More than half of the women aged from 45-55 suffer from menopausal symptoms which can seriously affect the quality of life of the midlife women. The menopause transition has become a very active research area in healthy aging in the last several decades. In recent years, more and more women have turned to traditional Chinese medicine (TCM) to manage their menopausal symptoms. Among various Chinese medicine formulae, Er-Xian Decoction (EXD) is one of the most acceptable Chinese medicine formulae to relieve menopausal symptoms. Although EXD is popular in the management of menopausal symptoms, its effectiveness has not been evaluated by strictly designed clinical study. A systematic review was conducted to evaluate the current evidence to assess the efficacy and safety of EXD as a basic formula for menopausal symptoms. A total of 12 randomized controlled trials (RCTs) were included for further analysis. The results of these studies suggested that EXD was more effective than the control interventions, which included various HRT and other Chinese herbal medicine. Seven of the studies compared EXD with HRT and the meta-analysis seemed to suggest that EXD as a basic formula was superior to hormone replacement therapy. However, the included studies were insufficient in methodological quality and had a high probability of bias. A double-blind randomized controlled clinical trial was then conducted to assess the efficacy and safety of EXD for menopausal symptoms. Of 557 recruited women, 108 subjects were eligible to participate in the study and 101 subjects finished the study. Comparisons between placebo and EXD groups were conducted by using an analysis of covariance (ANCOVA) with baseline as covariate. EXD granules when compared with placebo significantly reduced the frequency and severity of hot flushes and night sweats. EXD compared with placebo significantly reduced the frequency of hot flushes (P=0.041) and the hot flush severity score (P=0.016). Superiority of EXD over placebo was also observed in greater improvement in total scores of MRS (P=0.028) and MENQOL questionnaires (P=0.021). There were no differences between EXD and placebo group in serum hormones and bone markers. There were no serious adverse events and the safety indices of whole blood counts, renal and liver functions were normal before and after the treatment. Both EXD and placebo were well tolerated. In summary, this Chinese herbal formula EXD was found to be superior to placebo in reducing hot flushes and improving menopausal symptoms in Hong Kong perimenopausal women. It was well tolerated, with no serious adverse events noted during the study period. / published_or_final_version / Chinese Medicine / Doctoral / Doctor of Philosophy

Menopause is a period of biological transition in middle-aged women, when oestrogen levels gradually drop. After menopause women no longer can give birth to children. However, menopause is more than biology; it is also an example of a bio-psycho-social process, where psychosocial and cultural involvement can influence experiences of the biological transformation. Furthermore, many myths and meanings surrounds menopause, and the purpose of this study drawing on a Foucauldian perspective, is to examine discourses in contemporary society that affect the understanding of what menopause is. The methodological approach consists of an analysis of media articles and interviews with middleaged women to explore different conceptions of menopause. The analysis of articles in two leading Swedish newspapers during a period of five years (Dagens Nyheter and Svenska Dagbladet, 2007- 2011) reveals that the media present menopause as a substantial risk factor that increases the possibilities of many diseases, irrespective of genes and lifestyle, and that menopause appears to cause reduced quality of life and degraded body. This female period of life is portrayed as “the beginning of the end”, filled with dichotomies concerning whether menopause is natural or pathological, but with an emphasis on the pathological. The newspaper articles present different strategies for women on how to deal with this transformation, such as hormone replacement therapy, fitness, and different diets that can "calm" women’s experience of menopause. Media thus present menopause as both problematic and challenging. However, interviews with six middle-aged women show that women themselves view this differently. Women define menopause as the border between being young and old, and this makes menopause in conflict with today's youth-obsessed society, where health and appearance are essential components of personal identity, particularly for women. Women talk about menopause as a confirmation of age, and also indirectly as the beginning of deteriorating health. In contrast, the majority of women experience menopause positive in terms of what they had expected. Due to the confusion surrounding menopause women call attention to the lack of information and knowledge on the subject of menopause. Information that can increase women’s knowledge, and thus give women more control over their own bodies. These different images of menopause are problematized both in terms of the gendered body, as well as in terms of knowledge and power.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

