An exploration of factors affecting the quality of life of women with primary ovarian insufficiency: a qualitative study

A qualitative study of work and early menopause: 'On-the job' experiences and career trajectories

OBJECTIVES

Early menopause or premature ovarian insufficiency (POI), menopause occurring before age 45 and 40 years respectively, occur at the age when most women are establishing or consolidating their careers. Studies of older postmenopausal women indicate an adverse bidirectional relationship between menopause and work. However, data are lacking regarding the work experiences of women with early menopause or POI. We explored the experiences of women with early menopause or POI in relation to work.

STUDY DESIGN

Using maximum variation sampling, 30 women (median age 44 years and 38 years at menopause diagnosis) of diverse backgrounds and menopause causes (16/30 iatrogenic) participated in qualitative interviews to explore experiences of early menopause/POI in the context of their overall lives, work and career. Dual thematic (themes identified across interviews) and thematic narrative (themes identified within individual interviews) analysis was done using NVivo 12 software.

MAIN OUTCOME MEASURES

Themes related to work experiences and influencing factors.

RESULTS

Two major themes were identified: 'on-the-job' experiences (work performance, bodily presentation and disclosure) and career trajectories (intact and altered). Factors impacting the interaction between work and early menopause/POI included: career (type of work, environment, working conditions), personal (age, socio-economic background, family arrangements, migration history) and menopause experience (spontaneous versus iatrogenic, treatment complexity).

CONCLUSIONS

Early menopause/POI has multiple impacts on women's work experiences and career trajectories. As with older postmenopausal women, career and personal factors influence younger women's work experience. However, this research highlights differences associated with menopause occurring at an earlier, often unexpected age compared with menopause at the usual age.

Premature Ovarian Insufficiency Is Associated with Increased Risk of Depression, Anxiety, and Poor Life Quality: A Systematic Review and Meta-analysis

Background

Premature ovarian insufficiency (POI) seriously affects the reproductive health of women. Several studies have been conducted to show that POI appears to be associated with psychological and psychosocial problems, but whether POI increases the risk of mental health problems has not been identified. Therefore, this meta-analysis provides a preliminary systematic assessment of the studies published to date on the impact of POI on women's mental health.

Methods

We implemented a systematic search for studies on this topic up to October 2022. Pooled odds ratios (ORs) and 95% confident intervals (CIs) of prevalence were used to assess the impacts of POI on various psychological factors, and the publication bias was assessed by Egger's test.

Results

A total of 15 articles comprising 5820 participants were included in this meta-analysis. POI was found to be related to higher risk of 13 psychological and psychosocial problems identified and classified into 3 domains: depression (OR = 1.61; 95% CI: 1.11-2.33), anxiety (OR = 3.74; 95% CI: 1.78-7.87), and poor life quality (OR = 2.55, 95% CI: 1.63-3.97).

Conclusion

This meta-analysis reveals that women with POI have an increased risk of depression, anxiety, and poor life quality. The marital status of POI may be a possible influencing factor for depression, meaning that the unmarried status in POI is at high risk of psychological and psychosocial problems. We should pay attention to the mental health of women with POI who were unmarried.

[Endocrine and psychosomatic disorders in patients with amenorrhea]

The article presents data on the relationship of pathogenetic mechanisms for the development of menstrual disorders of functional and organic origin in connection with mental disturbances from the point of view of the psychosomatic concept. According to the latter, functional disorders of the menstrual cycle are considered as psychosomatic, in which gynecological pathology develops as a result of psychopathological illness. A striking example of such a disorder is functional hypothalamic amenorrhea. At the same time, endocrinopathies, such as polycystic ovary syndrome and premature ovarian insufficiency, can also be considered in the paradigm of psychosomatic illnesses of ovarian function due to the high prevalence of anxiety and depressive disorders in this cohort of patients. This review highlights the importance of interdisciplinary collaboration between a gynecologist and a psychiatrist for the most effective reproductive rehabilitation of patients with amenorrhea. Literature search was carried out in national (eLibrary, CyberLeninka.ru) and international (PubMed, Cochrane Library) databases in Russian and English. The priority was free access to the full text of articles. The choice of sources was prioritized for the period from 2018 to 2023.However, taking into account the insufficient knowledge of the chosen topic, the choice of sources dates back to 1985.

