Assessment of menopause-related symptoms in mid-aged women with the 10-item Cervantes Scale

Menopausal symptoms and the awareness of menopausal-related information in low-income mid-aged women from Guayaquil, Ecuador

OBJECTIVE

To assess menopausal symptoms and determine awareness of menopausal related information in mid-aged women.

METHODS

This was a cross-sectional study in which 140 women aged 40 to 60 years from Guayaquil, Ecuador were surveyed with the short 10-item Cervantes Scale (CS-10) and a questionnaire containing personal data and questions assessing awareness of menopause related information.

RESULTS

The mean age of the sample was 48.0 ± 5.6 years. More than half of surveyed women had low education and non-urban residency, none were on menopausal hormone therapy, 33.6% had hypertension, 35% were postmenopausal, 78.6% had an increased body mass index (overweight/obese) and 92.9% had abdominal obesity (waist > 88 cm). The average CS-10 score was 15.3 ± 9.0 with a median of 14.0. The three most frequent menopausal symptoms were muscle-joint pain (75.0%), changes in skin texture (74.3%) and vaginal dryness (71.4%). Regarding awareness of information related to the menopause, it was found that 98.6% of women had no idea about what the menopause is and the average age of its onset. Interestingly, although 61.4% knew that during the menopause there is weight gain, 57.9% were sedentary. Married, postmenopausal, older and less educated women presented higher mean total CS-10 scores. Contrarily, those with less awareness of menopause related information present lower scores.

CONCLUSION

In this low-income mid-aged female sample there was a high rate of non-awareness regarding information related to the menopause, including an unhealthy cardiometabolic profile. There is a need for educational programs aimed to increase awareness in this high-risk population in relation to the surveyed aspects in order to improve their health status and prevent chronic conditions.

Validation of the Brazilian 10-item Cervantes Scale for the assessment of menopausal symptoms

Objective

To validate the 10-item Cervantes Scale (CS-10) among Brazilian women.

Methods

This is a cross-sectional observational study involving women in the community aged 40-55 years in the Southern region of Brazil. They completed a general health, habits and socio-demographic questionnaire, the CS-10 and the Women's Health Questionnaire (WHQ). Women unable to understand the survey, not consenting to participate, or having incapacity imposing difficulties during the completion of the questionnaire were excluded. A Confirmatory Factor Analysis (CFA) was conducted with the AMOS 16.0 software. Chi-square of degrees of freedom (χ2/df), the Comparative Fit Index (CFI), the Tucker-Lewis Index (TLI) and the Root-Mean-Square Error of Approximation (RMSEA) were used as indices of goodness of fit. Cronbach's alpha coefficient was used for internal consistency.

Results

A total of 422 women were included (premenopausal n=35, perimenopausal n=172, postmenopausal n=215). The CFA for the CS-10 showed a good fit (χ²/df=1.454, CFI=0.989; TLI=0.985; RMSEA=0.033; CI 90%=0.002-0.052; PCLOSE=0.921; Model p=0.049). Good reliability was established in CS-10 and WHQ (Cronbach's alpha=0.724). Postmenopausal women had higher total CS-10 scores (p≤0.0001), reflecting worse quality of life (QoL) related to menopause symptoms and confirming the greater symptomatology evaluated by high total scores for WHQ found in this population when compared to those in the premenopausal period (p=0.041).

Conclusion

The CS-10 is a consistent tool for health-related QoL in Brazilian mid-aged women.

Prevalence of menopausal symptoms and severity related factors among mid-aged Paraguayan women as measured with the 10-item Cervantes Scale

