Among overweight and obese women with bothersome hot flushes during menopause, an intensive weight loss intervention program may lead to improvements in flushing, according to a report in the July 12 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

“Hot flushes are among the most common concerns of women during menopause and persist for five or more years past menopause in as many as one-third of women,” the authors write as background to the article. “In multiple observational studies, women with a higher body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) have reported more frequent or severe hot flushes compared with women with a lower BMI.”

Alison J. Huang, M.D., from the University of California, San Francisco, and colleagues in a six-month randomized controlled trial, used self-administered questionnaires to assess bothersome hot flushes. The authors studied 338 women (average age 53) who were overweight or obese and had urinary incontinence. Of the participants, 226 were randomized to the intensive weight loss intervention and 112 were randomized to the control group. Approximately half of the women in each group reported being at least slightly bothered by flushing at the beginning of the study. Compared to the control individuals, women randomized to the intervention group reported slightly greater physical activity at baseline but the two study groups did not differ significantly with regard to other characteristics, including flushing.

Women in the intensive intervention group were assigned to a lifestyle and behavior change program designed to produce an average loss of 7 to 9 percent of initial body weight by six months. This included weekly one-hour group sessions with experts in nutrition, exercise and behavior change during which participants were encouraged to increase physical activity to at least 200 minutes per week using brisk walking or activities of a similar intensity. Women were also instructed to follow a reduced-calorie diet (1,200-1,500 calories) and were offered sample meal plans providing appropriate food selections as well as meal-replacement products.

According to the authors, in analyses of all women reporting bothersome hot flushes at the initial stages, decreases in weight, BMI and abdominal circumference were each associated with improvement in self-reported hot flushes during six months. However, there were no significant associations between changes in physical activity, calorie intake, blood pressure or overall self-reported physical and mental functioning and change in bothersome flushing.

Additionally, “among women who were at least slightly bothered by flushing at baseline, the intensive lifestyle intervention was associated with significantly greater decreases in weight, body mass index, abdominal circumference and systolic and diastolic blood pressure relative to the control group,” the authors write. “No statistically significant effect of the intervention on self-reported physical activity, total calorie intake or overall physical or mental functioning was observed.”

“Our findings indicate that women who are overweight or obese and experience bothersome hot flushes may also experience improvement in these symptoms after pursuing behavioral weight loss strategies; however, improvements in weight or body composition may not be the only mediators of this effect,” the authors conclude.

Here are some facts regarding your diet that can help you control the symptoms of menopause including a healthy recipe for you to try.

• Medical research has shown that hot flushes are worse if you have extra tummy fat.

• High calorie snacking contributes on average 5lb (2kg) weight gain and 1in waist gain. Instead, choose a piece of fruit or add soup, salad or more vegetables.

• Soya beans, beansprouts, chickpeas, runner beans and red kidney beans provide natural plant oestrogens, but research has shown that these foods have no effect in controlling hot flushes in two thirds of women. Caffeine and spicy foods can be triggers, so avoid hot curries and use decaffeinated tea, coffee and soft drinks.

• Risk of heart disease increases after the menopause. Magnesium and potassium in vegetables helps lower blood pressure, while fibre in green, leafy vegetables, peas, beans, lentils and some fruits helps lower blood cholesterol.

• Low-fat dairy and calcium fortified soya foods boost bone health and protect against bowel cancer.

• Without Vitamin D the body won’t absorb calcium. A daily Vitamin D supplement (10-20mcg) is especially necessary if you avoid the sun. One portion of oily fish each week boosts both Vitamin D, and omega-3 fat intake helps ease muscle and bone aches and pains.

Here is a quick, tasty and beneficial recipe for you to try at home…

Mild Cauliflower Curry

Cauliflower is rich in protective glucosinolates.

Soya beans that are rich in plant oestrogens are simple to cook and an easy substitute for green peas in this recipe.

Herbs and spices are rich in antioxidants, and using spices without chilli prevents the heat that may trigger a hot flush.

Olive oil is a monounsaturated rich fat, good for heart health, as is garlic, and a healthy part of the Mediterranean diet.

