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Pinkerton JV, Simon JA, Joffe H, Maki PM, Nappi RE, Panay N, Soares CN, Thurston RC, Caetano C, Haberland C, Haseli Mashhadi N, Krahn U, Mellinger U, Parke S, Seitz C, Zuurman L. Elinzanetant for the Treatment of Vasomotor Symptoms Associated With Menopause: OASIS 1 and 2 Randomized Clinical Trials. JAMA 2024:2822766. [PMID: 39172446 PMCID: PMC11342219 DOI: 10.1001/jama.2024.14618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/08/2024] [Indexed: 08/23/2024]
Abstract
Importance Safe and effective nonhormonal treatments for menopausal vasomotor symptoms (VMS) are needed. Objective To evaluate the efficacy and safety of elinzanetant, a selective neurokinin-1,3 receptor antagonist, for the treatment of moderate to severe menopausal vasomotor symptoms. Design, Setting, and Participants Two randomized double-blind phase 3 trials (OASIS 1 and 2) included postmenopausal participants aged 40 to 65 years experiencing moderate to severe vasomotor symptoms (OASIS 1: 77 sites in the US, Europe, and Israel from August 27, 2021, to November 27, 2023, and OASIS 2: 77 sites in the US, Canada, and Europe from October 29, 2021, to October 10, 2023). Intervention Once daily oral elinzanetant, 120 mg, for 26 weeks or matching placebo for 12 weeks followed by elinzanetant, 120 mg, for 14 weeks. Main Outcomes and Measures Primary end points included mean change in frequency and severity of moderate to severe vasomotor symptoms from baseline to weeks 4 and 12, measured by the electronic hot flash daily diary. Secondary end points included Patient-Reported Outcomes Measurement Information System Sleep Disturbance Short Form 8b total T score and Menopause-Specific Quality of Life questionnaire total score from baseline to week 12. Results Eligible participants (mean [SD] age, OASIS 1: 54.6 [4.9] years; OASIS 2: 54.6 [4.8] years) were randomized to elinzanetant (OASIS 1: n = 199; OASIS 2: n = 200) or placebo (OASIS 1: n = 197; OASIS 2: n = 200). A total of 309 (78.0%) and 324 (81.0%) completed OASIS 1 and 2, respectively. For the elinzanetant and placebo groups, the baseline mean (SD) VMS per 24 hours were 13.4 (6.6) vs 14.3 (13.9) (OASIS 1) and 14.7 (11.1) v 16.2 (11.2) (OASIS 2). Baseline VMS severity was 2.6 (0.2) vs 2.5 (0.2) (OASIS 1) and 2.5 (0.2) vs 2.5 (0.2) (OASIS 2). Elinzanetant significantly reduced VMS frequency at week 4 (OASIS 1: -3.3 [95% CI, -4.5 to -2.1], P < .001; OASIS 2: -3.0 [95% CI, -4.4 to -1.7], P < .001) and at week 12 (OASIS 1: -3.2 [95% CI, -4.8 to -1.6], P < .001; OASIS 2: -3.2 [95% CI, -4.6 to -1.9], P < .001). Elinzanetant also improved VMS severity at week 4 (OASIS 1: -0.3 [95% CI, -0.4 to -0.2], P < .001; OASIS 2: -0.2 [95 CI, -0.3 to -0.1], P < .001) and week 12 (OASIS 1: -0.4 [95% CI, -0.5 to -0.3], P < .001; OASIS 2: -0.3 [95% CI, -0.4 to -0.1], P < .001). Elinzanetant improved sleep disturbances and menopause-related quality of life at week 12, and the safety profile was favorable. Conclusions and Relevance Elinzanetant was well tolerated and efficacious for moderate to severe menopausal VMS. Trial Registration ClinicalTrials.gov Identifier: OASIS 1: NCT05042362, OASIS 2: NCT05099159.
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Affiliation(s)
- JoAnn V. Pinkerton
- Department of Obstetrics and Gynecology, Division Midlife Health, University of Virginia Health, Charlottesville
| | - James A. Simon
- IntimMedicine Specialists, George Washington University, Washington, DC
| | - Hadine Joffe
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pauline M. Maki
- Department of Psychiatry, Psychology, and OB/GYN, University of Illinois at Chicago
| | - Rossella E. Nappi
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology, and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Nick Panay
- Queen Charlotte’s and Chelsea Hospital, Imperial College London, London, United Kingdom
| | - Claudio N. Soares
- Department of Psychiatry, Queen’s University School of Medicine, Kingston, Ontario, Canada
| | - Rebecca C. Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | - Christian Seitz
- Bayer AG, Berlin, Germany
- Charité–Universitätsmedizin Berlin, Germany
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Faubion SS, Shufelt CL. A New Era in Menopause Management? JAMA 2024:2822768. [PMID: 39172487 DOI: 10.1001/jama.2024.15118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Affiliation(s)
- Stephanie S Faubion
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida
- Women's Health Research Center, Mayo Clinic, Rochester, Minnesota
| | - Chrisandra L Shufelt
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida
- Women's Health Research Center, Mayo Clinic, Rochester, Minnesota
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Maki PM, Panay N, Simon JA. Sleep disturbance associated with the menopause. Menopause 2024; 31:724-733. [PMID: 38916279 DOI: 10.1097/gme.0000000000002386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
IMPORTANCE AND OBJECTIVES Sleep disturbance is one of the most common and debilitating symptoms experienced by women during the menopause transition. However, there are currently no therapies specifically approved for sleep disturbance associated with the menopause. Here, we consider how to characterize sleep disturbance associated with the menopause and discuss its etiology, including the latest advances in our understanding of the neuronal circuits that regulate reproduction, body temperature, sleep, and mood; and reflect on its impact on women's health and well-being. We also examine the current treatment landscape and look to the future of treatment for this condition. METHODS We conducted a review of the literature and combined this with discussion with experts in the fields of sleep and menopause as well as experiences from our own clinical practices. DISCUSSION AND CONCLUSIONS Sleep disturbance associated with the menopause is characterized by frequent night-time awakenings and increased awake time after sleep onset. Its impacts are wide-ranging, negatively affecting health as well as personal and social relationships, productivity, and work performance. There is currently an unmet need for effective, safe, and well-tolerated treatments to address this important symptom, and wider recognition of the association between sleep disturbances and the menopause is needed. Sleep disturbances associated with the menopause can result from hormone changes as well as vasomotor and mood symptoms. Growing research has contributed to our knowledge of the role of hypothalamic estrogen-sensitive kisspeptin/neurokinin B/dynorphin neurons. These neurons are thought to integrate the gonadotropin-releasing hormone pathway and the pathways responsible for the homeostatic control of body temperature and the circadian regulation of sleep-wake cycles. Understanding these neurons offers the potential to create treatments that target a key cause of sleep disturbance associated with the menopause. Further research to understand their etiology and characterize the neuronal circuits responsible could benefit the development of these targeted treatment approaches.
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Affiliation(s)
| | - Nick Panay
- Queen Charlotte's & Chelsea Hospital, Imperial College London, United Kingdom
| | - James A Simon
- George Washington University, IntimMedicine Specialists, Washington, DC
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Pinkerton JV, Simon J, Panay N, Seitz C, Parke S, Caetano C, Mellinger U, Haseli Mashhadi N, Haberland C, Atanackovic G, Holz C, Mao G, Morrison M, Nisius S, Schaefers M, Zuurman L. Design of OASIS 1 and 2: phase 3 clinical trials assessing the efficacy and safety of elinzanetant for the treatment of vasomotor symptoms associated with menopause. Menopause 2024; 31:522-529. [PMID: 38564691 DOI: 10.1097/gme.0000000000002350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Elinzanetant is a selective neurokinin-1,3 receptor antagonist in development for the treatment of vasomotor symptoms (VMS) associated with menopause. The pivotal, double-blind, randomized, placebo-controlled phase 3 studies Overall Assessment of efficacy and Safety of elinzanetant In patients with vasomotor Symptoms (OASIS) 1 and 2 will assess the efficacy and safety of elinzanetant in women with VMS. METHODS The OASIS 1 and 2 pivotal studies are designed in accordance with regulatory guidance. Postmenopausal women with moderate/severe VMS are randomized to receive 120 mg elinzanetant or placebo once daily for 12 weeks, followed by a 14-week active treatment extension. Primary endpoints are the mean change in frequency and severity of moderate/severe VMS from baseline to weeks 4 and 12. Key secondary endpoints will assess the onset of action and effects on sleep disturbance and menopause-related quality of life. Primary and key secondary endpoints will be analyzed using a mixed model with repeated measures. Feedback from postmenopausal women with VMS was used during protocol development. RESULTS Women confirmed the relevance of endpoints that assess the impact of VMS, sleep disturbance, and mood changes, and the need for new nonhormone treatments. Educational materials around study design, conduct and expected assessments and procedures were developed based on questions and concerns raised by women. CONCLUSIONS The OASIS 1 and 2 pivotal phase 3 studies will enable assessment of the efficacy and safety of elinzanetant as a treatment for VMS, together with its effect on sleep disturbances, depressive symptoms, and menopause-related quality of life. Feedback from postmenopausal women with VMS was used to maximize patient centricity in the trials.
