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Porterfield L, Davis JW, Weller SC, Chen L, Wilkinson G. Does hormone therapy exacerbate other venous thromboembolism risk factors? Menopause 2024; 31:123-129. [PMID: 38270903 DOI: 10.1097/gme.0000000000002305] [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: 01/26/2024]
Abstract
OBJECTIVE Postmenopausal symptoms in women at higher risk for venous thromboembolism (VTE) due to comorbidities are often undertreated because of concerns that hormone therapy (HT) may increase VTE risk; however, it is unclear how much HT impacts risk of VTE when compared with other risk factors. METHODS This is a case-control study in a commercial claims database from 2007 to 2019. Women aged 50 to 64 years (n = 223,949) were classified as cases if they had an International Classification of Diseases code indicating an acute VTE plus a filled prescription for an anticoagulant, placement of intravascular vena cava filter, or death within 30 days of diagnosis. Controls were matched 10:1 to each case by index date and age. Risk factors and comorbidities present within the year before index were examined. Exposure was defined as a HT prescription within 60 days before index. RESULTS There were 20,359 VTE cases and 203,590 matched controls. A conditional logistic regression indicated that the greatest risks for VTE were from metastatic cancer (odds ratio [OR], 13.66; 95% CI, 12.64-14.75), hospitalization/surgery (OR, 8.51; 95% CI, 8.09-8.96), trauma (OR, 3.52; 95% CI, 3.32-3.73), comorbidity burden (OR, 3.51; 95% CI, 3.34-3.69), history of hypercoagulable condition (OR, 3.10; 95% CI, 2.87-3.36), and varicose veins (OR, 2.87; 95% CI, 2.56-3.22). Regarding hormone exposure, we observed ORs of 1.51 (95% CI, 1.43-1.60) for any recent hormone exposure; 1.13 (95% CI, 1.04-1.23; number needed to harm, 4,274) for unopposed estrogen menopausal HT; 1.23 (95% CI, 1.10-1.38; number needed to harm, 2,440) for combined menopausal HT; and 5.22 (95% CI, 4.67-5.84) for combined hormonal contraceptives compared with no recent HT exposure. CONCLUSIONS Hormone therapy exposure did not appear to adversely influence other risk factors, and exposure generally played a minor role in VTE risk. Contraceptives, however, were a strong risk factor.
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Affiliation(s)
| | - John W Davis
- Department of Population Health Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX
| | - Susan C Weller
- Department of Population Health Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX
| | - Lu Chen
- Department of Population Health Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX
| | - Gregg Wilkinson
- Department of Population Health Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX
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Physical activity and social support are associated with quality of life in middle-aged women. PLoS One 2022; 17:e0268135. [PMID: 35522681 PMCID: PMC9075639 DOI: 10.1371/journal.pone.0268135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 04/22/2022] [Indexed: 12/01/2022] Open
Abstract
Purposes This cross-sectional study assessed the quality of life and related factors of Vietnamese women during perimenopause in terms of vasomotor, psychosocial, physical, and sexual aspects. Materials and methods A cross-sectional study on 400 middle-aged women was conducted in Hung Yen, a delta province in Vietnam. Data about socioeconomic characteristics, daily activity patterns, quality of life in terms of vasomotor, psychosocial, physical, and sexual aspects, and level of social support were collected. Tobit multivariate regression model was used to identify factors related to the quality of life among participants. Results The symptoms of perimenopause appeared to worsen with the increase of age and the existence of such health issues as migraine and diabetes. Meanwhile, exercises, recreational activities, and social support appeared to alleviate the negative impact of perimenopausal symptoms on women. Conclusions It is important to address the care needs of women during perimenopausal age, especially their sexual well-being, and development of specific healthcare services and programs focusing on sport, entertainment, and support for women in perimenopause should be facilitated.
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Cui X, Yu X, Sun G, Hu T, Likhodii S, Zhang J, Randell E, Gao X, Fan Z, Zhang W. Differential metabolomics networks analysis of menopausal status. PLoS One 2019; 14:e0222353. [PMID: 31532787 PMCID: PMC6750885 DOI: 10.1371/journal.pone.0222353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/27/2019] [Indexed: 12/22/2022] Open
Abstract
Menopause is an endocrine-related transition that induces a number of physiological and potentially pathological changes in middle-aged and elderly women. The intention of this research was to investigate the influence of menopause on the intricate relationships between major biochemical metabolites. The study involved metabolic profiling of 186 metabolic markers measured in blood plasma collected from 120 healthy female participants. We developed a method of network analysis using differential correlation that enabled us to detect and characterize differences in metabolites and changes in inter-relationships in pre- and post-menopausal women. A topological analysis was performed on the differential network that uncovered metabolite differences in pre-and post-menopausal women. In this analysis, our method identified two key metabolites, sphingomyelins and phosphatidylcholines, which may be useful in directing further studies into menopause-specific differences in the metabolome, and how these differences may underlie the body's response to stress and disease following the transition from pre- to post-menopausal status for women.
