their healthcare providers about the impact of the MT and midlife aging on overall health and well-being. RESULTS: SWAN characterized changes in reproductive axis and menstrual cycle patterns that informed the development of the reproductive aging staging system Staging of Reproductive Aging Workshop+10; MT-related symptoms and mental health (vasomotor symptoms, sleep complaints, psychological symptoms, cognitive performance, and urogenital and sexual health); and physiological systems and functions (cardiovascular and cardiometabolic health, bone health, physical function performance) that are influenced by the MT. SWAN demonstrated substantial interrelations among these changes and significant racial/ethnic differences in the rate and magnitude of change in multiple health indictors in midlife women. The findings point to midlife as a critical stage for adopting healthy behavior and preventive strategies. CONCLUSIONS: Over the past 23 years, SWAN has advanced our understanding of the impact of the MT and midlife aging on health and well-being in women. SWAN will be instrumental to determine whether MT-related changes during midlife are related to unfavorable health and well-being in early old age.

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.

Transcranial direct current stimulation effects on menopausal vasomotor symptoms.

OBJECTIVE: To assess the effects of transcranial direct current stimulation (tDCS) compared with tDCS-sham on vasomotor symptoms of postmenopausal women. METHODS: Postmenopausal women (N = 30), aged between 45 and 68 years, with at least four episodes of vasomotor symptoms per day, were recruited from a specialized outpatient clinic at a tertiary hospital in the south of Brazil and through a media call after inclusion and exclusion criteria were ensured. Active and tDCS-sham were administered over the motor cortex position (anode electrode) and contralateral supraorbital region (cathode electrode) for 10 consecutive days, except weekends. The number and intensity records of hot flashes were evaluated for 7 days before and along 30 days after the intervention. The Women's Health Questionnaire and the Hamilton Depression Rating Scale were applied to assess the quality of life and the depressive symptoms, respectively. RESULTS: The frequencies of hot flashes per day happened in a similar way in both groups, with a reduction in the first 3 weeks after the intervention. There was a return in hot flash frequencies to baseline in the fourth week (week 0: 79.0 ±â€Š6.2 and 75.8 ±â€Š6.0, week 1: 61.6 ±â€Š9.6 and 57.0 ±â€Š7.8, week 2: 56.8 ±â€Š8.9 and 55.9 ±â€Š7.1, week 3: 56.8 ±â€Š8.9 and 54.2 ±â€Š7.2, week 4: 64.9 ±â€Š10.7, 70.1 ±â€Š8.9; tDCS-sham and tDCS groups, respectively). In the tDCS group, a trend towards a conversion of intensive hot flashes into mild ones was observed. CONCLUSIONS: Our results suggest that the tDCS technique showed small trends on postmenopausal vasomotor symptoms, justifying searches for more effective methods by which tDCS could reduce hot flashes.

An investigation of life circumstances associated with the experience of hot flashes in Campeche, Mexico.

OBJECTIVE: The purpose of this study was to better understand the experience of calores (hot flashes) in the state of Campeche, Mexico, and characteristics of women's lives. This study was carried out to understand the sociocultural context of women's lives before conducting a larger semistructured survey in the same communities. METHODS: Eighty-five women from rural and urban settings participated in open-ended interviews about the menopausal transition, with particular attention to hot flashes. Univariate and logistic regression analyses identified potential determinants of hot flashes. Qualitative responses were analyzed for central themes from the 40 women who experienced "calores" associated with menopause at the time of interview. RESULTS: The word "calores" was used to describe a variety of sensations and experiences related to the hot climate, infections, going in and out of air-conditioning, emotional stress, and physical exertion, as well as the symptom associated with menopause. In quantitative analyses, the likelihood of experiencing hot flashes varied by menopause status and rural/urban residence. In qualitative analyses, themes that characterized the lives of women with hot flashes were as follows: the search for, and the availability of, biomedical care; presence or absence of networks of social support; marital status and quality of the relationship; and occupational stress. CONCLUSIONS: Hot flash questionnaires can elicit different symptom frequencies depending on the language used and the sociocultural context of women's lives. Qualitative findings suggest that the themes most likely to influence the perception and experience of hot flashes in Campeche are biomedicine, social support, marriage, and stress.

Relationship between changes in vasomotor symptoms and changes in menopause-specific quality of life and sleep parameters.

