Menopause Management Knowledge in Postgraduate Family Medicine, Internal Medicine, and Obstetrics and Gynecology Residents: A Cross-Sectional Survey

Real-world evaluation of treatment utilization by women experiencing vasomotor symptoms associated with menopause in the United States and Europe: Findings from the REALISE study

OBJECTIVES

Despite the profound impact of menopausal symptoms on women, treatment utilization is low, and many seek alternative therapies. The REALISE study aimed to evaluate the treatment landscape - that is, pharmacological treatment, lifestyle changes (LC), and use of over-the-counter (OTC) products - for women from six high-income countries experiencing vasomotor symptoms (VMS) and receiving healthcare.

STUDY DESIGN

Analysis of a secondary dataset, the Adelphi Real World Disease Specific Programme™, a large, cross-sectional, point-in-time survey conducted in the United States and five European countries (February-October 2020). Physicians provided demographic, clinical, and treatment data; women were stratified by VMS severity (mild; moderate-severe) and presence of concomitant sleep/mood symptoms. Women completed forms on VMS severity, concomitant symptoms, LC, and OTC product use. Two subgroups were identified: VMS-only and VMS + sleep/mood.

MAIN OUTCOME MEASURES

Prescription treatment, LC, and OTC product utilization.

RESULTS

Physicians (n = 233) provided data on 1767 women; 825 (46.7 %) completed a self-completion form. Physicians rated 60 % of women with moderate-severe VMS, of whom 709 (66.8 %) were currently prescribed pharmacological treatment; 27.1 % had never been prescribed. Hormone therapy was most frequently prescribed in the moderate-severe group (overall, 49.8 %; VMS-only, 57.4 %; VMS + sleep/mood, 47.3 %), followed by serotonergic antidepressants (15.7 %; 9.7 %; 17.6 %, respectively). Most women (78.3 %) with moderate-severe VMS adopted LC, and 57.6 % used at least one OTC product for VMS relief.

CONCLUSIONS

Nearly a third of women with moderate-severe VMS had never received treatment despite access to healthcare. This, combined with the prevalent use of LC/OTC products, suggests an unmet need for new treatment options to manage VMS and concomitant sleep/mood symptoms.

Menopause in Plastic Surgery Patients: An Underrecognized and Undertreated Comorbidity

SUMMARY

Nearly half of all patients undergoing plastic surgery are middle-aged cisgender women, all of whom will experience menopause. Plastic surgeons do not treat menopause directly, but it can be a concern-and even a motivating factor-for patients seeking plastic surgery. In addition, the changes associated with menopause underlie problems that many plastic surgeons seek to address, including with face lifts, breast surgery, and vaginal rejuvenation. Hormone replacement therapy has the potential to improve quality of life by treating bothersome symptoms and delaying the physical changes brought on by loss of estrogen. However, recent reports in the media highlight that women face significant barriers to accessing menopause care due to a lack of trained providers willing to manage hormone replacement therapy, as well as historical concerns regarding increased cancer risk, which recent evidence suggests were overestimated. Plastic surgeons may be the first, or only, providers with whom women discuss how their bodies change with age. As a result, plastic surgeons should consider menopause as an underlying risk factor or comorbidity for any woman presenting with aging-related complaints, and to ensure that these patients have access to appropriate menopause care in their communities. This is especially important for surgeons offering vaginal rejuvenation therapies, given that locally acting topical estrogen is a safe and highly effective treatment. The authors present guidance and recommendations for how plastic surgeons should take menopause into account when evaluating and advising patients. In addition, the authors present a treatment algorithm for safe prescribing of locally acting hormone replacement therapy for vaginal rejuvenation.

Prevalence of offering menopause hormone therapy among primary care doctors and its associated factors: A cross-sectional study

BACKGROUND

Guidelines recommend Menopausal Hormone Therapy (MHT) as the most effective treatment for menopausal symptoms. However, a local study found that the usage of MHT among menopausal women was low (8.1%), with one of the main reasons being it is not recommended by doctors. Therefore, the objectives of this study are to determine the prevalence of offering MHT in treating symptomatic menopausal women among primary care doctors (PCDs) and its associated factors.

METHODS

This cross-sectional study involved PCDs from the Federal Territory of Kuala Lumpur, the Federal Territory of Putrajaya and the state of Selangor. All PCDs provided services in government primary care clinics from the three states were invited through the doctor in charge of each clinic. An online survey links was provided for the participants to the self-administered questionnaire. The questionnaire included PCDs' demographics, their menopause management practices, attitudes towards MHT, perceived barriers in offering MHT, knowledge of related guidelines and received training on menopause management. The outcome variable was offering MHT which defined as either prescription of MHT or referral to hospital for MHT initiation. Multivariate logistic regression analysis was performed to determine the factors associated with offering MHT.

RESULTS

The response rate was 42.9% (559/1301). Of those who participated in the study, 77.8% of PCDs were female and 89.1% were medical officer. Although 66.9% of the participants reported offering MHT to their patients, the actual prescription rate was low (0.9%). Most PCDs (66%) would refer the patients to hospitals. 87.1% of PCDs (487/559) reported that MHT was not available in their clinic. In the past 12 months, 83% of PCDs had not received any related training. Female PCDs (AOR:2.5, CI: 1.51-4.13, p<0.001), perceiving MHT as preference treatment for menopause symptom (AOR:3.6, CI: 2.13-6.19, p < 0.001), having likelihood to recommend MHT to family and friends (AOR:3.0, CI: 1.87-4.83, p < 0.001), and receiving training on menopause management (AOR:2.7, CI: 1.30-5.56, p = 0.008) were the positive predictor of offering MHT. The negative predictors in offering MHT were no-experience in prescribing MHT (AOR: 0.4, CI: 0.15-0.87, p = 0.024) and lack of information regarding MHT for the patient (AOR: 0.4, CI:0.20-0.67, p < 0.001).

