Menopausal symptoms within a Hispanic cohort: SWAN, the Study of Women's Health Across the Nation

Información es poder (information is power): menopause knowledge, attitudes, and experiences in midlife Hispanic women and Latinas

BACKGROUND

Latinas constitute nearly 20% of midlife women in the United States (U.S.), but remain underrepresented in menopause research. Many midlife Latinas are disadvantaged by limited English proficiency, less formal education, living below the federal poverty level, lack of health insurance, and social isolation and discrimination - factors that negatively affect menopause-related symptoms and health outcomes. This study aimed to understand knowledge, attitudes, and experiences of the menopause transition among midlife Latinas.

METHODS

We conducted a qualitative descriptive study using five focus groups with 29 Hispanic/Latina midlife women. An emergent content analysis was performed by four bilingual coders. Data on socio-demographics, menopausal symptoms, menopause knowledge, and attitudes toward menopause and hormone therapy were collected over the phone. Descriptive statistics were performed to characterize study participants.

RESULTS

Participants were aged 50.3 ± 6.3 years, 45% postmenopausal, 79% viewed menopause positively, and 55% reported having "little knowledge" about menopause. Seven themes emerged: 1) menopause is a stage of life (una etapa de vida); 2) not wanting to become an old lady (no quererme hacer viejita); 3) in our culture, we do not ask [about menopause]; 4) family dynamics; 5) each body is different (todo cuerpo es diferente); 6) menopause self-management and treatment options; 7) information is power (información es poder).

CONCLUSIONS

Although Latinas reported having a positive view of menopause, we found a need for culturally-tailored comprehensive menopause education. The importance of involving family members in menopause education was also revealed. Our next steps are to determine the best menopause messaging strategies and educational formats for midlife Latinas.

Menopause in a globalized world - A systematic literature review focussing on the challenge of health problems associated with menopausal transition among women with a migration background

Globalization and international migration movements have massively changed the population structure of most industrial nations in recent decades. The ever-increasing proportion of people with a migration background also poses a challenge for the medical sector. A particular problem is the stressful phase of the menopausal transition, which - although not a pathological phenomenon but part of the female life history - can lead to psychological and physical symptoms due to hormonal changes, which significantly impair the quality of life of the women affected. However, treatment concepts, as well as access to medical facilities and information, are geared towards Western women from high-income countries. Women with a history of voluntary or forced migration originating from non-Western countries represent a particularly vulnerable group. To enable personalized treatment, studies on menopausal transition in women with a migration background are required. The present review shows that studies on menopausal women with a migration background have been conducted primarily in classic immigration countries such as the USA, Australia, or the UK, but that there is a lack of such studies in countries with no long tradition as an immigration country, such as Austria or Germany. This is becoming a growing problem, as the number of menopausal women with a migration background is increasing.

From maca to marijuana: cultural influences on joint pain symptoms and management in urban perimenopausal and early postmenopausal Latinas

OBJECTIVE

The purpose of this qualitative study was to explore the symptom experience and coping strategies for managing joint pain during the menopause transition in urban Latina women.

METHODS

We conducted focus groups with 13 English-speaking peri and early postmenopausal Latinas living in Upper Manhattan in New York City in 2014. Eligible participants were self-identified Latinas aged 45 to 60 years with new onset or worsening joint pain and spontaneous amenorrhea, recruited through flyers and snowball sampling. Focus group interviews conducted in English were audiotaped, transcribed, and analyzed by a bilingual research team, using NVivo software (QSR International) to organize and code themes.

RESULTS

On average, participants were aged 51.7 ± 4.8 years and overweight (body mass index of 29.3 ± 6.7 kg/m 2 ); 10 (76.9%) were Puerto Rican, and the last menstrual period was 1 month to 5 years ago. The following four themes emerged: 1) menopause and joint pain are an alarming package; 2) pain disrupts life and livelihood; 3) medical management is unsatisfactory and raises worries about addiction; and 4) home remedies for coping with pain-from maca to marijuana. Despite access to a world-class medical facility in their neighborhood, women seeking pain relief preferred to self-manage joint pain with exercise, over-the-counter products, and other culturally valued home remedies. Many suffered through it.

