Quality of life impairment among postmenopausal women varies according to race

Developing a Menopausal Transition Health Promotion Intervention With Indigenous, Integrative, and Biomedical Health Education: A Community-Based Approach With Urban American Indian/Alaska Native Women

Background

Few studies have examined the menopausal transition in American Indian and Alaska Native (AI/AN) women; these reports indicate they are the most likely group to report bothersome vasomotor symptoms (VMS). Evidence demonstrates VMS may be a biomarker for chronic diseases. Thus, evidence-based interventions to improve VMS and other symptoms and health-screening rates for urban midlife AI/AN women are needed.

Objective

The objectives of this community-based project were to form a Community Advisory Board (CAB) with whom to: 1) conduct CAB meetings (similar to a focus group) with midlife AI/AN women to understand their lived health care experiences and needs during the menopausal transition; and 2) obtain guidance in creating a tailored intervention.

Methods

Eligible participants indicated they were registered members of American Indian Tribes, self-identified as a woman, aged 35 or older, and were recruited through the Urban Indian Center of Salt Lake and community outreach. Three CAB meetings were conducted via Zoom. A qualitative-descriptive approach was used for analysis, with the aim of staying close to the data to understand AI/AN women's experiences and needs. Transcripts were iteratively coded using content/thematic analysis.

Results

Four themes emerged: 1) lack of and desire for information about the menopause transition; 2) barriers to accessing care; 3) matriarchal priorities impacting personal health outcomes; and 4) preferences for Indigenous and integrative medicine as first-line interventions, followed by conventional medicine.

Conclusions

Among this sample of urban AI/AN women, there was a great need for and interest in information about menopause, both for themselves and for their daughters and family. Integrative and Indigenous approaches were preferred. Proposed next steps include developing and pilot-testing a nurse-delivered health-education intervention with Indigenous, integrative, and conventional medical content.

Correlates of palpitations during menopause: A scoping review

Objective:

Palpitations during peri- and post-menopause are common. It is unclear what variables are related to palpitations in peri- and post-menopausal women. The purpose of this scoping review was to summarize potential correlates of palpitations in women transitioning through menopause.

Methods:

The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Authors included English-language, full-length, peer-reviewed, cross-sectional research articles on palpitations in menopausal women published through December 18, 2021, from PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO searches. Following de-duplication, screening of titles and abstracts, and review of full-texts, independent reviewers extracted data on variables studied in relationship to palpitations from 84 articles and resolved discrepancies. Authors extracted data on (1) demographic, clinical, biomarker, and symptom/quality of life variables and (2) data analysis method (bivariate, multivariate). Authors classified each variable as a likely, unlikely, or unclear correlate of palpitations.

Results:

Articles were diverse in region of origin, sample sizes, and variables assessed in relationship to palpitations. Evidence for any one variable was sparse. Likely correlates of palpitations included race/ethnicity, lower physical activity, worse vasomotor symptoms (VMSs), worse sleep, and worse quality of life. Unlikely correlates included age, employment, education, marital status, socioeconomic status, comorbidities, body mass index, and sexual difficulties. Unclear correlates due to equivocal evidence were menopausal status, smoking, and depression. Unclear correlates due to insufficient evidence (less than three articles) included all of the assessed biomarkers, anxiety, and stress.

Conclusion:

Likely correlates were identified including race/ethnicity, physical activity, VMS, sleep, and quality of life. However, additional research is needed to better understand potential correlates of palpitations.

Review of menopausal palpitations measures

Palpitations are reported commonly by women around the time of menopause as skipped, missed, irregular, and/or exaggerated heartbeats or heart pounding. However, much less is known about palpitations than other menopausal symptoms such as vasomotor symptoms. The objective of this review was to integrate evidence on menopausal palpitations measures. Keyword searching was done in PubMed, CINAHL, and PsycINFO for English-language, descriptive articles containing data on menopause and palpitations and meeting other pre-specified inclusion criteria. Of 670 articles, 110 met inclusion criteria and were included in the review. Results showed that 11 different measures were used across articles, with variability within and between measures. Inconsistencies in the wording of measurement items, recall periods, and response options were observed even when standardized measures were used. Most measures were limited to assessing symptom presence and severity. Findings suggest that efforts should be undertaken to (1) standardize conceptual and operational definitions of menopausal palpitations and (2) develop a patient-friendly, conceptually clear, psychometrically sound measure of menopausal palpitations.

