Introduction Menopause is the last physiological menstrual period and is a complex process involving the following: endocrine, genitourinary, cardiovascular, and locomotor system, and it leads to vasomotor symptoms and psychological complaints. This study aims to investigate the influence of smoking and body mass index (BMI) as risk factors on the age of onset of menopause in women in Bosnia and Herzegovina. Material and methods This study included 460 women in natural menopause. The study was conducted in 2 phases: interview and measurement of BMI. Each patient underwent an interview based on the questionnaire, following the verbal consent of the patient, who had previously been explained the nature of the research. Results The age at which menopause occurs increases with the BMI increase, and it can be described by the regression equation: age = 0.096 × BMI + 45.7, which has statistical significance. The mean age of menopause occurrence in current smokers was lower (47.5 ±0.4 years) than in non-smokers (48.8 ±0.2 years) (p = 0.010). Conclusions Our study confirmed the statistically significant correlation between smoking, BMI, and age of onset of menopause.

Clinic for Gynaecology and Obstetrics, University Clinical Centre Tuzla, 75000 Tuzla, Bosnia and Herzegovina School of Medicine, University of Tuzla, 75000 Tuzla, Bosnia and Herzegovina Department of Gynaecology and Obstetrics, General Hospital Tešanj, 74260 Tešanj, Bosnia and Herzegovina Gynecology Centre "Dr Mahira Jahic" Tuzla, 75000 Tuzla, Bosnia and Herzegovina University Department of Gynecology and Obstetrics, Clinical Hospital, "Sveti Duh", 10000 Zagreb, Croatia School of Medicine, Croatian Catholic University Zagreb, 10000 Zagreb, Croatia

Background: In postmenopause there are changes in metabolism of bone tissue and consequent decrease of bone density. With ageing redistribution of fat occurs and an increase in body weight. Because of hormone changes in postmenopause fat is redistributed from gluteofemoral area to the abdominal region. Objective: The objective of this study was to examine the relationship between bone density and a body mass index (BMI), and distribution of the fat tissue in women in postmenopause (WHR). Methods: This research was prospective, and it included total of 83 women, 53 women were in the natural postmenopause and 30 women with the regular menstruation. Results: BMI in women in postmenopause was statistically significantly higher than BMI in women with the regular menstruations (p= 0,005). There was no statistically significant difference between waist hip ratio in women in the postmenopause in relation to the women with the regular menstruations. In women in the postmenopause significant positive correlation between BMI and density of the neck of femur was found (Z and T-score) (p=0,019; p=0,005). There was also significant negative correlation between the WHR and density of the lumbal spine (backbone) in women in the postmenopause (Z-score) (p=0,043). The identical analysis in women with regular menstruations, negative correlation between the density of the lumbal spine was found again (Z-score) and WHR , but the same was highly expressed (p=0,041). The observed correlation between BMI and bone density in this group of women was not statistically significant. Conclusion: Based on the presented results we conclude that the higher the BMI (p=0,019; p=0,005) the higher density of the femoral neck postmenopausal women have, and lower bone density of the lumbar spine the higher ratio waist / hip (p = 0.043). In the women with regular menstruation bone density of the lumbar spine is the lower the higher the ratio of waist and hip (p=0,041), while there was no correlation between BMI and bone density in this group of women.

ObjectiveThis study aims to estimate age at onset of natural menopause in domicile and refugee women who lived in Tuzla Canton in Bosnia and Herzegovina during the war (1992-1995) and in the postwar period until the interview. MethodsA cross-sectional study was conducted on a sample of 331 postmenopausal women—264 (80%) domicile women and 67 (20%) refugee women—between June 2009 and February 2011. ResultsThe study encompassed 331 women with a mean age of 57.0 years (range, 39-75 y). The overall mean age at menopause was 49.1 years. The mean age at menopause was higher in domicile women (49.3 y) than in refugee women (48.0 y; unpaired t test, P = 0.023). After adjustment for age at menarche, education, marital status, living place, body mass index, number of abortions, use of contraceptives, and current smoking, only refugee status and parity remained as significant independent predictors of age at menopause (score test, P = 0.025). Refugee women had an increased probability of earlier onset of menopause compared with nonrefugee women (adjusted hazard ratio, 1.33; 95% CI, 1.02-1.75; P = 0.039), whereas there was a decreased probability of experiencing menopause with increasing number of births (adjusted hazard ratio, 0.92; 95% CI, 0.84-0.996; P = 0.04). ConclusionsThe age at onset of menopause in refugee women is lower than that in domicile women, indicating that war, independently of other factors, could influence the age when menopause occurs. On average, women who lived in Bosnia and Herzegovina during the war and postwar period entered menopause earlier than did women from Europe.