CONCLUSIONS

For midlife Latinas, joint pain symptoms may emerge or worsen unexpectedly as part of the menopause transition and carry distressing consequences for daily activities and quality of life. There is a need to develop more culturally specific approaches for menopause-related pain management in this underserved population.

Circadian dysfunction and cardio-metabolic disorders in humans

The topic of human circadian rhythms is not only attracting the attention of clinical researchers from various fields but also sparking a growing public interest. The circadian system comprises the central clock, located in the suprachiasmatic nucleus of the hypothalamus, and the peripheral clocks in various tissues that are interconnected; together they coordinate many daily activities, including sleep and wakefulness, physical activity, food intake, glucose sensitivity and cardiovascular functions. Disruption of circadian regulation seems to be associated with metabolic disorders (particularly impaired glucose tolerance) and cardiovascular disease. Previous clinical trials revealed that disturbance of the circadian system, specifically due to shift work, is associated with an increased risk of type 2 diabetes mellitus. This review is intended to provide clinicians who wish to implement knowledge of circadian disruption in diagnosis and strategies to avoid cardio-metabolic disease with a general overview of this topic.

Menopausal symptoms and attitudes toward hormone replacement therapy among Israeli women

Menopause occurs around midlife and is an inevitable component of women's aging. The study aimed to investigate the associations between the lifetime prevalence of menopausal symptoms and health-related characteristics among Israeli postmenopausal women aged 55-75 years. Additionally, this study aimed to estimate the use of hormone replacement therapy (HRT) and women's attitudes toward this treatment. Data for this study were extracted from a cross-sectional national telephone survey conducted in Israel between 2018 and 2020. For the current study, only postmenopausal women aged 55-75 years were included. Multivariate analyses were used to identify demographic and health-related characteristics associated with menopausal symptoms. The study included 688 participants. Most (68.8%) reported one or more menopausal symptoms, specifically vasomotor symptoms (50.4%). According to the multivariate logistic regression analysis, menopausal symptoms were associated with moderate-high anxiety and/or depression symptoms (OR = 2.01, 95% CI 1.12-3.58) and with osteoporosis (OR = 1.78, 95% CI 1.08-2.92). Although most (78.3%) symptomatic women were bothered by their symptoms, 29.1% received any treatment for symptom relief and only 12.6% reported current or past use of HRT. The findings show that menopausal symptoms were associated with a higher prevalence of anxiety and/or depression symptoms and osteoporosis in the years following menopause. Most symptomatic women did not receive any treatment and the majority were against HRT. Knowledge and awareness about menopause and treatment options should be increased among Israeli women. Additionally, the promotion of positive attitudes toward menopause and HRT use among women and healthcare providers is strongly recommended.

Vasomotor symptoms of menopause, autonomic dysfunction, and cardiovascular disease

Cardiovascular disease (CVD), the leading cause of death among US adults, is more prevalent in menopausal females compared with age-matched males. Vasomotor symptoms of menopause (VMS; hot flashes/flushes and night sweats) are common among females undergoing menopausal transition and have been associated with elevated blood pressure (BP) and increased CVD risk. Autonomic dysregulation of BP has been posited as a contributing factor to the elevated CVD risk in menopausal females with VMS. This review includes 1) a brief overview of the relationship between VMS and CVD, 2) mechanisms of hot flushes and their potential impact on short- and long-term BP regulation, and 3) how the disruption of autonomic function associated with VMS might provide a mechanistic pathway to CVD development. Finally, this review will highlight knowledge gaps and future directions toward better understanding of hot flush physiology and VMS contributions to CVD.

Do Migration and Acculturation Impact Somatization? A Scoping Review

Somatization is a phenomenon in which the individual experiences physical symptoms attributable to mental projections. It is a widely used term in common parlance to figuratively describe a stressful situation. Syndromes directly related to the mind have been described; pathologies are influenced by somatization. However, the extent of somatization is also related to social and cultural factors. In fact, each culture expresses varying levels of somatization characteristic of the country of origin. A disease can even manifest with different symptoms in different ethnic groups. The migration process arises from the need for change on the part of those who undertake it and culminates in the integration of the person in the host country. This process induces changes in the person of a psychological nature, which also affects somatization. In fact, the most integrated subjects show levels of somatization comparable to those of the host country. These considerations support the thesis that psychological changes are an integral part of health and can affect the development of organic and somatized pathologies.

