A model of care for healthy menopause and ageing: EMAS position statement

Challenges and Implications for Menopausal Health and Help-Seeking Behaviors in Midlife Women From the United States and China in Light of the COVID-19 Pandemic: Web-Based Panel Surveys

BACKGROUND

The global population of women of menopausal age is quickly increasing. The COVID-19 pandemic has led to an accelerated increase in the use of telehealth services, especially technological solutions targeting women's health. Understanding the factors behind midlife women's help-seeking behaviors amidst the pandemic will assist in the development of person-centered holistic telehealth solutions targeting menopausal and postreproductive health.

OBJECTIVE

This study aimed to compare the factors underlying help-seeking for menopausal distress among midlife women in the United States and China.

METHODS

We conducted 2 web-based panel surveys in the United States using Amazon Mechanical Turk and in China using Credamo between July and October 2022. A total of 1002 American and 860 Chinese women aged between 40 and 65 years took part in the survey. The survey was designed based on the Health Belief Model with questions related to their menopausal knowledge, perceived severity of menopausal symptoms, perceived susceptibility to menopausal distress, perceived benefits of help-seeking, perceived COVID-19- and non-COVID-19-related barriers against help-seeking, self-efficacy, and motivation to seek help. Structural equations models were fitted for the data using full information maximum likelihood to manage missing data.

RESULTS

Knowledge was not directly related to help-seeking motivation in both samples. Among the Chinese sample, knowledge was negatively related to perceived severity but positively related to COVID-19-related barriers; in turn, higher perceived severity, benefits, COVID-19-related barriers, and self-efficacy and lower non-COVID-19-related barriers were related to more motivation to seek help. In the US sample, knowledge was negatively related to perceived severity, susceptibility, benefits, barriers (COVID-19- and non-COVID-19-related), and self-efficacy; in turn, higher self-efficacy, COVID-19-related barriers, and benefits were associated with more help-seeking motivation. The factors explained 53% and 45.3% of the variance of help-seeking motivation among the American and Chinese participants, respectively.

CONCLUSIONS

This study revealed disparate pathways between knowledge, health beliefs, and the motivation for help-seeking among American and Chinese midlife women with respect to menopausal distress. Our findings show that knowledge may not directly influence help-seeking motivation. Instead, perceived benefits and self-efficacy consistently predicted help-seeking motivation. Interestingly, concern over COVID-19 infection was related to higher help-seeking motivation in both samples. Hence, our findings recommend the further development of telehealth services to (1) develop content beyond health education and symptom management that serves to enhance the perceived benefits of addressing women's multidimensional menopausal health needs, (2) facilitate patient-care provider communication with a focus on self-efficacy and a propensity to engage in help-seeking behaviors, and (3) target women who have greater midlife health concerns in the postpandemic era.

Menopause: Questions and Answers for Improving Homeopathic Clinical Practice

BACKGROUND

Medical attention for menopausal women is frequently delivered by health care providers (general practitioners, gynecologists or homeopathic physicians) who are not specialized in post-reproductive care. Homeopathy has been used for treating menopausal complaints for more than two centuries. Therefore, it is important to improve clinical knowledge in this field among homeopathic physicians. Nowadays, there is a special interest in the study of menopause-related chronic conditions due to the impact on women's quality of life. The aim of this review is to address the important key points of the menopause, clinical assessment, and available tests for evaluating menopausal women, as well as some general topics regarding homeopathic clinical practice for menopause.

METHODS AND RESULTS

A literature search regarding menopause and current guidelines and recommendations was performed. To be practical and concise, the information is presented in the form of questions and answers. Currently, there is an international classification of woman's reproductive aging that can be useful for clinical and research purposes in homeopathy. A comprehensive homeopathic approach is mandatory for evaluating women with a healthy menopause, but also for those experiencing co-morbidities. In an integrative health care system, several assessment resources can be incorporated into the homeopathic consultations. Clinical and laboratory examinations for detecting metabolic disorders (dyslipidemia, insulin resistance, diabetes and hypertension, among others), mood disorders, cognitive impairment and osteoporosis are available in many clinical settings. Screening for gynecological cancers is an international recommendation at this stage. All data obtained from homeopathic consultations would help to integrate well-documented case reports. This would give the possibility to generate hypotheses to design high-quality clinical research.

