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Study Finds Positive Change In Menopausal Experience

White women are becoming more optimistic about menopause, with many seeing it as an opportunity to rethink their lives and redefine themselves, a new University of Texas at Austin national study shows.

This is just one of the positive changes in the way women across different ethnic groups are experiencing the change of life, the School of Nursing research found. The study also found women are getting support from their family and friends and some even mentioned relief and benefits when going through menopause.

Past studies have shown that white women, in particular, were concerned about menopause as a “harbinger of physical aging taking them away from society’s youthful ideal,” said Dr. Eun-Ok Im, the La Quinta Motor Inns Inc. Centennial Professor in nursing. “Most of the white participants in our study say they try to be humorous and laugh — to boost their inner strength and motivate themselves to go through the hardships during the menopausal transition.”

Im’s four-year study, funded by a $1.2 million National Institutes of Health grant, looked at ethnic differences in menopausal symptoms reported by Whites, Hispanics, African American and Asian women. The study was done via a Internet survey among 512 women and included equal numbers of mid-age (40 to 60 years old) participants from each ethnic group.

“A possible reason for the positive changes in the way white women look at menopause might be that the recent women’s health movement has educated women to accept menopause as a normal developmental process, allowing them to refocus on themselves,” said Im.

Results of her research were published recently in the Western Journal of Nursing Research.

African American, Hispanic and Asian women already reported being more optimistic and positive about their menopause and menopause symptoms than white women.

In Im’s study, black participants cited they were raised to be strong and accepting of a natural aging process. They perceived that — compared to other difficulties in their lives — menopause was just another part of life to endure.

Getting support from family and friends during the menopausal transition is especially new to the literature on the menopausal symptom experience of Hispanic women, said Im.

“An interesting new finding, however, is that minority women prefer support from those who are of the same ethnicity,” she said.

Minority participants also expressed their need for more information and educational programs, which Im sees as an additional encouraging sign. In the past, ethnic minority groups rarely talked about menopause with others and hardly ever said they wanted more information about the change of life, she said.

Im’s study supported research that found significant ethnic differences in the total number and severity of menopausal symptoms.

Some of her findings on differences include:

• Black women had a slightly higher percentage of hot flashes at 67.8 percent with white women at 64.4 percent and Hispanic women at 52.5 percent. Only 26.1 percent of Asian Americans said they experienced hot flashes.

• More white women (60 percent) took some kind of treatments for menopause symptoms. These included antidepressants and alternative medicines like herbal remedies, chiropractic, meditation, acupuncture and dietary supplements.

• African American women — 54.6 percent — experienced weight gain compared to 33.3 percent for Asians, 45 percent for white and 50.8 percent for Hispanics.

• Whites reported higher percentages of racing heart, headache, fatigue, sleeping difficulty, breast pain, increased crying, depressed feelings, upset, grouchy feelings, difficulty in concentration, forgetfulness, breathing difficulty, ankle swelling, cold hand and feet, stomach pain, muscle and join stiffness.

• Whites, Hispanics and African Americans reported about the same numbers of bloating while Asians only reported 23.4 percent.

• Whites, Hispanics and African Americans reported about the same percentage of mood swings — above 50 percent — while Asians reported only 32.4 percent mood swing symptoms.

• Asians reported muscle and joint stiffness and neck and skull aches as frequent symptoms of menopause. Findings strongly suggest there are sub-ethnic — Chinese, Korean, Indian Filipino — differences in the menopausal symptom experience of Asians, and more studies are needed in this area.

The research also found few women (in all ethnic groups) reporting positive experiences with their physicians when they consulted them about menopausal symptoms.

Im believes her findings will work to eliminate ethnic biases and inequity in menopausal symptom management and promote culturally competent care for menopausal women. Earlier research about menopause has mostly been with white women, she noted.

“The increasing ethnic diversity of our population requires health professionals to practice with greater cultural competence,” Im said.

Menopause Symptoms and Memory Loss

While you may experience the misery of hot flashes and mood swings as you enter menopause, one thing you can’t blame on the “change” is memory loss.

In the latest study that exonerates menopause as a cause of impairing the ability to recall, Taiwanese researchers compared the memory of hundreds of women before they had any menopausal symptoms to their memory as they entered menopause.

They found the women who were going through the menopausal process scored as well or nearly as well on five different cognitive function tests. Results of the study are to be presented Oct. 4 at the American Neurological Association annual meeting in Toronto.

“When women go into perimenopause, they don’t need to worry about cognitive decline,” said Dr. Jong-Ling Fuh, an attending physician at Taipei Veterans General Hospital and an associate professor of Yang-Ming University School of Medicine.

The researchers said the myth of memory loss during menopause is a perception some women have because as they went through menopause, they felt their memory wasn’t as sharp as it had been before. Studies suggesting that hormone replacement therapy might protect against dementia strengthened that belief. However, a large study later found that in older women, hormone replacement therapy not only didn’t help protect women from dementia, but could actually increase the risk.

To try to answer the question of whether menopause did have any effect on memory, Fuh and her colleagues studied nearly 700 premenopausal women living on a group of rural islands between Taiwan and China. The Taiwanese government restricted access to these islands until the 1990s, so the authors report that the study’s population was nearly homogeneous, which would help rule out other potentially causative factors of memory loss.