Objective: To determine the prevalence of menopausal symptoms and factors related to severity in mid-aged women.Methods: Cross-sectional study in which 216 urban-living women from Asunción-Paraguay (40-60 years) were surveyed with the 10 item Cervantes Scale (CS-10) and a general questionnaire (personal and partner data).Results: Median (interquartile range [IQR]) age of the sample was 48 [9] years, 48.1% were postmenopausal, 8.8% used menopausal hormone therapy, 39.4% psychotropic drugs, 43.5% had hypertension, 6.5% diabetes, 51.9% abdominal obesity, and 89.3% had a partner (n = 193). A history of sexual abuse was present in 2.8%. Median total CS-10 score was 8.5 [9.75]. Overall, 93.3% (180/193) of women having a partner were sexually active, with a median coital frequency of 8 times per month. According to the CS-10, the three most prevalent menopausal symptoms were: aching in muscles and/or joints (70.8%), anxiety and nervousness (70.8%) and hot flashes/night sweats (54.2%). Factors associated with higher CS-10 scores were: female age and educational level, marital status, menopausal status, and marital sexual aspects. Partner educational level was inversely correlated (rho Spearman coefficient) with CS-10 total scores. However, multiple linear regression analysis found that higher total CS-10 scores (more severe menopausal symptoms) negatively correlated to coital frequency and positively correlated with peri- and postmenopausal status, parity, sedentary lifestyle and a history of sexual abuse.Conclusion: Menopausal symptoms in this mid-aged urban female Paraguayan sample were related to hormonal, sexual and other female aspects.

Psychometric properties and validity of the Menopause Rating Scale in postmenopausal Portuguese women

OBJECTIVE

The aim of the study is to analyze the reliability and validity of the Portuguese version of the Menopause Rating Scale (MRS) among postmenopausal Portuguese women.

METHODS

A total of 184 postmenopausal women completed the Portuguese MRS. Internal consistency and test-retest reliability were studied. Construct, convergent, and concurrent validity were assessed. The 10-item Cervantes Scale and the Hospital Anxiety and Depression Scale were used to determine convergent and concurrent validity, respectively. The ability and accuracy of the Portuguese MRS to discriminate between women with and without anxiety and depression cases were evaluated, and a receiver operating characteristic curve analysis was used.

RESULTS

The Portuguese MRS showed an appropriate level of internal consistency (Cronbach α, 0.84 for MRS total score) and test-retest reliability (MRS total score; intraclass correlation coefficient, 0.92; 95% confidence interval, 0.85-0.96). Factor analysis (construct validity) revealed a 3-factor structure (explained variance of 62.08%). The MRS total score and its 3 factors showed good convergent (10-item Cervantes Scale) and concurrent (Hospital Anxiety and Depression Scale anxiety and depression) validity (all P < 0.001). The Portuguese MRS total score was significantly able to discriminate between postmenopausal women with and without anxiety (P < 0.001) and depression (P = 0.001), with a cutoff point of 15.50 (80.00% sensitivity and 63.70% specificity) for detecting depression and a cutoff point of 16.50 (82.35% sensitivity and 78.57% specificity) for identifying anxiety.

CONCLUSIONS

The Portuguese MRS has been shown to be a valid and reliable questionnaire for assessing the severity of menopausal symptoms and discriminating among postmenopausal women with and without anxiety and depression.

A higher quality of life by the Cervantes Short-Form Scale is related to a better sexual desire in postmenopausal women

OBJECTIVE

Evaluate the association between health relate quality of life and sexual desire in postmenopausal women and the influence of demographic descriptors on sexual desire.

METHODS

A observational-cross-sectional study was conducted in 521 postmenopausal women in La Zarzuela Hospital between 2018-2020. Cervantes-short form (Cervantes-SF) scale and Brief profile female sexual function (B-PFSF) scale were filled out in the consultation. High score in Cervantes-SF implies worse health-related quality of life (HR-QoL). If score is lower or equal to 20 in B-PFSF implies diagnosis of hypoactive sexual desire disorder.

RESULTS

There is a positive relationship between HR-QoL measured by Cervantes-SF and sexual desire measured by B-PFSF (p < .001; correlation coefficient: .223). The mean score on Cervantes-SF was 30.8 ± 14.9 and on B-PFSF was 18.7 ± 7.4. The B-PFSF score was worse in those women using systemic or vaginal hormonal treatment versus using non-hormonal treatment (18.7 ± 7.8 or 17.2 ± 7.4 vs 19.7 ± 6.5; p = .033. Smoking (b exp: .384; p = .029) and using vaginal hormonal treatment (b exp: 1.759; p = .033) are independent factors related to sexual desire. No difference was found in the wellbeing perceived by women in the different treatments (mean of minimal clinically important difference score was 2.9 in systemic vs. 3.0 in vaginal hormonal treatment).

