The impact of menopause on health-related quality of life: results from the STRIDE longitudinal study

The relationship between religious affiliation and menopause symptoms and attitudes in United States women

OBJECTIVES

This study's aim is to examine patterns of menopause symptoms and attitudes among United States women from different religious affiliations.

STUDY DESIGN

We used data from a national sample of midlife and older adults. For this analysis, we included only women who were postmenopausal or had undergone hysterectomy. We constructed univariate and multivariate logistic regression models to examine the relationship between religious affiliation and menopause symptoms and attitudes while adjusting for potential confounders.

MAIN OUTCOME MEASURES

Menopause symptoms (hot flashes, pain in sexual interactions, pleasure in sexual interactions, trouble falling asleep) and attitudes (relief on periods stopping, regret on periods stopping, worry about becoming less attractive) measured by self-report on Likert scales.

RESULTS

Across denominations, 47 % of women experienced hot flashes, 48 % experienced pain in sexual interactions, 95 % experienced pleasure, and 88 % had trouble falling asleep. Regarding attitudes towards menopause and aging, 62 % felt relief in their periods stopping, while 56 % expressed worry about becoming less attractive with aging. Baptist women were more likely to experience hot flashes and trouble falling asleep compared to Catholic women. However, when adjusted for smoking status, this relationship did not persist. Unaffiliated and Spiritual women were less likely to experience trouble falling asleep and more likely to report pleasure in sexual interactions compared to Catholic women. Spiritual women were significantly more likely to feel regret on periods stopping compared to Catholics.

CONCLUSIONS

There is a relationship between religious affiliation and the menopause experience. These findings demonstrate the importance of considering social influences on women's health.

A cross-sectional study of symptoms and health-related quality of life in menopausal-aged women in China

OBJECTIVE

To measure symptoms and health-related quality of life in a cross-sectional cohort of menopausal-aged women in China.

METHOD

A cross-sectional survey was conducted in a general population cohort of 2,000 Chinese females over the age of 45 years. Patients completed the Chinese version of the EuroQol-5D five level (EQ5D5L) health-related quality of life instrument via Personal Digital Assistant. Raw scores were converted to utility tariffs using value sets for China. Statistical analysis included Pearson's chi-square test, z test for multiple comparisons with adjustment by the Bonferroni method, independent-sample t-test, ANOVA, and adjustment by the Tukey method for multiple comparison. Results were considered statistically significant when p < 0.05 and the study was reported according to the STROBE recommendations.

RESULTS

In a cohort of 2000 women, 732 (37%) were premenopausal, 798 (40%) were perimenopausal and 470 (23%) were postmenopausal. Perimenopausal women reported significantly more symptoms (91%) compared to premenopausal (77%) and postmenopausal (81%) women. Health-related quality of life was significantly lower in symptomatic perimenopausal women compared to premenopausal (0.919, p < 0.05) and postmenopausal (0.877, p < 0.05) women. Within each group there was a statistically significant difference between the health-related quality of life of women with symptoms compared to without symptoms.

CONCLUSION

The perimenopausal phase of menopause is associated with significantly more symptoms and significantly lower HRQoL compared to premenopausal and postmenopausal phases.

Is menopause managed well enough in general practice?

Menopause is an important phase in the life of older women. Women's life expectancy has increased worldwide. As women experience and perceive menopause differently depending on their personal, family and sociocultural backgrounds, perimenopausal symptoms can often go unnoticed and missed by general practitioners. General practitioners are uniquely placed in the healthcare delivery pyramid to close this gap and improve patients' quality of life by identifying perimenopausal signs and symptoms early. This article shares knowledge about continuing medical education for general practitioners to close the existing gap. As there is great variability within each menopausal woman's experience as well as among individual women, there is a need to individualise and render personalised care. By being able to discuss accepted and safe standards of care and by advocating for a holistic approach incorporating both non-pharmacological and pharmacological strategies, general practitioners would be able to improve the confidence of their patients for better health outcomes.

Health-related quality of life in women with various levels of spiritual health

This study investigates for the first time the relationship between spiritual health (SH) and health-related quality of life (HRQoL) in different periods of life in healthy women, which could be important in the current critical post-pandemic situation. We recruited data from 2238 healthy women in the Tehran Lipid and Glucose Study (TLGS) framework, performed a cross-sectional study, and divided them into four age groups: 1) 20-34, 2) 35-44, 3) 45-54, and 4) 55≤ years. HRQoL and SH were measured using Short-Form 12-Item Health Survey version 2 and spiritual health inventory in Muslim adults (SHIMA-48). We defined low and high SH as the first and third tertile of SHIMA-48 scores. Most participants were in the first age group (39 percent), were married (74.7 percent), and were housewives (74.7 percent). The mean mental component summary score and its domains were directly associated with age. This subscale was significantly higher in individuals with high SH scores in all age groups. However, except for general health, other physical subscales did not differ significantly between the two levels of SH among the age groups studied. Results indicate higher HRQoL, especially mental health, in healthy women with increased spiritual well-being. This finding can be used in programs to improve psychological health in women.

An umbrella systematic review of the effect of physical exercise on mental health of women in menopause

IMPORTANCE

The menopausal transition has been related to worsening mental health. The literature also points out that being physically active during menopause is associated with a favorable effect on climacteric symptoms, specifically on psychological aspects.

OBJECTIVES

The aims of the study are to analyze the effects of physical activity on mental health during menopause through an umbrella review and to evaluate the quality of the included Systematic Reviews and meta-analyses (MAs).

EVIDENCE REVIEW

A MeaSurement Tool to Assess Systematic Reviews was used to evaluate the methodological quality of the included studies and the Grading of Recommendations Assessment, Development and Evaluation was applied to assess the level of the evidence of the results. In addition, the effect size of the revised meta-analyses (MAs) was calculated.

FINDINGS

A total of 9 systematic reviews/MAs were included, published between 2014 and 2020. In the A MeaSurement Tool to Assess Systematic Reviews methodological quality assessment, 8 studies were classified as "high quality" and 1 as "low quality." In terms of quality of the evidence for each result through the Grading of Recommendations Assessment, Development and Evaluation classification, approximately 75% of the studies were classified as "moderate quality," 22.2% as "high quality," and 22.2% as "low quality," with the greatest bias concerning the high heterogeneity of the included studies. In addition, the studies showed low overlap. Despite the high heterogeneity, we can highlight the importance of the practice of physical activity by women in menopause, to prevent and/or reduce problems related to mental health.