Racial/ethnic disparities in the diagnosis and management of menopause symptoms among midlife women veterans

OBJECTIVE

Racial/ethnic disparities in menopause symptoms and hormone therapy management remain understudied among women served by the Veteran's Health Administration, despite the unique racial/ethnic diversity of this population. Thus, we determined racial/ethnic disparities in medical record-documented menopause symptoms and prescribed menopausal hormone therapy among women veterans.

METHODS

We conducted cross-sectional analyses of national Veteran's Health Administration electronic health record data from 2014 to 2015. We used logistic regression models to compare medical-record documented menopause symptoms and treatment (eg, vaginal estrogen or systemic hormone therapy) by self-identified race/ethnicity, adjusting for age, body mass index, and depression. Models examining hormone treatment were adjusted for menopause symptoms.

RESULTS

Among 200,901 women veterans (mean age 54.3, SD 5.4 y; 58% non-Hispanic/Latinx White, 33% non-Hispanic/Latinx Black, 4% Hispanic/Latinx, and 4% other), 5% had documented menopause symptoms, 5% were prescribed vaginal estrogen, and 5% were prescribed systemic hormone therapy. In fully adjusted multivariable models, non-Hispanic/Latinx Black women veterans had lower odds of documented menopause symptoms relative to non-Hispanic/Latinx White women (OR 0.82, 95% CI: 0.78-0.86). Moreover, non-Hispanic/Latinx Black women (OR 0.74, 95% CI: 0.70-0.77), as well as Hispanic/Latinx women (OR 0.68, 95% CI: 0.61-0.77), had lower likelihood of systemic hormone therapy prescription. Hispanic/Latinx women had higher odds of vaginal estrogen prescription (OR 1.12 95% CI: 1.02-1.24) than non-Hispanic/Latinx White women. Non-Hispanic/Latinx Black women had lower likelihood of estrogen use (OR 0.78 95% CI: 0.74-0.81) than non-Hispanic/Latinx White women.

CONCLUSION

Despite evidence suggesting higher menopause symptom burden among Black women in community samples, documented menopause symptoms and hormone therapy were less common among Black, compared with White, women veterans. Additionally, Hispanic/Latinx women veterans had lower odds of prescribed systemic menopause therapy and yet higher odds of prescribed vaginal estrogen, despite no difference in documented symptoms. These findings may signal important disparities in symptom reporting, documentation, and/or treatment for minority women veterans.

Menopausal Symptoms in Underserved and Homeless Women Living in Extreme Temperatures in the Southwest

Background: Little is known about menopausal symptoms in underserved women. Aim: To better understand self-reported menopausal symptoms in underserved and homeless women living in extreme heat during different seasons. Methods: A cross-sectional study, including the Greene Climacteric Scale (GCS), climate-related questions, and demographics was administered June to August of 2017 and December to February 2018 to women 40-65 years of age. Results: In 104 predominantly Hispanic (56%), uninsured (53%), menopausal (56%), and mid-aged (50 ± 9.5) women, 57% reported any bother, while 20% of these women reported "quite a bit" or "extreme" bother from hot flushes. The total GCS score was a mean of 41 ± 15.0; out of 63 indicating significant symptoms, the psychological and somatic clusters were highest. Women did not think temperature outside influenced their menopausal symptoms at either time point (69% in winter vs. 57% in summer, p = 0.23). In multivariable analyses after adjusting for race, body mass index, and living situation neither season nor temperature was associated with self-reported hot flush bother. While one-third of women reported becoming ill from the heat, 90% of women reported not seeking care from a doctor for their illness. Conclusion: Menopausal, underserved, homeless women living in Arizona reported few vasomotor symptoms regardless of season, and endorsed psychological and somatic complaints. Socioeconomic factors may influence types of bothersome menopausal symptoms in this population of women.

A multi-component, community-engaged intervention to reduce cardiovascular disease risk in perimenopausal Latinas: pilot study protocol

BACKGROUND

Cardiovascular disease (CVD) risk increases substantially during perimenopause. Latinas have a significantly worse CVD risk factor profile than non-Hispanic White women, potentially due to multiple sociocultural and environmental factors. To date, interdisciplinary interventions have not focused on improving nutrition, physical activity, stress management, and biologic CVD risk in perimenopausal Latinas. The purpose of this study is to examine the feasibility and initial efficacy of a multi-component intervention to reduce CVD risk in perimenopausal Latinas.

