No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
“Symptoms, Attitudes and Treatment Choices Surrounding Menopause among the Q’eqchi Maya of Livingston, Guatemala”
Abstract
The present study explored symptoms, attitudes and treatments surrounding women's health and menopause among the Q'eqchi Maya of the eastern tropical lowlands of Guatemala. Data were obtained through participant observation, semi-structured interviews, focus groups and plant walks with 50 Q'eqchi community members from the state of Izabal, Municipality of Livingston, including five midwives, five traditional male healers and eight postmenopausal women. Results indicate that the Q'eqchi Maya of Livingston possess their own cultural perceptions of women's health which affect attitudes, symptoms and treatment choices during the menopausal transition. Since discussions of menstruation and menopause are considered cultural taboos among the Q'eqchi, many women mentioned experiencing excessive preoccupation when unanticipated and unfamiliar symptoms occurred. Furthermore, many women suffered from additional hardship when their spouse misinterpreted menopausal symptoms (vaginal dryness, sexual disinterest) as infidelity. Seven of the eight postmenopausal women interviewed indicated experiencing one or more symptoms during the menopausal transition, including headaches, anxiety, muscular pain, depression, and hot flashes. These results differ from the lack of symptomatology reported in previous studies in Mexico, but are in line with the result of menopausal research conducted among other Maya groups from the highlands of Guatemala. Although the Q'eqchi did not use a specific term for "hot flash", three Q'eqchi women used the expression "baja presion" or a "lowering of blood pressure" to explain symptoms of profuse sweating followed by chills, heart palpitations, and emotional instability. The Q'eqchi Maya mentioned a number of herbal remedies to treat menopausal symptoms. Further research on these botanical treatments is needed in order to ascertain their safety and efficacy for continued use.
... In the Highlands of Guatemala, particularly, Maya women are the initial healthcare providers for their children, husbands, and other family members. They are viewed as the primary healers in their society, and as such, they assess the symptoms and determine how to proceed with medicinal plant treatments or when to seek medical help from the community healer or nearest clinic (Hughes 2004;Michel et al. 2006Michel et al. , 2012Schooley et al. 2009;United Nations Population Fund 2005). Commonly, herbal medicines are prepared as teas, decoctions, or infusions and taken orally; plants may also be steamed, smoked, or used as essential oils (Giron et al. 1991;Lentz 1993;Zamora-Martinez and de Pascual Pola 1992;Cohen 1982). ...
... In general, most of the botanicals used in Central America for the treatment of women's reproductive health have not been systematically documented or even tested for safety and possible efficacy. Considering that a large portion of the female population, particularly in (Coe, 2008) González Ayala (1994) and Coe (2008) (2014) and Michel et al. (2006Michel et al. ( , 2007Michel et al. ( , 2012 Panamá ...
... Lem. (2014) and Michel et al. (2006Michel et al. ( , 2007Michel et al. ( , 2012 Panamá (Picking et al. 2013). Leaf extracts bound to the 5HT7 receptor in vitro (Michel et al., 2007). ...
Over the past 20 years, Central America (CA) has made considerable progress in improving the health status of its populations. However, in some countries, the overall health status remains below average with poor outcomes concentrated geographically among the poor and Indigenous populations. Although Indigenous people make up the second largest population in CA, these populations have less access to healthcare, and funding for initiatives to improve maternal health is scarce. In many communities across CA, women continue to rely heavily on plant-based medicines for health and well-being, and yet there is a paucity of information regarding the safety and efficacy of these therapies. Sourced from available academic, governmental, and gray literature, in both English and Spanish, this chapter reviews maternal health issues among the Indigenous, Ladino, and other ethnic women of CA, evaluates the role of traditional medicine practices and their influence on maternal health outcomes, and reviews the existing scientific evidence supporting the use of traditional (i.e., plant-based) medicines for pregnancy-related health conditions.
... For a list giving a brief summary of each article, see the Appendix in the Supplemental material at http:// dx.doi.org/10.3109/13697137.2015.1119112. Most articles (14) described indigenous populations from either Central [13][14][15][16][17][18][19] or South America 20-26 , including in particular Mayan women [13][14][15][16][17][18] (Tables 1 and 2). Twenty were quantitative studies [15][16][17][18][19][20][21][22][23][24][25][26]31,33,34,[36][37][38][39][40] , generally using trained interviewers to obtain data from women because of need for local translation or concerns about literacy. ...
... For a list giving a brief summary of each article, see the Appendix in the Supplemental material at http:// dx.doi.org/10.3109/13697137.2015.1119112. Most articles (14) described indigenous populations from either Central [13][14][15][16][17][18][19] or South America 20-26 , including in particular Mayan women [13][14][15][16][17][18] (Tables 1 and 2). Twenty were quantitative studies [15][16][17][18][19][20][21][22][23][24][25][26]31,33,34,[36][37][38][39][40] , generally using trained interviewers to obtain data from women because of need for local translation or concerns about literacy. ...
... Twenty were quantitative studies [15][16][17][18][19][20][21][22][23][24][25][26]31,33,34,[36][37][38][39][40] , generally using trained interviewers to obtain data from women because of need for local translation or concerns about literacy. Six studies used qualitative methods 13,14,27,28,30,35 , using in-depth interviewing and/or observation. One paper reported both quantitative and qualitative methods 31 . ...
Every woman experiences the menopause transition period in a very individual way. Menopause symptoms and management are greatly influenced by socioeconomic status in addition to genetic background and medical history. Because of their very unique cultural heritage and often holistic view of health and well-being, menopause symptoms and management might differ greatly in aboriginals compared to non-aboriginals. Our aim was to investigate the extent and scope of the current literature in describing the menopause experience of aboriginal women.
Our systematic literature review included nine health-related databases using the keywords ‘menopause’ and ‘climacteric symptoms’ in combination with various keywords describing aboriginal populations. Data were collected from selected articles and descriptive analysis was applied.
Twenty-eight relevant articles were included in our analysis. These articles represent data from 12 countries and aboriginal groups from at least eight distinctive geographical regions. Knowledge of menopause and symptom experience vary greatly among study groups. The average age of menopause onset appears earlier in most aboriginal groups, often attributed to malnutrition and a harsher lifestyle.
This literature review highlights a need for further research of the menopause transition period among aboriginal women to fully explore understanding and treatment of menopause symptoms and ultimately advance an important dialogue about women’s health care.
... The inclusion of Indigenous women as part of the study is of great importance because Indigenous women are usually the most marginalized population in comparison to their Indigenous male and non-Indigenous counterparts (Layland et al., 2004). And differences between urban and rural women are examined because rural location is a predictor of healthcare use in previous studies (Michel et al., 2006;WHO, 2004;Ramos, 2003). Age is included because of the findings in other jurisdictions, such as India, that older women are underserved in eye care clinics (Nirmalan, 2003). ...
... This divide is consistent with literature findings. For example, Michel et al. (2006) find that regardless of Indigenous status, there exists a division between rural and urban women's views of healthcare in Guatemala (Michel et al., 2006). It is important to remember that these results are based on a study of only women. ...
... This divide is consistent with literature findings. For example, Michel et al. (2006) find that regardless of Indigenous status, there exists a division between rural and urban women's views of healthcare in Guatemala (Michel et al., 2006). It is important to remember that these results are based on a study of only women. ...
... Found at the northern end of the Central American isthmus, Guatemala is bordered by Mexico to the north, the Pacific Ocean to the west, the Caribbean Sea and Belize to the east and El Salvador and Honduras to the southeast [8]. Seated between 13º 44' to 17º 49' N latitude and 88º 13' to 92º 30' NW longitude, Guatemala covers roughly 131,800 km (approximately equal to the U.S. state of Tennessee) [9][10][11][12]. The country is divided into 23 departments (or states) and 330 municipalities that are inhabited by approximately 14,655,189 people [9]. ...
... Seated between 13º 44' to 17º 49' N latitude and 88º 13' to 92º 30' NW longitude, Guatemala covers roughly 131,800 km (approximately equal to the U.S. state of Tennessee) [9][10][11][12]. The country is divided into 23 departments (or states) and 330 municipalities that are inhabited by approximately 14,655,189 people [9]. Economically, Guatemala is among the poorest countries in CA (Fig. 1), and yet it is among one of the richest nations in terms of traditional medical knowledge and biological resources [13]. ...
... Fortunately, some community outreach strategies are showing signs of success in providing maternal care to the Maya women in the Guatemalan highlands, by integrating traditional medicine practices with Western medicine. One of these is the Guatemalan Ministry of Health that began an initiative to support the integration of traditional and conventional healing practices by forming a committee of healers representing each ethnolinguistic group in Guatemala [9]. However, even with these new initiatives, the maternal health-related Millennium Development Goals for 2015 will not be met for Guatemala, and high maternal mortality rates still persist. ...
The Central American (CA) isthmus consists of seven countries including Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama, some of the poorest countries in the world. Over the past twenty years, CA has made good progress in improving the health status of their populations. Analysis of the peer-reviewed literature, as well as national and international reports show that life expectancy at birth has increased and child mortality rates have fallen. Maternal mortality ratios (MMR) have declined by approximately 33%, however the MMRs for indigenous women remain at unacceptable levels. Despite the advances, made in many CA countries, the overall health status remains well below Latin American averages. In fact, in most CA countries, poor health outcomes are increasingly concentrated geographically among the poor and indigenous populations. Considering indigenous people make up the second largest population group in CA, any improvements in healthcare should significantly improve the health statistics for these countries. For these populations, the integration of local cultural practices and traditional healing methods with modern medicine and healthcare facilities is critical for acceptance. Investigations and analyses of local cultures, knowledge and traditional medicine practices should be used to determine the factors that contribute to poor health in these populations. Local health educational programs are needed, especially those that would involve men (spouses), families and entire communities. Furthermore, manywomen's reproductive issues still need to be addressed, particularly those that focus specifically on maternal mortality and cancer. For reductions in maternal mortality, El Salvador and Costa Rica may be good examples to follow. Access to inexpensive (or free) healthcare that is culturally sensitive and community based, particularly for indigenous women, would greatly improve the overall health. The major stumbling blocks to progress are that the funding for programs to reduce maternal mortality is woefully inadequate and that there has not been a focus on improving healthcare for indigenous women.
... Although there has been a significant amount of research about the ethnobotanical knowledge of different ethnic groups in Mexico (Alcorn 2000;Frei et al. 1998;Leonti et al. 2002;Weimann and Heinrich 1997), there has been less research done regarding the plant knowledge possessed by indigenous women (Browner 1985;Rodríguez López et al. 1998;Vázquez-García 2008). Additionally, there are few studies that examine the effect of globalization and change on indigenous women's knowledge (Vazquez-García 2008; see Michel et al. 2006 for information on Q'eqchi Maya in Guatemala). This article will contribute to this discussion. ...
... As is true in other parts of the world (Leslie 1998;Michel et al. 2006), health in this region of Mexico is often associated with equilibrium. The hot/cold duality is central to the idea of equilibrium in Mesoamerica; it refers to the humoral qualities of plants, people, illnesses, etc. ...
... These plants are torn up and crushed by the midwife, soaked in well water for a few hours, and then used to bathe the mother and infant. We find this concept of bathing in a mixture of medicinal plants in other societies, such as the use of the bakera in Indonesia (Zumsteg and Weckerle 2007), the temazcal in parts of Mexico (Castañeda Camey et al. 1996), and herbal baths in Guatemala (Michel et al. 2006). Blood expelled during birth is perceived to be both polluting (Douglas 2000) and humorally hot; it is the latter property that is perceived to harm the mother and infant, and thus they both have to be bathed in a mixture of cooling plants to counteract the effects of the blood. ...
Plants Used for Reproductive Health by Nahua Women in Northern Veracruz, Mexico. This paper reports the use of medicinal plants by Nahua women in the state of Veracruz, Mexico. It documents the women’s
plant knowledge for reproductive purposes, which includes uses such as conception, pregnancy, birth, contraception, menstruation,
post-partum, and general reproductive health. The concept of equilibrium is very important in regaining health among the Nahua;
consequently, many of the medicinal plants have this as their primary purpose. The introduction of biomedical clinics and
hospitals in the region has had a significant effect on the loss of knowledge about medicinal plants. Additionally, the midwives
are not taking any new apprentices and laywomen are not passing on their knowledge to future generations. This generational
gap contributes to the loss of knowledge about medicinal plants. This research contributes to the study of indigenous ethnobotany
by (a) creating a record of the plant knowledge possessed by indigenous women, (b) giving voice to some of their health concerns,
(c) indicating how the introduction of biomedicine has affected their plant use, and (d) providing a framework for understanding
how marginal peoples around the world respond to the impact that globalization and change has on their health needs and local
ethnobotanical knowledge.
... In Guatemala, as in other Central American countries, medicinal plants continue to be the most economically and culturally suitable treatment for a variety of health conditions, including those related to women's health (Michel et al., 2006). Many of these plants have not been thoroughly documented, yet research on their biological and phytochemical potential may provide important information on their safety and efficacy, not only for women in Latin America, but for women worldwide who are searching for alternative natural therapies for menstrual and menopausal problems. ...