Yogurt contributes protein and calcium, and also helps reduce perception of “hotness”.

The Curry Powder

2 tsp each of ground cumin and coriander

1 tsp each of ground ginger and turmeric

12 tsp of ground cardamon

12 tsp of ground red pepper (not paprika)

12 tsp of cinnamon powder

Pinch of mustard seeds

Combine all ingredients. Store in an airtight container in a dark, cool place for up to two months.

The Curry

1 cauliflower, cut into florets

8oz frozen soya beans

1 red onion, finely diced

1-2 cloves of garlic, crushed

Half a bunch of coriander, chopped

1-2 tbsp olive oil

1-2 tsp home made curry powder

2 tbsp of plain yogurt

1. Boil cauliflower and soya beans for 4-5 minutes until cauliflower starts to soften.

2. Heat oil in pan, then gently fry onions, garlic and spices for 2-3 minutes until vegetables soften and brown.

3. Add cauliflower and beans and cook for a further 3-4 minutes, stirring regularly.

4. Add chopped coriander just before cooking finishes.

5. Remove from heat and stir in the yogurt to serve.

Enjoy!

Research presented at the Annual Meeting of the Society for the Study of Ingestive Behavior, finds that a diet rich in soy prevents weight gain in post-menopausal female rats.

Previous research suggests that reduced levels of the hormone estrogen during menopause are responsible for the increased body weight and abdominal fat often experienced by postmenopausal women. However, while estrogen replacement therapies can reduce weight gain, they also have unwelcome side effects, prompting a search for alternative methods of treatment.

Soy naturally contains estrogen-like compounds called phytoestrogens, and so dietary soy may provide an alternative to typical estrogen replacement therapies.

Michelle Murphy from the Monell Chemical Senses Center found decreased body weight and increased energy expenditure in post-menopausal rats after adding soy phytoestrogens to their regular diet. She comments, “These results have implications for the development of alternative natural treatments for obesity in post-menopausal women.”

The results of this study highlight the need for further research into the actions of phytoestrogens on food intake in humans to determine the more long-term effects of consuming a soy-rich diet.

“In this world of an ever-increasing obesity epidemic, finding natural dietary solutions and treatments to combat obesity are of the utmost importance both to worldwide health and economy,” says Murphy.

The lead author was Michelle Murphy of the Monell Chemical Senses Center, Philadelphia, PA, USA. Co-authors were MR Rosazza, DR Reed and MG Tordoff also of the Monell Chemical Senses Center, Philadelphia, PA, USA.

It is dubbed the midlife crisis, middle age spread era, the climacteric, the change of life or simply “the change” and has even inspired a play, Menopause the Musical.

The variety of nicknames for menopause reflects the diversity of ways in which women are affected during this major turning point in their life.

Most women have a relatively easy time making their way through menopause, some completely breeze through without a whimper but there are the unfortunate ones who are hit hard by unrelenting symptoms.

Internationally renowned gynaecologist Dr Elizabeth Farrell, who specialises in menopause and is a founding Board member of the Jean Hailes Foundation for Women’s Health in Victoria, said that the majority of women would have mild to moderate symptoms and could probably manage without any added therapy.

About 20 per cent of women would experience no symptoms.

“Their periods will stop and they will feel fit and healthy and nothing will be different,” she said.

Another 20 per cent would have severe symptoms which impacted on their quality of life and were the women who really needed to have treatment.

For women in their perimenopausal and early-postmenopausal years, the use of hormone replacement therapy was considered safe.

“But it is contrary to people’s memories,” Dr Farrell said.

“They still have the study published in 2002 in the forefront of their brains.”

That study, the Women’s Health Initiative, reported a slightly increased risk of stroke, heart disease and thrombosis in women on long-term combined oestrogen and progesterone HRT.

Dr Farrell said that for women going through menopausal symptoms, the use of HRT was acceptable if they had no heart disease risks and were fit and healthy.

Although the WHI study showed that in those women taking oestrogen and progesterone, there was a small increase in the risk of breast cancer after five years of use, Dr Farrell said most of those women had been on HRT before the study. This was because the average age of participants was 63 years.

