Selección de Resúmenes de Menopausia

Abril de 2010

Juan Enrique Blümel. Departamento Medicina Sur. Universidad de Chile

Semanas del 21 al 27 de Abril de 2010

Maturitas. 2010 Apr 23. [Epub ahead of print]

EMAS position statement: Managing the menopause in women with epilepsy.

Erel CT, Brincat M, Gambacciani M, Lambrinoudaki I, Moen MH, Schenck-Gustafsson K, Tremollieres F, Vujovic S, Rozenberg S, Rees M.

Istanbul University, Cerrahpasa School of Medicine, Department of Obstetrics and Gynecology, Turkey.

INTRODUCTION: Epilepsy is a major public health problem worldwide which is clinically characterized by recurrent seizures. AIM: The aim of this position statement is to provide evidence-based advice on management of the menopause in postmenopausal women derived from the limited data available. MATERIALS AND METHODS: Literature review and consensus of expert opinion. RESULTS AND CONCLUSIONS: Women with epilepsy may undergo an earlier natural menopause, between 3 and 5 years depending on seizure frequency, but the data are limited. Data regarding the effects of the perimenopause and menopause on epilepsy are conflicting: some studies show an increased risk of seizures but others do not. With regard to hormone therapy (HT) one study has shown an increase in seizures with oral therapy with conjugated equine estrogens and medroxyprogesterone acetate, but no data are available for other regimens. Women starting HT should be closely monitored as their antiepileptic drug (AED) needs may change. As vitamin D and calcium metabolism can be affected by AEDS, supplements should be considered. Herbal preparations should be avoided as their efficacy is uncertain and they may interact with AEDs.

J Endocrinol Invest. 2010 Apr 22. [Epub ahead of print]

Effects of long-term hormon replacement therapy: results from a cohort study.

Signorelli SS, Sciacchitano S, Anzaldi M, Fiore V, Catanzaro S, Simili M, Neri S.

Department of Internal Medicine and Systemic Disease - University of Catania, Catania, Italy.

The positive effects of the hormonal replacement therapy (HRT) in protecting the cardiovascular system in women was suggested by several observational studies and also it was questioned by other randomized controller trials. To day, is unclear whether the HRT place a crucial role or if there is a possible role for this therapy in preventing or in lowering the cardiovascular disease (CVD). In the present study, we evaluated the ability of HRT in postmenopausal women treated for a long-lasting period both on the incidence of cardiovascular events and on the arterial remodelling as well as on some metabolic factors. Eighty four postmenopausal women (mean age: 46.3+/-5.2; age range 42 - 66 years) underwent to HRT for 10.9+/-1.2 years ( range 8 - 12 years). None of these subjects showed new cardiovascular events and we found a reduction of the intima-media thickness ( baseline 1.39+/-0.2. 1.35+/-0.2, 1.31+/-0.2 mm.) and total cholesterol, low density lipoprotein and antithrombin III levels were lower finally both high density lipoprotein and fibrinogen levels increased. The study shows different positive effects both on the vascular condition and on metabolic and coagulative markers that are usually considered as generic and crucial risk factors for CVD. The low number of patients is a limit of the study but the long-term period of follow-up could be considered as interesting point of view; the study is a "real-world study", describing the clinical experience of a Menopause Center.

J Gerontol A Biol Sci Med Sci. 2010 Apr 22. [Epub ahead of print]

What Is a Healthy Body Mass Index for Women in Their Seventies? Results From the Australian Longitudinal Study on Women's Health.

van Uffelen JG, Berecki-Gisolf J, Brown WJ, Dobson AJ.

School of Human Movement Studies, The University of Queensland, Blair Drive, Brisbane, Australia.

BACKGROUND: This study examines the relevance of the World Health Organization (WHO) optimal range for body mass index (BMI) of 18.5-25 kg/m(2) to morbidity in older women. METHODS: Data were from 11,553 women who completed five mailed surveys at 3-year intervals between 1996 (age 70-75 years) and 2008 (age 82-87 years). Incidence and prevalence of diabetes mellitus (DM), hypertension, heart disease, and osteoporosis; hospital admissions; and mortality were assessed. The association between BMI in 1996 and each outcome was examined using logistic regression models with repeated measures and a proportional hazards model for survival. RESULTS: There were consistent associations between increasing BMI and increasing incidence and prevalence of DM, hypertension, and heart disease and between increasing BMI and decreasing risk of osteoporosis. The association with hospital admission was J shaped and lowest for BMI of 22-24 kg/m(2), whereas the association with mortality was U shaped, being lowest for BMI of 25-27 kg/m(2). These associations were not affected by excluding women with cancer or excluding the first 5 years of follow-up. CONCLUSIONS: These results illustrate the complexity of determining the optimal BMI range for women who survived to age 70-75 years. Although the WHO recommendation is appropriate for DM, hypertension, heart disease, and hospitalization, a slightly higher BMI range may be optimal for osteoporosis and mortality.

