Menopausal Symptoms and Associated Social and Environmental Factors in Midlife Chinese Women

Determination of the association between aging anxiety and menopausal symptoms in middle-aged women

OBJECTIVES

This study was conducted to determine the association between aging anxiety and menopausal symptoms.

METHODS

The study was descriptive and cross-sectional, conducted with women between the ages of 40 and 59 who actively use internet social media (WhatsApp, Instagram, Facebook, etc). The Personal Information Form, Menopause Symptoms Rating Scale (Menopause Rating Scale), and Aging Anxiety Scale for Middle-Aged Women were used to collect the data.

RESULTS

In the study, a statistically significant positive correlation was found between women's aging anxiety and menopausal symptoms (P < 0.05, r = 0.659). It was determined that there is an association between the effect of aging anxiety and menopausal symptoms (B = 0.38, P < 0.001).

CONCLUSIONS

In the study, it was found that there was an association between menopausal symptoms and aging anxiety. However, the direction of the association is unknown. Therefore, it is recommended that health professionals address menopausal symptoms and aging anxiety together.

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women in China is rising, but the population's concept of menopausal hormone therapy (MHT) is still relatively outdated.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

Menopausal symptoms and utilization of menopausal hormone therapy among women aged 40-60 years in Addis Ababa, Ethiopia: a cross-sectional study

BACKGROUND

The onset of menopause leads to diminished estrogen exposure, resulting in a high morbidity burden related to menopausal symptoms. Menopausal hormonal therapy is an effective therapy that offers more advantages than disadvantages for women aged less than 60 years or who have had menopause for less than 10 years.

OBJECTIVE

This study aimed to assess the prevalence of menopausal symptoms, identify factors associated with menopausal symptoms, and assess the use of menopausal hormone therapy among women aged 40-60 who visited the gynecological clinics of three hospitals in Addis Ababa, Ethiopia.

METHODS

A facility-based cross-sectional study was conducted from January 2022 to June 2022 at Gandhi Memorial Hospital, Tikur Anbessa Hospital, and Zewditu Memorial Hospital on 296 middle-aged women. Data were collected using an interviewer-administered structured questionnaire and analyzed for sociodemographic factors, utilization of menopausal hormone therapy, and prevalence of menopausal symptoms using the menopause rating scale. Data were analyzed using SPSS version 25. Bivariate and multivariate logistic regression analyses were performed to identify independent predictors of each subscale of menopausal symptoms. The strength of the association was measured using odds ratios with 95% confidence intervals, and statistical significance was set at a value of P < 0.05.

RESULT

The prevalence of menopausal symptoms was 89.9%. According to the menopausal rating scale, the frequency of reported symptoms was hot flushes (54.7%), muscle and joint pain (32.1%) on the somatic subscale; physical and mental exhaustion (55.1%), irritability (48.6%) on psychological subscale; and sexual problems (41.3%), bladder problems (39.2%) on urogenital subscale. This study also showed that the age of women [aOR: 0.317, 95%CI (0.102, 0.990)], and monthly family income [aOR = 0.182, 95% CI (0.041, 0.912)] were significantly associated with somatic menopausal symptoms. There was no utilization of menopausal hormonal therapy to treat menopausal symptoms and to prevent complications.

CONCLUSION

The prevalence of menopausal symptoms is high; however, the utilization of individualized administration of menopausal hormone therapy according to symptoms is negligible. It appears essential for these institutions to work on service availability and delivery of menopausal hormone therapy for those in need of wider benefits for their clients.

Sleep disturbance associated with the menopause

IMPORTANCE AND OBJECTIVES

Sleep disturbance is one of the most common and debilitating symptoms experienced by women during the menopause transition. However, there are currently no therapies specifically approved for sleep disturbance associated with the menopause. Here, we consider how to characterize sleep disturbance associated with the menopause and discuss its etiology, including the latest advances in our understanding of the neuronal circuits that regulate reproduction, body temperature, sleep, and mood; and reflect on its impact on women's health and well-being. We also examine the current treatment landscape and look to the future of treatment for this condition.