Can walking exercise programs improve health for women in menopause transition and postmenopausal? Findings from a scoping review

OBJECTIVE

Our goal was to explore the range and characteristics of published papers on therapeutic walking programs for menopausal women and to identify program features that resulted in successful outcomes including reduced symptoms and improved long-term wellness.

METHODS

We searched biomedical and exercise-related databases for articles published up to June 1, 2017, using keywords related to menopause and walking. Data were collected into EndNote X8 reference manager to identify and remove duplicates. The final selection included all articles that studied walking as a health intervention for women in menopause transition or postmenopausal.

RESULTS

A total of 3,244 papers were collected from the six databases. After removing duplicates and applying inclusion and exclusion criteria, 96 articles were charted, including 77 different walking programs. Walking interventions ranged from 4 weeks to 3 years with an average weekly frequency of 3.8 ± 1.8 and were applied to a variety of symptoms and their biological markers and risk factors. Overall, 91% of the programs showed a beneficial outcome in at least one menopause-related medical issue. Information on menopause-specific symptoms, especially vasomotor symptoms and sleep problems, was scarce.

CONCLUSION

The scoping review highlights the growing interest in walking programs as therapies for menopause and related symptoms and provides evidence of their possible benefit as a wellness option for women in menopause and beyond. Further research would be recommended to establish the therapeutic value of walking programs for women with specific focus on typical menopause symptoms at different stages of menopause. : Video Summary:http://links.lww.com/MENO/A587.

Menopause experience in First Nations women and initiatives for menopause symptom awareness; a community-based participatory research approach

BACKGROUND

Little research has been conducted about menopause in First Nations women. In response to the wishes of Cree women living in Maskwacis, Alberta, to start a dialogue on menopause, we undertook community-based participatory research (CBPR) to explore menopause experience and raise awareness of menopause symptoms in the community.

METHODS

The research adhered to the principles of Ownership, Control, Access and Possession (OCAP™) and was guided by the interest of the participating women. Local women (target age 40-65 years) were invited to participate in workshops using word-of-mouth and community posters in health centers. Five research workshops were held in community settings, attended by experienced women's health researchers and consenting women. The participants guided the informal discussions. They also completed questionnaires which included menopause-related quality of life. The researchers used extensive hand-written field notes to record data; qualitative content analysis was applied to identify themes. Simple descriptive analysis was used for the questionnaire results. The findings were discussed at a community feedback session and laid the basis for further knowledge translation initiatives.

RESULTS

The five workshops included a total of 37, mostly post-menopausal women with 6-11 women/workshop. The main discussion themes were: "experiences of menopause symptoms" including their impact on quality of life; "menopause knowledge prior to their own experience" with most women feeling that they had insufficient information before menopause; "menopause symptom management" which mainly included practical strategies; "impact of menopause on family members" which was of prime concern with uncontrollable mood changes affecting the whole family and sometimes causing matrimonial disharmony. Questionnaire responses corroborated the workshop discussions. Knowledge translation of the research findings produced two information pamphlets specifically for the Maskwacis community: one for husband/partner, the other for women and family members. These pamphlets have been distributed in all areas of the community.

CONCLUSION

This CBPR project addressed a topic identified by the community as being important. Community members developed informative pamphlets in response to the women's concern of lack of understanding for menopause symptoms among families. This simple solution has been widely accepted by community members, opening the possibility of wider discussion about menopause.

Menopausal transition in Southern Europe: comparative study of women in Serbia and Portugal

OBJECTIVE

The aim of this study was to assess and compare general menopausal quality of life in Serbia and Portugal.

METHODS

In all, 1,503 women aged between 40 and 65 years from Belgrade, Serbia, and Lisbon, Portugal, were included in the study. A sociodemographic questionnaire and the Utian Quality of Life (UQOL) scale were used in data collection.

