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Maturitas. 2004 May 28; 48(1):39-49.The aims were to compare menopausal age and the use of oral contraceptives (OC) and hormonal replacement therapy (HRT) between the 32 populations of the WHO MONICA Project, representing 20 different countries. Using a uniform protocol, age at menopause and the use of OC and HRT was recorded in a random sample of 25-64 year-old women attending the final MONICA population cardiovascular risk factor survey between 1989 and 1997. A total of 39,120 women were included. There were wide variations between the populations in the use of OC and HRT. The use of OC varied between 0 and 52% in pre-menopausal women aged 35-44 years, Central and East Europe and North America having the lowest and West Europe and Australasia the highest prevalence rates. Among post-menopausal women between 45 and 64 years, the prevalence of HRT use varied from 0 to 42%. In general, the use of HRT was high in Western and Northern Europe, North America and Australasia and low in Central, Eastern and Southern Europe and China. With the exception of Canada (45 years), the mean age at menopause differed only little (ranging from 48 to 50 years) between the populations. The use of OC and HRT varies markedly between populations, in general following a regional pattern. Whereas, the prevalence rates are mostly similar within a country, there are remarkable differences even between neighbouring countries, reflecting nation-specific medical practice and public attitudes that are not necessarily based on scientific evidence. (author's)
World Health Organization Technical Report Series. 1981; (670):1-120.This report includes the collective views of a World Health Organization (WHO) Scientific Group on Research on the Menopause that met in Geneva during December 1980. It includes information on the following: 1) the endocrinology of the menopause and the postmenopausal period (changes in gonadotropins and estrogens immediately prior to the menopause and changes in gonadotropin and steroid hormone levels after the menopause); 2) the age distribution of the menopause (determining the age at menopause, factors influencing the age at menopause, and the range of ages at menopause and the definition of premature and delayed menopause); 3) sociocultural significance of the menopause in different settings; 4) symptoms associated with the menopause (vasomotor symptoms, psychological symptoms, disturbances of sexuality, and insomnia); 5) disorders resulting from, or possibly accelerated by, the menopause (osteoporosis, atherosclerotic cardiovascular disease, and arthritic disorders); 6) risks, with particular reference to neoplasia, of therapeutic estrogens and progestins given to peri- and postmenopausal women (endometrial cancer, breast cancer, and gallbladder disease); 7) fertility regulating methods for women approaching the menopause (fertility and the need for family planning in women approaching the menopause, problems of family planning in perimenopausal women, and considerations with regard to individual methods of family planning in women approaching the menopause); and 8) estrogen and the health care management of perimenopausal and postmenopausal women. At this time some controversy exists as to whether there is a menopausal syndrome of somatic and psychological symptoms and illness. There are virtually no data on the age distribution of the menopause and no information on its sociocultural significance in the developing countries. The subject of risks and benefits of estrogen therapy in peri- and postmenopausal women is of much importance in view of the large number of prescriptions issued for this medication in developed countries, which indicates their frequrnt use, and the different interpretations and opinions among epidemiologists and clinicians on both past and current studies on this subject. Specific recommendations made by the Scientific Group appear at the end of each section of the report. The following were among the general recommendations made: WHO sponsored research should be undertaken to determine the impact on health service needs of the rapidly increasing numbers of postmenopausal women in developing countries; uniform terminology should be adopted by health care workers with regard to the menopause; uniform endocrine standards should be developed which can be applied to the description of peri- and postmenopausal conditions and diseases; and descriptive epidemiological studies of the age at menopause should be performed in a variety of settings.