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Affiliation(s)
- Xiujuan Cui
- School of Pharmaceutical Sciences, Jilin University, Changchun, P.R. China
- Department of Pharmacy, Daqing Oil-Field General Hospital, Daqing, China
| | - Xiaoyan Yu
- School of Pharmaceutical Sciences, Jilin University, Changchun, P.R. China
| | - Guang Sun
- Discipline of Medicine, Faculty of Medicine, Memorial University, St. John’s, NL, Canada
| | - Ting Hu
- Department of Computer Science, Memorial University, St John’s, NL, Canada
| | - Sergei Likhodii
- BC Provincial Toxicology Centre, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Jingmin Zhang
- School of Pharmaceutical Sciences, Jilin University, Changchun, P.R. China
| | - Edward Randell
- Department of Laboratory Medicine, Faculty of Medicine, Memorial University, St. John’s, NL, Canada
| | - Xiang Gao
- College of Life Sciences, Qingdao University, Qingdao, China
| | - Zhaozhi Fan
- Department of Mathematics and Statistics, Memorial University, St. John’s, NL, Canada
| | - Weidong Zhang
- School of Pharmaceutical Sciences, Jilin University, Changchun, P.R. China
- Discipline of Genetics, Faculty of Medicine, Memorial University, St. John’s, NL, Canada
- * E-mail:
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Lee J, Han Y, Cho HH, Kim MR. Sleep Disorders and Menopause. J Menopausal Med 2019; 25:83-87. [PMID: 31497577 PMCID: PMC6718648 DOI: 10.6118/jmm.19192] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/22/2019] [Accepted: 04/17/2019] [Indexed: 01/18/2023] Open
Abstract
Sleep disorders are one of the main symptoms of menopause. Symptoms of sleep disorders that menopausal women complain about include falling asleep, frequent awakening and/or early morning awakening. There are many possible causes of sleep disorders in postmenopausal women, including vasomotor symptoms, ovarian hormone changes, restless legs syndrome, periodic leg movement syndrome, and obstructive sleep apnea. In this review, we discuss the relationship between menopause and sleep disorders.
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Affiliation(s)
- Jinju Lee
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youngsin Han
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Hee Cho
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mee-Ran Kim
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Jehan S, Jean-Louis G, Zizi F, Auguste E, Pandi-Perumal SR, Gupta R, Attarian H, McFarlane SI, Hardeland R, Brzezinski A. Sleep, melatonin, and the menopausal transition: What are the links? Sleep Sci 2017. [DOI: 10.1016/j.slsci.2017.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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6
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Jehan S, Jean-Louis G, Zizi F, Auguste E, Pandi-Perumal SR, Gupta R, Attarian H, McFarlane SI, Hardeland R, Brzezinski A. Sleep, Melatonin, and the Menopausal Transition: What Are the Links? Sleep Sci 2017; 10:11-18. [PMID: 28966733 PMCID: PMC5611767 DOI: 10.5935/1984-0063.20170003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/28/2016] [Indexed: 12/29/2022] Open
Abstract
The pineal hormone Melatonin plays an important role in the regulation of the circadian sleep/wake cycle, mood, and perhaps immune functions, carcinogensis and reproduction. The human circadian rhythm of melatonin release from the pineal gland is tightly synchronized with the habitual hours of sleep. Peri- and postmenopausal women often complain of difficulties initiating and/or maintaining sleep, with frequent nocturnal and early morning awakenings. In this review we discuss the pathophysiology of melatonin function as it relates to sleep disorders in menopausal women, highlighting the potential use of exogenous melatonin during the menopausal transition and beyond.
