Carol Morse

Sexuality and the menopause

Sexual problems are often reported to clinicians by women in the midlife years. Yet few of the epidemiological studies of women in midlife have investigated the relationship of the menopause to sexual functioning. This paper reports the results of a cross-sectional telephone survey of 2001 randomly selected Australian-born women aged between 45 and 55 years. The major outcome variables were questions relating to changes in sexual interest over the prior 12 months, reasons for any changes, occurrence of sexual intercourse, and of unusual pain on intercourse. Logistic regression was used to identify explanatory variables for change in sexual interest. The majority of women (62%) reported no change in sexual interest, although 31% reported a decrease. Decline in sexual interest was significantly and adversely associated with natural menopause (p < 0.01) rather than age, decreased well-being (p < 0.001), decreasing employment (p < 0.01) and symptomatology (vasomotor p < 0.05, cardiopulmonary p < 0.001 and skeletal p < 0.01). Eleven to twelve years of education was associated with a lowered risk of decreased sexual functioning (p < 0.01). Heterogeneous results were reported by users of hormone replacement therapies. Longitudinal studies of large and representative samples are needed to determine the etiology of adverse sexual changes with the menopause and the role of hormone replacement therapies.

Psychological well-being, mid-life and the menopause

Few studies of womens health in the menopausal years have formally assessed well being. The present study aimed to determine whether well-being during mid-life related to menopausal status, social circumstance, health status, interpersonal stress, attitudes and lifestyle behaviours. A random sample of 2000 Melbourne women aged 45-55 years were sought by random digital telephone dialling. A response rate of 70.6% was achieved. Interviews conducted on the telephone included a well-being scale--the Affectometer 2. The final data set, comprising 1503 individuals, was subjected to analyses of variance. Menopausal status did not significantly affect well-being. Well-being was found to be significantly related to current health status variables of general psychosomatic symptoms, general respiratory symptoms, history of premenstrual complaints, overall health assessment and interpersonal stress. Attitudes to ageing and to menopause were also significantly related to well-being scores. Lifestyle behaviors of smoking, exercise and marital status were also significantly related to well-being. Thus well-being of urban Australian-born, mid-aged women was related to current health status, psychosocial and lifestyle variables rather than to endocrine changes of the menopause.

Menstrual migraine: a double-blind trial of percutaneous estradiol

The present study investigated whether administration of percutaneous estradiol for the 7 days encompassing menstruation (the paramenstruum) would be effective in alleviating menstrual migraine. The study was a double-blind cross-over placebo comparison of percutaneous estradiol in gel form. Twenty-two women who suffered from regular recurring menstrual migraine were studied during 2 assessment menstrual cycles, 4 treatment cycles (2 of estradiol gel, 2 of placebo gel), and 1 follow-up (no treatment) cycle. Women completed daily records of the occurrence and severity of migraine and medication used. Eighteen women completed the study. There was a significant reduction in the frequency of migraine in the paramenstruum and in the amount of medication taken during use of percutaneous estradiol. Women expressed a significant preference for continuation of therapy with percutaneous estradiol.

The treatment-seeking woman at menopause

Recent studies suggest that health care utilisation by women during menopause transition in general is highly idiosyncratic, despite the widespread advocation of prophylactic hormone therapy and increased health vigilance. The Melbourne Womens Midlife Health Study, a community-based cross-sectional study of 2001 urban Australian-born women aged 45-55 years, evaluated womens physical and emotional experiences, past and present health status, attitudes and beliefs about menopause, health behaviours and current menopausal status in a 30-min telephone interview. This paper reports on those factors related to help-seeking and health care utilisation. Findings show that treatment utilisers, in contrast to non-utilisers, reported a wider range of general symptoms, but reports on vasomotor symptoms did not contribute to the regression analysis. Treatment utilisers were further identified as problem-related or prevention-related utilisers. In three-way analyses, the past and present social and physical health of the problem-related treatment user was reportedly worse than either the prevention-related utiliser or non-utiliser. These findings suggest that medical and societal views about the health of middle-aged women during menopausal transition are likely to be based on the experiences of a particular segment of the population only. It is proposed that biased views of menopause as a time of considerable distress and ill-health are being perpetuated and over-generalised. This perspective appears to have little relevance for the majority of middle-aged women.

A comparison of hormone therapy, coping skills training, and relaxation for the relief of premenstrual syndrome

Approximately 10% of women are severely affected by premenstrual syndrome (PMS) during their reproductive years. Several biological theories of causation have been proposed and each has provoked treatment attempts through medication to little sustained effect. As many of the reported complaints are psychological, a new treatment approach was considered using cognitive-behavioral therapy. A preliminary study which combined cognitive-behavioral therapy with drug treatment produced considerable symptom reduction. The present study examined the efficacy of cognitive-behavioral therapy alone in direct comparison with hormone treatment. Relaxation instructions were provided to a control group. Initial rapid responses to drug treatment and relaxation diminishes after 2 months, together with marked attrition in the control group. Significant positive benefits from cognitive-behavioral therapy were achieved after the first treatment month that continued throughout and were maintained at follow-up 3 months later. Implications for future management are discussed.