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Affiliation(s)
- JoAnn V Pinkerton
- From the Department of Obstetrics and Gynecology, UVA Health, University of Virginia, Charlottesville, VA
| | - James Simon
- IntimMedicine Specialists, George Washington University, Washington, DC
| | - Nick Panay
- Queen Charlotte's and Chelsea Hospital, Imperial College, London, United Kingdom
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Hager M, Goldstein T, Fitz V, Ott J. Elinzanetant, a new combined neurokinin-1/-3 receptor antagonist for the treatment of postmenopausal vasomotor symptoms. Expert Opin Pharmacother 2024; 25:783-789. [PMID: 38869992 DOI: 10.1080/14656566.2024.2358131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/17/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION In many postmenopausal women, quality of life is decreased due to vasomotor symptoms. Efficient and well-tolerated non-hormonal treatment options are needed. AREAS COVERED The present review summarizes what is known about the etiology of postmenopausal vasomotor symptoms as a rationale for the mechanism of action of Elinzanetant, a new neurokinin (NK)-1/-3 receptor antagonist, as well as its efficacy and side effect profile. EXPERT OPINION Elinzanetant likely exerts an antagonistic effect on the NK-3 receptor in the preoptic thermoregulatory zone, but also an additional antagonistic effect on the NK-1 receptor possibly leading to a reduction in vasodilatation and heat-sensing neuro-activity. Elinzanetant's reported peak drug concentrations are reached within one hour and the terminal elimination half-life is approximately 15 hours. Two phase IIb clinical trials evaluated the safety profile and efficacy of several doses. There were no serious adverse events, which also included a lack of evidence of drug-related hepatotoxicity. Overall, Elinzanetant seems to be well-tolerated. In the SWITCH-1 study, the 120 mg/day and 160 mg/day regimen showed good efficacy for the treatment of vasomotor symptoms and led to significant improvements in quality of life. Thus, 120 mg oral Elinzanetant/day was used in phase III trials, whose results have not yet been published.
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Affiliation(s)
- Marlene Hager
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Tal Goldstein
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Victoria Fitz
- Division of Reproductive Endocrinology and Infertility, Department of OB/GYN, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johannes Ott
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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Hickey M, LaCroix AZ, Doust J, Mishra GD, Sivakami M, Garlick D, Hunter MS. An empowerment model for managing menopause. Lancet 2024; 403:947-957. [PMID: 38458214 DOI: 10.1016/s0140-6736(23)02799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/31/2023] [Accepted: 12/11/2023] [Indexed: 03/10/2024]
Abstract
Menopause eventually happens to all people with typically functioning ovaries, and almost one billion women worldwide are postmenopausal. Although the biology of typical menopause is ubiquitous, the experience varies substantially. Factors contributing to the experience include not only individual factors, such as the nature and severity of symptoms, but also psychological, social, and contextual considerations, many of which are modifiable. In this first paper in the Lancet Series on menopause, we argue for a new approach that goes beyond the treatment of specific symptoms, to encompass a broad model to support women transitioning this life stage, using the model of empowerment. WHO defines empowerment as an active process of gaining knowledge, confidence, and self-determination to self-manage health and make informed decisions about care. Rather than focusing on menopause as an endocrine deficiency, we propose an empowerment model that recognises factors modifying the experience, in which the patient is an expert in their own condition and the health-care worker supports the patient to become an equal and active partner in managing their own care.
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Affiliation(s)
- Martha Hickey
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC, Australia.
| | - Andrea Z LaCroix
- Department of Epidemiology, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
| | - Jennifer Doust
- Centre for Longitudinal and Life Course Research, School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Gita D Mishra
- NHMRC Centre for Research Excellence in Women and NCDs, School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Muthusamy Sivakami
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | | | - Myra S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Wang R, Jiang C, Wu Z, Wang Z, Peng Y, Li Z, Zhang Z, Lin H, Chen Z. Fecal Microbiota Transplantation Revealed a Pain-related Gut Microbiota Community in Ovariectomized Mice. THE JOURNAL OF PAIN 2023; 24:1203-1212. [PMID: 36796501 DOI: 10.1016/j.jpain.2023.02.003] [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: 08/06/2022] [Revised: 12/30/2022] [Accepted: 02/05/2023] [Indexed: 02/16/2023]
Abstract
Higher sensitivity to pain is a common clinical symptom in postmenopausal females. The gut microbiota (GM) has recently been identified as participating in various pathophysiological processes and may change during menopause and contribute to multiple postmenopausal symptoms. Here, we investigated the possible correlation between GM alteration and allodynia in ovariectomized (OVX) mice. Results showed that OVX mice exhibited allodynia from 7 weeks after surgery compared with sham-operated (SHAM) mice by comparing pain-related behaviors. Fecal microbiota transplantation (FMT) from OVX mice induced allodynia in normal mice while FMT from SHAM mice alleviated allodynia in OVX mice. Microbiome 16S rRNA sequencing and linear discriminant analysis revealed alteration of the GM after OVX. Furthermore, Spearman's correlation analysis showed associations between pain-related behaviors and genera, and further verification identified the possible pain-related genera complex. Our findings provide new insights into the underlying mechanisms of postmenopausal allodynia, and suggest pain-related microbiota community as a promising therapeutic target. PERSPECTIVE: This article provided the evidence of gut microbiota playing essential roles in postmenopausal allodynia. This work intended to offer a guidance for further mechanism investigation into gut-brain axis and probiotics screening for postmenopausal chronic pain.
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Affiliation(s)
- Renyuan Wang
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chang Jiang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhaoyi Wu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhe Wang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Peng
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhuoxuan Li
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhiyang Zhang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haodong Lin
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zixian Chen
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China.
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Williams K. Perimenopausal depression: review of recent findings and implications for future research. Curr Opin Obstet Gynecol 2023; 35:150-153. [PMID: 36912352 DOI: 10.1097/gco.0000000000000857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on the most recent research regarding potential causes and treatments for perimenopausal depression. RECENT FINDINGS Erratic estrogen fluctuations and alterations in the neurosteroid allopregnanolone are important contributors to perimenopausal mood symptoms. These hormone changes augment increased risk associated with recent stressful events, as well as early life childhood events. Perimenopausal depressions have different clinical presentations and may respond to differential treatment approaches. SUMMARY Future research should focus on these recent findings of interindividual hormonal sensitivity, childhood trauma histories, and varying depression symptom profiles for a personalized treatment approach to perimenopausal depression.
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Affiliation(s)
- Katherine Williams
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California, USA
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Kim NY, Yoo SK, Jin JC, Yoon YJ, Han DH, Kim SM. Latent Profile Analysis for Classification of Psychosomatic Symptoms in Perimenopausal Women. J Acad Consult Liaison Psychiatry 2023; 64:136-146. [PMID: 36031073 DOI: 10.1016/j.jaclp.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Over 80% of perimenopausal women experience various physical and neuropsychiatric symptoms due to changes in hormones. However, accurate evaluation and treatment of menopausal symptoms are lacking due to limited evidence regarding customized treatment for each symptom type. OBJECTIVE This study aimed to identify and cluster psychosomatic symptoms in Korean perimenopausal women and to investigate the characteristics of each cluster type. METHODS This Web-based survey assessed 1060 Korean perimenopausal women recruited from nationally representative panels available from a commercial research company. Menopausal symptoms were evaluated using the Menopause Rating Scale, Patient Health Questionnaire-15, Patient Health Questionnaire-9, Insomnia Severity Index, Subjective Memory Complaints Questionnaire, and Overactive Bladder Symptom Score. Data were analyzed using latent profile analysis and multinomial logistic regression. RESULTS Latent profile analysis identified 4 latent classes: "all unimpaired (class 1)," "impaired sexual function, while others are unimpaired (class 2)," "unimpaired sexual function, while others are impaired (class 3)," and "all impaired (class 4)." Classes 3 and 4 were significantly more likely to have a family history of perimenopausal syndrome and a history of other mental disorders, postpartum depression, and postpartum psychosis than classes 1 and 2. CONCLUSIONS Psychosomatic symptoms appear during perimenopause along with depression, somatic symptoms, insomnia, impaired memory, and overactive bladder symptoms. Individuals with these symptoms are more likely to have a history of postpartum depression, psychosis, and other psychiatric disorders. Therefore, sexual dysfunction must be independently treated. Further studies are needed to develop and verify individualized treatments according to symptom class.