... Due to the limited ethnographic data on women's health in Latin America and the lack of systematic explorations on the biological activity of plants used to treat women's health complaints in Guatemala, extended participant observation (1999)(2000)(2001)(2002)(2003)(2004) and 8-months of in depth ethnobotanical field study (November 2003-June 2004 was carried out (Michel et al., 2006). A total of 50 individuals from four rural Q'eqchi villages and the semi-urban town of Livingston were interviewed, including five traditional Q'eqchi male healers (curanderos), 4 Q'eqchi female midwives (comadronas) and one Garifuna midwife, and 40 Q'eqchi men and women with no specialty healing expertise ranging in age from 18 to 60 years of age. ...
... Interviews lasted anywhere from 30 minutes to 2 hours, depending on the informants level of knowledge and willingness to share their information. A total of 50 interviews were conducted (25 men, 25 women) using the UIC IRB (Institutional Review Board) protocol number 2002-0514; informed consent was received from all participants before the interviews began (Michel et al., 2006). ...
Investigation on the medical ethnobotany of the Q'eqchi Maya of Livingston, Izabal, Guatemala, was undertaken in order to explore Q'eqchi perceptions, attitudes, and treatment choices related to women's health. Through participant observation and interviews a total of 48 medicinal plants used to treat conditions related to pregnancy, childbirth, menstruation, and menopause were collected and identified followed by the evaluation of 20 species in bioassays relevant to women's health. Results of field interviews indicate that Q'eqchi cultural perceptions affect women's health experiences while laboratory results (estrogen receptor and serotonin receptor binding assays) provide a scientific correlation between empirical medicinal plant use among the Q'eqchi and the pharmacological basis for their administration. These data can contribute to Guatemala's national effort to promote a complementary relationship between traditional Maya medicine and public health services and can serve as a basis for further pharmacology and phytochemistry on Q'eqchi medicinal plants for the treatment of women's health conditions.
... One informant applies the leaves directly to the forehead to treat headaches. Elsewhere in Guatemala, Q'eqchi' in Izabal infuse C. x aurantium leaves to drink and apply directly for night sweats and insomnia (Michel et al. 2006). Guatemalan Caribs drink a leaf decoction for flatulence, the pericarp for vomiting and diarrhea, the bud for "cardiac weakness" and nervousness, and eat the fruit for fever (Girón et al. 1991:184). ...
... Literature from Guatemala, and elsewhere, indicates similar P. americana medicinal uses. Eastern Guatemalan Q'eqchi' use the seed as an abortive (Michel et al. 2006). Guatemalan Caribs use the leaf tea for urinary and bronchial infection, to detoxify, and for cardiac weakness (Girón et al. 1991). ...
Five cultivated fruit trees are among the most popular medical plant species that Q’eqchi’ Maya horticultural villagers of Alta Verapaz, Guatemala grow in their dooryards. Participant-observation with informal interviews and 31 semi-structured interviews amidst walking homegarden tours inform findings. Beyond their apparent nutritional, ornamental, and shade values, Q’eqchi’ use bitter orange, Citrus x aurantium, for headaches, gastrointestinal problems, high blood pressure, cough, and fever. Prevalent home garden tree Citrus x latifolia treats fever, throat, cough, and heart problems; Mangifera indica treats fever and kidney pain; Persea americana helps gastrointestinal and skin problems, body pain, evil eye, and has abortive properties; and Psidium guajava remedies gastrointestinal problems, amoebas, and bites. We review these species’ regional ethnomedical use and pharmacology. Outside pharmacological research supports Q’eqchi’ villagers’ cultural reasons for these phytotherapies.
... 4 Furthermore, many women suffer from additional difficulty when their spouse misinterprets menopausal symptoms (vaginal dryness, sexual disinterest) as infidelity. 5 Men in this hard period have a very crucial role for women to have a smooth transition into postmenopausal period. ...
... A qualitative study earlier included 10 men and 10 women and all the participants stated that they were unaware of the menstruation or menopause until the event occurred. 5 Many of the women were already married at the time of menarche and relied on their husband's knowledge to inform them about menstruation. The information given to these women, however, was very restricted and these women were not alerted to anticipate the physiological nor psychological symptoms associated with menstruation or menopause. ...
To look at menopause from men's point of view and to provide a better understanding of this phase to improve the care delivered to menopausal women.
The study was conducted at the health centre of a single district of Istanbul, from April 2013 to June 2013, which serves as the research and training area of the Marmara University and which receives migrations from mainly southern and eastern regions of Turkey.The study sample included 33 married men. Qualitative in-depth interviews were performed individually and main themes were noted down for analysis.
The age range of the study population was 40-77 years. The subjects lacked basic knowledge about both menstruation and menopause. Most of the participants defined menopause as loss of fecundity, increased weight, and loss of beauty.The most important concern voiced was men's own sexual life. None of the men had heard about treatment modalities available for menopause.
Interventions are needed to increase men's awareness regarding menopause in order to help these men to be able to better support their spouses so that they can both have a smooth transition into postmenopausal years.
... 4 Furthermore, many women suffer from additional difficulty when their spouse misinterprets menopausal symptoms (vaginal dryness, sexual disinterest) as infidelity. 5 Men in this hard period have a very crucial role for women to have a smooth transition into postmenopausal period. ...
... A qualitative study earlier included 10 men and 10 women and all the participants stated that they were unaware of the menstruation or menopause until the event occurred. 5 Many of the women were already married at the time of menarche and relied on their husband's knowledge to inform them about menstruation. The information given to these women, however, was very restricted and these women were not alerted to anticipate the physiological nor psychological symptoms associated with menstruation or menopause. ...
Abstract
Objective: To look at menopause from men's point of view and to provide a better understanding of this phase to
improve the care delivered to menopausal women.
Methods: The study was conducted at the health centre of a single district of Istanbul, from April 2013 to June 2013,
which serves as the research and training area of the Marmara University and which receives migrations from mainly
southern and eastern regions of Turkey. The study sample included 33 married men. Qualitative in-depth interviews
were performed individually and main themes were noted down for analysis.
Results: The age range of the study population was 40-77 years. The subjects lacked basic knowledge about both
menstruation and menopause. Most of the participants defined menopause as loss of fecundity, increased weight,
and loss of beauty. The most important concern voiced was men's own sexual life. None of the men had heard about
treatment modalities available for menopause.
Conclusion: Interventions are needed to increase men's awareness regarding menopause in order to help these
men to be able to better support their spouses so that they can both have a smooth transition into postmenopausal
years.
Keywords: Men, Menopause, Qualitative, Turkish, Perceptions, In-depth. (JPMA 64: 1031; 2014)
... Plants used traditionally for female reproductive health, in particular those used for abortion, have received little attention from researchers, as for a long time these were considered as used for sinful or illegal objectives (Schiebinger, 2004). In recent decennia, however, a growing number of ethnobotanical studies have been published on plants used for reproductive health in the tropics (e.g., De Boer and Cotingting, 2014;Kamatenesi-Mugisha and Oryem-Origa, 2007;Michel et al., 2006Michel et al., , 2007Ososki et al., 2002). Some authors are still struggling with prejudices regarding women's choices over their own sexuality. ...
... The underlying motivation for the frequent use of remedies to regulate the menses is health-related, as cleansing of the womb is seen as a method to clean impurities and increase fertility, rather than reducing it by terminating a pregnancy (Levin, 2001;Madhavan and Diarra, 2001). In many societies, menstruating women are believed to be unclean, and not expected to cook or handle any sacred object at such times (Michel et al., 2006;Van de Walle and Renne, 2001). They are not allowed to participate in religious ceremonies and perform rituals, as they are thought to spoil whatever they touch (Iwu, 1993). ...
... Od ponad 20 lat stosuje się estrogen, jeszcze dłużej, bo od 30 lat progesteron. W terapii hormonalnej stosuje się te dwie substancje równocześnie lub oddzielnie [9][10][11][12]. Stosowanie HRT w walce z objawami menopauzy przyczynia się m.in. ...
... Ze względu na poważne skutki stosowania hormonalnej terapii zastępczej, trwają niekończące się poszukiwania roślinnych produktów leczniczych, które w bezpieczny dla zdrowia sposób zwalczałyby niekorzystne objawy menopauzy. Korzystając z doświadczeń medycyny alternatywnej Światowa Organizacja Zdrowia (WHO) oraz Panamerykańska Organizacja Zdrowia (PAHO) podjęły starania zapewnienia bezpieczeństwa stosowania produktów pochodzenia roślinnego prowadząc liczne badania kliniczne, ale również skupia się na zwiększeniu dostępności i powszechności tego typu produktów w świecie [10]. ...
The tradition of the use of plants resources in the fight against many diseases dates back to antiquity. Herbal medicine is used in the fight against less severe, as well as serious diseases. In view of the serious consequences of the use of hormone replacement therapy (HRT) to combat the symptoms of menopause are increasingly used plant medicines. According to the Women's Health Initiative (WHI) reported, their use is becoming more and more popular. An important advantage of this therapy is to prevent such the development of breast cancer, which is often a side effect of HRT. Therefore, this article also presents the most commonly used plants that help counteract the adverse symptoms of menopause.
... Indigenous women of this study had the most impaired QoL (highest total MRS score) of all. Our results are similar to those reported upon Maya Indians from Guatemala with high rates of menopausal symptoms [25,26] and to those reported by Castelo-Branco et al. [27], among Movima indigenous women (Bolivia) aged 35-54 years, in which the prevalence of hot flashes was 45% [27]. However, they differ from other publications regarding American aborigines in which menopausal symptoms seem to be less intense. ...
... Not obtaining information regarding the use of alternatives to HT, which could possibly have an influence over menopausal symptoms, among the black and indigenous group can also be seen as a potential limitation. Herbal therapy for the treatment of climacteric symptoms has been mentioned in several Latin American studies [11,25,35]. However, their use seems to be less frequent than in other populations. ...
Few studies have addressed the impact of menopausal symptom severity over quality of life (QoL) in Latin American women with different ethnics.
To assess menopausal symptom severity and the QoL among postmenopausal Colombian women with three different ethnicities.
Data of healthy naturally occurring postmenopausal Hispanic, indigenous and black women aged 40-59 years who participated in a cross-sectional study filling out the Menopause Rating Scale (MRS) and a general questionnaire was analysed.
A total of 579 women were included, 153 Hispanic, 295 indigenous and 131 Afro-descendent. Hispanic women had an average age of 55.3 +/- 3.3 years. Indigenous and black women were less educated than the Hispanic ones (2.2 +/- 1.8 and 4.6 +/- 4.4 vs. 6.4 +/- 3.5 years, p < 0.0001). Hispanic women displayed lower total MRS scores (better QoL) when compared to indigenous and black women. Urogenital scoring was worse among indigenous women compared to Hispanic and black women. Black women presented higher MRS psychological and somatic scorings than Hispanic and indigenous women. After adjusting for confounding factors, indigenous and black women continued to display a higher risk for impaired QoL, total MRS score > 16 (OR: 3.11, 95% CI: 1.30-7.44 and OR: 5.29, 95% CI: 2.52-11.10, respectively), which was significantly higher among indigenous women due to urogenital symptoms (OR: 102.75, 95% CI: 38.33-275.47) and black women due to psychological (OR: 6.58, 95% CI: 3.27-13.27) and somatic symptoms (OR: 3.88, 95% CI: 1.83-8.22).
In this postmenopausal Colombian series, menopausal symptoms in indigenous (urogenital) and black (somatic/psychological) women were more severe (impaired QoL) when compared to Hispanic ones.
... Indigenous women of this study had the most impaired QoL (highest total MRS score) of all. Our results are similar to those reported upon Maya Indians from Guatemala with high rates of menopausal symptoms [25,26] and to those reported by Castelo-Branco et al. [27], among Movima indigenous women (Bolivia) aged 35-54 years, in which the prevalence of hot flashes was 45% [27]. However, they differ from other publications regarding American aborigines in which menopausal symptoms seem to be less intense. ...
... Not obtaining information regarding the use of alternatives to HT, which could possibly have an influence over menopausal symptoms, among the black and indigenous group can also be seen as a potential limitation. Herbal therapy for the treatment of climacteric symptoms has been mentioned in several Latin American studies [11,25,35]. However, their use seems to be less frequent than in other populations. ...
Introducción. Pocos estudios han comparado el impacto del climaterio en la calidad de vida (CV) en diferentes etnias latinoamericanas. Objetivo: Evaluar la CV en mujeres postmenopáusicas colombianas de tres etnias distintas. Material y método: Estudio descriptivo transversal que incluyó mujeres sanas entre 40 y 59 años de edad, pertenecientes a las etnias hispánicas, indígenas y negras. La población evaluada hace parte del Estudio Calidad de Vida en la Menopausia y Etnias Colombianas (Cavimec). El instrumento utilizado para valorar CV fue el Menopause Rating Scale. Resultados: Se estudiaron 579 mujeres postmenopáusicas, 153 hispánicas, 295 indígenas y 131 afrodescendientes. Las hispánicas tenían en promedio 55,3 (DE 3,3) años de edad, 6,4 (DE 3,5) años de escolaridad y habían presentado su menopausia a los 48,3 (DE 2,5) años. Comparadas con las hispánicas, las indígenas tenían una edad similar, menor escolaridad (2,2 [DE 1,8] años, p
... For example, Genitourinary Syndrome of menopause was a term developed for defining a collection of signs and symptoms resulting from a decline in estrogen and other sex steroids which encompassed genital symptoms such as dryness, burning, and irritation; sexual symptoms 54 including absence of lubrication, dyspareunia, and urinary symptoms such as urgency, dysuria and recurrent urinary tract infections (98).This definition did not cover the array of symptoms that could constitute the menopausal experience in real life. For example, menopause was an additional hardship for some women because their spouse misinterpreted vaginal dryness and lack of sexual desire as infidelity (99). ...