RESULTS

The average age of women was 50 (SD = 5.61) years. Serbian and Portuguese women differed in all sociodemographic characteristics except for body mass index (BMI) and relationship status. There were no significant differences in UQOL total score (P = 0.629) or UQOL sexual score (P = 0.396) between Serbian and Portuguese women. However, occupational (P < 0.001) and health (P = 0.003) scores were significantly higher in the Serbian sample, whereas Portuguese women had higher emotional scores (P < 0.001). Based on the total study sample, women with an average UQOL score were more highly educated, employed, non-smokers, and physically active, and more likely to obtain medical assistance for climacteric symptoms compared with women who reported lower UQOL score. In addition to these characteristics, women with a higher UQOL score had higher annual income, no recent illnesses, and optimal BMI compared with women who reported a lower UQOL score.

CONCLUSIONS

This study showed that diverse populations of midlife women can have similar perceptions of quality of life as it encompasses broad dimensions of menopausal somatic and psychosocial symptoms, as well as habits and lifestyle. Further comparative studies using the UQOL scale are warranted to offer more information on the delicate factors influencing well-being in climacteric women worldwide.

Experience of menopause in aboriginal women: a systematic review

Every woman experiences the menopause transition period in a very individual way. Menopause symptoms and management are greatly influenced by socioeconomic status in addition to genetic background and medical history. Because of their very unique cultural heritage and often holistic view of health and well-being, menopause symptoms and management might differ greatly in aboriginals compared to non-aboriginals. Our aim was to investigate the extent and scope of the current literature in describing the menopause experience of aboriginal women. Our systematic literature review included nine health-related databases using the keywords 'menopause' and 'climacteric symptoms' in combination with various keywords describing aboriginal populations. Data were collected from selected articles and descriptive analysis was applied. Twenty-eight relevant articles were included in our analysis. These articles represent data from 12 countries and aboriginal groups from at least eight distinctive geographical regions. Knowledge of menopause and symptom experience vary greatly among study groups. The average age of menopause onset appears earlier in most aboriginal groups, often attributed to malnutrition and a harsher lifestyle. This literature review highlights a need for further research of the menopause transition period among aboriginal women to fully explore understanding and treatment of menopause symptoms and ultimately advance an important dialogue about women's health care.

A randomized, double-blind, multiple-dose escalation study of a Chinese herbal medicine preparation (Dang Gui Buxue Tang) for moderate to severe menopausal symptoms and quality of life in postmenopausal women

OBJECTIVE

This study is a phase II clinical trial that aims to investigate the dose-response relationship of a Chinese herbal medicine preparation, Dang Gui Buxue Tang (DBT), with short-term menopausal symptoms and quality of life in local postmenopausal women.

METHODS

A randomized, double-blind, multiple-dose escalation trial was performed in 60 postmenopausal women experiencing severe hot flashes and night sweats. The participants were randomized to receive DBT preparations at 1.5, 3.0, or 6.0 g/day for 12 weeks. The primary outcomes were vasomotor symptoms, Greene Climacteric Scale (GCS) score, and Menopause-Specific Quality of Life (MENQOL) score. Secondary outcomes included serum hormones and lipids.

RESULTS

There were between-group differences in psychological/psychosocial (P = 0.015, GCS; P = 0.013, MENQOL) and somatic/physical (P = 0.019, GCS; P = 0.037, MENQOL) domains, and improvement was significantly greatest (P < 0.05) in the 6.0 g/day dose group. The frequency and severity of hot flashes and night sweats were significantly reduced in the 3.0 g/day (14.5%-21.2%, P < 0.05, hot flashes; 28.6%-39.6%, P < 0.05, night sweats) and 6.0 g/day (34.9%-37.4.0%, P < 0.01, hot flashes; 10.1%-12.8%, P < 0.01, night sweats) dose groups. The female hormones follicle-stimulating hormone, luteinizing hormone, and 17β-estradiol, as well as the lipids total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, were not significantly different within groups and between groups.

CONCLUSIONS

DBT preparations at 6.0 g/day significantly improve physical and psychological scores and significantly reduce vasomotor symptoms from baseline. The treatment was well tolerated, with no serious adverse events noted during the 12-week intervention period. The changes do not affect hormones and lipid profiles.