Women on oestrogen alone had no increased risk of breast cancer after seven years. In community studies, including the Nurses Health Study, there was no increased risk in women on oestrogen alone until after 15-20 years, Dr Farrell said.

Dr Farrell, who is president of the Australasian Menopause Society and also the Asia Pacific Menopause Federation, said it was worth having a medical check to rule out other possible causes – such as high blood pressure and hyper-thyroidism – for hot flashes and sweats.

Although venlafaxine (an antidepressant) could be used to alleviate hot flashes and sweats, it also caused them in about 20-30 per cent of women.

Evidence suggested that women who were suffering from a dry vagina could first try lubricants but if these were not sufficient, they could use one of the vaginal oestrogen products fairly safely, Dr Farrell said.

These included oestriol vaginal creams or pessaries which should be used only about twice a week in the longer term.

Women who wanted to navigate menopause naturally, without any medication, could take certain steps, Dr Farrell said.

Anxiety and stress can be triggers for flushes and sweats. “Some of the things that are recommended are meditation and yoga,” she said.

“Acupuncture hasn’t been shown to be effective but hypnosis has been shown to be effective in some women and things like paced respiration, doing the deep breathing like you do in labour, and biofeedback programs can be helpful.”

Another hazard was a teenage daughter dealing with puberty at the same time her mother was going through menopause. “Sometimes a little bit of family counselling can help,” Dr Farrell said.

Gynaecologist Dr Margaret Smith, who established the first menopause clinic in WA and is a foundation member of the Australasian Menopause Society, said that hormone replacement therapy was now called hormone therapy because the aim was not to attain premenopausal levels of oestrogen but to give small amounts for a short time to ease the symptoms of menopause, such as hot flashes, without causing breast soreness.

But Dr Smith said while some effects of oestrogen deficiency could be relieved, others could last for years. These included loss of bone density, which could lead to osteoporosis, and lack of oestrogens in the vagina which can lead to painful intercourse and urinary tract infection.

Hormone therapy could be given locally into the vagina and did not raise the risk of breast cancer or cardiovascular disease, she said.

And while women who smoked or had high cholesterol, diabetes or hypertension had a slightly increased risk of heart attack and stroke, transdermal hormone therapy might be useful once the risk factors were treated and reduced.

Have you noticed your father, brother, or partner acting strangely lately? Does he forget things, seem lethargic, or wake up sweating?

If so, he may be suffering from male menopause. While this likely sounds unbelievable to most women, more and more people are suggesting that male menopause really does exist.

Like female menopause, menopause in men seems to involve a drop in hormone levels around middle age. Often referred to with contempt as the “mid-life crisis,” men may really be suffering from a documented illness. So grab the man in your life and make him aware of what he may be facing when he reaches middle age.

What Is Male Menopause?

Male menopause, also called andropause, refers to a gradual decline in a man’s testosterone levels. Not all men will go through andropause and it is unknown why those that will, do. Testosterone is the male sex hormone that is responsible for creating and releasing sperm, initiating sex drive and providing muscular strength.

Hormone levels tend to peak around the ages of 15 to 18 in most males. Sometime during his mid to late 20s, a man’s hormone levels will begin to drop slowly. Usually, these hormone levels will remain at a healthy level, but some men will see their testosterone levels drop significantly by the time they are 40. By age 50, half of all men will experience a significant reduction in testosterone levels, causing a variety of uncomfortable ailments.

Causes Of Male Menopause

Male menopause can occur naturally in some men. More often than not, though, andropause is triggered by illness, depression, dementia, and obesity. Certain diseases that attack the heart and lungs also seem to affect the production of testosterone. Men who have had autoimmune diseases or cancer seem to be at an increased risk for low testosterone levels.

Andropause vs. Menopause

Menopause in men is not entirely similar to female menopause. Female menopause involves the complete decline of sex hormones. During menopause, your estrogen levels will decrease and then disappear, causing acute symptoms and the complete loss of fertility. Men will never lose their fertility completely during andropause. Testosterone will continue to be produced, as will sperm, permitting a man to have children well into his 80’s. For this reason, there is much debate over whether this testosterone drop should be referred to as the male “menopause.”

