Objective To evaluate if the reduced likelihood of reproducing among women born small for gestational age (SGA), preterm (PT) or with low birth weight (LBW) persists towards the end of their reproductive era and to evaluate their use of medically assisted reproduction (MAR). Design Population-based register study. Setting Sweden. Population/Sample Women born in Sweden between 1973 and 1993 (n = 1 000 148). Methods Data was retrieved from registers, among others the Swedish Medical Birth Register. The study population was stratified into two cohorts, born 1973 to 1983 and 1984 to 1993. The likelihood of giving birth was analysed using a Cox Proportional Hazards model. Main Outcome Measures Giving birth to at least one child. Results Women born SGA, PT or LBW had a lower probability of giving birth (presented as HR), adjusted for sociodemographic factors, with 95% CI: SGA: HR 0.94 (0.93-0.96); PT: HR 0.95 (0.94-0.96); and LBW: HR 0.90 (0.88-0.92) but no reduction was seen for women in the younger cohort born SGA (HR 0.98 [0.95-1.01]). Women born SGA or LBW had a lower chance of childbirth after MAR (SGA 80.3%, LBW 80.0%) compared to women born with normal weight (84.6%, p < 0.001) as well as an increased risk of being treated with oocyte donation (SGA 5.5% vs. 2.5%, p < 0.001; LBW 5.0% vs. 2.5%, p < 0.001). Conclusion The decreased probability of parenthood for women born LBW, SGA, or preterm was even more evident after a longer follow-up time. When pursuing MAR with their own oocytes, they had a lower chance of conceiving.

Background

Women of advanced age (40 years or older) are generally, at risk for pregnancy and delivery related problems. In addition, there is limited knowledge on being of advanced age and having been given Assisted Reproductive Treatment (ART) and its association with negative obstetric outcomes. Therefore, data from the Swedish Medical Birth Register was used to investigate pregnancy and neonatal outcomes for women aged 40 or more who had given birth. The secondary aim was to compare the obstetric outcomes of women who had used ART and women who had not undergoneART while adjusting for marital status across the age groups.

Method

Women of advanced age who had given birth in Sweden during 2007–2012 formed the index group, n = 37,558; a reference group of women comprised 71,472 women under the age of 40. An additional subgroup of women aged 45 or older when giving birth was also formed, n = 2229. The obstetric and neonatal data for all the women was derived from national register data.

Results

Women of advanced age were more often single, had undergone ART, and more often experienced adverse obstetric outcomes than did younger women. The neonate’s health was also more often adversely affected expressed as being born with low birth weight and Small for Gestational Age (SGA), having lower Apgar scores, and having more health problems during the first week compared to the reference group.

Conclusions

Women who are approaching the upper limit of fecundity are at greater risk for having children who are preterm and SGA. The adverse effects of being preterm and SGA may have negative long-term effects, not only on the children but also on the mothers. This needs to be addressed more frequently in a clinical setting when advising women of all ages on pregnancy and ART treatment.

Internet-delivered therapies have a short history and promising results have been shown for several health problems, particularly for psychiatric conditions. This study was a first attempt to evaluate whether Internet-delivered applied relaxation for hot flushes in postmenopausal women may be useful. Due to a high drop-out rate the study was prematurely terminated after inclusion of approximately two thirds of calculated women. The Internet-delivered applied relaxation must probably be modified for such populations and settings before it can be used further. This article will discuss the benefits and pitfalls to learn in order to meet the challenges of future studies.

