Prevalence of sexual symptoms in relation to menopause in women in Asia: a systematic review

Update on Menopause Hormone Therapy; Current Indications and Unanswered Questions

OBJECTIVE

To provide clinicians involved in managing menopause with a summary of current evidence surrounding menopause hormone therapy (MHT).

DESIGN

The authors evaluate and synthesize existing pooled evidence relating to MHT's clinical indications, efficacy, and safety and explore the limitations of existing data.

PATIENTS

The review focuses on MHT-related outcomes in women with natural-timed menopause captured within observational studies, RCTs, and pooled data from pivotal meta-analyses and reviews.

MEASUREMENTS

Available published data are scrutinized. Available evidence and notably lacking data from women not adequately represented in published MHT trials, such as those with socioeconomic adversity, significant comorbidities, and minority ethnic backgrounds, are highlighted and deliberated.

RESULTS

The impact of MHT differs significantly between demographics. Current consensus recommendations for MHT emphasize the importance of tailoring type, route, dose, and duration of therapy to individual needs and risk/benefit ratio through shared decision-making. MHT impact can change over time. Current MHT data support its benefits for treating menopause symptoms and a potential window of opportunity in midlife to benefit skeletal health. Limitations of current evidence highlight menopause health inequalities and underscores the need for further research.

CONCLUSIONS

This review recommends tailored use of MHT for well-defined indications, recognizing its value for menopause symptom relief and skeletal benefits for many midlife women. MHT may be used as long as benefits outweigh risks, through shared decision-making. There is insufficient clinical evidence to support the long-term use of MHT in some contemporary cohorts of women accessing MHT in clinical practice.

Factors influencing sexual interest in postmenopausal Asian women

BACKGROUND

The sexual interest of postmenopausal women is a crucial aspect of their overall well-being. Despite its importance, factors influencing postmenopausal sexual interest, particularly in Asian women, remain understudied and poorly understood.

AIMS

To investigate the various factors influencing sexual interest in postmenopausal women in Malaysia.

METHODS

A cross-sectional study was conducted of postmenopausal women attending a gynecology or primary care clinic in a teaching hospital in Malaysia.

OUTCOMES

We investigated how interpersonal dynamics and cultural norms-including the physical and mental health of women and their partners, as well as their sexual values-affect menopausal sexual interest as measured by the Menopausal Sexual Interest Questionnaire.

RESULTS

Women in the study reported an average sexual interest, with a mean score of 32.8 (SD, 9.4) out of 70 on the Menopausal Sexual Interest Questionnaire. Multivariable analysis results showed that higher personal sexual values (odds ratio [OR], 2.65; 95% CI, 1.26-5.61) and spousal sexual values (OR, 2.68; 95% CI, 1.22-5.86) were significantly associated with higher menopausal sexual interest. There was a positive correlation between the physical fitness of spouses and menopausal sexual interest, with women who rated their spouses as very fit or fit (OR, 3.22; 95% CI, 1.15-9.00) or moderately fit (OR, 2.63; 95% CI, 1.05-6.63) showing higher menopausal sexual interest as compared with those whose spouses were very unfit or unfit. Women with normal stress levels (OR, 5.89; 95% CI, 1.03-33.62) and mild to moderate stress levels (OR, 8.13; 95% CI, 1.53-43.22) reported higher menopausal sexual interest.

CLINICAL IMPLICATIONS

This study emphasizes a holistic approach to postmenopausal sexual health, highlighting the significance of promoting positive sexual values, improving physical fitness, and managing stress. Health care providers should educate, counsel, and collaborate interdisciplinarily, ensuring culturally sensitive care tailored to individual needs.

STRENGTH AND LIMITATIONS

The study's strength lies in its provision of valuable insights into factors affecting sexual interest among postmenopausal Asian women, enhancing comprehension of holistic sexual health approaches. However, reliance on self-assessments may introduce response bias influenced by social desirability, and limited generalizability stems from single-site data collection.