CONCLUSION

Improving homeopathic clinical practice for menopause is useful for both clinical and research purposes. The international recommendations for evaluating menopausal women should be incorporated in homeopathic clinical practice, mainly in clinical settings where homeopathy is integrated in outpatient services.

Quality of life in heterosexual menopausal women: The indirect effect of sexual and marital satisfaction, menopause representations, and psychological morbidity

Menopause may negatively impact Quality of Life (QoL). Our study used a cross-sectional design and research participants were 99 women in natural menopause. In our study, we analyzed the relationship between age at menopause onset, hormone therapy use, duration of couple relationship, menopause duration, psychological morbidity, marital satisfaction, menopause representations, and QoL following the Wilson and Cleary Health-Related QoL conceptual model. The authors found that negative representations, lower marital satisfaction, psychological morbidity, and shorter duration of menopause contributed to lower QoL. Moreover, the authors found that psychological morbidity and menopause representations (identity and control/cure dimensions) had an indirect effect between marital satisfaction and vasomotor, psychosocial, and sexual QoL. Also, we found that age at the onset of menopause showed a moderating effect in the final model. Future studies should replicate these results in a longitudinal design and analyze how the variables that showed a moderating role and indirect effects will function as moderators and mediators, respectively, over time.

Changes in Food Consumption in Postmenopausal Women during the COVID-19 Pandemic: A Longitudinal Study

Studying the dietary habits and symptoms of postmenopausal women during situations such as the COVID-19 pandemic is important to mitigate long-term post-pandemic health problems. We compared the menopausal symptoms and food consumption in postmenopausal women before and during the COVID-19 pandemic. A longitudinal survey was conducted on postmenopausal Brazilian women between 2018 and 2021. The Kupperman-Blatt Menopausal Index, Women's Health Questionnaire, and 24 h food recall were used. Of 274 women, 78 (28.5%) participated in the study during the COVID-19 pandemic. The intensity of the symptoms was lower during the pandemic than during the previous period (p < 0.05). Energy and processed food consumption were lower during the pandemic than before (p = 0.003 and p = 0.003, respectively). Milk and plain yogurt consumption were also lower (p = 0.043), while the consumption of sugar-sweetened beverages and sweet foods was higher (p = 0.007 and p = 0.001, respectively) during the pandemic. There was also a decrease in the consumption of proteins and lipids (p = 0.001 and p = 0.004, respectively). In conclusion, we found that postmenopausal women consumed sweet foods and sugar-sweetened beverages in higher quantities and had a lower consumption of milk and plain yogurt and processed foods during the pandemic than during the pre-pandemic period. Furthermore, decreases in energy and macronutrient consumption were observed.

Cerebral arteriolar and neurovascular dysfunction after chemically induced menopause in mice

Cognitive decline is linked to decreased cerebral blood flow, particularly in women after menopause. Impaired cerebrovascular function precedes the onset of dementia, possibly because of reduced functional dilation in parenchymal arterioles. These vessels are bottlenecks of the cerebral microcirculation, and dysfunction can limit functional hyperemia in the brain. Large-conductance Ca2+-activated K+ channels (BKCa) are the final effectors of several pathways responsible for functional hyperemia, and their expression is modulated by estrogen. However, it remains unknown whether BKCa function is altered in cerebral parenchymal arterioles after menopause. Using a chemically induced model of menopause, the 4-vinylcyclohexene diepoxide (VCD) model, which depletes follicles while maintaining intact ovaries, we hypothesized that menopause would be associated with reduced functional vasodilatory responses in cerebral parenchymal arterioles of wild-type mice via reduced BKCa function. Using pressure myography of isolated parenchymal arterioles, we observed that menopause (Meno) induced a significant increase in spontaneous myogenic tone. Endothelial function, assessed as nitric oxide production and dilation after cholinergic stimulation or endothelium-dependent hyperpolarization pathways, was unaffected by Meno. BKCa function was significantly impaired in Meno compared with control, without changes in voltage-gated K+ channel activity. Cerebral functional hyperemia, measured by laser-speckle contrast imaging during whisker stimulation, was significantly blunted in Meno mice, without detectable changes in basal perfusion. However, behavioral testing identified no change in cognition. These findings suggest that menopause induces cerebral microvascular and neurovascular deficits.NEW & NOTEWORTHY Cerebral parenchymal arterioles from menopause mice showed increased myogenic tone. We identified an impairment in smooth muscle cell BKCa channel activity, without a reduction in endothelium-dependent dilation or nitric oxide production. Microvascular dysfunction was associated with a reduction in neurovascular responses after somatosensory stimulation. Despite the neurovascular impairment, cognitive abilities were maintained in menopausal mice.