CONCLUSION

The study revealed a low rate of MHT prescription among PCDs, with many relying on referrals to hospitals for managing menopausal symptoms. The findings underscore the need for strategies that includes fulfilling professional training gaps, improving MHT availability, and improving information dissemination for patient.

Willingness to use clinical scales for menopause management among general practitioners

OBJECTIVES

The use of digital healthcare technologies to enhance healthcare delivery has seen significant growth. However, a notable a notable research gap exists in the application of clinical scales for menopause management by general practitioners (GPs). This study aims to investigate willingness of GPs to use specific menopausal scale tools in the care of females for menopause management.

METHOD

An anonymous online survey was developed, which received responses from 348 French GPs in 2023. Multiple backward logistic regression was performed to identify the factors influencing the willingness to use a practical menopause management scale.

RESULTS

In total, 87.93% of GPs are not familiar with the Greene Climacteric Scale and 90.52% are not familiar with the Menopause Quick 6 scale. In contrast, 90.52% would be interested in having access to such scales. The willingness to use a menopause management scale is associated with caring for menopausal females (odds ratio [OR] = 6.13, 95% confidence interval [CI] [2.08-18.08], p = 0.001), less experience (OR = 7.10, 95% CI [2.05-25.22], p = 0.002), the importance of health prevention in daily practice (comparing 'very important' to 'not', OR = 12.98, 95% CI [1.68-97.60], p = 0.004) and the use of a digital scale in daily practice for menopausal management (OR = 2.13, 95% CI [1.04-5.83], p = 0.014).

CONCLUSION

Future research is essential in representative population to confirm these findings in menopause management.

African American women's experiences of menopause: A focus group study

OBJECTIVES

This study aimed to characterize African American women's experiences of menopause and their interactions with the health care system related to menopausal symptoms.

STUDY DESIGN

We conducted four focus groups with community-dwelling midlife African American women.

MAIN OUTCOMES MEASURES

Women who consented to participate completed demographic surveys. Transcripts of the four focus groups (n = 26) were analyzed and themes were elucidated.

RESULTS

In total, 26 midlife African American women participated in the four focus groups. Participants revealed unmet needs regarding obtaining menopause information from their clinicians. Clinician discussions about menopause tended to be initiated by patients based on their symptoms. Some women reported feeling ignored and/or dismissed by the clinician when they initiated discussions of menopause. Women wanted their clinicians to provide information on menopause, which included receiving information prior to the menopause transition to help them know what to expect.

CONCLUSION

Women wanted their clinicians to initiate discussions of menopause rather than wait for women to mention symptoms. Prioritizing menopause training for clinicians taking care of midlife African American women may help to improve discussions of menopause.

Real-world clinical evaluation of natural and induced vasomotor symptoms in the USA and Europe

OBJECTIVE

This study aimed to examine physicians' and patients' perceptions regarding symptom burden and impact in women experiencing natural vasomotor symptoms (nVMS) or vasomotor symptoms induced by endocrine therapy for breast cancer (iVMS).

METHODS

The cross-sectional survey based on real-world clinical consultations was conducted in the USA and five European countries. Obstetrician-gynecologists, primary-care physicians and oncologists provided demographic and symptom data for patients experiencing VMS; patients optionally self-reported their experiences via questionnaires, including their symptom profile and work/activity burden through the Menopause Quality of Life (MENQOL) and Work Productivity and Activity Impairment (WPAI) tools.

RESULTS

Physicians completed survey forms on 2451 consulting patients; patients completed 1029 questionnaires. nVMS and iVMS severity was significantly associated with the severity of mood symptoms and sleep disturbances (p < 0.0001). However, around half of the patients with mild nVMS/iVMS also experienced moderate-severe mood changes (55.4%/43.7%) or sleep disturbances (42.4%/40.4%). Presence of mood/sleep disturbances alongside nVMS increased MENQOL vasomotor scores (p = 0.004/p < 0.001). Presence of sleep disturbances increased WPAI activity impairment (p < 0.001) but mood changes did not. Similar findings were reported for iVMS patients.

CONCLUSION

Significant burden from the triad of natural or induced menopausal symptoms, sleep disturbances and mood changes affected women's daily activities, work and quality of life more than vasomotor symptoms alone.

Time for 'the change': increasing awareness of the menopause transition in dermatological training and practice

Dermatologists regularly encounter skin-related manifestations tied to the menopause transition, from hair loss and acne to vaginal dryness and hyperhidrosis. Yet, despite the frequency and significance of these presentations, there remains a conspicuous gap when it comes to training dermatologists in menopause care. This omission is highlighted by the absence of menopause-related content and guidance in dermatological educational materials. This article emphasizes the need for a holistic approach to menopause care in dermatology and suggests strategies to address the existing knowledge and practice gap.