CONCLUSIONS AND RELEVANCE

There was a positive effect of the interventions on depression, however, with no difference between durations (short or long). Regarding stress, the interventions applied did not show a positive effect. The studies that investigated depression linked to anxiety presented conflicting results.

"You're more engaged when you're listening to somebody tell their story": A qualitative exploration into the mechanisms of the podcast 'menopause: unmuted' for communicating health information

OBJECTIVE

While health podcasts can be effective in reducing stigma and increasing knowledge, we know little about their mechanisms of action. This qualitative study explored the mechanisms of how women connected with the podcast 'menopause: unmuted', which presented menopause information in a storytelling format.

METHODS

A diverse sample of 30 women aged 40-60 years were interviewed after listening to the podcast. Interviews covered participant's views and perceptions of the stories presented. Transcripts were analyzed thematically.

FINDINGS

Two overarching themes were identified. 'Openness and authenticity' describes the value of personal stories told in an authentic way by real experts-by-experience. 'Relatability and representation' explores participants' emotional reaction to the podcast, influenced by the extent to which they identified with the stories and storytellers on the podcast.

CONCLUSIONS

Authenticity and relatability were identified as key mechanisms through which participants connected with audio stories, consistent with Fisher's narrative theory. These findings have important implications for the application of storytelling in podcasts designed to influence health behaviors.

PRACTICE IMPLICATIONS

Diverse stories representing a range of demographic characteristics and experiences are needed when creating podcasts about health information to increase listener's relatability and connection.

Factors associated with health-related quality of life in patients with coronary heart disease

Coronary heart disease (CHD) contributes to decreased health-related quality of life (HRQOL). This review article investigates the factors that can affect the HRQOL in CHD patients. A literature search from PubMed and EBSCO databases was performed until March 2021 with predetermined keywords. The review of 15 included articles showed that many factors that can affect the HRQOL by using EQ-5D instrument in CHD patients, such as education, gender, comorbidity, percutaneous coronary intervention (PCI)/coronary artery bypass graft (CABG) intervention, patient-physician interaction, obesity, physical activity, numbers of medication, smoking, self-efficacy, social/family life, alcohol drinking, income, employment, and behavioral risk factor profile. The top three factors associated with HRQOL in CHD patients were education, gender, and comorbidity. Therefore, we should pay more attention to CHD patients with lower education levels, females, and comorbidity.

High-density Lipoprotein Cholesterol as a Risk Factor of Health-Related Quality of Life in 50–70-Year-Old Community-Dwelling Women

BACKGROUND: The prevalence of dyslipidemia, a risk factor of cardiovascular disease, is at present sufficiently high, particularly in the elderly. Health-related quality of life (HRQoL) is also an important outcome in the treatment of dyslipidemia, which is currently more targeted at lowering the low-density lipoprotein cholesterol (LDL-C) concentration. AIM: The aim of this study was to determine the relationship between the high-density lipoprotein cholesterol (HDL-C) concentration and HRQoL in community-dwelling women aged 50–70 years. METHODS: A cross-sectional study involving 137 women aged 50–70 years who underwent blood sampling for determining the concentrations of hemoglobin, total cholesterol (TC), LDL-C, and HDL-C. A questionnaire was given to all subjects regarding data on age, menopausal status, level of education, and also another questionnaire of SF-36 for evaluation HRQoL. Bivariate and multivariate logistic regression analysis was used to identify risk factors associated with HRQoL. RESULTS: In bivariate logistic regression analysis, age, menopausal status, education level, anemia, TC, and LDL-C were found to have non-statistically significant association with HRQoL, but HDL-C was significantly associated with HRQoL (odds ratio = 0.44; 95% Confidence interval [CI] = 0.20–0.97; p = 0.042). In multivariate analysis, menopausal status and education level have a non-statistically significant association with HRQoL, but those normal level of HDL cholesterol was found 0.18 times less likely to be associated with poor HRQoL (Adjusted odds ratio 0.18; 95% CI = 0.03–0.91; p = 0.038). CONCLUSION: This study showed that HDL-C levels were risk factors of HRQoL in women 50–70 years of age.

Hand grip strength and health-related quality of life in postmenopausal women: a national population-based study

OBJECTIVE

Muscle strength progressively decreases after menopause. Hand grip strength (HGS) reflects overall muscle strength and may be associated with health-related quality of life (HRQoL). We aimed to assess the association between HGS and HRQoL in postmenopausal women.

METHODS

We used nationally representative data on 6,059 postmenopausal women from the Korea National Health and Nutrition Examination Survey (2014-2018). HGS was determined as the maximum value in kilograms (kg) achieved using either hand. HRQoL was estimated using the European Quality of Life Questionnaire-Five Dimensions (EQ-5D) questionnaire. The prevalence ratios of having moderate/severe problems on the EQ-5D were evaluated with adjustment for covariates using complex survey analysis.

RESULTS

The prevalence of having a problem in at least one of the HRQoL dimensions among postmenopausal women was 43.6%. Compared with participants with the lowest quintile of HGS, women in the highest quintile had a significantly lower prevalence of moderate/severe problems in most dimensions (fully adjusted prevalence ratios [95% confidence intervals]; 0.73 [0.60-0.89], 0.45 [0.28-0.72], 0.52 [0.38-0.71], 0.74 [0.63-0.87], and 0.91 [0.70-1.18] for mobility, self-care, usual activity, pain/discomfort, and anxiety/depression, respectively). The associations between HGS and EQ-5D index were stronger among the participants who were older (65-79 y), had a higher body mass index (≥ 25.0 kg/m2), had low physical activity, had a longer duration since menopause (≥ 10 y), and had a chronic disease.

CONCLUSIONS

Higher HGS was associated with a lower prevalence of moderate/severe problems in each dimension of the EQ-5D in postmenopausal women. These associations were more apparent in individuals who were older, had higher body mass index, or had a chronic disease.

