Influencing factors on women's attitudes toward menopause: a systematic review

Menopausal Hormone Therapy, an Ever-Present Topic: A Pilot Survey about Women's Experience and Medical Doctors' Approach

Background and Objective: Menopause can be associated with many clinical manifestations: vasomotor symptoms, urogenital problems, and additional psychological disturbances, such as anxiety, mood changes, and sleep alterations. The prolonged lack of hormones also increases the risk of long-term consequences. Hormone Replacement Treatment (HRT) in menopause consists of the administration of estrogen, alone or associated to progesterone, to relieve these uncomfortable disturbances and to prevent the onset of other pathologic conditions. The aim of this study is to examine the prevalence of HRT use in a sample of menopausal women and their experience with menopause and HRT. This study also investigates the knowledge of general practitioners (GPs) and gynecologists about HRT and its prescription. Materials and Methods: We conducted a cross-sectional population survey on 126 women of 50-59 years in an industrial city in the North of Italy, Vercelli (Novara), in Eastern Piedmont. We also presented a questionnaire on the topic to 54 medical doctors (GPs and gynecologists) of the same area. Results: The prevalence of HRT use in our sample was 11.9%. In total, a good percentage of the users affirmed to be satisfied with HRT. Additionally, a minority of women reported being ideally against the use of replacement hormones, were advised against using HRT by doctors, and did not use it because of the fear of side effects. We found a positive association between patient education, health care attitude, and HRT usage. A significant number of women knew about HRT from the media, and most of them were not informed by a health professional. Despite this, the interviewed doctors considered their knowledge about HRT as 'good' and would recommend HRT: only 5.6% would not prescribe it. Conclusions: Our results highlight the need for information about HRT among patients and health professionals, along with the need for more effective communication, evaluation, and suggestion of treatment.

Needs assessment study for management of menopause in the community

Menopause is an inevitable phase in every woman's life. Women may suffer from unpleasant symptoms during perimenopause. Understanding the health needs of the community during this period will help in developing menopause management programs that can improve quality of life.

Aim

To study the symptoms of menopause and perception of women in relation to menopause in order to understand their needs.

Settings and Design

A cross-sectional, multi-centric study was undertaken at three institutions (called DH, SJ, and SK) at two cities in India. The study population comprised women between the ages of 40 and 60. Institutional Ethics Committee approval and consent of participants were ensured.

Material and Methods

Two instruments, a pilot-tested, peer-reviewed, validated, structured questionnaire and the Menopause Rating Scale (MRS) were utilized for the study. The minimum sample size was calculated to be 385 per site. Statistical analysis was conducted using the IBM Statistical Package for Social Sciences.

Results

A total of 1297 forms were analyzed. MRS scores showed psychological symptoms to be most prevalent. Joint and muscular pains were the most common somatic symptoms. Hot flashes and urogenital symptoms were experienced by a lower number. Our MRS scores were significantly higher than those seen in other regions. Urban women, site SJ, those with irregular menstrual cycles, and lower incomes scored higher than their counterparts. Awareness about menopause was patchy, especially regarding medication or support services available.

Conclusions

The high MRS scores emphasize the need to institute awareness programs, providing information on choices available for care (hormone replacement therapy, medications, or counseling) and information on where to access services. Primary care physicians can play a vital role in fulfilling this need by ensuring timely knowledge to the community, providing correct diagnosis and treatment. This will help improve the quality of life and sense of well-being of this community.

Translation, cross-cultural adaptation, and validation of the Persian version of the Attitude Towards Menopause scale

OBJECTIVES

This study describes translation, cross-cultural adaptation, and validation of the Attitude Towards Menopause (ATM) scale in Persian.

METHODS

A standard process was followed for translation and cross-cultural adaptation of the ATM scale into Persian. The content validity index and content validity ratio were used to measure content validity. The construct validity was tested using exploratory factor analysis and confirmatory factor analysis. The average variance extracted and construct reliability were used to indicate convergent and discriminant validity, respectively. Internal consistency and test-retest reliability of the Persian ATM scale were assessed using Cronbach α and intraclass correlation coefficient (ICC).