Geneva, Switzerland, WHO, 1978. (World Health Organization Technical Report Series No. 619) 54 pStudies on steroid contraception (SC) and risk of neoplasia are reviewed. Methodological issues in neoplasia etiology studies include: 1) possibility of a latent period between exposure to cause and disease development; 2) cumulative effects of prolonged or repeated SC exposure; 3) discontinued drugs or dosage schedules; 4) time of exposure (adolescence or prenatal, e.g.); 5) isolation of specific causes among multiple risks; and 6) variations in neoplasma diagnoses. The 4 epidemiological approaches to SC-associated neoplasia studies have inherent shortcomings, but cohorts yield significant associations. Relative risk (ratio of disease incidence among exposed vs. nonexposed persons) is an index of association only, not evidence of cause and effect. Benign breast neoplasia risk was reduced by current SC use of >2 years, and weak evidence points to a residual protective effect, apparently associated with progestogen dose. Aggregated breast cancer data show no clear adverse or beneficial effect of SC use; however, evidence suggests SCs may increase breast cancer risk in population subgroups (e.g., young women). Only short-term evidence is available; hence, no inference of long-term SC breast cancer effects is possible. No beneficial effect of SCs on uterine fibroids is evident, but sequential SCs, no longer marketed, may have increased risk to endometrial carcinoma. Inconclusive data suggest SCs may decrease ovarian cancer risk. Increased risk of cervical dysplasia and carcinoma in situ is associated with SC use, especially long-term use by women with predisposing factors. Risk of hepatocellular adenoma of the liver increases with prolonged SC exposure, especially high dose. Relevance of existing data from more developed countries to disease risk in less developed ones is discussed, and recommendations made.
CANCER CAUSES AND CONTROL. 1991 Nov; 2(6):389-94.As part of the Who Collaborative Study of Neoplasia and Steroid Contraceptives, physicians gathered data from 2796 cases and 18,900 controls from at least 1 hospital in each country between 1979-1982 and stopped between 1982-1988 to examine the association between breast cancer in women and combined oral contraceptives (COCs), particularly around menopause. The countries included Australia, Democratic Republic of Germany, Israel, Chile, China, Colombia, Kenya, Mexico, the Philippines, and Thailand. The relative risk (RR) was higher in women who had used COCs in the last year, but the increased RR was no greater for women who would be near menopause (45-49 years) than it was for women <40 years old (1.3 vs. 1.4). In fact, the RR was highest in 40-44 year old women (2.1). Further the RRs were greater in women who began using a COC >45 years of age than they were for women who began using it <45 years of age, but the RR did not increase with duration. For example, the RR for women who began to take the COC <45 years for 12-48 months was 0.86 compared to 1.4 for those who began >45 years. The RR for women who began to take the COC at >45 years old remained at 1.4 for the other durations. In addition, the RR in women who ever used COCs was greater in women who underwent an artificially induced menopause than those who underwent a natural menopause (1.7 vs. 1.04). This higher risk in COC users occurred no matter the duration between last use of COCs and induced menopause and the method of artificial menopause. In conclusion, this study did not support the hypothesis that COCs increase the risk of breast cancer in women who use them around the time of menopause.
September 1975. 41 p.Information gathered from knowledgeable sources (e.g., obstetricians, family doctors, pharmacists, nurses, family planning workers, and informal social network representatives) indicated the important position that menstrual bleeding, and the social implication related to it, holds in the life of Egyptian women. Menstrual bleeding is a sign of well-being, youth, fertility, and femininity. The majority of knowledgeable sources agreed that a normal cycle length among Eyptian women ranged from 21-32 days, whereas the normal bleeding interval ranged from 3-5 days. Abnormality, however, is a function of personal experience, i.e., a cycle is abnormal when it deviates from the woman's normal pattern. Egyptian women perceive menstrual blood as bad blood that they must lose every month, the retention is thought to result in bodily poisoning. Egyptian women are aware of specific color, smell, and texture of vaginal bleeding, and any change in quality or quantity is alarming. Illiterate women predict and recall their bleeding episodes by using a lunar calender which indicates national or religious ceremonies. Menarch is reported to be an occasion of joy signifying womanhood, whereas menopause is resented and dreaded, associated with drying or shrinking of the uterus. Menstruation is induced by various folk means, because it is believed that retention of blood causes cramping and that blood flow will alleviate that pain. The cleansing ritual after each cycle has both physical and religious importance.