What Are the Symptoms Of Male Menopause?

Male menopause symptoms are very similar to those experienced by women during menopause, only much less intense. Common menopause symptoms include hot flashes, night sweats, fatigue, muscle and joint aches. Men also suffer from emotional symptoms like mood swings, irritability, depression, and listlessness.

Sex and menopause in men is also an issue of concern. The most common symptom experienced by men with low testosterone is a diminished sex drive. 80% of men with documented andropause complain of low libido and an inability to maintain a strong erection. Like women going through menopause, men can begin to feel like they no longer enjoy sex. If this is the case, a visit to the doctor can really help men to feel more in control of their physical and sexual wellbeing.

Treatment Options

Men often do not seek treatment for andropause. A lot of men feel uncomfortable speaking about their symptoms and, in the past, doctors haven’t taken men’s menopause seriously. Signs of menopause in men can also be difficult to diagnose. Thanks to new studies, though, doctors have become more aware of this problem and are beginning to realize the importance of treatment.

The primary treatment for andropause is Testosterone Replacement Therapy (TRT). Like estrogen replacement in women, testosterone replacement aims to bring hormonal levels back up to a healthy level. Once testosterone levels are increased, most men begin to experience fewer symptoms. Unfortunately, testosterone replacement doesn’t always work well to combat erectile dysfunction. Because this is such a severe symptom for most men, other treatments for erectile dysfunction should be investigated.

It is important for men to understand what is happening to their bodies as they age. Andropause does not affect all men and its symptoms have varying degrees of severity. However, if you know someone who is affected by andropause, encourage him to talk about his symptoms with a doctor.

White women are becoming more optimistic about menopause, with many seeing it as an opportunity to rethink their lives and redefine themselves, a new University of Texas at Austin national study shows.

This is just one of the positive changes in the way women across different ethnic groups are experiencing the change of life, the School of Nursing research found. The study also found women are getting support from their family and friends and some even mentioned relief and benefits when going through menopause.

Past studies have shown that white women, in particular, were concerned about menopause as a “harbinger of physical aging taking them away from society’s youthful ideal,” said Dr. Eun-Ok Im, the La Quinta Motor Inns Inc. Centennial Professor in nursing. “Most of the white participants in our study say they try to be humorous and laugh — to boost their inner strength and motivate themselves to go through the hardships during the menopausal transition.”

Im’s four-year study, funded by a $1.2 million National Institutes of Health grant, looked at ethnic differences in menopausal symptoms reported by Whites, Hispanics, African American and Asian women. The study was done via a Internet survey among 512 women and included equal numbers of mid-age (40 to 60 years old) participants from each ethnic group.

“A possible reason for the positive changes in the way white women look at menopause might be that the recent women’s health movement has educated women to accept menopause as a normal developmental process, allowing them to refocus on themselves,” said Im.

Results of her research were published recently in the Western Journal of Nursing Research.

African American, Hispanic and Asian women already reported being more optimistic and positive about their menopause and menopause symptoms than white women.

In Im’s study, black participants cited they were raised to be strong and accepting of a natural aging process. They perceived that — compared to other difficulties in their lives — menopause was just another part of life to endure.

Getting support from family and friends during the menopausal transition is especially new to the literature on the menopausal symptom experience of Hispanic women, said Im.

“An interesting new finding, however, is that minority women prefer support from those who are of the same ethnicity,” she said.

Minority participants also expressed their need for more information and educational programs, which Im sees as an additional encouraging sign. In the past, ethnic minority groups rarely talked about menopause with others and hardly ever said they wanted more information about the change of life, she said.

Im’s study supported research that found significant ethnic differences in the total number and severity of menopausal symptoms.

Some of her findings on differences include:

• Black women had a slightly higher percentage of hot flashes at 67.8 percent with white women at 64.4 percent and Hispanic women at 52.5 percent. Only 26.1 percent of Asian Americans said they experienced hot flashes.

