Objective: The aims of this study were to investigate menopausal symptoms, psychological function, sexual function, and body image as experienced by younger Australian women with breast cancer and to examine the effect of different breast cancer treatments on these parameters. Methods: A questionnaire study was completed by 114 women aged 40 to 51 years with nonmetastatic breast cancer. Women were recruited from outpatient clinics or the community. Descriptive statistics and univariate analyses were conducted using Student's t tests and nonparametric tests, where appropriate. Results: The mean age of breast cancer women was 47.2 years. The most common symptoms reported were as follows: feeling tired/lacking energy (88%), loss of libido (87%), and hot flushes (83%). Anxiety and depression scores were high (18.00 ± 2.53 and 15.56 ± 1.56, respectively). Psychological symptoms (13.25 ± 6.91 vs 8.52 ± 5.61; P = 0.009), vasomotor symptoms (4.00 ± 1.90 vs 2.74 ± 1.91; P = 0.035), and sexual dysfunction scores (2.25 ± 0.86 vs 1.58 ± 1.01; P = 0.031) were significantly higher in breast cancer women with ovariectomy compared with breast cancer women without ovariectomy. Sexual feelings for partners (P = 0.02) and sexual frequency (P = 0.01) were less in women with ovariectomy compared with women without ovariectomy. Feelings of physical health, attractiveness, overall appearance, and satisfaction were significantly lower in ovariectomized women (P < 0.05). Conclusion: Menopausal symptoms, anxiety, and depression are common in younger breast cancer women. Importantly, ovariectomy in breast cancer women is associated with significant adverse menopausal physical symptoms, psychological impact, and sexual function. Both healthcare providers and women with breast cancer need to be aware of the impact of ovariectomy in younger women with breast cancer, and further education resources and support for these women should be targeted.

Objective To develop and evaluate the effectiveness of a community behavioural intervention to prevent weight gain and improve health related behaviours in women with young children. Design Cluster randomised controlled trial. Setting A community setting in urban Australia. Participants 250 adult women with a mean age of 40.39 years (SD 4.77, range 25-51) and a mean body mass index of 27.82 kg/m2 (SD 5.42, range 18-47) were recruited as clusters through 12 primary (elementary) schools. Intervention Schools were randomly assigned to the intervention or the control. Mothers whose schools fell in the intervention group (n=127) attended four interactive group sessions that involved simple health messages, behaviour change strategies, and group discussion, and received monthly support using mobile telephone text messages for 12 months. The control group (n=123) attended one non-interactive information session based on population dietary and physical activity guidelines. Main outcome measures The main outcome measures were weight change and difference in weight change between the intervention group and the control group at 12 months. Secondary outcomes were changes in serum concentrations of fasting lipids and glucose, and changes in dietary behaviours, physical activity, and self management behaviours. Results All analyses were adjusted for baseline values and the possible clustering effect. Women in the control group gained weight over the 12 month study period (0.83 kg, 95% confidence interval (CI) 0.12 to 1.54), whereas those in the intervention group lost weight (−0.20 kg, −0.90 to 0.49). The difference in weight change between the intervention group and the control group at 12 months was −1.13 kg (−2.03 to −0.24 kg; P<0.05) on the basis of observed values and −1.11 kg (−2.17 to −0.04) after multiple imputation to account for possible bias created by missing values. Secondary analyses after multiple imputation showed a difference in the intervention group compared with the control group for total cholesterol concentration (−0.35 mmol/l, −0.70 to −0.001), self management behaviours (diet score 0.18, 0.13 to 0.33; physical activity score 0.24, 0.05 to 0.43), and confidence to control weight (0.40, 0.11 to 0.69). Regular self weighing was associated with weight loss in the intervention group only (−1.98 kg, −3.75 to −0.23). Conclusions Weight gain in women with young children could be prevented using a low intensity self management intervention delivered in a community setting. Self management of health behaviours improved with the intervention. The response rate of 12%, although comparable with that in other community studies, might limit the ability to generalise to other populations. Trial registration Australian New Zealand Clinical Trials Registry number ACTRN12608000110381.