OBJECTIVE: This study characterizes and quantifies the relationship of vasomotor symptoms (VMS) of menopause with menopause-specific quality of life (MSQOL) and sleep parameters to help predict treatment outcomes and inform treatment decision-making. METHODS: Data were derived from a 12-week randomized, double-blind, placebo-controlled phase 3 trial that evaluated effects of two doses of conjugated estrogens/bazedoxifene on VMS in nonhysterectomized postmenopausal women (N = 318, mean age = 53.39) experiencing at least seven moderate to severe hot flushes (HFs) per day or at least 50 per week. Repeated measures models were used to determine relationships between HF frequency and severity and outcomes on the Menopause-Specific Quality of Life questionnaire and the Medical Outcomes Study sleep scale. Sensitivity analyses were performed to check assumptions of linearity between VMS and outcomes. RESULTS: Frequency and severity of HFs showed approximately linear relationships with MSQOL and sleep parameters. Sensitivity analyses supported assumptions of linearity. The largest changes associated with a reduction of five HFs and a 0.5-point decrease in severity occurred in the Menopause-Specific Quality of Life vasomotor functioning domain (0.78 for number of HFs and 0.98 for severity) and the Medical Outcomes Study sleep disturbance (7.38 and 4.86) and sleep adequacy (-5.60 and -4.66) domains and the two overall sleep problems indices (SPI: 5.17 and 3.63; SPII: 5.82 and 3.83). CONCLUSIONS: Frequency and severity of HFs have an approximately linear relationship with MSQOL and sleep parameters-that is, improvements in HFs are associated with improvements in MSQOL and sleep. Such relationships may enable clinicians to predict changes in sleep and MSQOL expected from various VMS treatments.

Measuring hot flash phenomenonology using ambulatory prospective digital diaries.

OBJECTIVE: This study provides the description, protocol, and results from a novel prospective ambulatory digital hot flash phenomenon diary. METHODS: This study included 152 midlife women with daily hot flashes who completed an ambulatory electronic hot flash diary continuously for the waking hours of three consecutive days. In this diary, women recorded their hot flashes and accompanying characteristics and associations as the hot flashes occurred. RESULTS: Self-reported hot flash severity on the digital diaries indicated that the majority of hot flashes were rated as mild (41.3%) or moderate (43.7%). Severe (13.1%) and very severe (1.8%) hot flashes were less common. Hot flash bother ratings were rated as mild (43%), or moderate (33.5%), with fewer hot flashes reported bothersome (17.5%) or very bothersome (6%). The majority of hot flashes were reported as occurring on the face (78.9%), neck (74.7%), and chest (61.3%). Of all reported hot flashes, 32% occurred concurrently with prickly skin, 7% with anxiety, and 5% with nausea. A novel finding from the study was that 38% of hot flashes were accompanied by a premonitory aura. CONCLUSIONS: A prospective electronic digital hot flash diary allows for a more precise quantitation of hot flashes while overcoming many of the limitations of commonly used retrospective questionnaires and paper diaries. Unique insights into the phenomenology, loci, and associated characteristics of hot flashes were obtained using this device. The digital hot flash phenomenology diary is recommended for future ambulatory studies of hot flashes as a prospective measure of the hot flash experience.

Anxiety as a risk factor for menopausal hot flashes: evidence from the Penn Ovarian Aging cohort.

