Journal of Mid-life Health Journal of Mid-life Health
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   Table of Contents - Current issue
Coverpage
October-December 2018
Volume 9 | Issue 4
Page Nos. 171-229

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EDITORIAL  

Menopause and Osteoarthritis: Any Association ? p. 171
Annil Mahajan, Ranu Patni
DOI:10.4103/jmh.JMH_157_18  PMID:30692810
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ORIGINAL ARTICLES Top

Assessment of quality of life based on psychological, somatovegetative, and urogenital health problems among postmenopausal women in Urban Puducherry, South India: A cross-sectional observational study p. 173
Yuvaraj Krishnamoorthy, Gokul Sarveswaran, Venkatachalam Jayaseelan, Manikandanesan Sakthivel, Yashodha Arivarasan, N Bharathnag
DOI:10.4103/jmh.JMH_61_18  PMID:30692811
Background: An average Indian woman spends almost one-third of her lifespan in the postmenopausal phase enduring the consequences of hormonal decline. This can have a significant impact on quality of life (QOL). Hence, this study was conducted to assess the QOL and health problems among postmenopausal women in urban Puducherry, South India. Methods: A cross-sectional study was carried out among postmenopausal women attending urban primary health center between April and May 2017. Information about social, economic, and demographic characteristics was collected using a semi-structured questionnaire, and menopause rating scale was used to assess the QOL. Results: Among 204 participants, 55.4% belonged to elderly age group (≥60 years); 61.3% did not have any formal education; 55.9% of the participants were unemployed; 68.7% were widowed, separated, or divorced; 89.7% belonged to Hindu religion; and 42.2% belonged to lower socioeconomic class. Majority (78%) suffered from psychological problems followed by somatovegetative (62%) and urogenital problems (33%). The prevalence of poor QOL was 37.2% (95% confidence interval: 30.8%–44.0%). Participants belonging to Hindu religion (annual percentage rate [aPR]-4.14), in nuclear family (aPR-2.31), and with chronic comorbidity (aPR-5.52) and alcohol/tobacco users (aPR-6.03) had significantly higher risk of poor QOL. Conclusion: The current study found that more than one-third of the postmenopausal women in urban Puducherry have poor QOL with majority suffering from psychological problems. Hence, more focus needs to be given to this target population to achieve physical, social, and mental well-being among females.
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Cervical cytopathological changes associated with onset of menopause p. 180
Jata Shanker Misra, Anand Narain Srivastava, Zeeshan Haider Zaidi
DOI:10.4103/jmh.JMH_4_18  PMID:30692812
Background: In the life of a woman, after 40 years of age, onset of menopause occurs during which hormonal imbalances take place. The present study is aimed at finding out cytopathological changes in the cervical epithelium associated with this hormonal disturbance. Materials and Methods: Cervical cancer screening program is in progress under auspices of Era's Lucknow Medical College and Hospital, Lucknow, since May 2013, in the villages of Lucknow West through camp approach. Till September 2017, 140 camps have been organized and 2440 women attending the camp have been cytologically examined. Out of these, 1534 women were perimenopausal, 165 premenopausal, and 441 postmenopausal. The cytopathological changes have been studied in these three categories of women in relation to different predisposing factors to the cervical carcinogenesis. Results: The squamous intraepithelial lesion (SIL) rate was higher with onset of menopause in the premenopausal women. The SIL rate was higher with nulliparity in these women as well as in the postmenopausal women and also with different gynecological symptoms and clinical lesions of the cervix. The SIL changes associated with HPV and HSV were also higher in them. Conclusion: A high SIL rate found with onset of menopause may be the outcome of gradual estrogen withdrawal in the premenopausal women. Hence, cytological evaluation is mandatory in women between 41 and 45 years of age to rule out any occurrence of cervical cytopathology.