Objectives: To identify the diverse meanings of menopause in various contextual settings and to be mindful of how these meanings are formed. Methods: An integrative review was performed to analyze the existing literature on the meanings of menopause. Whittemore and Knafl’s five-step process was followed. Literature published between 2005 to 2022 was reviewed. Medline, CINAHL Scopus, Nursing Reference Center Plus, and Google Scholar databases were searched. The PRISMA flow diagram was used to illustrate the review process. For the quality appraisal of the articles, the Critical Appraisals Skills Programme (CASP) checklists were used depending on the study design. Qualitative, quantitative, mixed method, and systematic review articles were included. A data extraction form was designed encompassing author, year, methods, context, setting sample, country, related theme. For each study, findings were coded inductively, and codes were reviewed for their commonalities and differences. Key contributing pieces relating to meanings of menopause were grouped into themes. Results: A total of 65 studies were analyzed for this review. Different menopause meanings and their contributing pieces were identified. The five main categorized themes were bio-physiological, socio-cultural, sexual, psychological, and spiritual meanings and contributing factors. Conclusions: Although meanings of menopause among women can differ, the contributing pieces for meanings of menopause are common across countries. It is significant to consider a holistic care approach to support women achieve their optimal health. This study proposes additional sexual piece for holistic care model as it was identified a major theme and concern among menopausal women.
... The most common assessment method was the Menopause Rating Scale (n = 69) [31][32][33][34][35][36][37][38][39][40]. The next three most common assessment methods were unspecified self-administered questionaries (n = 14) [115][116][117][118][119][120][121][122][123][124][125][126][127][128], interviews (n = 10) [7,[129][130][131][132][133][134][135][136][137], and the Blatt Kupperman Menopause Index (n = 8) [12,44,[101][102][103][104][105][106]. ...
Palpitations are reported commonly by women around the time of menopause as skipped, missed, irregular, and/or exaggerated heartbeats or heart pounding. However, much less is known about palpitations than other menopausal symptoms such as vasomotor symptoms. The objective of this review was to integrate evidence on menopausal palpitations measures. Keyword searching was done in PubMed, CINAHL, and PsycINFO for English-language, descriptive articles containing data on menopause and palpitations and meeting other pre-specified inclusion criteria. Of 670 articles, 110 met inclusion criteria and were included in the review. Results showed that 11 different measures were used across articles, with variability within and between measures. Inconsistencies in the wording of measurement items, recall periods, and response options were observed even when standardized measures were used. Most measures were limited to assessing symptom presence and severity. Findings suggest that efforts should be undertaken to (1) standardize conceptual and operational definitions of menopausal palpitations and (2) develop a patient-friendly, conceptually clear, psychometrically sound measure of menopausal palpitations.
... [25,73,86,104]). Most research on menopause has been conducted with white, English-speaking, middle-class, cisgender, heterosexual, married women, with some notable exceptions (e.g., [3,4,21,29,44,71,72,78,98,102]). We use the term women when citing previous research if the samples only included women. ...
... Eskişehir, Erzurum ve Sivas illerinde yapılan çalışmalarda kadınların en sık yaşadıkları semptomlar, daha çok sıcak basması, sinirlilik, yorgunluk ve kas-eklem ağrıları olarak saptanmıştır (9,17,23,24). Guatemala'da yapılan bir çalışmada menopozal dönemdeki kadınların en sık baş ağrısı, anksiyete ve kas ağrısı yaşadıkları (25), Hindistan'da ise sıcak basması, gece terlemesi ve yorgunlukla daha sık karşılaşıldığı belirtilmiştir (26). Nijerya'da sıcak basması, yorgunluk ve eklem ağrıları en çok karşılaşılan ilk üç yakınma iken (27), Avustralya'da kas ve eklem ağrılarının en sık yakınılan semptom, sıcak basması ve gece terlemesinin daha az karşılaşılan sorun olduğu görülmüştür (6). ...
Giriş: Menopoz, klimakteriyum içerisinde yer alan, overlerin fonksiyon kaybı ve menstruasyonun kalıcı olarak kesilmesi ile karakterize bir evredir. Amaç: Bu çalışmanın amacı; klimakterik dönemdeki kadınların menopozal semptom, menopozal tutum ve tutumlarını etkileyen faktörleri belirlemektir. Yöntem: Analitik-kesitsel tipte yürütülen araştırmanın evrenini, Aydın Kanser Erken Teşhis, Tarama ve Eğitim Merkezi’ne başvuran 5620 kadın oluşturmuştur. Örneklemde 360 kadın yer almıştır. Veriler, soru formu, Menopozal Yakınma Tarama Listesi ve Menopoza İlişkin Tutum Ölçeği kullanılarak yüz yüze görüşme yöntemi ve öz-bildirim yöntemi ile toplanmıştır. Verilerin değerlendirilmesinde, tanımlayıcı istatistikler ve regresyon analizi kullanılmıştır. Bulgular: Katılımcılar, ortalama 53.07 ± 3.95 yaşında olup %79.7’si menopoz dönemindedir. Ortalama 49.95 ± 1.56 yaşında menopoza giren kadınların %79.1’i menopozla ilgili bilgi almış, %89.1’i menopozal yakınmalarını bir başkası ile paylaşmıştır. Sinirlilik-gerginlik (%56), baş ağrısı-baş dönmesi (%25.6) ve sıcak basması-gece terlemesi (%24) en çok yakınılan menopozal semptomlar olmuştur. Araştırmada yer alan kadınların Menopoza İlişkin Tutum Ölçeği puan ortalaması 35.24 ± 6.13 olarak belirlenmiş olup, katılımcıların daha çok olumsuz tutuma sahip olduğu görülmüştür. Ayrıca kadınların menopozla ilgili bilgi almaları (p = .961), menopoza girmeleri (p = .324) ve menopozal yakınmalarının varlığının (p = .311) kadınların ölçek puanı üzerinde anlamlı bir etkisi olmadığı saptanmıştır. Sonuç: Bu çalışmada, kadınların menopoza yönelik tutumlarının çoğunlukla olumsuz olduğu ve tutumun kadınların bazı menopozal özelliklerinden etkilenmediği görülmüştür.
... En Guatemala se usa para la sudoración nocturna, infecciones urinarias, diarreas, dolores de estómago, leucorrea, fiebre y trastornos de sangre (Michel et al., 2007). En la tradición etnomedicinal de la República Dominicana se usa para tratar la infertilidad (Vandebroek et al., 2010), probablemente porque estimula los receptores de estrógeno que también ayudan a regular los síntomas menopaúsicos (Michel et al., 2006). Aunque no existen estudios fitoquímicos detallados de esta especie, puede señalarse que en el seno del género Smilax se han aislado e identificado esteorides, saponinas, flavonoides como quercetina, esteroles y smilásidos que han demostrado poseer propiedades analgésicas, antiinflamatorias y antimicrobianas, actuando también como excelentes reguladores de los sistemas inmunológico y digestivo (Cheng et al., 2004;Cáceres et al., 2012;Petrica et al., 2014;Dévora et al., 2015;Alonso-Castro et al., 2016). ...
Introducción: La etnobotánica, disciplina encargada de rescatar, salvaguardar y exponer los conocimientos de los pobladores que hacen uso de las plantas, centrándose principalmente en los grupos étnicos con identidad y acervo cultural en el uso de vegetales para su autoconsumo, parte esencial de su cultura que les identifica. Nicaragua es catalogada como "un país multiétnico y pluricultural" caso que podría generar datos interesantes en esta disciplina. Material y Métodos: para el análisis de datos se hizo uso de la encuestas etnobotánicas para la recolección de datos (especie, uso, dosis etc.), observación y clasificación taxonómica a través de una ficha de campo estructurada; análisis documental de las especies autóctonas especificando metabolitos secundarios y propiedades medicinales, el software PAST que es utilizado para medir biodiversidad y hacer correlaciones de similitud y finalmente los índices etnobotánicos para caracterizar culturalmente las comunidades. Resultados: Se identificó un total de 156 especies medicinales, los encuestados aportaron 4,404 citas etnomedicinales y 15 tipologías de uso medicinal. Las 5 especies más citadas: Eucalyptus camaldulensis, Cymbopogon citratus, Mangifera indica, Citrus x aurantium, Plectranthus amboinicus. Se contabilizaron ocho especies con usos etnobotánicos endémicos de estas especies no hay bibliografía alguna. La diversidad fue alta, según el índice Shannon-Weiner , referente al uso de los índices etnobotánicos siendo el de aloctoneidad: 59% autóctono contra un 41% de especies alóctonas; el índice de etnobotanicidad social medicinal, con características de interés (género, edad, educación y trabajo), demostró que, en referencia al género, el mayor conocimiento etnomedicinal corresponde a mujeres, en la edad los jóvenes entre 20-39 años poseen mayor cantidad de citas; el nivel académico relacionado con el acervo cultural está representado por las personas con una formación básica (primaria) que es más de la mitad y finalmente la relación entre labor son las amas de casa que tienen el primer lugar. El análisis de similitud por grupos generó tres cúmulos muy similares. Este método demostró que no existe una cultura mestiza e indígena diferenciada. Las comunidades indígenas poseen un gran acervo cultural sobre el uso de plantas medicinales, pero éste se fundamenta en especies alóctonas, lo que en cierta manera limita una "identidad cultural indígena". El conocimiento etnobotánico autóctono es una amalgama cultural tras análisis bibliográfico, que destacó que hay una gran influencia cultural provenientes de Norteamérica por las sucesiones culturales de México; se encontró con especies de amplio espectro de uso que van desde México hasta el Amazonas o incluso más al sur Se documentó un catálogo etnoflorístico medicinal de 79 especies, el catálogo incluye la caracterización química de los principales metabolitos secundarios responsables de las propiedades medicinales de las especies estudiadas, el uso histórico dado a éstas en las comunidades encuestadas así como en otras culturas, e, incluso, otro tipo de potencialidades en el ámbito de la salud cuando se ha considerado pertinente tal mención.
... However, in Guatemala, the Q'eqchi forbid the discussion of the menopause itself until it occurs. There are a range of different taboos surrounding menstruation, such as the prohibition of bathing, looking at newborn babies, and serving food (Michel et al, 2006). Whilst the literature does not directly refer to WASH, the existing literature has various implications for providing WASH for perimenopausal women. ...
... Plants use during postpartum recovery is more common but no specific plant or plant extracts are used during pregnancy or to facilitate childbirth. The plants are not used for the purpose of bath in India as in other societies such as the use of Bakera in Indonesia (Zumstag and Weckerle 2007), the Temazcal in parts of Mexico (Castaneda Camey et al. 1996) and herbal bath in Guatemala (Michel et al. 2006). The concept of Steam bath and mother roasting with a mixture of medicinal plants is not present here. ...
Childbirth is a critical period of life and behavior towards childbirth varies from culture to culture. In many Southeast Asian cultures, postpartum period is considered important from point of view of recovery by offering a period of confinement. This study aimed to describe the plants used in diet therapy after childbirth in postpartum period, their importance and tried to assess the potential effects of the practices on the health of new mother and baby. The study shows that medicinal plants play a significant role in the recovery of new mother as they possess many biological properties and their molecular targets cover vast area. Therefore, the above mentioned plant species should be further explored for their other pharmacological characteristics for human welfare. Formulations can be prepared using these plants for the better healthcare of women.
... para indígenas de la etnia wayúu, en la Costa Caribe colombiana, es: 47.8±3.5 años (12); para movimas, de Bolivia: 42.3±6.17 años (13); para mayas q'eqchi de Guatemala: 46±2.8 años (19), y para quechuas del Perú 45.5±3.0 años (7). Estos grupos indígenas con edad promedio de menopausia diferente, que residen ancestralmente a distintos niveles sobre el mar, que han tenido diferentes influencias del modernismo, que conservan en diferentes grados sus patrones de vida personal y comunitaria, tienen en común que presentan un fuerte y precoz compromiso de su dimensión urogenital, con síntomas, quejas, manifestaciones y patologías que se instalan o inician desde edades muy tempranas de premenopausia y se incrementan sensiblemente en la posmenopausia. ...