CONCLUSION

Our study highlights the significance of adopting a holistic approach to addressing sexual health in postmenopausal women, which includes promoting positive sexual values, improving physical fitness, and managing stress.

The prevalence and severity of vasomotor and sexual symptoms among refugee women in Australia

OBJECTIVE

This study aimed to document the prevalence and severity of vasomotor symptoms (VMS) and sexual symptoms among refugee women in Melbourne, Australia.

METHODS

This cross-sectional study included refugee women, aged 18-63 years, recruited from community centers and social media between February and July 2023. The Menopause-specific Quality of Life (MENQOL) questionnaire measured VMS and sexual symptoms. The scores were compared between different menopausal states.

RESULTS

Of 333 participants, 62.8% were premenopausal, 8.0% perimenopausal and 29.2% postmenopausal, with a median age of 40 years (range 18-63 years). Moderate-severe VMS was most prevalent amongst perimenopausal (20.8%; 95% confidence interval [CI]: 8.9-41.4%) versus postmenopausal (9.5%; 95% CI: 5.0-17.3%) and premenopausal (0%) women. Moderate-severe sexual symptoms affected 15.8% (95% CI: 5.2-39.3%) of perimenopausal and 16.9% (95% CI: 10.4-26.1%) of postmenopausal women versus 1.4% (95% CI: 0.3-5.3%) of premenopausal women. Perimenopausal and postmenopausal women had higher VMS and sexual symptom scores than premenopausal women (both p < 0.0001); the scores were also higher in perimenopausal women than postmenopausal women (p = 0.016 and p = 0.013, respectively).

CONCLUSION

While perimenopausal and postmenopausal VMS and sexual symptoms are not uncommon amongst refugee women, these symptoms were less prevalent in postmenopausal refugees than in the non-refugee population. Further research is warranted to confirm and expand on these findings.

Sexual satisfaction of postmenopausal women: An integrative review

A prerequisite for interventions for sexual satisfaction in postmenopausal women is a clear, objective measurement of the concept. Despite the large number of studies on the sexual satisfaction of postmenopausal women, there is no clear definition of sexual satisfaction in menopause. This study was conducted to investigate the concept of sexual satisfaction in postmenopausal women. The present study was carried out using an integrated review of data obtained from secondary sources, utilizing Whittemore and Knafl's method of bibliographic search. A literature search was performed without any data limitations in journals and international databases. The primary inclusion criterion was relevance to sexual satisfaction in postmenopausal women. The full texts of all these articles were evaluated using the checklists of the MMAT and PRISMA. Data were analyzed using MAXQDA 10 software using a constant comparison method. Meaning units were identified and coded. The codes were classified into subgroups and categories according to the characteristics, antecedents, and consequences of sexual satisfaction in postmenopausal women. During the integrative review of the 62 articles and three books, 580 codes about sexual satisfaction in menopause were extracted. The codes were grouped into three main attributes, five main antecedents, and three main consequences of sexual satisfaction in postmenopausal women. Four attributes, symptoms, or components were identified for the concept. These attributes were as follows: Change in sexual objective and subjective dimensions of sexual satisfaction after menopause, conditional sexual consent, change in behavior, and sexual function. These dimensions distinguish sexual satisfaction in menopause from other conditions. The concept of sexual satisfaction in menopause is a subjective (emotional interaction) and objective (physical interaction) experience that is conditioned by the fulfillment of expectations and the reconstruction of sexual relations while also being influenced by the change in sexual capacity during menopause.

Women's understanding and experiences of menopause in low-income and middle-income countries in the Asia Pacific region: a scoping review protocol

INTRODUCTION

Menopause denotes the end of a woman's reproductive life. A woman's experiences of menopause are shaped by her individual circumstances and may vary between social and cultural contexts. Evidence is needed to inform research and programme delivery that supports women's health and well-being throughout the menopausal transition. This scoping review will map evidence of women's experiences of menopause in Asia Pacific countries, where limited research exists.