OBJECTIVE: The aim of this study was to identify temporal associations of anxiety dimensions with menopausal hot flashes in women progressing through the menopausal transition. We hypothesized that associations of both somatic and affective dimensions of anxiety with hot flashes increased in the menopausal transition, and that somatic anxiety was an independent risk factor for menopausal hot flashes. METHODS: Hot flashes, anxiety symptoms, hormone levels, and other psychosocial variables were assessed annually for 14 years of follow-up. The 233 women were premenopausal at baseline and continued through 1 year or more after the final menstrual period. Anxiety dimensions were assessed with the Zung Anxiety Scale, a validated measure of affective anxiety and somatic anxiety. Summed item scores were divided by the number of items rated, so that ranges of the two dimensions were comparable. RESULTS: Seventy-two percent of the sample reported moderate/severe hot flashes during the 14-year interval. There was no significant interaction between anxiety dimensions and menopausal stages. When adjusted for menopausal stage, the magnitude of association between somatic anxiety and hot flashes, however, dramatically increased (odds ratio [OR], 3.03; 95% CI, 2.12-4.32; P < 0.001), whereas the association between affective anxiety and hot flashes increased to a lesser extent (OR, 1.27; 95% CI, 1.03-1.57; P = 0.024). Women with high levels of somatic anxiety (top third of the sample) had the greatest risk of hot flashes (P < 0.001). When the anxiety dimensions were considered in combination, the additive effect of high affective anxiety symptoms was minimal, with no significant difference between the group with high affective/low somatic symptoms and the low symptom group in incident hot flashes at each menopausal stage (P = 0.54). In multivariable analysis, somatic anxiety increased the risk of hot flashes more than three times (OR, 3.13; 95% CI, 2.16-4.53; P < 0.001), but affective anxiety was not significantly associated with hot flashes after adjustment for other study variables (OR, 1.19; 95% CI, 0.96-1.48; P = 0.117). Time-lagged somatic anxiety scores significantly predicted hot flashes, with a 71% increase in risk (OR, 1.71; 95% CI, 1.21-2.41; P = 0.002). Time-lagged affective anxiety scores did not predict hot flashes (OR, 1.06; 95% CI, 0.87-1.31; P = 0.58). CONCLUSIONS: This study showed a strong predictive association of somatic anxiety with the risk of menopausal hot flashes. The temporal associations suggest that somatic anxiety is not simply a redundant measure of hot flashes but predicts the risk of menopausal hot flashes and may be a potential target in clinical management of perimenopausal women.

Evaluation of the measurement model and clinically important differences for menopause-specific quality of life associated with bazedoxifene/conjugated estrogens.

OBJECTIVE: This study aims to confirm the factor structure of the Menopause-Specific Quality of Life (MENQOL) questionnaire by using confirmatory factor analysis (CFA) and to determine whether improvements in menopause-specific health-related quality of life (HRQOL) observed with bazedoxifene (BZA)/conjugated estrogens (CE) relative to placebo are clinically meaningful. METHODS: Postmenopausal women with seven or more moderate to severe hot flushes per day (or ≥50 per wk) received BZA 20 mg/CE 0.45 mg, BZA 20 mg/CE 0.625 mg, or placebo for 12 weeks. HRQOL and treatment satisfaction were evaluated using the MENQOL questionnaire and the Menopause Symptoms Treatment Satisfaction Questionnaire, respectively. The structure of the MENQOL questionnaire was evaluated using CFA. To estimate clinically important differences (CIDs) in HRQOL, we used a repeated-measures model to estimate changes in MENQOL domain and total scores using Menopause Symptoms Treatment Satisfaction Questionnaire items as anchors. RESULTS: The CFA model fits the MENQOL data (Bentler's comparative fit index >0.9). CID estimates ranged from 0.5 to 1.2 for the MENQOL domains and total score. Change from baseline in MENQOL vasomotor domain score for BZA 20 mg/CE 0.45 mg and BZA 20 mg/CE 0.625 mg compared with placebo was greater than the estimated CID, as were changes in MENQOL physical domain and total scores for BZA 20 mg/CE 0.625 mg compared with placebo. CONCLUSIONS: CFA confirms the factor structure of the MENQOL questionnaire. Treatment with BZA/CE provides clinically meaningful improvements in HRQOL in a population of postmenopausal women with bothersome vasomotor symptoms.

Aromaterapia e yogaterapia no climatério: Os efeitos de aromaterapia e yogaterapia na qualidade de vida, nos níveis de stress e na intensidade e frequência de fogacho em mulheres na fase do climatério / Aromatherapy and yogatherapy in climacterium: the effects of aromatherapy and yogatherapy on quality of life, stress levels and intensity and frequence of hot flashes in climacteric women

