Changes in Hormone Therapy Prescriptions Among Middle-Aged Women in Taiwan: Implications for Health Needs at Menopause

The 2017 Women's Health Initiative study and use of hormone therapy: an emulated repeated cross-sectional study

BACKGROUND

Hormone therapy (HT) use among menopausal women declined after negative information from the 2002 Women's Health Initiative (WHI) HT study. The 2017 post-intervention follow-up WHI study revealed that HT did not increase long-term mortality. However, studies on the effects of the updated WHI findings are lacking. Thus, we assessed the impact of the 2017 WHI findings on HT use in Taiwan.

METHODS

We identified 1,869,050 women aged 50-60 years, between June and December 2017, from health insurance claims data to compare HT use in the 3 months preceding and following September 2017. To address the limitations associated with interval-censored data, we employed an emulated repeated cross-sectional design. Using logistic regression analysis, we evaluated the impact of the 2017 WHI study on menopausal symptom-related outpatient visits and HT use. In a scenario analysis, we examined the impact of the 2002 trial on HT use to validate our study design.

RESULTS

Study participants' baseline characteristics before and after the 2017 WHI study were not significantly different. Logistic regressions demonstrated that the 2017 study had no significant effect on outpatient visits for menopause-related symptoms or HT use among women with outpatient visits. The scenario analysis confirmed the negative impact of the 2002 WHI trial on HT use.

CONCLUSIONS

The 2017 WHI study did not demonstrate any impact on either menopause-related outpatient visits or HT use among middle-aged women in Taiwan. Our emulated cross-sectional study design may be employed in similar population-based policy intervention studies using interval-censored data.

The effects of a new, improved Chinese medicine, Gengnianchun formula granules, on hot flushes, depression, anxiety, and sleep in Chinese peri- and postmenopausal women: a randomized placebo-controlled trial

OBJECTIVE

The aim of the study was to investigate the effectiveness and safety of a new, improved herbal formula of a traditional Chinese medicine, improved Gengnianchun (I-GNC), on hot flushes, depression, anxiety, and sleep in peri- and postmenopausal women in China.

METHODS

A randomized, single-blind, placebo-controlled trial of peri- and postmenopausal women with Kupperman Index (KMI) scores of 15 or higher was conducted for 12 weeks. Hot flush frequencies, KMI scores, Hamilton depression scale scores, Hamilton anxiety scale scores, and Pittsburgh Sleep Quality Index scores were evaluated. Each outcome was evaluated every 4 weeks.

RESULTS

Ninety-eight participants completed the study. The I-GNC formula significantly reduced the mean (SD) frequency of hot flushes from 7 (4.554) to 1.2 (1.675) in the I-GNC group and from 6.74 (3.43) to 3.66 (2.635) in the placebo group (P < 0.01). The KMI (P < 0.01), Hamilton depression scale (P < 0.01), and Hamilton anxiety scale (P < 0.01) scores decreased in both groups after treatment, and significant differences were observed between the two groups (P < 0.01); however, no significant difference in the Pittsburgh Sleep Quality Index score was observed. I-GNC had no effect on serum follicle-stimulating hormone or E2 levels. There were no obvious adverse effects.

CONCLUSIONS

The traditional Chinese medicine herbal formula I-GNC can alleviate the symptoms of menopausal syndrome and improve quality of life among peri- and postmenopausal women. I-GNC is safe and has no notable adverse effects.

Association of Menopausal Symptoms with Different Constitutions in Climacteric Women

OBJECTIVE

The aim of this study was to assess the correlation between the body constitution and menopausal symptoms in climacteric women.

METHODS

This cross-sectional study recruited 427 women aged 40-60 years from the hospital and nearby community. In addition to filling out a questionnaire on menopause rating scale - Traditional Chinese version, the participants completed the body constitution questionnaire. This classifies a person to 1 or more of 3 imbalanced constitutional types, which are yin-xu, yang-xu and stasis-stagnation. We constructed logistic regression models to estimate probabilities of the menopausal symptoms among climacteric women presenting with various menopausal status and differing body constitutions.

RESULTS

The frequency and scores of the yin-xu, yang-xu, and stasis-stagnation constitutions were significantly higher in perimenopausal and postmenopausal than premenopausal women. Compared to the non-constitution women, the odds ratio of having hot flushes, sleeping disorders, sexual problems, irritability, and anxiety were significantly higher with the yin-xu constitution. The women with a yang-xu constitution had significantly higher odds ratios for having bladder problems, muscle and joint problems, depressive mood, and heart discomfort. Symptoms of heart discomfort, physical and mental exhaustion, and sleeping disorders were correlated to the stasis-stagnation constitution.

