Cervantes Flores, Maribel

González Carrillo, I. Y.

Guerrero González, Geraldina

Vidal Gutiérrez, Oscar

Vázquez Méndez, Juana

Repositorio Academico Digital UANL

Medicina Universitaria 2014;16(62):12-14www.elsevier.com.mxmedicinauniversitaria* Corresponding author: Laguna de Catemaco 1359, Las Quintas, Z.P. 80060, Culiacán, Sin., Mexico. Telephone: (667) 715 8045. E-mail address: isabelyunuen@hotmail.com (I. Y. González-Carrillo).OrIGInaL arTICLeCorrelation between BMI and climateric symptoms in menopausal womenI. Y. González-Carrillo*, J. Vázquez-Méndez, G. Guerrero-González, O. Vidal-Gutiérrez, M. Cervantes-Flores Department of Gynecology and Obstetrics, “Dr. José Eleuterio González” University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexicoreceived: February 2013; accepted: november 2013KEYWORDS Climateric symptoms; Body mass index; Blatt-Kupperman index; Obesity; Mexico.AbstractObjectives: To determine the association between climateric symptoms and body mass index (BMI). In addition, to deine the age of onset of climateric symptoms and to associate a patient’s occupation and marital status with climateric symptom severity.Materials and methods: Observational, retrospective and cross-cohort study including 403 pa-tients attending the Menopause Clinic of the University Hospital of the Universidad Autónoma de Nuevo León from November 2008 to December 2011. Clinical history, physical examination, weight and height, and BMI were evaluated. Climateric symptoms were assessed through the Blatt-Kupperman modiied index. Marital status and occupation were also analyzed.Results: No relation was found between BMI and climateric severity, nor was there any relation between climateric symptoms and marital status or occupation. Conclusions: Additional research is needed to assess the inluence of climateric risk factors.1665-5796 © 2014 Revista Medicina Universitaria. Facultad de Medicina UANL. Publicado por Elsevier México. Todos los derechos reservados.IntroductionMenopause is the natural biological process in which a woman’s menstrual period stops permanently. During clima-terium, the progressive disappearance of the ovarian function occurs leading to a gradual decline in estrogen secretions and several associated hormonal alterations giving rise to a series of organic and psychological changes. In healthy women, me-nopause occurs between the ifth and the sixth decades of life (from ages 47 to 52).1 Climateric symptoms worsen in re-lation to social determinants linked to race, social and cultu-ral entitlements which fall upon their gender.2The manifestations produced as a consequence of the ova-rian function ceasing and the subsequent hormonal deicit, Documento descargado de http://www.elsevier.es el 24-08-2016Correlation between BMI and climateric symptoms in menopausal women 13are expressed with very unique symptoms known as climate-ric.1-3 In order to evaluate climateric symptoms, different scales have been developed, for instance the Kupperman index,4 the Utian Quality of Life (UQOL) Scale,5 the Greene scale,6 and the SUMEVA scale.7 Some assess the impact of climateric symptoms in the quality of life, especially the influence on perimenopausal patients, this information being useful in the follow-up of patients who receive hor-mone replacement treatment (HRT).8Hypoestrogenism has been related to physiological chan-ges which are, in part, responsible for the weight gain du-ring that period.9 In Mexico, an overweight prevalence of 72% in adult women has been reported.10 Obesity in connection with vasomotor symptoms is con-troversial. Previous studies suggest that body fat protects women from vasomotor symptoms due to the aromatization of androgens to estrogens in the adipose tissue; however, other evidence suggests that a greater body mass index (BMI), and increased body fat in particular, are associated with reports of greater climateric manifestations.11,12 In this study we assess the hypothesis that there is a correlation between BMI and the severity of climateric symptoms, stud-ying overweight (according to BMI) connection with climate-rium, through the Blatt-Kupperman index,4 with the purpose of determining whether or not obese or overweight patients suffer from more severe climateric symptoms.Materials and methodsan observational, retrospective, descriptive, cross-cohort study was described. We included 431 patients who atten-ded the Menopause Clinic of the “Dr. José Eleuterio Gonzá-lez” University Hospital of the Universidad Autónoma de Nuevo León, in Monterrey, N. L., Mexico, from November 2008 to December 2011. Patients who had received HRT du-ring the previous 3 months and those who did not comply with the required data were excluded.We performed a full clinical history check in order to ob-tain personal data and background information, a physical examination