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Paramanandam VS, Lensen S, Gabes M, Kann G, Donhauser T, Waters NF, Li AD, Peate M, Susanto NS, Caughey LE, Rangoonwal F, Liu J, Condron P, Obalowu IA, Archer DF, Bell RJ, Christmas M, Davies M, Davis SR, Giblin K, Iliodromiti S, Jaisamrarn U, Khandelwal S, Kiesel L, Aggarwal N, Mitchell CM, Mishra GD, Nappi RE, Panay N, Roberts H, Rozenberg S, Shifren J, Simon JA, Stute P, Vincent AJ, Wolfman W, Hickey M. Recommended measurement instruments for genitourinary symptoms associated with menopause: the COMMA (Core outcomes in menopause) consortium. Menopause 2024; 31:591-599. [PMID: 38743907 DOI: 10.1097/gme.0000000000002369] [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: 05/16/2024]
Abstract
OBJECTIVE The aim of the study is to identify appropriate definitions and patient-reported outcome measures (PROMs) for each of the eight core outcomes previously selected for genitourinary symptoms associated with menopause: pain with sex, vulvovaginal dryness, vulvovaginal discomfort or irritation, discomfort or pain when urinating, change in most bothersome symptom, distress, bother or interference of genitourinary symptoms, satisfaction with treatment, and side effects. METHODS We conducted a systematic review to identify possible definitions and PROMs, including their measurement properties. Identified definitions and relevant PROMs with acceptable measurement properties were entered into an international consensus process involving 28 participants from 10 countries to achieve final recommendations for each core outcome. RESULTS A total of 87 publications reporting on 34 PROMs were identified from 21,207 publications screened. Of these 34 PROMs, 29 were not considered to sufficiently map onto the core outcomes, and 26 of these also had insufficient measurement properties. Therefore, only five PROMs corresponding to two core outcomes were considered for recommendation. We recommend the PROMIS Scale v2.0 - Sexual Function and Satisfaction: Vaginal Discomfort with Sexual Activity to measure the outcome of "pain with sexual activity" and the Day-to-Day Impact of Vaginal Aging (DIVA) Questionnaire to measure "distress, bother or interference" from genitourinary symptoms. Six definitions of "side effects" were identified and considered. We recommend that all trials report adverse events in study participants, which is a requirement of Good Clinical Practice. CONCLUSIONS Suitable PROMs and definitions were identified to measure three of eight core outcomes. Because of the lack of existing measures, which align with the core outcomes and have evidence of high-quality measurement properties, future work will focus on developing or validating PROMs for the remaining five core outcomes.
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Affiliation(s)
| | - Sarah Lensen
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Michaela Gabes
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | - Theresa Donhauser
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Niamh F Waters
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Anna D Li
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Nipuni S Susanto
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Lucy E Caughey
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Fatema Rangoonwal
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Jingbo Liu
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Patrick Condron
- University Library, The University of Melbourne, Parkville, Australia
| | | | - David F Archer
- Obstetrics and Gynaecology, Eastern Virginia Medical School, Norfolk, VA
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Monica Christmas
- Department of Obstetrics and Gynaecology, University of Chicago, Chicago, IL
| | - Melanie Davies
- Institute for Women's Health, University College London, UK
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karen Giblin
- Red Hot Mamas North America, Inc., Bridgewater, New Jersey, United States
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health, QMUL, London, UK
| | - Unnop Jaisamrarn
- Menopause Research Group, Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sunila Khandelwal
- Department of Obstetrics and Gynaecology, Fortis Escort Hospital, Jaipur, India
| | - Ludwig Kiesel
- Department of Gynaecology and Obstetrics, University of Muenster, Muenster, Germany
| | - Neelam Aggarwal
- Department of Gynaecology and Obstetrics, PostGraduate Institute of Medical Education & Research, Chandigarh, India
| | - Caroline M Mitchell
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA
| | - Gita D Mishra
- Australian Women and Girls' Health Research Centre, School of Public Health, University of Queensland, St Lucia, Australia
| | - Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Nick Panay
- Queen Charlotte's & Chelsea and Chelsea and Westminster Hospitals, Imperial College London, London, UK
| | - Helen Roberts
- Auckland District Health Board, Auckland, New Zealand
| | - Serge Rozenberg
- Department of Ob-Gyn CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Jan Shifren
- Midlife Women's Health Center, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - James A Simon
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Clinic Inselspital, Bern, Switzerland
| | - Amanda J Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Wendy Wolfman
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
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Briggs P, Burton R, Mosely C, Sharp I, Mercy F, Delanerolle G, Hapangama DK. Methods of assessment of urogenital atrophy and the implication of these in estimated prevalence rates: A review of the literature. Post Reprod Health 2023; 29:135-142. [PMID: 37707431 DOI: 10.1177/20533691231199803] [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] [Indexed: 09/15/2023]
Abstract
BACKGROUND Urogenital atrophy is caused by lack of estrogen, most commonly due to the menopause. Symptoms frequently experienced include vaginal dryness, itching, burning, sexual difficulties and urinary problems, all of which can have a significant adverse effect on quality of life. Effective treatments are available for women with a confirmed diagnosis. The aim of this review is to determine whether a consistent diagnostic intervention exists, to support an accurate indication of prevalence. MATERIALS AND METHODS This study is a review of the literature. RESULTS A total of 1469 papers were identified on an initial search, including randomised controlled trials, cross sectional and cohort studies. By adoption of a systematic process, the number of papers in the final review was eight.There is inconsistent use of available assessment methods to diagnose urogenital atrophy in symptomatic women. There are no validated clinical assessment tools. CONCLUSION Absence of a defined intervention with which to confirm a diagnosis of urogenital atrophy, based on symptoms, influences research outcomes, but more importantly affects access to an accurate diagnosis and treatment, for affected women. This would ideally take place in a primary care setting.
