WOMEN 'S HEALTH AND MENOPAUSE : - National Heart, Lung ...

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in their survey of postmenopausal women, found a high prevalence of sexual problems, corroborating these changes in sexual function after menopause. 1 When women experience changes in their sexual function, they frequently turn to their health care provider for help with their problems. The prevalence of female sexual disorders, in both premenopausal and postmenopausal women, ranges from 25 to 63 percent. 2–4 The recently published U.S. <strong>National</strong> Health and Social Life Survey included survey data from 1,749 women between the ages of 18–59 years (table 7–1). 5 Sexual dysfunction was more prevalent in women (43 percent) than men (31 percent). One-third of women lacked sexual interest, and almost onefourth stated that they were unable to experience orgasm in menopause. According to the survey, 20 percent of those women reported lubrication difficulties, and another 20 percent reported that sex provided them little pleasure. Relevant to this survey, sexual dysfunction appeared to be more common in menopausal women than in premenopausal women. Similarly, more than 86 percent of postmenopausal women in Sarrel and Whitehead’s survey reported a variety of psychosexual problems. 1 The prevalence of female sexual disorders, in both premenopausal and postmenopausal women, ranges from 25 to 63 percent. Due to the high prevalence of sexual dysfunction and the importance that patients attach to sexual function, it is essential to identify and address these problems in our patients. Ultimately, it will assist them in improving their quality of life and interpersonal relationships. Much attention has been given to male sexual dysfunction, and only recently has attention shifted to better understand and identify female sexual dysfunction as a research priority. Clinicians receive little or no training in the diagnosis or treatment of sexual dysfunction and lack information on its causes and ways to prevent the changes that may 122 occur. The clinician’s individual clinical impressions and previous experience are frequently used as the basis for clinical practice and are conveyed to the patient as truth, without evidence to support those views. Regrettably, most practitioners’ clinical experience is not representative of most women’s experience in the menopause. This is in part because those presenting for treatment are only a small proportion of women troubled. Those who choose to identify themselves to the clinician as having a problem represent only a fraction of women with problems. 6,7 Armed with the appropriate facts, the clinician will be rewarded because all patients appreciate clinician awareness and competency in this field. Because of these barriers, many studies in this review have methodologic weaknesses, including sample bias, low measurement sensitivity, and lack of detail on sexual preference. Population-based surveys suggest a link between menopause and changes in sexuality. Yet, relatively few studies of the menopausal transition in middle-aged women have inquired about sexual functioning. Of those, only a minority have used a validated questionnaire to assess the different aspects of sexual functioning. In addition, cross-sectional studies are unable to distinguish between effects of social change on different age groups and aging, and some improperly infer causation from associations. (See also ch. 3, sec. 3.) Not insignificant is the controversy surrounding the study of sexual relationships. Kim noted that in some ethnic groups it is almost impossible to get an accurate answer from women about their sexual activities (Kim WW, personal communication). He accurately commented that there are very few norms set biologically or statistically, and, as a consequence, analyses done with questionnaires and interviews might not be reliable. Some interviewees are not sincere in answering the questions, and some give false information, as they feel shy about presenting their thoughts and feelings frankly. He emphasized that in most Asian countries,
TABLE 7–1 Prevalence of Female Sexual Disorders (Percent of Women) Age (years) 18–29 32 26 21 30–39 32 28 15 40–49 30 22 13 50–59 27 23 8 Marital Status Currently married 29 22 14 Never married 35 30 17 Divorced, separated, widowed 34 32 16 Race Lacked Interest in Sex (n = 1,486) Unable to Achieve Orgasm (n = 177) Experienced Pain During Sex (n = 1,479) Caucasian 29 24 16 Black 44 32 13 Hispanic 30 22 14 Other 42 34 19 123
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National Heart, Lung, and Blood Ins
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CHAIRS AND EDITORS Chair and Editor
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Anne McTiernan, M.D., Ph.D. Associa
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Lenore Manderson, Ph.D. Director an
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Michael Mendelsohn, M.D. Director,
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TABLE OF CONTENTS Preface XIII 1 Ex
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PREFACE Women’s health and menopa
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CHAPTER 1: EXECUTIVE SUMMARY Nanett
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TABLE 1-1 Evidence Categories Evide
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TABLE 1-2 (continued) Possible Bene
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symptom measures, cultural factors,