Pharmacotherapy. 2010 May;30(5):442-52.

Cardiovascular and metabolic effects of medroxyprogesterone acetate versus conjugated equine estrogen after premenopausal hysterectomy with bilateral ovariectomy.

Kalyan S, Hitchcock CL, Sirrs S, Pudek M, Prior JC.

Centre for Menstrual Cycle and Ovulation Research, University of British Columbia, British Columbia, canada.

STUDY OBJECTIVE: To compare the cardiovascular and metabolic effects of medroxyprogesterone acetate (MPA) with those of conjugated equine estrogen (CEE) as single-hormone therapies in women who underwent hysterectomy with bilateral ovariectomy. DESIGN: Secondary analysis of a 12-month, double-blind, randomized, parallel-therapy trial. SETTING: Four teaching hospitals and one community hospital in Vancouver, Canada. PARTICIPANTS: Thirty-three healthy women who underwent premenopausal hysterectomy with bilateral ovariectomy. INTERVENTION: Subjects received either MPA 10 mg/day (18 women) or CEE 0.6 mg/day (15 women) for 12 months, started immediately after hysterectomy with bilateral ovariectomy. MEASUREMENTS AND MAIN RESULTS: Lipid profiles (high-density lipoprotein cholesterol [HDL], total cholesterol, apolipoprotein B, and triglyceride levels), homeostatic measures (hemoglobin A(1c) and fasting blood glucose level), hormone levels (free and bioavailable testosterone, cortisol, sex hormone-binding globulin [SHBG], and dehydroepiandrosterone sulfate), inflammatory markers (C-reactive protein [CRP] and serum albumin levels), and anthropometric measures (body mass index [BMI], truncal fat, and total body fat) were assessed over the 12-month period. After 12 months, the women assigned to MPA had lesser increases in BMI (p=0.04), triglyceride (p=0.003), HDL (p<0.0005), SHBG (p<0.0005), total testosterone (p=0.003), and CRP values (p=0.01) and higher serum albumin levels (p<0.0005) compared with the women receiving CEE. CONCLUSION: Therapy with CEE, but not MPA, after surgical menopause appears to predispose healthy women to low-grade inflammation, as evidenced by its independent associations with elevated CRP and reduced albumin levels. In women treated with MPA, the favorable levels of inflammatory markers, BMI, and triglyceride levels need to be confirmed in larger controlled trials, as progesterone therapy may provide a safe and effective alternative to estrogen for vasomotor symptoms in women with surgical menopause.

J Clin Endocrinol Metab. 2010 Apr 21. [Epub ahead of print]

Thyroid Function within the Upper Normal Range Is Associated with Reduced Bone Mineral Density and an Increased Risk of Nonvertebral Fractures in Healthy Euthyroid Postmenopausal Women.

Murphy E, Glüer CC, Reid DM, Felsenberg D, Roux C, Eastell R, Williams GR.

Molecular Endocrinology Group (E.M., G.R.W.), Department of Medicine, London. United Kingdom.

Context: The relationship between thyroid function and bone mineral density (BMD) is controversial. Existing studies are conflicting and confounded by differences in study design, small patient numbers, and sparse prospective data. Objective: We hypothesized that variation across the normal range of thyroid status in healthy postmenopausal women is associated with differences in BMD and fracture susceptibility. Design: The Osteoporosis and Ultrasound Study (OPUS) is a 6-yr prospective study of fracture-related factors. Setting: We studied a population-based cohort from five European cities. Participants: A total of 2374 postmenopausal women participated. Subjects with thyroid disease and nonthyroidal illness and those receiving drugs affecting thyroid status or bone metabolism were excluded, leaving a study population of 1278 healthy euthyroid postmenopausal women. Interventions: There were no interventions. Main Outcome Measures: We measured free T4 (fT4) (picomoles/liter), free T3 (fT3) (picomoles/liter), TSH (milliunits/liter), bone turnover markers, BMD, and vertebral, hip, and nonvertebral fractures. Results: Higher fT4 (beta = -0.091; P = 0.004) and fT3 (beta = -0.087; P = 0.005) were associated with lower BMD at the hip, and higher fT4 was associated with increasing bone loss at the hip (beta = -0.09; P = 0.015). After adjustment for age, body mass index, and BMD, the risk of nonvertebral fracture was increased by 20% (P = 0.002) and 33% (P = 0.006) in women with higher fT4 or fT3, respectively, whereas higher TSH was protective and the risk was reduced by 35% (P = 0.028). There were independent associations between fT3 and pulse rate (beta = 0.080; P = 0.006), increased grip strength (beta = 0.171; P<0.001), and better balance (beta = 0.099; P < 0.001), indicating that the relationship between thyroid status and fracture risk is complex. Conclusions: Physiological variation in normal thyroid status is related to BMD and nonvertebral fracture.