Aim. To assess psychological features in young women with and without PCOS. Methods. Observational, cross-sectional pilot study in young women aged 18–25 with (n = 24) or without (n = 22) PCOS (age: 22.41 ± 0.39 vs. 21.95 ± 0.47 years, p = 0.46; BMI: 29.17 ± 1.54 vs. 22.05 ± 0.83 kg/m2, p = 0.0003). The main outcome measures were quality of life, anxiety, depression, risk perception and fears on future health. Results. Women with PCOS demonstrated worsened quality of life (p = 0.033) and greater anxiety (p = 0.01) and depression (p = 0.023) than women without PCOS related to BMI status. Women with PCOS were more likely to perceive themselves as at risk of obesity (p = 0.012) and infertility (p < 0.0001), and perceived greater importance in reducing future risk of prediabetes (p = 0.027), gestational diabetes (p = 0.039), type 2 diabetes (p = 0.01), heart disease (p = 0.005), obesity (p = 0.0007) and infertility (p = 0.023) than women without PCOS. Women with PCOS were more likely to have fears about future health related to weight gain (p = 0.045), loss of femininity (p = 0.035), loss of sexuality (p = 0.003) and infertility (p = 0.019) than women without PCOS. Conclusions. Worsened quality of life, anxiety and depression in young women with PCOS is related to BMI. Risk perception is appropriately high in PCOS, yet perceived risks of future metabolic complications are less common than those related to weight gain and infertility.

Lifestyle related diseases associated with physical inactivity and poor diet quality, represent a major health burden. This study assessed negative and positive health habits and health care utilization in healthy women (n = 50) and women with lifestyle related diseases such as polycystic ovary syndrome (PCOS) (n = 50), gestational diabetes mellitus (GDM) (n = 44) and type 2 diabetes (DM2) (n = 43). A significant difference existed across groups for negative health habits (P = .012) with a trend for positive health habits (P = .06) elevated in women with PCOS. Women with DM2 had the highest amount of health care utilization including doctors office visits (P < .001), overnight hospital treatments (P < .001) and emergency room treatments (P = .01). Health practitioners would benefit from both encouraging positive health habits and addressing negative health habits. Furthermore, self-management and emphasizing the pivotal role patients' have in managing their illness is important for optimizing health outcomes. Elevated health care utilization rates were observed in women with DM2 but there were no differences in positive health habits across sub-groups. Encouraging lifestyle modification in women with precursor diseases such as GDM and PCOS is vital in order to prevent progression to DM2.

Polycystic ovary syndrome (PCOS) is associated with high levels of depression, which impact quality of life and limit self-efficacy, yet less is known about prevalence of anxiety. This cross-sectional, observational study of community-based women with PCOS comprehensively examined mood and found that anxiety existed at higher levels than depression, anxiety was underdiagnosed, and more women with PCOS who reported infertility were depressed. (Fertil Steril (R) 2010;93:2421-3. (C) 2010 by American Society for Reproductive Medicine.)

AbstractObjectiveThe WHO has recommended that prevention of overweight and obesity should begin early and target adults, including those with an acceptable BMI. The aim of the present paper was to systematically review published interventions with a specific stated aim to prevent weight gain.DesignFive databases were searched to July 2008. The reference lists of review articles and obesity society meetings abstracts were hand searched. Interventions were included if the primary aim was to prevent weight gain and they included a comparison group.ResultsTen publications were included, describing nine separate interventions in adults of various ages and target populations. All interventions incorporated diet and physical activity with behaviour change strategies. Most studies were between 1 and 3 years in duration. Five studies reported a significant difference in weight between intervention and control subjects of between 1·0 and 3·5 kg, due largely to an increase in weight in the control group. However, there was a lack of consistent, clear, psychological models and a failure to identify successful components. More intensive interventions were not always successful, nor were mail-only or clinic-based interventions. In contrast, interventions that included mixed modes of delivery with some personal contact were successful.ConclusionsThere were relatively few trials aimed at the prevention of weight gain. Existing trials varied by intensity, delivery methods, target groups and study components, and therefore provide limited opportunities for comparison of effect size. Further large, effective, evidence-based programmes are urgently needed in the general population as well as high-risk groups.