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Affiliation(s)
- Shazia Jehan
- Center for Healthful Behavior Change, New York University School of
Medicine, New York, USA
| | - Giardin Jean-Louis
- Center for Healthful Behavior Change, New York University School of
Medicine, New York, USA
| | - Ferdinand Zizi
- Center for Healthful Behavior Change, New York University School of
Medicine, New York, USA
| | - Evan Auguste
- Center for Healthful Behavior Change, New York University School of
Medicine, New York, USA
| | | | - Ravi Gupta
- Department of Psychiatry & Sleep Clinic, Himalayan Institute of
Medical Sciences, Swami Ram Nagar, Jolly Grant, Dehradun-248016, INDIA
| | - Hrayr Attarian
- Circadian Rhythms and Sleep Research Lab, Department of Neurology,
Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Samy I. McFarlane
- Division of Endocrinology, Department of Medicine, SUNY Downstate
Medical Center, 11203 Brooklyn, NY, USA
| | - Rüdiger Hardeland
- Johann Friedrich Blumenbach Institute of Zoology and Anthropology,
University of Göttingen, D-37073 Göttingen, Germany
| | - Amnon Brzezinski
- Department of Obstetrics & Gynecology, the Hebrew
University-Hadassah Medical Center, Jerusalem, Israel
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7
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Barati M, Ahmadpanah M, Shirahmadi S, Bashirian S, Parsa P, Holsboer-Trachsler E, Brand S, Haghighi M. Differential Impact of Sociodemographic Variables on the Quality of Life of Menopausal Iranian Women. ACTA ACUST UNITED AC 2016. [DOI: 10.17795/ajnpp-39026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Plasma Metabolic Profiles in Women are Menopause Dependent. PLoS One 2015; 10:e0141743. [PMID: 26580805 PMCID: PMC4651324 DOI: 10.1371/journal.pone.0141743] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/11/2015] [Indexed: 12/31/2022] Open
Abstract
Menopause is an endocrinological transition that greatly affects health and disease susceptibility in middle-aged and elderly women. To gain new insights into the metabolic process of menopause, plasma metabolic profiles in 115 pre- and post-menopausal women were systematically analyzed by ultra-performance liquid chromatography/mass spectrometry in conjunction with univariate and multivariate statistical analysis. Metabolic signatures revealed considerable differences between pre- and post-menopausal women, and clear separations were observed between the groups in partial least-squares discriminant analysis score plots. In total, 28 metabolites were identified as potential metabolite markers for menopause, including up-regulated acylcarnitines, fatty acids, lysophosphatidylcholines, lysophosphatidylethanolamines, and down-regulated pregnanediol-3-glucuronide, dehydroepiandrosterone sulfate, p-hydroxyphenylacetic acid and dihydrolipoic acid. These differences highlight that significant alterations occur in fatty acid β-oxidation, phospholipid metabolism, hormone metabolism and amino acid metabolism in post-menopausal women. In conclusion, our plasma metabolomics study provides novel understanding of the metabolic profiles related to menopause, and will be useful for investigating menopause-related diseases and assessing metabolomic confounding factors.
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Abedi P, Nikkhah P, Najar S. Effect of pedometer-based walking on depression, anxiety and insomnia among postmenopausal women. Climacteric 2015; 18:841-5. [DOI: 10.3109/13697137.2015.1065246] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Increased hot flash severity and related interference in perimenopausal human immunodeficiency virus-infected women. Menopause 2014; 21:403-9. [PMID: 23820600 DOI: 10.1097/gme.0b013e31829d4c4c] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE As women with human immunodeficiency virus (HIV) are living longer, more are entering perimenopause. Prior studies suggest that HIV-infected women are more likely to have hot flashes than non-HIV-infected women. However, little is known regarding hot flash severity and hot flash-related interference with daily function, mood, and quality of life in this population. METHODS Perimenopausal HIV-infected and non-HIV-infected women matched by age, race, and menstrual patterns completed the Menopause Rating Scale (to assess hot flash severity) and the Hot Flash Related Daily Interference Scale (HFRDIS). Menopause Rating Scale and HFRDIS scores and subscores were compared between the groups. RESULTS Thirty-three HIV-infected women and 33 non-HIV-infected women who were similar in age (median [interquartile range], 47 [45-48] vs 47 [46-49] y), race (64% vs 52% nonwhite, P = 0.32), and menstrual patterns (number of periods in the past year; 5 [4-9] vs 6 [4-10], P = 0.53) were studied. Perimenopausal HIV-infected women reported greater hot flash severity (HIV vs non-HIV: 2 [1-3] vs 1 [0-3], P = 0.03) and hot flash-related interference (HFRDIS total score, 37 [10-60] vs 6 [0-20], P = 0.001). CONCLUSIONS Perimenopausal HIV-infected women experience greater hot flash severity and related interference compared with non-HIV-infected perimenopausal women. Increased distress secondary to hot flashes may reduce quality of life and negatively impact important health-promoting behaviors, including adherence to antiretroviral therapy, in HIV-infected women.