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Assessment of symptoms and quality of life among postmenopausal women in a tertiary care hospital in Kochi, South India: A hospital-based descriptive study p. 185
Sumathi Senthilvel, Senthilvel Vasudevan, PS Anju, Anjana Sukumaran, Jayanthi Sureshbabu
DOI:10.4103/jmh.JMH_98_18  PMID:30692813
Background: Menopause is a physiological event in the women's life that can strongly affect the quality of life (QOL). More than 80% of women state that physical and physiological symptoms commonly accompany menopause and affect women's health and well-being. Objective: The aim of the study was to assess the menopause-related symptoms and their impact on the women's life. Materials and Methods: We have done a hospital-based descriptive study at the Outpatient and Inpatient Department of Obstetrics and Gynecology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, with 150 postmenopausal women. The data were collected using the structured Menopause-specific QOL (MENQOL) questionnaire. The data were collected for 4 weeks from the Outpatient and Inpatient of Department of OBG with inclusion criteria of women who were coming as bystanders' age in between 50 and 65 years. Statistical Analysis: Mean, standard deviation, frequency, and proportions were calculated. The association between the MENQOL scores and selected demographic variables was found using one-way ANOVA test. Results: Among 150 postmenopausal women, 51 (34%) were in the age group of 55–59 years and more than half of the study population (n = 116, 77.3%) were married. The management of menopausal symptoms was followed by 28 (18.7%) women. The prevalence levels of the classical menopausal symptoms such as hot flushes, night sweats, and vaginal dryness in women aged 50–65 years were 75.3%, 58%, and 30.7%, respectively. The overall MENQOL mean total score was found as 112.47 ± 28.80. The majority of them experienced the mean physical symptom, which was found to be 62.05 ± 17.82. The associations between QOL scores with educational status and socioeconomic status were statistically highly significant with P < 0.01 and with marital status statistically significant with P < 0.05. Conclusion: From the present study, we have concluded that the postmenopause-related physical symptoms are frequently reported by the middle age group classifications. The association between QOL scores with educational status, socioeconomic status, and marital status was statistically highly significant. By nursing education, creating appropriate awareness and health education on the management of postmenopausal symptoms to that age group and it could be reducing the burden of the women population.
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Urogenital atrophy in 40–75 years women assessed with different scoring systems at tertiary care hospital of India p. 191
Maitri Shah, Ankita Khandelwal, Sangita Patel
DOI:10.4103/jmh.JMH_15_18  PMID:30692814
Objective: The present study was conducted to assess the validity of symptom score and Genital Health Clinical Evaluation (GHCE) score as diagnostic tools for urogenital atrophy in females of 40–75 years of age group. Materials and Methods: A cross-sectional study including 600 females in the age group of 40–75 years attending gynecology outpatient department was conducted. They were given a symptom score based on their history. GHCE score and smears for vaginal maturation index (VMI) were taken and percentages of superficial cells were counted. Statistical tests of significance such as Karl Pearson's coefficient of correlation were applied. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy of GHCE score, and symptom score with VMI score were calculated. Results: The prevalence of urogenital atrophy in females of 40–75 years of age group using VMI scoring was 38.1%. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of total symptom score for diagnosing urogenital atrophy were 66.4%, 75.3%, 56.3%, 82.4%, and 72.5%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of GHCE score for diagnosing urogenital atrophy were 43.4%, 80.7%, 75.3%, 51.3%, and 59.3%, respectively. Conclusion: Both symptom score and GHCE score can be used as valid alternatives to VMI as diagnostic tools for urogenital atrophy in females of 40–75 years of age group at least in resource-poor settings.
