MENOPAUSE: A NEGLECTED REPRODUCTIVE HEALTH CONCERN IN CAMEROON

J.N Fomulu, E Bechem, E Nkwabong, P.N Nana

Abstract


Introduction: Menopausal medicine is an outstanding problem in health care systems in Africa as a whole and in Cameroon in particular. Most menopausal women tend to seek medical attention in various medical specialties because of the polymorphous clinical features of menopause, yet its origin is gynaecological. This may be due to the lack of knowledge on menopause by health practitioners and decision makers.

Methods: In this complete literature review, we carried out a meta analysis of menopause through its definition, age of onset, pathophysiology, clinical presentation, complications, diagnosis and management.

Conclusion: Adequate provision of knowledge to medical practitioners and decision makers on this natural ageing phenomenon with emphasis on the creation of menopausal clinics as an integral part of reproductive health delivery system appears necessary for the appropriate management of the many menopausal women in Cameroon.


Keywords


Menopause- Clinical features- Management- Complications- Menopausal clinics

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References


MBU R. The period after menopause, how symptomatic is it among Cameroonian women. Journal of Health Sciences. FMBS, 2005.

Sallam H, Galal AF, Rashed A. Menopause in Egypt: past and present perspectives. Climacteric 9(6):421-9, 2006.

Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, PA: Mosby, 2007

Weel AE, Uitterlinden AG, Westendorp IC, Burger H, Schuit SC, HofmanA, et al. Estrogen receptor polymorphism predicts the onset of natural and surgical menopause. J Clin Endocrinol Metab 84: 3146-50, 1999.

Kato I, Toniolo P, Akhmedkhanov A, Koenig KL, Shore R, Zeleniuch- Jacquotte A. Prospective study of factors influencing the onset of natural menopause. J Clin Epidemiol 51: 1271-6, 1998.

Persuade TVN. Embrology of the female genital tract and gonads. Textbook of Gynaecology. Philadelphia, WB Saunder, 1992

Gougeon A. Relations entre vieillissement et nombre de follicules dans l’ovaire humain. Reprod Hum Horm 9: 91-8, 1996.

Hsueh AJW, Billig H, Tsafriri A. Ovarian follicle atresia: a hormonally controlled apoptotic process. Endocr Rev 15: 707-24, 1994.

Arias E. United States Life Tables, 2002, National Vital Statistics Reports. Center for Disease Control and Prevention 53(6), 2004 (11/10/2004) (www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_06.pdf)

Kato I, Toniolo P, Akhmedkhanov A, Koenig KL, Shore R, Zeleniuch- Jacquotte A. Prospective study of factors influencing the onset of natural menopause. J Clin Epidemiol 51: 1271-6, 1998.

Erickson GE: Normal ovarian function. Clin Obstet Gynecol 21: 31, 1978.

JoAnn V.P. Menopause basics: Physiology, Perimenopause, and Menopause. The North American Menopause Society. 2005

Judd HL. Origin of serum estradiol in postmenopausal women. Obstet Gynecol 59: 680, 1982.

Sherman BM, Korenman SG: Hormonal characteristics of the human menstrual cycle throughout reproductive life. J Clin Invest 55: 699-706, 1975.

Judd HL: Hormonal dynamics associated with the menopause. Clin Obstet Gynecol 1976; 19: 775.

Kronenberg F, Fugh-Berman A. NAMS Position Statement (Treatment of menopause-associated vasomotor symptoms) Menopause 11: 11-33, 2004.

Greendale GA, Reboussin BA, Hogan P, Barnabel VM, Shumaker S, Johnson S, et al. Symptom relief and side effects of postmenopausal hormones: results from the postmenopausal estrogen/progestin interventions trial. Obstet Gynecol 92: 982-8, 1998.

Kronenberg F. Mean age of natural menopause was 49.5 years; mean age of surgical menopause was 43.7 years. Ann NY Acad Sci. 592: 52-86, 1990.

Lopes P, Tremollieres F. Ostéoporose post-ménopausique. In: Guide pratique de la ménopause. Paris: Masson; p. 45-51, 2004.

World Health Organization: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Synopsis of a WHO Study Group. Osteopor Internat 4(6): 368-81, 1994.

