Prevalence, severity, and associated factors in women in East Asia with moderate-to-severe vasomotor symptoms associated with menopause

Changes in menopause-specific quality of life between women with transdermal estradiol versus oral estrogens: results of a randomized controlled trial

OBJECTIVE

To compare the efficacy of oral and transdermal estrogens in improving the quality of life in perimenopausal and recently postmenopausal women.

METHODS

257 women aged 40-55 years, within three years after their final menstrual period were randomized to receive transdermal oestrogel (t-E2) (n = 128) or oral estradiol valerate (o- E2V) (n = 129; both with micronized progesterone 200 mg for 14 days each month). Menopausal symptoms were recorded at screening and at 4, 12, and 24 weeks post-randomization. Menopausal symptoms were evaluated using the Menopause-Specific Quality of Life (MENQOL) questionnaire.

RESULTS

Significant improvements of MENQOL scores were observed in both groups compared with baseline. The decrease of MENQOL scores after treatment showed almost no difference between the two groups (p > 0.05) except the VMS domain which indicated a better result in oral estrogen group after 24 weeks.

CONCLUSIONS

This study showed that both transdermal and oral estrogens were highly effective in relieving the overall menopausal symptoms for recently-menopausal women, with little difference in treatment efficacy between the two routes.

An Open-Label, Single and Multiple Dose Study to Evaluate the Pharmacokinetics and Safety of Fezolinetant in Healthy Chinese Female Subjects

Purpose

To evaluate pharmacokinetics (PK) and safety of fezolinetant after single-dose and multiple-dose administration of 15, 30, and 60 mg in healthy Chinese women.

Patients and Methods

This was a fixed-sequence crossover study in 16 healthy Chinese female subjects, 18-45 years old. All received single doses of fezolinetant 15 mg, 30 mg or 60 mg with a 3-day washout. From Day 10, subjects received multiple doses of 30 mg fezolinetant once-daily for 7 days. PK parameters were obtained during the single- and multiple-dose periods. Safety assessments were based on adverse events, vital signs, and laboratory tests.

Results

Fezolinetant exhibited rapid absorption, with median time of the maximum concentration (tmax) 1.50 to 1.75 hours after single-dose administration of fezolinetant tablets in the fasted state, followed by a decline in plasma levels, with a mean t1/2 of 6.12-7.69 hours at dose levels of 15, 30 and 60 mg. There was a dose-proportional increase in maximum concentration and total exposure for fezolinetant across the doses studied. Mean peak concentration (Cmax) values were 221, 439 and 834 ng/mL, for the 15, 30, and 60 mg doses, respectively. The drug exposure parameters had a low-to-moderate variability (21.1-39.7%). Minimum accumulation was observed after multiple doses. Metabolite ES259564 showed rapid formation following a single dose of fezolinetant, with a median tmax of 1.50-2.00 hours. Plasma levels then declined, with mean t1/2 ranging from 5.72-6.31 hours. Dose-proportional increases in Cmax and AUCinf were observed following single-doses of fezolinetant. Steady state was achieved on the second day after starting multiple-dose administration. In total, 3 (18.8%) subjects experienced 4 drug-related treatment-emergent adverse events; all mild in severity.

Conclusion

Linear PK was confirmed within the dose range of 15 to 60 mg in healthy Chinese women.

Safety of Fezolinetant for Treatment of Moderate to Severe Vasomotor Symptoms Due to Menopause: Pooled Analysis of Three Randomized Phase 3 Studies

INTRODUCTION

This study evaluated the safety and tolerability of fezolinetant in women with vasomotor symptoms (VMS) due to menopause in a pooled analysis of data from three 52-week phase 3 studies (SKYLIGHT 1, 2, and 4).

METHODS

SKYLIGHT 1 and 2 were double-blind, placebo-controlled studies where women (≥ 40 to ≤ 65 years), with moderate to severe VMS (minimum average ≥ 7 hot flashes/day) were randomized to once-daily placebo, fezolinetant 30 mg or 45 mg. After 12 weeks, those on placebo were re-randomized to fezolinetant 30 mg or 45 mg, while those on fezolinetant continued on their assigned dose for 40 weeks. SKYLIGHT 4 was a placebo-controlled, double-blind, 52-week safety study. Safety was assessed by frequency of treatment-emergent adverse events (TEAEs) and endometrial events. TEAEs of special interest included liver test elevations and endometrial hyperplasia or cancer or disordered proliferative endometrium.