Objective: This work aimed to study the efficacy of group therapy with applied relaxation on vasomotor symptoms and health-related quality of life in postmenopausal women. less thanbrgreater than less thanbrgreater thanMethods: In this open, randomized controlled trial, 60 healthy postmenopausal women with at least seven moderate to severe hot flashes per 24 hours were randomized to either group therapy with applied relaxation (n = 33) or untreated control group (n = 27) for 12 weeks. A follow-up visit was scheduled 3 months after the end of therapy or participation in the control group. Salivary cortisol was measured three times during a 6-month period. Hot flashes were recorded in self-registered diaries, and health-related quality of life was assessed with the Womens Health Questionnaire. less thanbrgreater than less thanbrgreater thanResults: The number of hot flashes decreased by 5.0 per 24 hours in the applied relaxation group compared with 1.9 in the control group on the 12th week (P andlt; 0.001) and still remained at the same level at the 3-month follow-up (P andlt; 0.001). Health-related quality of life for vasomotor symptoms, sleep, and memory improved significantly on the 12th week measurement in the applied relaxation group compared with the control group. Salivary cortisol concentration was lowered markedly in the applied relaxation group on a single measurement but was otherwise mainly stable in both groups. less thanbrgreater than less thanbrgreater thanConclusions: Applied relaxation can be used to treat vasomotor symptoms in healthy postmenopausal women.

Objective: To assess if transdermal or oral estrogens, acupuncture and applied relaxation decrease the number of menopausal hot flushes/24 h and improve climacteric symptoms, as assessed by the Kupperman index, more than transdermal placebo treatment.

Setting: An outpatient clinic at a Swedish university hospital.

Methods: A total of 102 postmenopausal women were recruited to two studies performed in parallel. In Study I, the women were randomized between transdermal placebo or estrogen treatment and, in Study II, between oral estrogens, acupuncture or applied relaxation for 12 weeks. Climacteric symptoms were measured with daily logbooks on hot flushes. Women completed the assessment questionnaire for the Kupperman index at baseline and after 12 weeks.

Results: The number of flushes/24 h decreased significantly after 4 and 12 weeks in all groups except the placebo group. Both at 4 and 12 weeks, acupuncture decreased the number of flushes more (p < 0.05; p < 0.01, respectively) than placebo. At 12 weeks, applied relaxation decreased the number of flushes more (p < 0.05) than placebo. The Kupperman index score decreased in all groups except the placebo group. The decrease in score was significantly greater in all treatment groups than in the placebo group (p < 0.01).

Conclusion: Acupuncture and applied relaxation both reduced the number of hot flushes significantly better than placebo and should be further evaluated as alternatives to hormone therapy in women with menopausal vasomotor complaints.

The aim of this study was to evaluate the effect of applied relaxation and electro-acupuncture (EA) on psychological well-being in breast cancer-treated women with vasomotor symptoms. Thirty-eight breast cancer-treated postmenopausal women with vasomotor symptoms were included in the study. They were randomized to either treatment with electro-acupuncture (EA) (N = 19, three of them with tamoxifen) or applied relaxation (AR) (n = 19, five of them with tamoxifen) over a 12-week study period with six months follow-up. Vasomotor symptoms were registered daily. A visual analog scale was used to assess climacteric symptom, estimation of general well-being was made using the Symptom Checklist, and mood using the Mood Scale. These were applied during treatment and at follow-up. In total 31 women completed 12 weeks of treatment and six months of follow-up. Hot flushes were reduced by more than 50%. Climacteric symptoms significantly decreased during treatment and remained so six months after treatment in both groups. Psychological well-being significantly improved during therapy and at follow-up visits in both groups. Mood improved significantly in the electro-acupuncture treated group. In conclusion psychological well-being improved in women with breast cancer randomized to treatment with either AR or EA for vasomotor symptoms and we therefore suggest that further studies should be performed in order to evaluate and develop these alternative therapies. © 2006 Informa UK Ltd.

Objective: The aim was to evaluate and compare the effects of applied relaxation and oral estradiol treatment on hot flushes, mood and psychological wellbeing in postmenopausal women.

Patients and methods: In a prospective study, 30 postmenopausal women with vasomotor symptoms were randomized to applied relaxation or oral estradiol treatment during 12 weeks with 6 months follow-up. Number and severity of flushes were registered daily and Kupperman’s Index and a general estimate of climacteric symptoms, Mood Scale and Symptom Check List were completed at baseline, 4, 8 and 12 weeks of treatment, and 3 and 6 months after therapy.