Life habits of postmenopausal women: Association of menopause symptom intensity and food consumption by degree of food processing

OBJECTIVE

To evaluate in postmenopausal women the association between menopause symptom intensity and the quality of life and clinical, anthropometric, and lifestyle factors, focusing on food consumption by degree of processing.

STUDY DESIGN

A cross-sectional study of 288 postmenopausal women using interviews.

MAIN OUTCOME MEASURES

The Kupperman-Blatt Menopausal Index and the Women's Health Questionnaire were used to evaluate the main outcomes of menopausal symptom intensity and quality of life, respectively. Data on socioeconomic, clinical, anthropometric, and lifestyle variables (smoking, alcohol intake, physical activity, and food consumption) were collected.

RESULTS

Most women had moderate to severe intensity of menopausal symptoms. The highest tertile of ultra-processed food consumption was associated with a greater intensity of vasomotor symptoms (prevalence ratio [PR] 0.73, 95% confidence intervals [CI] 0.55-0.96) and sexual behavior (PR 1.22, CI 1.01-1.49). Higher intakes of sugar-sweetened beverages and sausages were associated with somatic symptoms (PR 1.23, CI 1.01-1.49) and poorer memory/concentration (PR 1.22, CI 1.02-1.47/ PR 1.22, CI 1.01-1.48). The highest tertile of vegetable intake was associated with greater protection against depressive mood (PR 0.64, CI 0.43-0.96), vasomotor symptoms (PR 0.79, CI 0.63-0, 99), and sleep disorders (PR 0.83, CI 0.69-0.99), and better quality of life (PR 0.79, CI 0.62-0.99).

CONCLUSION

More intense vasomotor, sexual, somatic, and memory and concentration symptoms are associated with a higher consumption of ultra-processed foods, whereas those with a higher consumption of vegetables reported lower menopause symptom intensity and a better quality of life.

Cognitive health after menopause: Does menopausal hormone therapy affect it?

Dementia is a pandemic chronic non-communicable disease. 10 in 100 women above age 65 will be diagnosed with dementia, primarily Alzheimer's disease (AD). Apart from age and hereditary risk factors, there are multiple acquired risk and protective factors. So far, Menopausal Hormone Therapy (MHT) is not recommended as preventive measure. A systematic literature search on MHT and dementia risk and MHT and cognitive performance in demented women, respectively, was performed. Two recent meta-analyses identified 18 and 16 studies analyzing the impact of MHT on dementia/AD risk. Our systematic literature search identified eight additional original articles. The majority of studies found a risk reducing impact of MHT by 11-33%. However, results may vary depending on MHT type, age at initiation and study design. For example, the Women's Health Initiative Memory Study (WHIMS) reported an approximately 2-fold increased risk of dementia/Alzheimer's disease if MHT comprising conjugated equine estrogens and medroxyprogesterone acetate was initiated in predominantly comorbid postmenopausal women above age 65. In general, MHT displays a beneficial effect on several dementia risk factors and also augments some protective factors. Accordingly, clinicians can be reassured that MHT can be safely prescribed in the context of cognition in women free of dementia. However, MHT is not indicated for cognitive improvement in demented women. International scientific guidelines on MHT and dementia should consider incorporating most recent data.

'As long as I have a restroom somewhere […], I am fine': a qualitative study on the perspectives of peri- and postmenopausal women on the impact of the urinary component of the genitourinary syndrome of menopause (GSM)

BACKGROUND

Our aim was to gain insight into the experiences of women suffering from the urinary component of the Genitourinary Syndrome of Menopause (GSM) and to understand the impact of urinary complaints as part of GSM on the lives of affected women.