Background: Preventing weight gain rather than treating established obesity is an important economic and public health response to the rapidly increasing rates of obesity worldwide. Treatment of established obesity is complex and costly requiring multiple resources. Preventing weight gain potentially requires fewer resources to reach broad population groups, yet there is little evidence for successful interventions to prevent weight gain in the community. Women with children are an important target group because of high rates of weight gain and the potential to influence the health behaviors in family members.Methods: The aim of this cluster randomized controlled trial was to evaluate the short term effect of a community-based self-management intervention to prevent weight gain. Two hundred and fifty mothers of young children (mean age 40 years +/- 4.5, BMI 27.9 kg/m(2) +/- 5.6) were recruited from the community in Melbourne, Australia. The intervention group (n = 127) attended four interactive group sessions over 4 months, held in 12 local primary schools in 2006, and was compared to a group (n = 123) receiving a single, non-interactive, health education session. Data collection included self-reported weight (both groups), measured weight (intervention only), self-efficacy, dietary intake and physical activity.Results: Mean measured weight decreased significantly in the intervention group (-0.78 kg 95% CI; -1.22 to -0.34, p < 0.001). Comparing groups using self-reported weight, both the intervention and comparison groups decreased weight, -0.75 kg (95% CI; -1.57 to 0.07, p = 0.07) and -0.72 kg (95% CI; -1.59 to 0.14 p = 0.10) respectively with no significant difference between groups (-0.03 kg, 95% CI; -1.32 to 1.26, p = 0.95). More women lost or maintained weight in the intervention group. The intervention group tended to have the greatest effect in those who were overweight at baseline and in those who weighed themselves regularly. Intervention women who rarely self-weighed gained weight (+0.07 kg) and regular self-weighers lost weight (-1.66 kg) a difference of -1.73 kg (95% CI; -3.35 to -0.11 p = 0.04). The intervention reported increased physical activity although the difference between groups did not reach significance. Both groups reported replacing high fat foods with low fat alternatives and self-efficacy deteriorated in the comparison group only.Conclusion: Both a single health education session and interactive behavioral intervention will result in a similar weight loss in the short term, although more participants in the interactive intervention lost or maintained weight. There were small non-significant changes to physical activity and changes to fat intake specifically replacing high fat foods with low fat alternatives such as fruit and vegetables. Self-monitoring appears to enhance weight loss when part of an intervention.Trial registration: ACTRN12608000110381

Background Lifestyle-related diseases, including diabetes, cardiovascular disease, and some cancers represent the greatest global health threat. Greater insight into health needs and beliefs, using broad community samples, is vital to reduce the burden of chronic disease. This study aimed to investigate gender, age, screening practices, health beliefs, and perceived future health needs for healthy ageing. Methods Random probability sampling using self-completion surveys in 1456 adults residing in Australia. Results Screening behaviors were associated with gender and age. Men and women >51 years were more likely (27%) to have screening health checks than those <50 years (2%). Factors nominated to influence health were lifestyle (92%), relationships (82%), and environment (80%). Women were more likely to nominate preparedness to have an annual health check, willingness to seek advice from their medical practitioner and to attend education sessions. Numerous health fears were associated with ageing, however participants were more likely to have a financial (72%) rather than a health plan (42%). More women and participants >51 years wanted information regarding illness prevention than men or those aged <30 years. Conclusion Age and gender are associated with health related behaviors. Optimal health is perceived as a priority, yet often this perception is not translated into preventative action. These findings will inform future research and policy makers as we strive towards a healthier ageing society and the prevention of chronic disease.

Women aged 25–45 years represent a high risk group for weight gain and those with children are at increased risk because of weight gain associated with pregnancy and subsequent lifestyle change. Average self-reported weight gain is approximately 0.60 kg per year, and weight gain is associated with increased risk of chronic disease. There are barriers to reaching, engaging and delivering lifestyle interventions to prevent weight gain in this population.

