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Hemachandra C, Taylor S, Islam RM, Fooladi E, Davis SR. A systematic review and critical appraisal of menopause guidelines. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024; 50:122-138. [PMID: 38336466 DOI: 10.1136/bmjsrh-2023-202099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE AND RATIONALE To identify and appraise current national and international clinical menopause guidance documents, and to extract and compare the recommendations of the most robust examples. DESIGN Systematic review. DATA SOURCES Ovid MEDLINE, EMBASE, PsycINFO and Web of Science ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Practice guidance documents for menopause published from 2015 until 20 July 2023. Quality was assessed by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. RESULTS Twenty-six guidance papers were identified. Of these, five clinical practice guidelines (CPGs) and one non-hormonal therapy position statement met AGREE II criteria of being at least of moderate quality. The five CPGs listed symptoms associated with the perimenopause and menopause to be vasomotor symptoms (VMS), disturbed sleep, musculoskeletal pain, decreased sexual function or desire, and mood disturbance (low mood, mood changes or depressive symptoms). Acknowledged potential long-term menopause consequences were urogenital atrophy, and increased risks of cardiovascular disease and osteoporosis. VMS and menopause-associated mood disturbance were the only consistent indications for systemic menopausal hormone therapy (MHT). Some CPGs supported MHT to prevent or treat osteoporosis, but specific guidance was lacking. None recommended MHT for cognitive symptoms or prevention of other chronic disease. Perimenopause-specific recommendations were scant. A neurokinin 3B antagonist, selective serotonin/norepinephrine (noradrenaline) reuptake inhibitors and gabapentin were recommended non-hormonal medications for VMS, and cognitive behavioural therapy and hypnosis were consistently considered as being of potential benefit. DISCUSSION The highest quality CPGs consistently recommended MHT for VMS and menopause-associated mood disturbance, whereas clinical depression or cognitive symptoms, and cardiometabolic disease and dementia prevention were not treatment indications. Further research is needed to inform clinical recommendations for symptomatic perimenopausal women.
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Affiliation(s)
- Chandima Hemachandra
- Women's Health Research Program, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Sasha Taylor
- Women's Health Research Program, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Rakibul M Islam
- Women's Health Research Program, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Ensieh Fooladi
- Monash School of Nursing and Midwifery, Clayton, Victoria, Australia
| | - Susan R Davis
- Women's Health Research Program, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
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Briscoe S, Thompson Coon J, Melendez-Torres GJ, Abbott R, Shaw L, Nunns M, Garside R. Primary care clinicians' perspectives on interacting with patients with gynaecological conditions: a systematic review. BJGP Open 2024; 8:BJGPO.2023.0133. [PMID: 37968071 PMCID: PMC11169973 DOI: 10.3399/bjgpo.2023.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/28/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Studies have found that women with gynaecological conditions and symptoms do not feel listened to by primary care clinicians (PCCs). Less understood is whether PCCs perceive that there are challenges around listening to and interacting with this patient group. AIM To understand PCCs' perspectives on the challenges of listening to and interacting with women patients with gynaecological conditions and symptoms. DESIGN & SETTING Systematic review of English-language studies. METHOD We searched ASSIA (Applied Social Sciences Index and Abstracts), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, HMIC (Healthcare Management Information Consortium), and MEDLINE from inception to July 2023. We also conducted forward and backward citation searches of included studies. Identified records were screened independently by two reviewers. Data extraction was undertaken by one reviewer and checked by a second. Quality appraisal used the Wallace checklist. 'Best-fit' framework synthesis was used to synthesise findings around themes that explored the challenges of patient-clinician interaction. RESULTS We identified 25 relevant articles. Perceived challenges associated with listening to and interacting with patients with gynaecological conditions and symptoms were identified at four 'levels': individual clinician level factors; structural and organisational factors; community and external factors; and factors related to gynaecological conditions. Interpretive analysis identified specific challenges relating to sociocultural factors affecting the consultation experience; the need for further education, training, or guidance for clinicians; factors affecting referral decisions; and factors related to service structure and organisation. CONCLUSION PCCs acknowledge that empathy, respect, and attentive listening are important when interacting with women patients with gynaecological conditions and symptoms. However, these ideals are impeded by several factors.