METHODS

This is a two-group, repeated measures experimental study. Eighty perimenopausal Latinas (age 40-55 years) from two community groups will be randomized: one group will complete the intervention; the other will be a wait-list control. The intervention consists of 12-weekly sessions (education, physical activity, stress management, coping skills training), followed by 3 months of continued support, and 6 months of skill maintenance on their own. The primary outcomes include arterial stiffness, blood pressure, lipids, and blood glucose. Secondary outcomes are health behaviors (nutrition, physical activity, sleep, coping strategies), self-efficacy, and other biological factors related to CVD risk (adiposity, C-reactive protein, hair cortisol, vasomotor symptoms). We will assess changes in outcomes from Time 1 (baseline) to Time 2 (6 months) and Time 3 (12 months) using general linear mixed models to test the hypotheses. We will also evaluate the feasibility of the intervention by assessing enrollment and retention rates, barriers, and facilitators to enrollment, intervention fidelity, the suitability of study procedures, and participant satisfaction with the intervention and study protocol. We hypothesize the intervention group will decrease biologic CVD risk and improve health behaviors and self-efficacy significantly more than the wait-list control.

DISCUSSION

Results from this study will contribute to knowledge on the feasibility of behavioral interventions, including stress management and coping skills training, which could reduce CVD burden among perimenopausal Latinas. Because Hispanic/Latinos are the largest ethnic minority in the United States (US), progress regarding CVD risk among perimenopausal Latinas may lead to significant improvement in the overall CVD burden in the US.

TRIAL REGISTRATION

Prospectively registered, NCT04313751 (03/19/2020), Protocol version 1.0.

Physiologic and psychosocial changes of the menopause transition in US Latinas: a narrative review

Latinos comprise the fastest-growing minority group in the USA, with Hispanic women (Latinas) constituting 17% of women aged 45-54 years. The menopause transition (MT) is associated with many physiological, behavioral, and psychosocial changes that can affect disease risk in women. While several epidemiologic investigations have enhanced our understanding of the MT, to date, menopause research has mostly focused on non-Latina White women. As a consequence, there is a dearth of information on strategies for managing menopause-related issues in Latinas and important factors to consider to provide culturally appropriate care and promote lifestyles that may reduce adverse health outcomes. This narrative review summarizes existing evidence of the MT in Latinas, with a focus on hormonal alterations, menopausal symptoms, mental health, cognition, and cardiometabolic health. The clinical and research implications of the current literature will also be discussed.

Factors associated with developing vaginal dryness symptoms in women transitioning through menopause: a longitudinal study

OBJECTIVE

To evaluate factors associated with incident self-reported vaginal dryness and the consequences of this symptom across the menopausal transition in a multiracial/ethnic cohort of community-dwelling women.

METHODS

We analyzed questionnaire and biomarker data from baseline and 13 approximately annual visits over 17 years (1996-2013) from 2,435 participants in the Study of Women's Health Across the Nation, a prospective cohort study. We used discrete-time Cox proportional-hazards regression to identify predictors of incident vaginal dryness and to evaluate vaginal dryness as a predictor of pain during intercourse and changes in sexual intercourse frequency.

RESULTS

The prevalence of vaginal dryness increased from 19.4% among all women at baseline (ages 42-53 years) to 34.0% at the 13th visit (ages 57-69 years). Advancing menopausal stage, surgical menopause, anxiety, and being married were positively associated with developing vaginal dryness, regardless of partnered sexual activity. For women not using hormone therapy, higher concurrent levels of endogenous estradiol were inversely associated (multivariable-adjusted hazard ratio: 0.94 per 0.5 standard deviation increase, 95% confidence interval: 0.91-0.98). Concurrent testosterone levels, concurrent dehydroepiandrosterone sulfate levels, and longitudinal change in any reproductive hormone were not associated with developing vaginal dryness. Both vaginal dryness and lubricant use were associated with subsequent reporting of pain during intercourse, but not with a decline in intercourse frequency.