• More white women (60 percent) took some kind of treatments for menopause symptoms. These included antidepressants and alternative medicines like herbal remedies, chiropractic, meditation, acupuncture and dietary supplements.

• African American women — 54.6 percent — experienced weight gain compared to 33.3 percent for Asians, 45 percent for white and 50.8 percent for Hispanics.

• Whites reported higher percentages of racing heart, headache, fatigue, sleeping difficulty, breast pain, increased crying, depressed feelings, upset, grouchy feelings, difficulty in concentration, forgetfulness, breathing difficulty, ankle swelling, cold hand and feet, stomach pain, muscle and join stiffness.

• Whites, Hispanics and African Americans reported about the same numbers of bloating while Asians only reported 23.4 percent.

• Whites, Hispanics and African Americans reported about the same percentage of mood swings — above 50 percent — while Asians reported only 32.4 percent mood swing symptoms.

• Asians reported muscle and joint stiffness and neck and skull aches as frequent symptoms of menopause. Findings strongly suggest there are sub-ethnic — Chinese, Korean, Indian Filipino — differences in the menopausal symptom experience of Asians, and more studies are needed in this area.

The research also found few women (in all ethnic groups) reporting positive experiences with their physicians when they consulted them about menopausal symptoms.

Im believes her findings will work to eliminate ethnic biases and inequity in menopausal symptom management and promote culturally competent care for menopausal women. Earlier research about menopause has mostly been with white women, she noted.

“The increasing ethnic diversity of our population requires health professionals to practice with greater cultural competence,” Im said.

YES

The male menopause is no myth, says Dr Malcolm Carruthers, who has treated more than 2,000 patients in the past two decades.

“Time and time again I listen to stories of testosterone-deficient men with classic symptoms such as loss of libido as well as irritability, depression, memory loss and a drop in drive, energy and virility. Night sweats and brain fog are common as are occasionally hot flushes.”

The average age, he sees, is 55. “Yet patients have been visiting their GPs for about five years so the age of onset is usually nearer 50 and some men are much younger,” says Dr Carruthers, medical director for the Centre for Men’s Health in Harley Street, London and president of the Society for the Study of Androgen Deficiency.

Unlike the female menopause, when levels of the hormone oestrogen take a nosedive for natural reasons, a man’s drop in the hormone testosterone can be caused or accentuated by stress or environmental influences.

“Some antidepressants can make symptoms worse, as can the use of anticonvulsant drugs for epilepsy. Other causes include mumps and testicular conditions and infections,” adds Dr Carruthers.

Many men who claim to be going through the menopause are found to have normal levels of testosterone. “There is a paradox between the levels of testosterone and symptoms due to what is called testosterone resistance,” he states.

“The easiest thing to compare this to is the relationship between insulin resistance and adult onset diabetes when you can have a high level of the hormone but the body is resistant to its action.”

If the male menopause didn’t exist, says Dr Carruthers, how could so many treatments have been successful? He has used testosterone replacement therapy (TRT) pellets over 1,000 times, just as HRT is implanted into female abdomens.

“More recently pills have become available and there is a gel that is rubbed into the skin once a day. There are also long-acting injections. All are available on the NHS and more and more GPs are prescribing them,” he adds.

Even scientists are coming round to the idea. The latest study from the University of Manchester identified three symptoms; a lack of a morning state of arousal, decreased sex drive and erectile dysfunction. If these are present and tests repeatedly show low levels of testosterone a man is going through a kind of menopause, concluded the researchers.

“We can conclude that yes the male menopause does exist,” says lead author Professor Fred Wu, although he prefers the term “late-onset hypogonadism”.

Unlike Dr Carruthers, who claims that 20 per cent of all men over 50 are suffering from testosterone deficiency, Professor Wu found only two per cent of men were affected.

NO

Medically speaking you can’t have a male menopause. By definition it means the end of the monthly cycle and men don’t have a monthly fertility cycle.

If you look at the symptoms of male menopause, including fatigue, memory loss, lack of concentration, a drop in energy and sex drive, it’s hard to deny how closely associated they are with simply getting older.

