Kupperman index-based analysis of factors influencing perimenopausal symptoms and establishment of risk nomogram in female petrochemical workers / 环境与职业医学

Background Women face more reproductive health problems in their whole life cycle. Occupational exposure to harmful factors in the petrochemical industry may have a synergistic effect on women’s existing health problems. Objective To analyze the influencing factors of perimenopausal syndrome (PMS) in female workers in petrochemical industry, and establish a nomogram model of the risk of PMS in female workers, so as to provide a easy and quick health monitoring and evaluation method for female workers. Methods A total of 2653 perimenopausal female workers aged 45-55 years old were selected from a petrochemical enterprise. A questionnaire survey was conducted to collect information on demographic characteristics, occupational characteristics, psychological status, and reproductive health information. The prevalence of PMS of female workers was evaluated by the Kupperman Index Scale, the physical fatigue and mental fatigue were evaluated by the Fatigue Scale. A linear graph prediction model was established by multiple logistic regression. A nomogram was presented and C-index was used to verify the differentiation of the model. Then Bootstrap method was used for internal validation. Results Among the 2653 female worker, a total of 1306 cases (49.2%) presented PMS with a Kupperman score ≥7. The main symptoms were fatigue (79.95%), irritability (71.32%), and insomnia (66.79%). Significant differences in PMS prevalence were found among female workers of different age, body mass index, and working posture groups (P < 0.05). The participants with alcohol drinking, maternal premature or late menopause, hypertension, lack of physical exercise, heavy lifting, sick leave in the last 6 months, combined occupational exposures to dust, chemicals, noise [> 80 dB(A)], or electromagnetic field, and not wearing protective masks, gloves or protective earplugs reported higher prevalence rates of PMS (P < 0.05). The prevalence rate of PMS in female workers with sleep duration ≤ 6 h was higher than that with > 6 h (P < 0.05), and higher in female workers with physical and mental fatigue than in those without (P < 0.05). The results of logistic regression analysis showed that those with maternal premature or late menopause (OR=1.572, 95%CI: 1.320−1.872), hypertension (OR=1.579, 95%CI: 1.127−2.213), alcohol drinking (OR=1.286, 95%CI: 1.080−1.532), no physical exercise (OR=1.598, 95%CI: 1.330−1.920), sleep duration ≤ 6 h (OR=1.853, 95%CI: 1.518−2.263), sick leave in recent 6 months (OR=1.614, 95%CI: 1.226−2.123), physical fatigue (OR=2.384, 95%CI: 1.887−3.012), mental fatigue (OR=5.649, 95%CI: 4.382−7.283), combined exposure to occupational harmful factors (OR=1.329, 95%CI: 1.108−1.593), long-time sitting (OR=2.014, 95%CI: 1.271−3.190), and heavy lifting (OR=1.505, 95%CI: 1.178−1.923) showed a higher risk of reporting PMS (P<0.05). The C-index from the ROC curve of the nomogram model was 0.748 (95%CI: 0.729−0.766). The results of Bootstrap validation showed that the standard curve and the predicted curve almost overlapped, and the absolute error was 0.008, indicating that the model fitness was good. Conclusion PMS in female petrochemical workers may occur due to long-term exposures to multiple factors. The established nomogram model has good predictive ability and could be applied to monitor and evaluate female reproductive health in petroleum industry.

Clinical Observation of Bu Shen Tiao Qi Needling for Perimenopausal Syndrome / 上海针灸杂志

Objective To observe the clinical efficacy of Bu Shen Tiao Qi(supplementing the kidney and regulating qi) needling in treating perimenopausal syndrome.Method Fifty patients were randomized into two groups, 25 cases each. The treatment group was intervened by Bu Shen Tiao Qineedling combined with electroacupuncture, while the control group was by shallow needling plus sham electroacupuncture. Kupperman Index (KI) wasobserved respectively before treatment, after 2-week and 4-week treatment, and in the 4-week follow-up study. The differences of scores and improvements of the 13 symptoms listed in KI were calculated.Result The total effective rate was 92.0% in the treatment group versus 44.0% in the control group; in the treatment group, the KI scores after 2-week treatment and in the 4-week follow-up study were significantly different from that before treatment (P<0.05), and a more significant difference was found after 4-week treatment (P<0.01); the between-group differences were statistically significant in comparing KI (P<0.05).Conclusion Bu Shen Tiao Qineedling can produce a satisfactory efficacy in treating perimenopausal syndrome.