CONCLUSION

In these longitudinal analyses, our data support many clinical observations about the relationship between vaginal dryness, menopause, and pain during intercourse, and suggest that reporting of vaginal dryness is not related to androgen level or sexual intercourse frequency.

Vasomotor Symptoms Across the Menopause Transition: Differences Among Women

Vasomotor symptoms (VMS) are the primary menopausal symptoms, occurring in up 80% of women and peaking around the final menstrual period. The average duration is 10 years, longer in women with an earlier onset. Compared with non-Hispanic white women, black and Hispanic women are more likely and Asian women are less likely to report VMS. Risk factors include greater body composition (in the early stage of menopausal transition), smoking, anxiety, depression, sensitivity to symptoms, premenstrual syndrome, lower education, and medical treatments, such as hysterectomy, oophorectomy, and breast cancer-related therapies. VMS patterns over time and within higher-risk subgroups are heterogeneous across women.

Bothersome menopausal symptoms amongst postmenopausal Iranian women

OBJECTIVES

This study was undertaken to determine the impact of menopause on middle-eastern women.

METHODS

This was a cross-sectional study of 1520 women, aged 40-64 years, living in Sari, Northern Iran, recruited by multistage cluster sampling between October 2016 and April 2017. All women completed the Menopause Quality of Life Questionnaire (MENQOL) and Beck Depression Inventory-II (BDI-II).

RESULTS

Of all the women, 54.5% were perimenopausal or postmenopausal. The prevalences of any vasomotor symptom (VMS) and moderate-severely bothersome VMS were greatest for postmenopausal women aged <55 years (66.4%, 95% confidence interval (CI) 59.9-72.3% and 13.5%, 95% CI 9.6-18.6%, respectively). Having moderate-severe VMS was associated with moderate-severe depressive symptoms (adjusted odds ratio (AOR) 2.9; 95% CI 1.6-5.2; p < 0.001). Symptoms of vulvovaginal atrophy (VVA) were reported by 41.1% (95% CI 37.4-45.0%) of perimenopausal and postmenopausal women, with 22.9% (95% CI 19.8-26.3%) reporting their symptoms as moderate-severely bothersome. In women with moderate-severe VMS, the proportion with both moderate-severe depressive symptoms and moderate-severe VVA symptoms (12.1%) was four times that in women with no or mild VMS (3.3%) (p < 0.001).

CONCLUSION

One in seven perimenopausal and postmenopausal women has moderate-severely bothersome VMS and few women receive appropriate therapy. The reporting of moderate-severe VMS should alert clinicians to the likelihood of significant concurrent VVA and depressive symptoms.

Measuring bothersome menopausal symptoms: development and validation of the MenoScores questionnaire

Background

The experience of menopausal symptoms is common and an adequate patient-reported outcome measure is crucial in studies where women are treated for these symptoms. The aims of this study were to identify a patient-reported outcome measure for bothersome menopausal symptoms and, in the absence of an adequate tool, to develop a new measure with high content validity, and to validate it using modern psychometric methods.

Methods

The literature was reviewed for existing questionnaires and checklists for bothersome menopausal symptoms. Relevant items were extracted and subsequently tested in group interviews, single interviews, and pilot tests. A patient-reported outcome measure was drafted and completed by 1504 women. Data was collected and psychometrically validated using item-response theory Rasch Models.

Results

All questionnaires identified in the literature lacked content validity regarding bothersome menopausal symptoms and none were validated using item-response theory. Our content validation resulted in a draft measurement encompassing 122 items across eight domains. Following psychometrical validation, the final version of our patient-reported outcome measure, named the MenoScores Questionnaire, encompassed 51 items, including one single item, covering 11 scales.

Conclusion

Menopausal symptoms are multidimensional with some symptoms unquestionably related to the menopausal transition. We identified four constructs of importance: hot flushes, day-and-night sweats, general sweating, and menopausal-specific sleeping problems. The MenoScores Questionnaire is condition-specific with high content validity and adequate psychometrical properties. It is designed to measure bothersome menopausal symptoms and all scales are developed and psychometrically validated using item-response theory Rasch Models.

Trial registration

Approved by the Danish Data Agency (J.nr. 2015–41-4057). Ethics Committee approval was not required.

Electronic supplementary material

The online version of this article (10.1186/s12955-018-0927-6) contains supplementary material, which is available to authorized users.