INTRODUCAO: Os sintomas de climaterio podem perturbar intensamente a vida, sendo o fogacho o sintoma de maior incidencia. Aromaterapia e yogaterapia podem oferecer tratamentos eficazes para sintomas de climaterio, em especial o fogacho, por apresentarem mecanismos terapeuticos semelhantes ao eixo fisiologico do fogacho. OBJETIVO PRINCIPAL: Verificar e analisar os desfechos clinicos fisiologicos e psicologicos da aromaterapia olfativa e de exercicios respiratorios de yogaterapia, associados e individualmente, na qualidade de vida, nos niveis de stress subjetivo e na intensidade e frequencia do fogacho de mulheres na fase do climaterio. METODO: Foram avaliadas 85 mulheres na fase do climaterio, das quais 64 participaram da Fase 1 (somente avaliacao) do estudo e 34 participaram da Fase 2 (tratamento). A coleta foi realizada no CEPE-USP. O estudo consiste de um ensaio clinico pragmatico com randomizacao restrita, controlado por grupo controle e placebo, duplo-cego, com intervencao baseada no modelo psiconeuroendocrinoimunologico. Foram realizados tratamentos com inalacao de sinergia aromaterapeutica com ou sem exercicios respiratorios de yogaterapia, durante 12 semanas, duas vezes por semana em sessoes de uma hora. O estudo foi aprovado pelo Comite de Etica em Pesquisa da Escola de Educacao Fisica e Esporte da Universidade de Sao Paulo e foi inscrito no clinicaltrials.gov. RESULTADOS E DISCUSSAO: Os resultados da pesquisa mostraram melhora estatisticamente significante dos sintomas de climaterio para os tres grupos de intervencao. Houve diminuicao significativa do sintoma de fogacho, assim como da queixa de fogacho, sendo que o fogacho foi eliminado em cinco sujeitos. A intensidade e a frequencia de fogacho diminuiram em todos os grupos de intervencao e se mantiveram constantes no grupo controle. O tratamento proposto de aromaterapia se mostrou mais eficaz do que o tratamento proposto de yogaterapia na diminuicao do sintoma de fogacho, quando esses tratamentos eram aplicados isoladamente. A associacao das duas terapias se mostrou benefica, aumentando a eficacia e intensificando a melhora do sintoma de fogacho. Os efeitos globais dos tratamentos variaram intensamente quanto aos outros dominios de sintomas do climaterio. A melhora dos sintomas vasomotores do climaterio (fogacho e suor noturno), foi acompanhada de melhora significativa nos niveis de stress subjetivo, na qualidade do sono e da qualidade de vida em todos os grupos de intervencao. Esse trabalho tambem permitiu discussoes secundarias sobre o climaterio e as terapias, permitindo a sua compreensao a partir do modelo psiconeuroendocrinoimunologico. CONCLUSAO: Esse estudo serviu como um delineamento geral dos sintomas de climaterio, da aromaterapia e da yogaterapia a partir do modelo psiconeuroendocrinoimunologico. Os resultados apresentados nao podem ser generalizados para a populacao por causa da amostra pequena, mas podem indicar os resultados mais promissores e, com isso, esse trabalho pode ser o ponto de partida para novos estudos, auxiliando na elaboracao de questoes de pesquisa claras e metodos de pesquisa adequados para estuda-las.(AU)

INTRODUCTION: Climacteric symptoms can disturb life considerably. Hot flashes are the symptom with highest incidence. Aromatherapy and yogatherapy can offer efficient treatments for climacteric symptoms, specially hot flashes, because their therapeutic mechanisms are similar to the physiological mechanism of hot flashes. MAIN OBJECTIVE: To analyze the psychological and physiological clinical outcomes of olfactory aromatherapy and breathing exercises of yogatherapy, associated or individually, on the quality of life, subjective stress levels and intensity and frequency of hot flashes in women in the climacteric period. METHODS: 85 women in the climacteric period were evaluated, 64 of these subjects participated in Phase 1 (assessment) and 34 participated in Phase 2 (treatment) . Data collection was performed at CEPE-USP. The study consists of a doubleblind, pragmatic clinical trial with restricted randomization, controlled by control and placebo groups. The intervention was based on the psychoneuroendocrineimmunological model. Treatments were performed with inhalation of an aromatherapeutic synergy developed for the study with or without yogatherapy breathing exercises for 12 weeks, twice per week in one hour sessions. The study was approved by the ethics comitte Comite de Etica em Pesquisa da Escola de Educacao Fisica e Esporte da Universidade de Sao Paulo and was registered in clinicaltrials.gov. RESULTS AND DISCUSSION: The results showed statistically significant improvement in symptoms of menopause for the three intervention groups. There was significant decrease in symptom of hot flashes, as well as complaints of hot flashes and this symptom was eliminated in five subjects. The intensity and frequency of hot flashes decreased in all intervention groups and remained constant in the control group. Aromatherapy was more effective than yogatherapy to decrease the symptoms of hot flashes, when these treatments were applied separately. The combination of the two therapies proved beneficial, increasing the effectiveness and enhancing the improvement of the symptom of hot flashes. The overall effects of the treatments varied intensely for other climacteric symptoms. The improvement of vasomotor symptoms of menopause (hot flashes and night sweats), was accompanied by a significant improvement in stress levels, quality of sleep and quality of life in all intervention groups. This research also permitted secondary discussions about climacterium and the therapies, permiting their understanding through the psychoneuroendocrineimmunological model. CONCLUSION: This study served as a general outline of climacteric symptoms, aromatherapy and yogatherapy through the psychoneuroendocrineimmunological model. The results cannot be generalized to the population because of the small sample size. However, the most promissing results can be indicated and this research can be the starting point for further studies, assisting in the preparation of clear research questions and suitable research methods to study them .(AU)

