Journal of Mid-life Health Journal of Mid-life Health
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   Table of Contents - Current issue
Coverpage
July-September 2018
Volume 9 | Issue 3
Page Nos. 111-167

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EDITORIAL  

The metabolic syndrome and menopause p. 111
Ranu Patni, Annil Mahajan
DOI:10.4103/0976-7800.241951  PMID:30294180
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ORIGINAL ARTICLES Top

Analyzing thyroid dysfunction in the climacteric p. 113
Subrat Panda, Ananya Das
DOI:10.4103/jmh.JMH_21_18  PMID:30294181
Introduction: Perimenopause and menopause is an integral part of every woman's life constituting about 30% of the Indian female population. Hypothyroidism is a condition that can mimic menopausal symptoms very often. Therefore, routine screening of thyroid function in the climacteric and menopausal period to determine subclinical thyroid disease can be recommended. Materials and Methods: With this background, we conducted a prospective study in our institute, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, to evaluate the abnormal thyroid function tests in perimenopausal and postmenopausal women aged 40–80 years. Results and Observations: Subclinical hypothyroidism status increases from the age group of 40–70 years and hypothyroidism increases in slow frequency from 40 to 70 years after that there is plateauing. Interestingly, the frequency of hyperthyroidism remains same in all the age groups. Conclusion: Looking at the increased risks of thyroid disorders with age, screening of thyroid disorders can be started at the age of 40 years with estimation of serum levels of TSH. This gives us the opportunity to treat both subclinical and clinical hypothyroidism and hyperthyroidism women.
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Prevalence of osteoporosis in peri- and post-menopausal women in slum area of Mumbai, India p. 117
Omna Shaki, Sanjay Kumar Rai, Manoj Kashid, Barun K Chakrabarty
DOI:10.4103/jmh.JMH_84_17  PMID:30294182
Objective: We conducted our study involving 1400 peri- and post-menopausal women who live in a slum area of Mumbai to determine the prevalence of osteoporosis, awareness about osteoporosis, education (knowledge regarding osteoporosis), treatment and prevention of osteoporosis. Material and Methods: A detailed medical, surgical, obstetrical & gynecological, menstrual, and drug history was recorded in a predesigned questionnaire designated for the study. Height and weight and body mass index were measured, physical activity level especially load bearing exercise was recorded, and amount of sunlight exposure per day was also recorded. Food intake was estimated using the 24 h dietary recall method and calcium and Vitamin D consumption pattern was assessed. We used calcaneum quantitative ultrasound to assess bone mineral density (BMD) for such large population. Results: The prevalence of low BMD was found in more than half of this population (81%). The mean age in Group I was found to be 36.50 ± 2.74 years as compared to 37.5 ± 3.44 years in Group II with low BMD, which was statistically significant (P = 0.02). The average age at menopause was 51.62 ± 5.72 years in Group I and 49.43 ± 4.52 years in Group II. The number of children and type of menopause has been found to be associated with low BMD in our study. Lack of physical exercise and low-calcium diet were significantly associated with low BMD. Conclusion: Our study showed that there is a high prevalence of Vitamin D deficiency and Osteoporosis even in adult women who live in a slum area. The findings from the study also suggest the need for large community-based studies so that high-risk population can be picked up early and early interventions and other lifestyle changes can be instituted so that no delay in implementing state and national or international health policy to tackle this increasing global health problem. The public awareness is important, and strategies to identify and manage low BMD in the primary care setting needs to be established and implemented.