The Art of Hormone Replacement Therapy (HRT) in Menopause Management

Hormone replacement therapy (HRT) is considered the gold standard for management of vasomotor and vaginal symptoms of menopause. Vasomotor symptoms of menopause may include hot flashes and diaphoresis that vary in intensity and duration. Other symptoms of menopause can include vaginal atrophy and dryness, leading to dyspareunia and increased risk of infection. These symptoms can be impactful on a woman's life and HRT has data to support its efficacy, however, HRT carries significant risks that are generally well known, including risk of stroke, cardiovascular disease, breast cancer, and venous thromboembolism. These risks were most well characterized by several landmark trials published in the early 2000s. There are several nuances to prescribing HRT that can make doing so complex. These include consideration of cyclic vs continuous administration and of tapering therapy. Additionally, estrogen is available in a variety of dosage forms including injections and transdermal formulations. However, for women with an intact uterus, estrogen will need to be combined with progestin or bazedoxifene (a selective estrogen receptor modulator - SERM), both once daily oral formulations, in order to minimize malignancy risk. Though product preference and considerations of dosing may vary depending on practitioner preference, this brief report aims to clarify some nuances to prescribing or recommending HRT.

Vaginal dryness: a review of current understanding and management strategies

The issue of vaginal dryness in genitourinary syndrome of menopause (GSM) and its pervasive impact on women's quality of life is often overlooked. Extensive surveys conducted worldwide reveal limited understanding of vaginal dryness among public and health-care providers. Physician knowledge on menopause medicine varies globally, highlighting the need for standardized training. Effective communication between physicians and patients plays a crucial role in diagnosing and treating GSM symptoms. There are multiple treatment options to improve vaginal lubrication, including hormonal and non-hormonal therapies, along with lifestyle modifications. Tailoring treatments to individual patient preferences is crucial for compliance. Overall, GSM is multifaceted, from the prevalence of vaginal dryness to the nuances of treatment preferences. The urgency of widespread education and awareness of this matter must be underscored to meet the aim of enhancing the well-being and quality of life for women.

Uncovering gaps in management of vasomotor symptoms: findings from a national need assessment

CONTEXT

This national needs assessment study explores the knowledge, attitude, beliefs, and practices (KABP) gaps related to vasomotor symptoms (VMS) associated with menopause among primary care and OB/GYN clinicians. VMS significantly impacts healthcare costs, workplace productivity, and patient psychosocial health, but a notable disconnect exists between healthcare providers and patients, with provider reticence and knowledge gaps playing a contributing role.

OBJECTIVES

This study aims to identify and propose optimal educational strategies to address these barriers, with attention to health disparities affecting women of color.

METHODS

Methods employed include a multimodal approach of literature review, expert opinion, qualitative interviews, surveys, focus groups, and case studies, ensuring diverse clinician input. Data collection involved in-depth clinician interviews, a nationally disseminated clinician survey, and focus groups.

RESULTS

Results indicate a critical deficiency in healthcare providers' understanding and management of VMS, especially among OB/GYN residents, with 75 % showing limited knowledge. The study also highlights the disproportionate impact of knowledge gaps on women of color, emphasizing the need for a culturally informed approach in medical training and practice. There's a notable discrepancy between clinicians' current and desired abilities in managing VMS, indicating a need for ongoing professional development. Significant variability in approaches to diagnosing and treating VMS, as well as substantial knowledge gaps about treatment options, underscore the need for evidence-based protocols.

CONCLUSIONS

Although VMS are a normal aspect of aging, they can significantly disrupt quality of life for many women, necessitating intervention. Beyond the immediate discomfort, VMS can impact quality of life and trigger insomnia and mood disturbances. This study exposes both new and previously recognized gaps in healthcare providers' knowledge and management skills concerning VMS treatment options, particularly regarding hormonal and nonhormonal therapies. Furthermore, our findings highlight the need for a deeper understanding of how VMS uniquely impacts women of diverse backgrounds. Research, including the Study of Women's Health Across the Nation (SWAN), suggests that the experience and severity of VMS may be influenced by socioeconomic status, race/ethnicity, body mass index (BMI), and smoking status. However, the complex interplay of these factors and their relative contributions remain unclear. Further investigation is crucial to facilitate equitable access to effective treatment for all women. To bridge these gaps, improved education starting as early as residency is essential. This education should address common misconceptions about VMS and its management. Healthcare providers must enhance their competence in discussing the broad spectrum of VMS impacts and employ effective communication strategies to ensure that patients are well-informed about their symptoms and available treatment options.

Promoting good mental health over the menopause transition

The potential risk for mental health conditions over the menopause transition shapes women's expectations and informs putative physiological mechanisms regulating women's mental health. We review evidence from prospective studies reporting on associations between mental health conditions and the menopause transition. Major depressive disorder and the more prevalent subthreshold depressive symptoms are the most common conditions studied. We reviewed 12 prospective studies reporting depressive symptoms, major depressive disorder, or both over the menopause transition and found no compelling evidence for a universal increased risk for either condition. However, specific subgroups of participants, primarily defined by menopause-related risk factors (ie, vasomotor symptoms that are severe or disturb sleep, a long duration of the transition, or reproductive hormone dynamics) and psychosocial risk factors (eg, stressful life events), were vulnerable to depressive symptoms. The increased risk of major depressive disorder over the menopause transition appears predominantly in individuals with previous major depressive disorder. Greater focus on recognising risk factors in primary care is warranted. On the basis of scarce data, we found no compelling evidence that risk of anxiety, bipolar disorder, or psychosis is universally elevated over the menopause transition. Potential misattribution of psychological distress and psychiatric disorders to menopause could harm women by delaying accurate diagnosis and the initiation of effective psychotropic treatments, and by creating negative expectations for people approaching menopause. A paradigm shift is needed. We conclude with recommendations for the detection and treatment of depressive symptoms or major depressive disorder and strategies to promote good mental health over the menopause transition, while responsibly preparing and supporting those at risk.