Effect of therapeutic massage on insomnia and climacteric symptoms in postmenopausal women.

INTRODUCTION: Physiological and psychological alterations in the climacteric period frequently influence women's quality of life. Hot flushes, nocturia, mood alterations, respiratory disturbances, insomnia and restless leg syndrome all affect sleep, and the altered hormonal state in this period impacts the aging process. As hormonal therapy is not indicated in some cases, the search for complementary therapies, such as massage therapy, to improve insomnia in the climacteric period is increasing. OBJECTIVE: To evaluate the effect of therapeutic massage on insomnia and climacteric symptoms in postmenopausal women. METHODS: Forty-four volunteers were randomly distributed into three groups: therapeutic massage (TM), passive movement (PM) and control (CTL). The women received 32 therapeutic massage sessions and passive movement twice a week. Questionnaires were given in the pre-trial and the 16th and 32nd sessions. The Insomnia Severity Index (ISI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Menopause Quality of Life questionnaire (MENQOL), Kupperman Menopausal Index and Lipp Symptoms of Stress Inventory were assessed. In addition, the women underwent polysomnography at baseline and post-treatment. Statistical analyses were calculated using Friedman and Wilcoxon non-parametric tests. The level of significance was fixed at p ≤ 0.05. RESULTS: There was an improvement in ISI in the TM group (p = 0.000) and in the PM group (p = 0.001). A decrease in the BDI occurred in the TM group (p = 0.004), and the MENQOL improved in the TM group (p = 0.015). Furthermore, there were no significant differences in polysomnography parameters in the TM group, with only an increase in minimal saturation (p = 0.053). CONCLUSION: The TM group exhibited improved subjective data considering the changes in symptoms according to the ISI and the MENQOL and a decrease in symptoms according to the BDI.

Physical, psychological, and menopause-related symptoms and minor psychiatric disorders in a community-based sample of Brazilian premenopausal, perimenopausal, and postmenopausal women.

OBJECTIVE: The aim of this study was to identify the prevalence of physical, psychological, and menopause-related symptoms and their association with minor psychiatric disorders in premenopausal, perimenopausal, and postmenopausal women. METHODS: This was a nested cross-sectional study. Demographic characteristics, education, and climacteric symptoms were investigated. The 20-item Self-Reporting Questionnaire was used to screen for minor psychiatric disorders, with a score of 8 or higher indicating positive screening. RESULTS: We studied 324 Brazilian women aged 36 to 62 years (86 premenopausal women, 156 perimenopausal women, and 82 postmenopausal women). Mean (SD) age was 44.8 (3.6), 46.3 (4.6), and 53.3 (3.8) years, respectively (P < 0.001); 52.4% had 8 years or less of schooling (whereas 22.8% had 4 years or less). Forty-five (28.8%) perimenopausal women and 32 (39%) postmenopausal women were users of hormone therapy; 15 (17.4%) and 21 (13.5%) premenopausal and perimenopausal participants, respectively, were users of oral contraceptives. Hormone therapy and oral contraceptive users were excluded from the analysis of symptom prevalence. Hot flashes, night sweats, and vaginal dryness were more prevalent among perimenopausal women (P < 0.001). Fatigue was the most frequent complaint in all groups (61%, 81%, and 88% in premenopausal, perimenopausal, and postmenopausal women, respectively). The variables most frequently associated with positive findings during the screening for minor psychiatric disorders were very low education level and memory loss and irritability. Classic vasomotor complaints were weakly associated with nonpsychotic disease. In turn, perimenopausal women, but not postmenopausal women, were at greater risk of minor psychiatric disorders. CONCLUSIONS: Low education level, memory loss, irritability, and the menopausal transition represent risk factors for positive findings in a screening for minor psychiatric disorders.