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Affiliation(s)
- Simon Briscoe
- Exeter PRP Evidence Review Facility, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, Devon, UK
| | - Jo Thompson Coon
- Exeter PRP Evidence Review Facility, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, Devon, UK
| | - G J Melendez-Torres
- Exeter PRP Evidence Review Facility, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, Devon, UK
| | - Rebecca Abbott
- NIHR Applied Research Collaboration South West Peninsula, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, Devon, UK
| | - Liz Shaw
- Exeter PRP Evidence Review Facility, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, Devon, UK
| | - Michael Nunns
- Exeter PRP Evidence Review Facility, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, Devon, UK
| | - Ruth Garside
- Exeter PRP Evidence Review Facility, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, Devon, UK
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Natvik M, Gjelsvik B, Vangen S, Skjeie H, Brekke M. Women's information needs about menopause: a cross-sectional survey in Norwegian general practice. BJGP Open 2024; 8:BJGPO.2023.0127. [PMID: 37669803 PMCID: PMC11169972 DOI: 10.3399/bjgpo.2023.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Research has indicated that providing women with information about menopause can improve their attitudes towards it and symptom experience. Nevertheless, information shared on the menopause is often arbitrary. AIM To examine women's information needs about menopause, and understand if, when, and from whom they want information. DESIGN & SETTING A cross-sectional study was undertaken. A questionnaire survey was distributed to women in the waiting room of 54 general practice clinics in South-Eastern Norway in autumn 2022. METHOD Medical students recruited women in the clinic waiting rooms. A 1-page study-specific questionnaire was used, focusing on need for information about menopause. A multinominal logistic regression model was used to analyse the association between the desire for information and education level, country of birth, and menopausal status. RESULTS A total of 625 women were included, with a mean age of 44.4 years (standard deviation [SD] 8.7). In all, 59% answered that they wanted information about menopause, and 81% of these wanted their GP to inform them, from a median age of 45 years. According to the women, only 10% of GPs had initiated a discussion on the menopause. Higher education was a predictor for wanting information. A main driver of information needs was to help oneself in the present and in the future. In all, 33% did not want information. The main reasons were that they already possessed sufficient information, would take menopause as it comes, were too young, or were already postmenopausal. The sex of the GP did not influence the results. CONCLUSION Most women wanted information about menopause from their GP. The study emphasises the need for GPs to consider prioritising this discussion, and to keep up to date on recommendations and treatment options.
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Affiliation(s)
- Marianne Natvik
- Department of General Practice, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjorn Gjelsvik
- Department of General Practice, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Siri Vangen
- Norwegian Research Centre for Women's Health, Oslo University Hospital & Clinical Medicine, University of Oslo, Norway
| | - Holgeir Skjeie
- General Practice Research Unit, University of Oslo, Norway
| | - Mette Brekke
- General Practice Research Unit, University of Oslo, Norway
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DePree B, Shiozawa A, King D, Schild A, Zhou M, Yang H, Mancuso S. Association of menopausal vasomotor symptom severity with sleep and work impairments: a US survey. Menopause 2023; 30:887-897. [PMID: 37625086 PMCID: PMC10487384 DOI: 10.1097/gme.0000000000002237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/07/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Menopausal vasomotor symptoms commonly disrupt sleep and affect daytime productivity. This online survey evaluated associations between vasomotor symptom severity and perceived sleep quality and work productivity. METHODS Participants were perimenopausal or postmenopausal US women aged 40 to 65 years with ≥14 vasomotor symptom episodes per week for ≥1 week in the past month. The women, who were recruited from Dynata panels via email invitation and categorized by vasomotor symptom severity based on the Menopause Rating Scale, were surveyed about sleep and work productivity and completed the Patient-Reported Outcomes Measurement Information System Sleep Disturbance Short Form 8b (primary outcome) and Sleep-Related Impairment Short Form 8a, Pittsburgh Sleep Quality Index, and Work Productivity and Activity Impairment questionnaire. RESULTS Among 619 respondents (mean age, 53 y; White, 91%; perimenopausal, 34%; postmenopausal, 66%; 57.5% were never treated for vasomotor symptoms), vasomotor symptoms were mild in 88, moderate in 266, and severe in 265. A majority (58% overall) were employed, including 64.8%, 49.6%, and 64.2% of women with mild, moderate, and severe VMS, respectively. Of the 90.8% who reported that vasomotor symptoms affect sleep (81.8%, 86.8%, and 97.7% of those with mild, moderate, and severe VMS), 83.1% reported sleep-related changes in productivity (75.0%, 73.2%, and 94.2%, respectively). Patient-Reported Outcomes Measurement Information System Sleep Disturbance Short Form 8b mean T scores in the mild (T score, 53.5), moderate (57.3), and severe (59.8) VMS cohorts indicated more sleep disturbance than in the general population (T score, 50; overall P < 0.001 before and after controlling for confounding variables). Sleep-Related Impairment 8a results were similar. Vasomotor symptom severity was positively associated with Pittsburgh Sleep Quality Index mean scores, presenteeism, absenteeism, overall work impairment, and impairment in general activities. CONCLUSIONS Greater vasomotor symptom severity was associated with more sleep disturbance, more sleep-related impairment, worse sleep quality, and greater impairment in daytime activities and work productivity.
