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Lensen S, Paramanandam VS, Gabes M, Kann G, Donhauser T, Waters NF, Li AD, Peate M, Susanto NS, Caughey LE, Rangoonwal F, Liu J, Condron P, Anagnostis P, Archer DF, Avis NE, Bell RJ, Carpenter JS, Chedraui P, Christmas M, Davies M, Hillard T, Hunter MS, Iliodromiti S, Jaff NG, Jaisamrarn U, Joffe H, Khandelwal S, Kiesel L, Maki PM, Mishra GD, Nappi RE, Panay N, Pines A, Roberts H, Rozenberg S, Rueda C, Shifren J, Simon JA, Simpson P, Siregar MFG, Stute P, Garcia JT, Vincent AJ, Wolfman W, Hickey M. Recommended measurement instruments for menopausal vasomotor symptoms: the COMMA (Core Outcomes in Menopause) consortium. Menopause 2024; 31:582-590. [PMID: 38688464 DOI: 10.1097/gme.0000000000002370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The aim of the study is to identify suitable definitions and patient-reported outcome measures (PROMs) to assess each of the six core outcomes previously identified through the COMMA (Core Outcomes in Menopause) global consensus process relating to vasomotor symptoms: frequency, severity, distress/bother/interference, impact on sleep, satisfaction with treatment, and side effects. METHODS A systematic review was conducted to identify relevant definitions for the outcome of side-effects and PROMs with acceptable measurement properties for the remaining five core outcomes. The consensus process, involving 36 participants from 16 countries, was conducted to review definitions and PROMs and make final recommendations for the measurement of each core outcome. RESULTS A total of 21,207 publications were screened from which 119 reporting on 40 PROMs were identified. Of these 40 PROMs, 36 either did not adequately map onto the core outcomes or lacked sufficient measurement properties. Therefore, only four PROMs corresponding to two of the six core outcomes were considered for recommendation. We recommend the Hot Flash Related Daily Interference Scale to measure the domain of distress, bother, or interference of vasomotor symptoms and to capture impact on sleep (one item in the Hot Flash Related Daily Interference Scale captures interference with sleep). Six definitions of "side effects" were identified and considered. We recommend that all trials report adverse events, which is a requirement of Good Clinical Practice. CONCLUSIONS We identified suitable definitions and PROMs for only three of the six core outcomes. No suitable PROMs were found for the remaining three outcomes (frequency and severity of vasomotor symptoms and satisfaction with treatment). Future studies should develop and validate PROMs for these outcomes.
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Affiliation(s)
- Sarah Lensen
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | | | | | | | - Theresa Donhauser
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Niamh F Waters
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Anna D Li
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Michelle Peate
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Nipuni S Susanto
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Lucy E Caughey
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Fatema Rangoonwal
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Jingbo Liu
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Patrick Condron
- University Library, The University of Melbourne, Parkville, Australia
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1 Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - David F Archer
- Department of Obstetrics and Gynaecology, Eastern Virginia Medical School, Norfolk, VA
| | - Nancy E Avis
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Peter Chedraui
- Escuela de Posgrado en Salud, Universidad Espíritu Santo, Samborondón, Ecuador
| | - Monica Christmas
- Department of Obstetrics and Gynaecology, University of Chicago, Chicago, IL
| | - Melanie Davies
- Institute for Women's Health, University College London, UK
| | - Tim Hillard
- Department of Obstetrics and Gynaecology, University Hospitals Dorset NHS Trust, Poole, Dorset, UK
| | - Myra S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health, QMUL, London, United Kingdom
| | - Nicole G Jaff
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Unnop Jaisamrarn
- Center of Excellence in Menopause and Aging Women Health, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology and the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sunila Khandelwal
- Department of Obstetrics and Gynaecology, Fortis Escort Hospital, Jaipur, India
| | - Ludwig Kiesel
- Department of Gynaecology and Obstetrics, University of Muenster, Germany
| | - Pauline M Maki
- University of Illinois at Chicago, Departments of Psychiatry, Psychology and Obstetrics and Gynecology, Chicago, IL
| | - Gita D Mishra
- Australian Women and Girls' Health Research Centre, School of Public Health, University of Queensland, St Lucia, Australia
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Nick Panay
- Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - Amos Pines
- Tel-Aviv University School of Medicine, Tel-Aviv, Israel
| | - Helen Roberts
- Menopause clinic, Te Toka Tumai, Auckland Hospital, Auckland, New Zealand
| | - Serge Rozenberg
- Department of Ob-Gyn CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Camilo Rueda
- University La Sábana, Country Clinic, Bogotá, Colombia
| | - Jan Shifren
- Midlife Women's Health Center, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - James A Simon
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC
| | - Paul Simpson
- Department of Obstetrics & Gynaecology, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Muhammad Fidel Ganis Siregar
