Factors associated with reporting classic menopausal symptoms differ

"I was just a shell": Mental health concerns for women in perimenopause and menopause

Early detection of deteriorating mental health for women who are experiencing symptoms associated with perimenopause and menopause is critical to ensure the well-being of women. Unfortunately, many women during this phase of their lives find it difficult to access relevant and timely treatment. This concurrent mixed methods study using an online survey and qualitative interviews explored Australian women's knowledge and experiences of perimenopause and menopause and specifically reports on findings associated with women's mental health. Four hundred and eleven women completed the online survey in its entirety and 25 women participated in semi-structured interviews between April and July 2022. Survey data were analysed using SPSS and, in this article, data are presented as descriptive statistics. Qualitative interviews were analysed using thematic analysis guided by Braun and Clarke (2013; 2019). Quantitative and qualitative data specific to women's mental health were integrated into three themes: (1) increased anxiety and depression, (2) a negative impact on emotions and (3) a negative impact on self-worth. Findings from this study will help to inform clinical services for women as it highlights the need to improve education about perimenopause and menopause for healthcare providers and women.

Postmenopausal women's cognitive function and performance of virtual reality tasks

OBJECTIVE

This study aimed to assess whether prior knowledge of computer use determines performance of virtual reality tasks by postmenopausal women and whether menopausal symptoms, sociodemographic factors, lifestyle and cognition modify or interfere with their performance.

METHOD

This cross-sectional study included 152 postmenopausal women divided into two groups: computer users and non-users. Age, ethnicity, time of menopause, menopausal symptoms, female health status, level of physical activity and cognitive function were considered. The participants played a virtual reality game and were assessed for hits, errors, omissions and game time. The Mann-Whitney, chi-square and Fisher exact tests and multivariate linear regression analysis were used.

RESULTS

Postmenopausal computer users play virtual reality games (p = 0.005) better than postmenopausal non-users of computers. Vasomotor symptoms were high in women who used computers compared to those who did not (p = 0.006). Multivariate linear regression analysis found that the best-fitting predictors for the number of hits - that is, age (p = 0.039), Mini-Mental State Examination score (p = 0.006) and the headache symptom (p = 0.021) - influence the performance of virtual reality tasks.

CONCLUSION

Computer users performed virtual reality tasks better than non-users. Headache and age but not vasomotor symptoms negatively affected the postmenopausal women's performance.

Epidemiology and treatment patterns of UK women diagnosed with vasomotor symptoms: Findings from the Clinical Practice Research Datalink GOLD database

OBJECTIVES

To describe the epidemiology and treatment of vasomotor symptoms (VMS) in the UK.

STUDY DESIGN

Retrospective study that used electronic medical records from UK primary care centers.

MAIN OUTCOME MEASURES

The prevalence and incidence of moderate-to-severe VMS, the proportion treated, persistence with initial treatment, treatment patterns, and menopausal hormone therapy (HT) experience were investigated over the study period (Jan. 2009-Dec. 2018). The study population comprised women aged 40-65 years registered at general practitioner clinics. For incident cases, the uptake of pharmacological non-hormonal or hormonal treatment was recorded, which included experience of HT.

RESULTS

Over the 10-year study period, 1,481,646 women were included from the database, among whom there were 313,031 prevalent and 90,434 incident cases of VMS. Annual prevalence and incidence rates were stable over time, with a weighted average of 21.1 % and 15.3 per 1000 person-years, respectively (results varied across age groups). Among women who were incident VMS cases, 32.4 % (29,275) were initially prescribed non-hormonal treatments for a median of 3.9 months, 49.4 % (44,700) were prescribed hormonal treatments for 4.0 months, and 18.2 % (16,459) had no treatment. Approximately one-third of treated women switched between non-hormonal and hormonal treatments. The HT experience results showed that 52.7 % (47,639) of women were HT-eligible, 13.1 % (11,872) were HT-contraindicated (they may or may not have received HT), and 34.2 % (30,923) did not receive HT.

CONCLUSIONS

Variations in prescribed treatment patterns suggest that education may be needed for clinicians and women regarding the potential pharmacological options for treating VMS in the UK.

