1
|
Beshyah SA, Alwatban L, Ekhzaimy A, Mustafa HE, Abdelmannan DK, Merheb M, Bashir M. Management of menopause: a survey of physicians from the Middle East and Africa. Climacteric 2023; 26:455-464. [PMID: 36999573 DOI: 10.1080/13697137.2023.2190509] [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: 11/15/2022] [Revised: 02/14/2023] [Accepted: 03/04/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE This study evaluated physicians' perceptions, practices, confidence, comfort level and prior training in managing menopause. METHODS A survey was conducted of a convenience sample of physicians from the Middle East and Africa (MEA) in 2019. We covered knowledge of symptoms, menopausal hormone therapy (MHT), other menopause management strategies and prior training in menopause medicine. RESULTS Of the 254 participants, 64.2% were seniors in family medicine (36.4%), endocrinology (36.0%), gynecology (15.8%) and internal medicine (13.8%). Fewer than one-third (28.8%) correctly identified the diagnostic criteria of menopause. Almost all recognized vasomotor symptoms (99.5%), vaginal dryness (96.2%) and mood disturbance (94.3%), but to a lesser extent other symptoms. Inconsistency and critical gaps were identified in responses to competence questions on six case studies. They recalled having occasional (43.2%) or no training (19.4%) in menopause medicine and rated their preparedness to treat menopause widely. A total of 66.2% agreed that training is very important. Variation between specialties was identified. CONCLUSION Many physicians recognize the importance of education in menopause management, but their responses revealed critical knowledge gaps that underscored the need for comprehensive, evidence-based menopause management.
Collapse
Affiliation(s)
- S A Beshyah
- Department of Medicine, Dubai Medical College, Dubai, UAE
- Department of Endocrinology, Yas Clinic Khalifa City, Abu Dhabi, UAE
- Department of Medicine, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE
| | - L Alwatban
- Department of Family and Community Medicine, King Saud University, Medical City, Riyadh, Saudi Arabia
| | - A Ekhzaimy
- Department of Medicine, Endocrinology Division, King Saud University, Medical City, Riyadh, Saudi Arabia
- Health Plus, Center for Diabetes and Endocrinology, Abu Dhabi, UAE
| | - H E Mustafa
- Health Plus, Center for Diabetes and Endocrinology, Abu Dhabi, UAE
| | - D K Abdelmannan
- Department of PostGraduate Medical Education, Dubai Academic Health Corporation, Dubai, UAE
- Dubai Diabetes Center, Dubai Health Authority, Dubai, UAE
| | - M Merheb
- Department of Endocrinology, Mount Lebanon Hospital, Beirut, Lebanon
| | - M Bashir
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
2
|
Christin-Maitre S, Givony M, Albarel F, Bachelot A, Bidet M, Blanc JV, Bouvattier C, Brac de la Perrière A, Catteau-Jonard S, Chevalier N, Carel JC, Coutant R, Donadille B, Duranteau L, El-Khattabi L, Hugon-Rodin J, Houang M, Grynberg M, Kerlan V, Leger J, Misrahi M, Pienkowski C, Plu-Bureau G, Polak M, Reynaud R, Siffroi JP, Sonigo C, Touraine P, Zenaty D. Position statement on the diagnosis and management of premature/primary ovarian insufficiency (except Turner Syndrome). ANNALES D'ENDOCRINOLOGIE 2021; 82:555-571. [PMID: 34508691 DOI: 10.1016/j.ando.2021.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Premature ovarian insufficiency (POI) is a rare pathology affecting 1-2% of under-40 year-old women, 1 in 1000 under-30 year-olds and 1 in 10,000 under-20 year-olds. There are multiple etiologies, which can be classified as primary (chromosomal, genetic, auto-immune) and secondary or iatrogenic (surgical, or secondary to chemotherapy and/or radiotherapy). Despite important progress in genetics, more than 60% of cases of primary POI still have no identifiable etiology; these cases are known as idiopathic POI. POI is defined by the association of 1 clinical and 1 biological criterion: primary or secondary amenorrhea or spaniomenorrhea of>4 months with onset before 40 year of age, and elevated follicle-stimulating hormone (FSH)>25IU/L on 2 assays at>4 weeks' interval. Estradiol level is low, and anti-Müllerian hormone (AMH) levels have usually collapsed. Initial etiological work-up comprises auto-immune assessment, karyotype, FMR1 premutation screening and gene-panel study. If all of these are normal, the patient and parents may be offered genome-wide analysis under the "France Génomique" project. The term ovarian insufficiency suggests that the dysfunction is not necessarily definitive. In some cases, ovarian function may fluctuate, and spontaneous pregnancy is possible in around 6% of cases. In confirmed POI, hormone replacement therapy is to be recommended at least up to the physiological menopause age of 51 years. Management in a rare diseases center may be proposed.