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sumatera Utara, Sumatera Utara, Indonesia
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Clinic Inselspital, Bern, Switzerland
| | - Joan Tan Garcia
- Menopause Clinic, Department of Obstetrics & Gynecology, St Lukes Medical Center, Quezon City, Philippines
| | - Amanda J Vincent
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Wendy Wolfman
- Department of Obstetrics and Gynaecology and Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Martha Hickey
- From the Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
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Carcelén-Fraile MDC, Hita-Contreras F, Martínez-Amat A, Loureiro VB, Marques de Loureiro NE, Jiménez-García JD, Fábrega-Cuadros R, Aibar-Almazán A. Impact of Qigong exercises on the severity of the menopausal symptoms and health-related quality of life: a randomized controlled trial. Eur J Sport Sci 2022; 23:656-664. [PMID: 35179431 DOI: 10.1080/17461391.2022.2044915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ABSTRACTThe aim of the present study was to analyze the effects of a Qigong exercise program on the severity of the menopausal symptoms and health-related quality of life (HRQoL) of community-dwelling postmenopausal women. This was done by means of a randomized clinical trial with a sample of 125 women who were assigned to either a control (n = 62) or an experimental group (n = 63). The severity of their menopause-related symptoms and HRQoL were assessed through the Menopause Rating Scale (MRS) and the 36-item Short-Form Health Survey (SF-36) respectively, before and after the intervention period. The main findings of our study reveal significant improvement in the severity of menopausal symptoms at the somatic, psychological, and urogenital levels, as well as in the total score of the MRS. Additionally, participants assigned to the Qigong group experienced improvement in the general health, physical functioning, role-physical, bodily pain, vitality, and mental health domains of the 36-item Short-Form Health Survey, as well as in its physical component and mental component summaries. We can therefore conclude that, among Spanish postmenopausal women, a twelve-week Qigong exercise program has beneficial effects on the severity of menopausal symptoms and HRQoL.Trial registration: ClinicalTrials.gov identifier: NCT03989453..
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Affiliation(s)
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén. Jaén, Spain
| | - Antonio Martínez-Amat
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén. Jaén, Spain
| | | | | | | | - Raquel Fábrega-Cuadros
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén. Jaén, Spain
| | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén. Jaén, Spain
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Seib C, McCarthy A, McGuire A, Porter-Steele J, Balaam S, McDonald N, Bailey T, Anderson D. Determining the psychometric properties of the Greene Climacteric Scale (GCS) in women previously treated for breast cancer: A pooled analysis of data from the Women's Wellness after Cancer Programs. Maturitas 2022; 161:65-71. [DOI: 10.1016/j.maturitas.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 02/06/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022]
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Roshi, Tandon VR, Mahajan A, Sharma S, Khajuria V. Comparative Efficacy and Safety of Clonazepam versus Nortrptilline on Menopausal Symptom among Forty Plus Women: A Prospective, Open-Label Randomized Study. J Midlife Health 2021; 11:120-125. [PMID: 33384533 PMCID: PMC7718939 DOI: 10.4103/jmh.jmh_130_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/21/2020] [Accepted: 07/25/2020] [Indexed: 11/04/2022] Open
Abstract
Aims and Objectives The aim of this study is to compare the effect of clonazepam and nortryptiline on menopausal symptoms in above 40 years women. Materials and Methods A prospective, randomized, open-label comparative study was conducted in a tertiary care teaching hospital for 1 year. Patients were randomized into two groups. Both the groups had 60 patients, out of which Group A had 39 menopausal patients and Group B had 31 menopausal patients, respectively. Group 1 received tablet clonazepam 0.5 mg bed time orally daily. Group 2 received tablet nortryptiline 25 mg bed time orally daily. The primary efficacy end points were effect on menopausal symptoms evaluated by at 0, 4, and 8 weeks. Results Mean age since menopause was 45 ± 4.06 years, and the mean number of years since menopause was 9.18 ± 7.59 years clonazepam and nortryptiline recorded statistically comparable effect with numerical superiority of nortryptiline both at 4 and 8 weeks on mean Menopausal Symptom Score, thereby indicating that both the drugs may have directly/indirectly improved the mean menopausal symptoms equally. Improvement in the clonazepam group was numerically and statistically more than nortryptiline group at 4 and 8 weeks on mean Vasomotor Symptom Score with P < 0.01 in clonazepam group and P < 0.05 in nortryptiline group both at 4 and 8 weeks. Both the drugs showed comparable results on psychosocial symptom score both at 4 and 8 weeks with numerical superiority in nortryptiline group. Clonazepam group showed more improvement on mean physical score than nortryptiline group numerically and statistically. Both the drugs showed comparable results on mean sexual symptom score at 4 weeks, but nortryptiline proved to be statistically better at 8 weeks P < 0.01 versus P < 0.05 in clonazepam group. Conclusion Clonazepam and nortryptiline recorded statistically comparable effect at 4 and 8 weeks on mean menopausal symptom. Both the drugs were equally safe and did not recorded any serious Adverse Drug Reaction (ADRs).