RESULTS

A revised version of the ATM scale, including 26 items assigned to seven factors, was obtained in exploratory factor analysis. The factors were interpreted as negative affect, postmenopausal recovery, control of symptoms, sexuality, psychological losses, unpleasant confrontation, and menstrual freedom, explaining 66.18% of the total variance. The factor structure of the scale was confirmed using confirmatory factor analysis (Comparative Fit Index = 0.90, Tucker-Lewis Index = 0.88, Goodness-of-Fit Index = 0.90, Adjusted Goodness-of-Fit Index = 0.86, Root Mean Square Error of Approximation = 0.07, χ2 / df = 4.56). The values of Cronbach α coefficient and ICC indicated an acceptable level of reliability ( α = 0.70, ICC = 0.89). The construct reliability for all factors was more than or equal to 0.7 except for psychological losses, indicating good discriminating validity. The values of average variances extracted for subscales varied from 0.48 to 0.99, representing adequate convergent validity.

CONCLUSIONS

The Persian version of the ATM scale is a reliable and valid tool to evaluate the attitudes of Iranian women toward menopause.

Women's understanding and experiences of menopause in low-income and middle-income countries in the Asia Pacific region: a scoping review protocol

INTRODUCTION

Menopause denotes the end of a woman's reproductive life. A woman's experiences of menopause are shaped by her individual circumstances and may vary between social and cultural contexts. Evidence is needed to inform research and programme delivery that supports women's health and well-being throughout the menopausal transition. This scoping review will map evidence of women's experiences of menopause in Asia Pacific countries, where limited research exists.

METHODS AND ANALYSIS

We will follow the five-stage framework of Arksey and O'Malley, further developed by Levac et al and the Joanna Briggs Institute. MEDLINE, CINAHL, PsycINFO and Scopus databases will be systematically searched between February 2022 and May 2022 using subject headings and keywords. The title-abstract and full text of retrieved studies will be assessed against eligibility criteria. The review will focus on studies with a qualitative research component. Citation searching of selected articles will supplement database searching. Data will be extracted, charted, synthesised and summarised. Findings will be presented in narrative format and implications for research and practice reported.

ETHICS AND DISSEMINATION

Ethical approval is not required for this scoping review of selected studies from peer-reviewed journals. Ethical approval has been granted from relevant ethics committees for community consultation. Findings will be shared in peer-reviewed publications, presented at conferences and disseminated with communities, health workers and researchers.

Why are women considering ovarian tissue cryopreservation to preserve reproductive and hormonal ovarian function? A qualitative study protocol

INTRODUCTION

Current fertility preservation options available to women are oocyte cryopreservation (egg freezing) or embryo cryopreservation. A newer procedure, ovarian tissue cryopreservation (OTC), has become available in some centres, which offers another option for women and girls considering fertility preservation. These procedures are commonly offered to women about to undergo treatments for cancer. OTC involves removing sections of ovarian tissue and cryopreserving it for future reimplantation, often several years later. OTC offers girls and women who may become infertile with optionality and the possibility of pregnancy. OTC has potential for other applications, including restoring ovarian endocrine function beyond biological menopause. This is not without controversy but has led to some women considering undergoing the procedure for purposes of ovarian hormonal preservation (conservation of ovarian endocrine function). OTC is invasive, involves two surgical procedures with concomitant risks and can be costly. Understanding why women may consider and ultimately undergo OTC is timely, so that evidence-based and women-centred care can be provided.

METHODS

A pragmatic narrative qualitative design will be used. A purposive sample of women aged 18-45 who are considering, or have sought, OTC will be recruited over 1-year period. Potential participants will be approached via a clinic that offers OTC on a private basis or via social media.

ANALYSIS

Participant interviews will be audio and, if consented, video recorded. These will be conducted face-to-face or virtually. The recordings will be transcribed verbatim and analysed using a thematic analysis approach supported by NVivo software.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the Institutional Ethical Review ERN_19-1578A. We expect to disseminate the findings of this study through journal articles, conference presentations and multimedia to public.