Use of a standardized menopause symptom rating scale in a sample of women with physical disabilities

Mental health outcomes across the reproductive life course among women with disabilities: a systematic review

PURPOSE

This systematic review examined literature on mental health outcomes among women with disabilities living in high-income countries within the context of reproductive health, spanning menstruation through menopause.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE, CINAHL, and PsycINFO databases for studies published through June 2023. Eligible studies were observational, quantitative, and included a comparison group without disabilities.

RESULTS

A total of 2,520 studies were evaluated and 27 studies met inclusion criteria. These studies assessed mental health during prepregnancy, pregnancy, postpartum, and parenting among women with and without disabilities. None of the studies examined reproductive health time periods related to menstruation, fertility, or menopause. Women of reproductive age with disabilities were more likely to have poor mental health outcomes compared to women without disabilities. During pregnancy and the postpartum, women with disabilities were at greater risk of diagnosed perinatal mental disorders and psychiatric-related healthcare visits. Findings also suggested mental distress and inadequate emotional and social support related to parenting among women with disabilities. The greatest risks of poor mental health outcomes were often observed among women with intellectual and developmental disabilities and among women with multiple types of disabilities, compared to women without disabilities.

CONCLUSIONS

Routine reproductive healthcare visits provide significant prevention and treatment opportunities for poor mental health among women with disabilities. Further research examining mental health outcomes within the context of reproductive health, especially understudied areas of menstruation, fertility, parenting, and menopause, among women with disabilities is needed.

Assessing menopause symptoms in women with traumatic brain injury: the development and initial testing of a new scale

With greater survival rates after catastrophic injury, more women with traumatic brain injury (TBI) are living longer than ever. However, knowledge about this transition in these women is largely unexamined and there are no scales that have been developed to assess the experience of symptoms. To address this gap, we developed and tested a new scale of menopause symptoms in midlife women with TBI. We selected candidate items from two existing measures based on feedback from focus group discussions with seven women with TBI. Twenty candidate items were tested in cognitive interviews with six women with TBI/1 non-TBI. Then, these were field tested with 221 participants (TBI, n = 68; non-TBI, n = 153) recruited from registries. Rasch analysis and convergent validity testing were used to evaluate the new scale. Results of the Rasch analysis indicate that overall, the scale fits well the Rasch model with evidence for unidimensionality. Differential item functioning indicated that the scale performed equally well for women with and without TBI and distinguished pre- and post-menopausal states. Convergent validity was found in the expected directions. These findings support further development of the new scale to understand the experience of menopause symptoms among women with TBI.

Postmenopausal Symptoms in Female Veterans with Type 2 Diabetes: Glucose Control and Symptom Severity

BACKGROUND

While type 2 diabetes mellitus (DM) is a common condition of midlife women, few studies have examined its influence on the symptom features of menopause. To explore this relationship, we conducted a study of symptom patterns of diabetic patients using a random sample of female veterans receiving care in the Veterans Affairs Healthcare system.

METHODS

A cross-sectional comparison was conducted with three groups of postmenopausal respondents (ages 45-60 years) to a mailed national survey who also consented to clinical data access: no diabetes (n=90), diabetes with better glucose control (hemoglobin A1c [HbA1c]≤7%, n=135) and diabetes with worse glucose control (HbA1c>7%, n=102).

RESULTS

Respondents, on average, were obese (body mass index: 33.9±0.4 kg/m(2)), 11.30±0.2 years postmenopause, with more than one chronic illness. Despite higher body mass index and increased comorbidities in women with diabetes compared with nondiabetic women, measures of mental health (anxiety, depressed mood, stress) were similar across groups. The pattern of menopause symptoms did not differ by group. Muscle aches/joint pain was the most prevalent symptom (78.6%), followed by vasomotor symptoms (74.4%). Respondents with elevated HbA1c demonstrated higher total menopausal symptom severity scores (DM-HbA1c>7: 15.4±0.8 vs. DM-HbA1c≤7%: 12.2±0.8 vs. No diabetes: 12.3±0.8; p=0.006) than the other two groups.

CONCLUSIONS

In postmenopausal female veterans with diabetes, glucose control is associated with the severity of those symptoms commonly attributed to menopause. Joint pain is an important part of the postmenopausal symptom complex in this population.

Efficacy of estrogen plus progestin on menopausal symptoms in women with systemic lupus erythematosus: a randomized, double-blind, controlled trial

OBJECTIVE

To define the effects of continuous sequential estrogen plus progestin therapy on menopausal symptoms in women with systemic lupus erythematosus (SLE).

METHODS

We performed a randomized, double-blind, 24-month clinical trial involving 106 women with SLE who were in the menopausal transition or early or late postmenopause. Patients received continuous sequential estrogen plus progestin (n = 52) or placebo (n = 54). Menopausal symptoms were assessed using the Greene Climacteric Scale at 0, 1, 2, 3, 6, 9, 12, 15, 18, 21, and 24 months. A new factor analysis of the scale reduced 21 items to 5 factors. The primary outcome was improvement of menopausal symptoms throughout the followup period. Results were analyzed by the intent-to-treat principle.