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Affiliation(s)
- Roshi
- Department of Pharmacology, GMC, Jammu, Jammu and Kashmir, India
| | - Vishal R Tandon
- Department of Pharmacology, GMC, Jammu, Jammu and Kashmir, India
| | - Annil Mahajan
- Department of Medicine and, Jammu, Jammu and Kashmir, India
| | - Sudhaa Sharma
- Department of Gynae and Obst, GMC, Jammu, Jammu and Kashmir, India
| | - Vijay Khajuria
- Department of Pharmacology, GMC, Jammu, Jammu and Kashmir, India
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Menopause symptoms delineated by HIV clinical characteristics in African American women with HIV. ACTA ACUST UNITED AC 2020; 28:189-197. [PMID: 33079741 DOI: 10.1097/gme.0000000000001678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To obtain data on prevalence and severity of climacteric symptoms in women with HIV (WWH) during the menopausal transition and early menopause and to evaluate for any differences in symptoms by CD4 count and viral load. METHODS We conducted an in-person survey of female patients attending the Johns Hopkins HIV clinic, ages 40 to 50 years with at least one menstrual period within 6 months before the survey. Interviews utilized the Greene Climacteric scale, a validated menopause questionnaire. We also queried patients, (1) if they were informing their primary care physician of menopause symptoms and (2) if their menopause symptoms were being treated. The study used nonparametric Mann-Whitney rank sum tests with significance defined as P < 0.05 to perform symptom severity comparisons of distributions and Fischer exact tests for comparisons of categorical variables such as comparing prevalence of anxiety and depression in the population. RESULTS Twenty-three women aged 40 to 50 years were interviewed with a median age of 47 years [25 percentile = 46, 75 percentile = 49]. All were African American with median length of HIV diagnosis of 12 years [25 percentile = 7, 75 percentile = 20.5]. Most of the patients, 87% (n = 20), reported experiencing at least one menopause symptom with intense frequency and extreme detrimental effects on quality of life. All women interviewed, 100% (n = 23), reported hot flashes, ranging from infrequent to persistent. Sleeping difficulty was reported by 78% (n = 18) of women. Most women, 78% (n = 18), reported feeling tired or lacking energy with moderate frequency. The majority of the women, 87% (n = 20), said they reported menopause symptoms to their primary care provider. Of these, only 20% received treatment for menopause symptoms. CONCLUSIONS These findings suggest that WWH undergoing the menopausal transition experience intense symptoms severely impacting quality of life. Although the majority of women reported experiencing menopause symptoms to medical providers, most remained untreated. An opportunity exists to educate providers caring for WWH on menopause medicine.