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Affiliation(s)
- Barbara DePree
- From the Women's Specialty Care, Holland Hospital, Holland, MI
| | - Aki Shiozawa
- Clinical Development, Astellas Pharma, Inc, Northbrook, IL
| | - Deanna King
- Clinical Development, Astellas Pharma, Inc, Northbrook, IL
| | - Arianne Schild
- Clinical Development, Astellas Pharma, Inc, Northbrook, IL
| | - Mo Zhou
- Health Economics and Outcomes Research, Analysis Group, Inc, Boston, MA
| | - Hongbo Yang
- Health Economics and Outcomes Research, Analysis Group, Inc, Boston, MA
| | - Shayna Mancuso
- Clinical Development, Astellas Pharma, Inc, Northbrook, IL
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Davis SR, Magraith K. Advancing menopause care in Australia: barriers and opportunities. Med J Aust 2023; 218:500-502. [PMID: 37330995 DOI: 10.5694/mja2.51981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 06/20/2023]
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DePree B, Houghton K, DiBenedetti DB, Shiozawa A, King DD, Kim J, Mancuso S. Practice patterns and perspectives regarding treatment for symptoms of menopause: qualitative interviews with US health care providers. Menopause 2023; 30:128-135. [PMID: 36696636 DOI: 10.1097/gme.0000000000002096] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To document health care providers' views regarding treatments for symptoms associated with menopause and discussions with patients about symptoms and treatment decisions. Results informed development of a data collection form for a retrospective medical record review (reported separately). METHODS Registered US gynecologists or primary care providers from all US regions were identified from local association directories and an in-house database and were invited to participate in a qualitative interview if they consulted with three or more patients per week presenting with menopausal symptoms. Participants provided demographic data, information about patients' symptoms, and health care provider and patient views on prescription and nonprescription therapies. Key concepts/themes from interviews were identified. RESULTS Participating health care providers (10 gynecologists, 10 primary care providers) agreed there are effective treatment options for menopausal symptoms, particularly vasomotor symptoms and vaginal dryness and/or atrophy. Health care providers reported that treatment was generally dictated by symptoms that interfered with quality of life and/or daily activities, although patients often had symptoms for months before presentation. All health care providers said they prescribe hormone and/or nonhormone therapies for treatment of menopausal symptoms; half stated that they typically inquire about patients' nonprescription therapy use, and 45% recommend specific nonprescription therapies. The most commonly cited barriers to initiation of any therapy for menopausal symptoms were patient concerns about risks and financial considerations (ie, insurance or cost). CONCLUSIONS US health care providers reported prescribing therapies for menopausal symptoms and noted that these therapies were perceived as generally effective; however, barriers to initiation of prescription therapy exist, and new treatment options are needed.
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Affiliation(s)
| | | | | | | | | | - Janet Kim
- Astellas Pharma, Inc., Northbrook, IL
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Stute P, Cano A, Thurston RC, Small M, Lee L, Scott M, Siddiqui E, Schultz NM. Evaluation of the impact, treatment patterns, and patient and physician perceptions of vasomotor symptoms associated with menopause in Europe and the United States. Maturitas 2022; 164:38-45. [DOI: 10.1016/j.maturitas.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/31/2022] [Accepted: 06/14/2022] [Indexed: 10/17/2022]
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Changes in the Oral Cavity in Menopausal Women-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010253. [PMID: 35010513 PMCID: PMC8750983 DOI: 10.3390/ijerph19010253] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/16/2021] [Accepted: 12/23/2021] [Indexed: 01/08/2023]
Abstract
Oral health awareness during the menopausal period is essential to minimize the inevitable inconveniences which may occur due to hormonal changes. The decrease in estrogen hormone concentration impacts the oral mucosa in a similar way to the vaginal mucosa due to the presence of estrogen receptors in both of these structures. An estrogen deficiency also affects the maturation process of the oral mucosal epithelium and can lead to its thinning and atrophy, making it more susceptible to local mechanical injuries, causing a change in pain tolerance and problems in the use of removable prosthetic restorations. Mucosal epithelium during the menopausal period is more vulnerable to infections, candidiasis, burning mouth syndrome, oral lichen planus (OLP), or idiopathic neuropathy. Moreover, salivary glands are also hormone-dependent which leads to changes in saliva secretion and its consistency. In consequence, it may affect teeth and periodontal tissues, resulting in an increased risk of caries and periodontal disease in menopausal women. Due to the large variety of complaints and symptoms occurring in the oral cavity, menopausal women constitute a significant group of patients who should receive special preventive and therapeutic care from doctors and dentists in this particular period.
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Carter S, Davis S, Black KI. Menopause workplace policy: The way forward or backward? Aust N Z J Obstet Gynaecol 2021; 61:986-989. [PMID: 34661905 DOI: 10.1111/ajo.13445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022]
Abstract
Workplace policies regarding women's reproductive and menopausal health are garnering global attention. The peri- and post-menopause stages may be turbulent times for many women, with some experiencing debilitating symptoms and some none at all. While the symptoms of menopause should be recognised by employers due to their various impacts, the implementation of policies that pertain to all women can alienate older female workers by creating prejudice surrounding work capability. This piece identifies other avenues for the inclusion of menopausal symptoms through pre-existing policy and highlights the issues facing menopausal women in this current age.
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Affiliation(s)
- Sarah Carter
- Thermal Ergonomics Laboratory, Faculty of Medicine and Health, Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Susan Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kirsten I Black
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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