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Woods NF, Shaver JF, Berg JA. Genitourinary Syndrome of Menopause: Prevalence and Predictors. Clin Obstet Gynecol 2024; 67:27-42. [PMID: 38126336 DOI: 10.1097/grf.0000000000000847] [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: 12/23/2023]
Abstract
The genitourinary syndrome of menopause (GSM) has been proposed as a diagnosis by a consensus of clinicians and investigators. Our purpose for this paper is to review extant evidence about: 1) the breadth of symptoms and symptom clusters as related to the syndrome; 2) the prevalence of GSM (includes vulvar and vaginal atrophy); 3) factors that are associated with, predict, or explain the syndrome; and 4) what should be pursued for expanding meaningful evidence. Within recent literature, we found a wide range of prevalence estimates, likely a function of the differing populations studied, study design, and methods of data collection. Factors related to the prevalence of GSM included age and aging; reproductive aging stage; hormones, especially estrogen; and culture and language. We recommend further specification of diagnostic criteria for GSM; clarification of urinary symptoms in GSM; use of longitudinal study designs; validation of GSM-related measures; exploration of cultural equivalence of GSM measures; and assessing biases in completed research.
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Affiliation(s)
- Nancy F Woods
- University of Washington School of Nursing, Seattle, Washington
| | - Joan F Shaver
- The University of Arizona College of Nursing, Tucson, Arizona
| | - Judith A Berg
- The University of Arizona College of Nursing, Tucson, Arizona
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Logan S, Thu WPP, Ho K, Cauley JA, Kramer MS, Yong EL. Sexual inactivity and sexual dysfunction in midlife Singaporean women: A prospective cross-sectional study of prevalence and risk factors. Maturitas 2021; 152:1-9. [PMID: 34674802 DOI: 10.1016/j.maturitas.2021.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To examine factors relating to both sexual inactivity and sexual dysfunction in midlife Singaporean women. STUDY DESIGN Sociodemographic, medical/lifestyle factors, physical activity, BMI, handgrip strength (HGS) and physical performance data collected from healthy Chinese, Indian, and Malay women, aged 45-69 years, attending gynaecology clinics. MAIN OUTCOME MEASURES Sexual inactivity and sexual dysfunction (defined as total score ≤ 26.55) assessed using the Female Sexual Function Index (FSFI). RESULTS 1048 women completed the FSFI. Mean (±SD) age was 56.2 (±6.2). Sexual inactivity was reported by 43.2% and was positively associated with older age [55-64 years (aOR 2.0, 95% CI 1.3-3.0) and ≥65 years (aOR 2.5, 95% CI 1.2-5.1)], younger menarche (aOR 1.8, 95% CI 1.3-2.5), lowest education (aOR 2.1, 95% CI 1.2-3.6), lowest income (aOR 1.8, 95% CI 1.1-2.8), unmarried (aOR 4.0, 95% CI 2.6-6.4), nulliparity (aOR 1.9, 95% CI 1.1-3.4), and BMI <18.5 kg/m2 (aOR 2.7, 95% CI 1.3-5.6). Among the sexually active, sexual dysfunction was identified in 70.3%. Sexual dysfunction was positively associated with menopause ≥10 years (aOR 2.4, 95% CI 1.1-5.0), nulliparity (aOR 3.0, 95% CI 1.1-9.8), moderate/severe vaginal dryness (aOR 13.8, 95% CI 4.8-38.7) and HGS <18 kg (aOR 1.9, 95% CI 1.1-3.2) and negatively associated with use of menopausal hormone therapy (aOR 0.3, 95% CI 0.1-0.6). CONCLUSION This, the largest Singaporean sexual function study, is the first to include physical performance in a healthy population. Most were sexually active but reported dysfunction. Novel associations included underweight BMI with sexual inactivity and weaker HGS and Malay ethnicity with greater and less sexual dysfunction, respectively.
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Affiliation(s)
- Susan Logan
- Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, 119228, Singapore; NUS Yong Loo Lin School of Medicine, National University of Singapore, 19228, Singapore.
| | - Win Pa Pa Thu
- Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, 119228, Singapore
| | - Kylie Ho
- NUS Yong Loo Lin School of Medicine, National University of Singapore, 19228, Singapore
| | - Jane A Cauley
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, United States
| | - Michael S Kramer
- Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, 119228, Singapore; Departments of Epidemiology, Biostatistics & Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec H3G 1Y6, Canada
| | - Eu-Leong Yong
- Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, 119228, Singapore; NUS Yong Loo Lin School of Medicine, National University of Singapore, 19228, Singapore.