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Affiliation(s)
- Na Yeon Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Seo-Koo Yoo
- School of Social Welfare, Soongsil University, Seoul, Republic of Korea
| | - Jae-Chan Jin
- School of Social Welfare, Soongsil University, Seoul, Republic of Korea
| | - Youn Jung Yoon
- Department of Obstetrics & Gynecology, National Police Hospital, Seoul, Republic of Korea
| | - Doug Hyun Han
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Sun Mi Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
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Simon JA, Anderson RA, Ballantyne E, Bolognese J, Caetano C, Joffe H, Kerr M, Panay N, Seitz C, Seymore S, Trower M, Zuurman L, Pawsey S. Efficacy and safety of elinzanetant, a selective neurokinin-1,3 receptor antagonist for vasomotor symptoms: a dose-finding clinical trial (SWITCH-1). Menopause 2023; 30:239-246. [PMID: 36720081 PMCID: PMC9970022 DOI: 10.1097/gme.0000000000002138] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Neurokinin (NK)-3 and NK-1 receptors have been implicated in the etiology of vasomotor symptoms (VMS) and sleep disturbances associated with menopause. This phase 2b, adaptive, dose-range finding study aimed to assess the efficacy and safety of multiple doses of elinzanetant (NT-814), a selective NK-1,3 receptor antagonist, in women experiencing VMS associated with menopause, and investigate the impact of elinzanetant on sleep and quality of life. METHODS Postmenopausal women aged 40 to 65 years who experienced seven or more moderate-to-severe VMS per day were randomized to receive elinzanetant 40, 80, 120, or 160 mg or placebo once daily using an adaptive design algorithm. Coprimary endpoints were reduction in mean frequency and severity of moderate-to-severe VMS at weeks 4 and 12. Secondary endpoints included patient-reported assessments of sleep and quality of life. RESULTS Elinzanetant 120 mg and 160 mg achieved reductions in VMS frequency versus placebo from week 1 throughout 12 weeks of treatment. Least square mean reductions were statistically significant versus placebo at both primary endpoint time points for elinzanetant 120 mg (week 4: -3.93 [SE, 1.02], P < 0.001; week 12: -2.95 [1.15], P = 0.01) and at week 4 for elinzanetant 160 mg (-2.63 [1.03]; P = 0.01). Both doses also led to clinically meaningful improvements in measures of sleep and quality of life. All doses of elinzanetant were well tolerated. CONCLUSIONS Elinzanetant is an effective and well-tolerated nonhormone treatment option for postmenopausal women with VMS and associated sleep disturbance. Elinzanetant also improves quality of life in women with VMS.
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Affiliation(s)
- James A. Simon
- From the George Washington University, IntimMedicine Specialists, Washington, DC
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | | | - Hadine Joffe
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mary Kerr
- NeRRe Therapeutics, Stevenage, United Kingdom
| | - Nick Panay
- Queen Charlotte's and Chelsea and Westminster Hospitals, Imperial College, London, United Kingdom
| | | | | | - Mike Trower
- NeRRe Therapeutics, Stevenage, United Kingdom
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Hatcher KM, Smith RL, Chiang C, Flaws JA, Mahoney MM. Nocturnal Hot Flashes, but Not Serum Hormone Concentrations, as a Predictor of Insomnia in Menopausal Women: Results from the Midlife Women's Health Study. J Womens Health (Larchmt) 2023; 32:94-101. [PMID: 36450126 PMCID: PMC10024068 DOI: 10.1089/jwh.2021.0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Sleep disruptions are among the most common symptoms experienced during menopause and can be associated with depression, hot flashes, and fluctuating hormones. However, few studies have examined how such risk factors influence sleep in midlife women in a network-based approach that will establish the complex relationship between variables. Materials and Methods: We used a Bayesian network (BN) to examine the relationship between multiple factors known to influence sleep and depression in midlife women, including hormone concentrations, hot flashes, and menopause status among participants of the longitudinal Midlife Women's Health Study. In year 1, 762 women (45-54 years of age) answered questions regarding the frequency of insomnia, hot flashes, and depression; 389 of the same women answered similar questions at year 4. We measured serum hormones and calculated free estradiol index, free testosterone index, and ratios of estradiol:progesterone, and estradiol:testosterone. For our model, we calculated the change in frequency of insomnia, depression, and covariates (body mass index, menopause status, hot flashes at night, and present quality of life) from year 1 to 4. Results: Using a BN, we found that self-reported hot flashes at night, and no other factors, were direct predictors of self-reported insomnia in year 1. Surprisingly, we did not identify an association between hormone concentrations and self-reported insomnia. Frequency of insomnia in year 4 was only predicted by frequency of insomnia in year 1, whereas frequency of depression in year 4 was predicted by year 4 insomnia and frequency of depression in year 1. No other factors were direct predictors of insomnia or depression in our model. Conclusions: Therefore, hot flashes at night, previous insomnia, and depression are stronger predictors of how women will self-report frequency of sleep disruptions and treatment may reduce menopausal sleep complaints.
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Affiliation(s)
- Katherine M. Hatcher
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Rebecca L. Smith
- Department of Pathobiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Catheryne Chiang
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Jodi A. Flaws
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Megan M. Mahoney
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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12
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Coborn J, de Wit A, Crawford S, Nathan M, Rahman S, Finkelstein L, Wiley A, Joffe H. Disruption of Sleep Continuity During the Perimenopause: Associations with Female Reproductive Hormone Profiles. J Clin Endocrinol Metab 2022; 107:e4144-e4153. [PMID: 35878624 PMCID: PMC9516110 DOI: 10.1210/clinem/dgac447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Nocturnal vasomotor symptoms (nVMS), depressive symptoms (DepSx), and female reproductive hormone changes contribute to perimenopause-associated disruption in sleep continuity. Hormonal changes underlie both nVMS and DepSx. However, their association with sleep continuity parameters resulting in perimenopause-associated sleep disruption remains unclear. OBJECTIVE We aimed to determine the association between female reproductive hormones and perimenopausal sleep discontinuity independent of nVMS and DepSx. METHODS Daily sleep and VMS diaries, and weekly serum assays of female reproductive hormones were obtained for 8 consecutive weeks in 45 perimenopausal women with mild DepSx but no primary sleep disorder. Generalized estimating equations were used to examine associations of estradiol, progesterone, and follicle stimulating hormone (FSH) with mean number of nightly awakenings, wakefulness after sleep onset (WASO) and sleep-onset latency (SOL) adjusting for nVMS and DepSx. RESULTS Sleep disruption was common (median 1.5 awakenings/night, WASO 24.3 and SOL 20.0 minutes). More awakenings were associated with estradiol levels in the postmenopausal range (β = 0.14; 95% CI, 0.04 to 0.24; P = 0.007), and higher FSH levels (β [1-unit increase] = 0.12; 95% CI, 0.02 to 0.22; P = 0.02), but not with progesterone (β [1-unit increase] = -0.02; 95% CI, -0.06 to 0.01; P = 0.20) in adjusted models. Female reproductive hormones were not associated with WASO or SOL. CONCLUSION Associations of more awakenings with lower estradiol and higher FSH levels provide support for a perimenopause-associated sleep discontinuity condition that is linked with female reproductive hormone changes, independent of nVMS and DepSx.
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Affiliation(s)
| | | | - Sybil Crawford
- Tan Chingfen Graduate School of Nursing at UMass Chan Medical School, Worcester, MA, 01605, United States
| | - Margo Nathan
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, United States
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, United States
| | - Shadab Rahman
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, United States
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, 02115, United States
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115, United States
| | - Lauren Finkelstein
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, United States
| | - Aleta Wiley
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, United States
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, United States
| | - Hadine Joffe
- Correspondence: Hadine Joffe, MD MSc, Brigham and Women’s Hospital, Thorn 1117, 75 Francis St, Boston MA 02115-6106, USA.
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Moss KM, Mishra GD, Krejany EO, Hickey M. What happens after menopause? (WHAM): A prospective controlled study of symptom profiles up to 12 months after pre-menopausal risk-reducing salpingo-oophorectomy. Gynecol Oncol 2022; 167:58-64. [PMID: 35933227 DOI: 10.1016/j.ygyno.2022.07.029] [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: 05/08/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Understanding how symptoms cluster after premenopausal risk-reducing salpingo-oophorectomy (RRSO) can inform patient expectations but information is lacking. We aimed to identify symptom profiles after RRSO, changes over time, and the effect of hormone therapy (HT). METHOD Participants were premenopausal women from a longitudinal controlled study (What Happens After Menopause? (WHAM)). Menopausal symptoms were prospectively measured in three groups: pre-menopausal comparisons who retained their ovaries (n = 99), RRSO HT users (n = 57) and RRSO non-HT users (n = 38). Symptoms (hot flashes, night sweats, low desire, vaginal dryness, poor sleep, anxiety/depression) were measured at baseline (pre-surgery) and at 3, 6 and 12 months using standardised questionnaires. Latent transition analysis was used to identify symptom profiles post-RRSO, and the probability of changing profiles over time. RESULTS Three symptom profiles were identified: Most Symptoms (81-87% non-HT; 36-41% HT; 7-9% comparisons), Few Symptoms (7-13% non-HT; 36-42% HT; 77-80% comparisons), and Sexual Symptoms (0-10% non-HT; 17-27% HT; 14-15% comparisons). Most of the non-HT group reported Most Symptoms at 3 months with only a 2% chance of improvement by 12 months. The HT group were split between profiles at 3 months with a 5-13% chance of improvement by 6 months (14% chance of worsening), and a 12-32% chance of improvement by 12 months (4-25% chance of worsening). CONCLUSIONS Symptoms cluster into distinct profiles after premenopausal RRSO. Most non-HT users are highly symptomatic with little chance of improvement by 12 months. In contrast, two-thirds of HT users have fewer symptoms and a much higher chance of improvement. These findings can inform patient decision-making and expectations.