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Jahangard L, Haghighi M, Bajoghli H, Holsboer-Trachsler E, Brand S. Among a sample of Iranian premenopausal and menopausal women differences in mood, sleep and health quality are small. Int J Psychiatry Clin Pract 2014; 18:139-44. [PMID: 24370121 DOI: 10.3109/13651501.2013.878366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Anecdotal evidence suggests that mood, sleep, and health quality change in women from premenopausal to menopausal period; however, data supporting these assumptions from non-Western countries are scarce. The aim of the present study was therefore to assess premenopausal and menopausal Iranian women with regard to mood, sleep, and general health. METHODS One hundred and twenty Iranian women took part in the study. Sixty were in a premenopausal state (mean age (M): = 46.9 years) and 60 in a menopausal state (M = 53.8 years). They completed a series of self-rating questionnaires related to sleep, mood, and health quality. RESULTS Compared to premenopausal women, menopausal women reported more difficulties such as falling asleep, and less general physical activities and vitality. No statistically significant differences were found for sleep quality, sleep schedules, difficulties in social life, general mood state, or general physical and mental health. Menopausal women reported to be more irritable, and to have more energy. CONCLUSIONS Data suggest that among a sample of Iranian premenopausal and menopausal women, differences in mood, sleep, and general health are small. Data, therefore, do not support "beliefs" and hearsay that mood, sleep, and general health do decrease from premenopausal to menopausal state.
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Affiliation(s)
- Leila Jahangard
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences , Hamadan , Iran
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12
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Health behaviors of postmenopausal women. MENOPAUSE REVIEW 2014; 13:22-6. [PMID: 26327824 PMCID: PMC4520334 DOI: 10.5114/pm.2014.41083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/25/2013] [Accepted: 12/15/2013] [Indexed: 11/17/2022]
Abstract
Introduction Health status and health-related quality of life of postmenopausal women are issues, which nowadays pose a serious challenge to many domains of science. Climacteric symptoms which occur at this stage of life, lower its quality and make a negative contribution to self-reported health status, are mostly observed in a particular group of women. Evaluation of health behaviors performed using a standardized questionnaire, the Health Behavior Inventory (HBI), may help establish a comprehensive diagnosis of women's health, and thus select effective interventions. A systemic approach to menopause assumes that full fitness of women and good quality of their lives can be maintained not only by means of pharmacotherapy but also other forms of action, especially health education oriented towards changes in the lifestyle and promotion of healthy behaviors. The aim of this study Aim of the study is to perform a HBI-based assessment of women's health behaviors in such categories as healthy eating habits (HEH), preventive behaviors (PB), positive mental attitudes (PMA), and health practices (HP). Material and methods The study involved 151 healthy postmenopausal women. A research tool was a standardized questionnaire, the Health Behavior Inventory (HBI). Results The surveyed women obtained 70% of the maximum score on average, which suggests a medium level of health behaviors in this group. The levels of health behaviors in the categories of positive mental attitudes and health practices significantly differed between older women and their younger counterparts (higher levels were observed among older respondents). There were also significant differences in the levels of healthy behaviors between women with secondary and higher education (those better educated declared healthy behaviors more often). There was no correlation between the level of health behaviors and the BMI of the surveyed women. Conclusions Older women attached greater importance to positive mental attitudes, and so they avoided tension, stress and depressing situations. They also attached more weight to health practices (HP), i.e. the number of hours devoted to sleeping, resting and physical activity. The main determinant of a healthy lifestyle was higher education.
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Associations between psychological well-being, mental health, and hormone therapy in perimenopausal and postmenopausal women: results of two population-based studies. Menopause 2014; 20:667-76. [PMID: 23277355 DOI: 10.1097/gme.0b013e318278eec1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A proportion of women experience depressive and anxiety symptoms and/or disorders in connection with the menopausal transition. Estrogen-only therapy has been reported to have beneficial effects on mental health, but the effects of combined hormone therapy (HT) on mental health are less clear. We studied the associations between HT use and psychopathology in perimenopausal and postmenopausal women. METHODS Data on women who participated in the Health 2000 Survey and the National FINRISK Surveys in Finland were analyzed. RESULTS An association between current HT use and psychiatric diagnosis in the previous 12 months was found. In addition, HT use was associated with recent self-reported diagnosis of depression and with depressed mood (FINRISK), as well as with major depressive disorder and anxiety disorder (Health 2000). Associations with the following symptoms were found: nervousness, frightening thoughts, nightmares, and headache (FINRISK), feelings of depression (FINRISK and Health 2000), and unhappiness (Health 2000). No differences between different routes of administration or types of HT emerged. CONCLUSIONS Current use of HT in perimenopausal and postmenopausal women is associated with worse psychological well-being and mental health than in women not using HT. It is important to identify women in need of psychiatric support at the time of the menopausal transition.