RESULTS

Totals of 952 participants receiving placebo, 1100 receiving fezolinetant 45 mg, and 1103 receiving fezolinetant 30 mg took ≥ 1 dose of study medication. TEAEs occurred in 55.3%, 62.9%, and 65.4%, respectively; exposure-adjusted results were consistent with these results. Most frequent TEAEs in fezolinetant-treated participants included upper respiratory tract infection (7.7-8.3%), headache (6.8-8.2%), coronavirus disease 2019 (5.8-6.1%), back pain (3.1-3.7%), arthralgia (2.9-3.2%), diarrhea (2.3-3.2%), urinary tract infection (2.9-3.4%), and insomnia (2.0-3.0%). The incidence of drug-related serious TEAEs and associated treatment withdrawals was low. Elevations in liver transaminases occurred in 1.5-2.3% of fezolinetant-treated participants, were typically asymptomatic and transient, resolved on treatment or discontinuation, with no evidence of severe drug-induced liver injury (Hy's law). Endometrial safety results were well within US Food and Drug Administration criteria. Analysis of benign and non-benign neoplasm controlled for exposure demonstrated no increased risk versus placebo.

CONCLUSION

Pooled data confirm the safety and tolerability of fezolinetant over 52 weeks.

TRIAL REGISTRATION

ClinicalTrials.gov identifiers, NCT04003155, NCT04003142, and NCT04003389. Graphical abstract available for this article.

Exploring menopausal symptoms, attitudes, and behaviors among menopausal women in China: an online research perspective

OBJECTIVE

The number of perimenopausal women in China is rising, but the population's concept of menopausal hormone therapy (MHT) is still relatively outdated.

METHODS

In this study, we used the Knowledge-Attitude-Practice (KAP) theory and collected online questionnaires from 1,100 women aged 40 to 60 years nationwide to find out their menopausal symptom profiles; to learn about their perceptions, attitudes, and behaviors toward menopause and MHT; to explore the factors influencing the acceptance of hormone treatments; and to look for better ways to promote the dissemination of menopausal knowledge.

RESULTS

The results revealed that among women aged 40 to 60 years, 82.36% experienced possible menopausal symptoms, with hot flushes/sweating, sleep disorders, mood disorders, and fatigue being the most prevalent; 55.90% reported moderate to severe symptoms, but only 46.99% of them sought healthcare services. Among those who sought medical care, 16.00% had their first visit to climacteric clinics/gynecological endocrinology, and 5.66% accepted MHT. Furthermore, 77.82% of participants never heard of MHT or were unaware of its existence. The healthcare-seeking behavior of menopausal women in response to symptoms and their willingness to accept MHT were found to be closely associated with their level of self-care.

CONCLUSIONS

The prevalence of menopausal symptoms is higher in China than previous research findings, but due to a lack of relevant knowledge, the rate of seeking treatment from the appropriate medical department and accepting MHT is relatively low. Enhancing physicians' knowledge of the menopausal transition and using Internet tools might help improve Chinese women's knowledge of menopause and help them pass through this period smoothly.

Treatment utilization and non-drug interventions for vasomotor symptoms in breast cancer survivors taking endocrine therapy: Real-world findings from the United States and Europe

OBJECTIVES

Vasomotor symptoms induced by endocrine therapy are common in breast cancer survivors and a risk factor for therapy discontinuation and lower quality of life. The REALISE study evaluated the real-world treatment landscape in breast cancer survivors with vasomotor symptoms taking endocrine therapy, including pharmaceuticals, lifestyle changes, and over-the-counter products.

STUDY DESIGN

Secondary analysis of the Adelphi Vasomotor Disease Specific Programme™, a large cross-sectional point-in-time survey and chart review conducted in the US and five European countries (February-October 2020). Oncologists provided demographic, clinical, and treatment data for adult breast cancer survivors with induced vasomotor symptoms taking endocrine therapy (tamoxifen or aromatase inhibitors); patients voluntarily completed self-report surveys on their symptom severity, concomitant sleep and/or mood symptoms, lifestyle changes, and use of over-the-counter products.

MAIN OUTCOME MEASURES

Patient characteristics; vasomotor symptom severity; use of pharmaceuticals, lifestyle changes, and over-the-counter products (from pre-defined lists); lines of treatment.

