Efficacy of pharmacological and non-pharmacological interventions on low sexual interest/arousal of peri- and post-menopausal women: a meta-analysis

What should we be studying? Research priorities according to women and gender-diverse individuals with sexual interest/arousal disorder and their partners

BACKGROUND

Sexual interest/arousal disorder (SIAD) is one of the most common sexual problems for women. In clinical research, there are often misalignments between the research priorities of patients and researchers, which can negatively impact care, and gender-diverse individuals are often excluded from research. Inclusion of patient perspectives when establishing research priorities may help to reduce these gaps; however, the research priorities of couples coping with SIAD remain unclear.

AIM

Identify the research priorities of women and gender-diverse individuals with SIAD and their partners.

METHODS

In an online survey, couples coping with SIAD provided consent and responded to an open-ended question asking them to list the top 3 things they think are important for researchers to focus on related to couples coping with low sexual desire. A team-based content analysis was conducted to identify themes and their frequency of endorsement.

OUTCOMES

An author-developed open-ended question.

RESULTS

Analysis of 1279 responses (n = 667 from women and gender-diverse individuals with SIAD, n = 612 from partners) resulted in our identification of 6 main themes: general causes, general treatment and coping, biophysiological, relationship, psychological, and environmental/contextual. Additionally, we identified 4 sub-themes within each of the latter 4 main themes: general, cause, treatment, and impact. For women and gender-diverse individuals with SIAD, their partners, and specifically gender-diverse participants, the 3 most endorsed themes were psychological general factors (24.3%, 21.2%, 24.3%; eg, stress and the link between SIAD and anxiety), relationship general factors (15.7%, 13.2%, 18.6%; eg, relationship length and communication on sexual desire), and biophysiological general factors (12.3%, 12.4%, 14.3%; eg, research on medications and hormones).

CLINICAL IMPLICATIONS

Clinical researchers should consider the research priorities of couples coping with SIAD to ensure their work aligns with the needs of the affected population.

STRENGTHS AND LIMITATIONS

This study is the first to identify the research priorities of both women and gender-diverse individuals with SIAD and their partners. Most participants identified as heterosexual, North American, and of middle to high socioeconomic status; results may not generalize. Responses were sometimes brief and/or vague; interpretation of these responses was therefore limited and may have required more contextual information.

CONCLUSION

Findings suggest that women and gender-diverse individuals with SIAD, their partners, and gender-diverse participants have similar research priorities that are consistent with a biopsychosocial approach to research. Heterogeneity of responses across themes supports a multidisciplinary, patient-oriented approach to SIAD research.

The Use of Nigella sativa in Cardiometabolic Diseases

Nigella sativa L. is an herb that is commonly used in cooking and in traditional medicine, particularly in Arab countries, the Indian subcontinent, and some areas of eastern Europe. Nigella sativa is also called "black cumin" or "black seeds", as the seeds are the most-used part of the plant. They contain the main bioactive component thymoquinone (TQ), which is responsible for the pleiotropic pharmacological properties of the seeds, including anti-oxidant, anti-inflammatory, anti-hypertensive, anti-hepatotoxic, hypoglycemic, and lipid-lowering properties. In this narrative review, both the potential mechanisms of action of Nigella sativa and the fundamental role played by pharmaceutical technology in optimizing preparations based on this herb in terms of yield, quality, and effectiveness have been outlined. Moreover, an analysis of the market of products containing Nigella sativa was carried out based on the current literature with an international perspective, along with a specific focus on Italy.

Comparison of predictive effect of the dietary inflammatory index and empirically derived food-based dietary inflammatory index on the menopause-specific quality of life and its complications

INTRODUCTION

Menopause, defined as the cessation of menstruation for at least 12 months, is one of the important stages of a woman's life cycle. Some hormonal variations occur during the transition to menopause, which affects women's quality of life. Recently, the role of dietary factors in alleviating symptoms has been investigated.