RESULTS

At baseline, demographic and disease characteristics were similar in both groups. Fifteen of 21 menopausal symptoms had a prevalence of ≥50%, with a similar distribution between groups. Vasomotor factor scores decreased over time in both groups (P = 0.002), but in the estrogen plus progestin group the reduction was more pronounced than in the placebo group (1.5-2.0 versus 0.35-0.8 points on a scale of 0-6; P = 0.03). Maximum effects were observed among the most symptomatic women. Psychological, subjective-somatic, and organic-somatic factors scores also improved along time (P < 0.001), but the treatment and placebo arms improved to a similar degree. Thromboses occurred in 3 patients receiving estrogen plus progestin and in 1 patient receiving placebo.

CONCLUSION

Menopausal symptoms are highly prevalent in peri- and postmenopausal lupus patients. Estrogen plus progestin improved vasomotor symptoms at a clinically significant level, but not other menopausal symptoms. Given the thrombotic risks of menopausal hormone therapy, this should be used only in women with significant vasomotor symptoms.

Menopause and post-polio symptoms as predictors of subjective sleep disturbance in poliomyelitis survivors

OBJECTIVES

Sleep disturbance in polio survivors is a common complaint, yet little is known about the effects of the interaction of physical disability and menopause on sleep. The purpose of this study was to understand the relative contribution of menopause factors and disability to subjective sleep disturbance.

METHODS

Participants were 465 women aged 50-65 years who had physical disabilities due to poliomyelitis. Hierarchical regression modeling was used to examine menopause (symptoms, status, hormone replacement use, ovarectomy status) and disability factors (post-polio symptoms) in sleep disturbance.

RESULTS

In the final model, 19% (frequency) and 17% (severity) of sleep disturbance variance was explained. Psychological symptoms exerted the most influence (for both outcomes) followed by post-polio symptoms, vasomotor symptoms, an interaction of vasomotor and post-polio symptoms and estrogen use. For women with fewer post-polio symptoms, vasomotor symptoms exerted greater influence on sleep disturbance than for women with greater post-polio symptoms.

CONCLUSIONS

Psychological symptoms had the strongest association with sleep disturbance in these women. Controlling for the influence of various menopause factors, our findings show that vasomotor symptoms were only one of several influences on sleep disturbance.

A qualitative study of menopause among women with disabilities

Few studies have examined the way women with disabilities understand and make decisions regarding menopause. This report is a qualitative descriptive study detailing how women with varying mobility impairments view the menopausal transition. Nineteen women aged 42 to 64 years were interviewed regarding their menopausal experiences. Results described their experiences as minority groups of women with disabilities using a women's ways of knowing framework. Overall, most women described menopause as a back burner issue, but maintained the need for accurate information from which to make informed decisions that might impact future health and functional outcomes.

Quality of life and menopause in women with physical disabilities

OBJECTIVE

The goal of this cross-sectional study was to explore quality of life (QOL) in a sample of postmenopausal women with physical disabilities due to polio contracted in childhood. A structural equation model was used to confirm that menopause symptoms will have a minimal effect on QOL when disability-related variables are taken into account.

METHODS

A sample of 752 women who were postmenopausal completed a written survey. The structural equation model contained two measured predictors (age, severity of postpolio sequelae) and one latent predictor (menopause symptoms defined by four measured indicators). Functional status (defined by two measured indicators) was included as a mediator, with QOL (defined by three measured indicators) as the outcome.

RESULTS

The original model yielded acceptable fit indices (CFI = 0.96, RMSEA = 0.055) but resulted in a number of unexpected relationships that proved to be artifacts after model respecification. The respecified model yielded a nonsignificant chi-square value, which indicated no significant discrepancy between the proposed model and the observed data (chisquare = 18.5, df = 13, p = 0.138). All fit indices indicated a good fit: CFI = 0.997, NNFI = 0.987, chi-square/df = 1.43, and RMSEA = 0.024.

CONCLUSIONS

When the effects of postpolio sequelae and functional status are included in the structural equation model, only the psychological symptoms of menopause play a prominent role in explaining QOL in this sample. The clinical implications of these findings suggest that attention to psychological symptoms and an exclusive focus on the physical aspects of menopause to the exclusion of other midlife life stressors and influences on a woman's psychological well-being ignore the larger context of life in which they live. In particular, many women with disabilities may contend with additional or exacerbated stressors related to their disability.

Menopause characteristics of women with physical disabilities from poliomyelitis

OBJECTIVE

To describe menopause characteristics of women with physical disabilities from poliomyelitis.

METHODS

Nine hundred and nine women with a history of poliomyelitis completed a survey on health, physical functioning, emotional well being and menopause.

RESULTS

The majority of the sample was postmenopausal having had a natural menopause around the average age of 50.3 years; 34.7% of the sample had had hysterectomies. Thirty-nine percent were using some form of hormone replacement therapy (HRT). Menopause symptoms were clustered into psychological, somatic-sensory, somatic-sleep and vasomotor factors. Among never and past HRT users, there were significant differences in menopause factor severity by menopause status. Somatic/sleep symptoms were lowest in never users; past users had significantly higher vasomotor symptoms; desire for sexual activity and painful intercourse did not vary by HRT use. Compared to population estimates, post-polio women had similar rates of hysterectomies overall, but among some age cohorts they had significantly lower rates, contrary to expectations. However, they used HRT at significantly higher rates than expected.

CONCLUSIONS

This study suggests that basic menopause characteristics of women with polio are generally similar to those of their non-disabled peers. There were few substantial differences in severity of menopause symptoms by HRT use, which is critical in light of the dearth of studies examining its risk-benefit ratio among women with physical disabilities. Until such studies provide some evidence of the specific risks or benefits to women with physical disability, each woman should carefully weigh the known risks and benefits with her physician.