Objective: To identify the most prevalent severe menopausal symptoms among indig-enous women in menopause stage. Methodology: Women Zenúes in the indigenous reserve of San Andres de Sotavento, Department of Córdoba, in the Colombian Caribbean, in different stages of menopause. Ages 40-59 years old were studied. Rated with "Menopause Rating Scale" (MRS). Results: 693 women were included in the study, 295 premenopausal and 398 postmeno-pausal. Average age of last menstrual period: 49.4 ± 3.0. The domain more impaired in premenopausal indigenous somatic-vegetative was (2.9 ± 1.6), influenced by muscle-joint discomfort. In postmenopausal women the most impaired domain was urogenital (5.5 + 3.0), the high prevalence of severe bladder problems. The severe occurrence was more prevalent among pre-menopausal vaginal dryness with muscle joint pains (10.8%) and postmenopausal bladder problems (60.3%). 5.4% of premenopausal and 52.0% of post-menopausal women 52.0% have a poor quality of life. Conclusions: Zenúes indigenous women have high prevalence of symptoms that are part of the urogenital domain and have the most influence to impair the quality of life. Post-menopausal women have worse quality of life and prevalence of bladder problems.
... Lock sees symptoms rather as the result of a "dialectic between biology and culture in which both are contingent," thus producing "local biologies" (1993: p XXI;. Ethnographic monographs are available (Davis, 1986;Guessous, 2000;Michel et al., 2006), but there are few qualitative comparative studies (Beyene, 1986). We still know too little about how sociocultural context and social status modulate the symptoms and experience of menopause, nor for what reasons social status does or does not change, in one direction or another. ...
The experience of menopause can vary strongly from one society to another: frequency of hot flushes, other somatic and psychological symptoms, and changes in family and social relations. Several studies have shown that country of residence, country of birth, ethnicity, and social class all play roles in these variations. But few comparative anthropological studies have analysed the social processes that construct the experience of menopause or considered menopausal women's social and financial autonomy. To study the impact of the social status accorded to menopausal women and their social resources, during 2007 and 2008 we conducted a series of 75 in-depth interviews with women in different sociocultural settings: Tunisian women in Tunisia, Tunisian women in France, and French women in France, all aged from 45 to 70 years. Our methodological approach to the data included content analysis, typology development and socio-demographic analysis. Quite substantial differences appeared, as a function of social class and cultural environment. We identified three principal experiences of menopause. Tunisian working class women, in Tunisia and France, experience menopause with intense symptoms and strong feelings of social degradation. Among Tunisian middle-class women in both countries, menopause was most often accompanied by a severe decline in aesthetic and social value but few symptoms. For most of the French women, menopause involved few symptoms and little change in their social value. The distribution of types of experiences according to social but not geographic or national factors indicates that, in the populations studied here, the differences in symptoms are not biologically determined. Different experiences of menopause are linked to social class and to the degree of male domination. A given level of independence and emancipation allows women an identity beyond their reproductive function and a status unimpaired by menopause.
Introduction
Menopause denotes the end of a woman’s reproductive life. A woman’s experiences of menopause are shaped by her individual circumstances and may vary between social and cultural contexts. Evidence is needed to inform research and programme delivery that supports women’s health and well-being throughout the menopausal transition. This scoping review will map evidence of women’s experiences of menopause in Asia Pacific countries, where limited research exists.
Methods and analysis
We will follow the five-stage framework of Arksey and O’Malley, further developed by Levac et al and the Joanna Briggs Institute. MEDLINE, CINAHL, PsycINFO and Scopus databases will be systematically searched between February 2022 and May 2022 using subject headings and keywords. The title–abstract and full text of retrieved studies will be assessed against eligibility criteria. The review will focus on studies with a qualitative research component. Citation searching of selected articles will supplement database searching. Data will be extracted, charted, synthesised and summarised. Findings will be presented in narrative format and implications for research and practice reported.
Ethics and dissemination
Ethical approval is not required for this scoping review of selected studies from peer-reviewed journals. Ethical approval has been granted from relevant ethics committees for community consultation. Findings will be shared in peer-reviewed publications, presented at conferences and disseminated with communities, health workers and researchers.
Actaea racemosa (AR) also known as Cimicifuga racemosa, is a perennial plant from Ranunculaceae family which was used as traditional remedies in treatment of various condition like rheumatoid muscular pain, headache, inflammation and dysmenorrhea. Actaea racemosa was basically native to Canada and the Eastern United State. This chapter proposed the ethnopharmacological uses of Actaea racemosa, and its phytochemical properties. Specifically, in this article we focused on use of Actaea racemose for menopausal and post-menopausal symptoms management. Electronic databases including PubMed and Scopus were searched for studies on Actaea racemose and its administration in management of menopausal symptoms. Chem Office software was also used in order to find chemical structures. The key words used as search terms were Cimicifuga racemose, Actaea racemose, Ranunculaceae, Black cohosh, Menopausal symptoms. We have included all relevant animal and human studies up to the date of publication. The analysis on Actaea racemose showed various indications for different plant’s extracts. Approximately 131 chemical compounds have been isolated and identified from Actaea racemosa. According to recently studies, the most important chemicals known of the Actaea racemosa are phenolic compounds, chromones, triterpenoids, nitrogen-containing constituents. In addition, in vivo and in vitro studies reported wide range of pharmacological activities for Black cohosh like attenuating menopausal symptoms. Mechanism of action for some ethnomedicinal indications were made clear while some of its activities are not confirmed by pharmacological studies yet. Further investigations on its pharmacological properties are necessary to expand its clinical effective use. Also, additional large clinical trials are recommended for clarifying the effect of Black cohosh.
Objetivo: describir el conocimiento y uso de las terapias alternativas a la hormonal en mujeres menopáusicas.
Materiales y métodos: durante 2009, se realizó un estudio descriptivo de corte transversal en mujeres menopáusicas de la ciudad de Medellín, Colombia.Los criterios de inclusión fueron edad ≥40 años, haber finalizado sus ciclos menstruales al menos un ano antes y no tener antecedente de histerectomía.
Resultados: un total de 274 mujeres fueron haber finalizado sus ciclos menstruales al menos un encuestadas. Un 10,6% de las mujeres utilizaban año antes y no tener antecedente de histerectomía. hormonas naturales y un 46,0% emplea productos a base de soya. Con respecto a las terapias médicas alternativas y complementarias para la sintomatología de la menopausia, diferentes a las hormonas naturales, el 32,8% de las mujeres manifestó haber oído hablar de alguna de ellas, siendo más conocidas la homeopatía (18,6%), el yoga (16,8%) y la terapia de relajación (12,0%).
Conclusión: un alto porcentaje de mujeres menopáusicas conocen y utilizan terapias alternas a la hormonal para el manejo de la sintomatología asociada a la menopausia, especialmente la de consumo de fitoestrógenos y productos a base de soya.
Context: Pimenta dioica (L.) Merr. (Myrtaceae) is used in Costa Rican traditional medicine for women’s health. Our previous work showed that P. dioica extracts were oestrogenic.
Objectives: This work identifies phytochemicals from P. dioica that are responsible for the plant’s oestrogen-like activities.
Materials and methods: P. dioica leaves were collected in Costa Rica in 2005. Fractions resulting from chromatographic separation of a methanol extract were tested at 50 μg/mL in a competitive oestrogen receptor-binding assay. Active compounds were isolated by HPLC and identified by NMR and MS. Pure compounds were tested at 1 μM in the oestrogen-responsive SEAP reporter gene assay. The effects on cell viability, cytotoxicity and apoptosis were investigated in breast cancer (MCF-7 and SK-BR3) and gastric cancer (AGS and NCI-N87) cell lines using the ApoTox-Glo and Caspase-Glo assays and qPCR.
Results: Quercitrin and three new chromones, including a 2-phenoxychromone, 6,8-di-C-methylcapillarisin (1) were isolated and identified. Compound 1 caused a 6.2-fold increase in SEAP expression at 1 μM (p < 0.05). This activity was blocked by the ER antagonist ICI 182,780. Compound 2 caused a 6.0-fold increase in SEAP, inhibited the growth of MCF-7, AGS and NCI-N87 cells (IC50 54.27, 38.13 and 51.22 μg/mL, respectively), and induced apoptosis via caspase 8 and increased the Bax/Bcl-2 mRNA ratio in MCF-7 cells. Compound 3 was anti-oestrogenic in MCF-7 cells.
Discussion and conclusions: Compounds from P. dioica have oestrogenic, anti-oestrogenic and cytotoxic effects that may explain the ethnomedical use of this plant.
Similar to their US counterparts, Costa Rican women enter menopause at ∼50 years of age, have similar symptoms, including hot flashes and night sweats, as well as an overall negative attitude toward the menopausal transition. One study of rural women in Monteverde reported that women knew little about the menopausal transition, as the subject was not discussed. Similar to other Latin American women, the use of hormone therapy by Costa Rican women is low and instead they use alternative therapies, including massage, dietary changes and herbal medicines. A wide variety of herbal therapies are used, and some of these herbs have estrogenic activities in vitro. However, clinical data on the safety and efficacy of any of these treatments is lacking. Recently, a disturbing increase in the incidence of human papilloma virus infections in menopausal women has been reported, due in part to more sexual freedom after menopause. Fortunately, the strain of HPV infecting these women is not associated with cervical cancer. Overall, there is a significant lack of scientific and medical research on menopausal women in Costa Rica. Considering the aging population, the high use of herbal medicines by menopausal women and the lack of clinical studies on these treatments, future research should focus on gaining a better understanding of menopause in this population. Furthermore, new educational programs for these women and the health professionals who serve them are necessary, as well as investigations of the safety and efficacy of the herbal supplements women use to manage their menopausal symptoms.
Ethnopharmacological relevance:
In Central America, most Maya women use ethnomedicines for all aspects of their reproductive cycle including menstruation, pregnancy and menopause. However, very few of these plants have been documented, collected and tested in appropriate pharmacological assays to determine possible safety and efficacy. The aim of this work was to provide an overview of information on the ethnomedical uses, ethnopharmacology, chemistry and pharmacological research for medicinal plants used for women's reproductive health in Guatemala, with a special emphasis on the Q'eqchi Maya of the Lake Izabal region, to demonstrate therapeutic potential and support future research in the field.
Materials and methods:
Reviews of the ethnobotanical, ethnomedical and ethnopharmacological literature were performed for thirty plants collected in the Lake Izabal region of Guatemala and used by the Q'eqchi Maya for treatment of reproductive health issues were performed up to and including July 2015 using multiple databases, library searches for abstracts, books, dissertations, and websites.
Results and conclusions:
Review of the published research confirms that many of the plants used by Q'eqchi Maya women for the management of reproductive health issues have pharmacological activities, including analgesic, anti-inflammatory, estrogenic, progestagenic and/or serotonergic effects, that support the use of these plants and provide plausible mechanisms of action for their traditional uses. Furthermore, a new serotonin agonist, 9, 10- methylenedioxy-5, 6-Z-fadyenolide was isolated, thereby demonstrating an untapped potential for drug discovery. However, to date much of the pharmacological assays have been in vitro only, and few in vivo studies have been performed. Considering the large percentage of the Maya population in Guatemala that use traditional medicines, there remains a significant lack of pharmacological and toxicological data for these plants. Future research should focus on the safety and efficacy of medicinal plants using in vivo preclinical studies and clinical trials, as well as chemical analysis. Since medicinal plants from the Piperaceae are most commonly used as traditional medicines by the Q'eqchi Maya women, and new bioactive compounds have been identified from Piper species, investigations of commonly used plants from this family would be an appropriate place to start. Data generated from such studies would contribute to Guatemala's national effort to promote a complementary relationship between traditional Maya medicine and public health services.
Introduction: The loss of the ovarian follicular function is a physiological event of the
climacteric that could affect the quality of life.
Objective: to evaluate the quality of life and sexual function in climacteric from a
population of the Colombian Caribbean.
Methodology: cross-sectional study carried out with the Menopause Rating Scale
(MRS) and the Female Sexual Function Index (FSFI-6) in healthy mestiza women, some
of them, women descendant of Zenues indigenous, and with ages between 40 and 59
years who were natives and residents in the Colombian Caribbean.
Results: 208 women were studied. 100 (48%) were in premenopause and 108 (52%)
in postmenopause, with average age of last period: 44.8±4.5. The total score of
the MRS was: 15.9±9.6, and the most prevalent symptoms were: sleep disturbance
(91.3%), physical-mental fatigue (91.3%) and muscle-joint discomfort (89.9%), with
high deterioration of the urogenital domain. 50% of women had severe deterioration of
the quality of life, with high prevalence of symptomatology, as much in premenopausal
as in postmenopausal women. 77% of the population presented sexual dysfunction
with higher prevalence in postmenopausal women. The most impaired domain was pain
coital penetration.
Conclusions: in women with mestizo phenotypic traits and who were native from
populations where settlements existed, it was observed early menopause and early
deterioration of the urogenital domain, similar to the observed in indigenous populations.
Rev.cienc.biomed. 2014:5(1):45-65
KEYWORDS
Climacteric; Menopause; Quality of life; Sexual dysfunction.