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5. PHYSIOLOGICAL ROLE OF ESTROGEN A
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The atherogenic risk profile of old
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• Hormone replacement therapy: Fi
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tion of the remaining ridge in area
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9.3.1 Interventions • In many cas
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Parkinson’s disease, no overall p
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TABLE 1-3 (continued) Sexuality •
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CHAPTER 2: THE MENOPAUSE AND AGING
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oped and are less prepared to addre
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FIGURE 2-4 Diabetes Mellitus. Estim
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Sarcopenia, defined as reduced musc
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Perimenopause WHO The term “perim
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decrease about 2 years before the F
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4.3 Menstrually Defined Menopausal
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to be under stress and to hold part
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21 Brincat MP. Hormone replacement
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62 Orentreich N, Brind JL, Rizer RL
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CHAPTER 3: SYMPTOMS AND THE MENOPAU
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women who may have reached natural
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numb-tingling feelings, headaches,
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(47 percent), problems sleeping (39
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FIGURE 3-2 Proportion of Women Both
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tomized hypogonadotropic women expe
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5.1 Exercise It has been suggested
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to consume 20-150 mg/day of isoflav
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REFERENCES 1 Stewart AL, Hays RD, W
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48 Avis NE, Crawford SL, McKinlay S
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92 Albertazzi P, Pansini F, Bonacco
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Hällström wrote that the psycholo
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countries. Perhaps, as the authors
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Beyene used a systematic ethnograph
Page 88 and 89: ange of variables, such as genetic
Page 90 and 91: REFERENCES 1 Gannon L, Ekstrom B. A
Page 92 and 93: 47 George T. Women in a south India
Page 94 and 95: 9. Estrogen and inhibins produced b
Page 96 and 97: HRT) display tissue-selective estro
Page 98 and 99: a partial agonist. In contrast, wit
Page 100 and 101: 3. UROGENITAL TRACT ERα and ERβ a
Page 102 and 103: 4. BONE: DEVELOPMENT AND HOMEOSTASI
Page 104 and 105: in response to estrogen. 106,105 In
Page 106 and 107: lation of sleep, motor behavior, an
Page 108 and 109: 7. HORMONE REPLACEMENT THERAPY: TRA
Page 110 and 111: REFERENCES 1 Jensen EV, Jacobsen HI
Page 112 and 113: 40 Power RF, Mani SK, Codina J, Con
Page 114 and 115: 83 Oursler MJ, Pederson L, Fitzpatr
Page 116 and 117: 125 Gabrielsson BG, Carmignac DF, F
Page 118 and 119: 169 Renier MA, Vereecken A, Buytaer
Page 120 and 121: FIGURE 6-1 Structural features of E
Page 122 and 123: ound, the conformation of the recep
Page 124 and 125: with extremely potent estrogenic ac
Page 126 and 127: Its potency as an antiestrogen was
Page 128 and 129: The observation that the degree of
Page 130 and 131: findings were remarkable because a
Page 132 and 133: Recently, the use of phage display
Page 134 and 135: 20 Crawley G. Non steroidal estroge
Page 136 and 137: 65 Qu Q, Zheng H, Dahllund J, et al
Page 140 and 141: where over half the world’s popul
Page 142 and 143: The Danish study of Koster and Gard
Page 144 and 145: Many studies of sexual interest in
Page 146 and 147: 7. ASSESSING SEXUAL ACTIVITY Clinic
Page 148 and 149: None of these studies evaluated the
Page 150 and 151: estrogen-androgen group during the
Page 152 and 153: REFERENCES 1 Sarrel PM, Whitehead M
Page 154 and 155: 52 Utian WH. The true clinical feat
Page 156 and 157: 140
Page 158 and 159: outes of administration and differe
Page 160 and 161: FIGURE 8-2 Change in Age-Adjusted D
Page 162 and 163: fied as overweight or obese. 32 The
Page 164 and 165: TABLE 8-1 148 Guide to Risk Reducti
Page 166 and 167: TABLE 8-1 (continued) 150 Recommend
Page 168 and 169: TABLE 8-1 (continued) 152 Recommend
Page 170 and 171: Interesting differences in atherosc
Page 172 and 173: similar effects in both patients wi
Page 174 and 175: a lowering of triglycerides, 140 an
Page 176 and 177: may account for a substantial propo
Page 178 and 179: associated with an independent prot
Page 180 and 181: eases preoperatively. Quality of li
Page 182 and 183: excess risk of 6-18 per 10,000 per
Page 184 and 185: REFERENCES 1 NHLBI Morbidity and Mo
Page 186 and 187: 36 Samaras K, Hayward CS, Sullivan
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79 Collins P, Rosano GM, Jiang C, L
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121 Mäkelä S, Savolainen H, Aavik
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162 Clarke S, Kelleher H, Lloyd-Jon