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A critical appraisal of vasomotor symptom assessment tools used in clinical trials evaluating hormone therapy compared to placebo. ACTA ACUST UNITED AC 2020; 26:1334-1341. [PMID: 31567867 DOI: 10.1097/gme.0000000000001387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Vasomotor symptoms (VMS) have been consistently reported as the leading predictor of health-related quality of life (HRQOL) among menopausal women, and the strongest indication for treatment. The North American Menopause Society endorses the use of oral estrogen for the treatment of VMS based on a Cochrane meta-analysis. The Cochrane review concludes that oral hormone therapy reduces the frequency and severity of VMS. The objective of this review is to critically appraise the outcome measures used in these clinical trials to evaluate whether there is adequate evidence that oral hormone therapy improves HRQOL. METHODS Each trial in the 2004 Cochrane review of oral hormone therapy for the management of VMS was evaluated with respect to study design, outcome measures, and method of analysis. RESULTS Twenty-four randomized, double-blind, placebo-controlled clinical trials were appraised. Six trials were excluded from the Cochrane meta-analysis due to inadequate reporting of outcome measures. Of the remaining trials, 15 trials assessed only symptom frequency and/or severity. One trial used a subscale of the General Health Questionnaire. Two trials used the Greene Climacteric Scale, a validated outcome measure in menopausal women, to directly assess the impact of hormone therapy on HRQOL. Both studies showed an improvement in HRQOL in the hormone-treated group, although the sample size was small (n = 118) and the effect was modest. CONCLUSION Although oral hormone therapy improves VMS scores, there is a paucity of evidence on whether it improves HRQOL in menopausal women. Future studies using validated, patient-reported outcome measures that directly assess HRQOL are needed.
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Thakur M, Kaur M, Sinha AK. Assessment of menopausal symptoms in different transition phases using the Greene Climacteric Scale among rural women of North India. Ann Hum Biol 2019; 46:46-55. [PMID: 30822155 DOI: 10.1080/03014460.2019.1587508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Menopause is the universal physiological process of women's midlife and exhibits a wide variety of symptoms. However, there is little data on the menopausal symptoms and factors associated with their severity among rural Indian women. AIM To evaluate the prevalence of menopausal symptoms during the different transition phases of menopause among rural women of North India. SUBJECTS AND METHODS This cross-sectional study consisted of 351 women aged 35-55 years (mean age 44.6 years) residing in rural areas of North India. A structured questionnaire was used to collect data regarding menopausal status, demographic profile and reproductive history of the participants. Frequency and severity of menopausal symptoms were evaluated using the Greene Climacteric Scale in different stages of menopause. All statistical procedures were accomplished using SPSS version 19.0. RESULTS In the present study the mean ages of attainment of menarche and menopause were 14.3 years and 47.2 years, respectively. Mean score of total Greene Climacteric Scale was highest among perimenopausal women (16.12 ± 8.1) over post-menopausal (14.78 ± 7.3) and pre-menopausal women (11.08 ± 6.1). Logistic regression analysis revealed that advancing age, low educational attainment, low socioeconomic status, menopausal status, later age at menarche and higher BMI were all associated with more severe menopausal symptoms. CONCLUSION The climacteric symptoms were more prevalent among women who were perimenopausal followed by post-menopausal women and were the lowest in pre-menopausal women. Age, menopausal status, socio-economic status, and reproductive factors significantly influenced the severity of menopausal symptoms.
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Affiliation(s)
- Monika Thakur
- a Department of Anthropology , Panjab University , Chandigarh , India
| | - Maninder Kaur
- a Department of Anthropology , Panjab University , Chandigarh , India
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Dwi Susanti H, Chang PC, Chung MH. Construct validity of the Menopause Rating Scale in Indonesia. Climacteric 2019; 22:454-459. [PMID: 30810401 DOI: 10.1080/13697137.2019.1574737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: This study assessed the construct validity of the Menopause Rating Scale (MRS) in Indonesia. Methods: The study included 240 women aged over 45 years in Indonesia. The MRS measures psychological, somatic-vegetative, and urogenital symptoms using 11 items obtained from participants' daily symptom records. The intraclass correlation coefficient (ICC) and Cronbach's alpha coefficient were measured to examine the test-retest reliability and internal consistency reliability. The test-retest reliability was evaluated by an extra 30 participants twice at 2-week intervals. For construct validity, exploratory factor analysis (EFA) was employed to assess factor structure and confirmatory factor analysis (CFA) was used to evaluate the structural model fit of the MRS. Results: The ICC for the test-retest reliability ranged between 0.90 and 0.95. The Cronbach alpha coefficients in the somatic-vegetative, psychological, and urogenital dimensions were 0.92, 0.93, and 0.95, respectively. The Kaiser-Meyer-Olkin value was 0.96, and the Bartlett's test of sphericity was statistically significant and adequate for EFA. CFA was tested using the second-order model with three first-order factors and yielded an excellent model fit. Conclusion: Results indicated that the brief questionnaire of the MRS possesses acceptable construct validity for evaluating menopause symptoms in Indonesian women.