Objective: describing knowledge about and the use of alternative therapies to traditional hormone replacement in menopausal women. Materials and methods: a cross-sectional, descriptive study of menopausal women was carried out in the city of Medellín, Colombia, during 2009. Inclusion criteria were: being aged ≥40, having finished their menstrual cycles at least one year beforehand and having no background of hysterectomy. Women who agreed to participate in the study answered a questionnaire requiring that they give anonymous information about socio-demographic variables, the date of their last menstruation, symptomatology during the menopause and the use and characteristics of alternative therapies and hormone replacement therapy during menopause. Results: 274 women were surveyed; 10.6% of them were using natural hormones and 46.0% used soy-based products. Regarding alternative and complementary medical therapies for menopausal symptomatology different to natural hormones, 32.8% of the women stated that they had heard of some of them, the most well-known being homeopathy (18.6%), yoga (16.8%) and relaxation therapy (12.0%). Conclusion: a high percentage of menopausal women in the survey knew about and used alternative therapies to that of traditional hormone replacement for managing menopauseassociated symptomatology, especially consuming phytoestrogens and soy-based products.
The Central American (CA) isthmus consists of seven countries including Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama, some of the poorest countries in the world. Over the past twenty years, CA has made good progress in improving the health status of their populations. Analysis of the peer-reviewed literature, as well as national and international reports show that life expectancy at birth has increased and child mortality rates have fallen. Maternal mortality ratios (MMR) have declined by approximately 33%, however the MMRs for indigenous women remain at unacceptable levels. Despite the advances, made in many CA countries, the overall health status remains well below Latin American averages. In fact, in most CA countries, poor health outcomes are increasingly concentrated geographically among the poor and indigenous populations. Considering indigenous people make up the second largest population group in CA, any improvements in healthcare should significantly improve the health statistics for these countries. For these populations, the integration of local cultural practices and traditional healing methods with modern medicine and healthcare facilities is critical for acceptance. Investigations and analyses of local cultures, knowledge and traditional medicine practices should be used to determine the factors that contribute to poor health in these populations. Local health educational programs are needed, especially those that would involve men (spouses), families and entire communities. Furthermore, manywomen's reproductive issues still need to be addressed, particularly those that focus specifically on maternal mortality and cancer. For reductions in maternal mortality, El Salvador and Costa Rica may be good examples to follow. Access to inexpensive (or free) healthcare that is culturally sensitive and community based, particularly for indigenous women, would greatly improve the overall health. The major stumbling blocks to progress are that the funding for programs to reduce maternal mortality is woefully inadequate and that there has not been a focus on improving healthcare for indigenous women.
Despite the prevalence of studies examining economic decision-making as a purely rational phenomenon, common sense suggests that emotions affect our decision-making particularly in a social context. To explore the influence of emotions on economic decision-making, we manipulated opponent-directed emotions prior to engaging participants in two social exchange decision-making games (the Trust Game and the Prisoner's Dilemma). Participants played both games with three different (fictional) partners and their tendency to defect was measured. Prior to playing each game, participants exchanged handwritten "essays" with their partners, and subsequently exchanged evaluations of each essay. The essays and evaluations, read by the participant, were designed to induce either anger, sympathy, or a neutral emotional response toward the confederate with whom they would then play the social exchange games. Galvanic skin conductance level (SCL) showed enhanced physiological arousal during anger induction compared to both the neutral and sympathy conditions. In both social exchange games, participants were most likely to defect against their partner after anger induction and least likely to defect after sympathy induction, with the neutral condition eliciting intermediate defection rates. This pattern was found to be strongest in participants exhibiting low cognitive control (as measured by a Go/no-Go task). The findings indicate that emotions felt toward another individual alter how one chooses to interact with them, and that this influence depends both on the specific emotion induced and the cognitive control of the individual.
The present study was a collaborative research project with the Q'eqchi Maya of Livingston, Izabal, to explore the influence of sociocultural factors on the health and well-being of Q'eqchi women and the role of plant medicines in treating women's health conditions. Data were obtained through participant observation, semi-structured interviews, focus groups, and plant walks with 50 Q'eqchi community members from four principal rural villages and Ak'Tenamit, a local nonprofit organization. Results suggest that traditional roles and perceptions of women in these communities affect community attitudes towards women's health and health conditions, limit a woman's access to health care, and influence her health-seeking behavior. Medicinal plants play a significant role in the treatment of conditions related to menstruation and pregnancy, yet data suggest that gender, age, and social rank influence medical knowledge and plant selection. A total of 47 plants belonging to 26 families were documented, with the most prominent plant families being Piperaceae (15%) and Lamiaceae (8%). In providing in vitro biological support for the traditional Q'eqchi uses of plants to treat women's health issues, 17 plants were submitted to in vitro biological analysis in serotonin bioassays. With one of the highest in vitro activities, Piper hispidum underwent additional phytochemical analysis leading to the isolation of a new compound that showed additional serotonergic activity. In an effort to sustain and foster local interest in traditional medicine, ethnobotanical findings were compiled into an educational curriculum and conservation field guide presented to a local Q'eqchi school. The results of this preliminary work support the traditional use of these plants by the Q'eqchi, justify further research on the use of Latin American herbal remedies for women's health, and underscore the importance of involving youth in medicinal plant research and traditional medicine conservation efforts.
Women's health care providers have noted an increased infant mortality rate among Ghanaian immigrants. We conducted focus groups with 17 women in Ghana. We asked them how they maintained their health both before and during pregnancy. When discussing their health, women repeatedly described the conditions or context of their daily lives and the traditional practices that they used to stay healthy. Knowledge of women's lives, the health care system that they previously used, and their cultural practices can be utilized by health care providers to more fully assess their patients and design more culturally appropriate care for this group of women.
In Mexico and Central America, women typically experience menopause up to 10 years earlier than their U.S. counterparts. This may be due in part to numerous pregnancies, long periods of lactation, poor nutrition, extreme environment, and the heavy workload of the Maya women. Unlike Western culture, there is no stigma associated with aging and the menopausal period in the Mayan culture. In fact, menopause is considered to be a welcome natural phenomenon in Central America that all Maya women, who come of age, will experience. Anxiety, negative attitudes, health concerns and stress for the Maya woman are all events that are commonly associated with pregnancy and childbearing, not with menopause. Maya women perceive the menopausal period very positively, as they are no longer burdened with menstrual bleeding and child bearing, and are more relaxed about sexual activities. Thus, compared with their U.S. counterparts, Maya women have a better overall perceptions and attitudes toward the menopausal transition, have symptoms that appear to be short-lived, do not generally use HRT and appear to have a lower prevalence of osteoporosis. Besides genetics, diet and life-style may play a significant role in the overall impact of menopause in these women, as their diet is primarily plant-based, they get plenty of exercise over a lifetime, and they use primarily plant-based medicines and massage to control menopausal symptoms. Thus, the impact of culture and attitude on the menopausal transition in Mexico and Central America appears to be a positive one. Future research should focus on why the prevalence of osteoporosis is low in Maya women and how women in the U.S. might benefit from this information. In addition, collections of data on cognition, as well as cardiovascular and cancer risk between these groups would be of benefit, considering that Maya women do not generally use HRT.
Hot flashes affect up to 75% of women undergoing the menopausal transition. They are among the most common health problems for perimenopausal women and are associated with a decrease in quality of life. The goal of this study was to examine the associations between reproductive history variables and midlife hot flashes.
Data were analyzed from 388 perimenopausal women who participated in the Midlife Health Study, a population-based, cross-sectional study of 639 women aged 45-54 years living in the Baltimore metropolitan region.
The unadjusted analyses showed that none of the reproductive history variables analyzed, including age at menarche, number of live births, ever having been pregnant, age at first birth, age at last pregnancy, and history of oral contraceptive use, were associated with ever experiencing hot flashes. However, after adjusting for race, age group, marital status, education, employment, total family income, smoking and alcohol status, and body mass index (BMI), age at last pregnancy was significantly associated with moderate to severe hot flashes. Specifically, participants who were ≥36 years of age at last pregnancy were less likely to report moderate or severe hot flashes than those ≤35 years of age at last pregnancy (odds ratio 0.36, 95% confidence interval 0.16, 0.84).
In this study, in general, characteristics of reproductive history were not associated with midlife hot flashes. However, there are a number of potentially modifiable factors that are associated with the occurrence of hot flashes. Thus, alternatives may be available when hormone treatment is contraindicated.
Background:
While they progress through the climacteric stage, women often develop physical and psychological health needs, calling for innovative health-care services that can be translated into preventive programs and empowerment towards self-care.
Objective:
To identify the changes in women's discourse regarding their concerns and needs about the climacteric stage and self-care after they had participated in an integrative women-centered health-care model with empowerment for self-care.
Methods:
Women's narratives during counseling group sessions were analyzed using qualitative inductive thematic analysis.
Results:
A total of 121 women between 45 and 59 years of age participated. At the beginning of the counseling group sessions, we identified the following themes: (1) Lack of information about changes during the climacteric stage and self-care; (2) Tradition: the climacteric stage as a taboo subject; (3) Life's changes and transitions: the complexity of the climacteric experience; (4) Stigma of menopause; (5) Relationship between the traditional gender role and the lack of self-care. At the end of the counseling group sessions, the themes were: (1) The climacteric as a natural stage; (2) Expectations for old age; (3) Empowerment and the change of awareness for self-care; (3) De-medicalization of the climacteric; (4) The richness of group work; (5) Empowerment as motivation to convey acquired knowledge.
Conclusion:
Women in the climacteric stage require more information about their physical, psychological and social needs, as well as the potential impact on their health during old age. Empowerment during the climacteric can contribute to improving the perception about this stage as well as the importance of self-care.
Vita. Thesis (Ph. D. in Pharmacognosy)--University of Illinois at Chicago, 2006. Includes bibliographical references (leaves 206-239).
Outcomes from the Women's Health Initiative have demonstrated adverse effects associated with hormone therapy and have prioritized the need to develop new alternative treatments for the management of menopause and osteoporosis. To this end, we have been investigating natural herbal medicines used by Costa Rican women to manage menopausal symptoms.
Seventeen plant species were collected and extracted in Costa Rica. To establish possible mechanisms of action and to determine their potential future use for menopause or osteoporosis, we investigated the estrogenic activities of the herbal extracts in an estrogen-reporter gene estrogen receptor (ER) beta-Chemically Activated Luciferase Expression assay in U2-OS cells and in reporter and endogenous gene assays in MCF-7 cells.
Six of the plant extracts bound to the ERs. Four of the six extracts stimulated reporter gene expression in the ER-beta-Chemically Activated Luciferase Expression assay. All six extracts modulated expression of endogenous genes in MCF-7 cells, with four extracts acting as estrogen agonists and two extracts, Pimenta dioica and Smilax domingensis, acting as partial agonist/antagonists by enhancing estradiol-stimulated pS2 mRNA expression but reducing estradiol-stimulated PR and PTGES mRNA expression. Both P. dioica and S. domingensis induced a 2ERE-luciferase reporter gene in transient transfected MCF-7 cells, which was inhibited by the ER antagonist ICI 182,780.
This work presents a plausible mechanism of action for many of the herbal medicines used by Costa Rican women to treat menopausal symptoms. However, it further suggests that studies of safety and efficacy are needed before these herbs should be used as alternative therapies to hormone therapy.
Few studies have examined the way women with disabilities understand and make decisions regarding menopause. This report is a qualitative descriptive study detailing how women with varying mobility impairments view the menopausal transition. Nineteen women aged 42 to 64 years were interviewed regarding their menopausal experiences. Results described their experiences as minority groups of women with disabilities using a women's ways of knowing framework. Overall, most women described menopause as a back burner issue, but maintained the need for accurate information from which to make informed decisions that might impact future health and functional outcomes.
Objective: To determine use of botanical dietary supplements (BDS) in women between the ages of 40 and 60 years at the University of Illinois at Chicago (UIC) clinics, including information about commonly used BDS, the reason for use, information resources used, and the overall perception of safety and efficacy of BDS. Design: Five hundred female outpatients at UIC clinics were interviewed by healthcare practitioners using a botanical/drug history questionnaire. Respondents were 46.8% African American, 39.6% Caucasian, 11.7% Hispanic, and 1.5% Asian, with a mean age of 50.34 years. Results: BDS were used by 79% of respondents (n = 395), of which 36.5% used BDS daily. Of the positive respondents, 51.7% used one or two BDS, whereas 48.4% used three or more. Commonly used botanicals included soy (42%), green tea (34.68%), chamomile (20.76%), gingko (20.51%), ginseng (17.97%), Echinacea (15.44%), and St. John's wort (7.34%). Black cohosh, garlic, red clover, kava, valerian, evening primrose, and ephedra were used by less than 15% of respondents. Efficacy ratings were high for BDS, and 68% claimed to have no side effects. Only 3% of respondents obtained BDS information from healthcare professionals, and 70% of respondents were not informing their physician of BDS use. Conclusions: A high percentage of women at UIC clinics were using multiple BDS. The respondents believed that these products were both safe and effective for the treatment of common ailments. Concomitant BDS use with prescription and over-the-counter medications was commonplace, often without a physician's knowledge. Consumer education about the possible benefits and risks associated with BDS use is urgently needed.