Religiosity and faith in relation to time to metabolic syndrome for Hispanic women in a multiethnic cohort of women-Findings from the Study of Women's Health Across the Nation (SWAN)

OBJECTIVES

We investigated whether faith was associated with a difference in time to incident metabolic syndrome (MetS) among midlife Hispanic women vs women of other ethnicities.

STUDY DESIGN

The Study of Women's Health Across the Nation (SWAN) is a community-based, longitudinal study of a cohort of midlife women. Social, demographic, psychosocial, anthropometric, medical, and physiological measures, and incident MetS were assessed in near-annual intervals using questionnaires and assays. Each participant answered key questions related to religion and meaning in her life. Differences in time to MetS were modeled by Hispanic ethnicity (vs. otherwise) among women reporting low and high levels of faith.

MAIN OUTCOME MEASURE

Incident MetS in the 7 years after the SWAN baseline assessment.

RESULTS

Among 2371 women, average baseline age 46, Hispanic women (n = 168) were more likely to have higher perceived stress and financial strain than non-Hispanic women (n = 2203). Nevertheless, Hispanic women were far more likely than non-Hispanic women to report that faith brought them strength and comfort in times of adversity, that they prayed often, and that their faith was sustaining for them. Hispanic women had the highest incidence rate of MetS of any racial/ethnic group. However, among women with high levels of faith, the incidence rate of MetS was similar in the Hispanic and non-Hispanic groups. Conversely, among women with low levels of faith, Hispanic women had a faster progression to MetS than did non-Hispanic women.

CONCLUSIONS

Faith might be associated with a different risk of MetS among women of Hispanic vs other ethnicities. Among women who are not part of a faith community, Hispanic ethnicity might be a risk factor for MetS.

Factors associated with mucosal dryness in multiple regions and skin: A web-based study in women

AIM

We hypothesized that feeling mucosal dryness in one body region and the skin may be associated with dryness in other regions and that there are common background factors for dryness. In an earlier web-based survey, we reported prevalence figures of dry eyes, nose, mouth, skin, and vagina. In the present study, additional analyses were made to investigate the factors associated with dryness in each region, and simultaneous dryness in multiple regions.

METHODS

A web-based questionnaire was completed by 310 Japanese women. The questions included dryness of the eyes, nose, mouth, vagina, and skin. Menopausal and other symptoms were also addressed. Multiple logistic regression modeling was performed to identify factors associated with dryness in each region and in multiple dry regions.

RESULTS

Dry eyes were associated with dryness in the nose and with headache; dry nose was associated with dryness in the vagina and eyes; dry mouth was associated with sticky mouth symptom and dryness of the nose; dry skin was associated with use of xerogenic medications and vaginal discharge; and dryness of the vagina was associated with vaginal itchiness and dry nose. Vaginal discharge (odds ratio, 9.64; 95% confidence interval, 3.15-29.51) and sticky mouth (odds ratio, 6.35; 95% confidence interval, 1.29-31.29) were further associated with dryness in multiple regions.

CONCLUSION

The present results confirmed our study hypothesis by showing that dryness in one region was clearly associated with that in another or in multiple regions. The result implies the need for holistic diagnosis and counseling for patients with dryness complaints.

Predictors of impact of vaginal symptoms in postmenopausal women

OBJECTIVE

This study aims to identify factors associated with greater impact of vaginal symptoms on the functioning and well-being of postmenopausal women.

METHODS

Postmenopausal women who reported vaginal dryness, itching, irritation, or pain with sexual activity completed the multidimensional Day-to-day Impact of Vaginal Aging (DIVA) questionnaire and underwent assessment of multiple sociodemographic and clinical factors that have the potential to influence the impact of vaginal symptoms. Multivariable linear regression analyses examined relationships between selected participant characteristics and DIVA scale scores assessing symptom impact on activities of daily living, emotional well-being, self-concept and body image, and sexual functioning.

RESULTS

Among 745 symptomatic participants, the mean (SD) age was 56 (9) years, and 66% were racial/ethnic minorities. Women with comorbid depression reported greater impact of vaginal symptoms on all dimensions of functioning and well-being measured by the DIVA questionnaire (11%-22% estimated increase in impact scores associated with every three-point increase in Hospital and Anxiety Depression Scale scores). Women with urinary incontinence also reported greater impact of vaginal symptoms on activities of daily living, emotional well-being, and self-concept and body image (27%-37% estimated increase in impact scores). Age, partner status, frequency of sexual activity, general health, and body mass index also predicted greater impact on at least one domain.