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Evaluation of cardiovascular risk in climacteric women: A cross-sectional study p. 123
Martha Pantel dos Santos Mota, Isabel Cristina Gomes Moura, Ricardo Mello Marinho, Eduardo Back Sternick, Alessandra Maciel Almeida
DOI:10.4103/jmh.JMH_67_18  PMID:30294183
Purpose: To identify cardiovascular risk factors in women between 40 and 65 years old in two private clinic of gynecology in Minas Gerais. Methods: Cross-sectional study from January/2016 to January/2017 in 137 climacteric women. A standardized questionnaire was used to evaluate socio-demographic characteristics, climacteric phases, cardiovascular risk factors, menopause (age, time and type), number of pregnancies, normal births, abortions, partners and hormonal therapy. The evaluation model was used according to the Framingham risk score. Results: The median age was 47 years, and 35% were postmenopausal. The majority were married and 42.3% caucasian. Abdominal circumference greater than 80 cm was observed in 87.6%, and greater than 88 cm in 67.2%. High total cholesterol (TC) was observed in 48.2%. Low levels of high-density lipoprotein (HDL-c) were observed in 42.3%. Elevated levels were observed for low density lipoprotein (LDL-c) in 39.4%, triglycerides in 29.9%, and fasting glucose in 8.8%. Also, systolic and diastolic blood pressure were considered high in 25.5% cases. Postmenopausal women presented higher values of TC and HDL-c. Analysis of the Framingham risk score revealed a higher cardiovascular risk for postmenopausal women. Higher values of waist circumference, glycemia and triglycerides were observed for women with higher cardiovascular risk. Conclusions: Postmenopausal women had a higher risk of cardiovascular events when compared to premenopausal ones.
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Study on prevalence and severity of urogenital complaints in postmenopausal women at a tertiary care hospital p. 130
Nidhi Gupta, Manju Aggarwal, Renuka Sinha, Neha Varun
DOI:10.4103/jmh.JMH_91_17  PMID:30294184
Objective: The objective of this study was (1) to find the prevalence of urogenital (UG) complaints after menopause, (2) to evaluate the various risk factors for UG problems in postmenopausal women, and (3) to assess the severity of the symptoms depending on the duration of menopause. Materials and Methods: This study is a prospective study conducted at the Specialty Outpatient Department in Safdarjung Hospital over a period of 1 year. Two hundred postmenopausal women during this period were screened for UG complaints by eliciting detailed history in a pro forma and were divided into two groups based on the duration of menopause. Women with preexisting complaints before menopause and those with some medical disorders such as diabetes, stroke, or neurological problems were excluded from the study. Data were analyzed by standard statistical analytical tests. Results: The prevalence of UG symptoms in our study was 67%. Group A constitutes 127 (63.5%) participants in which menopause attained was of 1–5-year duration. Group B comprises the women with >5-year duration of menopause and it includes 73 (36.5%) patients. Among the genital complaints, vaginal dryness was the most common complaint in both the groups (Group A: 62% and Group B: 48%) followed by vaginal discharge or infection (Group A: 28% and Group B: 25%). Around 19 (15%) in Group A and 10 (13.6%) in Group B were having burning micturition (dysuria), the most common complaint encountered. The UG complaints were not statistically significantly different in both the groups. The severity of the symptoms was significantly different in two groups with more severe complaints in Group A as compared to Group B. Conclusion: UG complaints associated with estrogen loss can occur episodically throughout a women's life, but it is most common and chronic in the duration in postmenopausal women.
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A prospective, randomized, open-label study comparing the efficacy and safety of clonazepam versus nortriptyline on quality of life in 40+ years old women presenting with restless leg syndrome p. 135
Roshi , Vishal R Tandon, Annil Mahajan, Sudhaa Sharma, Vijay Khajuria
DOI:10.4103/jmh.JMH_25_18  PMID:30294185
Introduction: Restless legs syndrome (RLS) is a neurological disorder characterized by an urge to move the legs usually accompanied by unpleasant leg sensations. RLS also impacts health related quality of life (QOL) in patients suffering from it. Further, it affects women more than men. Although a voluminous literature of studies is available evaluating the role of benzodiazepines (clonazepam and antidepressant (nortriptyline) in the treatment of RLS, but to the best of our knowledge, no comparative study is available comparing both of these drugs for efficacy and safety for the treatment of RLS QoL among 40 + years old women. Materials and Methods: A prospective, randomized, open label comparative study was conducted in Postgraduate Department of Pharmacology in collaboration with the Department of General Medicine, Government Medical College, Jammu, a tertiary care teaching hospital for 1 year. Conclusion: Clonazepam proved to be significantly better in improving RLSQoL score. Difference between respective baselines of both groups was statistically insignificant.