Collapse
Affiliation(s)
- Sophie Christin-Maitre
- Sorbonne University, Hôpital St Antoine, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France.
| | - Maria Givony
- French National Healthcare Network for Rare Endocrine Diseases (FIRENDO), AP-HP, Paris, France
| | - Frédérique Albarel
- Conception University Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Anne Bachelot
- Sorbonne University, Hôpital de la Pitié-Salpétrière, AP-HP, Paris, France
| | - Maud Bidet
- Clinique mutualiste La Sagesse, Rennes, France
| | - Jean Victor Blanc
- Sorbonne University, Hôpital St Antoine, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France
| | | | | | | | | | | | | | - Bruno Donadille
- Sorbonne University, Hôpital St Antoine, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France
| | - Lise Duranteau
- Saclay University, Hôpital du Kremlin-Bicêtre, AP-HP, Paris, France
| | - Laïla El-Khattabi
- Paris-Centre University, Hôpital Cochin Port-Royal, AP-HP, Paris, France
| | | | - Muriel Houang
- Sorbonne University, Hôpital Trousseau, AP-HP, Paris, France
| | - Michaël Grynberg
- Saclay University, Hôpital Antoine Béclère, AP-HP, Clamart, France
| | - Véronique Kerlan
- University of Brest, Centre Hospitalier Régional Universitaire, Brest, France
| | - Juliane Leger
- Paris-Centre University, Hôpital Robert Debré, AP-HP, Paris, France
| | | | | | | | - Michel Polak
- Paris Centre University, Hôpital Necker, AP-HP, Paris, France
| | | | | | - Charlotte Sonigo
- Saclay University, Hôpital Antoine Béclère, AP-HP, Clamart, France
| | - Phillipe Touraine
- Sorbonne University, Hôpital de la Pitié-Salpétrière, AP-HP, Paris, France
| | - Delphine Zenaty
- Paris-Centre University, Hôpital Robert Debré, AP-HP, Paris, France
| |
Collapse
|
3
|
Upton CE, Daniels JP, Davies MC. Premature ovarian insufficiency: the need for evidence on the effectiveness of hormonal therapy. Climacteric 2021; 24:453-458. [PMID: 33928827 DOI: 10.1080/13697137.2021.1902496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Premature ovarian insufficiency (POI) - the loss of ovarian function before the age of 40 years, a decade before natural menopause - is a life-changing diagnosis for women. POI causes significant short-term and long-term morbidity related to estrogen deficiency. The condition is managed by providing exogenous estrogen replacement, usually as the oral contraceptive pill or hormone therapy. These preparations have different estrogen formulations and may have differing benefits and risks. At present, there are no robust data to inform clinical recommendations and women's decision-making about treatment that they may be taking for many years. The POISE study (Premature Ovarian Insufficiency Study of Effectiveness of hormonal therapy) has been designed to determine whether hormone therapy is superior to combined oral contraceptives on important clinical outcomes and patient-reported symptoms, based on the hypothesis that hormone therapy provides more physiological continuous hormone supplementation with natural estrogens. The study is an open and pragmatic, parallel, randomized controlled trial. The primary outcome is absolute bone mineral density assessed by dual-energy X-ray absorptiometry of the lumbar spine after 2 years of treatment. The study will also investigate cardiovascular markers, symptom relief and acceptability of treatment, and will continue to collect long-term data on fractures and cardiovascular events. Results will inform future guidance on management of POI.
