The menopause in a Caribbean setting: does it differ? - abstract

ABSTRACT

The aim of this study was to assess the menopause, the climacteric syndrome and its management by local practitioners. The long-term implications of the menopause were assessed by comparison of osteoporotic fractures in the local population against a North American population. Seven hundred and seventy women between the ages of 40 and 60 years were asked to respond to a mailed questionnaire to assess the menopause, the climacteric syndrome complex and its treatment. The long-term implications of the menopause were assessed by observing the incidence of lower limb fractures (neck of femur, etc.) in females (cases) and males (controls) over the age of 50 years, in Trinidad. This local incidence was then compared with a similar age and sex distribution in a North American population. One hundred and fifty-four or 20 per cent of the 770 women over age 40 years responded to the questionnaire. The mean age of the natural and surgical menopause was 47 years and 43 years respectively. The climacteric syndrome complex occurred as shown (table given). This syndrome occurred in 62 per cent of patients before the menopause and in 38 per cent after the menopause. Irritability (80 per cent) and decreased libido (64 per cent) were the most common psychological and psychosexual symptoms, respectively. Menstrual irregularities occurred in 35 per cent of women. Fifty-four per cent of patients recognised the `change of life' and sought treatment while 46 per cent did not. The treatments offered locally were hormonal tablets (88 per cent), intramuscular hormonal injections (12 per cent) and psychotropic drugs (12 per cent). Osteoporosis as measured by fractures of the lower limbs and hip, occurred more commonly in females than in males. Fractures did not increase with age in a linear fashion as occurred in the North American population. This study suggests that women in Trinidad do not fully recognize the short- and long-term medical implications of the menopause and the climacteric syndrome. It suggests that family practitioners should ask about sypmtoms in the perimenopausal years and treat them with modern methods to possibly decrease the long-term sequelae. It suggests that the Caribbean female is possibly less prone to osteoporosis than her North American counterpart (AU)