DESIGN

Qualitative study.

SETTING

Online, primary care.

PARTICIPANTS AND METHODS

Postmenopausal women aged from 46 to 85 years reporting vaginal and urinary complaints were recruited to participate in either online or face-to-face focus groups to share their experiences with urinary complaints as part of GSM. Transcripts of sessions were analysed using qualitative content analysis.

RESULTS

One online focus group, one face-to-face focus group and one online-interview were conducted, involving 11 women. Five a priori assumed main themes related to the impact of urogenital symptoms were identified: daily life, emotional well-being, sexual functioning, self-concept and body image, and interpersonal relations and communication. Additionally, two further themes associated with GMS as a clinical condition were inductively found: unmet healthcare needs, including expectations of affected women regarding menopausal symptoms and a lack of adequate health education, and aspects on the personal dealing with the complaints, including personal coping strategies and medical treatment.

CONCLUSIONS

This study showed that urinary complaints as part of GSM have, similar to vaginal complaints, negative impacts on the daily life, the emotional well-being, the sexual functioning, the self-concept and body impact as well as interpersonal relations and communication of affected women. We further identified several unmet healthcare needs that should trigger improvements in healthcare.

Postmenopausal women in gynecological care

Menopause is one of the most important events in the female reproductive life cycle, being a transition from the reproductive to the nonreproductive stage. It is a milestone that may have a negative influence on quality of life and one that brings in several physiological changes that affect the life of a woman permanently. According to a Polish epidemiological forecast, in 2050 the average female life expectancy will be 87.5, which is 6.4 years longer than today. Thus, the life expectancy of women who will be 60 or older in 2050 will also extend. Therefore, strategies need to be optimized to maintain postreproductive health, in part because of increased longevity. The general gynecologist can expect to see more elderly female patients as the population continues to age. Office management of the gynecologic problems of geriatric women requires sensitivity to the special needs of this group. Nowadays, most women spend more than one-third of their lives after menopause; therefore there is plenty of opportunity for gynecologists to cater to the needs of postmenopausal women. It is in their scope of practice to help postmenopausal women through "healthy aging". In this review we look into screenings, early identification, lifestyle modifications and appropriate intervention that may prevent many chronic conditions that cause morbidity and mortality during the postmenopausal years.

Progestogens as a component of menopausal hormone therapy: the right molecule makes the difference

Optimizing menopausal hormone therapy (MHT) requires an awareness of the benefits and risks associated with the available treatments. This narrative review, which is based on the proceedings of an Advisory Board meeting and supplemented by relevant articles identified in literature searches, examines the role of progestogens in MHT, with the aim of providing practical recommendations for prescribing physicians. Progestogens are an essential component of MHT in menopausal women with a uterus to prevent endometrial hyperplasia and reduce the risk of cancer associated with using unopposed estrogen. Progestogens include natural progesterone, dydrogesterone (a stereoisomer of progesterone), and a range of synthetic compounds. Structural differences and varying affinities for other steroid receptors (androgen, glucocorticoid, and mineralocorticoid) confer a unique biological and clinical profile to each progestogen that must be considered during treatment selection. MHT, including the progestogen component, should be tailored to each woman, starting with an estrogen and a progestogen that has the safest profile with respect to breast cancer and cardiovascular effects, while addressing patient-specific needs, risk factors, and treatment goals. Micronized progesterone and dydrogesterone appear to be the safest options, with lower associated cardiovascular, thromboembolic, and breast cancer risks compared with other progestogens, and are the first-choice options for use in ‘special situations,’ such as in women with high-density breast tissue, diabetes, obesity, smoking, and risk factors for venous thromboembolism, among others.

Developing an ICF Core Set for Climacteric Syndrome based on the International Classification of Functioning, Disability and Health (ICF)

BACKGROUND

The International Classification of Functioning, Disability and Health (ICF) provides a globally accepted framework for the assessment of problems in functioning in relation to health conditions. ICF Core Sets are internationally accepted shortlists of the most relevant and essential ICF categories that can be used to assess and document the functioning of patients living with specific health conditions.