A Novel Nonhormonal Treatment for Vasomotor Symptoms of Menopause

Vasomotor symptoms of menopause, more commonly called hot flashes and night sweats, affect up to 80% of individuals going through the menopausal transition. Hormone therapy with estrogen and often progesterone is the most effective treatment for these symptoms. Many people, however, cannot take estrogen or do not want to take hormones. Many individuals seek nonhormonal, over-the-counter treatment options that have little safety and efficacy information to support their use. In March 2023, the U.S. Food and Drug Administration approved fezolinetant (Veozah), a neurokinin 3 receptor antagonist for the treatment of vasomotor symptoms of menopause. This article presents an overview of fezolinetant, including appropriate usage, adverse effects, its use in special populations, and implications for nursing practice.

Resident training to optimize patient-focused menopause management: a multispecialty menopause curriculum to enhance knowledge and preparedness

OBJECTIVE

Surveys of residents in obstetrics and gynecology, internal medicine, and family medicine have demonstrated low levels of knowledge and comfort in treating patients with menopausal symptoms, suggesting a need for improved training during residency. To address this problem, we used a flipped classroom design to deliver a novel menopause curriculum for medical residents. The curriculum included six podcast episodes followed by an interactive case-based classroom session. We then assessed effects of the curriculum on the residents' knowledge and preparedness to manage menopause symptoms.

METHODS

We targeted 200 residents (43 obstetrics and gynecology, 86 internal medicine, and 71 family medicine) from six residency programs from 2019 to 2020. Of these, 115 (58%) completed both pre- and postcurriculum assessments, including a 15-item knowledge test and self-ratings of their knowledge, comfort, and preparedness to manage menopause.

RESULTS

Following the curriculum, the proportion of correctly answered knowledge questions rose from 60.8% to 79.1% (+18.3%; 95% confidence interval, 15.4-21.2; Cohen's d = 1.2). Improvement did not significantly differ by specialty or year of residency. There were higher gains for residents who listened to the entirety of all six podcast episodes ( b = 11.4, P < 0.001) and who attended the classroom session ( b = 11.6, P = 0.003). Residents' self-ratings of knowledge, comfort, and preparedness also improved following the curriculum across all medical specialties (Cohen's d = 0.47-1.2). Residents rated the podcast format as convenient (73%) and effective (65%) compared with an equivalent amount of reading.

CONCLUSIONS

Pairing a podcast with a classroom discussion was found to be an effective combination for improving menopause knowledge.

Midlife Women's Menopausal Transition Symptom Experience and Access to Medical and Integrative Health Care: Informing the Development of MENOGAP

Background

Individuals with a uterus experience menopause, the cessation of menses, on average at age 51 years in the United States. While menopause is a natural occurrence for most, over 85% of women experience multiple interfering symptoms. Menopausal women face health disparities, including a lack of access to high-quality healthcare and greater disparities are experienced by women who are black, indigenous, and people of color. Some women are turning away from hormone therapy, and some seek integrative health interventions.

Objective

Some menopausal women who seek healthcare do not receive it as they lack access to medical and integrative healthcare providers. A potential solution to this problem is a medical group visit (MGV), during which a provider sees multiple patients at once. The aims of this study were to gather women's opinions about the menopause, provider access, and conventional and integrative health interventions for later use to develop a menopause MGV.

Methods

We conducted a Community Engagement Session and a Return of Results (RoR) with midlife women to learn about their menopause experiences, barriers and facilitators to accessing health providers, and their interest in and suggestions for designing a future integrative MGV (IMGV). Thematic qualitative research methods were used to summarize session results.

Results

Nine women participated in the Session and six attended the RoR. Participants were well-educated and diverse in race and ethnicity. Themes included: an interest in this topic; unfamiliar medical terms; relevant social factors; desired whole person care; interest in integrative health; barriers and facilitators to accessing healthcare. The group expressed interest in ongoing participation in the future process of adapting an IMGV, naming it MENOGAP.

Conclusion

These findings highlight the importance of stakeholder engagement before designing and implementing MENOGAP and the great need among midlife women for education about the menopausal transition, integrative self-care, and healthcare.

Perimenopausal women's voices: How does their period at the end of reproductive life affect wellbeing?

OBJECTIVE

To explore perimenopausal women's feelings towards their periods, the impact on their wellbeing and how we can support them.

STUDY DESIGN

Participants were recruited for focus groups through social media advertisements. In 6 online focus groups, 31 perimenopausal women aged 40-55 living in the UK were asked 5 questions relating to periods and perimenopause, support and education.

MAIN OUTCOME MEASURES

Content analysis.

RESULTS

When asked How do you feel about having a period? The participants often related back to the stress of menarche and said their period negatively impacted their wellbeing their whole lives. During perimenopause, their periods had become unpredictable, heavy, and a debilitating disruption to their lives. The women desired support at work through policy, and from family and friends. They believed that educating girls and boys during school was the best place to start, but that education through work and community groups was also needed. They felt healthcare professionals should have mandatory training regarding women's health issues and menopause.

CONCLUSION

The study highlights the impact of menstrual experiences on the wellbeing of perimenopausal women, emphasising the need for improved menstrual education from an early age. Comprehensive menstrual education in schools involving both genders to enable informed decision-making and improved training for healthcare professionals are recommended. Support networks for perimenopausal women will promote better quality of life for women as they go through their perimenopause journey.

Management of menopause: a survey of physicians from the Middle East and Africa

OBJECTIVE

This study evaluated physicians' perceptions, practices, confidence, comfort level and prior training in managing menopause.

METHODS

A survey was conducted of a convenience sample of physicians from the Middle East and Africa (MEA) in 2019. We covered knowledge of symptoms, menopausal hormone therapy (MHT), other menopause management strategies and prior training in menopause medicine.