RESULTS

Overall, 77 oncologists reported data for 618 breast cancer survivors, of whom 183 (29.6 %) completed self-report forms. Physicians classified 420 (68.0 %) women as experiencing moderate-severe vasomotor symptoms, of whom 66.9 % were receiving treatment. In total, 15.2 % of all breast cancer survivors were prescribed systemic hormone therapy. Venlafaxine (24.7 %), citalopram (16.5 %), and paroxetine (13.6 %) were the most commonly prescribed nonhormonal medications. Lifestyle changes (77.8 %) and over-the-counter products (61.6 %) were common, especially in patients with concomitant sleep and/or mood symptoms.

CONCLUSIONS

Despite contraindications, a relatively large proportion of treatment-seeking breast cancer survivors with vasomotor symptoms were prescribed systemic hormone therapy. This, combined with high patient-reported use of lifestyle changes and over-the-counter products, suggests a need for symptomatic relief and demand for new nonhormonal alternatives with established safety profiles in this population.

Menopausal Vasomotor Symptoms and Subclinical Atherosclerotic Cardiovascular Disease: A Population-Based Study

BACKGROUND

Menopausal vasomotor symptoms (VMS) are increasingly emphasized as a potentially important cardiovascular risk factor, but their role is still unclear. We assessed the association between VMS and subclinical atherosclerotic cardiovascular disease in peri- and postmenopausal women.

METHODS AND RESULTS

Using a cross-sectional study design, questionnaire data were collected from a population-based sample of women aged 50 to 64. The questionnaire asked whether menopause was/is associated with bothersome VMS. A 4-point severity scale was used: (1) never, (2) mild, (3) moderate, and (4) severe. The VMS duration and time of onset were also assessed. Associations with subclinical atherosclerotic cardiovascular disease, detected via coronary computed tomography angiography, coronary artery calcium score, and carotid ultrasound were assessed using the outcome variables "any coronary atherosclerosis," "segmental involvement score >3," "coronary artery calcium score >100," and "any carotid plaque," using logistic regression. Covariate adjustments included socioeconomic, lifestyle, and clinical factors. Of 2995 women, 14.2% reported ever severe, 18.1% ever moderate, and 67.7% ever mild/never VMS. Using the latter as reference, ever severe VMS were significantly associated with coronary computed tomography angiography-detected coronary atherosclerosis (multivariable adjusted odds ratio, 1.33 [95% CI, 1.02-1.72]). Corresponding results for ever severe VMS persisting >5 years or beginning before the final menstrual period were 1.50 (95% CI, 1.07-2.11) and 1.66 (95% CI, 1.10-2.50), respectively. No significant association was observed with segmental involvement score >3, coronary artery calcium score >100, or with any carotid plaque.

CONCLUSIONS

Ever occurring severe, but not moderate, VMS were significantly associated with subclinical coronary computed tomography angiography-detected atherosclerosis, independent of a broad range of cardiovascular risk factors and especially in case of long durations or early onset.

The Effect of Laughter Yoga on Vasomotor Symptoms and Sleep Quality in Menopausal Women: A Randomized Controlled Trial

This experimental study aimed to determine the effects of online laughter yoga on the sleep quality and vasomotor symptoms (VMS) of menopausal women through a prospective, randomized controlled trial. About 36 women who attend the Menopause School were randomized into either the laughter yoga (n = 18) or the control group (n = 18). The laughter yoga group participated in eight online laughter yoga sessions, with two sessions per week for four weeks, whereas the control group did not receive any intervention. Data were collected using the Descriptive Characteristics Form, Visual Analog Scale (VAS), and Pittsburgh Sleep Quality Index (PSQI). The laughter yoga group had significantly lower posttest VAS scores compared with the control group in all VMS (P < .05). Furthermore, the posttest PSQI score of the laughter yoga group was significantly lower than that of the control group (P < .05). Although there was no significant difference in the pretest and posttest scores obtained by the control group from the VAS and PSQI (P > .05), the intervention group exhibited a statistically significant difference in their pretest and posttest VAS and PSQI scores (P < .05; P < .001, respectively). The results indicate that laughter yoga is an effective method for reducing VMS and improving sleep quality.

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.