OBJECTIVES

The objective of this paper is to outline the process of developing an ICF Core Set for Climacteric Syndrome.

STUDY DESIGN

The development of an ICF Core Set follows an established, evidence-based process and will produce a comprehensive and a brief version of the ICF Core Set. The process includes four preliminary studies: 1) a systematic literature review; 2) a multi-center, cross-sectional study in a clinical setting with women 40+ years old; 3) an online expert survey with health professionals involved in caring for the health of women with climacteric syndrome; and 4) a qualitative study with focus groups of women 40+ years old. The results will be integrated at an international consensus conference, where it will be decided which ICF categories will be included in the ICF Core Set for Climacteric Syndrome.

CONCLUSION

An ICF Core Set for Climacteric Syndrome could provide a holistic assessment of limitations in peri- and post-menopausal women and integrate the psycho-social perspective into health care practice. It could further facilitate communication between health care providers, be useful for research and teaching, and support both the transparency and the comparability of information.

Chronic non-communicable disease risk calculators - An overview, part I

This review identifies the different risk assessment tools that stratify the individual's risk of four of the eight leading causes of death in women: breast cancer, lung cancer, colorectal cancer and osteoporosis. It will be followed by the publication of a second paper that summarizes the risk assessment tools for the other four leading causes of death (myocardial infarction, stroke, diabetes mellitus type 2 and dementia). The different tools were compared by their use of different variables and validation criteria. To corroborate the validation process, validation study papers were considered for each risk assessment tool. Four tables, one for each illness, were designed. The tables provide an outline for each risk assessment tool, which includes its inventor/company, required variables, advantages, disadvantages and validity. These tables simplify the comparison of the different tools and enable the identification of the most suitable one for each patient.

Management of depressive symptoms in peri- and postmenopausal women: EMAS position statement

INTRODUCTION

Globally, the total number of people with depression exceeds 300 million, and the incidence rate is 70 % greater in women. The perimenopause is considered to be a time of increased risk for the development of depressive symptoms and major depressive episodes.

AIM

The aim of this position statement is to provide a comprehensive model of care for the management of depressive symptoms in perimenopausal and early menopausal women, including diagnosis, treatment and follow-up. The model integrates the care provided by all those involved in the management of mild or moderate depression in midlife women.

MATERIALS AND METHODS

Literature review and consensus of expert opinion.

SUMMARY RECOMMENDATIONS

Awareness of depressive symptoms, early detection, standardized diagnostic procedures, personalized treatment and a suitable follow-up schedule need to be integrated into healthcare systems worldwide. Recommended treatment comprises antidepressants, psychosocial therapies and lifestyle changes. Alternative and complementary therapies, although widely used, may help with depression, but a stronger evidence base is needed. Although not approved for this indication, menopausal hormone therapy may improve depressive symptoms in peri- but not in postmenopausal women, especially in those with vasomotor symptoms.

Linking the menopause rating scale to the International classification of functioning, disability and health - A first step towards the implementation of the EMAS menopause health care model

OBJECTIVES

To link the Menopause Rating Scale (MRS-II) to the International Classification of Functioning, Disability and Health (ICF) and present a clinical application of an ICF-based tool.

STUDY DESIGN

The MRS-II was linked to the corresponding ICF category. The linked items were used to generate an ICF Categorical Profile. To broadly examine its feasibility in clinical practice, qualitative interviews with three patients were performed.

MAIN OUTCOME MEASURES

Corresponding items of the MRS-II in the ICF. Perception of the ICF Categorical Profile from patients' perspective.

RESULTS

A total of 44 concepts from the MRS-II were identified that could be linked to 24 different ICF categories, which all belonged to the component Body Functions. From patients' perspective, filling in the ICF Categorical Profile helped to structure their goals but did not improve the overview of symptoms.

CONCLUSIONS

The ICF Categorical Profile could be a valuable tool in menopause healthcare; however, it is necessary to adapt the ICF for this specific use. An ICF Core Set needs to be developed in order to accomplish the goal of the European Menopause and Andropause Society and implement its Healthy Menopause Health Care Model in daily practice.