RESULTS

Of the 254 participants, 64.2% were seniors in family medicine (36.4%), endocrinology (36.0%), gynecology (15.8%) and internal medicine (13.8%). Fewer than one-third (28.8%) correctly identified the diagnostic criteria of menopause. Almost all recognized vasomotor symptoms (99.5%), vaginal dryness (96.2%) and mood disturbance (94.3%), but to a lesser extent other symptoms. Inconsistency and critical gaps were identified in responses to competence questions on six case studies. They recalled having occasional (43.2%) or no training (19.4%) in menopause medicine and rated their preparedness to treat menopause widely. A total of 66.2% agreed that training is very important. Variation between specialties was identified.

CONCLUSION

Many physicians recognize the importance of education in menopause management, but their responses revealed critical knowledge gaps that underscored the need for comprehensive, evidence-based menopause management.

Management of perimenopausal and menopausal symptoms

Most women worldwide experience menopausal symptoms during the menopause transition or postmenopause. Vasomotor symptoms are most pronounced during the first four to seven years but can persist for more than a decade, and genitourinary symptoms tend to be progressive. Although the hallmark symptoms are hot flashes, night sweats, disrupted sleep, and genitourinary discomfort, other common symptoms and conditions are mood fluctuations, cognitive changes, low sexual desire, bone loss, increase in abdominal fat, and adverse changes in metabolic health. These symptoms and signs can occur in any combination or sequence, and the link to menopause may even be elusive. Estrogen based hormonal therapies are the most effective treatments for many of the symptoms and, in the absence of contraindications to treatment, have a generally favorable benefit:risk ratio for women below age 60 and within 10 years of the onset of menopause. Non-hormonal treatment options are also available. Although a symptom driven treatment approach with individualized decision making can improve health and quality of life for midlife women, menopausal symptoms remain substantially undertreated by healthcare providers.

Factors underpinning an improved menopausal experience in the workplace for doctors: a UK-based qualitative study

OBJECTIVES

A recent British Medical Association survey revealed that very few National Health Service (NHS) doctors felt comfortable discussing symptoms with their managers, and many feel unable to make changes to their working lives to accommodate their menopause. An improved menopausal experience (IME) in the workplace has been associated with increased job satisfaction, increased economic participation and reduced absenteeism. Currently, existing literature fails to explore menopausal doctors' experiences and none factors in non-menopausal colleagues' perspectives. This qualitative study aims to determine the factors underpinning an IME for UK doctors.

DESIGN

Qualitative study using semistructured interviews and thematic analysis.

PARTICIPANTS

Menopausal doctors (n=21) and non-menopausal (n=20) doctors including men.

SETTING

General practices and hospitals in the UK.

RESULTS

Four overarching themes underpinning an IME were identified: menopausal knowledge and awareness, openness to discussion, organisational culture, and supported personal autonomy. The levels of knowledge held by menopausal participants themselves, their colleagues and their superiors were identified as crucial in determining menopausal experiences. Likewise, the ability to openly discuss menopause was also identified as an important factor. The NHS culture, gender dynamics and an adopted superhero mentality-where doctors feel compelled to prioritise work over personal well-being-further impacted under the umbrella of Organisational culture. Personal autonomy at work was considered important in improving menopausal experiences at work for doctors. The superhero mentality, lack of organisational support and a lack of open discussion were identified as novel themes not found in current literature, particularly in the healthcare context.

CONCLUSIONS

This study highlights that doctors' factors underpinning an IME in the workplace are comparable to other sectors. The potential benefits of an IME for doctors in the NHS are considerable. NHS leaders can address these challenges by using pre-existing training materials and resources for their employees if menopausal doctors are to feel supported and retained.

Seeking Health Care for Perimenopausal Symptoms: Observations from The Women Living Better Survey

Background: The perimenopausal health care interaction can be challenging both for those seeking care and health care professionals (HCPs). We explore the factors that contribute to making these health care interactions either satisfying or unsatisfying for a midlife person with ovaries who consults an HCP about bothersome symptoms. Materials and Methods: Respondents to the Women Living Better (WLB) survey were asked about 61 symptoms often associated with the menopausal transition. They were then asked whether they sought health care for their most bothersome one. Of the 1024 participants who consulted an HCP, 964 provided a response to the open-ended question "how did that go?" We used conventional content analysis to code the responses and identify themes. Results: We identified six codes reflecting positive health care interactions which we then grouped into five themes suggesting satisfaction with these health care interactions. These included: validating experiences; having matching explanatory models; being supported by a team; engaging in shared decision-making; and having symptoms addressed. We identified 13 codes reflecting negative health care interactions which we then group into 4 themes suggesting dissatisfaction. These included: invalidating experiences, a mismatch in expectations between care recipients and HCP, barriers to treatment, and not feeling helped. Conclusions: Those seeking health care for bothersome symptoms on the path to menopause responded with both positive and negative comments about health care interactions in the WLB survey. Studying these comments identifies opportunities to improve midlife care.

Menopause and healthcare professional education: A scoping review

OBJECTIVES

There has been a growing discourse regarding menopause, but despite this growth there is little education on this important topic across health professions. This scoping review provides a comprehensive synthesis of how menopause is represented in health professions' education literature, to inform future pedagogy and practice.

DESIGN

A scoping review using the framework developed by Arksey and O'Malley (2005).

METHODS

In the scoping review, only empirical studies were considered and only those published in the English language were included. Four databases were interrogated using a variety of search terms, including menopause, healthcare, medical and education.

RESULTS

Twelve studies were included and mapped independently by the authors onto the internally developed data-extraction tool. Insights into how menopause is understood in educational terms and how it is taught within health professions' education were gained, specifically in relation to knowledge, language used, and learning and educational gaps.

