Skip to content


Recently, Sánchez-Zarza et al. [1] aimed at determining the prevalence of menopausal symptoms and factors related to severity in mid-aged women from Asunción, Paraguay. For this, they carried out a cross-sectional study in which 216 urban-living women (40-60 years) were surveyed with the 10 item Cervantes Scale (CS-10) and a general questionnaire containing personal and partner data. They found that the median age of the sample of 48 years, 48.1% were postmenopausal, 8.8% used menopausal hormone therapy, 39.4% psychotropic drugs, 43.5% had hypertension, 6.5% diabetes, 51.9% abdominal obesity, and 89.3% had a partner (n = 193). A history of sexual abuse was present in 2.8%. The median total CS-10 score was 8.5. Overall, 93.3% (180/193) of women having a partner were sexually active, with a median coital frequency of 8 times per month. According to the CS-10, the three most prevalent menopausal symptoms were: aching in muscles and/or joints (70.8%), anxiety and nervousness (70.8%) and hot flashes/night sweats (54.2%). Factors associated with higher CS-10 scores were: female age and educational level, marital status, menopausal status, and marital sexual aspects. Multiple linear regression analysis found that higher total CS-10 scores (more severe menopausal symptoms) negatively correlated to coital frequency and positively correlated with peri- and postmenopausal status, parity, sedentary lifestyle and a history of sexual abuse. The authors conclude that menopausal symptoms of this mid-aged urban female Paraguayan sample were related to hormonal, sexual and other female aspects.


During the menopausal transition women present a wide array of symptoms that affect their quality of life [1].  Although, in general, this is the clinical expression of a decrease of ovarian estrogens, cultural factors and social concepts regarding this period of life may have influences on the daily expression of complaints and symptoms that may differ from one region of the world to another. Paraguay is a hybrid   society   including   both   Spanish and Guarani cultural factors and myths that also may affect women’s interpretation or perception of how the climacteric may affect their quality of life. Despite the fact that data on sexuality and age at menopause regarding this population have been reported, there is no formal scientific report concerning how Paraguayan women live the menopausal transition, specifically regarding their menopausal symptoms. The authors used a simple and easy to use tool, the CS-10, to assess most prevalent menopausal symptoms and determine related factors. In a previous Latin American multicenter study, it was found that lowest age at menopause onset was observed for Asunción, Paraguay (43.8 years) [3]. In the present study [1] it was interesting finding that the most prevalent symptom was aching in muscles and/or joints which is in correlation with data from overall Latin America [2] and Ecuador [4], and not the usual vasomotor symptoms reported in other studies from developed countries as the leading bothersome climacteric symptom. As the authors state, as well as other researcher from Latina America, there are other factors, aside from decreased estrogens, that influence the presence and intensity of menopausal symptoms such cultural, socio-economical, partner, and lifestyle ones. More research in these Latin American populations is warranted to better understand the menopause.

The authors clearly state the limitations of their study basically related to study design (cross-sectional) and population (urban living women); yet also indicate that this is the first study reporting data related to menopausal symptoms of mid-aged Paraguayan women using a rapid screening tool, the CS-10, which can be seen as a potential strength, moreover if we take into account that until now, menopause related information from the Paraguayan population is pooled within reports of various multicentric Latin American studies, which have assessed age at menopause onset, sleep disorders, diabetes, hormone therapy use, but not exclusively menopausal symptoms. I agree with the authors that there is a need for further studies to better define correlates of menopausal symptoms (and other aspects) among Paraguayan mid-aged women, taking into account other female (i.e. ethnicity, sociodemographic background, nutrition and co-morbidity) and partner aspects (i.e sexually, intimate domestic violence, etc).

In conclusion, as determined with the CS-10, menopausal symptoms of this mid-aged urban female Paraguayan sample were related to hormonal, sexual and other female aspects.

Danny Salazar-Pousada, MD
Universidad Católica de Santiago de Guayaquil, Guayaquil Ecuador


  1. Sánchez-Zarza SC, Armeni AK, Chedraui P, Pérez-López FR, Gavilanes AWD. Prevalence of menopausal symptoms and severity related factors among mid-aged Paraguayan women as measured with the 10-item Cervantes Scale. Gynecol Endocrinol. 2023 Dec;39(1):2235427.
  2. Chedraui  P,  Blümel  JE,  Baron  G,  et  al.  Impaired quality of life among middle aged women:  a multicentre Latin American study.  Maturitas.  2008;61(4): 323-329.
  3. Castelo-Branco C, Blümel JE, Chedraui P, et al. Age at menopause in Latin America. Menopause. 2006;13(4):706-712.
  4. Chedraui P, Pérez-López FR, Sánchez H, et al. Application of the 10-item Cervantes Scale among mid-aged Ecuadorian women for the assessment of menopausal symptoms. Maturitas. 2014;79(1):100-105.

If you would like to add a comment or contribute to a discussion based on this issue, please contact Menopause Live Editor, Peter Chedraui, at

International Menopause Society

Install International Menopause Society - DEV

Install this application on your home screen for quick and easy access when you’re on the go.

Just tap then “Add to Home Screen”