CONCLUSIONS

Findings suggest that special efforts should be made to identify and treat vaginal symptoms in postmenopausal women known to have depression or urinary incontinence, as these women may experience greater impact of vaginal symptoms on multiple domains of functioning and quality of life.

Perimenopause: From Research to Practice

The menopausal transition, or perimenopause, is associated with profound reproductive and hormonal changes. These changes have been well chronicled and matched with concomitant symptoms. The pattern of appearance of menopausal symptoms and their natural history have become increasingly clear thanks to the conduct of several long-term, longitudinal cohort studies that have examined many aspects of women's biology and psychology through this time of life. Menopausal symptoms are highly prevalent; they are sufficiently bothersome to drive almost 90% of women to seek out their healthcare provider for advice on how to cope. (1) The classic symptom of menopause is the hot flash, which is experienced by most women, and is moderately to severely problematic for about 1/3 of women. While most women will have an experience of hot flashes limited to just a year or two, others will experience them for a decade or more, and a small proportion of women will never be free of them. Poor sleep becomes more common in perimenopausal women not only in association with the menopausal transition but also in relation to aging. Depressed mood and increased anxiety also increase during the transition, with an abrupt rise in prevalence as women approach the later stages of the menopausal transition and have longer bouts of amenorrhea. These common symptoms often interact with one another such that depressed women tend to experience worse hot flashes along with worse sleep. As women enter the latter stages of the transition, vaginal dryness and dyspareunia also become more likely, affecting about 1/3 of the population. Unlike hot flashes, mood issues, and sleep, vaginal symptoms will not go away without treatment. Clinical approaches to these problems often involve hormone therapy, which can be safely given to most perimenopausal women on a short-term basis. Therapeutic strategies that are nonhormonal and behavioral can also be deployed.

Menopausal hormone therapy and menopausal symptoms

A majority of women will experience bothersome symptoms related to declining and/or fluctuating levels of estrogen during their menopausal transition. Vasomotor symptoms, vaginal dryness, poor sleep, and depressed mood have all been found to worsen during the menopausal transition. While vasomotor symptoms gradually improve after menopause, the time course can be many years. Vaginal dryness does not improve without treatment, while the long-term course of sleep and mood deterioration is not clearly defined at this time. A small minority of women have vasomotor symptoms that persist throughout the remainder of their lives. These common menopausal symptoms all improve with estrogen treatment. Over the last 10 years, we have witnessed a dramatic reduction in enthusiasm for menopausal hormone therapy, despite its high efficacy relative to other treatments. We have also seen the emergence of sound, evidence-based clinical trials of non-hormonal alternatives that can control the common menopausal symptoms. Understanding the natural history of menopausal symptoms, and the risks and benefits of both hormonal and non-hormonal alternatives, helps the clinician individualize management plans to improve quality of life.

Assessment of symptoms of menopause and their severity among Saudi women in Riyadh

BACKGROUND AND OBJECTIVES

Research on menopause in Arab women is limited. The aim of our study was to assess the commonly experienced symptoms of menopause and their severity among Saudi women.

DESIGN AND SETTING

A cross-sectional study conducted at King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia.

PATIENTS AND METHODS

Four hundred and ninety healthy women aged 40-55 years and either attending KKUH themselves or accompanying their relatives in outpatient clinics participated in the study. The Menopause Rating Scale (MRS) was used to assess menopausal symptoms and severity.

RESULTS

The mean (SD) age of the women in menopause was 47.9 (6.03) years. The most frequent symptoms were muscle and joint problems occurring in 411 women (83.9%), physical and mental exhaustion in 393 (80.2%), heart discomfort in 358 (73.1%), sleeping disorders in 349 (71.2%), hot flashes in 348 (71.0%), and irritability in 348 (71.0%); in addition, 179 (36.5%) of these women experienced severe psychological distress. Perimenopausal women had higher total and subscales scorings for somatic symptoms than did premenopausal and postmenopausal women (P=.008).