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Diagnostic utility of endometrial aspiration cytology in women with abnormal uterine bleeding p. 140
Uma Handa, Chakshu Bansal, Phiza Aggarwal, Anju Huria, Harsh Mohan
DOI:10.4103/jmh.JMH_80_18  PMID:30294186
Context: Abnormal uterine bleeding (AUB) is a common problem for which women seek gynecological consultation. Endometrial aspiration cytology (EAC) has emerged as a minimally invasive and cost-effective diagnostic procedure for screening the endometrial status of these patients that can aid in diagnosis in high-burden and resource-limited settings. Aims: The study was conducted to evaluate the utility of EAC in women with AUB, and the cytological diagnosis was compared with the histopathology. Materials and Methods: A total of 100 patients presenting with AUB were subjected to EAC using a 4-mm Karman's cannula. Later, they also underwent endometrial dilation and curettage. The cytology smears were evaluated for architectural and cytomorphological features. The cytological diagnoses henceforth made were compared with the histopathological diagnosis to calculate sensitivity, specificity, and diagnostic accuracy of EAC. Results: EAC showed a sample adequacy of 89% viz a viz 90% for histopathology. EAC showed a sensitivity of 87.5% and 100% for diagnosing benign and malignant conditions, respectively. There was a good overall agreement between cytological and histopathological diagnosis (κ = 0.585). Conclusions: EAC is an effective and minimally invasive procedure for the primary investigation of women with AUB.
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Knowledge and attitude of adolescent girls and their mothers regarding cervical cancer: A community-based cross-sectional study p. 145
Pooja Ahlawat, Nitya Batra, Pragya Sharma, Shiv Kumar, Ajay Kumar
DOI:10.4103/jmh.JMH_45_18  PMID:30294187
Background: Cervical cancer is the second most commonly diagnosed cancer in India. The mother's awareness about the symptoms and risk factors has a large impact on the daughter's knowledge and attitude. Mother and adolescent daughter duos were selected as the sample as they are the target population at risk for suffering from carcinoma cervix. Mothers are the prime information providers and in an excellent position to aware their adolescent daughters about cervical cancer. Objectives: The aim of this study is to determine knowledge and attitude of adolescent girls and their mothers regarding cervical cancer and to find the association between the education of the mothers and their knowledge about risk factors. Materials and Methods: A community-based cross-sectional study was conducted among 100 duos of adolescent daughters along with their mothers residing in Balmiki Basti (Delhi), using a predesigned, pretested, semi-structured interview schedule. The collected data were analyzed using SPSS-22 version. Results: Only 61% of mothers and 52% of daughters have heard about cervical cancer. Inter-menstrual bleeding was the most common symptom recognized by the mother (50%) and daughter (44%) duos followed by postmenopausal bleeding (47% of mothers and 33% of daughters). Most common risk factors recognized by mothers and their daughters were promiscuity and tobacco and smoking. About 81% of mothers and 68% of daughters have a positive attitude toward internal examination by a gynecologist at least once in 3 years. Human papillomavirus infection was recognized as a risk factor by 13 among which 8 were educated till graduation (P < 0.05). Conclusions: Study revealed a low-level knowledge about cervical cancer among adolescent daughters and their mothers. Therefore, there is an urgent need to empower the women by educating them on this issue. Furthermore, there is a need to encourage the mothers to communicate the right information to their adolescent daughters.
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An overview of menopausal symptoms using the menopause rating scale in a tertiary care center p. 150
Aisha Khatoon, Samia Husain, Sonia Husain, Saba Hussain
DOI:10.4103/jmh.JMH_31_18  PMID:30294188
Context: Due to increased life expectancy worldwide, women are expected to spend a significant portion of their lives in menopause. Proven prevention strategies against serious risks and tested effective treatments for common symptoms may remain unutilized in our population if these women are not asked about these symptoms. Aim: This study aims to assess the prevalence of different menopausal symptoms and their severity according to menopause rating scale (MRS) in women. Setting and Design: The present study was a cross-sectional survey, conducted in the outpatient department of gynecology and obstetrics. Subjects and Methods: After written and informed consent, 121 women having their last menstrual period at least 1 year ago were included. The menopausal symptoms were assessed using the MRS. The primary outcome measure in this study was the prevalence of menopausal symptoms in these women according to MRS and the severity of these symptoms. Statistical Analysis Used: Data were analyzed using the SPSS software program, version 15.0 (IBM, Armonk, New York, USA). Results: The most common symptom was mental and physical exhaustion which was reported by 88 (72%) women, followed by joint and muscular discomfort which was reported by 83 (68.59%). Hot flushes were reported by 54 (44.62%) respondents. Majority of women reported mild-to-moderate symptoms. Conclusions: The prevalence of menopausal symptoms is high, and a health policy needs to be generated for the region.