Urinary incontinence, related factors and menopause-related quality of life in mid-aged women assessed with the Cervantes Scale

OBJECTIVE

To determine urinary incontinence (UI) prevalence, related factors and menopause-related quality of life (QoL) in mid-aged Colombian women.

METHODS

A total of 1739 women aged 40-59 were surveyed with the 31 item Cervantes Scale (CS) and a socio-demographic questionnaire. Item 18 of the scale was used to categorize the degree of UI. Remaining 30 items (Adjusted global score) were used to assess global menopause-related QoL.

RESULTS

Median age of the sample was 46 years. A 26.0% of women presented some degree of UI, rated as moderate to severe in 16.4% of cases. Adjusted global CS scores (excluding item 18) significantly increased with the severity of UI. Mean scores for item 18 were found to be significantly higher in relation to age, menopausal status, body mass index values, lower education and unemployment status. Multiple linear regression analysis determined that age, postmenopausal status and ethnicity (Mestizo) were significantly related to higher item 18 scores, and thus more severe UI.

CONCLUSION

This is the first study to report UI prevalence in a large mid-aged Latin American female population in which age, menopausal status and ethnicity were related factors.

Menopausal symptoms among healthy, middle-aged Omani women as assessed with the Menopause Rating Scale

OBJECTIVE

The aim of this study was to analyze the prevalence and severity of climacteric symptoms and associated risk factors among a cohort of healthy, middle-aged Omani women.

METHODS

In this cross-sectional study, 472 healthy Omani women between 40 and 60 years old from the representative regions of Omani society were surveyed using the Menopause Rating Scale. The scores obtained were plotted against their demographic data and menopausal stage.

RESULTS

Overall, 39.6% of the participants were premenopausal, 15.2% were perimenopausal, and 43.6% were postmenopausal. The Menopause Rating Scale scoring showed that somatic and psychological symptoms occurred more frequently than did urogenital symptoms in all three stages. Muscle and joint pain was the most common symptom (73.3%), followed by mental and physical exhaustion (47.2%) and anxiety (46.6%). An increase in the mean scores for both somatic and psychological symptoms and their severity was observed when the following factors were present: progression of menopausal stage (mean ± SD, 22.5 ± 2.6, 3.6 ± 2.9, 4.5 ± 3.2), old age (4.2 ± 3.2) versus young age (2.9 ± 2.6), single (4.3 ± 3.3) versus married (3.3 ± 2.9), illiterate (3.9 ± 3.1) versus educated (2.7 ± 2.6), and sexually inactive (4.4 ± 3.4) versus sexually active (3.1 ± 2.7).

CONCLUSIONS

Omani women were found to exhibit highly atypical symptoms of menopause. Increased severity of symptoms was found to be related to age, advanced stage of menopause, and lower educational level.

Assessment of self-esteem in mid-aged women

OBJECTIVE

To assess self-esteem and affecting factors in a middle-aged Ecuadorian female population using the Rosenberg Self-Esteem Scale (RSES).

STUDY DESIGN

This was a cross-sectional study in which 149 women (40-59 years) were requested to fill out the RSES and a general socio-demographic form containing personal and partner data.

RESULTS

Mean age of sample was 47.6+/-5.5 years, a 67.8% had less than 12 years of schooling and 33.6% were postmenopausal. At the moment of the survey 2.7% were on hormone therapy, and 2% were taking psychotropic drugs. Mean total RSES score was 26.6+/-3.1 (median 26, range 17-35). A 35.6% and 18.1% of women respectively presented total RSES scores below 26 (median) and 25 (25th percentile) suggesting lower self-esteem. Total scores did not differ when comparing older age, menopausal phases or time since the menopause. Logistic regression analysis determined that women with lower parity and an unhealthy partner were related to lower total RSES scores (below the 25th percentile) suggesting lower self-esteem.

CONCLUSIONS

In this mid-aged series lower self-esteem was not related to the aging process per se yet to socio-demographic female/male aspects. More research is needed in this regard that incorporates other sociological aspects.