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Uguz F, Sahingoz M, Gezginc K, Ayhan MG. Quality of life in postmenopausal women: the impact of depressive and anxiety disorders. Int J Psychiatry Med 2011; 41:281-92. [PMID: 22073767 DOI: 10.2190/pm.41.3.g] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Psychiatric symptoms are frequently present in postmenopausal women. The present study aimed to investigate the impact of depressive and anxiety disorders on the quality of life (QoL) of postmenopausal women. METHOD The study sample consisted of 342 postmenopausal women who presented to the Gynecology Outpatient Clinic. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition was used to determine depressive and anxiety disorders. The participants' QoL level was assessed by means of the World Health Organization QoL Assessment-Brief (WHOQOL-BREF). RESULTS Subjects without a diagnosis of depressive or anxiety disorder had significantly higher points in all domains of WHOQOL-BREF. According to linear regression analysis, all evaluated disorders except social phobia and specific phobia were independently associated with lower scores for at least one dimension of the QoL scale. However, major depression, dysthymic disorder, and generalized anxiety disorder predicted all domains of WHOQOL-BREF. CONCLUSION Depressive and anxiety disorders, particularly major depression, dysthymic disorder, and generalized anxiety disorder, seem to be considerable factors affecting the QoL in postmenopausal women.
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Affiliation(s)
- Faruk Uguz
- Selçuk Universitesi Meram Tip, Fakultesi, Konya, Turkey.
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Tao M, Teng Y, Shao H, Wu P, Mills EJ. Knowledge, perceptions and information about hormone therapy (HT) among menopausal women: a systematic review and meta-synthesis. PLoS One 2011; 6:e24661. [PMID: 21949743 PMCID: PMC3174976 DOI: 10.1371/journal.pone.0024661] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 08/16/2011] [Indexed: 11/19/2022] Open
Abstract
Background The use of hormone therapy (HT) by menopausal women has declined since the Women's Health Initiative randomized trial (WHI) in 2002 demonstrated important harms associated with long-term use. However, how this information has influenced women's knowledge and attitudes is uncertain. We aimed to evaluate the attitudes and perceptions towards HT use, as well as specific concerns and information sources on HT since the WHI trial. Method/Results We did a systematic review to assess the attitudes and knowledge towards HT in women, and estimate the magnitude of the issue by pooling across the studies. Using meta-synthesis methods, we reviewed qualitative studies and surveys and performed content analysis on the study reports. We pooled quantitative studies using a random-effects meta-analysis. We analyzed 11 qualitative studies (n = 566) and 27 quantitative studies (n = 39251). Positive views on HT included climacteric symptom control, prevention of osteoporosis and a perceived improvement in quality of life. Negative factors reported included concerns about potential harmful effects, particularly cancer risks. Sources of information included health providers, media, and social contact. By applying a meta-synthesis approach we demonstrate that these findings are broadly applicable across large groups of patients. Conclusions Although there are clear hazards associated with long-term HT use, many women view HT favorably for climacteric symptom relief. Media, as a source of information, is often valued as equivalent to health providers.
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Affiliation(s)
- MinFang Tao
- Department of Gynecology, Shanghai Jiaotong University, Affiliated Sixth People's Hospital, Shanghai, China.