Fezolinetant impact on health-related quality of life for vasomotor symptoms due to the menopause: Pooled data from SKYLIGHT 1 and SKYLIGHT 2 randomised controlled trials

OBJECTIVE

To assess the effect of fezolinetant treatment on health-related quality of life using pooled data from SKYLIGHT 1 and 2 studies.

DESIGN

Prespecified pooled analysis.

SETTING

USA, Canada, Europe; 2019-2021.

POPULATION

1022 women aged ≥40 to ≤65 years with moderate-to-severe vasomotor symptoms (VMS; minimum average seven hot flushes/day), seeking treatment for VMS.

METHODS

Women were randomised to 12-week double-blind treatment with once-daily placebo or fezolinetant 30 or 45 mg. Completers entered a 40-week, active extension (those receiving fezolinetant continued that dose; those receiving placebo re-randomised to fezolinetant received 30 or 45 mg).

MAIN OUTCOME MEASURES

Mean changes from baseline to weeks 4 and 12 on Menopause-Specific Quality of Life (MENQoL) total and domain scores, Work Productivity and Activity Impairment questionnaire specific to VMS (WPAI-VMS) domain scores, Patient Global Impression of Change in VMS (PGI-C VMS); percentages achieving PGI-C VMS of 'much better' (PGI-C VMS responders). Mean reduction was estimated using mixed model repeated measures analysis of covariance.

RESULTS

Fezolinetant 45 mg mean reduction over placebo in MENQoL total score was -0.57 (95% confidence interval [CI] -0.75 to -0.39) at week 4 and -0.47 (95% CI -0.66 to -0.28) at week 12. Reductions were similar for 30 mg. MENQoL domain scores were also reduced and WPAI-VMS scores improved. Twice as many women receiving fezolinetant reported VMS were 'much better' than placebo based on PGI-C VMS assessment.

CONCLUSIONS

Fezolinetant treatment was associated with improvement in overall QoL, measured by MENQoL, and work productivity, measured by WPAI-VMS. A high proportion receiving fezolinetant felt VMS were 'much better' based on PGI-C VMS responder analysis.

Core contents for a menopausal health literacy intervention for South Korean middle-aged women: an e-Delphi study

BACKGROUND

The attention on improving health literacy (HL) for self-management at the population level in many countries has been increasing. Although self-management among middle-aged women in the menopausal transition are important public health issues, few studies have developed the menopausal HL intervention reflecting the multidimensional aspects of HL. We aimed to generate consensus from an expert panel on the core contents of the menopausal HL intervention for middle-aged women based on the HL conceptual framework of the European Health Literacy Survey.

METHODS

The panel comprised 20 experts from multiple disciplines (nursing, medicine, public health, and food and nutrition). We conducted the e-Delphi process in three rounds, asking the panel to evaluate and prioritize the appropriateness of the core contents and provide open-ended responses to additional comments about the menopausal HL intervention. The e-Delphi questionnaire was developed based on the HL framework, integrating health and HL domains.

RESULTS

The experts reached a consensus on 38 components of the intervention. Among the 19 components of the four health domains, health topics in healthcare and disease prevention were more appropriate than those in health promotion. For the 19 HL competency components, strengthening the ability to access, appraise, and apply health information was more important than strengthening the ability to understand information. Finally, a consensus was achieved on the 12 priorities for intervention content by HL domains integrated with health domains. For example, contents included proper access to reliable information resources, understanding the definition and process of menopause, judging abnormal health symptoms, and performing the health checkups necessary for menopausal women.

CONCLUSIONS

Our findings provide evidence for HL skills that nurses and other health professionals can consider when developing interventions to improve self-management among middle-aged women. Future research should focus on incorporating the core contents of multidimensional HL skills into menopausal HL interventions to improve self-management among middle-aged women.

Efficacy and safety of fezolinetant for moderate to severe vasomotor symptoms associated with menopause among women in East Asia: a phase 3 randomized study (MOONLIGHT I)

OBJECTIVE

To evaluate the efficacy and safety of fezolinetant for moderate to severe vasomotor symptoms (VMS) associated with menopause in East Asian women.

METHODS

In this phase 3, randomized, double-blind study, postmenopausal women with moderate to severe VMS (minimum average frequency in the 10 days before randomization, ≥7/day or 50/week) received fezolinetant 30 mg/day or placebo (weeks 1-12), followed by an open-label extension phase with fezolinetant 30 mg/day (weeks 13-24). The co-primary endpoints were the mean changes in the daily frequency and severity of VMS at weeks 4 and 12.

