Racial and ethnic health disparities are highest in communities of color; providing culturally competent care could address these disparities. Culturally competent communication between the healthcare provider and the patient is an essential behavior that may improve health in racially and ethnically diverse women. A quality improvement project was completed with guidance from the 5 constructs of the Campinha-Bacote model as the conceptual framework, and the method used was the Consumer Assessment of Healthcare Providers and Systems survey. The perspective of 20 Mexican American and 20 African American women in El Paso, Texas between ages 45 and 72 with menopausal symptoms was surveyed to determine if culture had an impact on the presence or absence of communication with their healthcare providers. Results showed women's perceptions of positive and negative communication behaviors with their healthcare providers was inconclusive; however, results showed that provider communication about health promotions, use of alternative medicine, and shared-decision making regarding health management needs improvement to promote adherence to medical regimen and feelings of mutual respect. Integrating cultural competence into existing evidence-based care can positively impact the delivery of services and help improve the quality of care. Healthcare providers can impact positive social change through the lessening of burdens associated with the lack of diversity in the workforce by including cultural competence training into the curriculum of nursing and medical schools.

No description available.

Memory function was examined in association with sex hormone levels in women. The results of the first study suggest that self-reports of memory problems were especially prevalent among women attending a menopause clinic compared to a nonpatient sample. In the following investigation, women given placebo after undergoing a bilateral oophorectomy showed decreases in memory performance, specifically on a paired-associate learning task, coincident with declines in estrogen levels. Significant improvements were found in estrogen-treated women pre- to postoperatively in the immediate recall of paragraphs, in association with supraphysiological estrogen levels. A final study on naturally-cycling women found a decline in visual memory performance during the menstrual compared to the luteal phase of the cycle. Visual memory scores were positively correlated with progesterone levels whereas paired-associate recall scores were positively associated with estradiol levels during the luteal phase. These results suggest that certain aspects of memory covary with changes in sex steroid levels in some women.

Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2001? / Includes bibliographical references (leaves 254-288).