General and Central Obesity Are Associated With Increased Severity of the VMS and Sexual Symptoms of Menopause Among Chinese Women: A Longitudinal Study

BACKGROUND

Strong evidence has linked overweight and obesity to increased risks of cardiovascular disease and all-cause mortality in Chinese populations. Menopause is considered associated with increased obesity and central body fat distribution. However, the correlation between obesity and menopausal symptoms has not been well studied.

OBJECTIVE

To examine the associations between obesity or abdominal obesity and menopausal symptoms as women progressed from premenopausal to postmenopausal status.

DESIGN

This study included 430 midlife Chinese women who had experienced natural menopause and were followed up for 10 years. Physical examinations and questionnaires should be completed annually. The questionnaires include the Menopause-Specific Quality of Life questionnaire, the Hospital Anxiety and Depression Scale, and other physical and behavioral factors.

RESULTS

Among women who were not obese (n=345) or not abdominal obese (n=372) at baseline, 5.8% and 31.7% became obese or abdominal obese at the recent follow-up visit, respectively. Women at the recent follow-up visit had an increased body mass index (BMI) by 0.14%, and the waist-to-hip ratio (WHR) increased by 5.2% compared with the data at baseline. In multivariate analysis, more frequent hot flashes, moderate/severe bothered vasomotor symptoms (VMS), mild bothered sexual functioning, and less anxiety symptoms were significantly associated with obesity. Increasing age, moderate/severe bothered VMS, and less anxiety symptoms were independently associated with abdominal obesity. Multivariable analysis also showed that less education level is independently associated with both obesity and abdominal obesity.

CONCLUSION

Our findings suggest that the proportion of obesity and abdominal obesity increased gradually during menopause. The increase of abdominal obesity is more rapidly than obesity in middle-aged women. Both obesity and abdominal obesity are related with severe or frequent VMS and anxiety symptoms in Chinese women. Although the proportion of obese women in China is lower than in western countries, the problem of abdominal obesity and related complications cannot be ignored.

Climacteric symptoms more severe in 2010 than in 2000 - experience of Finnish women aged 52-56 years not now or previously on menopausal hormone therapy

OBJECTIVES

To analyze and compare the experience of climacteric symptoms and their associations with sociodemographic and health-related characteristics in two cohorts of Finnish women aged 52-56 years, born ten years apart and not now or previously on menopausal hormone therapy (MHT).

STUDY DESIGN

Nationwide population-based time-trend study with a large number of participants (n = 1986 + 1988).

MAIN OUTCOME MEASURES

The experience of climacteric symptoms was assessed by 12 commonly used menopause-related symptoms.

RESULTS

Women aged 52-56 experienced more moderate or severe symptoms and fewer mild symptoms in 2010 than in 2000. Being unemployed or inactive was associated with more severe symptoms (P = 0.007), but employment status had no effect on the relative odds estimates.

CONCLUSIONS

The influence of the birth cohort and time-period effects as well as work-related factors on the experience of climacteric symptoms in women not now or previously on MHT needs further research, particularly since the change in the experience of symptoms found in this study occurred within only ten years.

Evaluation of Clinical Meaningfulness of Red Clover (Trifolium pratense L.) Extract to Relieve Hot Flushes and Menopausal Symptoms in Peri- and Post-Menopausal Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The meta-analysis presented in this article covered the efficacy of red clover isoflavones in relieving hot flushes and menopausal symptoms in perimenopausal and postmenopausal women. Studies were identified by MEDLINE (PubMed), Embase, and the Cochrane Library searches. The quality of the studies was evaluated according to Cochrane criteria. A meta-analysis of eight trials (ten comparisons) demonstrated a statistically significant reduction in the daily incidence of hot flushes in women receiving red clover compared to those receiving placebo: weighted mean difference (WMD—weighted mean difference) −1.73 hot flushes per day, 95% CI (confidence interval) −3.28 to −0.18; p = 0.0292. Due to 87.34% homogeneity, the performed analysis showed substantive difference in comparisons of postmenopausal women with ≥5 hot flushes per day, when the follow-up period was 12 weeks, with an isoflavone dose of ≥80 mg/day, and when the formulations contained a higher proportion of biochanin A. The meta-analysis of included studies assessing the effect of red clover isoflavone extract on menopausal symptoms showed a statistically moderate relationship with the reduction in the daily frequency of hot flushes. However, further well-designed studies are required to confirm the present findings and to finally determine the effects of red clover on the relief of flushing episodes.