RESULTS

Among 301 participants, the difference in the least squares mean change (95% confidence interval) from baseline in the daily frequency of moderate to severe VMS versus placebo was -0.65 (-1.41 to 0.12) at week 4 and -0.55 (-1.35 to 0.26) at week 12. The differences in the least squares mean change from baseline in the VMS severity score versus placebo were -0.06 (-0.14 to 0.03) and -0.13 (-0.27 to 0.01) at weeks 4 and 12, respectively. Serious adverse events occurred in 0.7% of participants receiving fezolinetant in weeks 1 to 12, compared with 1.3% of those receiving placebo.

CONCLUSIONS

Fezolinetant was generally safe but did not reduce the frequency or severity of VMS versus placebo in postmenopausal women in this study.ClinicalTrials.Gov Identifier: NCT04234204.

Long-term safety of fezolinetant in Chinese women with vasomotor symptoms associated with menopause: the phase 3 open-label MOONLIGHT 3 clinical trial

OBJECTIVE

We aimed to assess long-term safety and tolerability of fezolinetant, a nonhormonal neurokinin 3 receptor antagonist, among Chinese women with vasomotor symptoms associated with menopause participating in the MOONLIGHT 3 trial.

METHODS

In this phase 3 open-label study, women in menopause aged 40-65 years received fezolinetant 30 mg once daily for 52 weeks. The primary endpoint was frequency and severity of treatment-emergent adverse events (TEAEs), assessed at every visit through week 52 and one follow-up visit at week 55.

RESULTS

Overall, 150 women were enrolled (mean age, 54 years) and 105 completed treatment. The frequency of TEAEs was 88.7%. Most TEAEs were mild (63.3%) or moderate (22.7%). The most common TEAE was upper respiratory tract infection (16.0%), followed by dizziness, headache, and protein urine present (10.7% each). There was no clinically relevant change (mean ± standard deviation) in endometrial thickness (baseline, 2.95 ± 1.11 mm; week 52, 2.94 ± 1.18 mm). Alanine aminotransferase and/or aspartate aminotransferase levels >3 times the upper limit of normal were reported in 1.4% of women; no Hy's Law cases occurred.

CONCLUSIONS

Fezolinetant 30 mg once daily was generally safe and well tolerated over a 52-week period among women in China with vasomotor symptoms associated with menopause.ClinicalTrials.gov Identifier: NCT04451226.

The 100 top-cited articles in menopausal syndrome: a bibliometric analysis

BACKGROUND

Significant scientific research has been conducted concerning menopausal syndrome(MPS), yet few bibliometric analyses have been performed. Our aim was to recognise the 100 most highly cited published articles on MPS and to analytically evaluate their key features.

METHODS

To identify the 100 most frequently cited articles, a search was conducted on Web of Science using the term 'menopausal syndrome'. Articles that matched the predetermined criteria were scrutinised to obtain the following data: citation ranking, year of publication, publishing journal, journal impact factor, country of origin, academic institution, authors, study type, and keywords.

RESULTS

The publication period is from January 1, 2000, to August 31, 2022. The maximum number of citations was 406 and in 2012. The median citations per year was 39.70. Most of the articles focused on treatment and complications. These articles were published in 36 different journals, with the Journal of MENOPAUSE having published the greatest number (14%). Forty-eight articles (48%) were from the United States, with the University of Pittsburgh being the leading institute (9%). Joann E. Manson was the most frequent first author (n = 6). Observational studies were the most frequently conducted research type (n = 53), followed by experimental studies (n = 33). Keyword analysis identified classic research topics, including genitourinary syndrome of menopause, bone mineral density (BMD), and anti-mullerian hormone (AMH) loci.

CONCLUSION

Using bibliometrics, we conducted an analysis to identify the inadequacies, traditional focal points, and potential prospects in the study of MPS across current scientific areas. Treatment and complications are at the core of MPS research, whereas prediction and biomarkers have less literature of high quality. There is a necessity for innovative analytical metrics to measure the real effect of these papers with a high level of citation on clinical application.