Cancer Epidemiol. 2010 Apr 19. [Epub ahead of print]

Recent trends in breast cancer incidence rates in the Loire-Atlantique, France: A decline since 2003.

Fontenoy AM, Leux C, Delacour-Billon S, Allioux C, Frenel JS, Campone M, Molinié F.

Registre des cancers de Loire-Atlantique et de Vendée, Nantes Cedex 1, France.

Background: A recent decline in breast cancer incidence rates has been reported in the United States and in Europe. This decrease has been partly attributed to the reduced use of hormone replacement therapy (HRT). No study in Europe has detailed recent breast cancer incidence trends both by hormonal receptor status and mode of detection at an individual level. Methods: We examined trends in breast cancer incidence rates in the French administrative area of Loire-Atlantique between 1991 and 2007, by age, mode of detection, histological subtype, estrogen/progesterone receptor (ER/PR) status and grade. Annual age-standardized breast cancer incidence rates were estimated using the Loire-Atlantique and Vendée Cancer Registry data. Annual percentage changes (APCs) were estimated using an age-adjusted Poisson regression model. Results: Incidence rates of breast cancer increased 3.5% per year in 1991-2003, dropped -4.3% per year in 2003-2006 and increased in 2007 (9.1%). Stratified analyses by age groups showed that the decrease concerned predominantly women aged 50-64 years, whereas an increasing proportion of cancers detected by organized screening was observed in this age group. Among these women, the decline of incidence particularly concerned positive estrogen and progesterone receptor tumors, lobular subtype tumors, and low-grade tumors. Conclusion: The drop in breast cancer incidence rates observed between 2003 and 2006 in women 50-64 years old was greater for ER+PR+ tumors. During the same period, the incidence of breast cancers diagnosed by organized screening increased. These patterns appear consistent with an impact of the reduced use of HRT.

Menopause. 2010 Apr 15. [Epub ahead of print]

The prevalence of depression symptoms and influencing factors among perimenopausal and postmenopausal women.

Timur S, Sahin NH.

From the 1Inonu University School of Health, Malatya, Turkey; Istanbul University, Turkey.

Abstract

OBJECTIVE:: This study was conducted for the purpose of determining the prevalence of depression in perimenopausal and postmenopausal women and the factors that influence the development of depression. METHODS:: A community-based sample of 685 women aged 45 to 59 years who were living in Malatya was recruited in this cross-sectional study. An information form that included questions on descriptive characteristics and lifestyle variables of cases, the Menopause-Specific Quality of Life Questionnaire, and the Beck Depression Inventory were administered to each woman in the sample. The data were collected through personal interviews with women at their home between February and May 2008. RESULTS:: The mean (SD) age of the respondents was 50.66 (4.15) years. The prevalence of depression symptoms among the perimenopausal and postmenopausal women was 41.8%. Of all women, 23.2% were premenopausal and 56.9% were postmenopausal. The logistic regression analysis revealed that depression symptom development was 1.8 times higher in the perimenopausal-postmenopausal period than in the premenopausal period, 3.6 times higher among those with an event history affecting life in a negative way than among those without, and 2.0 times higher among those with a body mass index of 25 kg/m or higher than among those with a body mass index of less than 25 kg/m. CONCLUSIONS:: There is a high level of prevalence of depression symptoms in perimenopausal and postmenopausal women.

Maturitas. 2010 May;66(1):56-71. Epub 2010 Mar 4.

Sex steroids to maintain cognitive function in women after the menopause: a meta-analyses of treatment trials.

Hogervorst E, Bandelow S.

Psychology Division, School of SE and Health, Loughborough University, Loughborough, United Kingdom.