The women were between the ages of 40 and 54. None of them had had a hysterectomy, and none took hormone replacement therapy during the study.

All took five cognitive tests designed to assess their memory and cognitive skills at the start of the study, and then again 18 months later.

During the study period, 23 percent of the women began to have symptoms of menopause.

The researchers then compared the memory of the women who had entered menopause to those who had not, and found very little difference. In four of the five tests, there were no statistically significant differences in the two groups of women.

Only on one test was the difference statistically significant, and that difference, said Fuh, was very slight. This test was designed to assess verbal memory and involved showing the women 70 nonsensical figures. Some of the figures were repeated during the test, while most were not. The women were asked whether they had seen the figure earlier.

“For women, menopause does not mean you’ll develop memory loss,” said Dr. Raina Ernstoff, an attending neurologist at William Beaumont Hospital in Royal Oak, Mich. As you’re going through perimenopause and experiencing symptoms like hot flashes, she said, you may feel lousy and have trouble sleeping, which might temporarily affect your cognitive skills.

“I don’t think declining estrogen levels are what causes memory loss,” said Dr. Steven Goldstein, an obstetrician/gynecologist at New York University Medical Center in New York City. “It’s not like your memory is bopping along, doing fine and then takes this big dive during menopause, like bone density can.”

Both Ernstoff and Goldstein said they weren’t aware of many women who believed that menopause might cause significant memory loss. They also both felt that results from this group of women who were so homogeneous might not apply to different groups of women, such as those living in more industrialized society. And they both said that other factors that weren’t studied could play a role in memory loss, such as hypertension, which can contribute to vascular dementia.

Ernstoff also pointed out that the education backgrounds can play a large role in memory loss. Fuh acknowledged the researchers did attempt to control the data for educational differences.

SOURCES: Jong-Ling Fuh, M.D., attending physician, Taipei Veterans General Hospital, and associate professor, Yang-Ming University School of Medicine, Taipei, Taiwan; Steven Goldstein, M.D., obstetrician/gynecologist, New York University Medical Center, and professor, obstetrics/gynecology, New York University School of Medicine, New York City; Raina Ernstoff, M.D., attending neurologist, William Beaumont Hospital, Royal Oak, Mich., and member, Alzheimer’s Board of Detroit; Oct. 4, 2004, presentation, American Neurological Association, Toronto.

Study Finds Menopause Symptoms Can Be Predicted

The number of eggs left in a woman’s ovaries are like the grains of sand in an hourglass, ticking away the hours on her biological clock.

Researchers now say they may be able to predict when that clock will wind down.

And while doctors can’t actually count the number of eggs in an ovary, they can measure ovarian volume. British researchers say there’s a direct correlation between the two, and by measuring ovarian volume with transvaginal ultrasound, doctors should be able to predict when menopause will set in and how many fertile years a woman has left.

According to the study authors, this information will revolutionize the care of women looking for assisted reproductive technologies, including those who were treated for childhood cancers as well as women who want to put off starting a family for whatever reason.

Although information still needs to be validated in clinical studies, its benefit is most likely to start with women who are being treated for cancer and women attending fertility clinics, said Tom Kelsey, co-author of the study appearing June 17 in the journal Human Reproduction.

“If women looking for some sort of assisted conception and their physicians know that they’ve got a long time till menopause, then you could plan for a range of treatments,” said Kelsey, who is a senior research fellow at the University of St. Andrews in Scotland. “If you knew menopause was likely in four to five years, you’d plan a different set of IVF [in vitro fertilization] treatments.”

Others reiterate, however, that the findings should be treated with caution.

“Should a young woman who is 30 years old go for a test to figure out whether she’s got three, five or 10 years left on her fertility? Should she make career decisions and life decisions? Are these data good enough to make those determinations?” asked Dr. Alan Copperman, director of reproductive medicine at Mount Sinai Medical Center in New York City. “The answer is obviously no to all of those questions. The predictive value of this test is not good enough to go and tell someone to change their life.”

According to the article, eggs form in a female’s ovary while she is still in the womb, peaking at several million about halfway through gestation and then starting a continuous decline. At birth, there are several hundred thousand and, when menstruation begins, about 300,000. At about age 37, a woman has about 25,000 eggs left, and at menopause only about 1,000.

The time at which menopause sets in is widely believed to be based on the number of eggs reaching a critically low threshold.

The authors of this study measured ovarian volume with transvaginal ultrasound, then looked at the relationship between ovarian volume — ovaries shrink as a woman ages — and number of eggs. They then applied mathematical and computer models to predict menopause.

The study authors are negotiating with a medical school to set up clinical trials. The idea would be to follow women to see if their predictions were indeed correct.

While these authors have come up with a tool to potentially help women plan their lives, a second study in the same issue of Human Reproduction warned that women might not want to leave it too late. Assisted reproductive technology (ART) could not be relied upon to fully compensate for lack of natural fertility after the age of 35, the article stated.

The authors used a computer simulation model to determine that the overall success rate of assisted reproductive technology would be 30 percent for those attempting to get pregnant from age 30, 24 percent for those trying from age 35, and 17 percent from age 40.

SOURCES: Tom Kelsey, Ph.D., senior research fellow, University of St. Andrews, St. Andrews, Scotland; Alan Copperman, M.D., director, reproductive medicine, Mount Sinai Medical Center, New York; June 17, 2004, Human Reproduction

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