Poor sleep in middle-aged women is not associated with menopause per se

Whether sleep problems of menopausal women are associated with vasomotor symptoms and/or changes in estrogen levels associated with menopause or age-related changes in sleep architecture is unclear. This study aimed to determine if poor sleep in middle-aged women is correlated with menopause. This study recruited women seeking care for the first time at the menopause outpatient department of our hospital. Inclusion criteria were an age ≥40 years, not taking any medications for menopausal symptoms, and no sleeping problems or depression. Patients were assessed with the Pittsburgh Sleep Quality Index (PSQI), modified Kupperman Index (KI), and Menopause Rating Scale (MRS). A PSQI score of <7 indicated no sleep disorder and ≥7 indicated a sleep disorder. Blood specimens were analyzed for follicle-stimulating hormone and estradiol levels. A total of 244 women were included in the study; 103 (42.2%) were identified as having a sleep disorder and 141 as not having one. In addition, 156 (64%) women were postmenopausal and 88 (36%) were not menopausal. Follicle-stimulating hormone and estradiol levels were similar between the groups. Patients with a sleep disorder had a significantly higher total modified KI score and total MRS score (both, P<0.001) compared with those without a sleep disorder. Correlations of the PSQI total score with the KI and MRS were similar in menopausal and non-menopausal women. These results do not support that menopause per se specifically contributes to sleep problems.

Clinical Observation of Acupuncture plus Medication for Perimenopausal Syndrome / 上海针灸杂志

ObjectiveTo compare the therapeutic efficacy of acupuncture plus medication versus using Chinese medication or acupuncture alone in treating perimenopausal syndrome.MethodNinety patients with perimenopausal syndrome were randomized into 3 groups, 30 in each group, to respectively receive acupuncture plus Chinese medication, Chinese medication alone, and acupuncture alone, totally for 3 months. Modified Kupperman index was adopted to evaluate therapeutic efficacy.ResultAfter intervention, the Kupperman scores decreased significantly in all three groups (P<0.01). The Kupperman score of the acupuncture-medication group was markedly superior to that ofthe medication group and acupuncture group (P<0.05).Conclusion Combination of acupuncture and medication can significantly improve the symptoms of perimenopausal syndrome, and is valuablein clinic.

Comparison of the Efficacy and Safety of the Unicenta and Melsmon Injection for the Menopausal Symptoms / 대한폐경학회지

OBJECTIVES: The objective of this study was to evaluate the efficacy of Unicenta (UNCNT) and Melsmon in women with the menopausal symptoms, by analysing the changes in the Kupperman index (primary endpoint), and the hormonal change (secondary endpoint). METHODS: This is a randomized, multi-Center, double-Blind, parallel, non-inferiority clinical study of four different tertiary medical centers. We began the participant recruitment in September 2011, with 218 patients applied over 7 months. All participants had the last visit in April 2012. RESULTS: The Unicenta injection was not inferior to that of Melsmon as measured by the Kupperman index following the injection in both the intent-to-treat and the per-protocol populations (P = 0.63, P = 0.85, respectively). Side effects occurred in 14.0% of the cases (15 patients/18 cases) in the case group, and in 12.6% (14 patients/15 cases) in the control group (P value=0.7599). None were reported to be associated with the medication. The laboratory results and the vital signs showed no statistically significant risk for safety. CONCLUSION: The study showed that Unicenta is not inferior to Melsmon in the change of the Kupperman index after 12 days of injection. The efficacy and safety of Unicenta was shown, with the improvement of the menopausal symptoms.