"It just makes me feel a little less alone": a qualitative exploration of the podcast Menopause: Unmuted on women's perceptions of menopause

OBJECTIVE

Menopause can negatively impact women's quality of life, with many women reporting inadequate information and support. Podcasts have grown in popularity in recent years and have been found to be accessible methods for increasing knowledge and challenging perceptions of stigmatized topics. The current research aimed to understand the impact of the podcast "menopause: unmuted" on women's menopause-related knowledge, understanding, and communication practices.

METHODS

A diverse sample of 30 women aged 40 to 60 years listened to the podcast series, which focused on menopause stories, before taking part in semistructured interviews to discuss the impact of the podcast on how they understood and communicated about menopause. The interviews were analyzed thematically.

RESULTS

Two overarching themes were identified in the data. A "journey of knowledge gain" explores participants' understanding of menopause before listening to the podcast and describes how this is deepened by hearing and connecting with women's stories. "Reframing menopause" describes the impact of the podcast, where women reflect on the value of communication amongst women, challenge and re-evaluate the stigmatization of menopause, and discuss ways to make positive behavioral changes in their lives.

CONCLUSIONS

The podcast "menopause: unmuted" helped women to learn about the menopause experience, have a greater sense of belonging to a community of women, and feel empowered to make changes in their own lives. Sharing stories via podcasts has potential as an accessible and impactful medium to educate women and reduce the widespread stigma associated with menopause.

The Effect of Evening Primrose Oil Capsule on Hot Flashes and Night Sweats in Postmenopausal Women: A Single-Blind Randomized Controlled Trial

Objectives

Menopause is associated with complications that could decline women's health during this period. Therefore, some of its complications, such as hot flashes and night sweats, must be treated or alleviated.

Methods

This randomized controlled trial included postmenopausal women who were referred to health centers in Hamadan from May 2018 to April 2019. The hot flash and night sweat questionnaires were completed by the researcher a week before and 8 weeks after the intervention. The intervention group took one capsule (1,000 mg) of evening primrose oil twice daily, while the control group received the same amount of placebo. Finally, the results were analyzed using Stata 13.

Results

The mean scores of duration, frequency, and severity of hot flashes did not significantly decrease in both groups after the intervention compared with before the intervention, and no statistically significant difference was observed (P > 0.05). However, the intervention group had lower frequency and severity of night sweats after the intervention than the control group, with statistically significant differences (P < 0.05).

Conclusion

Evening primrose oil effectively decreased the frequency and severity of night sweats.

Cocoa-Rich Chocolate and Quality of Life in Postmenopausal Women: A Randomized Clinical Trial

Menopause has a negative impact on quality of life (QoL). The aim of the present study was to analyse the effect on QoL of adding 10 g per day of chocolate with a high concentration of cocoa (99%) to the habitual diet, for 6 months, in a sample of postmenopausal women. Postmenopausal women (n = 140) aged 50–64 years were randomised to either an addition of 10 g per day of cocoa-rich chocolate to their usual diet or no supplement addition. All variables were measured at baseline and after six months of intervention. QoL was evaluated using the 3-level version of EuroQol-5D (EuroQoL-5D-3L), the EuroQol Visual Analogue Scale (EQ-VAS) and the Cervantes scale. Analysis of covariance (ANCOVA) analyses adjusted for the main determinants of QoL considered in this study showed no changes in the global score of QoL evaluated with the EuroQoL-5D-3L. The intervention group showed an increase of 6.0 points (95% confidence interval (CI): 0.4, 11.7) in the EQ-VAS compared to the control group (p = 0.036). No significant changes were observed between groups in the global score of QoL nor in the dimensions and subdimensions measured with the Cervantes scale. The additional daily contribution of 10 g of cocoa-rich chocolate in postmenopausal women could have a slight impact on their perception toward their health state, although without modifying the health-related QoL or the dimensions that compose it.

Association of Menopausal Symptoms with Overweight and Obesity among Rural Middle Aged Women in North India: A Population Based Study

Background:

Overweight and obesity are important determinant of increasing morbidity among all age groups, including menopausal women. The symptoms of menopause have a negative impact on the quality of life.

Objectives:

The aim of this study is to assess the prevalence of overweight and obesity in menopausal women and also to find its association with menopausal symptoms and sociodemographic variables.

Materials and Methods:

The study was conducted among middle-aged women (40–60 years) from April 2018 to March 2019. The Menopausal Rating Scale was used to assess the severity of menopausal symptoms in 400 women, and data were collected for sociodemographic factors, menstrual history in the past month, and personal history.

Results:

About 35.5% of menopausal women were overweight/obese (26% overweight and 9.5% obese) with average body mass index of 23.9 ± 4.84 and mean age of 53.65 ± 5.11 years Joint and muscular discomfort (P = 0.001), hypertension (P = 0.014), literacy level (P = 0.009), and socioeconomic status (P = 0.01) were significantly associated with overweight/obesity. With reference to women with no/little somatic and urogenital complaints, the odds of developing obesity was more (adjusted odds) in patients with mild (odds ratio [OR] - 2.8), moderate (OR - 2.1), and severe (2.19) somatic complaints and also higher risk in patients with mild (OR-3.2), moderate (OR - 1.1), and severe (OR - 1.74) urogenital symptoms. The age of menopause was significantly more among overweight than normal-weight women (P = 0.033).

Conclusion:

Overweight and obesity associated with menopause require increased attention and a multidisciplinary approach to women's health to prevent morbidity in this population group.

How gender-specific are predictors of post-MI HRQoL? A longitudinal study

Purpose

Extant research shows that health-related quality of life (HRQoL) differs between female and male survivors of myocardial infarction (MI), but the reasons for this are not fully understood. We aimed to examine the predictors of HRQoL in female and male survivors during the first year after MI.

Methods

At timepoints 1 and 2, the sample comprised 222 MI survivors (59 women and 163 men; mean age 53.84 years, range 24–65) referred for in-patient cardiac rehabilitation. This number dropped to 140 participants (42 women and 98 men) at the third timepoint, approximately one year after the MI. We examined the gender differences in various predictors of physical and mental HRQoL: demographic factors (e.g., age, education, marital status), disease-related factors (pre- and post-MI), personality and coping with stress.