including measurement of height and weight to obtain BMI and a questionnaire on climateric symptoms through the Blatt-Kupperman modiied index.5 The Blatt-Kupperman index is a scale used to determine the severity of climateric symptoms; it assesses 15 symptoms, which are rated by the patients as follows: 0 = none, 1 = mild, 2 = mo-derate, 3 = severe. Subsequently, a score was obtained which was categori-zed as mild (0-20), moderate (21-35), or severe (> 35).13 The variables included were: age, marital status, occupation, BMI, number of years of menopause, and modified Blatt-Kupperman index.With the data obtained we created a database in Micro-soft Excel®, for subsequent analysis using SPSS® v. 14. all the variables were analyzed with traditional descriptive statis-tics such as statistical average and dispersion measures (standard deviation). Pearson’s correlation test was used to assess the correlation between BMI and Blatt-Kupperman, as well as a dispersion graph. Using Pearson’s correlation, a value of -1 to 1 was obtained (a value closer to 1 indicates a positive correlation while a value closer to -1 indicates a negative correlation; if the value is close to 0, it implies that there is no lineal relation). We assessed the correlation between marital status and occupation with the Blatt-Kup-perman index through Pearson’s R test.ResultsA total of 403 patients with an average age of 50.01 (± 7.70) years, with an average of 5.69 (± 5.97) years of menopause were included in the study. The average BMI was 28.98 (± 5.71) kg/m2. The average value of the Blatt-Kupperman in-dex was 25.78 ± 13.48. Regarding marital status, 334 (83%) of the patients were married, 52 (13%) were single, and 17 (4%) were widows. Three hundred forty-nine patients (87%) were housewives, 42 (10%) were employed outside their ho-mes and 12 patients (3%) were retired.We found that the symptoms in 113 patients (28%) were rated as severe, in 140 (35%) as moderate, and in 150 (37%) as mild, according to the Blatt-Kupperman index. Concerning BMI and degree of obesity, 0.3% of the pa-tients were thin, only 20.1% had what is considered to be a normal BMI, 41.0% were overweight, and 37.7% were obese. We evaluated the correlation between BMI and the Blatt-Kupperman index through Pearson’s R test, obtaining a va-lue of 0.053; consequently, we did not ind a relationship between these 2 variables. In order to show a correlation between BMI and the Blatt-Kupperman index, a dispersion graph was created; no corre-lation was found since we were not able to see an increasing or decreasing tendency of the Blatt-Kupperman index regar-ding BMI (Fig. 1).We evaluated the relationship between marital status and occupation with the Blatt-Kupperman index, through Pearson’s R test, with a value of -0.074 and 0.017 respectively; therefore, no relationship was found between these variables.DiscussionThe information regarding the association between BMI and climateric symptoms is controversial. In this study we asses-sed the correlation between the degree of obesity and the Blatt-Kupperman index, since some authors concur that es-trogen production in adipose tissue in overweight and obese patients protects them from suffering climateric symp-toms,9 in contrast with other authors who conclude that a greater BMI and weight gain are associated with reports of greater climateric manifestations, mainly hot lashes, du-ring transition to menopause. These indings concur with a thermoregulatory model of vasomotor symptoms in which body fat acts as an insulator, preventing heat dissipation.14 Riley et al. found that 30% of 468 perimenopausal and 287 postmenopausal females reported hot lashes. Perimeno-pausal patients with a BMI > 25 kg/m2 reported more hot flashes with a relative risk (RR) of 2.00 (RI 95% = 1.28 - 3.12). We did not find an association with hot flashes in postmenopausal patients.15Martínez Pérez et al. carried out a study with 10,514 wo-men with an average age of 57.9 (± 7.1) years, inding that smoking, use of alcohol, BMI > 25 kg/m2, marital status, educational level, and social level were associated with more severe menopausal symptoms for BMI (RR = 3.64; RI 95% = 2.96 - 4.32).16 Documento descargado de http://www.elsevier.es el 24-08-201614 I. Y. González-Carrillo et alThurston et al. assessed the connection of the adiposity with vasomotor symptoms in the study of Women’s Health across the nation, which included 1,776 women aged 47 to 59 years with an intact uterus and at least 1 ovary, in whom vasomotor symptoms and hormonal serum levels were eva-luated. They concluded that a greater percentage of body fat was associated with vasomotor symptoms (RR = 1.27; RI 95% = 1.14 - 1.42).17 In this study, no connection between BMI and Blatt-Kup-perman index was found; a probable reason for this is the fact that estrogens of peripheral origin