METHODS AND ANALYSIS

We will follow the five-stage framework of Arksey and O'Malley, further developed by Levac et al and the Joanna Briggs Institute. MEDLINE, CINAHL, PsycINFO and Scopus databases will be systematically searched between February 2022 and May 2022 using subject headings and keywords. The title-abstract and full text of retrieved studies will be assessed against eligibility criteria. The review will focus on studies with a qualitative research component. Citation searching of selected articles will supplement database searching. Data will be extracted, charted, synthesised and summarised. Findings will be presented in narrative format and implications for research and practice reported.

ETHICS AND DISSEMINATION

Ethical approval is not required for this scoping review of selected studies from peer-reviewed journals. Ethical approval has been granted from relevant ethics committees for community consultation. Findings will be shared in peer-reviewed publications, presented at conferences and disseminated with communities, health workers and researchers.

Sexual inactivity and sexual dysfunction in midlife Singaporean women: A prospective cross-sectional study of prevalence and risk factors

OBJECTIVES

To examine factors relating to both sexual inactivity and sexual dysfunction in midlife Singaporean women.

STUDY DESIGN

Sociodemographic, medical/lifestyle factors, physical activity, BMI, handgrip strength (HGS) and physical performance data collected from healthy Chinese, Indian, and Malay women, aged 45-69 years, attending gynaecology clinics.

MAIN OUTCOME MEASURES

Sexual inactivity and sexual dysfunction (defined as total score ≤ 26.55) assessed using the Female Sexual Function Index (FSFI).

RESULTS

1048 women completed the FSFI. Mean (±SD) age was 56.2 (±6.2). Sexual inactivity was reported by 43.2% and was positively associated with older age [55-64 years (aOR 2.0, 95% CI 1.3-3.0) and ≥65 years (aOR 2.5, 95% CI 1.2-5.1)], younger menarche (aOR 1.8, 95% CI 1.3-2.5), lowest education (aOR 2.1, 95% CI 1.2-3.6), lowest income (aOR 1.8, 95% CI 1.1-2.8), unmarried (aOR 4.0, 95% CI 2.6-6.4), nulliparity (aOR 1.9, 95% CI 1.1-3.4), and BMI <18.5 kg/m² (aOR 2.7, 95% CI 1.3-5.6). Among the sexually active, sexual dysfunction was identified in 70.3%. Sexual dysfunction was positively associated with menopause ≥10 years (aOR 2.4, 95% CI 1.1-5.0), nulliparity (aOR 3.0, 95% CI 1.1-9.8), moderate/severe vaginal dryness (aOR 13.8, 95% CI 4.8-38.7) and HGS <18 kg (aOR 1.9, 95% CI 1.1-3.2) and negatively associated with use of menopausal hormone therapy (aOR 0.3, 95% CI 0.1-0.6).

CONCLUSION

This, the largest Singaporean sexual function study, is the first to include physical performance in a healthy population. Most were sexually active but reported dysfunction. Novel associations included underweight BMI with sexual inactivity and weaker HGS and Malay ethnicity with greater and less sexual dysfunction, respectively.

The Prevalence of Sexual Dysfunction in the Different Menopausal Stages: A Systematic Review and Meta-Analysis