Plants popularly used in Guatemala for the treatment of gonorrhoea were macerated in 50% alcohol and the tincture tested for in vitro activity against Neisseria gonorrhoeae using strains isolated from symptomatic patients and confirmed by standard bacteriological procedures. From 46 plants investigated, 13 (28.3%) showed evident inhibition zones (>9 mm), seven (15.2%) showed small activity (6.1–8.9 mm) and 26 (56.5%) showed no activity; nine of these plants inhibited five strains of N. gonorrhoea freshly isolated. The most active plants of American origin were: bark of Bixa orellana fruits of Parmentiera edulis, leaf of Diphysa robinioides, Eupatorium odoratum, Gliricidia sepium, Physalis angulata, Piper aduncum and Prosopis juliflora, root of Casimiroa edulis, and whole Clematis dioica.
Through ethnobotanical surveys in Guatemala, about 250 plants were identified for use in the treatment of urinary ailments. From 67 of these, aqueous extracts were prepared to investigate their oral diuretic activity in albino rats after a dose equivalent to 1 g/kg of dried plant material. The trials demonstrated that in 33 cases urinary excretion was not significantly increased (less than 90%), in 20 cases intermediate activity was seen (90-189%) and in 14 cases high diuretic activity was noted (greater than 189%). Control treatment increased urine output an average of 36% while 25 mg/kg hydrochlorothiazide treatment increased urine output by 286%. In a select group of the most used local plants, ethanol extracts were tested for their effect on urinary excretion of uric acid and electrolytes. Of these, three plants significantly increased uric acid excretion as did the reference drug, probenecid, 25 mg/kg.
A community-based survey was conducted during 1995-1997 of factors related to menopausal and other symptoms in a multi-racial/ethnic sample of 16,065 women aged 40-55 years. Each of seven sites comprising the Study of Women's Health across the Nation (SWAN) surveyed one of four minority populations and a Caucasian population. The largest adjusted prevalence odds ratios for all symptoms, particularly hot flashes or night sweats (odds ratios = 2.06-4.32), were for women who were peri- or postmenopausal. Most symptoms were reported least frequently by Japanese and Chinese (odds ratios = 0.47-0.67 compared with Caucasian) women. African-American women reported vasomotor symptoms and vaginal dryness more (odds ratios = 1.17-1.63) but urine leakage and difficulty sleeping less (odds ratios = 0.64-0.72) than Caucasians. Hispanic women reported urine leakage, vaginal dryness, heart pounding, and forgetfulness more (odds ratios = 1.22-1.85). Hot flashes or night sweats, urine leakage, and stiffness or soreness were associated with a high body mass index (odds ratios = 1.15-2.18 for women with a body mass index > or =27 vs. 19-26.9 kg/m2). Most symptoms were reported most frequently among women who had difficulty paying for basics (odds ratios = 1.15-2.05), who smoked (odds ratios = 1.21-1.78), and who rated themselves less physically active than other women their age (odds ratios = 1.24-2.33). These results suggest that lifestyle, menstrual status, race/ethnicity, and socioeconomic status affect symptoms in this age group.
In recent years, research on menopausal symptomalogy has focused on identifying symptom groupings experienced by women as they progress from premenopausal to postmenopausal status. However, most of these studies have been conducted among Caucasian women from western cultures. This leaves open the question of whether the findings from these studies can be extended to women of other racial/ethnic groups or cultures. Furthermore, many of the previous studies have been conducted on relatively small samples. This paper addresses the diversity of the menopause experience by comparing symptom reporting in a large cross-sectional survey of women aged 40–55 years among racial/ethnic groups of women in the United States (Caucasian, African-American, Chinese, Japanese, and Hispanic). Evaluation of the extent to which symptoms group together and consistently relate to menopausal status across these five samples provides evidence for or against a universal menopausal syndrome. The specific research questions addressed in this paper are: (1) How does the factor structure of symptoms among mid-aged women compare across racial/ethnic groups? (2) Is symptom reporting related to race/ethnicity or menopausal status? and (3) Does the relation between menopausal status and symptoms vary across racial/ethnic groups?
This ethnobotanical literature survey is part of an on-going study in New York City investigating Dominican and Chinese healing systems and the herbal treatments used for the following women's conditions: uterine fibroids (benign tumors of uterine smooth muscle); menorrhagia (excessive uterine bleeding); endometriosis (growth of endometrial tissue outside of the uterus); and hot flashes (sudden brief sensations of heat commonly experienced during menopause). The objectives of this survey were: (1) to search literature on medicinal plants used in the Dominican Republic and identify those used for the above listed conditions and their symptoms; (2) to compare the use between herbal treatments reported in the literature with those prescribed by Dominican healers in New York City; and (3) to evaluate the extent to which healers may have changed their use of plants in order to adapt to availability in the New York City environment. A total of 87 plant species were reported in the Dominican literature for these conditions and symptoms. Nineteen species overlapped from the literature survey and the fieldwork with Dominican healers in New York City, representing 29% (n=65) of the plants prescribed by healers in New York City. This study offers a model to investigate changes in plant use as people migrate to urban centers where they are surrounded by diverse cultures, healing systems, and new environments.
The use of herbal remedies for the treatment of reproductive health problems and the management of reproduction is still nearly
universal in many indigenous communities throughout modern Mexico. This paper describes the medicinal plants and related substances
used for childbirth, fertility regulation, and the treatment of reproductive disorders in a bilingual Chinantec-Spanish speaking
township in highland Oaxaca. The discussion focuses on how the group’s ideas about reproduction and reproductive physiology
influence their selection of these plant species.
To determine use of botanical dietary supplements (BDS) in women between the ages of 40 and 60 years at the University of Illinois at Chicago (UIC) clinics, including information about commonly used BDS, the reason for use, information resources used, and the overall perception of safety and efficacy of BDS.
Five hundred female outpatients at UIC clinics were interviewed by healthcare practitioners using a botanical/drug history questionnaire. Respondents were 46.8% African American, 39.6% Caucasian, 11.7% Hispanic, and 1.5% Asian, with a mean age of 50.34 years.
BDS were used by 79% of respondents ( = 395), of which 36.5% used BDS daily. Of the positive respondents, 51.7% used one or two BDS, whereas 48.4% used three or more. Commonly used botanicals included soy (42%), green tea (34.68%), chamomile (20.76%), gingko (20.51%), ginseng (17.97%), Echinacea (15.44%), and St. John's wort (7.34%). Black cohosh, garlic, red clover, kava, valerian, evening primrose, and ephedra were used by less than 15% of respondents. Efficacy ratings were high for BDS, and 68% claimed to have no side effects. Only 3% of respondents obtained BDS information from healthcare professionals, and 70% of respondents were not informing their physician of BDS use.
A high percentage of women at UIC clinics were using multiple BDS. The respondents believed that these products were both safe and effective for the treatment of common ailments. Concomitant BDS use with prescription and over-the-counter medications was commonplace, often without a physician's knowledge. Consumer education about the possible benefits and risks associated with BDS use is urgently needed.
Women commonly use soy products, herbs, and other complementary and alternative medicine (CAM) therapies for menopausal symptoms. Randomized, controlled trials have evaluated the efficacy and short-term safety of these therapies.
To review randomized, controlled trials of CAM therapies for menopausal symptoms in order to better inform practice and guide future research.
Searches of MEDLINE for articles published from January 1966 through March 2002, of the Alternative and Complementary Database (AMED) of the British Library for articles published from January 1985 through December 2000, and of the authors' own extensive files. Search terms were hot flash/flush, menopause, and climacteric, combined with phytoestrogens, alternative medicine, herbal medicine, traditional medicine, Traditional Chinese Medicine (TCM ), Ayurveda, naturopathy, chiropractic, osteopathy, massage, yoga, relaxation therapy, homeopathy, aromatherapy, and therapeutic touch.
29 randomized, controlled clinical trials of CAM therapies for hot flashes and other menopausal symptoms were identified; of these, 12 dealt with soy or soy extracts, 10 with herbs, and 7 with other CAM therapies.
Each author extracted information from half of the studies on the number of patients, study design, outcome measures, and results; the other author then checked these results.
Soy seems to have modest benefit for hot flashes, but studies are not conclusive. Isoflavone preparations seem to be less effective than soy foods. Black cohosh may be effective for menopausal symptoms, especially hot flashes, but the lack of adequate long-term safety data (mainly on estrogenic stimulation of the breast or endometrium) precludes recommending long-term use. Single clinical trials have found that dong quai, evening primrose oil, a Chinese herb mixture, vitamin E, and acupuncture do not affect hot flashes; two trials have shown that red clover has no benefit for treating hot flashes.
Black cohosh and foods that contain phytoestrogens show promise for the treatment of menopausal symptoms. Clinical trials do not support the use of other herbs or CAM therapies. Long-term safety data on individual isoflavones or isoflavone concentrates are not available.
The assumption that estradiol (E2) concentrations are reliably increased to therapeutic levels in postmenopausal women receiving hormone replacement therapy (HRT) has not been explicitly tested. Nor have factors that may modulate the E2 levels achieved been evaluated. The author examined E2 concentrations in a multiracial study population of 309 postmenopausal women treated with oral HRT and observed that 51.1% had achieved estradiol levels of at least 45 pg/ml (achievers). The odds of being an achiever were significantly elevated among non-Caucasian women by a HRT dose greater than 0.625 mg, current moderate drinking, and increasing duration of HRT use. The odds were significantly decreased by having a high school education or less and increasing time since last HRT dose. White postmenopausal women had significantly reduced odds of being an achiever, and both a dose of less than 0.625 mg and a dose equal to 0.625 mg significantly reduced the odds of being an achiever. Increasing body mass index and menopause duration were both associated with lower odds. This report demonstrates not only that women treated with HRT do not all achieve therapeutic levels of estradiol but also that factors can be identified that modulate the E2 concentration achieved in response to HRT administration. (C) 2002 the American College of Clinical Pharmacology.
CONTEXT: Despite decades of accumulated observational evidence, the balance of risks and benefits for hormone use in healthy postmenopausal women remains uncertain.
OBJECTIVE: To assess the major health benefits and risks of the most commonly used combined hormone preparation in the United States.
DESIGN: Estrogen plus progestin component of the Women's Health Initiative, a randomized controlled primary prevention trial (planned duration, 8.5 years) in which 16608 postmenopausal women aged 50-79 years with an intact uterus at baseline were recruited by 40 US clinical centers in 1993-1998.
INTERVENTIONS: Participants received conjugated equine estrogens, 0.625 mg/d, plus medroxyprogesterone acetate, 2.5 mg/d, in 1 tablet (n = 8506) or placebo (n = 8102).
MAIN OUTCOMES MEASURES: The primary outcome was coronary heart disease (CHD) (nonfatal myocardial infarction and CHD death), with invasive breast cancer as the primary adverse outcome. A global index summarizing the balance of risks and benefits included the 2 primary outcomes plus stroke, pulmonary embolism (PE), endometrial cancer, colorectal cancer, hip fracture, and death due to other causes.
RESULTS: On May 31, 2002, after a mean of 5.2 years of follow-up, the data and safety monitoring board recommended stopping the trial of estrogen plus progestin vs placebo because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits. This report includes data on the major clinical outcomes through April 30, 2002. Estimated hazard ratios (HRs) (nominal 95% confidence intervals [CIs]) were as follows: CHD, 1.29 (1.02-1.63) with 286 cases; breast cancer, 1.26 (1.00-1.59) with 290 cases; stroke, 1.41 (1.07-1.85) with 212 cases; PE, 2.13 (1.39-3.25) with 101 cases; colorectal cancer, 0.63 (0.43-0.92) with 112 cases; endometrial cancer, 0.83 (0.47-1.47) with 47 cases; hip fracture, 0.66 (0.45-0.98) with 106 cases; and death due to other causes, 0.92 (0.74-1.14) with 331 cases. Corresponding HRs (nominal 95% CIs) for composite outcomes were 1.22 (1.09-1.36) for total cardiovascular disease (arterial and venous disease), 1.03 (0.90-1.17) for total cancer, 0.76 (0.69-0.85) for combined fractures, 0.98 (0.82-1.18) for total mortality, and 1.15 (1.03-1.28) for the global index. Absolute excess risks per 10 000 person-years attributable to estrogen plus progestin were 7 more CHD events, 8 more strokes, 8 more PEs, and 8 more invasive breast cancers, while absolute risk reductions per 10 000 person-years were 6 fewer colorectal cancers and 5 fewer hip fractures. The absolute excess risk of events included in the global index was 19 per 10 000 person-years.
CONCLUSIONS: Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2-year follow-up among healthy postmenopausal US women. All-cause mortality was not affected during the trial. The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases, and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD.
Maya Resurgence in Guatemala: Q'eqchi' Experiences. Richard Wilson. Norman; University of Oklahoma Press, 1995.373 pp.
PurposeTo examine the factors that influence Hispanic women's decisions to initiate or not initiate hormone replacement therapy (HRT) during menopause to manage symptoms or to prevent longer-term conditions.Data SourcesA descriptive study of 51 Hispanic women who completed the Spanish version of the Menopausal Decision-Making Questionnaire (S-MDMQ) to describe their experience with and perceptions about menopause.Conclusions
Most of the low-income Hispanic women in this study would elect not to take HRT; however, they do use exercise, diet, vitamins, and other self-care activities to manage symptoms of menopause. Hispanic women were eager to discuss how to manage their health care during perimenopause and menopause with one another and their health care providers.Implications for PracticeNurse practitioners need to understand factors that might influence Hispanic women's decisions regarding management of menopausal symptoms, including the use of HRT, and to be able to assist women in making an individ-ualized personal treatment choice that is culturally acceptable.
