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Yap S, Vassallo A, Goldsbury DE, Salagame U, Velentzis L, Banks E, O'Connell DL, Canfell K, Steinberg J. Accurate categorisation of menopausal status for research studies: a step-by-step guide and detailed algorithm considering age, self-reported menopause and factors potentially masking the occurrence of menopause. BMC Res Notes 2022; 15:88. [PMID: 35246240 PMCID: PMC8895593 DOI: 10.1186/s13104-022-05970-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Menopausal status impacts risk for many health outcomes. However, factors including hysterectomy without oophorectomy and Menopausal Hormone Therapy (MHT) can mask menopause, affecting reliability of self-reported menopausal status in surveys. We describe a step-by-step algorithm for classifying menopausal status using: directly self-reported menopausal status; MHT use; hysterectomy; oophorectomy; intervention timing; and attained age. We illustrate this approach using the Australian 45 and Up Study cohort (142,973 women aged ≥ 45 years). RESULTS We derived a detailed seven-category menopausal status, able to be further consolidated into four categories ("pre-menopause"/"peri-menopause"/"post-menopause"/"unknown") accounting for participants' ages. 48.3% of women had potentially menopause-masking interventions. Overall, 93,107 (65.1%), 9076 (6.4%), 17,930 (12.5%) and 22,860 (16.0%) women had a directly self-reported "post-menopause", "peri-menopause", "pre-menopause" and "not sure"/missing status, respectively. 61,464 women with directly self-reported "post-menopause" status were assigned a "natural menopause" detailed derived status (menopause without MHT use/hysterectomy/oophorectomy). By accounting for participants' ages, 105,817 (74.0%) women were assigned a "post-menopause" consolidated derived status, including 15,009 of 22,860 women with "not sure"/missing directly self-reported status. Conversely, 3178 of women with directly self-reported "post-menopause" status were assigned "unknown" consolidated derived status. This algorithm is likely to improve the accuracy and reliability of studies examining outcomes impacted by menopausal status.
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Affiliation(s)
- Sarsha Yap
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia.
| | - Amy Vassallo
- Cancer Council NSW, Sydney, NSW, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David E Goldsbury
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Usha Salagame
- Centre for Health Record Linkage, Centre of Epidemiology and Evidence, NSW Health, Sydney, Australia
| | - Louiza Velentzis
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Victoria, 3010, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Dianne L O'Connell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Julia Steinberg
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
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Li D, Kong J, Yang Y, Wang S, Wu J, Chao J. Group cognitive behavioural therapy of physical and psychological menopausal symptoms of Chinese women, delivered via Internet and mobile phone versus face to face: A protocol for a randomized non-inferiority trial. Maturitas 2019; 129:23-29. [PMID: 31547909 DOI: 10.1016/j.maturitas.2019.08.005] [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: 05/05/2019] [Revised: 06/05/2019] [Accepted: 08/12/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Menopause syndrome generally includes psychological problems. Group treatment delivered via the Internet and mobile phone (imGT) may improve women's physiological and psychological conditions. OBJECTIVE To investigate the efficacy of group cognitive behavioural therapy of menopause-related mood swings and quality of life, delivered face to face or via the Internet and mobile phone. METHODS This protocol is for a randomized controlled clinical trial with a sample of 140 menopausal women divided into 2 groups: imGT and face-to-face group treatment (ffGT). The primary outcome will be the improvement in the menopausal symptoms of the two groups, as assessed by the Greene Climacteric Scale. The secondary outcomes will be: quality of life, assessed by the Short Form 36 Health Survey Questionnaire; insomnia, assessed by the Pittsburgh Sleep Quality Inventory; anxiety, assessed by the Hamilton Anxiety Rating Scale; and therapeutic alliance, assessed by the Working Alliance Inventory-Short Revised and Client Sat-is-fac-tion Qes-tion-naire-8. imGT will be performed once a week for 1.5 h for 10 weeks with a daily 'Punched-in' on the WeChat app; ffGT will be performed once a week for 1.5 h for 10 weeks. All outcomes will be assessed at baseline, at a post-intervention evaluation (week 10), and at a follow-up evaluation (week 22). DISCUSSION This study will be the first clinical trial to examine the effects of imGT on menopausal women in China. If imGT is found to be non-inferior to ffGT, it will facilitate access to menopausal health services.