AIM OF THIS STUDY

We tried to investigate the relationship between dietary inflammatory index (DII), food-based dietary inflammatory index (FDII) and quality of life, and menopausal symptoms, comparing their predictive power and suggesting the best cut-off point.

METHODOLOGY

One hundred forty-nine postmenopausal women were included in the cross-sectional study. After collecting data by interview, the desired variables were calculated. Logistic regression and ROC curves were used to investigate the relationship and predictive power of DII and FDII with menopausal symptoms.

FINDINGS

We observed that both DII and FDII were significantly associated with the severity of sexual symptoms. The first tertile of DII (OR = 0.252, P-value = 0.002) and FDII (OR = 0.316, P-value = 0.014) had a significantly lower odds ratio for severe to moderate symptoms compared to the third tertile. Both inflammatory indices had significant predictive power in predicting the probability of having severe to moderate poor quality of life (FDII (p-value = 0.004) > DII (p-value = 0.006)) and sexual symptoms (DII (p-value = 0.002) > FDII (p-value = 0.003)). Also, regarding the physical subtype, only FDII (p-value = 0.002) results were significant.

CONCLUSION

Both dietary inflammatory indices appear to be suitable for predicting quality of life, but FDII had slightly more predictive power. It seems that the quality of life and severity of menopausal symptoms may be improved, particularly with regard to sexual symptoms, by following an anti-inflammatory diet.

Comparison of predictive effect of the dietary inflammatory index and empirically derived food-based dietary inflammatory index on the menopause-specific quality of life and its complications

INTRODUCTION

Menopause, defined as the cessation of menstruation for at least 12 months, is one of the important stages of a woman's life cycle. Some hormonal variations occur during the transition to menopause, which affects women's quality of life. Recently, the role of dietary factors in alleviating symptoms has been investigated.

AIM OF THIS STUDY

We tried to investigate the relationship between dietary inflammatory index (DII), food-based dietary inflammatory index (FDII) and quality of life, and menopausal symptoms, comparing their predictive power and suggesting the best cut-off point.

METHODOLOGY

One hundred forty-nine postmenopausal women were included in the cross-sectional study. After collecting data by interview, the desired variables were calculated. Logistic regression and ROC curves were used to investigate the relationship and predictive power of DII and FDII with menopausal symptoms.

FINDINGS

We observed that both DII and FDII were significantly associated with the severity of sexual symptoms. The first tertile of DII (OR = 0.252, P-value = 0.002) and FDII (OR = 0.316, P-value = 0.014) had a significantly lower odds ratio for severe to moderate symptoms compared to the third tertile. Both inflammatory indices had significant predictive power in predicting the probability of having severe to moderate poor quality of life (FDII (p-value = 0.004) > DII (p-value = 0.006)) and sexual symptoms (DII (p-value = 0.002) > FDII (p-value = 0.003)). Also, regarding the physical subtype, only FDII (p-value = 0.002) results were significant.

CONCLUSION

Both dietary inflammatory indices appear to be suitable for predicting quality of life, but FDII had slightly more predictive power. It seems that the quality of life and severity of menopausal symptoms may be improved, particularly with regard to sexual symptoms, by following an anti-inflammatory diet.

Improved couple satisfaction and communication with marriage and relationship programs: are there gender differences?-a systematic review and meta-analysis

BACKGROUND

The aspects of marriage and relationship and their effect on couples' satisfaction are essential and critical aspects to be explored in this globalized and contemporary world. Since there are no reported meta-analysis and systematic reviews conducted in the last two decades in this area, we aimed to investigate the effect of marriage and relationship programs (MRP) on couples' relationship satisfaction (CRS) and couples' relationship communication (CRC) and also to determine the gender differences if any.

METHOD

In this systematic review and meta-analysis, the randomized clinical trials (RCTs) published between 2000 and July 26, 2019, were retrieved from several online electronic databases such as Medline, Embase, ProQuest, and Cochrane Library. Inclusion and exclusion criteria were developed using the PICO (Population, Intervention, Comparison, Outcome) framework of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The mean differences (MDs) and 95% confidence intervals (CIs) were calculated. The reported summary statistics were calculated as random effects models based on the heterogeneity between the studies model. Funnel plots and the Egger regression test was used to confirm the presence of any publication bias.