OBJECTIVE:To investigate risk perceptions in relation to menopausal experiences, comparing premenopausal women's expectations to actual experiences of menopause, including perceptions of symptoms, fears, risks of future illnesses, and side effects of symptomatic treatments. DESIGN:This was a cohort study using surveys in a random sample of Australians participating in an Australian Health Report series, supported by Pfizer. This article focuses on perceptions about menopause of 710 women. RESULTS:Peri- and postmenopausal women experienced more fatigue, sleeplessness, fluid retention, and bloating than premenopausal women expected to experience. Perimenopausal and postmenopausal women rated menopause as the "first day of the rest of [my] life" significantly more than premenopausal women. All women perceived that menopause had an impact on aging and weight gain, but more premenopausal women feared loss of sexuality (55%), loss of femininity (39%), and the inability to have more children (37%). Perceptions of illnesses differed from actual incidence, with 27% of all women perceiving breast cancer and 11% perceiving heart disease as a health risk, compared with actual female mortality figures of 3% and 41%, respectively. Perceptions of the effects of hormone therapy were inaccurate, with 53% of all women expecting a reduction in hot flushes, 44% expecting that hormone therapy increased breast cancer, and 23% expecting that hormone therapy decreased fractures. CONCLUSIONS:This study suggests a difference between perceptions of symptoms, fears, risks of future illnesses, and side effects of symptomatic treatments at menopause and actual experience. Because risk perception influences health-related behaviors, visits to healthcare providers, and treatment decisions and can be modified through education, an understanding of risk perception is clinically important. Further research is needed.

OBJECTIVES:Many studies have investigated anxiety and depression during the menopausal transition. However, there is little understanding of positive aspects of well-being among menopausal women. This paper reports on two studies which investigated how menopausal stage and age accounted for how women felt about their purpose in life, self-acceptance and social role.METHOD:In Study One, 304 women from a community sample completed structured questionnaires which included questions relating to demographic background and two subscales of the Psychological Well-being Inventory: purpose in life and self-acceptance. In Study Two, 203 participants from Study One returned a follow-up structured questionnaire related to purpose in life and social role.RESULTS:Study One found that the effects of age group and menopausal group could not be separated: All women felt they would be more positive about these well-being measures in the future than they had been in the past and at present. Study Two found that women who were perimenopausal and postmenopausal did not feel as positive about their role/s in life as premenopausal women, regardless of their age.CONCLUSIONS:The results suggest that the menopause may indicate to women that their role/purpose in life is changing. It is important that any understanding of the menopause incorporate psychosocial aspects of women's lives. Further longitudinal studies are needed to explore well-being factors and the menopause.

The authors of our theme articles this month discuss their approach to the assessment and management of a woman presenting with issues relating to menopause and midlife.

Psychosocial influences have been found to impact on the symptoms a woman may experience as she moves through the menopause transition. Consequently any assessment of the menopausal woman should include an exploration and understanding of how the many psychosocial factors influence the experience of menopause and midlife.This article describes the many psychosocial factors that influence the experience of menopause including midlife issues, role and purpose in life, interpersonal relationships, libido, personality, psychological history and present psychological functioning, body image and sociocultural issues. Case studies are included to illustrate the importance of including psychosocial factors in the assessment and treatment of the menopausal woman.Any assessment of the menopause experience should include psychosocial influences and the context of women's lives. In a consultation where both the physical and psychosocial issues are explored, we come closer to addressing the true needs of each patient.

The influence of endocrine function on the mood of the menopausal woman continues to be debated and researched. While many women present at the menopause with depression and anxiety, the reasons for these mood disorders cannot be attributed to menopause status alone. The influence of psychological factors, lifestyle, body image, interpersonal relationships, role, and sociocultural factors in predicting levels of depression and anxiety in the menopausal patient cannot be ignored. This chapter discusses the research to date on menopause and depression and anxiety. Included is a discussion of the role of psychosocial factors in the symptomatology of perimenopausal, post-menopausal and prematurely menopausal women. The importance of understanding the individual menopausal experiences of women within the context of their lives while offering support, education, and validation is highlighted. The need for a multidimensional approach to treating the menopausal woman who presents with mood disorders is examined. Finally, this chapter makes it clear that psychosocial aspects of menopause management require further research, particularly on the experiences of women who enter menopause prematurely.