Efficiency and safety of acupuncture for women with premature ovarian insufficiency: study protocol for a randomized controlled trial

Acupuncture has been widely used as an alternative and complementary therapy for premature ovarian insufficiency (POI) in China. However, research to date has not shown that acupuncture is effective for POI compared with hormone replacement therapy (HRT). We will conduct a randomized, controlled, and outcome assessor-blind trial to evaluate the efficacy and safety of acupuncture on POI. Seventy-six patients with POI will be randomly assigned to two groups. The treatment group will receive twenty-eight one-hour sessions of acupuncture treatments, and the control group will receive 12-week HRT. The whole study will consist of a 12-week treatment plan and a 12-week follow-up session. The primary outcome is measured by changes in serum anti-Müllerian hormone and follicle-stimulating hormone (FSH) levels at weeks 12 and 24. Secondary outcome measures include estradiol, luteinizing hormone (LH), LH/FSH ratio, Kupperman index, and menstrual condition. This trial is expected to clarify whether or not acupuncture is effective and safe for POI compared with HRT.

The risk of depressive and anxiety symptoms in women with premature ovarian insufficiency: a systematic review and meta-analysis

Premature ovarian insufficiency (POI) appears to be associated with depressive and anxiety symptoms. However, there is a lack of high-quality evidence relating to the risk of patients with POI developing depression or anxiety. Therefore, we conducted a systematic review and meta-analysis to quantify the risk of depressive and anxiety symptoms in women with POI. We searched English and Chinese databases to evaluate the risk of depression and anxiety disorders in patients with POI. The final search date was November 2021. The risk was quantified using meta-analysis, with an estimation of pooled odds ratio (OR) and 95% confidence interval (CI). Sources of heterogeneity were explored by subgroup analysis. A total of seven primary studies with 1316 individuals were included, five of which were related to depression and six to anxiety disorders. All included articles were case-control studies of high quality. Patients with POI were associated with a higher odds of depression and anxiety (depression: OR = 3.33, 95% CI = 2.31-4.81, P < 0.001; anxiety: OR = 4.89, 95% CI = 3.28-7.30, P < 0.001). Subgroup analysis also indicated that patients with POI are at a higher risk of anxiety and depression. POI appears to be associated with a high risk of depression and anxiety. Early psychosocial assessment and regular screening of patients with POI are also necessary. In addition, it is important to consider the mental health of patients with POI.

Perception of Female Identity in Women with Premature Ovarian Insufficiency: A Qualitative Study

Background

Premature ovarian insufficiency (POI) occurs in women before the age of 40. Although the outcomes of POI in women include its adverse effects on general health, sexual-reproductive health, and finally reduced quality of life. One of the first adverse consequences is a threat to female identity of the patients. The purpose of the present study was to investigate the perception and experience of women with POI about female identity.

Methods

In this qualitative study, interviews were conducted with 15 women having POI. Data included participants' recorded voices that were analyzed using conventional content analysis.

Results

After content analysis of the interviews with a focus on the perception and experience of women with POI about female identity, four categories emerged; they included the failure in realization of motherhood dream, the importance of menstruation, construction of female identity, and attempts to normalize the situation.

Conclusion

After analyzing the emerged categories obtained by interviewing with POI women, it seems that physicians need to pay special attention to the distortion of the female identity of these patients and educate the medical team about the importance of the effect of treatment on improving their emotional health.

Primary ovarian insufficiency quality of life scale (POIQOLS): development and psychometric properties

Background

Primary ovarian insufficiency is menopause before the age of 40. It can affect the quality of life of afflicted women. Because there is no instrument available for measuring the quality of life of these women, the present study was carried out to develop and assess the psychometric properties of the quality of life scale for women with primary ovarian insufficiency.