Changes in hot flash experiences and related factors in women with breast cancer

OBJECTIVE

Taiwanese women are younger than women in western countries when diagnosed with breast cancer, and many of them are still menstruating. One of many distressing side effects reported by premenopausal women treated for breast cancer are hot flashes (HFs). The purposes of this study were to identify: (1) the trajectories of hot flash (HF) occurrence, frequency, and interference and (2) potential factors associated with HF changes.

METHODS

Peri- or premenopausal women newly diagnosed with breast cancer scheduled to receive chemotherapy and hormonal therapy were enrolled. HF frequency, HF interference, and other symptoms were measured six times from prechemotherapy to 24 months after chemotherapy. Data were analyzed using hierarchical linear modeling.

RESULTS

A total of 90 women were eligible for the study. The prechemotherapy occurrence rate of HFs was 7.9%, but rapidly increased to 42.5% immediately after chemotherapy. The change curve of HF frequency and interference appeared quadratic, increasing first and slightly decreasing later. At any time point, increased body mass index (BMI) was associated with both higher HF frequency (P = 0.020) and HF interference (P = 0.002), whereas anxiety (P < 0.001) and loss of sexual desire (P = 0.038) were associated with higher HF interference. Six months after completing chemotherapy, premenopausal women reported significantly higher HF frequency than perimenopausal women (P = 0.041).

CONCLUSION

A significant proportion of pre- and perimenopausal women experienced HFs after receiving breast cancer treatment. Our findings on HF trajectories can educate patients newly diagnosed with breast cancer. Special attention should be paid to those with increased body mass index changes and those still regularly menstruating.

Does obesity increase the risk of hot flashes among midlife women?: a population-based study

OBJECTIVE

To evaluate the association between vasomotor symptoms and obesity in climacteric women.

METHODS

We conducted a cross-sectional population-based study of 749 women aged 45 to 60 years. The dependent variable was intensity of menopausal symptoms evaluated by the menopause rating scale questionnaire. Independent variables were sociodemographic and clinical characteristics, and obesity evaluated by body mass index.

RESULTS

There was no significant difference in the majority of clinical and sociodemographic characteristics between the body mass index groups. Obese women had less physical activity (P = 0.019) and a higher prevalence of hypertension (P < 0.001), diabetes (P = 0.002), urinary incontinence (P < 0.001), and urge incontinence (P = 0.0006). The total mean menopause rating scale score was 9.7. Scores for hot flashes increased progressively and were higher for participants with body mass index greater than 30 kg/m (P = 0.027). Joint and muscle pain scores also increased with increased body mass index (P < 0.001). Regarding urogenital symptoms, there was a significant difference in urinary problems only, which were more intense in obese women (body mass index >30 kg/m) (P < 0.0001). There was no significant difference in any psychological symptoms on the menopause rating scale. Factors associated with hot flash scores were higher body mass index, presence of urinary urgency, and vaginal dryness.

CONCLUSIONS

We found that menopausal symptoms, including vasomotor, joint, and urinary symptoms, were related to obesity. Hot flashes were associated with higher body mass index, urinary urgency, and vaginal dryness. Understanding this relationship may contribute to the development of healthcare strategies aimed at minimizing the impact of obesity on several health issues of climacteric women.