Results

Initially, both physical and mental HRQoL were lower in women than men, but the differences disappeared at timepoint 3. Stepwise regressions performed separately for men and women revealed that the factors shaping HRQoL were different in both genders; they also changed over time. Substantially fewer factors predicted physical HRQoL in women than in men. Trait anxiety seems to play a similarly negative role in both genders.

Conclusions

The psychosocial resources that influence HRQoL were different for women and men. There were also differences concerning predictors of HRQoL dimensions. Further studies with a different or broader range of predictors are needed, especially among women.

Using Bayesian Networks to Predict Long-Term Health-Related Quality of Life and Comorbidity after Bariatric Surgery: A Study Based on the Scandinavian Obesity Surgery Registry

Previously published literature has identified a few predictors of health-related quality of life (HRQoL) after bariatric surgery. However, performance of the predictive models was not evaluated rigorously using real world data. To find better methods for predicting prognosis in patients after bariatric surgery, we examined performance of the Bayesian networks (BN) method in predicting long-term postoperative HRQoL and compared it with the convolution neural network (CNN) and multivariable logistic regression (MLR). The patients registered in the Scandinavian Obesity Surgery Registry (SOReg) were used for the current study. In total, 6542 patients registered in the SOReg between 2008 and 2012 with complete demographic and preoperative comorbidity information, and preoperative and postoperative 5-year HROoL scores and comorbidities were included in the study. HRQoL was measured using the RAND-SF-36 and the obesity-related problems scale. Thirty-five variables were used for analyses, including 19 predictors and 16 outcome variables. The Gaussian BN (GBN), CNN, and a traditional linear regression model were used for predicting 5-year HRQoL scores, and multinomial discrete BN (DBN) and MLR were used for 5-year comorbidities. Eighty percent of the patients were randomly selected as a training dataset and 20% as a validation dataset. The GBN presented a better performance than the CNN and the linear regression model; it had smaller mean squared errors (MSEs) than those from the CNN and the linear regression model. The MSE of the summary physical scale was only 0.0196 for GBN compared to the 0.0333 seen in the CNN. The DBN showed excellent predictive ability for 5-year type 2 diabetes and dyslipidemia (area under curve (AUC) = 0.942 and 0.917, respectively), good ability for 5-year hypertension and sleep apnea syndrome (AUC = 0.891 and 0.834, respectively), and fair ability for 5-year depression (AUC = 0.750). Bayesian networks provide useful tools for predicting long-term HRQoL and comorbidities in patients after bariatric surgery. The hybrid network that may involve variables from different probability distribution families deserves investigation in the future.

Health-related quality of life and its influencing factors in Chinese with knee osteoarthritis

PURPOSE

To evaluate the health-related quality of life (HRQoL) of knee osteoarthritis (KOA) patients in China, compare their HRQoL with norm population, and examine the associations between the potential influencing factors and HRQoL.

METHODS

A cross-sectional study was conducted in 912 KOA patients from 4 provinces between March and November 2017. All participants were diagnosed according to the National Institute for Health and Care Excellence (NICE)'s criterion or the Chinese Medical Association (CMA)'s criterion. Recruited patients were surveyed for HRQoL using the 12-item Short Form (SF-12) and sociodemographic, disease-related factors. We assessed the associations between potential influencing factors and HRQoL using multiple linear regression models.

RESULTS

Among the KOA patients, the mean physical component summary (PCS) of HRQoL was 40.91 ± 11.62, lower than norm (P < 0.001). And the mean mental component summary (MCS) was 50.25 ± 11.99, similar to the norm. Patients who were older (β = - 0.155, P = 0.001), women (β =  - 4.589, P < 0.001), had ever been treated (β =  - 2.426, P = 0.006), had longer course of KOA (β =  - 0.164, P = 0.012), and were in early stage (β =  - 2.968, P = 0.001) or progressive/late stage (β =  - 7.636, P < 0.001) showed lower scores of PCS. Patients who lived in Hunan (β = 4.988, P < 0.001) and had education levels of junior high school (β = 3.134, P = 0.012) or senior high school and above (β = 3.050, P = 0.010) had better mental status. Those suffered from non-knee pains (β =  - 2.308, P = 0.027) and with progressive or late KOA (β =  - 4.690, P = 0.016) had lower MCS scores.

CONCLUSION

KOA patients had worse physical condition. The mental and physical health of patients were affected by different factors. Targeted management measures should be taken to improve their HRQoL.

A Neural Circuit Underlying the Generation of Hot Flushes

Hot flushes are a sudden feeling of warmth commonly associated with the decline of gonadal hormones at menopause. Neurons in the arcuate nucleus of the hypothalamus that express kisspeptin and neurokinin B (Kiss1^ARH neurons) are candidates for mediating hot flushes because they are negatively regulated by sex hormones. We used a combination of genetic and viral technologies in mice to demonstrate that artificial activation of Kiss1^ARH neurons evokes a heat-dissipation response resulting in vasodilation (flushing) and a corresponding reduction of core-body temperature in both females and males. This response is sensitized by ovariectomy. Brief activation of Kiss1^ARH axon terminals in the preoptic area of the hypothalamus recapitulates this response, while pharmacological blockade of neurokinin B (NkB) receptors in the same brain region abolishes it. We conclude that transient activation of Kiss1^ARH neurons following sex-hormone withdrawal contributes to the occurrence of hot flushes via NkB release in the rostral preoptic area.

Midlife Predictors of Health-Related Quality of Life in Older Women

Background

Midlife represents an important time to evaluate health status and health behaviors that may affect health-related quality of life (HRQL) in later years. This study examines change in women's HRQL over 11 years from ages 47-59 to 57-69 and identifies midlife characteristics that predict HRQL at older ages.

Methods

Physical (PCS) and mental component summaries (MCS) of the SF-36 were used to assess HRQL from 2002 to 2013 in 2,614 women from the Study of Women's Health Across the Nation (SWAN), a multiethnic/racial cohort study. We used locally weighted scatterplot smoothing (LOESS) models to obtain unadjusted predicted mean trajectories of PCS and MCS as a function of age.