Violência doméstica e sexual em mulheres e suas repercussões na fase do climatério / Impact of domestic and sexual violence on women's health

INTRODUÇÃO: a violência doméstica e, particularmente, a sexual pode implicar em maior ocorrência de comorbidades no climatério. OBJETIVO: avaliar as repercussões no climatério da violência domestica e sexual. MÉTODO: estudo transversal em 124 mulheres menopausadas, entre 40 e 65 anos, que sofreram violência doméstica e/ou sexual, e um grupo controle (mulheres na menopausa que não sofreram violência n=120). As expostas à violência foram divididas em três grupos: 1-violência sofrida na infância e/ou adolescência, 2-fase adulta, 3-ambas as fases, e aplicou-se questionário sobre violência doméstica e sexual. Correlacionou-se a intensidade dos sintomas climatéricos medido pelo Índice Menopausal de Kupperman (IK), tipo de violência sofrida, fase da vida exposta à violência, comorbidades apresentadas no climatério e percepções da mulher sobre a forma com que os diversos profissionais acolheram ou não nos eventos traumáticos. No grupo controle avaliamos IK e numero de comorbidades. RESULTADOS: aquelas que sofreram violência na infância/adolescência apresentam media de 5,1 comorbidades; na fase adulta 4,6; e em ambas as fases 4,4, com mediana de 5,0 em todas as fases; sem violência (controle) 2,8. As que sofreram violência sexual apresentam mais comorbidades em relação aquelas que sofreram outros tipos de violência. Houve associações significativas entre ter sofrido qualquer tipo de violência em ambas às fases e IK grave e ter sofrido violência sexual em qualquer fase da vida, e IK no mínimo moderado. CONCLUSÃO: mulheres que sofreram violência doméstica e sexual apresentam mais comorbidades e IK elevado em relação ao grupo controle.

Impact of bilateral ovariectomy on climacteric symptoms in post-menopausal women / 上海交通大学学报（医学版）

Objective To evaluate the impact of bilateral ovariectomy in post-menopausal women by comparison of climacteric symptoms before and after operation. Methods Post-menopausal women who received hysterectomy with concurrent bilateral ovariectomy on benign uterine indications were recruited.Climacteric symptoms before and after operation were accessed by a questionaire including modified Kupperman Index.Comparison was made after grouping the patients into early menopause group,whose menopausal period was no more than 5 years,and late menopause group,whose menopausal period was more than 5 years. Results Among a total of 95 individuals,8 had normal,46 had mild,34 had moderatc,and the other 7 had severe Kupperman Index scores before operation,while 5 had normal,28 had mild,48 had moderate,and the other 14 had severe Kupperman Index scores after operation,with more moderate and severe climacteric symptoms after operation than before operation(P<0.05).Women of early menopause group had higher total Kupperman Index scores and symptom scores of sweating,insomnia,depression,fatigue and headache than those of late menopause group before operation(P<0.05).Women of early menopause group had significantly higher Kupperman Index scores after operation than before operation(23.93±7.53 vs 17.63±8.07,P<0.05).However,there was no significant difference in total Kupperman Index scores in women of late menopause group before and after operation. Conclusion Bilateral ovariectomy may affect the climacteric symptoms in post-menopausal women,especially in early menopausal period.

Impacto dos transtornos depressivos e ansiosos sobre as manifestações da menopausa / Impact of depressive and anxiety disorders over menopause manifestations

OBJETIVO: Determinar, pela primeira vez, em uma amostra ambulatorial brasileira, o impacto dos diagnósticos psiquiátricos sobre os sintomas da menopausa presentes no índice de menopausa de Blatt-Kupperman (B-K). MÉTODOS: Avaliamos consecutivamente, através do instrumento diagnóstico estruturado MINI 4.4 e da entrevista psiquiátrica tradicional, mulheres (n = 86) em atendimento no ambulatório de menopausa do Instituto de Ginecologia da Universidade Federal do Rio de Janeiro. As pacientes incluídas no estudo (n = 48) foram avaliadas pela escala B-K até 6 meses antes ou depois da entrevista pelo MINI e divididas em dois grupos: o grupo com algum transtorno depressivo-ansioso (GTDA) (n = 26) e o grupo-controle (GC) (n = 22). RESULTADOS: O GTDA apresentou uma pontuação significativamente maior do que o GC na escala de B-K (22,6 versus 13,7). Entre os sintomas significativamente mais intensos no GTDA estão parestesia e melancolia. Além disso, observamos que as pacientes do GTDA queixavam-se de um maior número de sintomas do que as pacientes do GC (6,8 vs. 4,8). Entre os sintomas significativamente mais relatados no GTDA, estão parestesia, fraqueza e melancolia. CONCLUSÃO: Apesar da limitação da pequena amostra, pudemos observar o significativo viés dos transtornos depressivos e ansiosos sobre as pacientes em tratamento por queixas referentes à menopausa. Por esse motivo, o perfil sintomático de cada paciente deve ser sempre observado, evitando o ginecologista basear-se na intensidade global dos sintomas do B-K para decidir sobre o tratamento.