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Affiliation(s)
- Katrina M Moss
- Australian Women and Girls' Health Research Centre, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Gita D Mishra
- Australian Women and Girls' Health Research Centre, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Efrosinia O Krejany
- Gynaecology Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
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Carpenter JS. Leadership corner: Focusing on flashes. Nurs Outlook 2021; 70:355-357. [PMID: 34749987 DOI: 10.1016/j.outlook.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 09/15/2021] [Indexed: 10/19/2022]
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Conklin D, Carpenter JS, Whitney MS, DeLozier S, Ogede DO, Bazella C, McVoy M, Sajatovic M. Narrative Analyses: Cognitive Behavior Group Therapy for Women with Menopause and Bipolar or Major Depressive Disorders. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2021; 2:430-442. [PMID: 34671764 PMCID: PMC8524736 DOI: 10.1089/whr.2021.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/12/2022]
Abstract
Background: Bipolar and depressive disorders (bipolar disorder [BD], major depressive disorder [MDD]), as well as menopause affect millions of women. Although there are three known cognitive behavioral group treatment (CBGT) protocols to help women with problematic menopause symptoms, they do not target women on the BD or MDD spectrum. The purpose of this qualitative study was to learn more about the treatment needs and group experiences of women with problematic menopause symptoms and diagnosed on the BD and MDD spectrum, who participated in a CBGT intervention for menopausal symptoms. Methods: Narrative data recorded by clinicians (Interventionists' notes) and participants (Evaluation of Groups Survey) were analyzed using content analyses. Results: Several themes emerged from (n = 11 BD; n = 48 MDD) what women wanted help with (specific symptoms and general aspects of menopause), what women liked about CBGT (specific and general aspects of the program), and changes needed in the CBGT intervention (things wished for and barriers that interfered with the program). The two diagnostic groups differed in their responses, although both groups identified content and delivery gaps they wished would be addressed. Specifically related to their diagnosis, women most commonly talked about problems with worsening mood and mood instability and multiple stressors interfering with their ability to follow through with the intervention. Conclusions: These findings can help refine existing CBGT protocols for women diagnosed on the BD and MDD spectrum seeking help for menopause symptoms. Trial Registry: Parent study ClinicalTrials.gov [identifier: NCT02860910].
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Affiliation(s)
- Danette Conklin
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Meredith Sorenson Whitney
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Cleveland, Ohio, USA
| | - Sarah DeLozier
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Daisy Okwa Ogede
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Corinne Bazella
- Department of Obsterics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Molly McVoy
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Martha Sajatovic
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Coslov N, Richardson MK, Woods NF. Symptom experience during the late reproductive stage and the menopausal transition: observations from the Women Living Better survey. Menopause 2021; 28:1012-1025. [PMID: 34313615 PMCID: PMC8549458 DOI: 10.1097/gme.0000000000001805] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the occurrence of a variety of symptoms, their frequency, bother, burden, and interference in the lives of women in the late reproductive stage (LRS) and compare their experiences to that of women in the menopausal transition (MT) stage. METHODS Women ages 35 to 55 years responded to an 82-question online survey offered by Women Living Better. Participants reported current menstrual patterns, recent changes and symptom frequency, bother, and interference. Women's cycles were classified as LRS or MT using Stages of Reproductive Aging Workshop +10 criteria. RESULTS Of 2,406 respondents, 946 met criteria for LRS and 583 for MT. Participants included 30% from outside the United States, 31% from diverse racial/ethnic groups, and 18% reported having difficulty paying for basics. A similar proportion of women in the LRS and MT+ groups reported each of the symptoms: there was a less than 10% difference for 54 of the 61 symptoms. Of mean bother ratings for all symptoms, only hot flashes differed significantly between the LRS and MT groups. LRS women experienced similar levels of symptom-related interference with personal relationships and daily living to those in the MT stage but did not anticipate these symptoms occurring until they were 50 years old. CONCLUSIONS Women in the LRS experience symptoms strikingly similar to those often associated with the MT. Women do not expect these changes until the age of 50 years or later and are surprised by such symptoms before cycle irregularity. Research about the epidemiology and management of LRS symptoms, anticipatory guidance for women, and education for clinicians who care for them warrant increased attention.
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Affiliation(s)
| | | | - Nancy Fugate Woods
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA
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Hypothalamic neurokinin signalling and its application in reproductive medicine. Pharmacol Ther 2021; 230:107960. [PMID: 34273412 DOI: 10.1016/j.pharmthera.2021.107960] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/29/2022]
Abstract
The discovery of the essential requirement for kisspeptin and subsequently neurokinin B signalling for human reproductive function has sparked renewed interest in the neuroendocrinology of reproduction. A key discovery has been a population of cells co-expressing both these neuropeptides and dynorphin in the hypothalamus, directly regulating gonadotropin hormone releasing hormone (GnRH) secretion and thus pituitary secretion of gonadotropins. These neurons also project to the vasomotor centre, and their overactivity in estrogen deficiency results in the common and debilitating hot flushes of the menopause. Several antagonists to the neurokinin 3 receptor, for which neurokinin B is the endogenous ligand, have been developed, and are entering clinical studies in human reproductive function and clinical trials. Even single doses can elicit marked declines in testosterone levels in men, and their use has elicited evidence of the regulation of ovarian follicle growth in women. The most advanced indication is the treatment of menopausal vasomotor symptoms, where these drugs show remarkable results in both the degree and speed of symptom control. A range of other reproductive indications are starting to be explored, notably in polycystic ovary syndrome, the most common endocrinopathy in women.
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Reame NK. Anxiety and hot flashes as predictors of mid-life palpitations: getting to the heart of the matter in the time of COVID-19. Menopause 2021; 28:731-734. [PMID: 34165445 PMCID: PMC8240496 DOI: 10.1097/gme.0000000000001808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 11/26/2022]
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Effects of NT-814, a dual neurokinin 1 and 3 receptor antagonist, on vasomotor symptoms in postmenopausal women: a placebo-controlled, randomized trial. ACTA ACUST UNITED AC 2021; 27:498-505. [PMID: 32068688 PMCID: PMC7188053 DOI: 10.1097/gme.0000000000001500] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To evaluate the safety, pharmacokinetics, and preliminary efficacy of NT-814, a dual neurokinin 1,3 antagonist, in postmenopausal women with vasomotor symptoms (hot flashes). METHODS We completed a double-blind, randomized, placebo-controlled trial in three US clinical research units in 76 postmenopausal women with moderate/severe hot flashes. Participants were randomized to 14 days of once-daily NT-814 or placebo within each of four sequential dose cohorts; 50, 100, 150, and 300 mg. Participants completed diaries of hot flash frequency and severity and waking due to night sweats before (baseline) and during treatment. RESULTS All prespecified efficacy parameters (24-h hot flash frequency and severity, frequency of waking due to night sweats) decreased in all groups (including placebo). Mean reduction from baseline at week 2 in moderate/severe hot flash frequency was 37% in the placebo group and, respectively, 24% (P = 0.048 vs placebo), 59% (P = 0.155), 84% (P < 0.001) and 66% (P = 0.022) in the 50 mg, 100 mg, 150 mg, and 300 mg NT-814 groups; in waking due to night sweats reduction was 20% (P = 0.059), 55% (P = 0.135), 81% (P < 0.001), and 63% (P = 0.031) in the NT-814 groups and 32% in the placebo group. The improvement with NT-814 ≥150 mg was also evident in the first week of treatment. The most common treatment-related adverse events were mild somnolence and headache, more frequently in the 300 mg group. Safety monitoring identified no concerns. CONCLUSIONS Once-daily NT-814 (≥150 mg/d) resulted in a rapid, marked improvement in hot flashes and waking due to night sweats. No safety concerns were identified. Doses up to 300 mg were well tolerated.