RESULTS

Of the total 12 intervention studies included, five (5) are education/communication skills programs, three (3) enrichment programs, and four (4) therapy programs. The impact of these programs was investigated on CRS and CRC. Therapy programs had a larger effect than other programs (pooled MD: 0.53 (95% CI = 0.35 to 0.71, I² = 71.5% p = 0.0001) and had a larger effect size on wives (pooled MD: 0.53 (95% CI 0.25 to 0.80, I² = 74.1% p = 0.0001) than husbands RS (pooled MD: 0.26 (95% CI 0.25 to 0.76, I² = 72.4% p = 0.0001). In RC (relationship communication) area, the Enhancement programs showed the small to large effect on CRC (pooled MD: 1.31 (95% CI = 0.13 to 2.50, I² = 94.7% p = 0.0001)) and educational programs showed small to medium effect (pooled MD: 0.32 (95% CI = 0.13 to 0.50, I² = 74.5% p = 0.0001) on women and no effect on men.

CONCLUSION

Due to the high effect of the therapy programs on CRS and enhancement program on CRC in the current meta-analysis, the priority of their utilizations in interventions, especially by psychologists and mental health professionals, should be emphasized. Therefore, mental health planning in communities to develop MRP and care for couples' health should be given special attention to men's health. Due to the high heterogeneity of the results and with scanty literature in this specific domain, we are uncertain about their actual effect. However, well-designed RCTs with a larger sample size would be beneficial in closely examining the effect of MRPs on CRS and CRC.

An Interventional strategy of physical activity promotion for reduction of menopause symptoms

Background: Physical activity (PA) programs are inexpensive, non-pharmaceutical and universally accessible options with demonstrated efficacy in reducing menopausal symptoms. The purpose of this study was to determine the effectiveness of a behavioral strategy for initiating and sustaining PA with the hope to reduce or eliminate menopausal symptoms.

Methods : Menopausal and perimenopausal women (n=190) were randomly assigned to intervention (n=95) and non-intervention (n=95) groups using a random-numbers table. The intervention group consisted of 18 neighborhood network subgroups, each consisting of five to six women known to one another. They participated in a 12-week regular PA program, augmented by eight interactive group education and discussion sessions. The Menopause Rating Scale (MRS) self-report instrument was used to determine perceived severity of menopausal symptoms.

Results: The intervention group showed a significant reduction in the frequency and severity of menopausal symptoms (P < 0.001). Those whose symptoms rated severe/very severe for hot flushes were reduced from 30.1% to 11.8%. Also, participants whose sleep problems and joint discomfort rated severe/very severe declined from 28% to 6.5% and joint discomfort rated severe or very severe was reduced from 52.7% to 4.4%, respectively. Conversely in the nonintervention group, hot flushes, sleep problems and joint problems got significantly worse(P < 0.05).

Conclusion: Implementing educational program that increases awareness of PA benefits in combination with existing neighborhood networks that facilitate communication and cooperation may increase PA levels and decrease menopausal symptoms. Such networks offer alow-cost means of improving quality of life (QOL) for perimenopausal and menopausal women.

The Persian Version of Menopause Rating Scale (MRS): A Psychometric Study

Objective

Menopause-related symptoms can strongly affect health-related quality of life (HRQOL) in most peri-menopausal women. The aim of the present study was to explore the psychometric properties of a culturally adapted and translated Persian version of the Menopause Rating Scale (MRS).

Study Design

The study was conducted on a random sample of 270 middle-aged women (age range 40-60 yrs) selected from 25 urban health service centers across Tabriz, Iran. Content validity was evaluated by a panel of 11 experts. Construct validity was assessed by exploratory factor analyses with Varimax rotation and principal axis factoring extraction method and by confirmatory factor analyses. Internal consistency and test-retest reliability were assessed with Cronbach's alpha and intra-class correlation coefficient (ICC), respectively. In addition, the feasibility of the measure was judged based on ceiling and floor effects.