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Affiliation(s)
- Paula Briggs
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Rachel Burton
- Liverpool University Foundation Trust, Liverpool, UK
| | - Chiara Mosely
- Simulation Lead Mid Cheshire NHS Foundation Trust, Crewe, UK
- Manchester Metropolitan University, Manchester, UK
| | | | | | - Gayathri Delanerolle
- Southern Health NHS Foundation Trust, Southampton, UK
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - Dharani K Hapangama
- Department of Women's and Children's Health, Centre for Women's Health Research, University of Liverpool, Liverpool, UK
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Kearley-Shiers K, Holloway D, Bruce D. Intravaginal dehydroepiandrosterone for genitourinary symptoms of the menopause: Is the evidence sufficient? Post Reprod Health 2022; 28:237-243. [PMID: 36300276 DOI: 10.1177/20533691221135906] [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] [Indexed: 06/16/2023]
Abstract
Intravaginal dehydroepiandrosterone (DHEA) is a locally metabolised estrogen and androgen precursor, licensed in 2018 in the EU for moderate to severe vulvovaginal atrophy in postmenopausal women. A literature search revealed four original trials suitable for appraisal, three evaluating change in dyspareunia or dryness as a primary outcome, one evaluated safety as a primary outcome. In two trials of 255 and 558 women without cancer, the benefit of placebo (nightly vaginal suppositories with a lipophilic base) was a 0.9 and 1 point reduction in dyspareunia as measured on a 3 point scale, an unvalidated outcome measure. With nightly DHEA, dyspareunia was reduced by an additional 0.4 points compared to placebo. When 464 women with gynaecological cancer were randomised, those using nightly plain moisturiser gel reported a reduction of 'most bothersome symptom' (either dyspareunia or dryness) of 1.5 points on a 3 point scale. Those using nightly DHEA reported an additional symptom reduction of 0.3 points. This is also an unvalidated outcome measure. Data evaluating the efficacy of DHEA over placebo is unconvincing and based on unvalidated primary outcome measures that also do not reflect the complex psycho-sexual and socio-cultural components of genitourinary menopausal symptoms. The efficacy and safety data excluded women taking systemic HRT, applies to postmenopausal, not perimenopausal, women and had relatively short follow up. It is important further independent trials use sophisticated and validated assessment tools to better establish the efficacy, safety and cost effectiveness of intravaginal DHEA in clinically representative groups of women before being routinely prescribed.
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Affiliation(s)
| | | | - Deborah Bruce
- Guys and St Thomas' NHS Trust, London, UK
- GKT School of Medical Education Faculty of Life Sciences and Medicine, King's College, 4616London, UK
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Le Berre M, Filiatrault J, Reichetzer B, Dumoulin C. Feasibility, acceptability and effects of a group pelvic floor muscle telerehabilitation program to treat urinary incontinence in older women. Digit Health 2022; 8:20552076221123720. [PMID: 36325439 PMCID: PMC9618754 DOI: 10.1177/20552076221123720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/16/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Urinary incontinence (UI) is one of the most prevalent health concerns in women age 65 and over. The recommended first-line treatment for UI is individual pelvic floor muscle training (PFMT). However, healthcare systems worldwide are unable to meet the demand for this resource-intensive approach. Recently, the Group Rehabilitation Or IndividUal Physiotherapy (GROUP) trial showed that group-based PFMT was not inferior to individual PFMT to treat UI in older women, despite using fewer resources. This study aims to assess the feasibility, acceptability and effects on UI-related symptoms and associated quality of life (QoL) of an online adaptation of the GROUP program (teleGROUP) for UI in older women. METHODS AND ANALYSIS This pilot study will involve the recruitment of 32 older women with UI. Participants' attendance to online sessions, adherence to weekly home exercises, and side effects, in addition to the physiotherapist's fidelity to the program delivery will be collected to evaluate the program's feasibility. Participants' dropout rates, reasons for dropout, satisfaction and usability scores will be collected to evaluate the program's acceptability for participants. A survey will evaluate the program's acceptability for the physiotherapists. Additionally, at the end of the study, qualitative semi-structured interviews and focus groups will investigate further feasibility and acceptability. To measure the effects of teleGROUP, number of weekly leakages and percentage reduction will be the primary outcomes.
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Affiliation(s)
- Mélanie Le Berre
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada,Centre de recherche de l’Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, QC, Canada
| | - Johanne Filiatrault
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada,Centre de recherche de l’Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, QC, Canada
| | - Barbara Reichetzer
- Department of Obstetrics and Gynecology, Centre Hospitalier de l’Université de Montréal, Montreal (CHUM), Montreal, QC, Canada,Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada,Institut universitaire de gériatrie de Montréal (IUGM), Montreal, QC, Canada
| | - Chantale Dumoulin
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada,Centre de recherche de l’Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, QC, Canada,Chantale Dumoulin, Centre de recherche de l’Institut universitaire de gériatrie de Montréal, 4545 Queen-Mary road, office M5816, Montreal, QC, Canada H3W 1W4.
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