Age at menopause, and knowledge of and attitudes to menopause, of women in Karachi, Pakistan

Secular trends in premature and early menopause in low-income and middle-income countries

BACKGROUND

While secular trends in high-income countries show an increase in the mean age at menopause, it is unclear if there is a similar pattern in low-income and middle-income countries (LMICs), where women's exposure to biological, environmental and lifestyle determinants of menopause may differ. Premature (before age 40 years) and early (ages 40-44 years) menopause could have negative repercussions on later life health outcomes which in ageing societies could mean further stress on low-resource health systems. An evaluation of such trends in LMICs has been hampered by the suitability, quality and comparability of data from these countries.

METHODS

Using 302 standardised household surveys from 1986 to 2019, we estimate trends and CIs using bootstrapping in the prevalence of premature and early menopause in 76 LMICs. We also developed a summary measure of age at menopause for women who experience menopause before the age of 50 years based on demographic estimation methods that can be used to measure menopausal status in surveys with truncated data.

RESULTS

Trends indicate an increasing prevalence of early and premature menopause in LMICs, in particular in sub-Saharan Africa and South/Southeast Asia. These regions also see a suggested decline of the mean age at menopause with greater variation across continents.

CONCLUSIONS

This study enables the analysis of menopause timing by exploiting data generally used for the study of fertility by methodologically allowing the use of truncated data. Findings show a clear increase in prevalence of premature and early menopause in the regions with the highest fertility with possible consequences for later life health. They also show a different trend compared with high-income regions, confirming a lack of generalisability and the importance of accounting for nutritional and health transitions at the local level. This study calls for further data and research on menopause on a global scale.

Menopause knowledge and education in women under 40: Results from an online survey

BACKGROUND

All women experience the menopause, yet education around the topic is limited. Studies conducted in women aged over 40 show that women have limited knowledge about the menopause.

OBJECTIVES

This study aims to understand what women under 40 know about the menopause, how they have acquired this knowledge and where they think menopause education should be taught. This data will help to determine how to effectively deliver menopause education.

DESIGN

A survey was designed that asked women under 40 what they know of, and their attitudes to, the menopause, using Qualtrics XM software.

METHODS

The survey was advertised for 5 weeks on social media. Six questions related to menopause education were analysed. Responses between age groups under 20, 21-30 and over 30 were compared using a chi-square test. A thematic-style analysis was also conducted on a free-text question where answers referred to education.

RESULTS

A total of 738 women's responses were included in the analysis; over 80% had no knowledge or just some knowledge of the menopause. Women over 30 used official websites (p = 0.017) and scientific literature (p = 0.047) significantly more than other age groups to learn about the menopause, while women under 20 were more likely to learn from family members (p = 0.002). These women felt education should start in schools.

CONCLUSION

Many women under 40 have limited education of the menopause. Women under 20 are more passive in their approach to learning about the menopause compared with those over 30, who are more proactive. Menopause education strategies must start at school and extend beyond schools adopting a multifaceted approach; it is recommended that the workplace, social media and public health campaigns are used to deliver menopause education moving forward.

Breast cancer among Asian Indian and Pakistani Americans: A surveillance, epidemiology and end results-based study

Breast cancer incidence is increasing among Asian Indian and Pakistani women living in the United States. We examined the characteristics of breast cancer in Asian Indian and Pakistani American (AIPA) and non-Hispanic white (NHW) women using data from the surveillance, epidemiology and end results (SEER) program. Breast cancer incidence rates were estimated via segmented Poisson regression using data between 1990 and 2014 from SEER 9 registries, including New Jersey and California. Disease characteristics, treatment and survival information between 2000 and 2016 for 4900 AIPA and 482 250 NHW cases diagnosed after age 18 were obtained from SEER 18 registries and compared using descriptive analyses and multivariable competing risk proportional hazards regression. Breast cancer incidence was lower in AIPA than NHW women, increased with age and the rate of increase declined after age of 46 years. AIPA women were diagnosed at significantly younger age (mean (SD) = 54.5 (13.3) years) than NHW women (mean (SD) = 62 (14) years, P < .0001) and were more likely than NHW cases (P < .0001) to have regional or distant stage, higher grade, estrogen receptor-negative, progesterone receptor-negative, triple-negative or human epidermal growth factor receptor 2-enriched tumors, subcutaneous or total mastectomy, and lower cumulative incidence of death due to breast cancer (hazard ratio = 0.79, 95% CI: 0.72-0.86, P < .0001). AIPA had shorter median follow-up (52 months) than NHW cases (77 months). Breast cancer in AIPA women has unique characteristics that need to be further studied along with a comprehensive evaluation of their follow-up patterns.

Effect of ibandronate therapy on serum homocysteine and leptin in postmenopausal osteoporotic females

A significant change in serum leptin level and no change in homocysteine were observed with ibandronate treatment. No correlation of homocysteine and leptin was found with bone mass density (BMD). Results indicate that ibandronate reduces serum leptin levels but how does it help in reducing the osteoporosis. It needs to be explored.