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Zhao Y, Dong W, Sun L, Su Q, Zhu Y, Lu M, Tan C, Yang X. Analysis of factors that influence the quality of sexual life of climacteric women in China. Climacteric 2018; 22:73-78. [PMID: 30499736 DOI: 10.1080/13697137.2018.1514002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The study aimed to identify the factors associated with the sexual lives of perimenopausal and postmenopausal women in China. METHODS A total of 426 participants were approached about this study from May 2012 to August 2013. In total, 252 cases were included in this study. One hundred and ninety-seven women who filled out the Quality of Sexual Life Questionnaire for Women (QSLQW) and the modified Kupperman Menopausal Index (KMI) had an active sexual life. Pearson's coefficient index was used to determine the correlation between the KMI and different domains of the QSLQW. Multivariable statistical analysis was performed to determine the correlation between different factors and the sexual life of perimenopausal and postmenopausal women. RESULTS When the participants reported a higher KMI, they suffered lower sexual satisfaction (r = -0.16, p = 0.035), more severe sexual anxiety (r = -0.367, p = 4.9 × 10-7), and less sexual response (r = -0.21, p = 0.004). No correlation was found between the KMI and sexual communication, sexual attitude, and self-image. Multivariable statistical analysis showed that menopause status and higher KMI scores are associated with a decrease in sexual satisfaction among Chinese women (β = -9.76, 95% CI -16.89 to -2.64 and β = -0.41, 95% CI -0.68 to -0.15, respectively), and that the better the spousal relationship, the fewer deliveries and the higher the scores of sexual life quality (β = 8.86, 95% CI -0.91 to 18.63 and β = -6.65, 95% CI -11.83 to -1.48, respectively). CONCLUSION Factors including parity, spousal relationship, menopausal status, and menopausal symptoms are associated with the quality of sexual life of perimenopausal and postmenopausal women in China.
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Affiliation(s)
- Y Zhao
- a Department of Gynecology and Obstetrics , Peking University People's Hospital , Beijing , P. R. China
| | - W Dong
- b Department of Gynecology and Obstetrics , The First People's Hospital of Yunnan Province , Kumming City, P. R. China
| | - L Sun
- c Department of Gynecology and Obstetrics , Tianjin Medical University Cancer Institute and Hospital , Tianjin , P. R. China
| | - Q Su
- a Department of Gynecology and Obstetrics , Peking University People's Hospital , Beijing , P. R. China
| | - Y Zhu
- a Department of Gynecology and Obstetrics , Peking University People's Hospital , Beijing , P. R. China
| | - M Lu
- a Department of Gynecology and Obstetrics , Peking University People's Hospital , Beijing , P. R. China
| | - C Tan
- a Department of Gynecology and Obstetrics , Peking University People's Hospital , Beijing , P. R. China
| | - X Yang
- a Department of Gynecology and Obstetrics , Peking University People's Hospital , Beijing , P. R. China
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Yeom HE. Gender differences in climacteric symptoms and associated factors in Korean men and women. Appl Nurs Res 2018; 41:21-28. [PMID: 29853209 DOI: 10.1016/j.apnr.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/09/2018] [Accepted: 03/02/2018] [Indexed: 12/19/2022]
Abstract
Both men and women may experience multifaceted symptoms that are part of natural aging throughout the climacteric period. This study compared the prevalence and severity of climacteric symptoms between genders and identified the underlying clusters of climacteric symptoms and associated factors in midlife men and women. A cross-sectional study was done with 254 middle-aged Korean men (n = 129, M = 50.4) and women (n = 125, M = 49.5). Data were collected by self-administered surveys and analyzed using t-tests, chi-square tests, exploratory factor analysis, and regression analysis. Significant gender differences in overall climacteric symptoms were not detected except for muscle weakness, weight gain, and hot flashes. Climacteric symptoms were clustered as physical, vasomotor-genital, psychological, and metabolic dimensions, with the physical dimension being the most explanatory cluster. A significant gender effect was found only in the metabolic dimension after adjusting for the relevant covariates, and regular eating was significantly associated with all symptom clusters. This study offers evidence that most climacteric symptoms are shared by both men and women and emphasizes the importance of healthier lifestyles in the climacteric transition period. The findings highlight the critical need for integrated assessments of the multifactorial symptoms and of modifying poor lifestyles in both genders throughout the climacteric transition period.
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Affiliation(s)
- Hyun-E Yeom
- College of Nursing, Chungnam National University, Munhwaro 266, Jung-gu, Daejeon, South Korea.