The relationship between the menstrual cycle and female sexual interest in women with PMS complaints and volunteers

This study assesses the influence of menstrual cycle phases and hormones on female sexual interest in both a nonclinical sample of volunteers (n = 18) and women who complained of premenstrual tension (n = 150). Women were assessed prospectively for two menstrual cycles with daily symptom charts. In addition mental status was assessed clinically and the Moos Menstrual Distress Questionnaire completed in the follicular and premenstrual phases. On the basis of these assessments women were assigned to subject groups. During the second cycle, daily 24-h urinary estrogens and urinary pregnanediol were determined. Sexual interest and feelings of well-being were recorded on a daily symptom rating chart. Sexual interest was found to be significantly higher in the follicular and ovulatory phases, than in the luteal, premenstrual, or menstrual phases. Sexual interest and feelings of well-being were correlated (R = 0.29). Sexual interest and feelings of well-being were not correlated with urinary estrogen or pregnanediol levels.

Physical activity and the menopause experience : a cross-sectional study

A randomly selected community cohort of 2000 Australian born women aged 45 to 55 were interviewed on the telephone and information obtained on their health and well-being. These women were divided into pre-, peri-, natural and surgical menopausal groups on their menstrual history. A physical activity questionnaire was sent to 1181 women in the first three of these groups. These questionnaires were completed and returned by 61.6% of the women. The response rate in all groups was significantly associated with the years of education, employment status, body mass index (BMI) and self-rated health of the participants. The aim of the study was to test the hypothesis that physical activity is a major contributor to health and well-being by establishing the relationships between physical activity and certain health outcomes, such as menopausal symptoms, psychological well-being, self-rated health and BMI in this cohort of mid-life women. The inter-relationship between physical activity and other variables, including menopausal status, interpersonal stress, health related and preventive health behaviours was examined. Levels of physical activity were significantly associated with better self-rated health, lower BMI measurements, moderate alcohol intake and self-breast examination. There was no significant association between levels of physical activity, psychological well-being and womens experience of symptoms during the natural menopause transition.

Comparative bioavailability of orally and vaginally administered progesterone.

OBJECTIVE To study the pharmacokinetics of progesterone (P) in healthy premenopausal female volunteers to compare the bioavailability of orally or vaginally administered hormone. DESIGN Subjects were randomly allocated to receive either oral P or a vaginal pessary then crossed over to the alternate preparation 1 month later. SETTING The study was conducted in outpatient setting. SUBJECTS All subjects were healthy, normal female volunteers who underwent a physical and gynecological examination before the study. None were using oral contraceptives. Ten subjects (mean age 32.6 +/- 7.3 years) entered the study and all completed it. INTERVENTIONS Progesterone was administered as 200 mg of micronized hormone or as a pessary containing 400 mg. MAIN OUTCOME MEASURE Plasma levels of P were measured by radioimmunoassay to test the apriori hypothesis of similar bioavailability. RESULTS Peak plasma P concentrations attained within 4 hours after oral administration ranged from 8.5 to 70.6 ng/mL, whereas after vaginal administration the peak levels were attained within 8 hours and ranged from 4.4 to 181.1 ng/mL. Considerable interindividual variation was noted. Area under the plasma concentration-time curve for the two formulations was not significantly different (F = 1.09; P greater than 0.1; ANOVA). CONCLUSIONS The two formulations had similar bioavailability.

Infertile Couples Entering an In Vitro Fertilisation Programme: A Preliminary Survey

This paper presents the findings of a pilot survey of 30 infertile couples who presented for in vitro fertilisation treatment at the Monash—Epworth—Queen Victoria Medical Centre. Wives of the couples underwent an extensive pre-treatment interview for demographic information and psychiatric evaluation. In addition, psychometric testing was carried out to provide psychological profiles. Husbands were interviewed separately and completed self-report questionnaires on marital adjustment. Two sub-groups were identified where the diagnosis of infertility was regarded as of organic or ‘idiopathic’ aetiology. Differences between the two sub-groups were found on neuroticism, anxiety, locus of control and dyadic adjustment. At 2 months after treatment great difficulty was experienced in obtaining follow-up responses. Reasons for this are suggested and recommendations for further investigations and supportive therapy are presented.

A review of psychological and social aspects of in vitro fertilisation

Involuntary infertility is regarded as a cause of much distress and marital un-happiness. Couples arrive at the IVF Clinic after many years of investigations and operations and often a long waiting list. The IVF procedure itself is highly stressful and involves medicalisation of the most intimate aspects of the couples relationship. Inability to achieve pregnancy after so much emotional, physical and financial expense may lead to feelings of failure in one or both members of the couple. Furthermore, since IVF is regarded as the last chance for treatment, when pregnancy does not occur the couple are often forced for the first time to confront their sterility as a pair. This may trigger a crisis, which if successfully resolved can lead to adaptation. Thus the clinician involved with IVF needs to be aware of psychological and social aspects of the aetiology, maintenance, sequelae and adaptation to infertility. Psychiatrists, psychologists and social workers have to be integral members of the IVF team. By ut...