Pomegranate effects on the health aspects of women during peri- and postmenopause: A systematic review and meta-analysis

Pomegranate is widely used to preserve human health and help prevent many kinds of diseases. This study aims to review and assess the effects of pomegranate on women's health during and after menopause. PubMed, Web of science, Cochrane, Scopus, and Google Scholar were searched up to the end of 2022 with no language or study type restriction. All types of clinical research studies (randomized clinical trial [RCT], pre-post, case report, and case series) were included. The Cochrane RoB 2.0 tool was used for quality assessment of RCTs. A summary of intervention's effects for each study was provided by calculating standardized mean differences and accompanying 95% confidence interval using random effect model. Weighted mean differences and heterogeneity between studies were assessed using Hedges's method and Cochran's Q test, respectively. Pomegranate can significantly improve hot flashes severity and menopause symptoms and decrease FSH. It significantly improves high-density lipoprotein but not low-density lipoprotein, body mass index, and weight. Most of our results are inconclusive, and the small sample sizes and the lack of blinding and randomization have led to an increased risk of bias. Pomegranate can decrease menopause symptoms, but more well-designed studies, with bigger sample sizes are needed to establish its other clinical benefits for menopausal women.

Prevalence and impact of vasomotor symptoms due to menopause among women in Brazil, Canada, Mexico, and Nordic Europe: a cross-sectional survey

OBJECTIVE

This study investigated the prevalence and impact of moderate to severe vasomotor symptoms (VMS), related treatment patterns, and experiences in women.

METHODS

The primary objective was to assess the prevalence of moderate to severe menopause-related VMS among postmenopausal women aged 40 to 65 years in Brazil, Canada, Mexico, and four Nordic European countries (Denmark, Finland, Norway, and Sweden) using an online survey. Secondary objectives assessed impact of VMS among perimenopausal and postmenopausal women with moderate to severe VMS using the Menopause-Specific Quality of Life questionnaire, Work Productivity and Activity Impairment questionnaire, Patient-Reported Outcomes Measurement Information System sleep disturbances assessment, and questions regarding treatment patterns and attitudes toward symptoms and available treatments.

RESULTS

Among 12,268 postmenopausal women, the prevalence of moderate to severe VMS was about 15.6% and was highest in Brazil (36.2%) and lowest in Nordic Europe (11.6%). Secondary analyses, conducted among 2,176 perimenopausal and postmenopausal women, showed that VMS affected quality of life across all domains measured and impaired work activities by as much as 30%. Greater symptom severity negatively affected sleep. Many women sought medical advice, but most (1,238 [56.9%]) were not receiving treatment for their VMS. The majority (>70%) considered menopause to be a natural part of aging. Those treated with prescription hormone therapy and nonhormone medications reported some safety/efficacy concerns.

CONCLUSIONS

Among women from seven countries, moderate to severe menopause-related VMS were widespread, varied by region, and largely impaired quality of life, productivity, and/or sleep.

Influencing factors on women's attitudes toward hormone therapy acceptance for menopause treatment: a systematic review

IMPORTANCE

There is a paucity of data on recent attitudes and perceptions toward hormone therapy use, especially subsequent reanalysis and follow-up of Women's Health Initiative data.

OBJECTIVE

The aim of this systematic review was to assess the factors influencing women's attitudes and perceptions toward hormone therapy use for menopausal symptoms.

EVIDENCE REVIEW

We conducted a comprehensive search of several medical databases including PubMed, Web of Science, Google Scholar, and Scopus. Quality assessment was performed using the Strengthening the Reporting of Observational Studies in Epidemiology Statement for cross-sectional studies. A search was conducted for cross-sectional articles published from January 2012 to March 2023 in English medical databases (PubMed, Web of Science, Scopus, and Google Scholar). Search keywords included "hormone therapy," "acceptance," "menopause," "attitudes," "influence," "factor," "estrogen," "perimenopause," "postmenopause," and "climacteric." Studies evaluating factors that influenced women's attitudes toward hormone therapy were identified.

FINDINGS

A total of 1,280 articles were initially identified. Twenty-one articles were ultimately included in the review after screening studies based on inclusion and exclusion criteria. The studies were conducted between 2012 and 2023 and included a total of 40,226 participants. The most common positive factor included awareness of the existence and efficacy of hormone therapy. The most common negative factors included concern for general adverse effects and negative perception of hormone therapy from family and friends. The factors assessed in this review on women's attitudes toward hormone therapy acceptance for menopause treatment were categorized into three main themes: (1) demographic factors, (2) environmental/contextual factors, and (3) health care-related factors.