Methods

This exploratory sequential mixed method study was performed in two phases. In the qualitative phase (item generation), semi-structured in-depth interviews were conducted with 16 women having primary ovarian insufficiency, and a literature review was performed to generate initial items pool. In the quantitative phase (psychometric evaluation), the face, content, and construct validity (exploratory factor analysis), as well as reliability (internal consistency and test–retest methods), were evaluated. Besides, the responsiveness and interpretability were investigated.

Results

During the first phase of the study, the initial item pool was generated with 132 items. After the face and content validity, the number of items was reduced to 40. The results of exploratory factor analysis yielded a 28 item scale with six factors. These factors explained 58.55% of the total variance. The Cronbach’s alpha for each factor was more than 0.7. Furthermore, the intraclass correlation coefficient for the entire scale was 0.95.

Conclusions

The primary ovarian insufficiency quality of life scale (POIQOLS) is a valid and reliable tool for accessing the quality of life of women with primary ovarian insufficiency.

Health-related quality of life in women with primary ovarian insufficiency: a scoping review of the literature and implications for targeted interventions

STUDY QUESTION

What is known about health-related quality of life (HR-QoL) in women with idiopathic primary ovarian insufficiency (POI)?

SUMMARY ANSWER

Women with POI have a range of unmet psychosocial needs relating to three interrelated themes: 'diagnostic odyssey', 'isolation and stigma' and impaired 'ego integrity'.

WHAT IS KNOWN ALREADY

Prior studies have reported increased depressive symptoms, diminished sexual function and altered body image/self-concept in women with POI.

STUDY DESIGN, SIZE, DURATION

A systematic scoping review (11 databases) on HR-QoL in POI including published quantitative, qualitative and mixed-methods studies as well as unpublished gray literature (i.e. unpublished dissertations) through June, 2021.

PARTICIPANTS/MATERIALS, SETTING, METHODS

After removing duplicates, 1244 articles underwent title and abstract review by independent reviewers. The remaining 72 relevant articles underwent dual full text review to determine inclusion criteria yielding 24 articles (100% concordance) for data extraction. Findings were summarized in tables by methodology and recurrent HR-QoL themes/sub-themes were mapped to define key aspects of HR-QoL in POI. Promoters of active coping were charted at the individual, interpersonal and healthcare system levels. Targets for tailored interventions supporting active coping and improved HR-QoL were mapped to the Theory of Planned Behavior (TPB).

MAIN RESULTS AND THE ROLE OF CHANCE

Three interrelated themes affecting HR-QoL in POI emerged from the data synthesis. First, the theme 'diagnostic odyssey' comprised sub-themes of uncertainty, lack of control, knowledge gaps, discontinuous care and negative clinical interactions. The second theme 'isolation and stigma' included sub-themes of guilt, shame, concealment, feeling labeled as infertile, lack of social support and unsympathetic clinicians. The third theme, impaired 'ego integrity' captured sub-themes of decreased sexual function, altered body image, psychological vulnerability and catastrophizing. Targets promoting active coping at the individual (n = 2), interpersonal (n = 1) and healthcare system (n = 1) levels were mapped to the TPB to inform development of tailored interventions supporting active coping and improved HR-QoL in POI (i.e. narrative intervention, co-creating patient-facing materials, peer-to-peer support and provider resources).

LIMITATIONS, REASONS FOR CAUTION

No studies using a POI-specific HR-QoL instrument were identified. No interventional studies aimed at improving HR-QoL in POI were identified. Only articles published in English were included in the study.

WIDER IMPLICATIONS OF THE FINDINGS

Women with POI frequently have impaired HR-QoL related to the life-altering infertility diagnosis. The range of unmet psychosocial needs may be relevant for informing interventions for other populations with infertility.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development 'Massachusetts General Hospital-Harvard Center for Reproductive Medicine' (1 P50 HD104224-01 NICHD). The authors have no conflicts to declare.

REGISTRATION NUMBER

N/A.

