Impact of women's health initiative study on attitude and acceptance of hormone replacement therapy in Thai women attending menopause clinics.

OBJECTIVE: To assess the attitude and acceptance of Thai women attending menopause clinics on hormone replacement therapy (HRT) after the Women's Health Initiative (WHI) publication. MATERIAL AND METHOD: A standardized questionnaire was used to assess attitude and acceptance of HRT in 1,206 women who visited menopause clinics in six hospitals between September 2005 and February 2006. RESULTS: Of the total respondents, 92% were in the age of 40-70 years, 75% were in their peri- and post menopause, 25% were current users and the average duration of hormone use was 5.6 +/- 5.3 years. The women's perception of hormone benefits on osteoporosis prevention, skin improvement, and hot flashes treatment were 39.1%, 31.7%, and 28.9%, respectively. The most common concern of hormone use was malignancy. Hormone side effects were found to be the most common reason for switching hormone regimen. Of all the past users, 85% stopped HRT because they changed to another treatment regimen. Only 3.7% had been aware the WHI, of which 43.5% were influenced by its results. The most common source of HRT information was from doctors. For the ever users, 72.3% had some knowledge about HRT. CONCLUSION: The present survey revealed that very few women had been aware of the WHI study. Nevertheless, the prevalence of HRT current users was lower compared to a prior survey before the WHI publication. Doctors appeared to be the important source of HRT information, which may indirectly have an influence over women's attitude and acceptance on HRT.

Randomized comparison of lower and standard dosages of transdermal estradiol on serum estradiol levels and vaginal maturation index.

OBJECTIVE: To evaluate serum estradiol (E2) in postmenopausal women who received 0.025 mg/d or 0.05 mg/d transdermal estradiol, in an equivalent trial. MATERIAL AND METHOD: One hundred and eight postmenopausal women were randomized into 0.025 mg/d and 0.05 mg/d of transdermal E2 matrix patch. After 12 weeks, serum E2 and vaginal maturation index (VMI) were checked in both groups. Adverse effects, such as breast tenderness, application site reaction, weight gain, and headache, were also assessed. RESULTS: Serum E2 in 0.025 mg/d and 0.05 mg/d groups were 42.43 +/- 35.11 and 48.41 +/- 22.36 pg/mL, respectively. There was no statistically significant difference between the groups. Equivalence was found under CI of +/- 14 pg/mL. Mean value of superficial cells and vaginal maturation index (VMI) were comparable between both groups. Adverse effects seem to be less in the lower dosage group compared to the standard dosage group. CONCLUSION: The lower dosage (0.025 mg/d) of the transdermal E2 matrix system is probably an appropriate treatment option for postmenopausal women who need minimal effective and minimal adverse effects.

Prevalence of genital prolapse in Thai menopausal women (using new standardization classification).

BACKGROUND: There is an increasing number of menopausal women in Thailand (estimation of 5 million women). There is no published data on the prevalence of genital prolapse among Thai menopausal woman. So the authors created this hospital based study to identify the magnitude of this problem in Thai menopausal women. OBJECTIVE: To study the prevalence and symptoms of genital prolapse in Thai menopausal women attending the menopausal clinic in King Chulalongkorn Memorial Hospital. STUDY DESIGN: Descriptive study (Cross-sectional study). MATERIAL AND METHOD: Two hundred and fifteen Thai menopausal women attending the menopause clinic at King Chulalongkorn Memorial Hospital from the 1st of January to the 28th of February 2004 were recruited. Urinary symptoms history taking and pelvic examination were done. The severity of any prolapse was classified using International Continence Society classification. RESULTS: Prevalance of Thai menopausal women having any type of genital prolapse was 43.3%. Anterior vaginal wall prolapse and superior vaginal prolapse were the two highest prevalences of genital prolapse (29.3% and 14.9%). The prevalence of genital prolapse increased by the menopausal age. The two leading symptoms were stress incontinence and vaginal outlet relaxation (89.3% and 51.6%). CONCLUSION: From the present study, the authors found the prevalence of any genital prolapse (43.3%) and stress incontinence(89.3%) among Thai women attending menopausal clinic in King Chulalongkorn Memorial Hospital. The authors strongly recommend pelvic examination and urinary-symptoms history taking to evaluate the severity of genital prolapse.

Hormone replacement therapy: attitude and acceptance of Bangkokian women.

OBJECTIVE: To conduct a hospital-based survey to assess women's attitude and acceptance towards menopause and hormone replacement therapy (HRT). METHOD: The authors conducted a survey in women who visited the menopause clinic in 5 university and public hospitals in Bangkok. A group of 615 women who lived in those catchment areas and voluntarily cooperated in responding to a set of standardized questionnaires was randomly selected. RESULTS: Of the total respondents, 97.0 per cent were in the age range between 40-70 years, 51.7 per cent were in the peri- and postmenopausal period, 65.7 per cent believed that menopause is a natural change but some may need medical treatment, 53.9 per cent were current users of which the average duration of HRT use was 4.70 +/- 3.36 years. The most common reasons for HRT initiation were osteoporosis, hot flashes, and vaginal dryness. The most common side effects found in the current users were breast pain, headache, and vaginal bleeding. Of all the current users, 43.2 per cent wanted to switch from HRT. Most of the respondents (95.4%) based their decision on the choices of treatment on medical advice. Of the total respondents, 62.0-74.7 per cent reported not having enough clear information on menopause and HRT. CONCLUSION: According to the present study, most of the women regarded menopause as a natural change of life although some need treatment. The most common indications for HRT were osteoporosis, hot flashes and vaginal dryness. Nearly half of the current users wanted to switch from HRT. Most of the respondents based their treatment decision on medical advice.

Climacteric: concept, consequence and care.

Climacteric is the period of life starting from the decline in ovarian activity until after the end of ovarian function. According to the definition, the period includes peri-menopause, menopause and post-menopause. Climacteric is considered to be a natural change of life which may be accompanied by various health consequences i.e., menopausal symptoms, osteoporosis, coronary heart disease, or Alzheimer's disease. The key concept is that women enter menopause with different menopausal status for instances, natural menopause, surgical menopause, early menopause or even premature ovarian failure. Women may experience various health consequences due to the difference in genetic and environmental interaction. The prevalence and incidence of menopausal problems vary according to ethnic groups. For instance, Asian women seem to have less problems after menopause than their occidental counterparts. Nevertheless, the problems do exist and seem to be increasing due to the longer life expectancy and lifestyle changes of people in the region. Clinical decision in menopausal therapy can be determined according to health risk stratification. Appropriated menopausal therapeutic strategies include medical and non-medical modalities. The non-medical modalities are mainly focussed on lifestyle modification, while the medical modalities are classified as hormone replacement therapy (HRT) and non-HRT. Those in the high risk group will probably benefit most from medication besides lifestyle modification. There are various types, doses, routes and regimens of medication which need to be appropriately matched with the proper women's characteristics. Those who have contraindications to HRT or can not tolerate its side effects may choose other alternatives eg, selective estrogen receptor modulators, bisphosphonates, calcitonin or calcium and vitamin D. The success of menopausal therapy is to give an appropriate therapeutic option to the right woman. The future direction of research will remain focussing on the development in diagnosis and menopausal therapy particularly the main three areas of health promotion, disease prevention and treatment. The trend of research and development will probably be concentrated on new pharmaceutical agents with more specific action and high selectivity in an attempt to maximize its efficacy and safety. Attention may be paid more on the convenience of drug administration to increase its compliance. Alternative medicine and appropriated technologies are also the fields of special interest of which research is underway.