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Abstract
BACKGROUND Dysmenorrhea is a prevalent pain condition among women and a risk factor for other chronic pain conditions. Individuals vary in dysmenorrhea pain severity, the number of painful sites, and co-occurring gastrointestinal symptoms. Three dysmenorrhea symptom-based phenotypes were previously identified using latent class analysis; however, there is a need to validate these in an independent sample, so they can be used in mechanistic and interventional research. There is also a need to further characterize dysmenorrhea symptom-based phenotypes in terms of demographic, clinical, and psychobehavioral characteristics so they can be used to inform precision dysmenorrhea treatment. OBJECTIVES The study objectives were to (a) determine whether the same dysmenorrhea symptom-based phenotypes would be found in a new sample; (b) determine whether including demographic, clinical, and psychobehavioral covariates in latent class analyses would change individuals' phenotype memberships; and (c) investigate relationships between dysmenorrhea symptom-based phenotypes and demographic, clinical, and psychobehavioral characteristics. METHODS This cross-sectional survey study included 678 women (aged 14-42 years) with dysmenorrhea. Participants reported dysmenorrhea symptom severity, demographic, clinical (comorbid chronic pain and gynecological conditions), and psychobehavioral characteristics (perceived stress, anxiety, depression, sleep disturbance, and pain catastrophizing). We used latent class analysis to identify symptom-based phenotypes. We compared analyses with and without covariates (i.e., demographic, clinical, and psychobehavioral characteristics) to determine if individuals' phenotype memberships changed. We then examined associations between phenotypes and demographic, clinical, and psychobehavioral characteristics. RESULTS We reproduced three dysmenorrhea symptom-based phenotypes: the "mild localized pain" phenotype (characterized by mild abdominal cramps), the "severe localized pain" phenotype (characterized by severe abdominal cramps), and the "multiple severe symptoms" phenotype (characterized by severe pain at multiple locations and gastrointestinal symptoms). Analyses with and without covariates had little effect on individuals' phenotype membership. Race, comorbid chronic pain condition, endometriosis, and pain catastrophizing were significantly associated with the dysmenorrhea phenotypes. DISCUSSION Findings provide a foundation to further study mechanisms of dysmenorrhea symptom heterogeneity and develop dysmenorrhea precision treatments. The three dysmenorrhea symptom-based phenotypes were validated in a second sample. Demographic, clinical, and psychobehavioral factors were associated with dysmenorrhea symptom-based phenotypes.
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Abstract
OBJECTIVE The aims of this study were to: (1) characterize the menopause transition (MT) on social media and (2) determine if concordance or discordance exists when comparing MT-focused social media posts and biomedical research literature. METHODS We analyzed 440 sequential Instagram posts with the hashtag #menopause over 2 weeks from January to February 2019. Posts were composed of 299 unique accounts, resulting in an average of 1.7 posts per account (standard deviation [SD] 1; range 1-9; median 1 and interquartile range [IQR] 1-2). Each account had an average of 2,616 followers (SD 11,271; range 3-129,000; median 421.5 and IQR 177-1,101). Content and thematic analyses were completed for posts, images, and videos to identify codes related to the MT. The top 15 codes were then searched along with the key term "menopause" in PubMed to ascertain the level of concordance between Instagram content and peer-reviewed literature on the MT. RESULTS We identified 69 codes in our corpus of Instagram content, resulting in 9 categories: physical health, mental health, complementary and integrative health, advertising, social, advice, self-care, nature, and self-expression (kappa 0.95-1.00). The most prevalent codes were related to weight loss/fitness (20.5%) and hormones (18.4%). The majority of frequent codes identified in Instagram posts were infrequently listed in biomedical literature related to menopause. However, there were two codes, Weight loss/Fitness and Hot flashes, that were frequently discussed in Instagram posts and the biomedical literature. CONCLUSIONS The examination of #menopause on Instagram provides novel insights for researchers and clinicians. Our findings provide a better understanding of the experiences and support needs of individuals experiencing menopause. Furthermore, codes related to menopause have low prominence in the biomedical literature, suggesting key topics that could be explored in the future.
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Abstract
OBJECTIVE The Menopause Strategies: Finding Lasting Answers for Symptoms and Health clinical trials network was funded by the National Institutes of Health to find new ways to alleviate the most common, bothersome menopausal symptoms by designing and conducting multiple concurrent clinical intervention studies, accommodating a wide scope of populations and intervention strategies. METHODS Trials were conducted in Boston, Indianapolis, Minneapolis, Oakland, Philadelphia, and Seattle, with the Data Coordinating Center in Seattle, and were designed with standardized eligibility criteria and endpoints. Primary outcomes focused on vasomotor symptoms, sleep quality and insomnia symptoms, and vaginal symptoms. Secondary outcomes included quality of life, sexual function, and mood. RESULTS We completed five randomized clinical trials and three ancillary studies, testing nine interventions in over 1,300 women and collecting nearly 16,000 bio-specimens. Escitalopram, venlafaxine hydrochloride extended release, and low-dose estradiol diminished hot flashes by approximately 50% as compared with a 30% decrease by placebo. No benefits on vasomotor symptoms were observed with yoga or exercise compared with usual activity, nor with omega-3 supplementation compared with placebo. Cognitive behavioral therapy for insomnia reduced self-reported insomnia symptoms and improved overall sleep quality compared with menopause education control. We did not find significant benefit from a vaginal estradiol tablet or a vaginal moisturizer compared with placebo tablet and gel in diminishing the severity of vaginal symptoms. CONCLUSIONS The MsFLASH trials contributed substantially to our understanding of bothersome menopausal symptom treatment. It is important that clinicians counseling women about available treatment options consider all therapies-both nonhormonal and hormonal.
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Carpenter JS, Tisdale JE, Chen CX, Kovacs R, Larson JC, Guthrie KA, Ensrud KE, Newton KM, LaCroix AZ. A Menopause Strategies-Finding Lasting Answers for Symptoms and Health (MsFLASH) Investigation of Self-Reported Menopausal Palpitation Distress. J Womens Health (Larchmt) 2020; 30:533-538. [PMID: 33217253 DOI: 10.1089/jwh.2020.8586] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Study to describe the degree of menopausal palpitation distress and its demographic, clinical, symptom, and quality-of-life (QOL) correlates. Analysis of existing, baseline, data from peri- and postmenopausal women, 42 to 62 years of age, who participated in the Menopause Strategies-Finding Lasting Answers for Symptoms and Health (MsFLASH) clinical trials testing interventions for vasomotor symptoms (n = 759). Up to 46.8% of menopausal women report having palpitations, yet the symptom is relatively understudied. Little is known about palpitation distress or its correlates. Materials and Methods: Degree of distress from "heart racing or pounding" was self-reported over the past two weeks as "not at all," "a little bit," "moderately," "quite a bit," or "extremely." Other measures included self-report forms, clinic-verified body mass index (BMI), vasomotor symptom diaries, and validated symptom and QOL tools. Results: The percentage who reported palpitation distress was 19.6%, 25.2%, and 33.5% in the three trials or 25.0% overall. In multivariate analysis, the odds of reporting palpitation distress was lower in past smokers (odds ratio [OR] = 0.59 [95% confidence interval (CI) 0.38-0.90]) and current smokers (OR = 0.48 [0.27-0.87]) relative to never-smokers and lower with every 5 kg/m2 higher BMI (OR = 0.82 [0.69-0.98]).The odds of reporting palpitation distress was higher with every five point more severe insomnia (OR = 1.28 [1.05-1.54]), five point worse depressive symptoms (OR = 1.47 [1.11-1.95]), five point worse perceived stress (OR = 1.19 [1.01-1.39]), and one point worse menopausal QOL (OR = 1.29 [1.06-1.57]). Conclusions: Menopausal palpitation distress is common and associated with demographic, clinical, symptom, and QOL factors. Findings can be used for screening in clinical practice and to justify additional research on this understudied symptom.
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Affiliation(s)
| | - James E Tisdale
- College of Pharmacy, Purdue University, West Lafayette, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Chen X Chen
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
| | - Richard Kovacs
- School of Medicine, Indiana University, Indianapolis, Indiana, USA.,Krannert Institute of Cardiology, Indianapolis, Indiana, USA
| | - Joseph C Larson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Katherine A Guthrie
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Center for Care Delivery and Outcomes Research, Minneapolis VAHCS, Minneapolis, Minnesota, USA
| | - Katherine M Newton
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Andrea Z LaCroix
- Department of Family Medicine and Public Health, University of California, San Diego, California, USA
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Health Characteristics Associated With Hot Flashes in Women With HIV During Menopause: An Integrative Review. J Assoc Nurses AIDS Care 2019; 30:87-97. [PMID: 30586086 DOI: 10.1097/jnc.0000000000000024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hot flashes (HFs) are a prominent symptom of menopause known to unfavorably influence mood, sleep, and quality of life. More women living with HIV are entering menopause and may experience a greater prevalence of HFs and more severe HFs compared with uninfected women. This integrative review evaluated existing evidence on potential health characteristics associated with HFs in women living with HIV during menopause. A search strategy was conducted within 6 databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided the review, and the Johns Hopkins Nursing Evidence-Based Practice model was used to evaluate methodological quality and appraisal of the evidence. Five articles met the review eligibility criteria. Three content categories emerged from the key findings of the 5 articles: HIV-specific characteristics, mental health and cognitive characteristics, and quality of life and social characteristics. Implications for research and clinical care were identified.