CONCLUSION

With the additional key symptoms related to the 3 constitutional types, physicians performing traditional Chinese medicine (TCM) are able to diagnose the menopausal syndrome more accurately. Integrating menopausal symptoms with TCM constitutional theory will contribute to a more rapid diagnosis and treatment of menopausal syndrome.

Critical review of complementary and alternative medicine use in menopause: focus on prevalence, motivation, decision-making, and communication

OBJECTIVE

This study aims to undertake the first critical review of complementary and alternative medicine (CAM) use among menopausal women (a term here used to include premenopausal, perimenopausal and postmenopausal women) by focusing on the prevalence of CAM use and CAM users' characteristics, motivation, decision-making, and communication with healthcare providers.

METHODS

A comprehensive search of 2002-2012 international literature in the Medline, CINAHL, AMED, and SCOPUS databases was conducted. The search was confined to peer-reviewed articles published in English with abstracts and reporting new empirical research findings regarding CAM use and menopause.

RESULTS

A considerable level of CAM use was observed among women in menopause. Many menopausal women use CAM concurrently with their conventional medicine. However, communication regarding CAM between menopausal women and healthcare providers seems less than optimal, with a demand for further information on the safety and efficacy of medicines. Existing literature is of variable methodological rigor, often presenting small sample sizes and low-quality data collection. Further rigorous research on this topic-including quantitative and qualitative methods using large national samples, where relevant-is required.

CONCLUSIONS

The findings of this critical review provide insights for those practicing and managing health care in this area of women's health. Healthcare providers should prepare to inform menopausal women about all treatment options, including CAM, and should be aware of the possible adverse effects of CAM and potential interactions between CAM and conventional medicine among women in menopause who are under their care.

A critical review of traditional Chinese medicine use amongst women with menopausal symptoms

OBJECTIVES

To provide the first critical review of traditional Chinese medicine (TCM) use amongst symptomatic menopausal women, drawing upon work examining the perspectives of both TCM users and TCM practitioners.

METHODS

A search was conducted in three English-language databases (MEDLINE, CINAHL and AMED) and three Chinese-language databases (CNKI, VIP and CBM Disc) for 2002-2013 international peer-reviewed articles reporting empirical findings of TCM use in menopause.

RESULTS

A total of 25 journal articles reporting 22 studies were identified as meeting the review inclusion criteria. Chinese herbal medicine appears to be the most common therapy amongst symptomatic menopausal women, and vasomotor symptoms and emotional changes are the most frequent symptoms for which TCM is sought. However, evidence regarding the prevalence of TCM use and users' profile in menopause is limited. Existing studies are of varied methodological quality, often reporting low response rate, extensive recall bias and a lack of syndrome differentiation.

CONCLUSIONS

This review provides insights for practitioners and health policy-makers regarding TCM care to symptomatic menopausal women. More nationally representative studies are required to rigorously examine TCM use for the management of menopausal symptoms. Syndrome differentiation of menopausal women is an area which also warrants further attention.

Age- and gender-specific population attributable risks of metabolic disorders on all-cause and cardiovascular mortality in Taiwan

Background

The extent of attributable risks of metabolic syndrome (MetS) and its components on mortality remains unclear, especially with respect to age and gender. We aimed to assess the age- and gender-specific population attributable risks (PARs) for cardiovascular disease (CVD)-related mortality and all-cause mortality for public health planning.

Methods

A total of 2,092 men and 2,197 women 30 years of age and older, who were included in the 2002 Taiwan Survey of Hypertension, Hyperglycemia, and Hyperlipidemia (TwSHHH), were linked to national death certificates acquired through December 31, 2009. Cox proportional hazard models were used to calculate adjusted hazard ratios and PARs for mortality, with a median follow-up of 7.7 years.

Results

The respective PAR percentages of MetS for all-cause and CVD-related mortality were 11.6 and 39.2 in men, respectively, and 18.6 and 44.4 in women, respectively. Central obesity had the highest PAR for CVD mortality in women (57.5%), whereas arterial hypertension had the highest PAR in men (57.5%). For all-cause mortality, younger men and post-menopausal women had higher PARs related to Mets and its components; for CVD mortality, post-menopausal women had higher overall PARs than their pre-menopausal counterparts.

Conclusions

MetS has a limited application to the PAR for all-cause mortality, especially in men; its PAR for CVD mortality is more evident. For CVD mortality, MetS components have higher PARs than MetS itself, especially hypertension in men and waist circumference in post-menopausal women. In addition, PARs for diabetes mellitus and low HDL-cholesterol may exceed 20%. We suggest differential control of risk factors in different subpopulation as a strategy to prevent CVD-related mortality.