Pouillès JM, Trémollières F, Ribot C. Effet de la ménopause sur la masse osseuse vertébrale, étude longitudinale. Presse Med 23: 1069-73, 1994.

Torgerson DJ, Bell-Syer SE. Hormone replacement therapy and prevention of non vertebral fractures. A meta-analysis of randomized trials. JAMA 285: 2891-7, 2001.

National Osteoporosis Foundation: Physician's Guide To Prevention and Treatment of Osteoporosis. National Osteoporosis Foundation, 2005.

Sumino H, Ichikawa S, Abe M, Endo Y, Ishikawa O, Kurabayashi M. Effects of aging, menopause and hormone replacement therapy on forearm skin elasticity in women. J Am Geriatr Soc 52: 945-9, 2004.

Trémollières FA, Pouilles JM, Cauneille C, Ribot C. Coronary heart disease risk factors and menopause: a study in 1684 french women. Atherosclerosis 142: 415-23, 1999.

Williams JK, Adams MR, Klopfenstein HS. Estrogen modulates responses of atherosclerotic coronary arteries. Circulation 81(5): 1680-7, 1990.

Manson JE: Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med 349: 523-34, 2003.

Lebrun CE, Van der Schouw YT, De Jong FH, Pols HA, Grobbee DE, Lamberts SW. Endogenous oestrogens are related to cognition in healthy elderly women. Clin Endocrinol (Oxf) 63: 50-5, 2005.

Schneider LS. Estrogen and dementia insights from the Women’s Health Initiative memory study. JAMA 291: 3005-7, 2004.

Arias E: United States Life Tables, 2002, National Vital Statistics Reports. Centers for Disease Control and Prevention. 53(6), 2004.

Bergkvist L: The risk of breast cancer after estrogen and estrogen-progestin replacement. N Engl J Med 321: 293, 1989.

Collaborative group on hormonal factors in breast cancer: Breast cancer and hormone replacement therapy. Lancet 350: 1047-59, 1997.

Jensen J. Long-term effects of percutaneous estrogens and oral progesterone on serum lipoproteins in postmenopausal women. Am J Obstet Gynecol 156: 66, 1987.

Adelercreutz H. Phyto-oestrogens and cancer. Lancet Oncol 3: 364-73, 2002.

Campisi R. Tibolone improves myocardial perfusion in postmenopausal women with ischemic heart disease: an open-label exploratory pilot study. J Am Coll Cardiol 47: 559-64, 2006.

Recommendation by the Hong Kong College of Obstetricians and Gynaecologists. Available at: http://www.hku.hk/obsgyn/CME_CNE/powerpoint/MM.ppt.

MBU R. The period after menopause, how symptomatic is it among Cameroonian women. Journal of Health Sciences. FMBS, 2005.

Sallam H, Galal AF, Rashed A. Menopause in Egypt: past and present perspectives. Climacteric 9(6):421-9, 2006.

Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, PA: Mosby, 2007

Weel AE, Uitterlinden AG, Westendorp IC, Burger H, Schuit SC, HofmanA, et al. Estrogen receptor polymorphism predicts the onset of natural and surgical menopause. J Clin Endocrinol Metab 84: 3146-50, 1999.

Kato I, Toniolo P, Akhmedkhanov A, Koenig KL, Shore R, Zeleniuch- Jacquotte A. Prospective study of factors influencing the onset of natural menopause. J Clin Epidemiol 51: 1271-6, 1998.

Persuade TVN. Embrology of the female genital tract and gonads. Textbook of Gynaecology. Philadelphia, WB Saunder, 1992

Gougeon A. Relations entre vieillissement et nombre de follicules dans l’ovaire humain. Reprod Hum Horm 9: 91-8, 1996.

Hsueh AJW, Billig H, Tsafriri A. Ovarian follicle atresia: a hormonally controlled apoptotic process. Endocr Rev 15: 707-24, 1994.

Arias E. United States Life Tables, 2002, National Vital Statistics Reports. Center for Disease Control and Prevention 53(6), 2004 (11/10/2004) (www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_06.pdf)

Kato I, Toniolo P, Akhmedkhanov A, Koenig KL, Shore R, Zeleniuch- Jacquotte A. Prospective study of factors influencing the onset of natural menopause. J Clin Epidemiol 51: 1271-6, 1998.