A peek at GPs’ records would also reveal a tendency for men to seek a medical justification for nearly every change to their bodies.

Almost every medical study and review says the male menopause is a myth, pointing to the fact many men who report symptoms have normal hormone levels.

The journal Drug And Therapeutics Bulletin adds that, unlike the menopause in women when levels of the female hormone fall dramatically, testosterone levels fall by only one to two per cent a year from the age of 40. In fact around 80 to 90 per cent of 60-year-olds and half of those in their 80’s still have normal levels.

Even the recent study by the University of Manchester, which claimed two per cent of men do suffer from the menopause, found the vast majority who think they have it are more likely to be ailing from poor health and obesity.

Just because a man responds to TRT it doesn’t prove anything. “The effect is likely to be a placebo which is quite expected. This has been shown in scientific trials,” adds Professor Wu.

This matters, he says, because medication can be dangerous. “The treatment may worsen prostate problems, sleep apnoea and raise red blood cell counts too high which may increase the risk of a stroke.”

Professor Ashley Grossman, consultant endocrinologist at St Bartholomew’s Hospital in London, believes the concept of the male menopause is financially driven.

“Among the most likely explanations for the symptoms suffered by men are unemployment, retirement, partner-fatigue and disappointed expectations. Yet the pharmaceutical companies and some doctors have spotted an opportunity here,” he says.

While treatments are available on the NHS he adds that most men who end up being treated privately self-refer. Professor Pierre Bouloux, director of the department of endocrinology at the Royal Free Hospital in London, agrees with him. “Within the private sector the scope for misuse of testosterone in pharmacological doses is recognised.”

Dr Ian Banks, president of the Men’s Health Forum, has similar concerns, saying: “It’s obviously very attractive to the pharmaceutical industry to have people on treatment for the rest of their lives. It’s also attractive for men to have a better quality of life. Is it worth it if the pay-off may be endangering life expectancy?”

Study challenges old notion that menopause starts in the ovaries.

Some of the most unpleasant symptoms of menopause, such as hot flashes and night sweats, have long been believed to originate in the ovaries.

But new research challenges that assumption, and instead suggests that menopausal symptoms, at least in part, may begin in the brain.

That’s because the hypothalamus and the pituitary gland stop reacting normally to estrogen in some women, suggesting they may have developed a reduced sensitivity to estrogen, researchers at the New Jersey Medical School report in the Dec. 22/29 issue of the Journal of the American Medical Association.

“This is an important new concept: Menopause doesn’t just originate in the ovary, but also in the brain,” said Laura Goldsmith, a professor of obstetrics and gynecology and women’s health at the New Jersey Medical School of the University of Medicine and Dentistry of New Jersey.

These findings may lead the way to further research that will ultimately help doctors predict the type of menopausal transition a woman might have, and help to design non-estrogen medications that could help reduce symptoms that women experience as they enter this phase of life, said Dr. Gerson Weiss, chairman of obstetrics and gynecology and women’s health at the New Jersey Medical School.

Menopause refers to the time when menstruation stops. A woman is not considered menopausal until she has not had a period for 12 consecutive months, according to the North American Menopausal Society. The time before menopause, which is often rife with symptoms due to hormonal fluctuations, is called perimenopause. During perimenopause, common symptoms include hot flashes, trouble sleeping, vaginal dryness, mood swings and irregular periods.

This study stemmed from research done for the Study of Women’s Health Across the Nation (SWAN), which was funded by the National Institutes of Health, that examined women’s’ health as they approached menopause.

The SWAN study included more than 3,300 women between the ages of 42 and 52 at the start of the study. A subset group of 840 women provided daily urine samples, which were tested for hormone levels. The samples were collected daily for one full menstrual cycle or 50 days, whichever came first.

From that group, the researchers learned that 160 did not ovulate. After further analyzing the hormone levels from the non-ovulating women, the researchers discovered that these women fell into three distinct groups.

The first group had an increase in their levels of estrogen, and then had an appropriate surge of luteinizing hormone (LH) that should have triggered ovulation, but didn’t. According to Weiss, this lack of response indicated a problem originating in the ovary.

