The Internet and the menopause consultation: menopause management in the third millennium

Potential effects of virtual interventions for menopause management: a systematic review

IMPORTANCE

Menopausal women are one of the fastest growing demographic groups globally. Virtual interventions have emerged as alternate avenues for menopausal women to manage and cope with their symptoms.

OBJECTIVE

The purpose of this review is to summarize existing research on the potential effects of virtual interventions for menopause management.

EVIDENCE REVIEW

This systematic review was written in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, PsychINFO, CINAHL, AgeLine, ERIC, ProQuest, Nursing and Allied Health Database, PsychARTICLES, and Sociology Database were used for literature search and searched from conception to December 2021. Original studies, including randomized controlled trials and quasi-experimental studies, were included if they evaluated a virtual intervention for menopause management and investigated the effects of these interventions on physical and psychosocial outcomes and/or the feasibility of these interventions among menopausal women. Included studies were published in peer-reviewed journals and assessed for quality using the Critical Appraisal Skills Program Checklists.

FINDINGS

A total of 16 articles were included in this review. Virtual interventions have the potential to improve physical health outcomes including body weight/body mass index/waist circumference, pain, blood pressure, and cholesterol. However, conflicting results were identified for the outcomes of vasomotor and endocrine symptoms, sleep, and sexual functioning. Virtual interventions might also improve psychosocial outcomes, including knowledge and patient-physician communication, although conflicting results were again identified for treatment decision-making ability, quality of life, and anxiety and depression. Virtual interventions were feasible in terms of being usable and cost-effective, and eliciting satisfaction and compliance among menopausal women.

CONCLUSIONS AND RELEVANCE

Virtual interventions might have the potential to improve the physical and psychosocial health outcomes of menopausal women, although some conflicting findings arose. Future studies should focus on including diverse menopausal women and ethnic minorities, conducting research within low- to middle-income countries and communities, further exploring intervention design to incorporate features that are age and culture sensitive, and conducting full randomized controlled trials to evaluate the effects of the interventions.

The need to do better - Are we still letting our patients down and at what cost?

OBJECTIVE

To survey women's views on HRT and alternative therapies and make comparisons with 2007 data.

STUDY DESIGN

A questionnaire on a UK patient-tailored independent clinician-led website with anonymous responses analysed using descriptive statistics.

MAIN OUTCOME MEASURES

Answers to survey questions in 2007 and 2014.

RESULTS

A total of 1476 responses from 33 countries were obtained. Almost 70% of respondents had used/would consider using HRT. Over the last 5 years, 27.7% felt that their views had changed for the better. Most obtained information from health professionals or the Internet. About 51.1% felt that their family doctor did not recognise the importance of the menopause with one-third feeling resistance to being offered HRT. Compared to 2007, significantly more women were aware of the different risks associated with different types of HRT. More women were able to respond positively to the question asking whether or not they felt able to make an informed choice regarding HRT/alternative therapies.

CONCLUSIONS

There has been negativity and confusion regarding HRT management since the beginning of the millennium. Our findings suggest that we, as health professionals, continue to let our patients down with poor provision of information, inaccurate or wrong information, or access to the right care. The cost of this is women living with preventable sequelae associated with the menopausal transition with a consequent adverse impact on health and the health economy. The importance of the menopause consultation as part of a life course approach is highlighted as well as the emerging discipline of Health Web Science.

Web-based survey on the effect of digital storytelling on empowering women to seek help for urogenital atrophy

OBJECTIVE

To evaluate an online digital story aimed to empower women suffering from urogenital atrophy to seek health professional advice.

STUDY DESIGN

A questionnaire evaluating a digital story on the UK-based menopause website www.menopausematters.co.uk. Main outcome measure Answers to questions on empowerment.

RESULTS

A total of 539 responses were obtained over the 62 weeks that the questionnaire was online. In women who had not previously sought help for urogenital atrophy, 145 were too embarrassed and 105 did not want to bother the health professional. Having watched the video, 73% (n = 105/143) of women who had been too embarrassed to discuss their symptoms with their doctor would now do so and 87% (n = 89/102) of women who had not wanted to bother their doctor would also make an appointment. Ninety-six percent (n = 138/144) of women would be willing to try treatment. Over two-thirds of women favoured webcast information to written information; however, postmenopausal women were less likely than peri- or premenopausal to favour this method of presenting health information.

CONCLUSION

Using digital stories for health promotion is a new area for research. Our data provide preliminary evidence that women can feel more empowered to seek help for urogenital atrophy using digital storytelling.

Web-based survey on the effect of menopause on women's libido in a computer-literate population

Objective

The objective of this study is to use the internet to survey the effect of menopause on women's experience of libido.

Study design

A questionnaire incorporating the Brief Profile of Female Sexual Function (B-PFSF) on a UK menopause website.

Main outcome measure

Questions on reduced libido, distress, level of help sought and treatment.

Results

Eighty-four percent of women ( n = 2112/2527) felt that an active sex life was important. One thousand and fifty-one perimenopausal and 560 postmenopausal women reported reduced libido causing distress with 23% and 35% discussing this with health professionals. Eighteen percent perimenopausal and 30% postmenopausal women had tried non-testosterone hormone replacement therapy with 34% and 37%, respectively, finding it helpful. Testosterone was deemed useful in some perimenopausal ( n = 6/17) and postmenopausal ( n = 23/50) women. Twenty-seven percent premenopausal, 38% perimenopausal and 56% postmenopausal women reported vaginal dryness with 78% peri- and 87% postmenopausal women believing it a factor causing reduced libido. Twenty-two percent premenopausal, 28% perimenopausal and 46% postmenopausal women had discussed this with health professionals and 17%, 36% and 55%, respectively, were on treatment. Women in all reproductive epochs completed the B-PFSF (a validated tool for postmenopausal women only).

Conclusions

An active sex life was deemed to be important but many women were not seeking help for menopause-related reduced libido causing distress. For many, vaginal changes contributed to their symptoms. In those seeking advice, treatment was commonly not prescribed. Health professionals must ask appropriate direct questions to all women, especially as part of menopausal assessment. A need for the B-PFSF to be validated in non-postmenopausal women was also indicated.