In this dissertation, I look to contemporary menopause management in the Southwest, United States, as an ideal case study of the 'real world' negotiation of a widespread contemporary conundrum--characterized by discourses of risk, proliferation of information and choice, chronic doubt, and personal responsibility for decision-making. While there have been previous studies of menopause in the US, this circumstantial ethnography seeks to understand contemporary menopause management in an era characterized by a massive shift in the biomedical risk discourses about menopause, the explosion of therapeutic choice in a burgeoning pluralistic health care environment, and the broad expansion of women's identities, body projects, and life priorities over the last several decades.I report on fourteen months of ethnographic fieldwork conducted in 2007 and 2008 with menopausal women and health care providers in the southwestern US. Research components included ethnographic interviews (N=60) and focus groups (6 groups with 27 participants) with midlife women, interviews with health care providers across a range of therapeutic modalities (N=20), and observation of emerging discourses of menopause in science, media and marketing.This dissertation illustrates that contemporary menopause management is a recursive process characterized by the ongoing re-evaluation of the impact menopause is having on one's life--in context. Participants described the unfolding of the lived-experience of menopause over time--even years beyond the end of menstruation. Risk discourses are not embodied en masse but reflect the concerns most salient in women's lives. While women access various expert and lay resources, they favor personal experts--sources deemed professionally sound and personally relevant--and their own embodied knowledge. For their part, health care providers described themselves as "normalizing" menopause and practicing patient-centered care aimed at empowering women to make their own decisions about how to manage menopause. Lacking an ideal choice, women make provisional treatment decisions that resonate with their current menopausal subjectivity. Despite abundant options, menopause management is increasingly stratified, with some able to access more information resources and afford more extensive decision-support. Among women with severe symptoms, bioidentical hormone therapy--productively positioned between biomedicine and complementary/alternative medicine--has emerged as a popular harm reduction strategy.

This early phase study examined the effects of a series of ten standard-protocol acupuncture treatments over four weeks in 12 healthy, but symptomatic, menopausal women. Two biologic markers, heart rate variability to evaluate effects of acupuncture on the autonomic nervous system as it relates specifically to the heart, and interleukin 6, a proinflammatory cytokine, to capture physiologic impact of acupuncture on the immune-inflammatory response, were collected.Women who exhibited significant menopausal symptoms, as measured by a minimum score of 22 out of a possible 44 points on the Menopause Rating Scale (MRS), underwent 10 sessions of a standard acupuncture point protocol intervention over a four-week period. Symptoms were evaluated for 28 days using the MRS. After the intervention was complete, one final open-ended question was asked of each participant to explore subjective experiences not captured by the validated instrument. Physiologic measurements included a 30-minute continuous measure of electrocardiogram data before and during acupuncture, as well as pre and post acupuncture measures of serum interleukin 6 at the first and final acupuncture treatment. Heart rate variability was assessed using spectral analysis, and interleukin 6 changes were measured using ELISA. Analysis included linear regression, Wilcoxon Signed Ranks test and Spearman correlation coefficients.After the acupuncture intervention, menopausal symptoms improved significantly. Heart rate variability did not show consistent or predictable intra or inter-subject changes, however several components of HRV, interleukin 6 and symptoms were found to have significant correlations.A larger study was deemed feasible. Menopause symptoms improved. Heart rate variability showed no consistent changes or trends. Interleukin 6 decreased in seven subjects, between the first and tenth acupuncture treatment, but did not reach statistical significance.This small project suggests that heart rate variability, when measured at each acupuncture treatment, does not change in a consistent or predictable manner. Rather, acupuncture may provide a modulating influence that depends on the body's functional state at each treatment.