It is still debated whether estrogen treatment after the menopause could result in improved cognitive function in women. This debate is based on many animal and cell culture data showing that estrogens can positively affect the aging brain. Observational data also show a halved risk of dementia in women who took estrogens around the age of menopause. However, large treatment trials have shown negative effects of long-term treatment with estrogens in older women. The present meta-analyses included 36 randomised treatment trials and tested various hypotheses which have been developed to attempt to explain discrepant data. Results indicated that, contrary to expectations, age of women and duration of time elapsed when treatment was initiated since menopause ('window of opportunity' hypothesis) did not significantly affect treatment outcome, nor did it matter whether women were symptomatic or not. It was not clear whether bilateral oophorectomy affected the outcome, as this effect was based on only a few studies from the same group and some observational studies show negative effects on cognition in surgical menopausal women treated with hormones for more than 10 years. Duration of treatment overall significantly affected outcome. More negative effects were seen in longer studies, where positive effects were mainly seen in short term studies (<4 months). Treatment with combined estrogens and progestagens also negatively affected the outcome. Whether women with symptoms should be treated for a couple of months or using other (intermittent) modes of treatment and whether this could have long-term positive consequences remains to be investigated.

Maturitas. 2010 May;66(1):33-8. Epub 2010 Feb 23.

Interaction between menopausal status and obesity in affecting breast cancer risk.

Rose DP, Vona-Davis L.

Department of Surgery, Mary Babb Randolph Cancer Center, West Virginia University Robert C. WV. USA.

Obesity has a complex relationship to breast cancer risk that differs in premenopausal and postmenopausal women. Before the menopause, the level of adiposity is inversely related to risk, indicative of a protective effect, whereas in postmenopausal women, particularly the elderly, the association is a positive one, consistent with obesity being a risk factor. The importance of high estrogen production in adipose tissue, with consequent elevation of circulating biologically available estradiol, in the promotional effect of obesity on postmenopausal breast carcinogenesis is well established; the resulting tumors express both estrogen and progesterone receptors. The mechanism(s) for the protective effect in premenopausal women is less well understood, but the breast cancers that do develop in the presence of obesity are most often estrogen and progesterone receptor negative, consistent with the selection of non-estrogen-dependent tumor cells which are dependent on growth factors such as insulin, insulin-like growth factor-I and some adipokines. The influence of menopausal status on the relationships between adiposity and breast cancer appears to be modified within each category by age; the protective effect before the menopause may be limited to younger women (<35 years), and the adverse effect was found to apply specifically to older postmenopausal women. Although randomized trials of weight reduction for postmenopausal breast cancer prevention have not been performed, observational studies suggested that risk reduction does occur; in addition, other health benefits of weight control need to be considered regardless of menopausal status.

Semana del 7 al 13de Abril 2010

Maturitas. 2010 Apr 6. [Epub ahead of print]

Ultra low dose continuous combined hormone replacement therapy with 0.5mg 17beta-oestradiol and 2.5mg dydrogesterone: Protection of the endometrium and amenorrhoea rate.

Bergeron C, Nogales FF, Rechberger T, Tatarchjuk T, Zipfel L.

Laboratoire Cerba, 95066 Cergy Pontoise Cedex 9, France.

Abstract

OBJECTIVES AND STUDY DESIGN: The aim of this open, multicentre study was to demonstrate the endometrial safety and assess the bleeding pattern of ultra low dose continuous combined hormone replacement therapy with 0.5mg 17beta-oestradiol and 2.5mg dydrogesterone in 446 healthy, non-hysterectomised, postmenopausal women with symptoms of oestrogen deficiency. MAIN OUTCOME MEASURE: Aspiration endometrial biopsies were performed at baseline and after 1 year of treatment to assess the incidence of endometrial hyperplasia or a more serious endometrial outcome. RESULTS: The only adverse endometrial outcome at the end of the study was one case of simple hyperplasia. This gives an overall incidence of 0.27% (95% CI: 0.01-1.48%) in the per protocol sample (n=395). The overall rate of amenorrhoea in the full sample (n=446) was 68% and 14% had only one or two bleeding/spotting episodes. The rate of amenorrhoea in months 10-12 (n=413) was 88%. The number of bleeding/spotting days per cycle fell during the study. The mean number of bleeding/spotting days was 5.8 and the mean number of days without bleeding was 358.2. Spotting alone was the most prevalent bleeding intensity, whilst heavy bleeding was rare. CONCLUSIONS: In conclusion, 2.5mg dydrogesterone continuously combined with 0.5mg 17beta-oestradiol effectively protects the endometrium in postmenopausal women in accordance with the guidelines of the Committee for Medicinal Products for Human Use (CHMP). It has a favourable amenorrhoea rate and is well tolerated by the majority of women.