A menopausa é conseqüência da falência ovariana, caracterizada pela queda na produção de estrógenos, podendo causar na mulher vários sintomas e condições patológicas como vaginite atrófica, osteoporose e doençsa cardiovasculares. A terapia estroprogestiva é largamente prescrita na pós-menopausa, no entanto existem freqüentes efeitos colaterais e contra-indicações, inclusive possibilidade de aumento do câncer de mama. Devido a toda esta polêmica as terapias alternativas para combaterem os sintomas da menopausa estão largamente sendo exploradas, neste contexto cita-se os fitohormônios. A isoflavona é um deles obtido de várias plantas e mais usualmente da soja, que possui na sua molécula uma estrutura fenólica que se liga aos receptores de estrogênio e exerce um efeito estrogênico. Neste estudo enfocando a isoflavona, extraída da soja Glycine max, para o tratamento dos sintomas da menopausa, avaliou-se o efeito desse composto sobre a maturação do epitélio cérvico-vaginal e microbiota vaginal. Para isto propô-se um estudo randomizado, duplo cego, placebo controlado do qual participaram 49 voluntárias. Um grupo de 23 mulheres recebeu 1 cápsula/dia de 40 mg de caseína de leite, constituindo o grupo placebo e o outro grupo de 26 mulheres tratadas com 1 cápsula/dia de 40 mg de isoflavona. Amostras de urina e secreção vaginal para colpocitograma, colpocitograma com coleta úmida, bacterioscopia foram colhidas antes do início e ao término do tratamento. Foram determinados índice de maturação (I.M.) e valor de maturação (V.M.) pela técnica da citologia hormonal. O estudo da microbiota foi avaliado por exame direto a fresco e bacterioscopia de Gram. As mulheres participantes do estudo forneceram dados através de entrevistas mensais, antes do início e após o término do estudo, respondendo a questionários sobre queixas, sintomas, história da vida sexual, percepção da menopausa, estado de saúde e questões sócio demográficas. A avaliação destes dados aparece no índice de Kuppermann, nas maiores queixas e melhoras mais evidentes das mulheres tratadas com isoflavona. A avaliação do I.M. resultou no grupo tratado com isoflavona em redução significativa das células parabasais (P=0,003) no colpocitograma tradicional, em aumento significativo das células superficiais cianofílicas (P=0,006) e tendência de aumento das células superficiais eosinofílicas (P=0,18). No colpocitograma obtido por coleta úmida houve diminuição significativa das células parabasais (P=0,004), aumento significativo na porcentagem de células superficiais cianofílicas (P=0,008) e tendência de aumento das células superficiais eosinofílicas (P=0,18). No urocitograma houve redução significativa de células parabasais (P=0,008), aumento significativo na porcentagem de células superficiais cianofílicas (P=0,013) e aumento das células superficiais eosinofílicas (P=0,002). No grupo placebo não se observou variação significativa nos índices acima mencionados. O V.M. no grupo tratado com isoflavona apresentou aumento significativo (P=0,007) no colpocitograma tradicional, colpocitograma, obtido por coleta úmida (P=0,004); e no urocitograma (P=0,0008). No grupo placebo houve diminuição significativa (P=0,02) para este índice. Após o tratamento pela isoflavona houve aumento significativo de bacilos de Döederlein (P=0,005), diminuição significativa de 19,3% nos casos de vaginose bacteriana (índice de Nugent) e diminuição de outros agentes microbiológicos patogênicos. Houve diminuição dos sintomas da menopausa após o tratamento com isoflavona, também se observou diminuição das queixas após o tratamento com placebo. / The lack of estrogens characterizes postmenopausal condition and is associated with pathological conditions and symptoms, including atrophic vaginites, osteoporosis and cardiovascular disease. Hormone replacement therapy is recommended for postmenopausal women but there are contraindications and side effects. There are many alternative therapy researches in order to alleviate these symptoms. Soy isoflavone has hormonal effects in postmenopausal women, by binding a common phenolic structure to estrogens receptors. The aim of this study focusing isoflavone, extracted from soy beans Glycine max, was to evaluate the effects of isofavone on vaginal cytology, vaginal maturation index (M.I.), maturation value (M.V.), vaginal microbiota and menopausal symptoms. This study involved 49 postmenopausal women, a randomized double blind placebo controlled. The first group of 23 women was treated with 40 mg/day capsule of placebo (caseyne) and the second group of 26 women was treated with 40 mg/day capsule of isoflavone. Urine and vaginal samples for 3 slides: colpocytogram, wet sample colpocytogram, Gram-stained smears was taken at baseline and after treatment in order to determine M.I., M.V., vaginal microbiological findings and colpocytologic findings. Study participants answered an in-person interview with questions in order to determine menopausal symptoms, complains, menopause perception, sexual life, general health to determine, for instance the Kuppermann menopausal index (KMI) at baseline, every month and after six-months of treatment. The M.I. from traditional colpocytogram reduced significantly the parabasal cells (P=0,003), increased significantly the percentage of Superficial Cianophilic cells (P=0,006), there was a tendence of increasing the Superficial Eosinofilic cells (P=0,18). From wet sample colpocytogram, similar results were obtained: reduced significantly the parabasal cells (P=0,004), increased significantly the percentage of Superficial Cianophilic cells (P=0,008) there was a tendence of increasing the Superficial Eosinofilic cells (P=0,18).. In urocytogram, the results obtained were: reduced significantly the parabasal cells (P=0,008), increased significantly the percentage of Superficial Cianophilic cells (P=0,013), increase of Superficial Eosinofilic cells (P=0,002). For placebo group there were no significative changes. The Maturation Value, M.V. increased significtively (P=0,007) in traditional colpocytogram; in wet sample colpocytogram (P=0,004) and in urocytogram (P=0,0008), comparing with placebo was observed significant decrease (P=0,02) for M.V. After treatment with isoflavone there was significative increase of Döederlein bacillus (P=0,005), decrease of 19,3% in cases of bacterial vaginosis (Nugent score) and decrease of others pathogenic microbial agents. The symptoms decreased significatively in woman treated with placebo and decreased significatively in women treated with isoflavone.

No description available.