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Could a midwife leading health behavior counseling improve self-care of women during perimenopause? A quasi-experimental study p. 195
Katayoon Faraji, Mahnaz Akbari Kamrani, Sara Esmaelzade Saeieh, Malihe Farid
DOI:10.4103/jmh.JMH_18_17  PMID:30692815
Background: Promoting the health and providing a sense of well-being in each period of a woman's life could improve her life quality and would bring lots of benefits to the community. Menopause has a remarkable impact on quality of life during the climacteric stage and the early stages of post menopause. Aims: This study aims to evaluate the effectiveness of a behaviour change counselling program based on the model A, which is planned in order to improve the women self-care during the climacteric stage. Methods: The study is quasi-experimental type, conducted before and after counselling intervention, to evaluate effect of the health behaviour counselling of model 5A on self-care of 42 women aged 39-51 (during climacteric stage) in areas of general health, physical activity, nutrition, sleep, psycho-social health, body image and sexual health. After obtaining permission from the ethics of Alborz University of Medical Sciences, a clinical trial registry (IRCT2016042427557N1) was performed. Results: Results of non-parametric Fridman test showed a change in score average grade of self-care before and after the health behaviour counselling in the area studied (P < 0.0001). There was a significant difference between the self-care score before counselling, and one and three months later, in all areas except body image and sleep. Conclusions: Multidimensional changes of women in climacteric stage may affect their life quality. They need more information about menopause process to manage its symptoms. Results of this study highlight more the effectiveness of health behaviour change counselling planned by emphasizing the individual's self-care level.
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Health-promoting behaviors and menopausal symptoms: An interventional study in rural India p. 200
Ekta Malik, Poonam Sheoran, Adiba Siddiqui
DOI:10.4103/jmh.JMH_96_18  PMID:30692816
Background: Menopausal transition initiates with menstrual cycle length variety and finishes when last menstrual period happens. As life expectancy has increased, a menopausal woman has to spend one-third of her life span with estrogen deprivation stage that leads to major long-term symptomatic and metabolic complications. Methods: This was a quasi-experimental study conducted on 103 menopausal women between 40 and 60 years of age residing in Ambala district, Haryana. In the experimental group, women received lifestyle modification program that includes six domains, i.e., health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management. Intervention was divided into two sessions of total 2-h duration on 2 consecutive days. Sociodemographic pro forma, Menopausal Rating Scale, and Health Promoting Lifestyle Profile II were used to collect data from women through face-to-face interview. Results: There was a significant difference (P < 0.05) in mean menopausal symptom score and mean health-promoting behavior score in the experimental group after the intervention, but there was no significant difference in the comparison group (P > 0.05). It was revealed that there was no significant difference between the groups with regard to mean menopausal symptom score and mean health-promoting behavior score before intervention (P < 0.05). The mean posttest menopausal symptom score (t = −8.99, P = 0.01**) was significantly low and the mean health-promoting behavior score (t = 8.7, P = 0.01**) was significantly high in the experimental group. Conclusion: Based on the finding of the study, it can be concluded that Lifestyle modification program was significantly effective in reducing menopausal symptoms and improving health-promoting behaviors among women.
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CASE REPORTS Top

Second primary cancer after radiotherapy for cervical cancer p. 207
Sushma Jhamad, Rajendra Aanjane, Sanjog Jaiswal, Suchita Jain, Priyanka Bhagat
DOI:10.4103/jmh.JMH_74_18  PMID:30692817
Radiation is a treatment for many gynecological malignancies, especially locally advanced cervical cancer. Development of sarcoma due to previous radiation occurs very rarely. They develop within the radiation field. We report a case of carcinosarcoma in our patient developed 8 years after the radiotherapy (RT) that she received in the form of external beam radiation and intracavitary RT along with concomitant chemotherapy consisting of cisplatin. Although the development of secondary primary cancer is rare, for every patient who receives radiation for treatment of cancer, close follow-up is recommended as they may have viable endometrium.
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Malignant mixed mullerian tumor secondary to tamoxifen for Ca breast: Shadow of the past! p. 210
Surendra Bisu, Vinu Choudhary
DOI:10.4103/jmh.JMH_79_18  PMID:30692818
Tamoxifen is used in the treatment of hormone-responsive breast cancer because of its antiestrogenic effect. However, it also has an estrogenic effect on the uterus, thereby increasing the risk of endometrial hyperplasia, endometrial polyp, and malignant mixed Mullerian tumor (MMMT). This case describes the pathogenesis and risk of MMMT due to long-term tamoxifen intake in hormone-responsive breast cancer.