Beliefs regarding menopausal hot flushes among climacteric women as assessed with the Hot Flush Beliefs Scale.

BACKGROUND: Hot flushes (HFs) and night sweats are frequent complaints among both peri- and postmenopausal women. Beliefs regarding these complaints may vary from one population to another. OBJECTIVE: To assess HF beliefs and factors related to negative beliefs in a climacteric Hispanic population using the Hot Flush Beliefs Scale (HFBS). METHODS: A total of 1154 healthy women (40-59 years) were assessed with the Menopause Rating Scale (MRS), those presenting HFs were requested to fill out the HFBS and a questionnaire containing socio-demographic data (female and partner). RESULTS: A total of 646 presented HFs (56%) graded according to the first item of the MRS as mild (28.6%), moderate (33.2%), severe (29.1%) and very severe (9.1%). Mean age of these women was 49.5+/-5.2 years, with 51.9% having 12 or less years of education, 61.5% being postmenopausal and 47.2% living in high altitude. At the moment of the survey 13.9% were on HT, 12.8% on phytoestrogens and 7.1% on psychotropic drugs. Women strongly disagreed in more negatively oriented items of those contained in subscale one (beliefs about self in social context). Contrary to this, women strongly agreed in more negative oriented items contained in subscale two which assesses beliefs about coping with HFs. Women presenting with severe-very severe HFs displayed higher HFBS total and subscale scores indicating a more negative belief regarding HFs. Logistic regression analysis determined that HF severity was related to higher HFBS scores for the total and subscales one and two. Current smoking, higher parity, lower female education, female psychiatric consultation, time since menopause and partner unhealthiness and alcohol consumption were also related to higher HFBS scorings. Postmenopausal status and church attendance were related to lower scores. CONCLUSION: In this mid-aged Ecuadorian female series negative beliefs regarding HFs were related to the severity of HFs and individual female or partner characteristics. Data provided from clinical research using this tool, alone or in combination with other tests, is warranted.

Perceived control over menopausal hot flushes in mid-aged women.

BACKGROUND: Hot flushes (HFs) and night sweats are frequent complaints among both peri- and postmenopausal women. Perceived control of this complaint may vary from one population to another. OBJECTIVE: To assess perceived control over menopausal HFs and determinant factors among mid-aged Ecuadorian women. METHODS: In this cross-sectional study healthy women aged 40-59 years, seeking healthcare centres of eight main cities of Ecuador with more than 100,000 inhabitants, were assessed with the Menopause Rating Scale (MRS) and those presenting HFs were requested to fill out the Perceived Control Index (PCI) and a questionnaire containing socio-demographic data (female and partner). RESULTS: A total of 1154 women participated in this study of which 56% presented HFs (n = 646). According to the MRS, 29.1% and 9.1% of these HFs were graded as severe and very severe, respectively. Mean age of women presenting HFs was 49.5 +/- 5.2 years, with 51.9% having 12 years or less of education, 61.5% being postmenopausal and 47.2% living in high altitude. At the moment of the survey 13.9% were on hormone therapy, 12.8% on phytoestrogens and 7.1% on psychotropic drugs. There was a significant decreasing trend for PCI scores (total and difficulty in control items) from one menopausal stage to the next, with no differences observed for time since menopause onset. Despite this, logistic regression analysis determined that HF severity, as determined with the MRS, was the only single predictive factor related to lower HF perceived control (total PCI score <38) (OR: 1.83 CI 95% [1.15-2.90], p < 0.01). CONCLUSION: As determined with the PCI, HF severity was related to a lower perceived control among mid-aged women.

Quality of life impairment during the female menopausal transition is related to personal and partner factors.