Results

LOESS predicted PCS declined from 51.6 to 47.1, whereas MCS increased from 49.2 to 53.1. In multivariable models, controlling for baseline PCS, higher baseline physical activity (p = .002) and increase in physical activity from baseline (p < .0001) predicted better PCS. Time since baseline (ie, aging; p < .001), higher baseline body mass index (p < .0001), increased body mass index over time (p < .0001), smoking (p < .05), two or more medical conditions (p < .0001), sleep problems (p < .0001), and urinary incontinence (p < .0001) were related to lower PCS. Early (p = .004) and late postmenopause (p = .001; vs. premenopause) and aging (p = .05) predicted higher MCS. Predictors of lower MCS were less than very good health (p < .0001), sleep problems (p < .0001), stressful life events (p < .0001), higher perceived stress (p < .0001), and higher trait anxiety (p = .004). Race/ethnicity was related to MCS, but not PCS.

Conclusions

Several potentially modifiable midlife factors, such as improved sleep hygiene, physical activity, and body mass index, might improve HRQL for older women.

Relationships between body image, sexual dysfunction, and health-related quality of life among middle-aged women: A cross-sectional study

OBJECTIVES

To examine whether body image, sexual function, and relationship with a partner influence health-related quality of life (HRQoL) among middle-aged women, as well as to identify the association with menopausal symptoms.

MAIN OUTCOME MEASURES

Physical component summary and mental component summary of HRQoL.

METHODS

This was an analysis of 1026 women (2013-2014); data regarding demographic characteristics, sexual function, body image, relationship with partner, menopausal symptoms and HRQoL during middle age were collected. HRQoL, sexual function, body image, relationship with partner, and menopausal symptoms were measured using the Medical Outcomes Study SF-12, Female Sexual Function Index (FSFI), Multidimensional Body-Self Relations Questionnaire-Appearance Scale, the Relationship Assessment Scale, and the Greene Climacteric Scale, respectively. A multivariate regression was used to examine factors influencing HRQoL.

RESULTS

After adjusting for covariates, significant factors predicting the physical component summary (PCS) of HRQoL among middle-aged women included the orgasm domain of the FSFI (β = 0.69; p =  0.023), appearance evaluation (β = 0.93; p =  0.037), and menopausal symptoms (β = -0.25; p <  0.001). The factors predicting the mental component summary (MCS) of HRQoL included the satisfaction domain of the FSFI (β = 0.70; p =  0.014), appearance evaluation (β = 2.09; p < 0.001), self-classified weight (β = 1.21; p <  0.001), relationship with partner (β = 0.16; p =  0.034), and menopausal symptoms (β = -0.36; p <  0.001).

CONCLUSION

The results indicated that negative appearance evaluation and menopausal symptoms predicted poor HRQoL among middle-aged women. Higher frequency of orgasm predicted better PCS; sexual satisfaction and satisfaction with relationship with a partner predicted better MCS of HRQoL.

Relationships between menopausal symptoms, sense of coherence, coping strategies, and quality of life

OBJECTIVES

The aims of this study were to examine the relationships between menopausal symptoms, sense of coherence (SOC), coping strategies, and quality of life, and to test the mediating effects of SOC and coping strategies on the relationships between menopausal symptoms and quality of life among Chinese women during menopausal transition.

METHODS

Two hundred one women aged 40 to 60 years and currently undergoing menopausal transition were recruited at community centers between June and August 2017. Menopausal symptoms, SOC, coping strategies, and quality of life were assessed by the Menopause Rating Scale, the Sense of Coherence Scale, the Brief COPE Inventory, and the Medical Outcomes Study Short-Form-36, respectively. Data were analyzed by path analysis.

RESULTS

Menopausal symptoms were associated with poorer quality of life, and both SOC and maladaptive coping were found to mediate the effects of menopausal symptoms on quality of life. The results suggest that SOC might alleviate the adverse effects of menopausal symptoms on quality of life, whereas maladaptive coping strategies might aggravate the adverse effects of menopausal symptoms on quality of life.

CONCLUSIONS

The results provide new insights into the importance of considering SOC and coping strategies and their interactions with menopausal symptoms and quality of life in the situation of menopausal transition.

Insomnia and sexual dysfunction associated with severe worsening of the quality of life in sexually active hysterectomized women

Hysterectomy is a common gynecologic surgery carried out to remove the pathologic uterus. Objective: To establish if sleep disorders and sexual function are associated with deterioration of the quality of life (QoL) in hysterectomized and sexually active women. Methods: A cross-sectional study was carried out with inhabitants from two cities of the Colombian Caribbean. The pollsters invited women aged between 40-59 years to participate; in their communities they applied surveys with demographic characteristics: Female Sexual Function Index, Atenas Insomnia Scale and Menopause Rating Scale. Sexually active women were selected; then the association was established with logistic regression. Results: 522 women were studied with an average age of 50 years: 30% oophorectomized, 59.8% Hispanic, 40.2% afro-descendants and 22.2% hormonal therapy users. 80% of them had somato/vegetative, psychological or urogenital deterioration; 29.1% with severe deterioration of QoL and 47.5% with insomnia. Out of 390 (74.7%) with sexual activity, 59.7% suffered from sexual dysfunction. Insomnia: OR:3.05 [95%CI:1.86-4.99], sexual dysfunction OR:3.52 [95%CI:2.01-6.17], dissatisfaction about sexuality OR:4.77 [95%CI:2.08-10.93], low or non-existent sexual desire OR:2.94 [95%CI:1.65-5.25], daytime drowsiness OR:3.15 [95%CI:1.59-6.24] and decrease in daytime well-being OR:3.18 [95%CI:1.79-5.64]. These were factors associated with severe worsening of QoL, while the presence of genital lubrication was protective, OR: 0.44 [95%CI:0.21-0.93], p=0.0332. Conclusion: It was observed that insomnia and sexual dysfunction behaved as factors associated with three times more severe deterioration of the QoL in climacteric and sexually active women previously hysterectomized.