Dietary supplementation for female infertility: Recent advances in the nutritional therapy for premature ovarian insufficiency

Premature ovarian insufficiency (POI) ranks top in the reproductive disorders that may impair multiple functioning systems, reduce the quality of life and ultimately deprive patients of their fertility among women. Symptoms can be partially alleviated by present hormone replacement therapy that cannot improve conception or decrease occurrence rates of systemic complication. Nutritional dietary supplements are attracting more and more attention because of their safety, bioavailability, and efficacy for well-being. Nutrients in the daily food are composed of carbohydrates, fat and lipoprotein, protein and polypeptide, vitamins, and vegetable or fruits containing phytoestrogens. These are functional nutrients due to the proliferative, anti-inflammatory, anti-oxidant, and mitochondria-protective potential during the course of menopause. Apart from dietary nutrients, microbe-related nutritional substances, including probiotics, prebiotics and the combination-synbiotics, display high potential as well in supporting estrous cycle, ovarian viability and modulating other vital reproductive functions. The present review will discuss dietary and microbial nutrients and their roles and applications in the living body based upon animal or human research, evaluate possible effect mechanisms from molecular, cellular and tissue levels, and provide insights into nutritional therapy for prolonging reproductive lifespan in female patients.

Assessment of premature menopause on the sexual function and quality of life in women

INTRODUCTION

Premature Ovarian Insufficiency (POI) is characterized by ending menstruation in women under 40 years of age. It has a significant effect on women's sexuality and mental health and quality of life. This study aimed to evaluate the sexual function and quality of life of premature menopausal women.

METHODS

This study was a case-control study on 132 people (66 women with a diagnosis of POF and 66 women of reproductive age with normal ovarian function) who were matched in terms of the age, presenting to Women's Clinic in Jahrom in 2019. The WHOQOL-BREF questionnaire and the Female Sexual Function Index (FSFI) questionnaire were used to collect data. p < .05 was considered statistically significant.

RESULTS

The mean score of sexual function in premature menopausal women was 21.35 ± 4.82 and in non-menopausal women was 25.4 ± 6.61 (OR = 0.11, 95% CI = 0.04-0.28). All areas of sexual function; desires disorder (OR = 0.21 95% CI = 0.07-0.56), Arousal disorder(OR = 0.28, 95% CI = 0.08-0.93), orgasm disorder (OR = 0.36 95% CI = 0.16-0.80), lubrication disorder (OR = 0.21 95% CI= 0.05-0.78), satisfaction disorder (OR = 0.11, 95% CI = 0.04-0.28) and quality of life domains: physical health (OR = 0.4 95%CI = 0.06-0.3), mental health (OR = 0.28 95% CI = 0.06-0.1), environmental health (OR = 0.22 95%CI = 0.04-0.6) and social health (OR = 0.28 95%CI = 0.01-0.2) saw a decrease in the premature menopausal women group compared to the control group.

CONCLUSION

The results demonstrated that premature menopausal women are found to be weaker than the control group in all areas of sexual function and quality of life. Among the areas of sexual function, such as libido, arousal, satisfaction, and pain have the most impact on quality of life. Therefore, based on the results from improving sexual function, this issue can improve the quality of life.

Perceptions and experiences of women with premature ovarian insufficiency about sexual health and reproductive health

BACKGROUND

Premature ovarian insufficiency (POI) is a condition with impaired ovarian function that occurred in women before the age of 40. Considering that women with POI are in reproductive age and their fertility and sexual life are afflicted by this disorder directly, the present study aimed to investigate perception and experience of women with POI of sexual and reproductive health (SRH).

METHODS

This is a qualitative that was implemented based on the conventional content analysis approach. The data were collected using semi-structured in-depth interviews with 16 women having POI, based on purposeful sampling and continued until data saturation. The participants were women with POI that referred to the three infertility center in Tehran, Iran. The audio recorded data were transcribed verbatim and then analyzed using conventional content analysis based on the method proposed by Zhang and Wildmouth.

RESULTS

After content analysis of the interviews with a focus on the perception and experience of women with POI of SRH, four main categories emerged i.e. endangerment of women's health, psychological agitation, disruption of social life and disturbance in sexual life.

CONCLUSION

POI affects different aspects of women SRH (women physical, psychological, social and sexual heath). Therefore, knowledge of patients' concerns by health professionals is helpful to improve service delivery and increasing the effectiveness of treatment interventions by a comprehensive health care attitude.