Menopause Live (01 March, 2010) from International Menopause Society

Menopause is a global physiological milestone in any woman’s life. Multitudes of studies have already described every aspect of this unique phenomenon, yet more are published in an attempt to further highlight ethnic, cultural, social and geographic differences in the symptomatology of menopause. Recently, a cross-sectional study of 1000 postmenopausal women from China, Malaysia, Taiwan, Thailand and Hong Kong addressed the perception of postmenopausal symptoms, use and knowledge of hormone replacement therapy (HRT), breast discomfort and knowledge of breast cancer risk and sexual function among Asian women [1]. In this study, participants were interviewed face to face following street interception or door-to-door visits. The eligible women in the study were between the ages of 45 and 60 years and from middle-class socioeconomic communities. The main reason for seeking treatment was found to be sleeplessness in 42% of the women; on average, 54% of the women were aware of HRT, but most of them (38%) were unable to mention any associated benefits. Only 19% received HRT and 37% received herbal or natural treatment. Breast discomfort was reported by 27% of respondents and 70% reported performing self-breast examination. HRT was described by 24% as being a risk factor for breast cancer; 66% of the women and 51% of their partners reported no reduction in sexual function. Among those with sexual dysfunction, only 33% were willing to seek treatment.

Comment
The experience of menopause is very different across the demographic areas and cultures. However, the management of menopause has taken many turns, particularly after publication of the results of the Women’s Health Initiative (WHI) trial in 2002, after which there was significantly reduced physician and patient confidence in acceptance of HRT as an appropriate treatment option for menopause-associated vasomotor symptoms.

For the purpose of framing local guidelines and prescribing tailored therapy, an understanding is necessary of the prevalent core menopausal symptoms, their severity, and knowledge of the beliefs and fears of menopausal women regarding available treatment options. It is commonly believed that Asian women have a lower prevalence of menopausal symptoms than Western women. A survey of some of the epidemiological studies in Asia shows this to be generally true [2]. Contrarily, the European Menopause Survey in 2005 pointed out that almost all European women experience postmenopausal symptoms and are affected by the symptoms [3]. The findings of the Asian menopause survey [1] are also in accordance with the European Menopause Survey but the apparently smaller rate of women seeking treatment was found to be either due to acceptance of the menopause as a natural process of life or to treatment with herbal/natural remedies due to a lack of knowledge of the treatment options available. According to the European survey, the decision to use HRT is highly dependent on concern about breast cancer risk, as 59% of European women consider HRT as a contributor to breast cancer as compared to 29% of Asian women.

Shea reported markedly lower prevalence rates for hot flushes, sleeplessness, depression, headache, irritability and vaginal dryness in a population of Chinese women aged between 40 and 65 years [4]. The Study of Women’s Health across the Nation in a US cohort confirmed this observation, noting that women of Chinese or Japanese origin were far less likely to report significant symptoms than their Caucasian and African American counterparts [5].

The most common and most severe menopausal symptom was muscle and joint pain, according to a Singapore study by Loh and colleagues [6] and a study on Bangkok women by Chaopotong and colleagues [7] (52.6% and 84.5% of women, respectively).

Malik and colleagues, in their study on Pakistani women, reported that 94% of women did not consider menopause to be a medical condition and only 1.96% of respondents were aware of HRT, but the majority of their study population (75.5%) came from a poor socioeconomic class [8]. Similarly, HRT usage among Malaysian women was reported to be very low (8.1%) in very recent study by Alwi and colleagues [9]. On the contrary, a study on the menopausal experiences of professional women by Simon and co-workers from the US indicated that 41% of respondents had used hormone therapy and 57% of them continued use at the time of the survey; among those who discontinued HRT, 39% cited the WHI results as one of the reasons [10].

From the various studies, it is clear that there is a diverse range of experiences of menopausal symptoms among women from different parts of the world. Asia has more than half of the world’s population, with many different cultures, yet the prevalence of menopausal symptoms and the use of HRT are both far less than in European cultures. Among Asian countries also, the perception of menopause varies in the different countries. Knowledge and acceptance of HT are greater in educated and upper socioeconomic classes. Greater efforts are thus needed to increase awareness and knowledge about the menopause process, its effects and role of HRT in short-term and long-term management of menopause in Asian women and their health-care providers.

Seema Sharma
Associate Professor, Department of Obstetrics & Gynecology, Mahatma Gandhi Medical College & Hospital, Jaipur, India

References
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http://www.ncbi.nlm.nih.gov/pubmed/20018469
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http://www.ncbi.nlm.nih.gov/pubmed/15919681
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http://www.ncbi.nlm.nih.gov/pubmed/16864146
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http://www.ncbi.nlm.nih.gov/pubmed/16472950
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http://www.ncbi.nlm.nih.gov/pubmed/15191936
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http://www.ncbi.nlm.nih.gov/pubmed/16257608
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http://www.ncbi.nlm.nih.gov/pubmed/16518972
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http://www.ncbi.nlm.nih.gov/pubmed/18655421
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http://www.ncbi.nlm.nih.gov/pubmed/19958163
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http://www.ncbi.nlm.nih.gov/pubmed/18779760