INTRODUCTION

The current study was planned to determine the effects of ibandronate on serum homocysteine and leptin levels in postmenopausal osteoporotic females and to correlate these with BMD.

METHODS

Forty-two newly diagnosed and untreated postmenopausal osteoporotic females were selected on the basis of their BMD (BMD < -2.5) from Orthopaedic Out Patient Department of Shaikh Zayed Hospital, Lahore, Pakistan, and 36, age and BMI matched non-osteoporotic postmenopausal females, were also selected as a control group. Baseline physical and biochemical parameters were compared. In osteoporotic patients, changes in circulating leptin and homocysteine levels were studied after 6 months of therapy with ibandronate (150 mg). The collected data were analyzed on SPSS 16.

RESULTS

There was no significant difference observed in the mean value of all baseline parameters except BMD in both groups. After 6 months of treatment with ibandronate (150 mg), a significant change was observed in serum leptin levels (19.48 ± 1.60 ng/ml vs. 14.09 ± 0.85 ng/ml, p < 0.002), while no considerable change observed in serum homocysteine levels (16.22 ± 0.95 μmol/l vs. 16.80 ± 1.03 μmol/l, p < 0.63). Serum leptin was found significantly correlated with anthropometric parameters. No correlation of serum leptin and homocysteine was found with BMD (r = 0.09, p value = 0.54; r = -0.17, p value = 0.27).

CONCLUSION

Our results show that ibandronate reduces serum leptin levels while it has no effect on serum homocysteine levels. Further studies are needed to explain how the decrease in serum leptin level may help in reducing the progression of osteoporosis.

Assessment of women's awareness level about symptoms and complications of menopause and methods to their prevention

Context: Since menopause age is constant, an increase in life expectancy has resulted in an increase of the menopause period in women. Aims: This study was done to assess women's awareness level about symptoms and complications of menopause and methods of their prevention. Settings and design: This cross-sectional research was conducted on 220 women, 40 years of age or older referrals in selected health care centers. Methods and material: The research was conducted using a questionnaire with regular random sampling method. Statistical analysis used: The analysis of obtained findings was done by SPSS statistical software and statistical tests. Results: Based on their total score, 48.6% of women had good awareness, 24.1% of them had average awareness, and 27.3% of them had low awareness. Eighty-five percent of the participants had read or heard some topics about menopause from their relatives (26.8%), friends (25.5%), health care staffs (20%), books and journals (10.5%), and television or radio (8.6%). Women's awareness level had significant correlation with child number, job, education, income, hearing or reading text about menopause and their informational source, but awareness did not have significant correlation with age and being menopausal. Conclusions: Based on the findings of this study, the rate of participants' correct answers was lower than 50%. Key message: It is suggested to enhance women's awareness level through all sources including television, radio, journals, newspaper and medical staffs, since education is the most important tool in any prevention programs.

Perception and experience regarding menopause among menopaused women attending teaching hospitals in Erbil City

BACKGROUND AND OBJECTIVES

The timing of menopause, perception as well as menopausal symptoms varies between populations and within populations. The main objective of the present study was to assess women's perception and experience regarding menopause, to find out symptoms and mean age of menopause and to study socio-demographic characteristics of menopaused women and to find out its relationship with their age at menopause and their knowledge about menopause.

METHODS

Over a period of eight months a descriptive cross sectional study were carried out at the outpatient departments of four teaching hospitals in Erbil city. A total of 500 menopaused women their age ranged from 40-60 years were interviewed using a close ended self administered questionnaire.

RESULTS

Mean age of menopause was 47.44 years with median age was 48 years, 4.4% had premature menopause and 23.6% had early menopause. The only factors that significantly associated with age at menopause were education and pattern of menstrual cessation and 93.4% of menopaused women were heard about menopause, 56.6% had prior knowledge of menopausal symptoms, cessation of menstruation was positive in 47.0% and 85.8% of women perceive menopause as natural condition and the most common menopausal symptoms were tiredness occurring in 83.2%.

CONCLUSION

Most of menopaused women perceive menopause as natural condition and not aware about hormone replacement therapy and the mean age of menopause is comparable to that mean reported in other part of Iraq. Among menopaused women tiredness was the most common complaint was followed by hot flushes and night sweats.

Early age of natural menopause in India, a biological marker for early preventive health programs

OBJECTIVE

The objective of the study 'Women's health at menopause across India' was to understand the experience of menopause in urban Indian women. The study aimed to ascertain the average age of menopause and its symptomatology, to study the prevalence of chronic diseases, and to understand the health status, health behavior and health needs of Indian women.

METHODS

This is a cross-sectional study of 1765 menopausal women carried out at ten clinical centers managed by gynecologists in urban India. Face-to-face interviews were conducted by gynecologists using a validated structured questionnaire in English.