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Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause 2019; 25:1069-1085. [PMID: 30179986 DOI: 10.1097/gme.0000000000001174] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is a new appreciation of the perimenopause - defined as the early and late menopause transition stages as well as the early postmenopause - as a window of vulnerability for the development of both depressive symptoms and major depressive episodes. However, clinical recommendations on how to identify, characterize and treat clinical depression are lacking. To address this gap, an expert panel was convened to systematically review the published literature and develop guidelines on the evaluation and management of perimenopausal depression. The areas addressed included: 1) epidemiology; 2) clinical presentation; 3) therapeutic effects of antidepressants; 4) effects of hormone therapy; and 5) efficacy of other therapies (eg, psychotherapy, exercise, and natural health products). Overall, evidence generally suggests that most midlife women who experience a major depressive episode during the perimenopause have experienced a prior episode of depression. Midlife depression presents with classic depressive symptoms commonly in combination with menopause symptoms (ie, vasomotor symptoms, sleep disturbance), and psychosocial challenges. Menopause symptoms complicate, co-occur, and overlap with the presentation of depression. Diagnosis involves identification of menopausal stage, assessment of co-occurring psychiatric and menopause symptoms, appreciation of the psychosocial factors common in midlife, differential diagnoses, and the use of validated screening instruments. Proven therapeutic options for depression (ie, antidepressants, psychotherapy) are the front-line treatments for perimenopausal depression. Although estrogen therapy is not approved to treat perimenopausal depression, there is evidence that it has antidepressant effects in perimenopausal women, particularly those with concomitant vasomotor symptoms. Data on estrogen plus progestin are sparse and inconclusive.
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Woods NF, Utian W. Quality of life, menopause, and hormone therapy: an update and recommendations for future research. Menopause 2019; 25:713-720. [PMID: 29933353 DOI: 10.1097/gme.0000000000001114] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Nancy Fugate Woods
- School of Nursing, University of Washington, Seattle, WA Case Western Reserve University, Beachwood, OH
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In people living with HIV (PLWH), menopause (natural or surgical) contributes to the greater symptom burden in women: results from an online US survey. Menopause 2019; 25:744-752. [PMID: 29509596 DOI: 10.1097/gme.0000000000001083] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The majority of people living with HIV in the United States are now over the age of 50, but symptom burden research has seldom included older women or the potential role of menopause. The aim of the study was to examine the influence of menopause as part of sex differences in HIV symptom burden. METHODS A cross-sectional study was conducted that included both a sex-based analysis of previously reported HIV symptom characteristics of 1,342 respondents to an online survey (males, n = 957; female, n = 385) and a follow-up online survey of menstrual bleeding patterns (inferred menopause) in eligible females (n = 242) from the respondent pool. Using linear mixed models, we identified predictors of symptom burden scores in female respondents. RESULTS For the most troublesome symptoms assessed in the sex-based analysis, depression scores were similar (P > 0.05), but higher (worse) burden scores for fatigue (P = 0.013) and muscle aches/pains (P = 0.004) were exclusively observed in females after adjusting for covariates. Respondents to the female survey (n = 222) were predominantly Black, heterosexual, nonsmokers, and obese, with an HIV diagnosis of approximately 16 years and at least one comorbid condition. Burden scores were higher in women reporting amenorrhea due to natural menopause or hysterectomy (n = 104) versus the menstruating group (n = 118) for muscle aches/pains (P = 0.05), fatigue (P = 0.03), and difficulty falling asleep (P = 0.04), independent of age, HIV duration, and number of HIV-associated non-AIDS conditions. CONCLUSIONS Two of the most common symptoms in people living with HIV-fatigue and muscle aches/joint pains-invoke additional burden in women. Independent of aging, symptom burden may be exacerbated after menopause, supporting a shifting paradigm for HIV care management.
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Sleep disturbance in women who undergo surgical menopause compared with women who experience natural menopause. Menopause 2019; 26:357-364. [DOI: 10.1097/gme.0000000000001257] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Maki PM, Kornstein SG, Joffe H, Bromberger JT, Freeman EW, Athappilly G, Bobo WV, Rubin LH, Koleva HK, Cohen LS, Soares CN. Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations. J Womens Health (Larchmt) 2019; 28:117-134. [DOI: 10.1089/jwh.2018.27099.mensocrec] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Pauline M. Maki
- Department of Psychiatry and Department of Psychology, University of Illinois at Chicago, Chicago Illinois
| | - Susan G. Kornstein
- Department of Psychiatry and Institute of Women's Health, Virginia Commonwealth University, Richmond, Virginia
| | - Hadine Joffe
- Connors Center for Women's Health and Department of Psychiatry, Brigham and Women's Hospital and Dana Farber Cancer Institute/Harvard Medical School, Boston, Massachusetts
| | - Joyce T. Bromberger
- Department of Epidemiology, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ellen W. Freeman
- Department of Obstetrics and Gynecology and Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Geena Athappilly
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford Massachusetts; Harvard Medical School, Boston Massachusetts
| | - William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Lee S. Cohen
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Claudio N. Soares
- Department of Psychiatry, Queen's University School of Medicine, Ontario Canada
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Frange C, Hachul H, Hirotsu C, Tufik S, Andersen ML. Insomnia with Musculoskeletal Pain in Postmenopause: Associations with Symptoms, Mood, and Quality of Life. J Menopausal Med 2018; 24:17-28. [PMID: 29765923 PMCID: PMC5949304 DOI: 10.6118/jmm.2018.24.1.17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/22/2018] [Accepted: 03/08/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives To investigate the relationship between insomnia (INS) combined with chronic musculoskeletal pain (MSP) in postmenopausal women and its characteristics regarding MSP, menopausal and mood symptoms, sleep and quality of life (QOL). Methods A cross-sectional control study in 4 groups of postmenopausal women: control (n = 15), MSP (n = 15), INS (n =15) and INS + MSP (n = 17). Sixty-two participants completed questionnaires and had blood collected, and 43 underwent polysomnography. Results INS was associated with increased anxiety (P = 0.04) and sleep fragmentation (P = 0.02); worse MSP severity (P = 0.00), MSP interference with daily function (P = 0.00), higher pain intensity at midday (P = 0.02) and menopausal symptoms (P = 0.00); and reduced QOL (P = 0.00). MSP was associated with increased anxiety (P = 0.02) and menopausal symptoms (P = 0.00), and reduced QOL (P = 0.05). In the whole sample, depression symptoms were higher but no statistical differences were found between groups (P = 0.47). Worse QOL was associated with both higher depressive symptoms (P = 0.01) and worse pain interference (P = 0.02) Conclusions INS + MSP was related to higher menopausal and anxiety symptoms, more sleep fragmentation and complaints of MSP severity and interference, more pain sites and worse QOL. The presence of INS was associated to more MSP. Sleep management is essential in women who have developed chronic MSP.
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Affiliation(s)
- Cristina Frange
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Helena Hachul
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynecology, Casa de Saúde Santa Marcelina, São Paulo, Brazil
| | - Camila Hirotsu
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica Levy Andersen
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
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Steels E, Steele M, Harold M, Adams L, Coulson S. A double-blind, randomized, placebo-controlled trial evaluating safety and efficacy of an ayurvedic botanical formulation in reducing menopausal symptoms in otherwise healthy women. J Herb Med 2018. [DOI: 10.1016/j.hermed.2018.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Woods NF, Cray LA, Mitchell ES, Farrin F, Herting J. Polymorphisms in Estrogen Synthesis Genes and Symptom Clusters During the Menopausal Transition and Early Postmenopause: Observations From the Seattle Midlife Women's Health Study. Biol Res Nurs 2018; 20:153-160. [PMID: 29334760 PMCID: PMC5942527 DOI: 10.1177/1099800417753536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
During the menopausal transition and early postmenopause, participants in the Seattle Midlife Women's Health Study (SMWHS) experienced one of the three symptom severity clusters identified through latent class analysis: severe hot flashes with moderate sleep, mood, cognitive, and pain symptoms (high-severity hot flash); low-severity hot flashes with moderate levels of all other symptom groups (moderate severity); and low levels of all symptom groups (low severity). In an effort to determine whether gene polymorphisms were associated with these symptom severity classes, we tested associations between gene polymorphisms in the estrogen synthesis pathways (cytochrome P450 19 [CYP 19] and 17 beta hydroxysteroid dehydrogenase [ 17HSDB1]) and the three symptom severity clusters. SMWHS participants ( N = 137) recorded symptoms monthly in diaries and provided buccal smears for genotyping. Multilevel latent class analysis with multinomial regression was used to determine associations between gene polymorphisms and symptom severity clusters. Only the 17HSDB1 polymorphisms ( rs615942 and rs592389) were associated significantly with the high-severity hot flash cluster versus the low-severity symptom cluster. None of the polymorphisms was associated with the moderate-severity cluster versus the low-severity symptom cluster. Findings of associations of the 17HSDB1 polymorphisms with the high-severity hot flash symptom cluster are consistent with those of an association between 17HSDB1 polymorphisms and hot flashes in the Study of Women and Health Across the Nation population and our previous findings of associations between these polymorphisms with greater estrone levels.