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201 Rahimtoola SH, Bennett AJ, Grun
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243 Varas-Lorenzo C, Garcia-Rodriqu
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7. A connection between menopausal
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3. PATHOGENESIS OF FRACTURE Fractur
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Diagnosis of osteoporosis according
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density and has a favorable effect
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How should this information be inco
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emergence of proved treatment alter
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Data on the relation between skelet
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REFERENCES 1 Osteoporosis Preventio
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42 Gluer CC. Quantitative ultrasoun
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85 Ettinger B, Pressman A, Silver P
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130 Jeffcoat MK, Lewis CE, Reddy M,
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1. INTRODUCTION Perimenopausal wome
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for breast cancer are at increased
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findings on biopsy in women with an
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thra. Patients typically describe l
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Biofeedback: Used in conjunction wi
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There has been one systematic revie
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ence in pelvic organ prolapse. The
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21 Ferenczy A. Endometrial carcinom
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65 Wyman JF, Fantl JA, McClish DK,
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222
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1. INTRODUCTION Worldwide, breast c
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difficult to compare because of com
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Although HRT has been related to an
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cyclic use and 2.9 (95 percent CI 2
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TABLE 11-3 Selected Studies on Horm
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TABLE 11-3 (continued) Thus, a stro
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TABLE 11-4 236 Cohort Studies on Ho
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TABLE 11-5 238 Case-Control Studies
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TABLE 11-5 (continued) 240 Adjustme
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When the same women in NSABP were r
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REFERENCES 1 Pisani P, Parkin DM, B
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47 Day NE. Epidemiology: the role o
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93 Rodriguez C, Patel AV, Calle EE,
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139 Parazzini F, La Vecchia C, Negr
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1. INTRODUCTION Menopause is associ
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inverse relation with nonverbal mem
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ease decreased significantly with i
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of households selected to be repres
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standard antipsychotic drugs increa
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5. FUTURE NEEDS • Explore the pos
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19 Berman KF, Schmidt PJ, Rubinow D
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64 Lerner A, Koss E, Debanne S, Row
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114 Smith R, Studd JW. A pilot stud
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162 Klein BE. Lens opacities in wom
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patients with strong personal convi
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Therefore, convincing evidence of t
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3.1.1 Risk Factors Many factors are
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278 lower dosages of estrogen will
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• Diabetes: Women with diabetes b
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Lipids and lipoproteins • LDL cho
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284 persists but is less steep in w
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5.2.3 Pharmacotherapy Breast Cancer
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• There is no clinical trial evid
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Sirtori CR, Pazzucconi F, Colombo L
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Hansson L, Zanchetti A, Carruthers
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Dementia and Mental Health Forette
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CRP C-reactive protein CT computed
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PTCA percutaneous transluminal coro
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U.S. DEPARTMENT OF HEALTH AND HUMAN
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