OBJECTIVE: To assess the female quality of life (QoL) during the menopausal transition and determine factors (personal and partner) related to its impairment. The frequency of menopausal symptoms was also assessed. METHODS: In this cross-sectional study, healthy women aged 40-59 years were asked to fill out the Menopause Rating Scale (MRS) and a questionnaire assessing personal and partner demographic data. RESULTS: During the study period, a total of 409 women were surveyed. Mean age was 47 +/- 5.3 years (median 46). Mean educational level was 13.2 +/- 4.1 years (median 14), with 28.1% having 12 or less years of schooling; premenopausal (42.1%), perimenopausal (24.4%) and postmenopausal (33.5%). At the time of the survey, 9.8% were receiving hormonal therapy (HT) for the menopause, 1.5% were on psychotropic drugs and 1.2% on alternative treatments for the menopausal. Regarding partner profile, 10.3% had erectile dysfunction, 11.2% had precocious ejaculation and 7.3% had abused alcohol. Mean total MRS score was 9.1 +/- 6.4 (median 9); for the somatic subscale, 4 +/- 2.7; the psychological subscale, 3 +/- 2.8 and the urogenital subscale, 2.1 +/- 2.5. Of the surveyed women, 50.6% presented a total MRS scoring of 9 or more (moderate to severe intensity). The four most frequently found symptoms of those composing the MRS were hot flushes (68.9%), sleeping problems (68.4%), depressive mood (55.2%) and irritability (51.6%). After adjusting for confounding factors, logistic regression analysis determined that female age, menopause and partner precocious ejaculation increased the risk for presenting higher total MRS scores (impaired female QoL) whereas HT use, church assistance and partner faithfulness decreased this risk. CONCLUSIONS: A high rate of middle-aged women in this series presented impaired QoL associated to female age and hormonal status and additionally to partner's health and sexual behavior.

Relationship between psychological complaints and vasomotor symptoms during climacteric.

BACKGROUND: It has been suggested that hormonal changes and environmental alterations during the climacteric period are important in the development of psychological symptoms. OBJECTIVE: To evaluate the role of biological and psycho-social factors in the prevalence of climacteric symptoms. DESIGN: Open, cross-sectional, observational and descriptive study. MATERIAL AND METHODS: A total of 300 women between 40 and 59 years of age were evaluated using Greene scale for climacteric symptoms, Cooper questionnaire for psychosomatic symptoms of stress, Smilkstein family apgar for family dysfunction, Duke-UNC questionnaire for social support and Israel scale for vital events. All these tests have been previously validated in Spanish. RESULTS: Postmenopausal women do not have higher prevalence of psychological symptoms, they only have more vasomotor symptoms. Premenopausal women with vasomotor symptoms have more psychological and somatic symptoms and stress, independently of the vital events, family dysfunction or poor social support. Vasomotor symptoms in the premenopause are associated with increased risk of anxiety (OR: 3.7, IC: 1.4-9.7; P<0.008), depression (OR: 8.1, IC: 2.5-26.4; P<0.0005), somatic symptoms (OR: 14.9, IC: 3.4-65.3; P<0.0003), sexual dysfunction (OR: 7.2, IC: 2.5-20.6; P<0.0002) and stress (OR: 7.5, IC: 3.5-15.9; P<0.0001). Negative vital events and family dysfunction increase in minor intensity the risk of anxiety, depression and stress. CONCLUSION: In conclusion, psychological symptoms are frequent in the premenopause and are associated to vasomotor symptoms. This observation links psychological symptoms with menopausal transition and might suggest an organic base in their origin. The negative psycho-social environment is a factor that favours the development of these symptoms.

Sintomas depressivos em mulheres no climatério / Depressive symptoms, in climateric women

De acordo com a hipótese neuro-hormonal, podem ocorrer distúrbio na atividade neurotransmissora cerebral durante o climatério em virtude de redução nas concentrações circulantes de estrógenos, o que poderia levar a sintomas depressivos. Em contraposição, a hipótese do"efeito dominó" propõe que os sintomas depressivos que ocorrem nesse período são secundários aos sintomas vasomotores, e não estão diretamente ligados à privação de estrógenos. O objetivo do presente trabalho é verificar se existe correlação dos mesmos com níveis plasmáticos de hormônio sexuais, bem como, correlação entre sintomatologia depressiva e vasomotora. Foram realizados anamnese e exame físico, dosagem das concentrações séricas de esteróides sexuais e aplicação de escalas de mensuração de sintomas somáticos e de sintomas depressivos em quarenta e duas pacientes entre 46 e 60 anos. Os resultados demonstraram percentual significativo em termos de frequência de sintomas depressivos, observando-se correlação estatística entre os escores da escala de depressão e a intensidade dos sintomas vasomotores(p<0.5). Não se correlacionaram, entretanto, sintomas. Concluímos que os dados obtidos nessa observação seccional estão em concordância com a "teoria dominó"dos sintomas vasomotores