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Objectives: Early menopause is shown to correlate with an increased rate of cardiovascular diseases with age advancement. Smoking, physical activity, body mass index (BMI), and the socio-economic level are consistently linked with the onset of menopause though there is no consensus on the residential factor. Considering the undesirable relation of menopause with women’s health, the present review sought to identify the correlation between the rural-urban factor and natural menopausal age. Methods: A comprehensive literature search, covering publications from 1984 to 2017, was done using several databases such as MEDLINE, PubMed, and Google scholar. Evidence from 13 research articles was analyzed for a rural-urban difference in natural menopausal age. The search was later expanded to explore correctable confounding factors such as smoking habits, physical activities, and BMI. Results: Rural women in the Asian region appeared to reach their natural menopausal age earlier than their urban counterparts. This was in contrast with the majority of findings in the non-Asian regions, suggesting a regional variation in the rural-urban difference in natural menopausal age. Based on the findings, earlier menopausal age was related to smoking prevalence and this relationship was consistent in both Asian and non-Asian regions. Similarly, higher physical activity was linked to the early age of natural menopause in both Asian and non-Asian regions. Finally, the results revealed the association between higher BMI and higher menopausal age in the Asian region although this association was not observed in the non-Asian regions. Conclusions: The rural-urban difference in menopausal age has regional variations with rural Asian women reaching menopause earlier than their urban counterparts, but this association was not replicated in the non-Asian regions. Eventually, this difference was affected by factors such as tobacco smoking, high physical activity, and BMI.

Introduction This study explored attitudes towards vasectomy and its acceptance as a method of contraception among clinical-year medical students, and determined the association between their demographic characteristics, and attitudes and acceptance. Methods A cross-sectional survey was conducted among clinical-year medical students from a Malaysian private medical college using a self-administered questionnaire. Results There were 330 participants with a female preponderance and a mean age of 22.0 ± 1.1 years. The largest proportion of respondents were from Year 3. The vast majority were ethnically Malay (91.8%) and followed Islam (92.4%). Overall, 60.9% of participants had a positive attitude towards vasectomy and 76.0% showed good acceptance. Gender, academic year, ethnicity and religion variables were not associated with attitudes and acceptance (p > 0.05). A significantly higher proportion of male respondents thought that vasectomy was religiously forbidden and would give a bad impression. A significantly higher proportion of Year 5 students agreed to the statement 'I would recommend vasectomy to relatives, friends and people close to me' compared to Year 3 and 4 students. Conclusion Students' perception of vasectomy as a contraceptive method was encouraging. Our results suggest that their knowledge improved as medical training progressed, and attitudes evolved for the better irrespective of their traditional, cultural and religious beliefs - highlighting the importance of providing students with evidence-based learning about male sterilisation, which is more cost-effective and is associated with lower morbidity than female sterilisation. A qualitative study involving students from different ethnicities and religions would provide a better understanding of this subject.

To explore women’s rationalization for using alternative medications, their experience and view on safety of long-term use. Two focus group discussions, involving 5 participants each for Chinese and Indian groups, were conducted separately. Participant’s personal information was collected anonymously. The discussion covered 5 areas: determinants for taking medications; reason for choosing alternative medications rather than hormone replacement therapy (HRT); how these medications help them; their view on cost-effectiveness and concerns over long-term use. The discussions were audio-taped, transcribed and analyzed. Chinese participants took supplements for controlling symptoms while Indian participants used herbs as a preventive measure during menopause according to their tradition. Women of both groups mentioned that they did not take HRT because of fear of side effects. Chinese group mentioned that medications remarkably improved their symptoms whereas Indian participants appreciated their herbals more for improvement in general wellbeing than for specific symptoms. All members agreed that using alternative medication was cost-effective. Both Chinese and Indian participants were quite confident in saying that long-term use will not be associated with any side effects. However, Indian group emphasized that proper preparation of herbal compound using different types of leaves, is essential in order to avoid untoward effects. Chinese and Indian women used alternative medicine in prevention and treatment of menopause-related problems even as they were avoiding HRT because of the fear of side effects. They believed that their supplements were effective, safe and cost-beneficial even with long-term use.