Trajectories of mood and stress and relationships with protective factors during the transition to menopause: results using latent class growth modeling in a Canadian cohort

The menopause transition is characterized by significant hormonal changes that may predispose women to psychosocial maladjustment. Prospective studies to date have focused primarily on negative mood states and show equivocal findings. The primary goal of this study was to identify patterns of change with respect to positive and negative mood states (vigor, depression, tension, and stress) over a 5-year period in a cohort of women undergoing the transition to menopause. A secondary aim was to determine whether the identified trajectories were associated with menopause status as well as baseline health-related and psychological characteristics. This longitudinal study observed 102 healthy Canadian women who were premenopausal at baseline (age 47-55 years). Analyses consisted of latent class growth modeling. Mood states were predominantly normal and stable, raising doubts regarding the notion that psychosocial distress is a common and natural occurrence during the transition to menopause. Neither time spent in perimenopause nor BMI had a significant influence on levels of mood indicators. However, higher scores on body image, self-esteem, and general health perceptions were predictive of more positive psychological outcomes over the 5-year period. Targeting improvements in self-perceptions may promote a healthier psychological adjustment during this natural transitional period in a women's lifespan.

Physical activity and perceptions of stress during the menopause transition: A longitudinal study

The transition to menopause is a critical period of significant biopsychosocial change. The purpose of this study was to examine the influence of the transition to menopause and volume of physical activity on levels of perceived stress over five years in 102 healthy middle-aged women. Questionnaire and accelerometer data were analyzed using linear mixed models. Adjusting for age and body mass index, there were no significant effects of menopause status or time on perceived stress. Independent of menopause status, minutes per week of vigorous activity was associated with lower perceived stress in years 1 and 2 of the study.

Long-term exercise training and soy isoflavones to improve quality of life and climacteric symptoms

OBJECTIVE

To verify the efficacy of phytoestrogen supplementation combined with aerobic and resistance training on the improvement of climacteric symptoms and health-related quality of life (HRQoL) in postmenopausal women.

METHODS

From a pool of women who had participated in a 1-year intervention study and were randomly assigned to either exercise + phytoestrogen (EX + PHY) or exercise + placebo (EX + PL), a total of 31 healthy but overweight women (mean age 59.2 ± 4.8 years, body mass index 29.1 ± 3.5 kg/m2) finished the study (EX + PHY, n = 15; EX + PL, n = 16). All the following variables were measured before, after 6 months and after 12 months of intervention: body composition (fat and lean body mass, DXA), HRQoL (SF-36 questionnaire: physical and mental component summaries and subscales; and the 10-item Perceived Stress Scale questionnaire), climacteric symptoms (Kupperman Index questionnaire).

RESULTS

After 1 year of intervention, physical functioning (p = 0.003), role-emotional (p = 0.031), vitality (p = 0.007), and global health (p < 0.001) were significantly and similarly increased in both groups. Regarding climacteric symptoms, an improvement in the Kupperman index total score (p = 0.015) was observed.

CONCLUSION

Our results demonstrate that adding phytoestrogens to exercise training does not provide the additive effect for HRQoL in postmenopausal and overweight women. Moreover, exercise and phytoestrogen may interfere in the improvement of climacteric symptoms in the long term.

Effect of Group Counseling on Quality of Life among Postmenopausal Women in Hamadan, Iran

Objectives

This study aimed to investigate the effect of counseling on quality of life (QOL) in postmenopausal women conducted in Hamadan, Iran in 2015.

Methods

In this quasi-experimental study, 80 postmenopausal women were randomly selected and allocated to case and control groups (40 per group). Data collection tool included questionnaires of demographic information and QOL during menopause, which were completed by the samples before the intervention. In the case group, training program was run during four sessions in the form of weekly consulting sessions for 45 to 60 minutes. Training program included familiarity with menopause symptoms, confrontation and self-care during this period. The control group, only received routine cares. Three months after intervention, information were collected in both groups. Data were analyzed using SPSS for Windows.

Results

Before the intervention, mean ± standard deviation for QOL in case group was 101.2 ± 31.4 and it was significantly decreased to 96.9 ± 27.0 after intervention (P < 0.05). While no significant change was observed in the control group (from 98.9 ± 35.5 to 102.3 ± 35.0, P = 0.443). Symptoms of physical (P = 0.033) and sexual (P < 0.001) dimensions significantly decreased in the case group. While significant increase was observed in terms of psychosocial (P = 0.049) and sexual symptoms in control group.

Conclusions

Findings suggested impact of consulting on improvement of QOL during menopause. Supportive consulting can be a suitable approach for improving women's health, reducing problems and enhancing QOL in menopause period.

Impact of Menopausal Status, Metabolic Syndrome and its Risk Factors on Impaired Quality of Life above Middle-aged Women

PURPOSE

This study explored influencing factors on quality of life (QoL) above middle-aged women in relation to demographic factors, health-related factors, menopausal status, metabolic syndrome (MS) and its risk factors.

METHODS

This study was secondary data analysis from the Sixth Korea National Health and Nutrition Examination Survey 2013~2015 that utilized a complex, multi-stage probability sample design. Study sample of 2,310 was inclusive of (28.8%) of women who were over 40. To evaluate the factors that would influence an impaired quality of life, χ² test, GLM, and logistic regression analysis were done.

RESULTS

Level of quality of life was lower in women with late post-menopause(over 10 years since menopause) than women with pre-menopause. Factors influencing impaired QoL were as follows: graduated middle school and elementary school or less (OR=2.43, 4.42, respectively, p<.05), no job (OR=1.92, p<.001), stress (OR=1.92, p=.001), depression (OR=1.93, p=.001), insufficient sleep (OR=1.64, p=.003), late post-menopause (OR=2.61, p=.044) and over 85cm of waist circumference (OR=1.76, p=.01).

CONCLUSION

These results suggest that late post-menopause may be an independent factor influencing an impaired QoL. To promote post-menopausal womens' health, a nursing strategy is required to teach women how to manage levels of stress, depression, insufficient sleep, and abdominal obesity through health education, nutritional counselling, and physical activity program.

Severity and clustering of menopausal symptoms among obese and nonobese postmenopausal women in India

Background:

The symptoms of menopause have a negative impact on quality of life, especially in women transitioning to menopause and earlier transitions. This study was conducted with the objective of assessing the effect of obesity on the severity of menopausal symptoms and the clustering of symptoms in postmenopausal women in India.