Overweight and obesity and factors associated with menopause

This study aims to check the association between overweight and obesity and sociodemographic, behavioral and clinical factors in menopausal women. A cross-sectional study of a sample of 253 menopausal women who answered questions about socioeconomic and demographic factors, health in general, eating habits and behaviors. Body-mass index (BMI) was used to assess participant nutritional status. The Menopause Rating Scale (MRS) was used to assess quality of life. To assess sexual performance we used SQ-F (Sexual Quotient, Female Version). We used bivariate analysis and hierarchical multiple regression to identify the factors associated with being overweight during menopause. Using BMI we found that 30.8% of the sample was overweight and 35.2% obese, totaling 66% overweight women in the sample. In the multiple analysis, not owning a home, the severity of symptoms using MRS, use of continuous use medication and having been on any type of diet were associated with being overweight or obese. Nutritional intervention for weight control and changing behaviors could produce considerable benefits in terms of the health and quality of life of menopausal women.

Risk factors for hot flashes among women undergoing the menopausal transition: baseline results from the Midlife Women's Health Study

OBJECTIVE

The aim of this study was to examine the associations of demographic characteristics, health behaviors, and hormone concentrations with the experience of any, current, more severe, and more frequent midlife hot flashes.

METHODS

Baseline data from 732 women aged 45 to 54 years who were enrolled in the Midlife Women's Health Study were analyzed. A clinic visit was conducted to collect blood samples for hormone assays and to measure ovarian volume using transvaginal ultrasound. A self-administered questionnaire ascertained information on demographic factors, health habits, and hot flash history. Multivariable logistic regression was conducted to examine associations between potential risk factors and hot flash outcomes.

RESULTS

Approximately 45% of participants reported experiencing midlife hot flashes. In covariate-adjusted models, older age, perimenopause status, current and past cigarette smoking, and depressive symptoms were significantly associated with increased odds of all of the hot flash outcomes. In addition, history of oral contraceptive use was associated with increased odds of any hot flashes. In contrast, higher current alcohol intake was significantly associated with decreased odds of any, current, and more severe hot flashes. Higher estradiol and progesterone concentrations were significantly associated with decreased odds of all hot flash outcomes.

CONCLUSIONS

Although the temporality of such associations is not known because of the cross-sectional nature of the data, these observed relationships can help to identify women at risk for hot flashes.

Prevalence and severity of menopause symptoms and associated factors across menopause status in Korean women

OBJECTIVE

The present study investigated the prevalence and severity of menopause symptoms experienced by Korean women aged 44 to 56 years and their associated factors.

METHODS

A cross-sectional study was performed on 2,201 women aged 44 to 56 years in health checkup centers between November 2012 and March 2013. The 29-item Menopause-Specific Quality of Life Questionnaire was used to assess vasomotor, psychosocial, physical, and sexual symptoms related to menopause. The guidelines for the classification of reproductive aging stages proposed at the Stages of Reproductive Aging Workshop were used. Multivariable linear regression analyses were performed to identify factors associated with severity of menopause symptoms.

RESULTS

Among participants, 42.6% were premenopausal, 36.7% were perimenopausal, and 20.7% were postmenopausal. Although physical symptoms were the most severe menopause symptoms experienced by premenopausal and perimenopausal women, postmenopausal women reported sexual symptoms as the most bothersome. The mean scores for each domain increased from the premenopausal period through the postmenopausal period (P for trend < 0.001). The regression model revealed that age (for vasomotor and sexual symptoms) and obesity (for vasomotor and physical symptoms) were significantly associated with severity of menopause symptoms (P < 0.05). Physically active women had fewer severe physical symptoms related to menopause than inactive women.

CONCLUSIONS

Postmenopausal women experience the most severe symptoms. Obesity and physical activity are the main modifiable factors associated with symptom severity. Further studies are needed to examine the effects of physical activity promotion and weight control interventions on preventing menopause symptoms in Korean women.

Ethnic differences in the clusters of menopausal symptoms

Our purpose for this study was to identify clusters of midlife women by menopausal symptoms in a multiethnic sample, and to determine ethnic differences in the clusters. This was a secondary analysis of data from 501 women in a larger Internet study on menopausal symptom experiences. The data were analyzed using factor analysis, hierarchical cluster analysis, and multinominal logistic analysis. A three cluster solution was adopted (F = 575.71, p <.01). The clusters differed significantly in the country of birth and ethnicity (p <.05). Only in the low symptomatic cluster were there significant ethnic differences in menopausal symptoms.