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Affiliation(s)
- H Dwi Susanti
- School of Nursing, College of Nursing, Taipei Medical University , Taipei , Taiwan
| | - P C Chang
- School of Nursing, College of Nursing, Taipei Medical University , Taipei , Taiwan
| | - M H Chung
- School of Nursing, College of Nursing, Taipei Medical University , Taipei , Taiwan.,Department of Nursing, Shuang Ho Hospital, Taipei Medical University , New Taipei City , Taiwan
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Craig BM, Mitchell SA. Examining the Value of Menopausal Symptom Relief Among US Women. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:158-166. [PMID: 27021749 DOI: 10.1016/j.jval.2015.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/09/2015] [Accepted: 11/01/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Menopausal symptoms can cause significant distress to women, yet little is known about the value women place on these symptoms. METHODS In April 2013, 3397 US women, aged 40 to 69 years, completed an online survey that included 30 paired comparisons. Specifically, respondents were shown two menopausal symptoms described using the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events and asked, "Which do you prefer?" From their choices, we estimated a generalized linear model to assess the values women place on symptom relief in terms of quality-adjusted life-years (QALYs). RESULTS Approximately half the respondents (1753 of 3397 [52%]) always preferred a reduced lifespan (up to 90 days) instead of experiencing menopausal symptoms at their worst for 30 days. For most of the symptoms (248 of 263 [94%]), including low-grade events, QALYs were significantly reduced (P < 0.05). The value women placed on relief ranged widely by symptom domain: the relief from depression, problems with memory, headache, pain in abdomen, problems with anger, and vomiting were the most valuable. CONCLUSIONS Overall, the value women place on menopausal symptom relief is surprisingly high. As the first national study to directly ask women about their preferences and to estimate the value of menopausal symptom relief on a QALY scale, this work provides critical evidence for health outcomes research in midlife women and can be applied in the evaluation of treatments that reduce or eliminate menopausal symptoms. This work also provides proof-of-concept for an approach to value Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events responses on a QALY scale.
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Affiliation(s)
- Benjamin M Craig
- Health Outcomes and Behavior, Moffitt Cancer Center and University of South Florida, Tampa, Florida, USA.
| | - Sandra A Mitchell
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, Maryland, USA
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Malik S, Pannu D, Prateek S, Sinha R, Gaikwad H. Comparison of the symptomatic response in Indian menopausal women with different estrogen preparations for the treatment of menopausal symptoms: a randomized controlled trial. Arch Gynecol Obstet 2016; 293:1325-33. [PMID: 26884352 DOI: 10.1007/s00404-016-4034-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/02/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare symptomatic response in Indian women using different estrogen preparations for treatment of menopausal symptoms. METHODOLOGY A randomized, single blind, four arm, parallel assignment study was conducted in VMMC and SJH, New Delhi, India. 200 Indian menopausal women were recruited and assigned into four treatment groups viz., estradiol valerate (E2V), conjugated equine estrogen (CEE), isoflavones and Placebo group. The statistical significance of categorical variables was determined by Chi-square, Fisher's exact test. In case of quantitative variable parametric test Student's t test was used. In case of quantitative variables where data are not normally distributed, Kruskal-wallis test and Wilcoxon Mann-Whitney test were used. Symptomatic response in vasomotor/vaginal symptoms was assessed in all groups. RESULTS Both E2V and CEE groups were effective in reducing severity and frequency of hot flashes. 91.9 % decrease was observed in mean hot flash score in the E2V group after 24 weeks of treatment, 89.2 % in the CEE group, 60.42 % decrease in the isoflavones group. While placebo led to 47.9 % decrease in mean hot flash score. After 24 weeks of therapy there was significant increase in vaginal health index in the E2V and CEE and the isoflavones group. No serious side effect was reported in any of the groups. CONCLUSION Low doses of both CEE and E2V were equally effective for management of vasomotor/vaginal symptoms when administered over 24 weeks. However, it seems more reasonable to replenish with less costly and bio-identical hormone, i.e. micronized estradiol valerate which is equally effective. TRIAL REGISTRY The trial was registered under Clinical trial registry of India prospectively (number: CTRI/2012/04/002566).