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Chuni N, Sreeramareddy CT. Frequency of symptoms, determinants of severe symptoms, validity of and cut-off score for Menopause Rating Scale (MRS) as a screening tool: a cross-sectional survey among midlife Nepalese women. BMC Womens Health 2011; 11:30. [PMID: 21672198 PMCID: PMC3126771 DOI: 10.1186/1472-6874-11-30] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 06/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Majority of Nepalese women live in remote rural areas, where health services are not easily accessible. We determined the validity of Menopause Rating Scale (MRS) as a screening tool for identification of women with severe menopausal symptoms and cut-off MRS score for referral. METHODS A cross-sectional survey was carried out between February and August, 2008. Trained health workers administered MRS and a questionnaire to 729 women (40 to 65 years) attending health screening camps in Kaski district of Western Development Region of Nepal. Information about demographics, menopausal status, and use of hormone replacement therapy (HRT), chronic disease, self-perceived general health and reproductive history was also collected. Menopausal status was classified according to the Staging of Reproductive Ageing Workshop (STRAW). We calculated rates of menopausal symptoms, sensitivity, and specificity and likelihood ratios of MRS scores for referral to a gynaecologist. We also carried out multivariate analyses to identify the predictors for referral to a gynaecologist for severe symptoms. RESULTS A total 729 women were interviewed. Mean age at menopause was 49.9 years (SD 5.6). Most frequently reported symptoms were, sleeping problems (574, 78.7%), physical and mental exhaustion (73.5%), hot flushes (508, 69.7%), joint and muscular discomfort (500, 68.6%) and dryness of vagina (449, 61.6%). Postmenopausal women (247, 33.9%) and perimenopausal (215, 29.5%) women together experienced significantly higher prevalence of all symptoms than the premenopausal (267, 36.6%) women. MRS score of ≥16 had highest ratio for (sensitivity + specificity)/2. Women who reported urogenital symptoms [OR 5.29, 95% CI 2.59, 10.78], and self perceived general health as poor [OR 1.29, 95% CI 1.11, 1.53] were more likely to be referred to a gynaecologist for severe menopausal symptoms. While women reporting somatic [OR 0.72, 95% CI 0.63, 0.82] and psychological [OR 0.86, 95% CI 0.74, 0.99] symptoms were less likely to be referred. CONCLUSION MRS may be used as a screening tool at a cut-off score of ≥16 with least misclassification rate. However, its utility may be limited by woman's general health status and occurrence of urogenital symptoms.
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Affiliation(s)
- Neena Chuni
- Department of Obstetrics and Gynaecology, Manipal Teaching Hospital, Manipal College of Medical Sciences, Pokhara, Nepal
- Department of Obstetrics and Gynaecology, Indira Gandhi Memorial Hospital, Male, Maldives
| | - Chandrashekhar T Sreeramareddy
- Department of Community Medicine, Manipal Teaching Hospital, Manipal College of Medical Sciences, Pokhara, Nepal
- Department of Community Medicine, Melaka Manipal Medical College, Jalan Batu Hampar, Bukit Baru, Melaka, Malaysia
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Abstract
OBJECTIVE There is currently a gap in treatment options for menopausal symptoms and a need for comprehensive therapies that are safe and effective for postmenopausal women. This review discusses challenges in the management of menopausal symptoms and the effect of the Women's Health Initiative (WHI) study findings on current treatment patterns. It also examines present and future therapies. RESEARCH DESIGN AND METHODS A literature search was conducted using Medline, the Cochrane Database, and the National Heart Lung and Blood Institute WHI website with the following search terms: primary care, menopause, vasomotor symptoms, hormone therapy, osteoporosis, and vaginal atrophy. Searches were limited to articles published between 1995 and 2009. RESULTS Comprehensive therapies that target several aspects of menopause, such as vasomotor symptoms and chronic disease prevention, are currently hormone based. These hormone-based approaches are considered more effective than currently available nonhormonal therapies for the relief of menopausal symptoms. However, hormone therapy is not recommended for women at high risk for venous thromboembolic events, cardiovascular disease, and/or breast cancer. A need exists for novel therapies that mitigate menopausal symptoms, provide protection from osteoporosis, and encourage patient compliance without promoting cancer, heart disease, or stroke. Emerging modalities and strategies, such as the tissue selective estrogen complex (TSEC), Org 50081, MF101, and desvenlafaxine, may provide improved options for postmenopausal women. CONCLUSIONS Several new menopausal therapies that may help to address the ongoing unmet need for safe and effective therapies for postmenopausal women are currently in development. In particular, the TSEC, which provides the benefits of both a selective estrogen receptor modulator and conjugated estrogens with an improved tolerability profile, may offer advantages over currently available treatment options. Limitations of this review include the narrow search criteria and limited search period.
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Affiliation(s)
- Vivian Lewis
- University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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Epidemiology of risk factors and symptoms associated with menopause in Spanish women. Maturitas 2009; 62:30-6. [DOI: 10.1016/j.maturitas.2008.10.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 09/29/2008] [Accepted: 10/01/2008] [Indexed: 11/18/2022]
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