CONCLUSION

The review establishes how menopause is understood in educational terms and how it is taught within health professions' education, and develops an understanding of the pedagogy of menopause. There is an urgent need for menopause to be included in mainstream curricula and for an appropriate pedagogy that acknowledges the complexity of the topic, to achieve excellence in education across health professions' education. There is a broader perspective in addressing the challenges for health professions' education in terms of the prioritisation and pedagogy of women's health.

The Menopause Management Vacuum

ABSTRACT

The burden of untreated menopause symptoms in midlife women is substantial and can result in reduced quality of life as well as lost work productivity, lost opportunities for advancement at work, and increased health care costs. Unfortunately, the health care system is largely unprepared to help women manage these symptoms, which have a mean duration of 7 to 9 years. Hormone therapy usage rates have plummeted following publication of the results of the Women's Health Initiative trials due to safety concerns. In addition, postgraduate medical training programs include minimal to no training on menopause management. These and other factors have contributed to what is essentially a menopause management vacuum. This vacuum created a market opportunity, particularly given the fact that midlife women are potent drivers of the global economy. In this review, we outline the menopause management gaps and discuss a multipronged approach to close these gaps and improve the care of midlife women.

Brief Report: Undertreated Midlife Symptoms for Women Living With HIV Linked to Lack of Menopause Discussions With Care Providers

BACKGROUND

Increasingly, women living with HIV are entering menopause (ie, cessation of menses for ≥1 year) and experiencing midlife symptoms. Menopausal hormone therapy (MHT) is first-line therapy for bothersome hot flashes and early menopause (ie, before age 45 years); however, its use in women living with HIV is poorly described. We conducted a cross-sectional assessment of MHT uptake and barriers to use in this group.

SETTING

This study was conducted across 3 Canadian provinces from 2015 to 2017.

METHODS

Perimenopausal and postmenopausal women living with HIV (35 years or older) in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study who answered questions related to MHT use were included. Univariable/multivariable logistic regression evaluated factors associated with MHT use, adjusted for age and contraindications.

RESULTS

Among 464 women, 47.8% (222 of 464) had a first-line indication for MHT; however, only 11.8% (55 of 464) reported ever using MHT and 5.6% (26 of 464) were current users. Only 44.8% had ever discussed menopause with their care provider despite almost all women having regular HIV care (97.8%). African/Caribbean/Black women had lower unadjusted odds of MHT treatment compared with White women [odds ratio (OR) 0.42 (0.18-0.89); P = 0.034]. Those who had discussed menopause with their care provider had higher odds of treatment [OR 3.13 (1.74-5.86); P < 0.001]. In adjusted analyses, only women having had a menopause discussion remained significantly associated with MHT use [OR 2.97 (1.62-5.61); P < 0.001].

CONCLUSION

Women living with HIV are seldom prescribed MHT despite frequent indication. MHT uptake was associated with care provider-led menopause discussions underscoring the need for care provider education on menopause management within HIV care.

An online survey of perimenopausal women to determine their attitudes and knowledge of the menopause

Introduction:

Women are not usually taught about the menopause formally, and many general practitioners have relatively little training. The aim of this study was to explore perimenopausal women’s attitudes and knowledge of the menopause.

Method:

An online survey was designed to evaluate attitudes and knowledge of the menopause in women older than 40 years. The survey was generated with Qualtrics XM® and promoted via social media. In all, 3150 women started the survey. In this study, data from 947 perimenopausal women were analysed.

Results:

Regarding women’s attitudes to the menopause, 38.8% were accepting of it but more than 30% were dreading it. The women had experienced a number of menopause symptoms including mood swings (68.9%), brain fog (68.3%), and fatigue (66.8%). More than 90% of women had never been taught about the menopause at school, and more than 60% did not feel informed at all about the menopause. School was thought to be the best place for menopause education to start (83.6%). In all, 68.2% of women had only looked for information about the menopause as their symptoms started and they had talked to friends and used a variety of websites to look for information. When asked for their free-text views on the menopause, thematic analysis produced four themes: the overarching knowledge gap, the onset and impact of symptoms, perimenopause: the hidden phenomenon, and managing symptoms: differing schools of thought.

Conclusion:

Lack of education for women and their general practitioners is causing perimenopausal women to go through this important stage in their lives with a lack of knowledge and appropriate medical care. It is essential that women are taught about the menopause, from school onwards and that we offer health professionals appropriate training starting from the medical school curriculum.

Menopausal Hormone Therapy and the Role of Estrogen

Menopause is a universal experience for midlife women. The physiological decline in endogenous estrogen can be associated with vasomotor symptoms or hot flashes, sleep disruption, and mood disorders. Long-term concerns arise with sequelae of estrogen loss such as genitourinary syndrome of menopause and osteoporosis. Although the pendulum has swung widely since the 1942 approval of conjugated equine estrogens, estrogen therapy, now available in an ever-expanding menu of preparations, routes of administration, and dosing, remains the most effective means to collectively address these, and potentially, additional concerns. Refinement of knowledge of risks and benefits facilitates patient selection and counseling.

Differences in patient-reported hormone therapy use for menopause symptoms by provider specialty

OBJECTIVE

Hormone therapy (HT) is an effective treatment for menopause symptoms in select women. This study aimed to determine whether there is different prevalence of HT use based on patient report by women who see different provider specialties.