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Affiliation(s)
- Dan Li
- Southeast University, China
| | - Jing Kong
- Nanjing Maternity and Child Health Care Hospital, China
| | - Ying Yang
- Nanjing Maternity and Child Health Care Hospital, China
| | - Suli Wang
- Nanjing Maternity and Child Health Care Hospital, China
| | - Jiangping Wu
- Nanjing Maternity and Child Health Care Hospital, China
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Salagame U, Banks E, O’Connell DL, Egger S, Canfell K. Menopausal Hormone Therapy use and breast cancer risk by receptor subtypes: Results from the New South Wales Cancer Lifestyle and EvaluAtion of Risk (CLEAR) study. PLoS One 2018; 13:e0205034. [PMID: 30403669 PMCID: PMC6221262 DOI: 10.1371/journal.pone.0205034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/18/2018] [Indexed: 12/31/2022] Open
Abstract
Breast cancer risk is increased with current Menopausal Hormone Therapy (MHT) use, with higher risks reported for ER+ (Estrogen Receptor positive), and ER+/PR+ (Estrogen and Progesterone Receptor positive) breast cancers than those of ER- and ER-/PR- status, respectively. There is limited evidence to suggest MHT use is associated with the specific subtype characterised as ER+/PR+/HER2- (Estrogen and Progesterone Receptor positive and Human Epidermal growth factor Receptor2 negative) status. This study aims to investigate the MHT-breast cancer relationship for breast cancer tumor receptor subtypes defined by ER expression alone, by ER and PR expression only and by joint expression of ER, PR, and HER2. Analyses compared 399 cancer registry-verified breast cancer cases with receptor status information and 324 cancer-free controls. We used multinomial logistic regression to estimate adjusted odds ratios (aORs) and 95% Confidence Intervals (CI) for current and past versus never MHT use, for subgroups defined by tumor receptor expression. Current, but not past, use of MHT was associated with an elevated risk of ER+ breast cancer (aOR = 2.04, 95%CI: 1.28-3.24) and ER+/PR+ breast cancer (aOR = 2.29, 1.41-3.72). Current MHT use was also associated with an elevated risk of the ER+/PR+/HER2- subtype (aOR = 2.30, 1.42-3.73). None of the other subtypes based on ER, ER/PR or ER/PR/HER2 expression were significantly associated with current MHT use in this analysis. Current, but not past, use of MHT increases the risk of breast cancer, with consistently higher risks reported for ER+ and ER+/PR+ subtypes and mounting evidence regarding the specific ER+/PR+/HER2- subtype. Our findings contribute to quantification of the effects of MHT, and support efforts to articulate the receptor-mediated mechanisms by which MHT increases the risk of breast cancer.