PIP
In many hunter gatherer societies, food taboos dictate the diets of females. These taboos often happen during their most critical reproductive times in their life, e.g., pregnancy. Among some subarctic Athapaskan societies, females at menarche cannot eat fresh meat. They, like other hunter gatherer societies, also restrict fresh meat consumption for menstruating women. Young women of the Aranda society in Australia cannot eat protein rich foods, e.g., lizards, until they have a child. Australian aboriginal societies restrict protein and fat foods for pregnant and lactating women. Even though the literature shows that the undernourished are inclined to reach menarche at a later age than those who eat a well balanced diet, it does not clearly establish whether differences in age at menarche significantly affect overall fertility. Research done on many different under or marginally nourished populations indicates that maternal nutritional health influences birth spacing significantly. Specifically, undernutrition causes longer postpartum amenorrhea. Therefore, lower fertility rates follow longer birth intervals. Research shows that poor maternal nutritional health does not prevent the fetus from surviving and growing. Yet mothers who do not consume many calories often have low birth weight infants. These infants are at high risk of dying because they have little to no fat reserves and they consume inadequate amounts of nutrition since the mothers cannot make insufficient amounts of milk. Since contemporary research shows that maternal nutritional health does effect fertility and infant mortality, food taboos do have the ability to influence population size. More research is needed to understand the factors that influenced the reproductive rates of past hunter-gatherer societies, so anthropologists can identify the demographically significant changes which sedentism and agriculture caused 10,000 years ago.
The menopause is universal, but what about the climacteric? In an attempt to answer this question, a study was conducted in seven south-east Asian countries, namely, Hong Kong, Indonesia, Korea, Malaysia, the Philippines, Singapore and Taiwan. Samples of approximately 400 women in each country were questioned about a number of climacteric complaints, incontinence and dyspareunia, consultation of a physician, menopausal status and several background characteristics. Special care was taken to overcome linguistic and cultural problems, and the data collected were kept as objective as possible. From the results obtained we were able to show that the climacteric was indeed experienced in south-east Asian countries, although in a mild form. The prevalence of hot flushes and of sweating was lower than in western countries, but was nevertheless not negligible. The percentages of women who reported the more psychological types of complaint were similar to those in western countries. The occurrence of climacteric complaints affected perceived health status. A physician was consulted for climacteric complaints by 20% of the respondents, although this was most frequently associated with the occurrence of psychological complaints and less so with that of hot flushes and sweating. The median age at menopause (51.09) appeared to be within the ranges observed in western countries. Ethnic background and age at menarche were found to have a significant influence on age at menopause. The study clearly demonstrated that climacteric complaints occur in south-east Asia. The findings suggest, however, that vasomotor-complaint-related distress might be 'translated' into psychological complaints, which are more frequently considered to warrant consulting a physician.
An ethnobotanical survey was conducted among the Carib population of Guatemala in 1988-1989. In general terms, the sample surveyed possessed a relatively good standard of living. Results indicated that health services were utilized by the population, and that domestic medicine, mainly plants (96.9%) was used by 15% of the population. One hundred and nineteen plants used for medicinal purposes were collected, of which 102 (85.7%) could be identified; a list of these together with the information provided for each plant is presented. The most frequently reported plants used as medicine are: Acalypha arvensis, Cassia alata, Cymbopogon citratus, Melampodium divaricatum. Momordica charantia, Neurolaena lobata, Ocimum basilicum, Petiveria alliacea and Solanum nigrescens. Most of these plants are found in the region, but some are brought from the Highlands or outside of the country, such as Malva parviflora, Matricaria chamomilla, Peumus boldus, Pimpinella anisum, Rosmarinus officinalis and Tagetes lucida. This survey demonstrated that the Carib population of Guatemala has survived in a transcultural environment of African and native Amerindian beliefs.
Europe and North America have been the focus of most research on the menopause and its symptoms. In this study, in the course of in-depth interviews Japanese physicians and women were asked to describe the menopausal experience. A cross-sectional survey concerning women and their health at midlife was then distributed to 1738 women. The analysis in this paper is based on the replies received from 1141 non-hysterectomized women aged 45-55. Factor analysis was used to group the symptoms these women had experienced in the previous 2 wk. After constructing an index based on the factor scores, one-way analysis of variance was used to examine the relationship between symptom experience and the epidemiological menopausal status as well as the self-defined menopausal status. Symptom experience was always significantly related to self-defined menopausal status.
This paper examines the intellectual roots of the medicalization of menopause in the 1930s and 1940s. An analysis of published papers written by prominent American medical specialists reveals three models that were developed to understand menopause--biological, psychological and environmental--and shows how each contributed to its medicalization. This transformation was made possible by the paradigm of sex endocrinology and the availability of a new drug (DES), which was produced in 1938. Exploring the medicalization of menopause illuminates some of the special and complicated ways that women's experiences are vulnerable to medical control.
The perception and experiences of menopause vary cross-culturally. However, the lack of physiological symptoms such as hot flashes, in some cultures, calls for more explanations beyond social and cultural factors alone. Like other developmental events, menopause is a biocultural experience. Therefore, research on menopause should consider biocultural factors such as environment, diet, fertility patterns and genetic differences that may be involved in the variations of menopausal experience.
One of the prerequisites for the success of primary health care is the availability and use of suitable drugs. Plants have always been a common source of medicaments, either in the form of traditional preparations or as pure active principles. It is thus reasonable for decision-makers to identify locally available plants or plant extracts that could usefully be added to the national list of drugs, or that could even replace some pharmaceutical preparations that need to be purchased and imported. This update article presents a list of plant-derived drugs, with the names of the plant sources, and their actions or uses in therapy.
Research was conducted to learn how women of two ethnic groups in the United States experience and describe menopause-related hot flashes, their reports of associated events and activities, and the ways in which they cope with the occurrence of the flashes. The women's cognitive ordering of events was learned through ethnographic inquiry, using questions which were derived from respondent-generated topics. Descriptions and responses to this physiological event were similar, but interpretation differed. Middle-class Anglo American women spoke of the sensations negatively, but for Mexican American women, the menopausal hot flash had positive components of meaning.
Our purpose was to determine the characteristics of menopause among Mayan women who did not have menopausal symptoms.
A cross-sectional study of Mayan women from Chichimila, Mexico, was performed. Demographic information, history and physical examination, hormone concentrations, and radial bone density measurement were obtained.
Fifty-two postmenopausal women were compared with 26 premenopausal women. Menopause occurred at 44.3 +/- 4.4 years. None of the women admitted to hot flushes and did not recall significant menopausal symptoms. Hormone levels included elevated follicle-stimulating hormone (66.6 +/- 29 mlU/ml), low estradiol and estrone (9.4 +/- 8.3 and 13.3 +/- 7.8 pg/ml), estrone greater than estradiol levels, normal levels of testosterone and androstenedione (0.17 +/- 0.14 and 0.31 +/- 0.17 ng/ml). Bone mineral density declined with age, but height did not. Clinical evidence of osteoporosis was not detected.
Lack of symptoms during the menopausal transition is not attributable to a difference in endocrinology. Postmenopausal Mayan women are estrogen deprived and experience age-related bone demineralization but do not have a high incidence of osteoporotic fractures.
An exploratory study was conducted to determine Mexican American women's attitudes toward menopause and the relationships between these attitudes and socioeconomic status, level of acculturation, menopausal status, symptoms, self-esteem, and social support. The sample included 130 Mexican American women who ranged in age from 28 to 75 years. Attitudes did not differ by socioeconomic status, menopausal status, or number and severity of symptoms. More positive attitudes were reported by less acculturated women and women with higher self-esteem. Menopause was perceived as a potentially disturbing transition, and irritability and depressive mood were expected. Findings support the need for more accessible information to decrease uncertainty and avert negative expectations.
We examined the association between physical activity and reproductive factors with bone density among 313 Mexican women, aged 26-83 years. Bone mineral density (BMD) was measured with a HOLOGIC QRD 1000 w, DXA densitometer at the lumbar spine and femoral region. We explored the relation between BMD and parity, age, body mass index (BMI), type of menopause, and level of exercise. Multiple regression models examining determinants of bone density at the lumbar and femoral regions showed that increasing age and lack of exercise were statistically significant predictors of bone demineralization. The number of pregnancies also had a deletereous effect on bone density, especially for lumbar spine, as well as BMI <20 kg/m2. Our results suggest that physical activity, parity, and BMI are important determinants of bone density in this population.
In rural populations in Mexico, the system of ideas in relation to the reproductive cycle is built on a mestizo base, with pre-Colombian and Western elements. The objective of the study was the analysis of concepts and resources related to human reproduction in Morelos, in order to design a primary reproductive health care program. The use of ethnographic methods helped identify bio-cultural constructs on which the communities base their reproductive patterns. Our main research results reveal that these populations attribute great value to the extension of the family through descendants. Women's sexuality is directly linked to reproduction and blood is the supremely feminine substance. Great importance is consistently attributed to menstruation about which well-defined concepts exist in the community, where as pre-menarche changes are perceived as a state of bio-psychosocial maturity. Menarche beyond 14 years of age is considered abnormal and is attributed to an 'excess of cold' in the body, therapy is usually administered by traditional birth attendants. In the mythical explanations given for bleeding, the moon plays a fundamental role, as the first rupture of the hymen is attributed to it. A general lack of knowledge about ovulation and its relation to reproduction was observed, resulting in incorrect contraceptive practices.
To determine the symptoms of climacterium in women from rural areas of Yucatan.
We conducted a transversal study of 202 women in the villages of Seye and Cuzama. A questionnaire on socioeconomic status, and symptoms of the menopause was applied.
In both villages, the commonest menopause-related symptoms were backache tiredness in more than half of the women. Sweating and hot flashes were reported by 35% and 31%, respectively.
Our observations differed from the absence of hot flashes and sweating reported by another group in rural women living in Yucatan (Ref 7).
In North America and Europe, it is usually assumed that biological changes associated with the end of menstruation and the onset of specific diseases commonly associated with the postmenopausal condition are universal. Using an anthropological approach in which menopause is understood as a concept that is historically and culturally produced, an argument is made for additional systematic investigation of what protects the majority of women from distress at menopause, and what factors contribute to a healthy old age.
Survey research based on questionnaire responses, together with open-ended interviews and textual analyses, were used.
Differences are demonstrated in postmenopausal experiences and symptom reporting in Japan as compared with Canada and the United States. Reporting of hot flashes and nights sweats is significantly lower in Japan. These findings, together with the well established figures about greater longevity and lower incidence of heart disease, breast cancer, and osteoporosis in Japan, compared with North America, indicate that cultural and biological variables act in concert to produce this variation. Theories about the evolution of menopause and demographic data on aging are also discussed. This data challenges the widely held assumption that populations of postmenopausal women only recently have come into existence because of cultural and technological interventions.
Postmenopausal women have been present in human populations since homo sapiens first evolved. Culturally mediated life styles affect both the menopausal experience and the health of women as they age. Additional investigations are needed.
Attitudes have a potential role to play in the experience of menopause. The objective of this study was to examine the degree to which attitudes toward menopause and aging vary across ethnic groups and menopausal status (ie, premenopausal through postmenopausal).
More than 16,000 women were interviewed by telephone as part of the Study of Women's Health Across the Nation. They represented five ethnic/racial groups (African American, white, Chinese American, Japanese American, and Hispanic) from seven geographical sites (Boston, MA; Pittsburgh, PA; Chicago, IL; Michigan; New Jersey; and northern and southern California).
African American women were significantly more positive in attitude. The least positive groups were the less acculturated Chinese American and Japanese American women. Menopausal status was not a consistent predictor of attitude across ethnic groups.
In general, women's attitudes toward menopause range from neutral to positive. Ethnic groups within the United States vary slightly, but reliably, in their attitudes toward menopause and aging. Factors other than those directly associated with menopausal status seem to play a role in attitude.
Many women will spend one third of their lifetime after menopause. A growing number of options are available for the treatment of menopausal symptoms like vasomotor instability and vaginal atrophy, as well as the long-term health risks such as cardiovascular disease and osteoporosis that are associated with menopause. Currently, hormone replacement therapy (estrogen with or without progestin) is the primary treatment for the symptoms and long-term risks associated with menopause. However, recent evidence calls into question the protective effect of estrogen on cardiovascular disease risk. The association of risk for breast cancer with estrogen replacement therapy also has not been fully clarified. In addition, many women cannot or choose not to take hormones. For treatment of osteoporosis and heart disease, pharmacologic choices include antiresorptive agents such as bisphosphonates and calcitonin, and estrogens or selective estrogen receptor modulators such as raloxifene. In addition, complementary options that include vitamins, herbal treatments, exercise and other lifestyle adaptations are gaining increased interest. The growing number of choices and questions in this area emphasizes the need to individualize a treatment plan for each woman to meet her specific needs.