METHODS

This study was a cross-sectional analysis of published data from the Survey of Midlife in the United States (MIDUS), a telephone or self-administered questionnaire of 3294 participants aged 39-90 years. Postmenopausal women were included. Self-reported HT use and provider specialty seen were each assessed by one question. Univariate logistic regression assessed factors possibly related to HT use. Variables with p < 0.1 were entered into a multivariable logistic regression model.

RESULTS

Of the 938 postmenopausal respondents, 720 (76%) saw a gynecologist for care. One-hundred and thirty-one (13%) women used HT for menopausal symptoms. Of women using HT, 72 (55%) saw a gynecologist. When controlling for other factors, women who saw a gynecologist had three times higher odds of using HT. The most frequently seen provider specialty was not associated with use.

CONCLUSIONS

Women who ever see a gynecologist are more likely to use HT for menopausal symptoms, but fewer women see gynecologists as they age. Generalists are the most seen provider specialty, positioning them to counsel patients about HT.

Medical student exposure to women's health concepts and practices: a content analysis of curriculum at Canadian medical schools

BACKGROUND

Women's health (WH) includes a broad array of concerns and challenges that affect health across the lifespan. Considerable research shows that women continue to experience disparities in access to and quality of care. Apart from surveys of medical trainees and faculty, little research and none in Canada examined medical curriculum for WH. This study assessed how Canadian medical schools integrate WH in their curriculum.

METHODS

We used deductive and summative content analysis to describe instances and the nature of WH topics in program and course descriptions that were publicly-available on web sites of Canadian medical schools. We reported results using summary statistics and text examples. We employed a framework, tested in our prior research, that included mention of women's health principles and practices relevant to any health concern or condition including factors (e.g. sex, gender, social determinants) that influence health, and access to or quality of care.

RESULTS

We retrieved 1459 documents from 16 medical schools (median 49.5, range 16 to 301). Few mentioned WH (125, 8.6 %), and the quantity of mentions varied by school (range 0.0-37.5 %). Pre-clerkship course documents more frequently mentioned WH (61/374, 17.3 %, chi square 43.2, p < 0.00001) compared with clerkship course documents (58/1067, 5.4 %). Core course documents more frequently mentioned WH (72/542, 13.3 %, chi square 29.0, p < 0.00001) compared with elective course documents WH (47/899, 5.2 %). Overall, documents more frequently referred to the WH domain of social determinants of health (88, 70.4 %). Few documents addressed women's health (21, 16.8 %), sex or gender (19, 15.2 %), other considerations (15.2 %) or principles/components of women's health (2, 1.6 %). Most documents that mentioned WH provided little detail about what those concepts referred to or how to optimize WH.

CONCLUSIONS

Based on program and course descriptions, WH may not be well-integrated at Canadian medical schools, and future physicians may not be consistently exposed to the full breadth of WH. This reveals opportunities for enhancing WH in the medical curriculum. Future research is needed to engage stakeholders including women in developing, implementing and evaluating competencies and corresponding curriculum that reflect the full range of WH concepts and practices.

Menopausal hormone therapy for women living with HIV

People living with HIV are ageing, and a growing number of women living with HIV are entering menopause. Women living with HIV commonly have bothersome vasomotor symptoms and onset of menopause at earlier ages; both factors go on to affect quality of life and systemic health. Vasomotor symptoms and early menopause are both indications for menopausal hormone therapy; however, current evidence suggests that this therapy is seldom offered to women living with HIV. Additionally, women living with HIV have several risks to bone health and are likely to benefit from the bone-strengthening effects of menopausal hormone therapy. We present an assessment of the benefits and risks of menopausal hormone therapy in the context of HIV care and propose a practical approach to its prescription. If considered in the appropriate clinical context with discussion of risks and benefits, menopausal hormone therapy might provide substantial benefits to symptomatic menopausal women living with HIV and improve health-related quality of life.

Health-care providers' views of menopause and its management: a qualitative study

OBJECTIVE

This study aimed to explore Australian health-care providers' knowledge of menopause and its consequences, and their views about menopause-related health care.

METHODS

This was a cross-sectional qualitative study of Australian general practitioners (GPs), gynecologists (GYs) and pharmacists (PHs). Recruitment was ultimately achieved through professional networks and cold calling.

RESULTS

There were equal numbers of GPs, GYs and PHs, and equal numbers of males and females in each group. All participants demonstrated sound understanding of menopause and its consequences. A strong theme was recognition of high usage of complementary and alternative medicines (CAMs) by women for menopausal symptoms. Most participants highlighted lack of efficacy evidence for most CAMs, but the majority of GPs and PHs considered CAMs to 'have a role'. Most supported menopausal hormone therapy (MHT) when symptoms impaired quality of life. Limitations to comprehensive care included knowledge gaps and lack of time.

CONCLUSIONS

Australian health-care providers appeared knowledgeable about menopause, but uncertain about its management. MHT prescription appeared limited to women with severe symptoms despite lifestyle modification and a trial of CAMs. The upskilling of clinicians providing care for women at midlife, with respect to the indications for and prescribing of MHT, urgently needs to be addressed.