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Affiliation(s)
- Sunita Malik
- Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Deepika Pannu
- Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
| | - Shashi Prateek
- Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Renuka Sinha
- Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Harsha Gaikwad
- Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Confirmatory factor analysis of the Menopausal Interpretations/Perceptions Questionnaire. Menopause 2014; 21:1091-8. [DOI: 10.1097/gme.0000000000000215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kumar A, Archana E, Pai A, Nayak G, Shenoy RP, Rao A. Serum mineral status and climacteric symptoms in perimenopausal women before and after Yoga therapy, an ongoing study. J Midlife Health 2014; 4:225-9. [PMID: 24381464 PMCID: PMC3872669 DOI: 10.4103/0976-7800.122251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Many women report an increased level of anxiety, irritability and mood swings during their perimenopausal state. Studies show that physically active people can reduce their anxiety and depression by practicing yoga. Serum minerals such as calcium, copper and magnesium and the ferro-oxidase, ceruloplasmin play an important role in the body during the perimenopausal period. OBJECTIVE The objective of this study is to assess the serum mineral status, anthropometric parameters and climacteric symptoms in perimenopausal women before and after yoga intervention. SUBJECTS AND METHODS A total of 30 subjects with perimenopausal symptoms, aged between 40 and 60 years (49.43 ± 6.15) were included in the study. Yoga intervention was given on a daily basis (45 min duration) for 12 weeks. The climacteric symptoms were assessed by Greene's climacteric scale and biochemical parameters were analyzed spectrophotometrically. RESULTS A significant decrease in the waist hip ratio (P < 0.036) and body mass index (P < 0.036) was observed after yoga intervention. Systolic (P < 0.064) and diastolic (P < 0.082) blood pressure (BP) showed marginal decrease after yoga therapy. Climacteric symptoms improved significantly (P < 0.001) after yoga intervention. A significant increase (P < 0.001) in serum calcium and copper and a marked decrease in serum magnesium (P < 0.05) and ceruloplasmin (P < 0.028) levels was observed, post yoga therapy. Serum magnesium negatively correlated (r = -0.467, P < 0.035) with systolic BP after yoga intervention. CONCLUSION The overall changes observed in the mineral status and climacteric symptoms suggest that yoga therapy protocol can be effectively used to improve the quality of life in perimenopausal women.
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Affiliation(s)
- Alok Kumar
- Department of Biochemistry, Kasturba Medical College, Manipal, Karnataka, India
| | - E Archana
- Department of Biochemistry, Kasturba Medical College, Manipal, Karnataka, India
| | - Akshatha Pai
- Department of Biochemistry, Melaka Manipal Medical College, Manipal, Karnataka, India
| | - Gayathry Nayak
- Department of Yoga, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Revathi P Shenoy
- Department of Biochemistry, Kasturba Medical College, Manipal, Karnataka, India
| | - Anjali Rao
- Department of Biochemistry, Melaka Manipal Medical College, Manipal, Karnataka, India
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Unique symptoms at midlife of women with osteoporosis and cardiovascular disease in Taiwan. Menopause 2013; 20:315-21. [DOI: 10.1097/gme.0b013e31826d30f2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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14
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Factor structure and normative data of the Greene Climacteric Scale among postmenopausal Portuguese women. Maturitas 2012; 72:256-62. [DOI: 10.1016/j.maturitas.2012.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 04/09/2012] [Accepted: 04/12/2012] [Indexed: 11/29/2022]
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Yeh SCJ, Chang MY. The effect of Qigong on menopausal symptoms and quality of sleep for perimenopausal women: a preliminary observational study. J Altern Complement Med 2012; 18:567-75. [PMID: 22537466 DOI: 10.1089/acm.2011.0133] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The study objectives were to examine the effect of a 12-week 30-minute-a-day Ping Shuai Qigong exercise program on climacteric symptoms and sleep quality in perimenopausal women. DESIGN This was a prospective observational study. SETTINGS/LOCATION The subjects (N=70) from two communities were women aged 45 years and above who were experiencing menopausal symptoms. SUBJECTS Thirty-five (35) women from one community were assigned to a Ping Shuai Qigong intervention group, while 35 women from the other community were assigned to the control group. INTERVENTIONS This was a 12-week, 30-minute-a-day Ping Shuai Qigong program. OUTCOME MEASURES The Greene Climacteric Symptom scale and the Pittsburgh Sleep Quality Index were the outcome measures. METHODS Descriptive analysis and repeated-measures analysis of variance were used. RESULTS Pretest scores at baseline found no significant group differences in climacteric symptoms or sleep quality. Significant improvements in climacteric symptoms were found at 6 weeks and 12 weeks (t=4.07, p<0.001 and t=11.83, p<0.001) in the intervention group. They were also found to have significant improvements in sleep quality in those times (t=5.93, p<0.001 and t=10.58, p<0.001, respectively). CONCLUSIONS Ping Shuai Qigong improved climacteric symptoms and sleep quality in perimenopausal women at 6 weeks and 12 weeks. The longer a person practiced this form of meditative exercise, the greater the improvement in sleeping quality and climacteric symptoms.