Results: After 12 weeks of treatment, the number of flushes/24 h decreased significantly over time in both treatment groups. In the group receiving applied relaxation, the mean number of flushes/24 h decreased from 6.0 (95% CI 4.5–7.6) to 3.0 (95% CI 2.1–3.9) after 12 weeks of treatment. The mean number of flushes/24 h was 1.7 (95% CI 0.7–2.5) at 6 months follow-up; i.e. a 72% decrease. In the estrogen group, the mean number of flushes/24 h decreased from 8.4 to 0.8; i.e a 90% decrease in the number of flushes after 12 weeks of treatment. The significant change in flushes reached after 12 weeks of treatment and remained to 6 months after end of treatment in both groups. Estrogen therapy reduced flushes significantly faster than applied relaxation. General climacteric symptoms according to the Visual Analogue Scale and the Kupperman’s Index decreased significantly over time in both groups. General mood (Mood Scale) increased significantly in the estrogen group, but not in the group receiving applied relaxation. Psychological wellbeing according to Symptom Checklist, increased significantly from baseline to 12 weeks in both groups.

Conclusions: We suggest that applied relaxation may be used as an alternative treatment of vasomotor symptoms for postmenopausal women but should be further evaluated.

Vasomotor symptoms often disturb the night sleep and may lead to tiredness and mood disturbances. Many women who suffer from vasomotor symptoms ask for medical help and are often prescribed hormonal treatment. During the last years the popularity of HRT among women and doctors has decreased, probably because of the findings of long-term risks of HRT on breast cancer and the fact that the positive effects on cardiovascular health has not been confirmed in prospective randomized studies. The most effective treatment for hot flushes is HR T but for various reasons there is a need for developing alternative treatments. Relaxation therapy and behavioral therapies have been suggested for vasomotor symptoms but there are few randomized, controlled studies in this field, especially in women with breast cancer.

The general aim of this thesis was to evaluate a technique in behavior therapy, applied relaxation, as a possible treatment of vasomotor symptoms in healthy women and women treated for breast cancer.

The specific aims were:

• to assess if stress coping differed between postmenopausal women, who wanted therapy for vasomotor symptoms and postmenopausal women without symptoms and to assess if stress coping changed when women with vasomotor symptoms received estrogen therapy. 18 women were recruited to the target group and 17 women to the comparison group

• to evaluate if training applied relaxation for 12 weeks would decrease the number ofvasomotor symptoms and to evaluate if applied relaxation for 12 weeks would affect wellbeing in postmenopausal women seeking medical advice for vasomotor symptoms. 30 postmenopausal women were recruited and randomized to applied relaxation or estrogen therapy. In this study we also aimed to compare applied relaxation and estradiol as treatment of vasomotor symptoms in healthy postmenopausal women and also to compare the effects of applied relaxation and estradiol on wellbeing in healthy postmenopausal women

• to evaluate if applied relaxation or electro-acupuncture for 12 weeks would decrease the number of vasomotor symptoms in postmenopausal women treated for breast cancer and to evaluate if applied relaxation or electro-acupuncture for 12 weeks would affect wellbeing in postmenopausal women treated for breast cancer. 38 women with breast cancer and with moderate to sever vasomotor symptoms were recruited.

The main results were: Postmenopausal women bothered by vasomotor symptoms had significant lower stress coping ability measured with SCI, than women without symptoms.

Eleven out of 12 healthy postmenopausal women randomised to treatment with applied relaxation had a mean decrease of flushes about 77% six months after end of therapy. The reduction was significant and persisted six months after end of therapy. General psychological wellbeing and mood were significantly ameliorated in healthy postmenopausal women treated with applied relaxation.

Ten out of 14 breast cancer treated women randomised to treatment with applied relaxation had a mean decrease of flushes with 78 %. General psychological wellbeing was significantly ameliorated and this phenomenon appeared after the flushes were significantly reduced. Both the significant reduction of flushes and significantly ameliorated wellbeing persisted 6 months after end of therapy.

In summary: This thesis shows that that behavioral therapy with applied relaxation significantly decreases flushes and ameliorates general psychological wellbeing in postmenopausal women bothered by climacteric symptoms. Therefore we suggest that applied relaxation is a viable alternative treatment of vasomotor symptoms in healthy postmenopausal women and in women treated for breast cancer.