Bakgrund: Alla människor i alla åldrar har rätt till att uppnå god hälsa och välbefinnande. Sexualitet beskrivs som en central aspekt för kvinnor i klimakteriet då god sexuell hälsa kan öka kvinnors livskvalité. Dock är det vanligt med menopausala symtom och sexuell dysfunktion bland kvinnor under och efter klimakteriet vilket har en negativ inverkan på kvinnornas sexualitet och sexuella välbefinnande. För att säkerställa hälsosamma liv och främja välbefinnande för dessa kvinnor behövs tillgång till en god sexuell hälsovård. Syfte: Syftet med denna metasyntes var att undersöka hur kvinnor upplever sin sexualitet under och efter klimakteriet. Metod: Kvalitativ metasyntes med en meta-etnografisk analysmetod. Databaser som inkluderats var CINAHL, PsycInfo, PubMed och Web of science. Efter kvalitetsgranskning återstod 13 artiklar som representerar metasyntesens resultat. Resultat: Fyra huvudteman har identifierats, Lust, Kroppsbildens förändring och betydelse, Yttre faktorer och ”Job as a wife”. I resultatet har även sju underteman identifierats, Symtom, Lustens transition, Acceptans, Strategier och kommunikation, Intimitet, Information och Adaptation. Slutsats: Metasyntesens resultat visade att klimakteriet medförde förändringar som ofta hade inverkan på kvinnors upplevelse av deras kroppsbild och sexuella lust. Till följd av minskad lust undvek kvinnor sexuella aktiviteter vilket hade en negativ inverkan på deras välbefinnande och relationer. Yttre faktorer påverkade även kvinnornas sexualitet. Partnerns roll och handlingar påverkade kvinnornas upplevelse av sin sexualitet vilket medförde att kvinnan adapterade sina sexuella behov efter partnerns behov och funktion. Klinisk tillämpbarhet: Resultaten av metasyntesen kan framför allt användas av barnmorskor men även av annan vårdpersonal för att öka kunskapen om hur kvinnor upplever sin sexualitet under och efter klimakteriet för att bättre kunna bemöta och tillhandahålla med information till dessa kvinnor. Förslagsvis kan barnmorskan göra det möjligt för kvinnor att mötas för diskussion och lyfta fram frågor, erfarenheter och upplevelser rörande sexualitet och sexuell hälsa. / Backgound: All people of all ages have the right to achieve good health and well-being. Sexuality is described as a central aspect for women during menopause as good sexual health can increase women's quality of life. However, menopausal symptoms and sexual dysfunction are common among women during and after menopause, which have negative impact on women's sexuality and sexual well-being. To ensure healthy lives and promote well-being for these women, access to good sexual health care is needed. Aim: The purpose of this metasynthesis was to investigate how women experience their sexuality during and after menopause. Method: Qualitative metasynthesis with a meta-ethnographic analysis method. Databases included were CINAHL, PsycInfo, PubMed och Web of science. After quality review, 13 articles remained to represent the results of the metasynthesis. Result: Four main themes have been identified, Lust, Change in body image and its significance, External factors and "Job as a wife". The result also identified seven sub-themes, Symptoms, Transition of Lust, Acceptance, Strategies and Communication, Intimacy, Information and Adaptation. Conclusion: The results of the meta-synthesis showed that menopause brought changes that had an impact on women's experience of their body image and sexual desire. As a result of decreased desire, women avoided sexual activities, which had a negative impact on their well-being and relationships. External factors also affected women's sexuality. The partner's role and actions influenced the women's experience of their sexuality, which meant that the woman often adapted her sexual needs to the partner's needs and function. Clinical implications: The results of the metasynthesis can primarily be used by midwives but also by other healthcare professionals to increase knowledge about how women experience their sexuality during and after menopause in order to better respond and provide information to these women. As a suggestion, the midwife can make it possible for women to meet for discussion and highlight questions and experiences concerning sexuality and sexual health.