OBJECTIVE: To establish for the first time in a Brazilian outpatient sample the impact of depressive and anxiety disorders over the symptoms of the Blatt-Kupperman menopausal index (B-K). METHODS: Women (n = 86) receiving care in the menopause clinic at Instituto de Ginecologia da Universidade Federal do Rio de Janeiro were consecutively assessed using a structured diagnostic instrument (MINI 4.4) and a traditional psychiatric interview. Patients included in the study (n = 48) were assessed using the B-K scale within 6 months before or after the MINI. The total sample was divided into the anxiety and depressive disorder group (GTDA) (n = 26) and the control group (CG) (n = 22). RESULTS: B-K total scores were greater in the GTDA comparing with the CG (22.6 vs. 13.7). Paresthesia and melancholia were significantly more severe in the GTDA. GTDA patients also complained of a greater number of symptoms (6.8 vs. 4.8) than the GC. Paresthesia, weakness and melancholia were significantly more present in the GTDA. CONCLUSION: Although the small sample limitation we could observe a great bias of depressive and anxiety disorders over menopause outpatients. For that reason, the symptomatic profile of each patient must always be observed by the gynecologist, avoiding exclusive observation of B-K total score to decide about the treatment.

Effects of surgery-induced menopause on neuropsychological symptoms in women with perimenopause / 上海第二医科大学学报

Objective To investigate the effects of surgery-induced menopause on neuropsychological symptoms in women with perimenopause. Methods Sixty-eight women with perimenopause who underwent bilateral oophorectomy for benign indications were evaluated by the modified Kupperman index on the perimenopause syndrome pre-and post-surgery,including the score in neuropsychological symptoms.Patients were further requested to remake a decision on the acceptance of surgery,and were divided into "accept the surgery" group(n=30) and "postpone the surgery" group(n=38).The neuropsychological symptoms were reevaluated and comparison was made between these two groups. Results The prevalence of perimenopause syndrome pre-surgery was 67.65%(22/68),and that of moderate and severe symptoms was 30.88%.The prevalence of perimenopause syndrome post-surery(97.06%)(66/68)was significantly increased,as well as that of moderate and severe symptoms(70.59%)(P

Effects of Isoflavone on Surgically Menopaused Women / 대한산부인과학회잡지

OBJECTIVE: To evaluate the effects of isoflavone intake on estrogen deprivated symptoms in surgically menopaused women. METHODS: Premenopausal women who took total hysterectomy with both adnexectomy were randomized into three groups. One group took conjugated equine estrogen 0.625 mg daily for 12 weeks after surgery, the second group took isoflavone 100 mg #3 daily for 12 weeks after surgery, and the third group took no medication for controlled group. Questionnaires about the acute menopausal symptoms, incontinence score, blood lipid profile, bone turnover marker were checked before and 12 weeks after surgery. RESULTS: Kupperman's index and insentience score were showed less increased rate than control group. Total cholesterol and triglyceride were increased in all groups and HDL cholesterol was increased in estrogen and isoflavone groups. Osteocalcin was decreased in estrogen and isoflavone groups, ICTP was decreased in estrogen group, and increased in the other groups. CONCLUSION: Isoflavone was effective to acute postmenopusal symptoms, urogenital atrophy and bone turnover.