Collapse
Affiliation(s)
- C E Upton
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - J P Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - M C Davies
- Reproductive Medicine Unit, University College London Hospitals, London, UK.,Institute for Women's Health, University College London, UK
| |
Collapse
|
4
|
Tsiligiannis S, Panay N, Stevenson JC. Premature Ovarian Insufficiency and Long-Term Health Consequences. Curr Vasc Pharmacol 2020; 17:604-609. [PMID: 30819073 DOI: 10.2174/1570161117666190122101611] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/31/2018] [Accepted: 11/03/2018] [Indexed: 01/26/2023]
Abstract
Premature ovarian insufficiency (POI) is defined as the cessation of ovarian function before the age of 40 years. The trio of amenorrhea, elevated gonadotropins and oestrogen deficiency is associated with long-term health consequences including increased cardiovascular disease (CVD), decreased bone mineral density (BMD), significantly reduced fertility, psychological distress, vulvovaginal atrophy, neurological effects and overall reduced life expectancy. There are deficits in our understanding of this condition and subsequently the long-term health consequences. The underlying aetiology of POI and the optimal management strategies are also poorly understood. Our knowledge of long-term cardiovascular consequences specifically relating to women with POI is limited as most data on the subject are derived from studies involving women who experienced menopause at the natural age (after 40 years with an average age of 51).
Collapse
Affiliation(s)
| | - Nick Panay
- Chelsea and Westminster Hospital, London, United Kingdom.,Imperial College Healthcare, NHS Trust, London, United Kingdom
| | - John C Stevenson
- National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
| |
Collapse
|
5
|
Jarcevic R, Christakis MK, Wolfman W, Ye XY, Shirreff L. Survey of Canadian PGY-4 and PGY-5 Obstetrics and Gynaecology Residents on Knowledge of and Exposure to Premature Ovarian Insufficiency. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1324-1328. [PMID: 30025870 DOI: 10.1016/j.jogc.2018.01.005] [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: 11/23/2017] [Revised: 12/26/2017] [Accepted: 01/01/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES (1) To determine exposure to and general knowledge on premature ovarian insufficiency (POI) among Canadian senior obstetrics and gynaecology residents. (2) To identify opportunity to improve trainee exposure to POI. METHODS Canadian PGY-4 and PGY-5 obstetrics and gynaecology residents were approached to complete an electronic survey. The questions in the survey included the basic POI knowledge, previous exposure to POI, and comfort level in managing POI patients. Data from the survey was summarized descriptively and compared between two trainee groups (PGY-4 and PGY-5) using chi-square or Fisher exact tests. RESULTS Responses were received from trainees in all Canadian residency programs with an overall response rate of 45% (95/210 residents). Most respondents (79%, 75/95 residents) identified correct age for POI diagnosis, and 65% (62/95 residents) recognized the most common aetiology. A majority (99%, 92/93 residents) would prescribe hormone therapy for POI patients. Most trainees (62%, 59/95 residents) lack access to a POI clinic at their centre and 63% (59/94 residents) have seen less than six POI patients during residency training. Most feel somewhat comfortable managing POI patients (67%, 64/95 residents), but 22% (21/95 residents) feel totally uncomfortable with a majority of respondents (83%, 78/94 residents), indicating they would benefit from additional training. Compared with PGY-4 residents, the proportion of trainees who could identify the correct age for diagnosis of POI was significantly higher in PGY-5 residents (89% vs. 70%, P = 0.024). CONCLUSION Many senior obstetrics and gynaecology residents in Canada lack knowledge around POI, and most indicate need for further exposure to POI during residency training. We identified an opportunity for improved POI curricula.
Collapse
Affiliation(s)
- Radomir Jarcevic
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON.