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Patterns of age- and sex-related variations in bone mineral density of lumbar spine and total femur: A retrospective diagnostic laboratory-based study p. 155
Manmohan Singh, Sanjay Arora, Amanpreet Kaur, Sukanya Ghildiyal, Rohit Kumar
DOI:10.4103/jmh.JMH_95_18  PMID:30294189
Background: Osteoporosis is a major public health problem and should be a priority for healthcare providers and policymakers as it is an important reason of morbidity, mortality, and high-cost incurred in the management of its complications such as hip fractures. This study is designed to assess the bone mineral density (BMD) variation with age, site, and sex. Study is based on diagnostic laboratory data of BMD. Methods: A retrospective analysis was conducted on a sample population of 935 persons (73.5% women, 26.4% men), who underwent dual-energy X-ray absorptiometry scan between 2015 and 2017 in a National Accreditation Board for Testing and Calibration Laboratories accredited Mumbai (Maharashtra, India) based diagnostic laboratory. Lumbar spine, right and left total femur, BMD were analyzed across age, sex, and sites. The prevalence of low BMD and osteoporosis at these sites has been estimated as per the World Health Organization criteria of osteoporosis diagnosis using T scores. Results: Overall the prevalence of osteoporosis was found to be 6.4%, 5.5%, and 16.4%, while the prevalence of low BMD was 32.6%, 32.8%, and 31.2% at right total femur, left total femur, and lumbar spine, respectively. The decline in BMD at lumbar spine is more among women and it was a consistent decline with age, while among men' decline rate was less at all three sites. Conclusion: Our study highlighted the variation of BMD at different sites of body and higher vulnerability of spine for fragility fractures. Our study has shown a sharp decline in BMD among women during transition from 5th to 6th decade which signifies association of menopause with osteoporosis. Major limitation of the study is unavailability of clinical profiles of the subjects because of which it is difficult to ascertain whether BMD estimation was a diagnostic or screening procedure. In addition, study is conducted in diagnostic lab settings, due to which it is possible to overestimate prevalence of low BMD and osteoporosis by extrapolating these findings to the community.
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CASE REPORTS Top

Retained fetal bones: An unusual cause of granulomatous reaction on papanicolaou smear p. 162
Sabina Khan, Arifa Anwar, Sujata Jetley
DOI:10.4103/jmh.JMH_65_18  PMID:30294190
Granulomas are a rare finding on Papanicolaou (Pap) smear which if encountered are usually attributed to tuberculosis, especially in an endemic country like India. Here, we report an interesting case of a 40-year-old female presenting with blood-stained discharge and chronic pelvic pain for 8 years. She was advised Pap smear which showed granulomatous inflammation suggestive of tuberculosis. The patient was worked up for tuberculosis which was noncontributory. Dilatation and curettage was done which revealed multiple small bones and bony chips in the endometrial cavity. Following the removal of bones, the patient showed considerable symptomatic improvement. Repeat Pap smear did not reveal any evidence of granuloma. Even after extensive search of literature, we did not come across any such case report in which intrauterine retention of fetal bones evoked a granulomatous response in cervical smears though the presence of uterine granulomas in response to foreign body has been well documented.
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Low-grade endometrial stromal sarcoma in a postmenopausal woman with third-degree uterovaginal prolapse: A rare case with review of the literature p. 165
Meenakshi Gothwal, Garima Yadav, Meenakshi Rao, Pratibha Singh, Aasma Nalwa
DOI:10.4103/jmh.JMH_90_18  PMID:30294191
Endometrial stromal sarcomas (ESSs) are rare malignant tumors of the uterus that arise from the endometrial stroma, the annual incidence of ESS being 1–2/million women. Patients present with nonspecific complaints of abnormal uterine bleeding, pelvic pain, and pressure symptoms. Postmenopausal women rarely present with a low-grade ESS, as it is more common in younger women. ESS is usually confused with leiomyomas radiologically. Histopathological examination and immunohistochemistry are essential for the diagnosis. We, herein, report a case of a postmenopausal female who presented with something coming out per vagina. The clinical impression was that of a third-degree uterovaginal prolapse that on histopathological examination was diagnosed as a low-grade ESS.
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