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Affiliation(s)
- Usha Salagame
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
- Sax Institute, Sydney, New South Wales, Australia
| | - Dianne L. O’Connell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sam Egger
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, New South Wales, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, UNSW, Sydney, Australia
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Sandvei MS, Vatten LJ, Bjelland EK, Eskild A, Hofvind S, Ursin G, Opdahl S. Menopausal hormone therapy and breast cancer risk: effect modification by body mass through life. Eur J Epidemiol 2018; 34:267-278. [DOI: 10.1007/s10654-018-0431-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 07/27/2018] [Indexed: 12/28/2022]
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Obesity, physical activity and cancer risks: Results from the Cancer, Lifestyle and Evaluation of Risk Study (CLEAR). Cancer Epidemiol 2017; 47:56-63. [DOI: 10.1016/j.canep.2017.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/19/2016] [Accepted: 01/03/2017] [Indexed: 11/19/2022]
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Bolton JL. Menopausal Hormone Therapy, Age, and Chronic Diseases: Perspectives on Statistical Trends. Chem Res Toxicol 2016; 29:1583-1590. [PMID: 27636306 PMCID: PMC5069683 DOI: 10.1021/acs.chemrestox.6b00272] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Indexed: 02/07/2023]
Abstract
The release of the Women's Health Initiative (WHI) study in 2002 was a shock to the medical community. Hormone therapy (HT) had generally been considered to be highly beneficial for postmenopausal women since it was the gold standard for relief of menopausal symptoms (hot flashes, night sweats, vaginal atrophy) and it was thought to protect women from osteoporosis, heart disease, and cognitive decline and to generally improve quality of life. However, WHI showed a statistically significant increase in a number of disease states, including breast cancer, cardiovascular disease, and stroke. One problem with the WHI study was that the average age of women in the study was 63, which is considerably older than the age at which most women enter menopause (about 51). The timing hypothesis attempts to rationalize the effect of age on response to HT and risk of various diseases. The data suggests that younger women (50-60) may be protected from heart disease with only a slight increase in breast cancer risk. In contrast, older women (>65) are more susceptible to breast cancer and heart disease and should avoid HT. This Perspective on Statistical Trends evaluates the current data on HT and risk for chronic diseases as a function of age.
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Affiliation(s)
- Judy L. Bolton
- Department of Medicinal Chemistry
and Pharmacognosy (M/C 781) College of Pharmacy, University of Illinois at Chicago, 833 S. Wood St., Chicago, Illinois 60612-7231, United States
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Velentzis LS, Banks E, Sitas F, Salagame U, Tan EH, Canfell K. Use of Menopausal Hormone Therapy and Bioidentical Hormone Therapy in Australian Women 50 to 69 Years of Age: Results from a National, Cross-Sectional Study. PLoS One 2016; 11:e0146494. [PMID: 27008039 PMCID: PMC4805183 DOI: 10.1371/journal.pone.0146494] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/17/2015] [Indexed: 11/18/2022] Open
Abstract
Menopausal Hormone Therapy (MHT) use in Australia fell by 55% from 2001 to 2005, following the release of large-scale findings on its risks and benefits. Comprehensive national data, including information on overall prevalence of MHT use as well as information on duration of use in Australia have not been reported since the 2004–5 National Health Survey, when 11% of women aged 45+ years were estimated to be current MHT users. No national data are available on prevalence of use of “bioidentical” hormone therapy (BHT). The objective of this study was to determine recent prevalence of MHT and BHT use. A cross-sectional, national, age-stratified, population survey was conducted in 2013. Eligible women, aged 50–69 years, resident in Australia were randomly sampled in 5-year age groups from the Medicare enrolment database (Australia’s universal health scheme). The response rate was 22% based on return of completed questionnaires, and analyses were restricted to 4,389 women within the specified age range. The estimated population-weighted prevalence of current use of MHT was 13% (95%CI 12–14), which was broadly similar to the previously reported national figures in 2004–5, suggesting that the use of MHT in Australia has largely stabilised over the past decade. A total of 39% and 20% of current-users with an intact uterus reported use of oestrogen-progestagen MHT and oestrogen-only MHT, respectively, whereas 77% of hysterectomised current-users used oestrogen-only MHT. Almost three-quarters of current-users [population-weighted prevalence 9% (95%CI 8–10)] had used MHT for ≥5 years. In regard to BHT, estimated population-weighted prevalence of ever use was 6% (95%CI 6–7) and 2% (95%CI 2–3) for current use. The population-weighted prevalence of MHT and BHT combined, in current users in their fifties and sixties was 15% (95%CI 14–16). These data provide a recent national “snapshot” of Australian women’s use of both conventional MHT and of BHT.
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Affiliation(s)
- Louiza S. Velentzis
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- * E-mail:
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Freddy Sitas
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Usha Salagame
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
| | - Eng Hooi Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- School of Public Health, University of Sydney, Sydney, NSW, Australia
- Lowy Cancer Research Centre, University of New South Wales, Sydney, NSW, Australia
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