In the second group, estrogen levels peaked, but there was no correlating surge in LH, which Weiss said should be triggered by the hypothalamus and pituitary gland responding to higher estrogen levels.

The third group had similar estrogen levels early in their cycles, but didn’t have an increase in estrogen later as the first and second groups did. LH levels didn’t surge, but were higher for most of the cycle than they were in the other groups.

According to Weiss, this is “clear evidence that the brain is not responding to hormones,” suggesting the second and third groups showed different kinds of decreased sensitivity to estrogen in the brain.

The women in the third group were also the ones most likely to report symptoms, such as hot flashes and night sweats.

Goldsmith said the researchers hope to continue studying these women. She said they’d especially like to learn how the timing of menopause correlates with their findings. For example, the researchers would like to see if the women in the third group were, perhaps, further along in the menopausal process.

“It appears that what’s going on in menopause isn’t only ovarian,” said Dr. Steven Goldstein, a professor of obstetrics and gynecology at New York University School of Medicine. “We thought the pituitary responded to lower levels of estrogen, but there may be a lack of sensitivity to estrogen in the hypothalamus and pituitary.”

What’s important for women to know, said Goldsmith, is that there are “real biochemical changes occurring during menopause.” Researchers are beginning to understand how those changes start to occur, which is the first step in trying to come up with more effective treatments.

While you may experience the misery of hot flashes and mood swings as you enter menopause, one thing you can’t blame on the “change” is memory loss.

In the latest study that exonerates menopause as a cause of impairing the ability to recall, Taiwanese researchers compared the memory of hundreds of women before they had any menopausal symptoms to their memory as they entered menopause.

They found the women who were going through the menopausal process scored as well or nearly as well on five different cognitive function tests. Results of the study are to be presented Oct. 4 at the American Neurological Association annual meeting in Toronto.

“When women go into perimenopause, they don’t need to worry about cognitive decline,” said Dr. Jong-Ling Fuh, an attending physician at Taipei Veterans General Hospital and an associate professor of Yang-Ming University School of Medicine.

The researchers said the myth of memory loss during menopause is a perception some women have because as they went through menopause, they felt their memory wasn’t as sharp as it had been before. Studies suggesting that hormone replacement therapy might protect against dementia strengthened that belief. However, a large study later found that in older women, hormone replacement therapy not only didn’t help protect women from dementia, but could actually increase the risk.

To try to answer the question of whether menopause did have any effect on memory, Fuh and her colleagues studied nearly 700 premenopausal women living on a group of rural islands between Taiwan and China. The Taiwanese government restricted access to these islands until the 1990s, so the authors report that the study’s population was nearly homogeneous, which would help rule out other potentially causative factors of memory loss.

The women were between the ages of 40 and 54. None of them had had a hysterectomy, and none took hormone replacement therapy during the study.

All took five cognitive tests designed to assess their memory and cognitive skills at the start of the study, and then again 18 months later.

During the study period, 23 percent of the women began to have symptoms of menopause.

The researchers then compared the memory of the women who had entered menopause to those who had not, and found very little difference. In four of the five tests, there were no statistically significant differences in the two groups of women.

Only on one test was the difference statistically significant, and that difference, said Fuh, was very slight. This test was designed to assess verbal memory and involved showing the women 70 nonsensical figures. Some of the figures were repeated during the test, while most were not. The women were asked whether they had seen the figure earlier.

“For women, menopause does not mean you’ll develop memory loss,” said Dr. Raina Ernstoff, an attending neurologist at William Beaumont Hospital in Royal Oak, Mich. As you’re going through perimenopause and experiencing symptoms like hot flashes, she said, you may feel lousy and have trouble sleeping, which might temporarily affect your cognitive skills.

“I don’t think declining estrogen levels are what causes memory loss,” said Dr. Steven Goldstein, an obstetrician/gynecologist at New York University Medical Center in New York City. “It’s not like your memory is bopping along, doing fine and then takes this big dive during menopause, like bone density can.”