Results

Content validity of the measure was good with a mean content validity index (CVI) and mean content validity ratio (CVR) of 0.88 and 0.94, respectively. Exploratory factor analyses identified three factors accounting for 47.69% of the variance. Confirmatory factor analyses found the original three-factor model to have the best fit to the data. Cronbach's alpha coefficient (0.85) and the test-retest reliability score (0.91) indicated good internal consistency.

Conclusion

The Persian version of the MRS demonstrated excellent reliability and validity. It can therefore be used in both clinical and research settings to assess menopause-related symptoms and associated quality of life.

Psychological well-being and happiness among Middle-aged women: A cross-sectional study

Biological, physical, and psychosocial changes that occur during the aging process can negatively impact women's mental health and happiness at midlife. In this cross-sectional study, we aimed to determine the level of psychological well-being and happiness among middle-aged women in Tabriz. Data were collected from December 2017 to February 2018 by face-to-face interviews, using structured questionnaires of happiness and psychological well-being. The participants were 40-60-year-old middle-aged women (n = 300) selected by clustered random sampling allocation. A total of 167 (55.7%) out of all the women had decreased levels of psychological well-being. Psychological well-being was found to be significantly lower among the women with low levels of happiness (B: 24.43, CI (18.57 to 30.29), p < 0.001). Health care centers should implement more comprehensive mental health promotion programs for middle-aged women, including free of charge recreational opportunities (e.g., walking, swimming, dancing) to improve psychological health and well-being.

A Randomized Trial of a Relationship-Enhancement Approach in Improving Marital Intimacy in Middle-Aged Iranian Couples

The purpose of this study was to evaluate the effects of a relationship enhancement education and counseling (REEC) program on improving middle-aged couples' marital intimacy. The randomized controlled trial study was conducted in Tabriz, Iran, from May to December 2017. Thirty-two married couples, attending a public health center and meeting the inclusion criteria, were randomly assigned to the intervention (receiving REEC) and control (receiving routine care) groups. The outcome measures were marital intimacy, sexual motivation, and sexual function. Data were collected at three points in time. The Statistical Package for the Social Sciences was used for the purpose of data analysis. In all analyses, the interventional group outperformed the control group on all outcome measures. In the intervention group, results showed statistically significant improvement in all variables of interest after one week and 12 weeks in comparison with preintervention. Upon the completion of the experimentation, it can be concluded that a REEC program positively affects marital intimacy, sexual function, and sexual motivation in middle-aged couples.

Sexual motivations during the menopausal transition among Iranian women: a qualitative inquiry

BACKGROUND

Women's sexuality may be adversely affected during the menopausal transition. This exploratory qualitative study was conducted to explore how women assign meaning to and process sexual motivation during the menopausal transition.

METHODS

We purposefully approached 22 married women ages 44-59 (52.81 ± 3.6 years) in urban health care centers and workplaces in Tabriz city, located in northwest Iran. Individual face-to-face interviews were performed at a place and time convenient to the women. All interviews were audio recorded and then transcribed to create verbatim written accounts. Inspiring Graneheim and Lundman approach, we employed conventional content analysis to derive coding categories directly from our row data.

FINDINGS

Four main themes emerged from data analysis: "Diminished sexual capacity" (effect of menopause, Illnesses associated with mid-life, desire discrepancy); "intimate coupling" (lack of physical and/or emotional intimacy, couple communication and romance); "sociocultural scripts" (sexual script, parental responsibilities); and "sense of youthfulness" (having an active and happy life, maintaining physically attractiveness).

CONCLUSION

The qualitative findings suggest that providing sexual health education and counseling, to encourage critical discussions regarding current sociocultural scripts and to create an environment that would enable men and women alike to adopt a healthy and happy lifestyle for eliminating barriers and preserving and enhancing motivational factors associated with sexuality.