Bakgrund Klimakteriet är en naturlig process nästan alla kvinnor går igenom och inträffar vanligtvis vid 45–55 års ålder. Processen pågår i flera år och det sker en gradvis minskning av östrogennivåer i blodet vilket till slut leder till kvinnans sista menstruation, menopaus.Klimakteriet medför kroppsliga förändringar och olika symtom som kan inverka på det fysiska, psykiska och sociala välmåendet. Egenvård är en viktig faktor vid behandling av klimakterierelaterade symtom. Det handlar om en individs förmåga att vårda sig själv med hjälp av kunskap och medvetenhet. Syfte Syftet är att belysa olika egenvårdsinsatser som kan lindra klimakterierelaterade symtom. Metod En icke systematisk litteraturöversikt utfördes. Artikelsökningarna utfördes i databaserna PubMed, CINAHL och Web of Science med relevanta sökord för syftet. Artiklarnas kvalitet granskades och en integrerad dataanalys genomfördes. Resultat 17 vetenskapliga originalartiklar inkluderades. 16 vetenskapliga artiklar var av kvantitativ design och en var av designen mixad metod. Identifierade huvudkategorier var: Levnadsvanor och Behandlingsinsatser. Fyra underkategorier utformades och beskrev olika egenvårdsinsatser vid klimakterierelaterade symtom. Egenvårdsinsatserna var fysisk aktivitet, hälsosamma kostvanor, knipövningar, användning av glidmedel samt relaxations-och andningsövningar. Dessa påvisades ha effekt för vasomotoriska symtom, sömnproblematik, stressreducering samt för det psykiska och sexuella välmåendet. Slutsats Det finns effektiva icke medicinska egenvårdsinsatser för att minska klimakterierelaterade symtom. Det är viktigt för hälso- och sjukvårdspersonal att ha kunskap kring klimakteriet som process, samt vilka egenvårdsinsatser som finns för att stötta kvinnorna i samband med upplevda besvär. Mer forskning bör bedrivas för att utveckla hur egenvårdsinsatser kan individualiseras och nyttjas kliniskt. / Background Menopause is a naturally occurring process that nearly all women go through at the age of 45–55. The process extends over several years and there is a gradual decrease in blood eostrogen levels which results in the womans last menstruation. The menopause comes with bodily changes and several different symptoms that can interfere with the physical, psychological and social wellbeing. Self-care is an important factor in treating menopause related symptoms and can be described as an individual's ability to care for themselves with knowledge and awareness.  Aim The aim is to highlight different self-care measures to treat menopause related symptoms.  Method A non-systematic literature review was conducted. The article searches were carried out in the databases PubMed, CINAHL and Web of Science, using relevant keywords for the aim of the review. The quality of the articles were analysed and an integrated data analysis was conducted. Results 17 original research articles were included. 16 articles were of quantitative design, and one was mixed method. The identified main headings were: lifestyle habits and treatment measures. Four subcategories were established and described different self-care measures for menopause related symptoms. Self-care measures were physical activity, a healthy diet, Kegel exercises, use of lubricant gel and relaxation/breathing techniques. These measures were shown to have effect on vasomotor symptoms, sleep problems, stress reduction and for the psychological and sexual wellbeing.  Conclusions There are several effective, non-medical self-care measures to reduce menopause related symptoms. It’s important for healthcare professionals to have knowledge about the process of menopause and which self-care measures are available to support women in their experience with problematic symptoms. More research is needed to develop how self-care measures can be individualised and used in practice.

published_or_final_version / Pharmacology / Doctoral / Doctor of Philosophy

Menopause is a natural transition heralded by the cessation of menstrual cycles and ovulation, and it occurs in all women at an average of about 50 years of age. While not a disease, menopause is often accompanied by symptoms that interfere with the quality of life and these symptoms are due to the relatively abrupt deprivation of E2 and P4 experienced during reproductive aging. Reproductive aging consists of changes in the synthesis and release of hormones from the hypothalamus, pituitary and gonad, which make up the HPG axis. Because gonadal hormones play critical roles in many systems throughout the body and brain, not just reproduction, treatment of menopausal symptoms to date largely involves hormone replacement therapy (HRT) with E2, P4 or their combination. While not intended to treat other neurobiological symptoms beyond hot flushes, HRT has the potential to exert widespread actions due to the abundance of hormone receptors throughout the nervous system. Thus, a fuller understanding of the neurobiology of menopause is badly needed. Although much of the research into the mechanisms that underlie reproductive aging focuses on ovarian failure and follicular atresia (cell death), there is evidence that there are significant alterations in the function of the neuroendocrine levels - the hypothalamus and pituitary - that also contribute to this process. As the mean age of the population increases, the number of post-menopausal women continues to grow with broad economic, healthcare and social costs. It is increasingly important to understand the complex mechanisms underlying reproductive aging and the effects of HRT. In this dissertation, I focus on the question of how the female non-human primate hypothalamus changes both with aging and in response to steroid hormone treatments. / text