Erickson GE: Normal ovarian function. Clin Obstet Gynecol 21: 31, 1978.

JoAnn V.P. Menopause basics: Physiology, Perimenopause, and Menopause. The North American Menopause Society. 2005

Judd HL. Origin of serum estradiol in postmenopausal women. Obstet Gynecol 59: 680, 1982.

Sherman BM, Korenman SG: Hormonal characteristics of the human menstrual cycle throughout reproductive life. J Clin Invest 55: 699-706, 1975.

Judd HL: Hormonal dynamics associated with the menopause. Clin Obstet Gynecol 1976; 19: 775.

Kronenberg F, Fugh-Berman A. NAMS Position Statement (Treatment of menopause-associated vasomotor symptoms) Menopause 11: 11-33, 2004.

Greendale GA, Reboussin BA, Hogan P, Barnabel VM, Shumaker S, Johnson S, et al. Symptom relief and side effects of postmenopausal hormones: results from the postmenopausal estrogen/progestin interventions trial. Obstet Gynecol 92: 982-8, 1998.

Kronenberg F. Mean age of natural menopause was 49.5 years; mean age of surgical menopause was 43.7 years. Ann NY Acad Sci. 592: 52-86, 1990.

Lopes P, Tremollieres F. Ostéoporose post-ménopausique. In: Guide pratique de la ménopause. Paris: Masson; p. 45-51, 2004.

World Health Organization: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Synopsis of a WHO Study Group. Osteopor Internat 4(6): 368-81, 1994.

Pouillès JM, Trémollières F, Ribot C. Effet de la ménopause sur la masse osseuse vertébrale, étude longitudinale. Presse Med 23: 1069-73, 1994.

Torgerson DJ, Bell-Syer SE. Hormone replacement therapy and prevention of non vertebral fractures. A meta-analysis of randomized trials. JAMA 285: 2891-7, 2001.

National Osteoporosis Foundation: Physician's Guide To Prevention and Treatment of Osteoporosis. National Osteoporosis Foundation, 2005.

Sumino H, Ichikawa S, Abe M, Endo Y, Ishikawa O, Kurabayashi M. Effects of aging, menopause and hormone replacement therapy on forearm skin elasticity in women. J Am Geriatr Soc 52: 945-9, 2004.

Trémollières FA, Pouilles JM, Cauneille C, Ribot C. Coronary heart disease risk factors and menopause: a study in 1684 french women. Atherosclerosis 142: 415-23, 1999.

Williams JK, Adams MR, Klopfenstein HS. Estrogen modulates responses of atherosclerotic coronary arteries. Circulation 81(5): 1680-7, 1990.

Manson JE: Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med 349: 523-34, 2003.

Lebrun CE, Van der Schouw YT, De Jong FH, Pols HA, Grobbee DE, Lamberts SW. Endogenous oestrogens are related to cognition in healthy elderly women. Clin Endocrinol (Oxf) 63: 50-5, 2005.

Schneider LS. Estrogen and dementia insights from the Women’s Health Initiative memory study. JAMA 291: 3005-7, 2004.

Arias E: United States Life Tables, 2002, National Vital Statistics Reports. Centers for Disease Control and Prevention. 53(6), 2004.

Bergkvist L: The risk of breast cancer after estrogen and estrogen-progestin replacement. N Engl J Med 321: 293, 1989.

Collaborative group on hormonal factors in breast cancer: Breast cancer and hormone replacement therapy. Lancet 350: 1047-59, 1997.

Jensen J. Long-term effects of percutaneous estrogens and oral progesterone on serum lipoproteins in postmenopausal women. Am J Obstet Gynecol 156: 66, 1987.

Adelercreutz H. Phyto-oestrogens and cancer. Lancet Oncol 3: 364-73, 2002.

Campisi R. Tibolone improves myocardial perfusion in postmenopausal women with ischemic heart disease: an open-label exploratory pilot study. J Am Coll Cardiol 47: 559-64, 2006.

Recommendation by the Hong Kong College of Obstetricians and Gynaecologists. Available at: http://www.hku.hk/obsgyn/CME_CNE/powerpoint/MM.ppt


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