Methodology:

The Menopausal Rating Scale (MRS) was used to assess the severity of menopausal symptoms of postmenopausal women of Chennai, visiting Saveetha Medical College, Chennai, India. This cross-sectional study was conducted from August to November 2013 in Chennai, India. Sociodemographic characteristics, anthropometric measurements, blood pressure level, menopausal history, personal health history, and hormonal disorder issues were investigated.

Results:

The results have shown that 24% of the participants had complaint of mild to severe hot flushes, half of them had reported heart ailments (49%; n = 74), and disturbed sleep (48%; n = 72). The proportion of overweight/obese participants was higher in married (64%) than widows (41%), and this difference was found statistically significant (P = 0.005). There were no significant differences in MRS scores of obese and nonobese postmenopausal participants.

Conclusion:

There is a need of developing interactive, user friendly, technology based education module for addressing the chronic ailments of postmenopausal women.

Association between quality of life, menopausal status, and sociodemographic factors among middle-aged women in Iran

OBJECTIVE

Assessment of overall health, well-being, and quality of life (QoL) during middle age and menopause deserves special attention. The aim of this study was to investigate the effect of menopausal status and some sociodemographic variables on QoL among middle-aged women in Semnan, Iran.

PARTICIPANTS AND METHODS

This cross-sectional survey was conducted in 2012 in Semnan, Iran. The participants included 770 women aged 45-60 years. The data were collected by interview using a structured questionnaire that included sociodemographic characteristics, data on menopausal status, and QoL measurement using the Menopause-Specific Quality of Life questionnaire.

RESULTS

The mean±SD age of the women was 50.9±4.7 years. The overall unadjusted mean scores obtained for each domain were as follows: vasomotor: 1.83±1.86; psychosocial: 1.62±1.41; physical: 1.98±1.28; and sexual: 1.63±1.87. Logistic regression analysis showed that menopausal status was significantly associated with QoL in all domains, except the psychosocial domain. Age, BMI, household income, and number of children were significantly associated with impairment in QoL. Marital status, educational level, and residential area did not show any association with QoL in multivariate analysis.

CONCLUSION AND RECOMMENDATIONS

Our findings confirm previous literature on the negative impact of menopausal symptoms on QoL, and show the interaction of some sociodemographic characteristics including age, number of children, household income, and BMI, on QoL. Health professionals should ensure that they consider a range of factors in middle-aged women's lives and provide insight into possible treatment strategies and lifestyle interventions for improving QoL.

Menopause and Sexuality

Sexuality is an important component in the lives of menopausal women. Despite the importance of sexual function in menopausal women, sexual dysfunction increases with age. Age-related decline in sexual function may significantly reduce quality of life, making recognition of sexual dysfunction by physicians important for getting menopausal women effective care. Sexual dysfunction can result from multiple etiologies including psychosocial factors, medication side effects, vulvovaginal atrophy, chronic illness, or hypoactive sexual desire disorder. Discovering the etiology and identifying modifiable factors of the sexual function will help define appropriate treatment.

Gender differences in health-related quality of life in patients undergoing coronary angiography

Background

Health-related quality of life (HRQOL) reflects the general well-being of individuals. In patients with coronary artery disease (CAD), HRQOL is compromised. Female patients with CAD have been reported to have lower HRQOL. In this study, we investigate gender differences in HRQOL and in associations of patient characteristics with HRQOL in patients with coronary angiography (CAG).

Methods

We cross-sectionally analysed patients from the Utrecht Coronary Biobank undergoing CAG. All patients filled in an HRQOL questionnaire (RAND-36 and EuroQoL) on inclusion. RAND-36 and EuroQoL HRQOL measures were compared between the genders across indications for CAG, CAD severity and treatment of CAD. RAND-36 HRQOL measures were compared with the general Dutch population. Additionally, we assessed interactions of gender with patient characteristics in their association with HRQOL (EuroQoL).

Results

We included 1421 patients (1020 men and 401 women) with a mean age of 65 in our analysis. Women reported lower HRQOL measures than men (mean EuroQoL self-rated health grade 6.84±1.49 in men, 6.46±1.40 in women, p<0.001). The reduction in RAND-36 HRQOL as compared with the general Dutch population was larger in women than in men. From regression analysis, we found that diabetes, a history of cardiovascular disease and symptoms of shortness of breath determined HRQOL (EuroQoL) more strongly in men than in women.

Conclusions

Women reported lower HRQOL than men throughout all indications for CAG and regardless of CAD severity or treatment. As compared with the general population, the reduction in HRQOL was more extreme in women than in men. Evident gender differences were found in determinants of HRQOL in patients undergoing CAG, which deserve attention in future research.

Trial registration

NCT02304744 (clinicaltrials.gov).

Nutrigenomic effects of edible bird's nest on insulin signaling in ovariectomized rats

Estrogen deficiency alters quality of life during menopause. Hormone replacement therapy has been used to improve quality of life and prevent complications, but side effects limit its use. In this study, we evaluated the use of edible bird’s nest (EBN) for prevention of cardiometabolic problems in rats with ovariectomy-induced menopause. Ovariectomized female rats were fed for 12 weeks with normal rat chow, EBN, or estrogen and compared with normal non-ovariectomized rats. Metabolic indices (insulin, estrogen, superoxide dismutase, malondialdehyde, oral glucose tolerance test, and lipid profile) were measured at the end of the experiment from serum and liver tissue homogenate, and transcriptional levels of hepatic insulin signaling genes were measured. The results showed that ovariectomy worsened metabolic indices and disrupted the normal transcriptional pattern of hepatic insulin signaling genes. EBN improved the metabolic indices and also produced transcriptional changes in hepatic insulin signaling genes that tended toward enhanced insulin sensitivity, and glucose and lipid homeostasis, even better than estrogen. The data suggest that EBN could meliorate estrogen deficiency-associated increase in risk of cardiometabolic disease in rats, and may in fact be useful as a functional food for the prevention of such a problem in humans. The clinical validity of these findings is worth studying further.