Both Ernstoff and Goldstein said they weren’t aware of many women who believed that menopause might cause significant memory loss. They also both felt that results from this group of women who were so homogeneous might not apply to different groups of women, such as those living in more industrialized society. And they both said that other factors that weren’t studied could play a role in memory loss, such as hypertension, which can contribute to vascular dementia.

Ernstoff also pointed out that the education backgrounds can play a large role in memory loss. Fuh acknowledged the researchers did attempt to control the data for educational differences.

SOURCES: Jong-Ling Fuh, M.D., attending physician, Taipei Veterans General Hospital, and associate professor, Yang-Ming University School of Medicine, Taipei, Taiwan; Steven Goldstein, M.D., obstetrician/gynecologist, New York University Medical Center, and professor, obstetrics/gynecology, New York University School of Medicine, New York City; Raina Ernstoff, M.D., attending neurologist, William Beaumont Hospital, Royal Oak, Mich., and member, Alzheimer’s Board of Detroit; Oct. 4, 2004, presentation, American Neurological Association, Toronto.

The number of eggs left in a woman’s ovaries are like the grains of sand in an hourglass, ticking away the hours on her biological clock.

Researchers now say they may be able to predict when that clock will wind down.

And while doctors can’t actually count the number of eggs in an ovary, they can measure ovarian volume. British researchers say there’s a direct correlation between the two, and by measuring ovarian volume with transvaginal ultrasound, doctors should be able to predict when menopause will set in and how many fertile years a woman has left.

According to the study authors, this information will revolutionize the care of women looking for assisted reproductive technologies, including those who were treated for childhood cancers as well as women who want to put off starting a family for whatever reason.

Although information still needs to be validated in clinical studies, its benefit is most likely to start with women who are being treated for cancer and women attending fertility clinics, said Tom Kelsey, co-author of the study appearing June 17 in the journal Human Reproduction.

“If women looking for some sort of assisted conception and their physicians know that they’ve got a long time till menopause, then you could plan for a range of treatments,” said Kelsey, who is a senior research fellow at the University of St. Andrews in Scotland. “If you knew menopause was likely in four to five years, you’d plan a different set of IVF [in vitro fertilization] treatments.”

Others reiterate, however, that the findings should be treated with caution.

“Should a young woman who is 30 years old go for a test to figure out whether she’s got three, five or 10 years left on her fertility? Should she make career decisions and life decisions? Are these data good enough to make those determinations?” asked Dr. Alan Copperman, director of reproductive medicine at Mount Sinai Medical Center in New York City. “The answer is obviously no to all of those questions. The predictive value of this test is not good enough to go and tell someone to change their life.”

According to the article, eggs form in a female’s ovary while she is still in the womb, peaking at several million about halfway through gestation and then starting a continuous decline. At birth, there are several hundred thousand and, when menstruation begins, about 300,000. At about age 37, a woman has about 25,000 eggs left, and at menopause only about 1,000.

The time at which menopause sets in is widely believed to be based on the number of eggs reaching a critically low threshold.

The authors of this study measured ovarian volume with transvaginal ultrasound, then looked at the relationship between ovarian volume — ovaries shrink as a woman ages — and number of eggs. They then applied mathematical and computer models to predict menopause.

The study authors are negotiating with a medical school to set up clinical trials. The idea would be to follow women to see if their predictions were indeed correct.

While these authors have come up with a tool to potentially help women plan their lives, a second study in the same issue of Human Reproduction warned that women might not want to leave it too late. Assisted reproductive technology (ART) could not be relied upon to fully compensate for lack of natural fertility after the age of 35, the article stated.

The authors used a computer simulation model to determine that the overall success rate of assisted reproductive technology would be 30 percent for those attempting to get pregnant from age 30, 24 percent for those trying from age 35, and 17 percent from age 40.

SOURCES: Tom Kelsey, Ph.D., senior research fellow, University of St. Andrews, St. Andrews, Scotland; Alan Copperman, M.D., director, reproductive medicine, Mount Sinai Medical Center, New York; June 17, 2004, Human Reproduction