| | - Marie K Christakis
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON
| | - Wendy Wolfman
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON
| | - Xiang Y Ye
- Micare Research Centre, Mount Sinai Hospital, Toronto, ON
| | - Lindsay Shirreff
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON
| |
Collapse
|
6
|
Burgos N, Cintron D, Latortue-Albino P, Serrano V, Rodriguez Gutierrez R, Faubion S, Spencer-Bonilla G, Erwin PJ, Murad MH. Estrogen-based hormone therapy in women with primary ovarian insufficiency: a systematic review. Endocrine 2017; 58:413-425. [PMID: 29039146 PMCID: PMC5765545 DOI: 10.1007/s12020-017-1435-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 09/20/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Sex hormones play a role in bone density, cardiovascular health, and wellbeing throughout reproductive lifespan. Women with primary ovarian insufficiency (POI) have lower estrogen levels requiring hormone therapy (HT) to manage symptoms and to protect against adverse long-term health outcomes. Yet, the effectiveness of HT in preventing adverse outcomes has not been systematically assessed. We summarize the evidence regarding effects of HT on bone and cardiovascular health in women with POI. METHODS A comprehensive search of the electronic databases MEDLINE, EMBASE, and Scopus was conducted by a medical reference librarian from database inception to January 2016. Randomized trials and observational cohort studies with an estrogen-based HT intervention in women with POI under the age of 40 were included. Reviewers worked independently and in duplicate to assess eligibility and risk of bias, and extract data of interest from each study. RESULTS The search identified 1670 articles; 12 met inclusion criteria. Four randomized clinical trials and eight cohort studies at high risk of bias enrolled 806 women with POI. The most common HT formulations were transdermal estradiol and oral conjugated equine estrogen combined with medroxyprogesterone acetate. Bone mineral density was the most frequent outcome, with three out of eight studies showing HT associated increase benefits. Only one study reported effects on fractures or vasomotor symptoms and none on cardiovascular mortality. Results regarding lipid profiles were inconsistent. CONCLUSIONS Evidence supporting bone and cardiovascular benefits of HT in women with POI is limited by high risk of bias, reliance on surrogate outcomes, and heterogeneity of trials regarding the formulation, dose, route of administration, and regimen of HT. Further research addressing patient important outcomes such as fractures, stroke, and cardiovascular mortality are crucial to optimize benefits of this therapy.
Collapse
Affiliation(s)
- Nydia Burgos
- Internal Medicine Department, VA Caribbean Health Care System, San Juan, PR, 00921, USA
| | - Dahima Cintron
- Mayo Graduate School, Mayo Clinic, Rochester, MN, 55905, USA.
- University of Puerto Rico-Medical Sciences Campus, San Juan, PR, 00921, USA.
| | | | - Valentina Serrano
- Department of Medicine, Knowledge and Evaluation Research Unit in Endocrinology, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Nutrition, Diabetes and Metabolism, Escuela de Medicina, Pontifica Universidad Católica de Chile, Santiago, Chile
| | - Rene Rodriguez Gutierrez
- Department of Medicine, Knowledge and Evaluation Research Unit in Endocrinology, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Medicine, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Internal Medicine, Division of Endocrinology, University Hospital "Dr. Jose E. Gonzalez", Autonomous University of Nuevo Leon, Monterrey, 64460, Mexico
- Laboratorio Nacional para el Estudio y Aplicación de la Medicina Basada en Evidencia, Análisis Crítico de la Información Científica y Farmacoeconomía, Universidad Autónoma de Nuevo León, Monterrey, 66460, Mexico
| | - Stephanie Faubion
- Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Gabriela Spencer-Bonilla
- Mayo Graduate School, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Medicine, Knowledge and Evaluation Research Unit in Endocrinology, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, 55905, USA
| | | | | |
Collapse
|
7
|
|
8
|
Maclaran K, Panay N. Current Concepts in Premature Ovarian Insufficiency. WOMENS HEALTH 2015; 11:169-82. [PMID: 25776291 DOI: 10.2217/whe.14.82] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Premature ovarian insufficiency (POI) is a life-changing diagnosis, with profound physical and psychological consequences. Unfortunately, there are many deficiencies in our understanding of the condition as the underlying etiology and optimum management strategies are poorly understood. Improved awareness of POI and its long-term implications has led to increased research interest in recent years. Current research has allowed a greater understanding of the changing epidemiology in POI, genetic factors in its etiology and randomized controlled trials of hormone therapy are underway to provide evidence for treatment. This article reviews the latest literature on POI to summarize current understanding and future directions.
Collapse
Affiliation(s)
- Kate Maclaran
- West Middlesex University Hospital NHS Trust, Twickenham Road, Isleworth, Middlesex TW7 6AF, UK
| | - Nick Panay
- Queen Charlotte's & Chelsea and Chelsea & Westminster Hospitals, West London Menopause & PMS Centre, Du Cane Road, London W12 0HS, UK
| |
Collapse
|
9
|
Haller-Kikkatalo K, Uibo R, Kurg A, Salumets A. The prevalence and phenotypic characteristics of spontaneous premature ovarian failure: a general population registry-based study. Hum Reprod 2015; 30:1229-38. [DOI: 10.1093/humrep/dev021] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/19/2015] [Indexed: 01/01/2023] Open
|