CONCLUSIONS AND RELEVANCE

Hormone therapy can be a safe and effective tool to improve the quality of life in perimenopausal and postmenopausal women with vasomotor and genitourinary symptoms. However, there are many complex factors that shape women's perceptions of the efficacy, safety, and accessibility of hormone therapy. Healthcare providers should seek to understand these factors to better discuss the benefits and risks with women and assist with decision making based on cultural, personal, and environmental factors.

The severity of menopause and associated factors among middle-aged women residing in Arba Minch, DHSS, Ethiopia, 2022

BACKGROUND

Menopause is a common practice in women, and it is recognized as a complete pause of menses for more than twelve months. A decrease in sex hormone levels particularly estrogen in the blood is associated with different types of menopausal symptoms. Those symptoms include different psychological, vasomotor, physical, and sexual symptoms. They are among the major public health problems of middle-aged women. Particularly severe forms of menopausal symptoms are bothersome for middle-aged women. However, little is known about the severity status and associated factors of menopausal symptoms among middle-aged women in the study area.

OBJECTIVE

The main aim of the present study was to assess the severity of menopausal symptoms and associated factors among middle-aged women residing in Arba Minch DHSS.

METHODS AND MATERIALS

Community-based crossectional study was employed. A single population proportion formula was used to determine the sample size. A total of 423 study participants were recruited to conduct the study. A simple random sampling technique was used to employ study participants. Proportional sample size allocation formula was used to allocate study participants in each Kebele of Arba Minch DHSS (demographic and health surveillance site). A menopausal rating scale was used to assess the severity status of Menopausal symptoms. The collected data were analyzed by using SPSS version 20. A descriptive analysis was made to describe the Sociodemographic characteristics of the study participants. Moreover, binary and ordinal logistic regressions were used to identify the factors associated with the severity of menopausal symptoms among middle-aged women. On binary logistic regression variables with p-value < 0.25 were eligible for ordinal logistic regression. Variables with a p-value < 0.05 were considered statistically significant.

RESULT

The present study revealed that the prevalence of menopausal symptoms was 88.7%. According to the Menopausal rating scale, 91.7% of the study participants were Asymptomatic, 6.6% of them were mild in severity, 1.4% of them were moderate and the remaining 0.23% individuals were severe menopausal symptoms. The most severe menopausal symptom was the sexual problem. The factors that have a significant association with the severity of menopausal symptoms were Age with [AOR = 1.46(95%CI: 1.27-1.64)] and history of chronic disease with [AOR = 2.56(95%CI: 1.78-3.4)] and p < 0.001.

CONCLUSION AND RECOMMENDATION

Generally, menopausal symptoms among middle-aged women were common. Asymptomatic and mild forms are the dominant severity forms of menopausal symptoms. Age and history of chronic diseases have statistically significant associations with the severity of menopausal symptoms. The ministry of health, researchers, and different stakeholders are recommended to be concerned about this neglected issue.

The Association of Menopausal Symptoms and Social Support Among Saudi Women at Primary Health Care Centers in Taif, Saudi Arabia

Background

Menopause is a challenging period for all women. The severity of menopausal symptoms hurts their quality of life and daily activity. The aim of this study was to investigate whether the severity of menopausal symptoms are associated with social support and lifestyle factors among Saudi women to help policymakers develop the appropriate intervention health program.

Methods

A cross-sectional study of 361 middle-aged Saudi women was conducted through interviews using a valid and reliable questionnaire. The menopause rating scale (MRS) was used to determine the severity of menopausal symptoms and the multidimensional scale of perceived social support (MSPSS) was used to assess perceived social support among females. Linear regression was conducted to assess the association between MRS scores and MSPSS scores after adjustment of covariates.

Results

The mean total menopause rating scale was 13.7 ± 8.3. Physical and mental exhaustion (80.3%), joint and muscular discomfort (79.2%), and irritability (75.9%) were the most prevalent menopausal symptoms for all women. The mean MSPSS was calculated as 4.3 ±1.8. Perceived social support and lifestyle factors were significant predictors of menopausal symptoms.

Conclusions

Postmenopausal Saudi women complain of a variety of physical and psychological symptoms. The current study shows that social support, quitting smoking, losing weight, and increasing physical exercise can help to alleviate or reduce many of the unpleasant symptoms of menopause. This evidence will help policymakers design health intervention for this age group.