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Affiliation(s)
- Shu-Chuan Jennifer Yeh
- Department of Business Management, Institute of Health Care Management, National Sun Yat-sen University, Kaohsiung, Taiwan.
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Cravioto MDC, Durand-Carbajal M, Jiménez-Santana L, Lara-Reyes P, Seuc AH, Sánchez-Guerrero J. Efficacy of estrogen plus progestin on menopausal symptoms in women with systemic lupus erythematosus: a randomized, double-blind, controlled trial. Arthritis Care Res (Hoboken) 2012; 63:1654-63. [PMID: 22127965 DOI: 10.1002/acr.20608] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To define the effects of continuous sequential estrogen plus progestin therapy on menopausal symptoms in women with systemic lupus erythematosus (SLE). METHODS We performed a randomized, double-blind, 24-month clinical trial involving 106 women with SLE who were in the menopausal transition or early or late postmenopause. Patients received continuous sequential estrogen plus progestin (n = 52) or placebo (n = 54). Menopausal symptoms were assessed using the Greene Climacteric Scale at 0, 1, 2, 3, 6, 9, 12, 15, 18, 21, and 24 months. A new factor analysis of the scale reduced 21 items to 5 factors. The primary outcome was improvement of menopausal symptoms throughout the followup period. Results were analyzed by the intent-to-treat principle. RESULTS At baseline, demographic and disease characteristics were similar in both groups. Fifteen of 21 menopausal symptoms had a prevalence of ≥50%, with a similar distribution between groups. Vasomotor factor scores decreased over time in both groups (P = 0.002), but in the estrogen plus progestin group the reduction was more pronounced than in the placebo group (1.5-2.0 versus 0.35-0.8 points on a scale of 0-6; P = 0.03). Maximum effects were observed among the most symptomatic women. Psychological, subjective-somatic, and organic-somatic factors scores also improved along time (P < 0.001), but the treatment and placebo arms improved to a similar degree. Thromboses occurred in 3 patients receiving estrogen plus progestin and in 1 patient receiving placebo. CONCLUSION Menopausal symptoms are highly prevalent in peri- and postmenopausal lupus patients. Estrogen plus progestin improved vasomotor symptoms at a clinically significant level, but not other menopausal symptoms. Given the thrombotic risks of menopausal hormone therapy, this should be used only in women with significant vasomotor symptoms.
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Abstract
Use of a wide variety of quality of life (QoL) instruments, each measuring a different aspect of menopause with a different type of underlying scale, has been a major problem in menopause research. The aim of this review was to identify instruments developed for menopausal women and evaluate the psychometric properties and appropriateness of instruments for the study of QoL in menopausal women. Seven measures from 16 papers were chosen for the review. The psychometric evaluations were conducted based on quality judgment criteria. Of the seven measures reviewed in this study, the psychometric quality scores of Women’s Health Questionnaire (WHQ) was the highest. However, the result indicates that most instruments of menopause-specific QoL need further testing and evaluation of the various aspects of their psychometric properties. In addition, future research assessing psychometric properties with cross-cultural samples may be beneficial in adapting measures to specific context and study populations.
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Herbal treatment of the menopause: refelecting on tools strategies and outcomes. Complement Ther Med 2010. [DOI: 10.1016/j.ctim.2010.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Prospective follow-up of changes in menopausal complaints and hormone status after surgical menopause in a Malaysian population. Menopause 2010; 17:351-8. [DOI: 10.1097/gme.0b013e3181bcd6f8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Measuring climacteric symptoms and age at natural menopause in an Indian population using the Greene Climacteric Scale. Menopause 2009; 16:378-84. [DOI: 10.1097/gme.0b013e31818a2be9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Treating the climacteric symptoms in Indian women with an integrated approach to yoga therapy. Menopause 2008; 15:862-70. [DOI: 10.1097/gme.0b013e318167b902] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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