Comparative Study on Treatment of Postmenopausal Symptoms with Black Cohosh Root Extract and Hormone Replacement Therapy / 대한산부인과학회잡지

OBJECTIVE: The fears and side effects of a prolonged hormone replacement therapy on the postmenopausal symptoms reinforce a growing interest about alternatives. The present study was performed to investigate whether black cohosh root extract (BCRE) can be used or not as an alternative to hormone replacement therapy (HRT) in order to relieve postmenopausal symptoms. MATERIAL & METHODS: Randomized, double-blind prospective clinical trial examined the effects of BCRE and HRT on Kupperman index, biochemical bone markers, lipid profiles, and side effects in 74 women with postmenopausal symptoms. Treatments included placebo (Festal(R)) (n=12), BCRE (Feramin(R)) (n=32) and HRT (Premarin(R)) (n=30) for 3 months. Kupperman index, biochemical bone markers (osteocalcin and deoxypyridinoline), and lipid profiles (total cholesterol, triglyceride and HDL-cholesterol) were measured at 0, 1 and 3 months. Side effects were checked at 3 months. RESULTS: BCRE was significantly effective in lowering of Kupperman index as much as HRT at two control times (1 month: p<0.05, 3 months: p<0.001). It also showed slightly favorable effects on biochemical bone markers and lipid profiles but not statistically significant. Fewer side effects were seen in BCRE than HRT. CONCLUSION: BCRE appears to be a safe and effective alternative to HRT for early postmenopausal symptoms and may be especially useful in women with intolerances or contraindications to traditional HRT.

Comparative Study on Treatment of Postmenopausal Symptoms with Black Cohosh Root Extract and Hormone Replacement Therapy / 대한산부인과학회잡지

OBJECTIVE: The fears and side effects of a prolonged hormone replacement therapy on the postmenopausal symptoms reinforce a growing interest about alternatives. The present study was performed to investigate whether black cohosh root extract (BCRE) can be used or not as an alternative to hormone replacement therapy (HRT) in order to relieve postmenopausal symptoms. MATERIAL & METHODS: Randomized, double-blind prospective clinical trial examined the effects of BCRE and HRT on Kupperman index, biochemical bone markers, lipid profiles, and side effects in 74 women with postmenopausal symptoms. Treatments included placebo (Festal(R)) (n=12), BCRE (Feramin(R)) (n=32) and HRT (Premarin(R)) (n=30) for 3 months. Kupperman index, biochemical bone markers (osteocalcin and deoxypyridinoline), and lipid profiles (total cholesterol, triglyceride and HDL-cholesterol) were measured at 0, 1 and 3 months. Side effects were checked at 3 months. RESULTS: BCRE was significantly effective in lowering of Kupperman index as much as HRT at two control times (1 month: p<0.05, 3 months: p<0.001). It also showed slightly favorable effects on biochemical bone markers and lipid profiles but not statistically significant. Fewer side effects were seen in BCRE than HRT. CONCLUSION: BCRE appears to be a safe and effective alternative to HRT for early postmenopausal symptoms and may be especially useful in women with intolerances or contraindications to traditional HRT.

The effect of hormone replacement therapy on the postmenopausal symptoms In the women medicated continuously and the women quitted the medcation -

BACKGROUND: This study was performed to assess the effect of hormone replacement therapy (HRT) on the menopausal symptoms of Korean women by comparing the postmenopausal symptoms before and after HRT in women who continued therapy and those who stopped. METHODS: The subjects were 40 menopausal women(24 women on continuous medication, 16 women who discontinued medication) who received HRT and were alde follow of at least 2 months later in the Department of Family Practice. The menopausal symptoms were evaluated by two doctors according to the modified Kupperman Index. RESULTS: The basic values of Kupperman Index were not significantly different between women who had received the HRT continuously and those who discontinued HRT. In women with continued HRT improved symptoms after HRT were hot flushes, sweating, fatigue, headache, tachycardia and total score of Kupperman Index. However, only vertigo and headache were improved in women who discontinued HRT. Treatment period was the single most predictor of total score of Kupperman Index after therapy. And it could explain the 44.1% of variance of total score in the direction of improvement proportional to the treatment period. CONCLUSIONS: The HRT is helpful to relieve the menopausal symptoms. And the treatment period is more important than the severity of basic symptoms to improve menopausal symptoms after therapy.