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Tonob D, Melby MK. Broadening our perspectives on complementary and alternative medicine for menopause: A narrative review. Maturitas 2017; 99:79-85. [PMID: 28364873 DOI: 10.1016/j.maturitas.2017.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/26/2017] [Indexed: 12/20/2022]
Abstract
Complementary and alternative medicine (CAM) is widely used for menopause, although not all women disclose use to their healthcare providers. This narrative review aims to expand providers' understanding of cross-cultural approaches to treating and managing menopause by providing an overarching framework and perspective on CAM treatments. Increased provider understanding and awareness may improve not only provider-patient communication but also effectiveness of treatments. The distinction between illness (what patients suffer) and disease (what physicians treat) highlights the gap between what patients seek and doctors provide, and may help clarify why many women seek CAM at menopause. For example, CAM is often sought by women for whom biomedicine has been unsuccessful or inaccessible. We review the relevance to menopause of three CAM categories: natural products, mind-body practices including meditation, and other complementary health approaches including traditional Chinese medicine (TCM) and Japanese Kampo. Assessing the effectiveness of CAM is challenging because of the individualized nature of illness patterns and associated treatments, which complicate the design of randomized controlled trials. Because many women seek CAM due to inefficacy of biomedical treatments, or cultural or economic marginalization, biomedical practitioners who make an effort to learn about CAM and ask patients about their CAM use or interest may dramatically improve the patient-provider relationship and rapport, as well as harnessing the 'meaning response' (Moerman, 2002) imbued in the clinical encounter. By working with women to integrate their CAM-related health-seeking behaviors and treatments, providers may also boost the efficacy of their own biomedical treatments.
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Affiliation(s)
- Dunia Tonob
- Department of Anthropology, University of Delaware, USA
| | - Melissa K Melby
- Department of Anthropology, University of Delaware, USA; College of Health Sciences, University of Delaware, USA.
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Abstract
Our purpose for this study was to identify clusters of midlife women by menopausal symptoms in a multiethnic sample, and to determine ethnic differences in the clusters. This was a secondary analysis of data from 501 women in a larger Internet study on menopausal symptom experiences. The data were analyzed using factor analysis, hierarchical cluster analysis, and multinominal logistic analysis. A three cluster solution was adopted (F = 575.71, p <.01). The clusters differed significantly in the country of birth and ethnicity (p <.05). Only in the low symptomatic cluster were there significant ethnic differences in menopausal symptoms.
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Affiliation(s)
- Eun-Ok Im
- a School of Nursing, University of Pennsylvania , Philadelphia , Pennsylvania , USA
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Cross-cultural study: experience, understanding of menopause, and related therapies in Australian and Laotian women. Menopause 2013; 19:1300-8. [PMID: 22929035 DOI: 10.1097/gme.0b013e31825fd14e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate and compare symptom experiences, beliefs, attitudes, and understanding of menopause and menopausal therapies in Australian and Laotian women. METHODS This was a cross-cultural, questionnaire-based study involving 108 women (56 Australian women and 52 Laotian women aged 40-65 y) attending outpatient clinics in Australia and Laos. Descriptive statistics and univariate analysis were conducted using Student's t test or Mann-Whitney U test, where appropriate. RESULTS Psychological symptoms, depression, vasomotor symptoms, and sexual dysfunction were significantly higher in Australian women compared with Laotian women (P < 0.05). Australian women perceived the meaning of menopause as aging (57%), whereas most Laotian women reported not knowing what menopause meant to them (81%). Australian women's fears about menopause included weight gain (43%), aging (41%), and breast cancer (38%), whereas Laotian women reported not knowing about potential menopausal problems (85%). Exercise (55%), education and awareness (46%), and improving lifestyle (41%) were reported by Australian women as being effective in alleviating menopausal symptoms, with only 21% reporting not knowing what was effective compared with 83% of Laotian women. Many women reported not knowing the risks/benefits of hormonal therapies (50% of Australian women and 87% of Laotian women) and herbal therapies (79% of Australian women and 92% of Laotian women). General practitioners were the most common source of menopause information for both Australians (73%) and Laotians (67%). CONCLUSIONS Sociocultural factors influence women's perception of menopause. Psychological symptoms, sexual dysfunction, and vasomotor symptoms are more commonly reported by Australian women than by Laotian women. Women have a limited understanding of the risks/benefits of menopausal therapies, and culturally appropriate education is needed.
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Detecting cross-cultural differences in somatization. Menopause 2012; 19:121-2. [DOI: 10.1097/gme.0b013e318240bfbf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Methods used in cross-cultural comparisons of vasomotor symptoms and their determinants. Maturitas 2011; 70:110-9. [DOI: 10.1016/j.maturitas.2011.07.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 07/13/2011] [Accepted: 07/14/2011] [Indexed: 11/23/2022]
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Melby MK, Sievert LL, Anderson D, Obermeyer CM. Overview of methods used in cross-cultural comparisons of menopausal symptoms and their determinants: Guidelines for Strengthening the Reporting of Menopause and Aging (STROMA) studies. Maturitas 2011; 70:99-109. [DOI: 10.1016/j.maturitas.2011.07.011] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 07/13/2011] [Accepted: 07/14/2011] [Indexed: 11/27/2022]
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