Knowledge and Needs of Resident Physicians Regarding Osteoporosis: A Nationwide Survey of Residents

Large‐scale studies have not addressed the knowledge level of US resident physicians regarding osteoporosis management. We gauged the knowledge level of family medicine, internal medicine, and obstetrics and gynecology resident physicians regarding osteoporosis management. In 2019, we sent an anonymous survey via e‐mail to all program directors of Accreditation Council for Graduate Medical Education–accredited residency programs in family medicine, internal medicine, and obstetrics and gynecology for distribution to resident physicians. Knowledge items assessed osteoporosis screening, diagnosis, and treatment. We received responses from 182 family medicine, 275 internal medicine, and 122 obstetrics and gynecology programs. Of 582 resident physician respondents, 31% were family medicine residents, 47% were internal medicine residents, and 21% were obstetrics and gynecology residents. Although 77% of respondents correctly selected the T‐score threshold for the diagnosis of osteoporosis among persons aged 50 years and older (−2.5), only 20% of respondents correctly identified minimal‐trauma hip fracture as being diagnostic of osteoporosis. One‐third of respondents correctly identified which medications were demonstrated in clinical trials to decrease hip fracture risk. Fifteen percent of respondents correctly identified that denosumab and alendronate are associated with osteonecrosis of the jaw; and 40% of respondents correctly identified that decline in bone density is more rapid after discontinuation of denosumab than after discontinuation of bisphosphonates. Less than half of resident physicians knew that bisphosphonate‐associated atypical femoral fractures are duration‐dependent. One‐quarter of respondents felt not at all prepared to manage osteoporosis. In this nationwide survey of resident physicians, knowledge regarding osteoporosis diagnosis and treatment was poor, with a striking lack of knowledge regarding the two most serious adverse effects of osteoporosis pharmacotherapy (osteonecrosis of the jaw and atypical femoral fractures). The undertreatment of osteoporosis is unlikely to improve without increased education of resident physicians. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

It's Getting Hot in Here: Piloting a Telemedicine OSCE Addressing Menopausal Concerns for Obstetrics and Gynecology Clerkship Students

INTRODUCTION

Although menopause is a common condition, trainees still express high levels of discomfort with managing climacteric symptoms. Trainees also receive little preparation for conducting telemedicine visits, which have become increasingly important in clinical care. We present a formative standardized patient (SP) encounter to introduce medical students to the diagnosis and treatment of menopausal symptoms and the process of conducting a telemedicine visit.

METHODS

We designed a virtual telemedicine encounter with an SP for medical students. Students received feedback via a post-encounter note on history taking, differential diagnosis, and diagnostics/management and an SP debrief. We collected student input on the experience at the midpoint and end of clerkship and analyzed it for recurring themes. We calculated summary statistics from student post-encounter notes.

RESULTS

Thirty-two OB/GYN students completed the menopause telemedicine SP encounter between April and June 2020. Students scored a median of 20 out of 45 (interquartile range: 18, 22) on the post-encounter note. All students correctly provided a diagnosis of perimenopause/menopause; however, 50% did not offer any strategy for counseling or managing menopausal symptoms. Students expressed discomfort with using a telehealth format (78%) but found it a useful skill to practice (47%). A majority (66%) found the educational encounter to be of excellent or above-average educational value.

DISCUSSION

While medical students demonstrated discomfort with both managing menopause and utilizing a telemedicine format, this SP case provided an opportunity for them to practice both skills in a safe learning environment. The majority of participants rated the learning experience highly.

Using the Jigsaw Teaching Method to Enhance Internal Medicine Residents' Knowledge and Attitudes in Managing Geriatric Women's Health

INTRODUCTION

Although studies surveying internal medicine (IM) residency program directors identify geriatric women's health as an essential curriculum topic, there are limited published women's health curricula for IM residents. Our IM residency program performed a needs assessment, which revealed that the majority of residents were unsatisfied with our current curricula and most were not confident managing geriatric women's health. We developed and assessed a structured curriculum to improve IM residents' knowledge and confidence in addressing geriatric women's health.

METHODS

This 2-hour interactive workshop used the jigsaw teaching method (a cooperative learning strategy where peers deliver specific content in teams) to teach 84 categorical IM residents of all PGY levels about the diagnosis and management of menopause, osteoporosis, urinary incontinence, and abnormal uterine bleeding. Participants completed a pretest and immediate posttest to assess knowledge and confidence about the targeted topics. We compared baseline and postworkshop responses using chi-square and Wilcoxon signed rank tests.

RESULTS

Seventy-four (88%) IM residents completed the pretest, and 62 (74%) completed the posttest. Mean knowledge scores improved from 51% to 69% (p < .0001). Residents who reported feeling somewhat confident or confident in addressing women's health topics increased from 14% to 44% (p < .0001). The majority were satisfied or very satisfied with the workshop (94%) and requested additional women's health education (92%).

DISCUSSION

Our results suggest that workshops using the jigsaw teaching method can effectively increase IM resident knowledge and confidence in managing geriatric women's health.

Attitude and knowledge for menopause management among health professionals in mainland China

OBJECTIVE

This study aims to understand the attitude of health-care professionals (HPs) in mainland China toward menopause management (MM) as well as the knowledge they have received regarding MM during training.

METHODS

An anonymous survey recruited 3709 medical workers nationwide (including physicians, orthopedists, obstetricians and gynecologists, and general practitioners) through online surveys and on-site interviews at professional meetings.

RESULTS

Of the 3709 questionnaires completed, 3426 questionnaires met the inclusion criteria. Of the participants, 1532 HPs had not received menopause management training (MMT) in nearly 1 year. Among the residents and physician assistants, 103 reported they were not familiar with MM. Satisfyingly, 98.3% of HPs considered it very important or essential to accept MM. Although most interviewees replied some correct menopausal knowledge, nearly half of them could not correctly identify the contraindications for menopause hormone therapy (MHT). Additionally, 73.1% of HPs would advise patients with premature ovarian insufficiency to receive hormone replacement therapy at least until the average age of menopause.

CONCLUSION

This survey indicated that HPs have some knowledge regarding MM, but a gap remains to master the basic theory of MHT. In order to manage the growing menopausal population in China, creating more in-depth educational MMT programs for HPs is necessary.