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Affiliation(s)
| | - Lori A Cray
- 2 College of Nursing, Seattle University, Seattle, WA, USA
| | | | - Fred Farrin
- 3 Department of Environmental and Occupational Health Sciences, Center for Ecogenetics and Environmental Health, University of Washington, Seattle, WA, USA
| | - Jerald Herting
- 4 Department of Sociology, University of Washington, Seattle, WA, USA
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Guthrie KA, Larson JC, Ensrud KE, Anderson GL, Carpenter JS, Freeman EW, Joffe H, LaCroix AZ, Manson JE, Morin CM, Newton KM, Otte J, Reed SD, McCurry SM. Effects of Pharmacologic and Nonpharmacologic Interventions on Insomnia Symptoms and Self-reported Sleep Quality in Women With Hot Flashes: A Pooled Analysis of Individual Participant Data From Four MsFLASH Trials. Sleep 2018; 41:4642822. [PMID: 29165623 PMCID: PMC6380606 DOI: 10.1093/sleep/zsx190] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Study Objectives The Menopause Strategies: Finding Lasting Answers for Symptoms and Health network conducted three randomized clinical trials (RCTs) testing six interventions treating vasomotor symptoms (VMS), and also collected self-reported sleep outcomes. A fourth RCT assessed an intervention for insomnia symptoms among women with VMS. We describe these seven interventions' effects relative to control in women with comparably severe insomnia symptoms and VMS. Methods We analyzed pooled individual-level data from 546 peri- and postmenopausal women with Insomnia Severity Index (ISI) ≥ 12, and ≥14 bothersome VMS/week across the four RCTs. Interventions included the following: escitalopram 10-20 mg/day; yoga; aerobic exercise; 1.8 g/day omega-3 fatty acids; oral 17-beta-estradiol 0.5-mg/day; venlafaxine XR 75-mg/day; and cognitive behavioral therapy for insomnia (CBT-I). Outcome measures were ISI and Pittsburgh Sleep Quality Index (PSQI) over 8-12 weeks of treatment. Results CBT-I produced the greatest reduction in ISI from baseline relative to control at -5.2 points (95% CI -7.0 to -3.4). Effects on ISI were similar for exercise at -2.1 and venlafaxine at -2.3 points. Comparably small decreases in ISI were observed with escitalopram, yoga, and estradiol. The largest reduction in PSQI from baseline was with CBT-I at -2.7 points (-3.9 to -1.5), although PSQI decreases of 1.2 to 1.6 points were significantly better than control with escitalopram, exercise, yoga, estradiol, and venlafaxine. Omega-3 supplements did not improve insomnia symptoms. Conclusions This study's findings support current recommendations for CBT-I as a first line treatment in healthy midlife women with insomnia symptoms and moderately bothersome VMS.
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Affiliation(s)
- Katherine A Guthrie
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Joseph C Larson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kristine E Ensrud
- Department of Medicine, Division of Epidemiology and Community Health, University of Minnesota, Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN
| | - Garnet L Anderson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Ellen W Freeman
- Departments of Obstetrics/Gynecology and Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Hadine Joffe
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Andrea Z LaCroix
- Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, CA
| | - JoAnn E Manson
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Charles M Morin
- Department of Psychology, Universite Laval, Quebec, QC, Canada
| | | | - Julie Otte
- Indiana University School of Nursing, Indianapolis, IN
| | - Susan D Reed
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Susan M McCurry
- Department of Psychosocial and Community Health, University of Washington, Seattle, WA
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Chen CX, Ofner S, Bakoyannis G, Kwekkeboom KL, Carpenter JS. Symptoms-Based Phenotypes Among Women With Dysmenorrhea: A Latent Class Analysis. West J Nurs Res 2017; 40:1452-1468. [PMID: 28914180 DOI: 10.1177/0193945917731778] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Dysmenorrhea is highly prevalent and may increase women's risk for developing other chronic pain conditions. Although it is highly variable, symptom-based dysmenorrhea phenotypes have not been identified. The aims of the study were to identify symptom-based dysmenorrhea phenotypes and examine their relationships with demographic and clinical characteristics. In a cross-sectional study, 762 women with dysmenorrhea rated severity of 14 dysmenorrhea-related symptoms. Using latent class analysis, we identified three distinctive phenotypes. Women in the "mild localized pain" phenotype ( n = 202, 26.51%) had mild abdominal cramps and dull abdominal pain/discomfort. Women in the "severe localized pain" phenotype ( n = 412, 54.07%) had severe abdominal cramps. Women in the "multiple severe symptoms" phenotype ( n = 148, 19.42%) had severe pain at multiple locations and multiple gastrointestinal symptoms. Race, ethnicity, age, and comorbid chronic pain conditions were significantly associated with phenotypes. Identification of these symptom-based phenotypes provides a foundation for research examining genotype-phenotype associations, etiologic mechanisms, and/or variability in treatment responses.
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Carpenter JS, Bakoyannis G, Otte JL, Chen CX, Rand KL, Woods N, Newton K, Joffe H, Manson JE, Freeman EW, Guthrie KA. Validity, cut-points, and minimally important differences for two hot flash-related daily interference scales. Menopause 2017; 24:877-885. [PMID: 28509814 PMCID: PMC6002749 DOI: 10.1097/gme.0000000000000871] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To conduct psychometric analyses to condense the Hot Flash-Related Daily Interference Scale (HFRDIS) into a shorter form termed the Hot Flash Interference (HFI) scale; evaluate cut-points for both scales; and establish minimally important differences (MIDs) for both scales. METHODS We analyzed baseline and postrandomization patient-reported data pooled across three randomized trials aimed at reducing vasomotor symptoms (VMS) in 899 midlife women. Trials were conducted across five MsFLASH clinical sites between July 2009 and October 2012. We eliminated HFRDIS items based on experts' content validity ratings and confirmatory factor analysis, and evaluated cut-points and established MIDs by mapping HFRDIS and HFI to other measures. RESULTS The three-item HFI (interference with sleep, mood, and concentration) demonstrated strong internal consistency (alphas of 0.830 and 0.856), showed good fit to the unidimensional "hot flash interference factor," and strong convergent validity with HFRDIS scores, diary VMS, and menopausal quality of life. For both scales, cut-points of mild (0-3.9), moderate (4-6.9), and severe (7-10) interference were associated with increasing diary VMS ratings, sleep, and anxiety. The average MID was 1.66 for the HFRDIS and 2.34 for the HFI. CONCLUSIONS The HFI is a brief assessment of VMS interference and will be useful in busy clinics to standardize VMS assessment or in research studies where response burden may be an issue. The scale cut-points and MIDs should prove useful in targeting those most in need of treatment, monitoring treatment response, and interpreting existing and future research findings.
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Affiliation(s)
| | - Giorgos Bakoyannis
- School of Nursing, Indiana University, Indianapolis, IN
- Department of Biostatistics, Fairbanks School of Public Health, School of Medicine, Indiana University, Indianapolis, IN
| | - Julie L. Otte
- School of Nursing, Indiana University, Indianapolis, IN
| | - Chen X. Chen
- School of Nursing, Indiana University, Indianapolis, IN
| | - Kevin L. Rand
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis
| | - Nancy Woods
- University of Washington School of Nursing, Seattle, WA
| | | | - Hadine Joffe
- Brigham and Women’s Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, and Harvard School of Public Health, Boston, MA
| | - Ellen W. Freeman
- Departments of Obstetrics/Gynecology and Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Katherine A. Guthrie
- MsFLASH Data Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA
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Abstract
Background Patterns of symptom clustering in midlife women may suggest common underlying mechanisms or may identify women at risk of adverse health outcomes or, conversely, likely to experience healthy aging. This paper assesses symptom clustering in the Study of Women’s Health Across the Nation (SWAN) longitudinally by stage of reproductive aging and estimates the probability of women experiencing specific symptom clusters. We also evaluate factors that influence the likelihood of specific symptom clusters and assess whether symptom clustering is associated with women’s self-reported health status. Methods This analysis includes 3289 participants in the multiethnic SWAN cohort who provided information on 58 symptoms reflecting a broad range of physical, psychological and menopausal symptoms at baseline and 7 follow-up visits over 16 years. We conducted latent transition analyses to assess symptom clustering and to model symptomatology across the menopausal transition (pre, early peri-, late peri- and post-menopausal). Joint multinomial logistic regression models were used to identify demographic characteristics associated with premenopausal latent class membership. A partial proportional odds regression model was used to assess the association between latent class membership and self-reported health status. Results We identified six latent classes that ranged from highly symptomatic (LC1) across most measured symptoms, to moderately symptomatic across most measured symptoms (LC2), to moderately symptomatic for a subset of symptoms (vasomotor symptoms, pain, fatigue, sleep disturbances and physical health symptoms) (LC3 and LC5) with one class (LC3) including interference in life activities because of physical health symptoms, to numerous milder symptoms, dominated by fatigue and psychological symptoms (LC4), to relatively asymptomatic (LC6). In pre-menopause, 10% of women were classified in LC1, 16% in LC2, 14% in LC3 and LC4, 26% in LC5, and 20% in LC6. Intensity of vasomotor and urogenital symptoms as well as sexual desire) differed minimally by latent class. Classification into the two most symptomatic classes was strongly associated with financial strain, White race/ethnicity, obesity and smoking status. Over time, women were most likely to remain within the same latent class as they transitioned through menopause stages (range 39–76%), although some women worsened or improved. The probability of moving between classes did not differ substantially by menopausal stage. Women in the highly symptomatic classes more frequently rated their health as fair to poor compared to women in the least symptomatic class. Conclusion Clear patterns of symptom clustering were present early in midlife, tended to be stable over time, and were strongly associated with self-perceived health. Notably, vasomotor symptoms tended to cluster with sleep disturbances and fatigue, were present in each of the moderate to highly symptomatic classes, but were not a defining characteristic of the symptom clusters. Clustering of midlife women by symptoms may suggest common underlying mechanisms amenable to interventions. Given that one-quarter of midlife women were highly or moderately symptomatic across all domains in the pre-menopause, addressing symptom burden in early midlife is likely critical to ameliorating risk in the most vulnerable populations. Electronic supplementary material The online version of this article (doi:10.1186/s40695-017-0021-y) contains supplementary material, which is available to authorized users.