Objectives: Despite the noticeable advances in sexual dysfunction (SD) research in the menopausal period, scientific literature showed different reports on the prevalence of SD in the menopausal stages. The primary objective of this study was to systematically review and meta-analysis the prevalence of SD in the different menopausal stages and then meta-analysis the included studies in domains of SD separately. Methods: In this systematic review and meta-analysis, keywords were retrieved through MeSH strategy and databases such as PubMed/MEDLINE, PsycINFO, Web of Science (ISI), Scopus, ScienceDirect, SID (Scientific Information Database), Magiran, and Google scholar were searched. Manual review of retrieved citations identified additional citations. The quality of the included studies was assessed using The Newcastle-Ottawa Scale. The main outcome measure in this study was the prevalence of SD in three stages of menopause such as pre, peri, and postmenopause. Results: Of 54 included studies 81,227 menopausal aged women from different menopause stages participated and the sample sizes varied from 49 to 31,581 individuals. The articles from 17 countries worldwide were included in this study. The prevalence of SD in premenopausal aged women was ranged between 22.7% and 72.2%, in perimenopausal aged women, was 37.3-78.2% and also in postmenopausal aged women was extremely reported a wide variety of prevalence ranges and was estimated between 8.7% and 89.01%. The premenopausal women had a lower prevalence of SD compared to other stages of the menopausal period. Conclusion: The results indicated that the prevalence of SD and also domains of SD in different studies were reported much widely. This study can be used as a good resource for obstetricians to understand the high possibility of recurrence of SD and assess the sexual activity of menopausal aged women in the menopause clinic. However, based on the systematic review, more standard and high-quality studies are needed to perform regarding the prevalence of SD in menopausal periods.

Effect of Vitamin D Supplement on Vulvovaginal Atrophy of the Menopause

The effects of oral vitamin D supplements on vaginal health in postmenopausal women with vulvovaginal atrophy (VVA) was evaluated. A double-blinded, randomized placebo-controlled trial was conducted for 12 weeks to investigate changes on vaginal maturation index (VMI), vaginal pH, and the visual analog scale (VAS) of VVA symptoms. The vitamin D group received oral ergocalciferol, at 40,000 IU per week, while the placebo group received an identical placebo capsule. Eighty postmenopausal women were enrolled. There were no significant differences in baseline characteristics between both groups. In an intention-to-treat analysis, VMI, vaginal pH, and VAS of VVA symptoms showed no significant differences between both groups at the six and 12 weeks. However, the mean difference of VMI in the vitamin D group between baseline and at six weeks showed significant improvement (5.5 + 16.27, p <0.05). Moreover, the mean vaginal pH and VAS of VVA patients in the vitamin D group were significantly improved at both six and 12 weeks compared to baseline. The oral vitamin D supplementation for 12 weeks potentially improves vaginal health outcomes in postmenopausal women with VVA symptoms, demonstrated by the improved mean VMI, vaginal pH, and VAS at six and 12 weeks between baseline, however, no significant differences were observed from the placebo treatment.

The experiences and needs of Asian women experiencing menopausal symptoms: a meta-synthesis

OBJECTIVE

The aim of the study was to explore the experiences and needs of Asian women who were experiencing or had experienced menopause and to determine possible differences in experiences due to acculturation by comparing Asian women living in Asia and those living in Western countries.

METHODS

Six electronic databases were systematically searched: PubMed, CINAHL, Embase, Scopus, PsycINFO, and ProQuest. The search resulted in 17 qualitative studies that met the inclusion and exclusion criteria. Quality appraisal was conducted using the Critical Appraisal Skills Programme Checklist. All 17 studies were analyzed using meta-summaries and, then, using meta-synthesis.

RESULTS

Five themes were identified from the 17 included studies (United States, n = 5; Asia, n = 12): (1) perceptions and attitudes toward menopause (n = 14), (2) physical and emotional experiences during menopause (n = 16), (3) changes in life and relationships (n = 11), (4) needs and coping strategies (n = 13), and (5) unique Asian experiences in Western societies (n = 5). Asian women generally had neutral or positive attitudes toward menopause, but their negative physical, emotional, and psychosocial experiences highlighted their unmet needs and unpreparedness for this phase of life. Diverse self-management strategies were adopted, but there was a high demand for more trustworthy informational resources. Asian women in Western societies were not highly acculturated and retained traditional practices.

CONCLUSIONS

Although cultural influences serve as a protective factor against menopausal symptoms, the traditional and conservative nature of the Asian society poses as a help-seeking barrier. Therefore, to ensure the healthy well-being of postmenopausal women, the implementation of culturally appropriate mitigation and management strategies is necessary.