Scand J Gastroenterol. 2010 Apr 5. [Epub ahead of print]

Prevention of colorectal cancer with vitamin D.

Rheem DS, Baylink DJ, Olafsson S, Jackson CS, Walter MH.

Department of Gastroenterology, Loma Linda University Medical Center, Loma Linda, USA.

Abstract

Abstract The fact that colorectal cancer (CRC) is the second leading cause of cancer mortality in the United States emphasizes the need for more effective preventive and therapeutic modalities. There is growing evidence that vitamin D may reduce the incidence of CRC. Results of epidemiologic, in vitro, in vivo animal and clinical studies suggest that a low serum vitamin D level may be a serious risk factor for CRC and a high serum vitamin D level may reduce the risk of CRC. On a molecular level, vitamin D suppresses CRC development and growth by affecting cell proliferation, differentiation, apoptosis, and angiogenesis. Vitamin D insufficiency and CRC are common in the elderly population. Vitamin D insufficiency is simple to screen for and treatable with vitamin D supplementation. Serum 25-hydroxyvitamin D (calcidiol) is the best measure of vitamin D status and should be checked routinely for individuals with risk factors for CRC. Maintaining serum concentrations of calcidiol above 32 ng/ml (80 nmol/l) in individuals whose serum calcidiol level is low may help prevent CRC as well as osteoporosis, fractures, infections, and cardiovascular disease. Daily calcidiol intake of 1000 International Units can increase serum vitamin D to sufficient levels in most elderly persons and, based on available data, may substantially lower the incidence of CRC with minimal risks.

Fertil Steril. 2010 Apr 6. [Epub ahead of print]

Endothelial function in patients with polycystic ovary syndrome: a long-term follow-up study.

Hudecova M, Holte J, Olovsson M, Lind L, Poromaa IS.

Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.

Abstract

OBJECTIVE: To investigate pulse wave reflection and endothelial-dependent vasodilation in patients with polycystic ovary syndrome (PCOS) and age-matched healthy controls. DESIGN: Long-term follow-up study. SETTING: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. PATIENT(S): Sixty-seven patients with PCOS and with a mean age of 43.3 years at the follow-up investigation and 66 age-matched controls. INTERVENTION(S): Aplanation tonometry before and after beta-2 receptor agonist (terbutaline) challenge. MAIN OUTCOME MEASURE(S): Baseline augmentation index (AI) aorta, baseline AI-radial, and change in AI-radial after terbutaline administration as a measure of endothelial-dependent vasodilation. RESULT(S): There was no difference in baseline AI-aorta between patients with PCOS and control subjects. Change in AI-radial after terbutaline administration was less pronounced in patients with PCOS compared with control subjects. This difference remained when adjusted for use of combined oral contraceptives (OC)/hormone replacement therapy (HT) and postmenopausal status but not after adjustment for body mass index (BMI). CONCLUSION(S): Middle-aged patients with PCOS display signs of endothelial dysfunction in comparison to age-matched controls, but this is largely due to the increased prevalence of independent risk factors for cardiovascular disease found in this group.

J Trauma. 2010 Apr 6. [Epub ahead of print]

Osteoporosis in Patients With a Low-Energy Fracture: 3 Years of Screening in an Osteoporosis Outpatient Clinic.

Woltman K, den Hoed PT.

From the Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands.

Abstract

BACKGROUND:: The prevalence of osteoporosis in the Netherlands is 52 per 1,000 men and 166 per 1,000 women (age >55 years). Previous results of an osteoporosis screening program showed that 55%, 41%, and 37.1% had osteoporosis. This study aims to evaluate the incidence of osteoporosis after low-energy fractures and to describe the care program for osteoporosis screening. The second endpoint was to investigate the incidence of risk factors in the whole study population and a subgroup analysis from the three major groups with osteoporotic fractures. METHODS:: All female and male patients older than 50 years with a low-energy fracture were included for the osteoporosis screening program. Patients with a fracture of the vertebrae were also included if the age was less than 50 years. All patients underwent a bone mineral density measurement by means of dual-energy X-ray film absorptiometry. All obtained data were registered by a nurse specialist in osteoporosis, in a computerized database. RESULTS:: The incidence of osteoporosis in patients with low-energy fractures is high, 46.4%. At the time of fracture presentation, there were 33.2% of the patients with a low body weight (<67 kg), almost all osteoporotic patients (96%) had a low-energy fracture occurred after their 50th year. In patients diagnosed with osteoporosis, the hip fracture is the most common fracture site (34%), followed by the humerus (20.1%). CONCLUSIONS:: In conclusion, a screening program for osteoporosis is necessary and should be a tool in the armamentarium of every traumatology department.