ABSTRACT Aim: The objective of the study was to examine whether cardiotocography can (CTG) predict asphyxia of the embryo, manifested as hypoxic-ischemic encephalopathy (HIE), and to what extent one can rely on CTG record. Material and methods: Retrospective research was carried out at the Clinic for Gynecology and Obstetrics UKC Tuzla and medical documentation from the history of mothers and newborns was used. The study group consisted of 68 pregnancies and newborns who developed HIE. The control group consisted of 40 pregnancies, which resulted in birth of healthy newborns – without signs of asphyxia. CTG records were analyzed, Apgar score, the ways of finishing delivery. Results: Pathological CTG records (bradycardia 100, tachycardia 180, silent type of curve, late decelerations) were found in 45 (66,17%) cases of the study group in comparison to 11 (27,5%) in the control group. In the study group Apgar score in 5th minute lower than 7 had 17,46% newborns and the highest incidence of the normally finished deliveries. We conclude that cardiotocography is one of the reliable methods of fetal monitoring in pregnancy and delivery, and that pathological CTG record very likely indicates the possible presence of perinatal asphyxia. Conclusion: Achieving a low degree of correlation between pathological intrapartum cardiotocography findings and long-term outcome of children can be achieved by rapid and adequate obstetric intervention and the relatively short duration of fetal acidosis, and optimal procedures during intensive care of newborns.

INTRODUCTION Menopause is the last physiological menstruation and represents a crucial moment in the life of every woman. OBJECTIVE OF THE STUDY Determine the effect of parity and menarche as risk factors in the time of menopause occurrence. PATIENTS AND METHODS This study included 460 women in natural menopause. Each patient has undergone an interview based on the questionnaire, following the verbal consent of the patient who was previously explained nature of the research. Statistical analysis of data was carried out by the usual statistical methods of descriptive statistics, using regression models and "hazard ratio" for the period of life compared to the individual parameters. RESULTS The average age of menopause occurrence in women who gave birth, was somewhat higher (48.6), in comparison to women who did not give birth (47.8), but the difference was not statistically important (t=-1.07, p=0.287). In the study group there was no correlation between the age of menarche occurrence and the age of menopause occurrence. CONCLUSION There is no correlation between the age of menarche occurrence, parity and age of the menopause.

AIM The aim of this research was to examine the correlation between lipid profile and bone density in postmenopausal and premenopausal women. MATERIAL AND METHODS This research covered 53 subjects who were in postmenopause and 30 subjects who had regular menstruation, older than 45. RESULTS AND DISCUSSION The postmenopausal subjects have lower bone density of the lumbar spine, if triglyceride levels were higher (p = 0.030) and VLDL is higher (p = 0.032). In subjects with regular menstruation, the density of the neck of the femur was greater if the cholesterol values were higher (p = 0.002) and the density of the lumbar spine was greater where the levels of triglycerides (p = 0.002) and of ApoB (p = 0.026) were higher. In subjects in postmenopause there was a correlation between the density of the lumbar spine (p = 0.04) and the density of the neck of the femur (p = 0.008) with the length of menopause. The effect of lipid profile on bone density differs in women with regular menstruation and in postmenopausal women. The triglyceride levels in postmenopausal women contribute to a reduction in bone density, whilst the effect on bone density in women with regular menstruation is reversed, which indicates that the lipid profile is not an isolated factor affecting bone density, but that other factors, such as oestrogen levels and the length of post-menopause, have a significant effect on bone density.