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Frange C, Naufel MF, Andersen ML, Ribeiro EB, Girão MJBC, Tufik S, Hachul H. Impact of insomnia on pain in postmenopausal women. Climacteric 2017; 20:262-267. [PMID: 28391713 DOI: 10.1080/13697137.2017.1309381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sleep disturbances and pain are assumed to be reciprocally linked. Insomnia and pain are central symptoms of the postmenopausal period and are closely related. Insomnia affects quality of life, increases pain sensitivity, the risk of pain-related disability, and other health problems. OBJECTIVE To investigate whether insomnia influences aspects of pain (pain intensity and the effect of pain on daily function) in postmenopausal women, and to evaluate the objective sleep pattern of insomniacs with pain. METHODS Fifty-seven women completed questionnaires about insomnia, climacteric symptoms, and pain. Polysomnography data were collected as well as their medical history. Patients were allocated into three groups: control, subthreshold insomnia, and insomnia. Pain intensity, climacteric symptoms and objective sleep pattern were compared between groups. RESULTS Postmenopausal women with insomnia had statistically significant higher pain interference in their activities (e.g. relationships with other people, enjoyment of life and sleep) than controls, and had more severe climacteric symptoms. There were no statistically significant differences in pain intensity and objective sleep pattern between groups. CONCLUSIONS Insomnia status affected climacteric symptoms and pain interference, but not pain intensity in postmenopausal women. Women with insomnia had higher rates of climacteric symptoms than those without insomnia or those with subthreshold insomnia. No changes in objective sleep pattern were found.
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Affiliation(s)
- C Frange
- a Department of Psychobiology , Universidade Federal de São Paulo , São Paulo , Brazil
| | - M Fernanda Naufel
- b Department of Nutrition , Universidade Federal de São Paulo , São Paulo , Brazil
| | - M Levy Andersen
- a Department of Psychobiology , Universidade Federal de São Paulo , São Paulo , Brazil
| | - E Beraldi Ribeiro
- b Department of Nutrition , Universidade Federal de São Paulo , São Paulo , Brazil
| | - M J B Castelo Girão
- c Department of Gynecology , Universidade Federal de São Paulo , São Paulo , Brazil
| | - S Tufik
- a Department of Psychobiology , Universidade Federal de São Paulo , São Paulo , Brazil
| | - H Hachul
- a Department of Psychobiology , Universidade Federal de São Paulo , São Paulo , Brazil.,c Department of Gynecology , Universidade Federal de São Paulo , São Paulo , Brazil
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McCurry SM, Guthrie KA, Morin CM, Woods NF, Landis CA, Ensrud KE, Larson JC, Joffe H, Cohen LS, Hunt JR, Newton KM, Otte JL, Reed SD, Sternfeld B, Tinker LF, LaCroix AZ. Telephone-Based Cognitive Behavioral Therapy for Insomnia in Perimenopausal and Postmenopausal Women With Vasomotor Symptoms: A MsFLASH Randomized Clinical Trial. JAMA Intern Med 2016; 176:913-20. [PMID: 27213646 PMCID: PMC4935624 DOI: 10.1001/jamainternmed.2016.1795] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Effective, practical, nonpharmacologic therapies are needed to treat menopause-related insomnia symptoms in primary and women's specialty care settings. OBJECTIVE To evaluate the efficacy of telephone-based cognitive behavioral therapy for insomnia (CBT-I) vs menopause education control (MEC). DESIGN, SETTING, AND PARTICIPANTS A single-site, randomized clinical trial was conducted from September 1, 2013, to August 31, 2015, in western Washington State among 106 perimenopausal or postmenopausal women aged 40 to 65 years with moderate insomnia symptoms (Insomnia Severity Index [ISI] score, ≥12) and 2 or more daily hot flashes. Blinded assessments were conducted at baseline, 8, and 24 weeks postrandomization. An intent-to-treat analysis was conducted. INTERVENTIONS Six CBT-I or MEC telephone sessions in 8 weeks. Participants submitted weekly electronic sleep diaries and received group-specific written educational materials. The CBT-I sessions included sleep restriction, stimulus control, sleep hygiene education, cognitive restructuring, and behavioral homework; MEC sessions provided information about menopause and women's health. MAIN OUTCOMES AND MEASURES Primary outcome was scores on the ISI (score range, 0-28; scores ≥15 indicate moderate to severe insomnia). Secondary outcome was scores on the Pittsburgh Sleep Quality Index (score range, 0-21; higher scores indicate worse sleep quality). Additional outcomes included sleep and hot flash diary variables and hot flash interference. RESULTS At 8 weeks, ISI scores had decreased 9.9 points among 53 women receiving CBT-I (mean [SD] age, 55.0 [3.5] years) and 4.7 points among 53 women receiving MEC (age, 54.7 [4.7] years), a mean between-group difference of 5.2 points (95% CI, -6.1 to -3.3; P < .001). Pittsburgh Sleep Quality Index scores decreased 4.0 points in women receiving CBT-I and 1.4 points in women receiving MEC, a mean between-group difference of 2.7 points (95% CI, -3.9 to -1.5; P < .001). Significant group differences were sustained at 24 weeks. At 8 and 24 weeks, 33 of 47 women (70%) and 37 of 44 (84%) in the CBT-I group, respectively, had ISI scores in the no-insomnia range compared with 10 of 41 (24%) and 16 of 37 (43%) in the MEC group, respectively. The CBT-I group also had greater improvements in diary-reported sleep latency, wake time, and sleep efficiency. There were no between-group differences in frequency of daily hot flashes, but hot flash interference was significantly decreased at 8 weeks for the CBT-I group (-15.7; 95% CI, -20.4 to -11.0) compared with the MEC group (-7.1; 95% CI, -14.6 to 0.4) (P = .03), differences that were maintained at 24 weeks for the CBT-I group (-22.8; 95% CI, -28.6 to -16.9) and MEC group (-11.6; 95% CI, -19.4 to -3.8) (P = .003). CONCLUSIONS AND RELEVANCE Telephone-based CBT-I improved sleep in perimenopausal and postmenopausal women with insomnia and hot flashes. Results support further development and testing of centralized CBT-I programs for treating menopausal insomnia. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01936441.
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Affiliation(s)
- Susan M McCurry
- Department of Psychosocial and Community Health, University of Washington, Seattle
| | - Katherine A Guthrie
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Charles M Morin
- Department of Psychology, Université Laval, Quebec City, Quebec, Canada
| | - Nancy F Woods
- Biobehavioral Nursing and Health Systems, University of Washington, Seattle
| | - Carol A Landis
- Biobehavioral Nursing and Health Systems, University of Washington, Seattle
| | - Kristine E Ensrud
- Division of Epidemiology and Community Health, Department of Medicine, University of Minnesota, Minneapolis6Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Joseph C Larson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Hadine Joffe
- Division of Women's Mental Health, Department of Psychiatry, Brigham & Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Lee S Cohen
- Department of Psychiatry, Center for Women's Mental Health, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Julie R Hunt
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Katherine M Newton
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Julie L Otte
- Department of Science of Nursing Care, Indiana University, Indianapolis
| | - Susan D Reed
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Barbara Sternfeld
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Andrea Z LaCroix
- Department of Family Medicine and Public Health, University of California-San Diego, La Jolla
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