Br J Nutr. 2010 Apr 7:1-8. [Epub ahead of print]

The effects of a 30-month dietary intervention on bone mineral density: The Postmenopausal Health Study.

Moschonis G, Katsaroli I, Lyritis GP, Manios Y.

Department of Nutrition & Dietetics, Harokopio University of Athens, Athens, Greece.

Abstract

Low dietary Ca intake and vitamin D insufficiency have been implicated as part of the aetiology leading to osteoporosis. The aim of the present study was to examine the effects of a 30-month dietary intervention that combined supplementation of dairy products fortified with Ca and vitamin D3 and lifestyle and nutrition counselling sessions on bone mineral density (BMD) of postmenopausal women. Sixty-six postmenopausal women (aged 55-65 years) were randomised into a dietary group (DG; n 35), receiving daily and for the first 12 months 1200 mg Ca and 7.5 mug vitamin D3, while for the next 18 months of intervention 1200 mg Ca and 22.5 mug vitamin D3 through fortified dairy products, and a control group (CG; n 31) receiving neither counselling nor dairy products. The DG was found to have more favourable changes in arms (P < 0.001), total spine (P = 0.001) and total body BMD (P < 0.001) compared with the CG. Furthermore, a significant increase was observed for the DG in lumbar spine BMD (0.056; 95 % CI 0.009, 0.103), which was not found to differentiate significantly compared with the change observed in the CG (P = 0.075). In conclusion, the present study showed that intakes of vitamin D of about 22.5 mug/d and of Ca close to the recommended level of 1200 mg from fortified dairy foods for 30 months, with compliance ensured by lifestyle and nutrition counselling sessions, can induce favourable changes in arms, total spine and total body BMD of postmenopausal women.

Arch Gynecol Obstet. 2010 May;281(5):879-85. Epub 2009 Aug 14.

Severe menopausal symptoms in middle-aged women are associated to female and male factors.

Chedraui P, Pérez-López FR, Mendoza M, Morales B, Martinez MA, Salinas AM, Hidalgo L.

Academic and Research Department, Hospital Gineco-Obstétrico Enrique C. Sotomayor, Pedro Pablo Gómez s/n y 6 de Marzo, and Facultad de Ciencias Médicas, Universidad Católica de Guayaquil, Guayaquil, Ecuador. pchedraui@jbgye.org.ec

Abstract

BACKGROUND: The frequency and intensity of menopausal symptoms within a given population, as assessed by several tools, may vary and depend on several factors, such as age, menopausal status, chronic conditions and personal and partner socio-demographic profile. OBJECTIVE: To determine the frequency and intensity of menopausal symptoms and related risk factors among middle-aged women. METHODS: In this cross-sectional study a total of 404 women aged 40 to 59 years, visiting inpatients at the Enrique C. Sotomayor Gynecology and Obstetrics Hospital, Guayaquil, Ecuador, were requested to fill out the menopause rating scale (MRS) and a questionnaire containing personal and partner data. RESULTS: Mean age of surveyed women (n=404) was 48.2+/-5.7 years, 85.1% had 12 or less years of schooling and 44.8% were postmenopausal. None was on hormonal therapy (HT) for the menopause or psychotropic drugs. Regarding their partner, erectile dysfunction was present in 23.8%, premature ejaculation in 21.2% and 43.5% abused alcohol. The four most frequently found symptoms of those composing the MRS were muscle and joint problems (80%), depressive mood (73.5%), physical and mental exhaustion (71.3%) and irritability (68%). Mean total MRS score was 18+/-10.6 (median 17) and for subscales: 7.2+/-4.5 (somatic); 6.9+/-4.8 (psychological) and 3.9+/-3.4 (urogenital). Women presented severe scores in 53, 36.1, 48.3 and 49.8% for total MRS and somatic, psychological and urogenital subscales, respectively. After adjusting for confounding factors, logistic regression analysis determined that female higher parity and partner premature ejaculation increased the risk for presenting severe total MRS scores (impaired female quality of life), whereas women who had a positive perception of their health status were at decreased risk. CONCLUSION: In this middle-aged series psychological menopausal symptoms were the most frequent in which severity was associated to parity and partner sexual dysfunction.