CONCLUSION

The number of Saudi women reporting hot flashes and night sweats was comparable to the number of Western women. In addition, somatic symptoms were more prevalent among perimenopausal than among premenopausal women.

Psychosocial features associated with lifetime comorbidity of major depression and anxiety disorders among a community sample of mid-life women: the SWAN mental health study

BACKGROUND

In clinical samples, comorbidity between depressive and anxiety disorders is associated with greater symptom severity and elevated suicide risk. Less is known, however, regarding the long-term psychosocial impact that a lifetime history of both major depressive disorder (MDD) and one or more anxiety disorders has in community samples. This report evaluates clinical, psychological, social, and stress-related characteristics associated with a lifetime history of MDD and anxiety.

METHODS

Data from 915 women aged 42-52 who were recruited as part of the the Study of Women's Health across the Nation (SWAN) Mental Health Study were used to examine clinical and psychosocial features across groups of women with a lifetime history of MDD alone, anxiety alone, both MDD and anxiety, or neither MDD nor anxiety.

RESULTS

As compared with women with a history of either MDD or anxiety alone, women with a comorbid history were more likely to report recurrent MDD, multiple and more severe lifetime anxiety disorders, greater depressive and anxiety symptoms, diminished social support, and more past-year distressing life events. Exploratory analyses indicated that women with a comorbid history also report more childhood abuse/neglect and diminished self-esteem, as compared with women with a history of either disorder alone.

CONCLUSIONS

Midlife women with a comorbid history that includes both MDD and anxiety disorders report diminished social support, more symptomatic distress, and a more severe and recurrent psychiatric history. Future research is needed to clarify the biological and psychosocial risk factors associated with this comorobid profile, and to develop targeted interventions for this at-risk group. Depression and Anxiety 00:1-8, 2012. © 2012 Wiley Periodicals, Inc.

Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation

Vasomotor symptoms (VMS), or hot flashes and night sweats, are often considered the cardinal symptoms of menopause. SWAN, one of the largest and most ethnically diverse longitudinal studies of the menopausal transition, has allowed unique insights into VMS. Specifically, SWAN has helped yield important information about the prevalence of, racial/ethnic differences in, risk factors for, and implications of VMS for midlife women's mental and physical health. We have reviewed the literature on VMS, emphasizing findings that have emerged from SWAN and new areas of inquiry in the area of VMS.

The SWAN song: Study of Women's Health Across the Nation's recurring themes

Reproductive health can be a reflection of overall health. It follows that abnormalities of reproductive milestones may be a manifestation of unhealthy aging. Since 1994, the Study of Women's Health Across the Nation (SWAN) has assessed how menopause and the process of that transition may affect future health. Themes have emerged from SWAN associating patterns of hormones and symptoms with metabolic status.The nature of these relationships vary as women traverse the menopause and ovarian hormone production ceases. This review describes these cross-cutting themes and their possible meaning for the health of the mid-life woman.

Assessing comprehension of clinical research

BACKGROUND

Comprehension and retention of study-related concepts by research subjects are understudied, particularly in certain areas of women's health such as menopausal hormone therapy (MHT).

METHODS

In a multi-center trial of MHT, a 9-item participant comprehension questionnaire (PCQ) tested knowledge of key concerns relating to MHT at two study sites. The PCQ was administered at baseline. At study site1, PCQ was re-administered to assess information retention months later. Multivariable analyses assessed predictors of participant comprehension after adjusting for age, race, education, annual family income (AFI), menopausal symptoms and study site.

RESULTS

151 participants (n = 89 at site I, n = 62 at site II) completed the PCQ at baseline; 71 participants from site I completed the follow-up PCQ. Participant comprehension at baseline was influenced by age, marital status, education, symptom of dyspareunia, season of enrollment and AFI<$40,000. Significant improvement in correct responses was observed at follow-up compared to baseline (p = 0.02); season and low AFI<$20,000 were predictive of likelihood for correctly answering <5/9 at follow up.

CONCLUSION

Assessing participant comprehension of research-related concepts using a PCQ identifies a need for ongoing reinforcement of relevant details, especially in symptomatic early menopausal women of lower education and income. Improved participant comprehension at follow up is reassuring and reflects success of the research team in communicating study-related concepts to participants enrolled in longitudinal studies.