It is known that sleep problems affect people’s wellbeing and has great consequences for public health. Restless legs syndrome (RLS) gives uncomfortable sensations in the legs at rest, leading to an irresistible need for activity. It aggravates in evening and at night. Therefore, RLS provides poorer sleep and can affect quality of life through fatigue, family life and social activities, work, and comorbidity. It is demonstrated a dysfunction of the dopaminergic system in the brain with low levels of dopamine and / or less sensitive dopamine receptors. RLS is more common in women and the prevalence increases with age and during pregnancy. Periodic limb movements are characterized by uncontrolled stretching movements of the legs, especially the toes, ankles, knees and hips during sleep. They last between 0.5 and 5 seconds, and can cause brief awakenings leading to daytime sleepiness. The clinical significance of PLM is rather controversial and PLM is sometimes seen in healthy people with no daytime symptoms. RLS is a subjective diagnosis and translated with the help of questionnaires. PLM however, can objectively be evaluated by polysomnography. Depression is common during and after pregnancy. It is not known whether women with RLS during pregnancy have a higher risk of prenatal or postpartum depression. The aims of this thesis was to  to examine the prevalence, associated symptoms and comorbidities, in particular, vasomotor symptoms, menopause, and hormone replacement therapy (HRT) use, among women who suffer from RLS and PLMs. We also evaluated the impact of RLS and PLMs on health related quality of life (HRQoL), and if RLS before and during pregnancy increases the risk of antenatal or postpartum depressive symptoms. Three different poulations were used.  Paper 1-3 were cross-sectional and included 5000 resp. 10000 randomly selected women from the general populations of Dalarna and Uppsala County. Questionnaires, polysomnographic recordings, blodtests etc. were used. Paper 4 was a longitudinal cohort study where 1428 pregnant women in Uppsala County were followed. In summary, data included in this thesis points out that RLS and PLMs are more common in women with estrogendeficiency-related symptoms of menopause. RLS-positive women had an impaired mental HRQoL compared to RLS-negative women and more often suffered from comorbidities. Data also revealed that women with RLS before and during pregnancy are at increased risk for depression during and after pregnancy.

Background: Moderate-to-vigourous intensity physical activity (MVPA) is among the few modifiable factors known to reduce breast cancer risk. However, the independent effects of leisure-time, household, and occupational MPVA by age period across the life course remain poorly understood. Whether these effects differ by menopausal status and by tumour subtypes defined by the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) is unknown. An understanding of these issues will help advance policy and public health action targeting breast cancer prevention through physical activity. Methods: A case-control study of 1,011 incident breast cancer cases and 1,014 cancer-free controls aged 40-80 years was conducted from 2006-2010 in Vancouver, British Columbia (BC). Lifetime leisure-time, household, and occupational MVPA were assessed by questionnaire and mean MET-hrs/week of each were calculated for age periods 12-17, 18-34, 35-49, and ≥50 years and the total lifetime. Odds ratios for pre- and post-menopausal breast cancer risk associated with each activity domain across age periods were estimated using unconditional logistic regression, and odds ratios for risks of ER/PR-defined and ER/PR/HER2-defined breast tumours were estimated using unconditional polytomous logistic regression. Results: Among post-menopausal women, lifetime leisure-time and household MVPA reduced breast cancer risk by approximately 50% at volumes equal to 3 hours per week of running and 21 hours per week of active household work. MVPA reduced risk at all age periods across the life course, particularly during adulthood. Effects of leisure-time MVPA appeared restricted to HER2- tumours. Household MVPA reduced risk for ER/PR+ tumours, regardless of HER2 status. MVPA was not associated with pre-menopausal breast cancer risk, except occupational MVPA performed during ages 18-34 was associated with a doubling in risk. Conclusions: MVPA is a lifestyle factor women may engage in to reduce post-menopausal breast cancer risk. Results suggest HER2 may be implicated in anti-breast carcinogenic effects of leisure-time MVPA. Increased risk associated with occupational MVPA may be due to occupational exposures related to job intensity. Further research on specific aspects of weekly MVPA energy expenditure dose required to reduce breast cancer risk will aid in refining physical activity recommendations for breast cancer prevention. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-06-29 10:01:45.535

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In an attempt to determine the relationship between dietary fiber and estrogen levels in premenopausal adult women, seven subjects completed all of the requirements as volunteers for this study. The subjects consumed two experimental diets using a cross-over experimental design. One-half of the subjects were randomly assigned to a low-fiber treatment group and one-half were assigned to a high-fiber treatment group. Food records were utilized to determine fiber intake throughout the study. Nutrient intake during the experimental periods demonstrated significant differences indicating the affect of the varied dietary regimens. No significant difference was seen in mean estrogen levels between the low- and high-fiber experimental periods, however, a positive significant correlation (p<.05) was observed with the change in estrogen level and insoluble fiber intake. Further study with a larger subject sample would be beneficial in determining recommendations for amounts of insoluble fiber intake for the general population. / Department of Family and Consumer Sciences