CONCLUSIONS

Improvement on HR-QoL is related to improvement on sexual desire. Sexual desire is better in women with non-hormonal treatment than in women with systemic or vaginal hormonal treatment. The vaginal hormonal treatment and being current smoker are independent factors of low and high sexual desire, respectively.

Menopause Representations Questionnaire: development and validation with Portuguese women

OBJECTIVE

This study aimed to develop and validate a Portuguese version of the Menopause Representations Questionnaire (MenoSentations-Q), a self-report measure to assess cognitive appraisal of menopause, based on cognitive components of the Self-Regulation Model and the results from a previous Portuguese qualitative study.

METHODS

A total of 309 Portuguese women, aged 45-65 years, completed the questionnaire. Factorial, convergent, discriminant, and criterion validity, as well as reliability and psychometric sensitivity, were studied.

RESULTS

MenoSentations-Q has demonstrated acceptable factorial, convergent, and discriminant validity, as well as good values of sensitivity and reliability for the four factors (i.e. identity; positive consequences; negative consequences; and control, awareness, and cause). Criterion validity was only obtained for two factors.

CONCLUSIONS

MenoSentations-Q, a brief measure of menopausal representations, in this sample of Portuguese women provides information to inform interventions that might include challenging unhelpful menopausal representations. This instrument could be used in both clinical and community settings.

Women with low quality of life by cervantes-short form scale choose menopausal hormone therapy

OBJECTIVES

The aim of the study is to assess whether women who choose to use menopausal hormone therapy (MHT) have lower quality of life (QoL) than those who do not initiate it using Cervantes short form scale (C-SF), and analyze sociodemographic factors associated with lower QoL in women.

STUDY DESIGN

A cross-sectional descriptive observational study was made in four hundred and eighty women with climacteric symptoms.

RESULTS

Mean age was 51.1 years. Two hundred and sixty-one women (54.3 %) started MHT. The sample´s global mean in C-SF score was 51.3 ± 13.9. Women who choose to use MHT have higher score in C-SF (lower QoL) than women who reject it (58.7 ± 15.9 vs 46.7 ± 12.8; p < 0.001). We found higher score in women with early menopause (53.7 ± 15.9 vs 49.7 ± 13.1; p = 0.037); with no obesity (<30 vs >30 BMI) (52.8 ± 13.5 vs 41.0 ± 8.2; p = 0.002); with previous malignancies (56.2 ± 18.2 vs 50.2 ± 13.5; p = 0.020) and without sexual activity (58.0 ± 25.4 vs 50.4 ± 13.1; p = 0.009. No differences were found in C-SF score with respect to tobacco habits or physical activity. In the multivariate analysis, the variable independently associated to lower QoL by C-SF (high score) was to be a woman who want to initiate MHT (p = 0.004).

CONCLUSIONS

Women who choose to use MHT due to menopausal symptoms have lower quality of life measured by C-SF scale. Women with early menopause, with no obesity (<30 BMI), without sexual activity and with previous malignances have lower quality of life measured by C-SF scale. Women with early menopause have more psychic symptoms like nervousness, fatigue and sleep complaints by C-SF scale than women with natural menopause.

Perimenopause, body fat, metabolism and menopausal symptoms in relation to serum markers of adiposity, inflammation and digestive metabolism

BACKGROUND

Perimenopausal women gain weight that may alter inflammatory status, endocrine equilibrium, and the intensity of vasomotor symptoms.

OBJECTIVE

To measure serum levels of markers related to adiposity, inflammation/angiogenesis and digestive metabolism and correlate them with body mass index (BMI), waist-to-hip ratio (WHR), metabolic parameters and menopausal symptoms (assessed with the 10-item Cervantes Scale [CS-10]).

METHODS

Serum of perimenopausal women (n = 24), STRAW stages-2 and -1, was analyzed using the Bio-Plex 200 System technology to assess 30 proposed analytes. The MetS was defined by the American Heart Association criteria and women were divided as: normal BMI (NBMI), excessive BMI (EBMI), and EBMI with MetS (EBMI-MetS).