Cancer in Women over 50 Years of Age: A Focus on Smoking

The increase in life expectancy worldwide has resulted in a greater prevalence of chronic non-communicable diseases. This study aims to evaluate the prevalence and factors associated with the occurrence of cancer among Brazilian women over the age of 50. A cross-sectional study with 622 women over the age of 50 was performed using a population survey. The outcome variable was the occurrence of a malignant tumor in any location. The independent variables were sociodemographic characteristics, self-perception of health, health-related habits and morbidities. Statistical analysis was carried out using the chi-square test and Poisson regression. The mean age of the women was 64.1 years. The prevalence of cancer was 6.8%. The main sites of occurrence of malignant tumors were the breast (31.9%), colorectal (12.7%) and skin (12.7%). In the final statistical model, the only factor associated with cancer was smoking > 15 cigarettes/day either currently or in the past: PR 2.03 (95% CI 1.06-3.89). The results have improved understanding of the prevalence and factors associated with cancer in Brazilian women aged 50 years or more. They should be encouraged to maintain a healthy lifestyle and pay particular attention to modifiable risk factors such as smoking.

Should menopausal characteristics be considered during cardiorespiratory exercise prescription in postmenopausal women?

OBJECTIVE

Menopausal characteristics (i.e. the nature of menopause, hormone therapy, and time elapsed since menopause) are known to affect women's health-related quality of life. The purpose of this study was to determine whether menopausal characteristics affect the cardiorespiratory exercise response and which characteristics should be considered for exercise prescription.

METHODS

Fifty-eight postmenopausal women (60.21 ± 4.49 years of age; 66.26 ± 8.99 kg body weight; 157.09 ± 4.92 cm in height; 29.70 ± 4.79 ml·kg(-1)·min(-1) maximal oxygen uptake) participated in this study. A graded 25-W/min(2) cycle ergometer exercise protocol was applied to assess aerobic power and ventilatory thresholds. Participants' heart rates and gas-exchange variables were measured continuously using a COSMED K4b(2) portable gas analyzer system. The first and the second ventilatory thresholds were determined by the time-course curves of ventilation and oxygen and carbon dioxide ventilatory equivalents. Using age as a covariate, an analysis of covariance was performed to assess the effect of menopause characteristics upon the data.

RESULTS

Regardless of the nature of menopause, use of hormone therapy, time elapsed since menopause, and the interaction between these characteristics, the participants presented no differences in maximal oxygen uptake values, neither on submaximal variables often used in evaluations of exercise prescription, such as percent of maximal oxygen uptake, maximal heart rate, and heart rate reserve, nor in respiratory exchange ratio and gas exchange energy expenditure at aerobic and anaerobic ventilatory thresholds.

CONCLUSIONS

These data suggest that a personalized cardiorespiratory target zone for this population should be set according to the published literature, and that consideration of the individual menopausal characteristics seems to be unnecessary.

Treatment of dyspareunia secondary to vulvovaginal atrophy

Declining estrogen levels associated with menopause can result in vulvovaginal atrophy and some degree of dyspareunia for more than half of all women in menopause. In 2013, the U.S. Food and Drug Administration approved ospemifene, a nonhormonal oral medication for the treatment of dyspareunia in menopause. This article will provide an overview of ospemifene and its indications, side effects and implications for nurses.

Effect of soy isoflavone supplementation on menopausal quality of life

OBJECTIVE

The purpose of this study was to assess the effect of soy isoflavone supplementation on quality of life in postmenopausal women.

METHODS

A multicenter, randomized, double-blind, placebo-controlled 24-month trial was conducted to assess the effect of 80 or 120 mg of daily aglycone hypocotyl soy isoflavone supplementation on quality of life in 403 postmenopausal women using a validated Menopause-Specific Quality of Life questionnaire.

RESULTS

Menopause-Specific Quality of Life domain scores at 1 year and 2 years were similar to baseline. There were no differences in domain scores among treatment groups.

CONCLUSIONS

Soy isoflavone supplementation offers no benefit to quality of life in postmenopausal women.

A life course perspective on polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a major public health problem in the US. Worldwide, the public is largely unaware of the condition and health care providers do not seem to fully understand it. Research on PCOS has primarily focused on its etiology and clinical characteristics and less on the psychosocial aspects of human development associated with PCOS. This paper posits that a life course perspective provides a framework for further understanding the psychosocial experiences of women with PCOS and the contexts in which they live. The paper discusses how life course principles of human development, constraints on agency, interdependence of lives, time and place, and timing of events and experiences are relevant to the management of PCOS and prevention of its complications.

Relationship between menopause and health-related quality of life in middle-aged Chinese women: a cross-sectional study

Background

Chinese menopausal women comprise a large population and the women in it experience menopausal symptoms in many different ways. Their health related quality of life (HRQOL) is not particularly well studied. Our study intends to evaluate the influence of menopause on HRQOL and explore other risk factors for HRQOL in rural China.

Methods

An interview study was conducted from June to August 2010 in Beijing based on cross-sectional design. 1,351 women aged 40–59 were included in the study. HRQOL was measured using the EuroQol Group’s 5-domain (EQ5D) questionnaire. Comparison of HRQOL measures (EQ5D index and EQ5D-VAS scores) was done between different menopausal groups. Logistic regression and multiple regression analysis were performed to adjust potential confounders and explore other risk factors for health problems and HRQOL measures.

Results

Postmenopausal women who had menopause for 2–5 years (+1b stage) were more likely to suffer mobility problems (OR = 1.835, p = 0.008) after multiple adjustment. Menopause was also related to impaired EQ5D index and EQ5D-VAS scores after adjustment for age. Among menopausal groups categorized by menopausal duration, a consistent decrement in EQ5D index and EQ5D-VAS scores, that is, worsening HRQOL, was observed (p < 0.05). Multiple regression analysis revealed low education level and physical activity were associated with EQ5D index (β = -0.080, p = 0.003, and β = 0.056, p = 0.040, respectively). Cigarette smoking and chronic disease were associated with EQ5D index (β = -0.135, p < 0.001 and β = -0.104, p < 0.001, respectively) and EQ5D-VAS (β = -0.057, P = 0.034 and β = -0.214, p < 0.001, respectively).

Conclusions

Reduction in physical function was found within the first five years after menopause. Worsening EQ5D index and EQ5D-VAS scores were related to menopause. Education level, physical activity, cigarette smoking, and chronic disease history were associated with HRQOL in middle aged Chinese rural women.