This cross-sectional study reports on the menopausal transition of Mayan women from Yucatan, Mexico. A total of 228 women completed the study, and 118 women were classified by history as postmenopausal; the others were premenopausal. Demographic information, reproductive history, physical examination, hormone concentrations, radial bone density, food samples, and history of physical activity were obtained. The average age at which menopause occurred by history was 44.3 +/- 4.4 years; this is reflected in the distribution of FSH levels by age. None of the women reported symptoms of hot flashes, and none recalled any history of significant symptoms associated with their menopausal transition. Hormone levels were similar to U.S. reference values with elevated FSH (66.6 +/- 29.1 mIU/ml), low estradiol (9.4 +/- 8.3 pg/ml) and estrone (13.3 +/- 7.8 pg/ml), E1 > E2, and normal levels of testosterone and androstenedione. BMD declined with age, and values were lower than reference values for United States women. Clinical evidence of fracture was not detected by history or physical examination even for those who were 20 years postmenopausal. The endocrine characteristics of menopause among Mayan women in Yucatan are similar to hormonal changes reported for women in the United States, but signs, symptoms, and apparent consequences are different in the two populations.
The assumption that estradiol (E2) concentrations are reliably increased to therapeutic levels in postmenopausal women receiving hormone replacement therapy (HRT) has not been explicitly tested. Nor have factors that may modulate the E2 levels achieved been evaluated. The author examined E2 concentrations in a multiracial study population of 309 postmenopausal women treated with oral HRT and observed that 51.1% had achieved estradiol levels of at least 45 pg/ml (achievers). The odds of being an achiever were significantly elevated among non-Caucasian women by a HRT dose greater than 0.625 mg, current moderate drinking, and increasing duration of HRT use. The odds were significantly decreased by having a high school education or less and increasing time since last HRT dose. White postmenopausal women had significantly reduced odds of being an achiever, and both a dose of less than 0.625 mg and a dose equal to 0.625 mg significantly reduced the odds of being an achiever. Increasing body mass index and menopause duration were both associated with lower odds. This report demonstrates not only that women treated with HRTdo not all achieve therapeutic levels of estradiol but also that factors can be identified that modulate the E2 concentration achieved in response to HRT administration.
Despite decades of accumulated observational evidence, the balance of risks and benefits for hormone use in healthy postmenopausal women remains uncertain.
To assess the major health benefits and risks of the most commonly used combined hormone preparation in the United States.
Estrogen plus progestin component of the Women's Health Initiative, a randomized controlled primary prevention trial (planned duration, 8.5 years) in which 16608 postmenopausal women aged 50-79 years with an intact uterus at baseline were recruited by 40 US clinical centers in 1993-1998.
Participants received conjugated equine estrogens, 0.625 mg/d, plus medroxyprogesterone acetate, 2.5 mg/d, in 1 tablet (n = 8506) or placebo (n = 8102).
The primary outcome was coronary heart disease (CHD) (nonfatal myocardial infarction and CHD death), with invasive breast cancer as the primary adverse outcome. A global index summarizing the balance of risks and benefits included the 2 primary outcomes plus stroke, pulmonary embolism (PE), endometrial cancer, colorectal cancer, hip fracture, and death due to other causes.
On May 31, 2002, after a mean of 5.2 years of follow-up, the data and safety monitoring board recommended stopping the trial of estrogen plus progestin vs placebo because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits. This report includes data on the major clinical outcomes through April 30, 2002. Estimated hazard ratios (HRs) (nominal 95% confidence intervals [CIs]) were as follows: CHD, 1.29 (1.02-1.63) with 286 cases; breast cancer, 1.26 (1.00-1.59) with 290 cases; stroke, 1.41 (1.07-1.85) with 212 cases; PE, 2.13 (1.39-3.25) with 101 cases; colorectal cancer, 0.63 (0.43-0.92) with 112 cases; endometrial cancer, 0.83 (0.47-1.47) with 47 cases; hip fracture, 0.66 (0.45-0.98) with 106 cases; and death due to other causes, 0.92 (0.74-1.14) with 331 cases. Corresponding HRs (nominal 95% CIs) for composite outcomes were 1.22 (1.09-1.36) for total cardiovascular disease (arterial and venous disease), 1.03 (0.90-1.17) for total cancer, 0.76 (0.69-0.85) for combined fractures, 0.98 (0.82-1.18) for total mortality, and 1.15 (1.03-1.28) for the global index. Absolute excess risks per 10 000 person-years attributable to estrogen plus progestin were 7 more CHD events, 8 more strokes, 8 more PEs, and 8 more invasive breast cancers, while absolute risk reductions per 10 000 person-years were 6 fewer colorectal cancers and 5 fewer hip fractures. The absolute excess risk of events included in the global index was 19 per 10 000 person-years.
Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2-year follow-up among healthy postmenopausal US women. All-cause mortality was not affected during the trial. The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases, and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD.
We studied the possible influence of modern cultural conditions on symptoms at menopause in three distant populations, comparing urban vs. rural women from three different States of Mexico: Guanajuato, Coahuila and Yucatán. In these groups we compared the age at menopause and symptoms at pre- and postmenopause.
A total of 7632 volunteers were selected from Guanajuato, Coahuila and Yucatán. In house visits, an oral questionnaire was applied to women 45-60 years old, non-pregnant or lactating, without hysterectomy, chronic illness, or hormone treatment. We collected general and personal data, clinical, somatometric variables, and symptoms: hot flashes, vaginal dryness, dispareunia, and diminished sexual interest. Depressive mood and anxiety were evaluated with the Hamilton-Bech-Rafaelsen Scale.
The mean age at menopause was 48.0 years. A logistic regression identified the association of age at menopause with urban or rural residence, and the State of origin. Scores for depression and anxiety were lower in Yucatán, and they were higher in rural women. Hot flashes, vaginal dryness and the diminished sexual interest were increased at postmenopause. Hot flashes varied from 73 to 32%, and were associated with menopause, low schooling, rural residence, body mass index (BMI), and State of residence. Similar factors were associated with vaginal dryness, dispareunia, and loss of sexual interest. Depressive mood was associated with rural residence, State of residence, menopause, high BMI, smoking habit, age, and schooling. Anxiety was associated with menopause, rural residence, low schooling, high BMI, and age. The loss of sexual interest was associated with age, BMI, menopause and number of pregnancies.
The frequencies of symptoms at menopause have similar ranges to other countries. Ethic and socio-cultural and environmental factors are involved in the appearance or symptoms.
To explore any feelings and symptoms surrounding menopause among Mayan women in three ethnolinguistic groups in highland Guatemala and compare these with previous reports from Mexico.
This was a qualitative exploratory study of the experiences around menopause of eight middle aged women and one local key informant in each of three villages in western highland Guatemala (n=27). Individual interviews were conducted in women with irregular menses or whose menses has ceased in the last 3 years. Field notes were kept and then an analysis undertaken by the author.
Twenty-four Mayan women, aged 38-55, and three Mayan key informants (all women over age 50) were interviewed. Most women reported some symptoms, including hot flashes, night sweats, changes in libido, irritability, moodiness, abdominal cramps and menstrual clots occurring at some stage during the last 3 years. Although women reported symptoms, they mostly accepted them with equanimity; and rejoiced at the cessation of their periods.
Highland Guatemalan Mayan women reported symptoms that were not reported in Mayan women in Yucatan, Mexico in the years surrounding menopause. The reasons for this disparity are unclear but may reflect differences in body weight and diet. Despite these symptoms, Mayan women looked forward to menopause and their newfound freedom and status. Symptoms in women in the years around menopause must be interpreted in geographical, nutritional, biological, psychological and cultural context.
Extensive cross-cultural and comparative research reveals that the majority of women do not find the menopausal transition a difficult time. This research also shows considerable variation in symptom reporting at the end of menstruation. It is argued that socio/cultural variables, including language usage and expectations about the menopausal experience, do not fully account for these differences, and that biological variation must also be taken into account. In those societies where subjective reporting of symptoms, including vasomotor symptoms, is low, such findings should not be dismissed as the result of learned cultural expectations that mask reality.
This comprehensive review examines the safety of Cimicifuga racemosa for the treatment of menopause symptoms, particularly in populations in which conventional menopause treatment regimens, including estrogen replacement, are contraindicated.
An extensive database of information on Cimicifuga, which included all published literature pertaining to preclinical and clinical safety of various forms of Cimicifuga, the FDA and World Health Organization adverse-event reporting systems, monographs, compendia, internal unpublished data from a major manufacturer, foreign literature, and historical anecdotal reports, was reviewed, and findings pertaining to the safety of Cimicifuga use for menopause treatment were reported.
Uncontrolled reports, postmarketing surveillance, and human clinical trials of more than 2,800 patients demonstrate a low incidence of adverse events (5.4%). Of the reported adverse events, 97% were minor and did not result in discontinuation of therapy, and the only severe events were not attributed to Cimicifuga treatment.
Although the effects of Cimicifuga may be dependent on the specific extract preparation, this review clearly supports the safety of specific Cimicifuga extracts, particularly isopropanolic preparations, for use in women experiencing menopausal symptoms and as a safe alternative for women in whom estrogen therapy is contraindicated.
To examine how attitudes toward menopause were associated with symptom frequencies after controlling for menopause status and level of education.
Women aged 28-70 (n = 755) were interviewed from May, 1999 through August, 2000 in the city of Puebla, Mexico. Over 90% of the sample were aged 40-60. Participants were asked to select from a set of dichotomies to describe "how a woman feels during menopause." Symptom frequencies were assessed by a checklist of everyday complaints experienced during the two weeks before interview. Symptom presence or absence was examined in relation to attitudes while controlling for menopause status and level of education using binary logistic regression analyses.
The majority of respondents said that a menopausal woman feels "insecure" and "unattractive" yet "complete," "necessary," and "successful." Pre-menopausal women and respondents who had undergone a hysterectomy were more likely to express negative attitudes. Post-menopausal women and women with fewer years of education were significantly more likely to report symptoms such as hot flashes, joint aches, and nervous tension. A range of negative attitudes were associated with nervous tension, feeling blue, and head aches; however, only a few negative attitudes were significantly predictive of estrogen-related symptoms (e.g., hot flashes).
There is a high value placed on both external appearance and familial responsibility among menopausal women in Puebla, Mexico, and negative characterizations of menopause reflect these values. Negative attitudes were associated with more frequently reported symptoms compared with positive attitudes. The challenge remains to separate factors related to the hormonal changes of menopause from those not associated with hormonal changes to better understand symptom experience.
The Convention on Biodiversity mandates a new approach to the discovery of natural product drugs, one that incorporates concepts of national ownership of genetic resources, intellectual property rights in traditional knowledge, and sharing of economic benefits with countries that are the source of new natural products. The International Cooperative Biodiversity Group (ICBG) program was established to support experimentation in implementation of the Convention through development and execution of international agreements for bioprospecting. The agreement of one such ICBG program, between the University of Illinois at Chicago and institutions in Vietnam and Laos, is presented here. The core elements contained in the single, five-way Memorandum of Agreement are the arrangements for intellectual property rights, treatment of informed consent, and plans for benefit-sharing (including the sharing of short- and long-term royalty benefits, capacity building, and community reciprocity). Program participants were able to develop a practical and flexible agreement that satisfies the wishes of all institutions that are parties to it.
Managing menopause Medicinal plants in therapy Oral hormone replacement therapy: Factors that influence the estradiol concentrations in a multiracial study population
- T M Cutson
- E Meuleman
- N R Farnsworth
- O Akerele
- A S Bingel
- D D Soejarto
- Z Guo
Cutson, T. M., & Meuleman, E. (2000). Managing menopause. American Family Physician, 61(5), 1391–1400 405-6. Farnsworth, N. R., Akerele, O., Bingel, A. S., Soejarto, D. D., & Guo, Z. (1985). Medicinal plants in therapy. Bulletin of the World Health Organization, 63(6), 965–981. Gavaler, J. S. (2002). Oral hormone replacement therapy: Factors that influence the estradiol concentrations in a multiracial study population. Journal of Clinical Pharmacology, 42, 137–144. Giron, L., Freire, V., Alonzo, A., & Caceres, A. (1991)
Traditional Health Systems in Latin America and the Caribbean: Base Information Technical Project Report. Parra-Cabreras, Exercise and reproductive factors as predictors of bone mineral density among osteoporotic women in Mexico City
- S Hernandez-Arila
- M Tamayo
- J Orozco
- L Lopez-Carillo
- F Gonzalez
Pan American Health Organization (PAHO). (1999). Traditional Health Systems in Latin America and the Caribbean: Base Information Technical Project Report. Parra-Cabreras, S., Hernandez-Arila, M., Tamayo-y-Orozco, J., Lopez-Carillo, L., & Meneses-Gonzalez, F. (1996). Exercise and reproductive factors as predictors of bone mineral density among osteoporotic women in Mexico City. Calcified Tissue International, 59(2), 89–94.
La comadrona a traves de la historia en las practicas obstetrico pediatricas: una experiencia en el area Ixil, Quiche
- Villatoro
Villatoro E. La comadrona a traves de la historia en las practicas obstetrico pediatricas: una experiencia
en el area Ixil, Quiche. La Tradicion Popular 1994;97:1-20.