RESULTS

A total of 1132 (64.14%) of the 1765 women had a natural menopause and 486 (27.54%) had a surgical menopause; 147 (12.99%) women (mean age 35.89 ± 3.02 years) were considered to have premature menopause. Out of 1765 women, 192 women were asymptomatic and 1573 reported symptoms. Vasomotor symptoms were reported by 1211 (75.3%) women and psychological symptoms by 999 (62.01%), physical ailments by 515 (32%) and genitourinary symptoms by 250 (15.53%). Diabetes mellitus was reported by 11.7% and hypertension by 21.9%.

CONCLUSION

The average age of menopause in the sample studied is 46 years. Chronic diseases are on the rise and osteoporosis presents a decade earlier than in Caucasians. These findings can be a basis for further research and help to understand the symptoms, health status and health needs, to formulate guidelines, and to establish menopause clinics for screening and managing women in the transition phase in India.

Prevalence, frequency and problem rating of hot flushes persist in older postmenopausal women: impact of age, body mass index, hysterectomy, hormone therapy use, lifestyle and mood in a cross-sectional cohort study of 10,418 British women aged 54-65

OBJECTIVE

Hot flushes and night sweats (HFs/NSs) are the main menopausal symptoms, but few studies have been adequately powered to examine the dimensions or predictors of experiencing HFs/NSs. We report on these variables in a large UK cohort of postmenopausal women.

DESIGN

Cross-sectional cohort study.

SETTING

UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) cohort.

POPULATION

A cohort of 202,638 postmenopausal women, aged 50-74 years, without oophorectomy, recruited to UKCTOCS between 2001 and 2005.

METHODS

Women completed a follow-up questionnaire, and those aged 54-65 years were mailed a survey in July 2008.

MAIN OUTCOME MEASURES

  Hot flush prevalence and hot flush rating scale.

RESULTS

Of the 15,000 women mailed, 10,418 returned completed questionnaires; 90% had previously had HFs/NSs. Despite being on average 10 years postmenopausal, 54% experienced HFs/NSs (frequency of 33 per week with mean problem rating 4/10) that persisted across the age range. Past hysterectomy (OR 1.50, 95% CI 1.19-1.86), ever having smoked (OR 1.27, 95% CI 1.11-1.46) and alcohol consumption (current units) (OR 1.05, 95% CI 1.01-1.09) predicted ever having had HFs/NSs. Anxiety (OR 3.09, 95% CI 2.57-3.72), hysterectomy (OR 2.74, 95% CI 2.32-3.25), depressed mood (OR 1.57, 95% CI 1.24-1.99), years since last menstrual period (OR 0.95, 95% CI 0.94-0.96) and education (above and below 18 years) (OR 0.98, 95% CI 0.97-0.99) predicted the current prevalence of HFs/NSs. Few predictors of frequency were identified, but problem rating was associated with depressed mood, hysterectomy, skirt size increase and frequency of HFs/NSs. Past hormone therapy users who had discontinued treatment were more likely to have HFs/NSs that were more frequent and problematic.

CONCLUSIONS

To date, this is the largest UK study of the experience of HFs/NSs amongst older postmenopausal women. HFs/NSs are more prevalent in this age band than has previously been assumed. These findings and the associations of smoking, hysterectomy, anxiety, depressed mood and hormone therapy use with the experience of HFs/NSs have implications for prevention and symptom management.

Assessment of the variation in menopausal symptoms with age, education and working/non-working status in north-Indian sub population using menopause rating scale (MRS)

OBJECTIVE

To study the variation of the menopause rating scale (MRS) scores with age, working/non-working and educated/uneducated status in a cohort of north-Indian subpopulation and to look for the possible reasons for the incurred variations. MRS is a well-known and validated instrument for assessing the frequency and intensity of menopausal symptoms.

METHOD

A menopause clinic was organized in collaboration with a primary care centre (under the guidance of a gynecologist). A random sample of 208 women aged 35-65 years participated in the study. The MRS scale, a self-administered standardized questionnaire was applied with additional patient related information (age at menopause, level of education, working/non-working and exercising or not).

RESULTS

The results were evaluated for psychological (P), somatic (S), and urogenital (U) symptoms. The average age at which menopause set in, in the cohort was found to be 48.7+/-2.3 years (46.4-51 years). Based on the average age at the menopause, the cohort was divided into peri (35-45), menopausal/early menopause (46-51) and the postmenopausal (52-65) groups. A significantly higher % of perimenopausal women (36%) showed a P score of > or =7; while a higher % of postmenopausal showed S score and U score > or =7 (>40%; p< or =0.001). Working women seem to suffer more from psychological symptoms whereas non-working women showed a greater incidence of somatic symptoms. Educated women showed a lower incidence of psychological and somatic symptoms.

CONCLUSIONS

Present study indicates that age, level of education and working/non-working status (in a group of women with same socio-cultural background) may also contribute to significant variations in menopausal symptoms.