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Giant endometrial polyp: An enigma in a postmenopausal woman p. 212
Sonam Sharma
DOI:10.4103/jmh.JMH_82_18  PMID:30692819
Giant polyp is an unusual female genital tract pathology, commonly arising from the cervix than the endometrium. It is a great masquerader of cervical or endometrial malignancy and can lead to a diagnostic dilemma and unnecessary aggressive interventions. Experience in one such case of an extremely rare protruding giant endometrial polyp in a 58-year-old postmenopausal female is being described herewith so as to create awareness among the dealing clinicians. The approach to such a case, differential diagnosis, and review of the literature is also presented.
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Bladder perforation: A missed diagnosis posttransobturator tape p. 216
Vineet V Mishra, Ruchika A Verneker, Sunita Lamba
DOI:10.4103/jmh.JMH_22_18  PMID:30692820
The advent of transobturator tape (TOT) in 2001 reduced the risk of bladder perforation to 1% in TOT as compared to 5% in tension-free vaginal tape (TVT). We present a case of bladder perforation in TOT where the diagnosis was missed for 5 years. This patient presented with dysuria and dyspareunia repeatedly and was treated for repeated urinary tract infection. The mesh was excised by cystoscopy, following which the symptoms were relieved. Thus, bladder perforation through a rare complication of TOT should always be ruled out in patients presenting with the failure of surgery or irritable detrusor activity such as dysuria and urgency.
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Adenoma malignum diagnosed postoperatively in a case of fibroid uterus: Case report with review of literature p. 219
Garima Yadav, Meenakshi Rao, Meenakshi Gothwal, Pratibha Singh
DOI:10.4103/jmh.JMH_102_18  PMID:30692821
“Minimal deviation adenocarcinoma” of the uterine cervix (MDA), historically known as Adenoma Malignum, is a rare variant of cervical adenocarcinoma. Both the clinicians and pathologists must be vigilant about this entity as it could be mistaken for a benign pathology both clinically and microscopically, which can prove disastrous to the patient as these tumors behave like adenocarcinomas We hereby report an incidentally detected case of AM which was diagnosed in a post-menopausal female postoperatively. We discuss the intraoperative complications, histopathological diagnosis, post-operative management and follow up.
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Sertoliform endometrioid carcinoma of ovary presenting as abdominal wall abscess p. 222
Murali Subbaiah, Gowri Dorairajan, Bhawana A Badhe, Norton S Stephen
DOI:10.4103/jmh.JMH_47_18  PMID:30692822
Sertoliform endometrioid carcinoma (SEC) is a rare epithelial ovarian cancer which may be mistaken for sex cord tumour on microscopy. Immunohistochemistry and extensive sampling of tumour to look for areas of conventional endometrioid carcinoma are important to confirm the diagnosis of SEC. We report a case of SEC of ovary in a postmenopausal lady who presented to us with abdominal wall abscess in epigastric region.
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CASE SERIES Top

Struma ovarii: A report of three cases and literature review p. 225
Pratibha Singh, Nitisha Lath, Shashank Shekhar, Manu Goyal, Meenakshi Gothwal, Garima Yadav, Pushpinder Khera
DOI:10.4103/jmh.JMH_53_18  PMID:30692823
Struma ovarii is a variant of mature cystic teratoma, with predominant thyroid element. Confirmatory diagnosis is by histopathology. It may mimic as ovarian malignancy in some. It may be associated with ascites in minority; even CA-125 has been found to be raised in some cases. We here report three cases – two operated for suspected ovarian malignancy in a postmenopausal female and one case operated for persistent benign ovarian cyst with raised CA-125 in a young female. In all histopathological diagnosis was a benign struma ovarii. It is difficult to diagnose these cases preoperatively as there are no specific clinical, radiological or serum markers for these rare tumors in the absence of thyroid biology abnormality. Most cases are diagnosed on histopathology. These benign tumors many times require extensive staging laparotomy for suspected ovarian malignancy in the absence of preoperative diagnosis. Prognosis is good for these tumors. Subtle radiological signs and a clinical suspicion can avoid extensive staging laprotomies in these patients.
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