RESULTS

Weight, BMI, abdominal circumference, WHR, systolic blood pressure, glucose and triglyceride levels were significantly higher and high-density lipoprotein cholesterol (HDL-C) was lower in EBMI-MetS women compared to NBMI ones. Insulin, C-peptide, resistin, adipsin, GIP, leptin, IL-6, FGF21 and PAI-1 levels were significantly higher and ghrelin and IGFBP-1 lower in EBMI-MetS women as compared to NBMI ones. Spearman's correlation of pooled data showed a significant positive correlation between abdominal perimeter and WHR and C-peptide, insulin, adipsin, resistin, leptin, PAI-1 and FGF21 and a negative correlation with IGFBP-1 levels. Total CS-10 scores and hot flush intensity did not differ between studied groups, yet positively correlated with anthropometric values but not with studied analytes.

CONCLUSION

Perimenopausal women with EBMI and the MetS showed an altered metabolic profile, but no differences in menopausal symptoms which also did not correlate with changes in studied biomarkers.

Measuring bothersome menopausal symptoms: development and validation of the MenoScores questionnaire

Background

The experience of menopausal symptoms is common and an adequate patient-reported outcome measure is crucial in studies where women are treated for these symptoms. The aims of this study were to identify a patient-reported outcome measure for bothersome menopausal symptoms and, in the absence of an adequate tool, to develop a new measure with high content validity, and to validate it using modern psychometric methods.

Methods

The literature was reviewed for existing questionnaires and checklists for bothersome menopausal symptoms. Relevant items were extracted and subsequently tested in group interviews, single interviews, and pilot tests. A patient-reported outcome measure was drafted and completed by 1504 women. Data was collected and psychometrically validated using item-response theory Rasch Models.

Results

All questionnaires identified in the literature lacked content validity regarding bothersome menopausal symptoms and none were validated using item-response theory. Our content validation resulted in a draft measurement encompassing 122 items across eight domains. Following psychometrical validation, the final version of our patient-reported outcome measure, named the MenoScores Questionnaire, encompassed 51 items, including one single item, covering 11 scales.

Conclusion

Menopausal symptoms are multidimensional with some symptoms unquestionably related to the menopausal transition. We identified four constructs of importance: hot flushes, day-and-night sweats, general sweating, and menopausal-specific sleeping problems. The MenoScores Questionnaire is condition-specific with high content validity and adequate psychometrical properties. It is designed to measure bothersome menopausal symptoms and all scales are developed and psychometrically validated using item-response theory Rasch Models.

Trial registration

Approved by the Danish Data Agency (J.nr. 2015–41-4057). Ethics Committee approval was not required.

Electronic supplementary material

The online version of this article (10.1186/s12955-018-0927-6) contains supplementary material, which is available to authorized users.

Application of the 10-item Cervantes Scale among mid-aged Ecuadorian women for the assessment of menopausal symptoms

BACKGROUND

The majority of instruments used to evaluate menopausal symptoms are long and complex. In this sense, more simple tests are being designed to rapidly obtain a snapshot of the global clinical picture.

OBJECTIVE

To assess menopausal symptoms in mid-aged women using the short 10 item version of the original menopause Cervantes Scale (CS-10).

METHOD

This was a cross sectional study in which a total of 451 Ecuadorian women (40-59 years) were surveyed with the CS-10 and a general socio-demographic questionnaire containing personal and partner data.

RESULTS

Median age of the whole sample was 48 years. A 41.2% were postmenopausal, 44.3% abdominally obese (waist circumference >88cm), 6% diabetic, 16.9% hypertense, 11.5% smoked, 6.9% currently used hormone therapy, 9.5% phytoestrogens and 6.7% psychotropic drugs. For the entire sample, median [interquartile range] CS-10 global scores were 10.0 [9.5], and for pre-, peri- and postmenopausal women: 5.0 [7.0], 11.0 [9.0] and 13.5 [8.0], respectively. The CS-10 displayed good internal consistency (Cronbach's alpha 0.87). According to the CS-10, the three most prevalent menopausal symptoms were: muscle and joint pains (88.5%), hot flushes (77.6%) and skin dryness (71.4%). Multiple linear regression analysis found that postmenopausal status, parity, unhealthy perceived status, psychotropic drug use, partner erectile dysfunction, lower coital frequency and living at high altitude were related to higher CS-10 global scores.

CONCLUSION

In this mid-aged Ecuadorian female sample severity of menopausal symptoms, as determined by the CS-10, were related to environmental and female/partner personal and socio-demographical aspects.