do not have the bio-logical action that ovarian estrogen has.The reason for the inconsistent indings regarding a con-nection between BMI and climateric symptoms is unknown. Some studies suggest that the inconsistencies may be rela-ted to the different endogenous estrogen and other hormo-nes levels in women with different body sizes. Hormonal changes are customary during the transition into menopau-se. Furthermore, for the formation of estrogens from cir-culating androgen precursors, the adipose tissue produces hormones such as leptin and tumor necrosis factor, which suppress ovarian production of steroids and have an inluen-ce on thermoregulation.18 Pérez-Pérez found that women who work in public spaces adapt more easily to hormonal changes in climaterium and menopause, in contrast to those who are housewives who feel misunderstood, rejected, and have a low self-esteem.19 However, no connection was established between the Blatt-Kupperman index and occupation or marital status in our study. Further studies assessing all risk factors, like health problems, use of alcohol, smoking, role at work, family dy-namics, presence of depression, as well as their connection with weight gain or loss in the female in transition to meno-pause are required. While the results of this study report that the degree of obesity does not have an impact on climateric symptoms severity, most patients showed some degree of overweight or obesity; hence obese patients should undergo more com-plete tests, including sociological, physical, and per- sonal history, in order to identify those with a higher risk of presenting symptoms and to develop appropriate preventa-tive strategies, including lifestyle modiications and the es-tablishment of better treatment. Conlicts of interestThe authors have no conlicts of interest to declare.FundingNo inancial support was provided.References1. Accessed in January 2014. http://www.consultorsalud.com/bi-blioteca/Guias/Menopausia.pdf2. Accessed in January 2014. http://www.scog.sld.cu/Articulos/consenso2006seccclimymenop.pdf3. accessed in January 2014. http://www.docstoc.com/docs/74212096/The-Menopause-Handbook4. Kupperman HS, Wetchler BB, Blatt M. Contemporary therapy of the menopausal syndrome. JaMa 1959;171:103-113.5. Utian WH, Janata JW, Kingsberg SA, et al. The Utian Quality of Life (UQOL) scale: development and validation of an instru-ment to quantify quality of life through and beyond menopau-se. Menopause 2002;9:402-410.6. Greene JG. Construcción de una escala climatérica estándar. rev Climaterio 1998;1:292-301.7. Carranza LS, Reyes RP, Chan VR. SUMEVA, a new system of cli-materic symptom evaluation, and its correlation with FSH and estradiol levels. Int J Fertil Womens Med 2006;51:140-144.8. Carranza LS, Cruz Sánchez K. relación entre síntomas del cli-materio y la calidad de vida. Ginecol Obstet Méx 2008;76:703-705.9. Pavón de Paz I. Obesidad y menopausia. Nutrición Hospitalaria españa 2006;21:633-637.10. Díaz Villaseñor A. La obesidad en México. Salud Pública. Méxi-co: Fundación este País; 2011. p. 61-64.11. Lambrinoudaki I, Brincat M, Erel CT, et al. EMAS position state-ment: Managing obese postmenopausal women. Maturitas Gre-cia 2010;66:323-326.12. Thuston RC, Sowers MR, Sternfeld B, et al. Gains in body fat and vasomotor symptom reporting over the menopausal transi-tion. am J epidemiol 2009;170:766-774.13. Casado Méndez PR, Arró Martínez Y, Arias Hernández D. Reper-cusión del tabaquismo pasivo en el síndrome climatérico. Rev Cubana Hig Epidemiol 2012;50:1-10.14. Schwingl PJ, Hulka BS, Harlow SD. Risk factors of menopausal hot lashes. Obstet Gynecol 1994;84:29-34.15. Hyde Riley E, Inui TS, Kleinman K, et al. Differential association of modiiable health behaviors with hot lashes in perimenopau-sal and postmenopausal women. J Gen Intern Med 2004;19:740-746. 16. Martínez JA, García FC, Palacios S, et al. Epidemiology of risk factors and symptoms associated with menopause in Spanish women. Maturitas 2009;62:30-36.17. Thurston rC, Sowers Mr, Chang Y, et al. adiposity and reporting of vasomotor symptoms among midlife women. Am J Epidemiol 2008;167:78-85.18. Whiteman MK, Staropoli CA, Benedict JC, et al. Risk factors for hot lashes in midlife women. J Womens Health 2003;12:459-472.19. Pérez-Pérez R, Medina Barragán RA, Espiricueta-Medina M. Res-puestas adaptativas de mujeres en climaterio y menopausia. Rev Enferm Inst Mex Seguro Soc 2011;19:123-126.706050403020100Blatt Kupperman BMI0 100 200 300 400 500Figure 1 Dispersion chart between BMI and the Blatt-Kupper-man index.Documento descargado de http://www.elsevier.es el 24-08-2016

Correlation between BMI and climateric symptoms in menopausal women

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Correlation between BMI and climateric symptoms in menopausal women

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