METHODS

We conducted a review of the literature and combined this with discussion with experts in the fields of sleep and menopause as well as experiences from our own clinical practices.

DISCUSSION AND CONCLUSIONS

Sleep disturbance associated with the menopause is characterized by frequent night-time awakenings and increased awake time after sleep onset. Its impacts are wide-ranging, negatively affecting health as well as personal and social relationships, productivity, and work performance. There is currently an unmet need for effective, safe, and well-tolerated treatments to address this important symptom, and wider recognition of the association between sleep disturbances and the menopause is needed. Sleep disturbances associated with the menopause can result from hormone changes as well as vasomotor and mood symptoms. Growing research has contributed to our knowledge of the role of hypothalamic estrogen-sensitive kisspeptin/neurokinin B/dynorphin neurons. These neurons are thought to integrate the gonadotropin-releasing hormone pathway and the pathways responsible for the homeostatic control of body temperature and the circadian regulation of sleep-wake cycles. Understanding these neurons offers the potential to create treatments that target a key cause of sleep disturbance associated with the menopause. Further research to understand their etiology and characterize the neuronal circuits responsible could benefit the development of these targeted treatment approaches.

Dorsal brain activity reflects the severity of menopausal symptoms

OBJECTIVE

The severity of menopausal symptoms, despite being triggered by hormonal imbalance, does not directly correspond to hormone levels in the blood; thus, the level of unpleasantness is assessed using subjective questionnaires in clinical practice. To provide better treatments, alternative objective assessments have been anticipated to support medical interviews and subjective assessments. This study aimed to develop a new objective measurement for assessing unpleasantness.

METHODS

Fourteen participants with menopausal symptoms and two age-matched participants who visited our outpatient section were enrolled. Resting-state brain activity was measured using magnetoencephalography. The level of unpleasantness of menopausal symptoms was measured using the Kupperman Kohnenki Shogai Index. The blood level of follicle-stimulating hormone and luteinizing hormone were also measured. Correlation analyses were performed between the oscillatory power of brain activity, index score, and hormone levels.

RESULTS

The level of unpleasantness of menopausal symptoms was positively correlated with high-frequency oscillatory powers in the parietal and bordering cortices (alpha; P = 0.016, beta; P = 0.015, low gamma; P = 0.010). The follicle-stimulating hormone blood level was correlated with high-frequency oscillatory powers in the dorsal part of the cortex (beta; P = 0.008, beta; P = 0.005, low gamma; P = 0.017), whereas luteinizing hormone blood level was not correlated.

CONCLUSION

Resting-state brain activity can serve as an objective measurement of unpleasantness associated with menopausal symptoms, which aids the selection of appropriate treatment and monitors its outcome.

Efficacy and Safety of Shatavari Root Extract for the Management of Menopausal Symptoms: A Double-Blind, Multicenter, Randomized Controlled Trial

Background Menopause is a physiological state that occurs in all women and refers to the halt of the reproductive phase. The cessation of the reproductive phase occurs through various stages and presents different symptoms such as hot flashes, night sweats, insomnia, anxiety, depression, and irritability. Such pre- and post-menopausal symptoms may affect the daily activities and production capacities of women, impacting the quality of life (QoL) of women. Hormone replacement therapy (HRT) is primarily used to manage menopausal symptoms. However, various side effects have been reported related to HRT. Therefore, women are choosing alternative medicine such as Ayurveda that can benefit them with less or no adverse effects. Shatavari (Asparagus racemosus) is known in Ayurveda as an effective medicinal plant source for various women's health remedies since ancient times. This study aimed to evaluate the safety and efficacy of the Ayurvedic Shatavari formulation on menopausal symptoms compared to the placebo. Methodology This is a randomized, double-blinded, multicenter, placebo-controlled, clinical study. Altogether, 70 patients were randomized to two groups, i.e., the test group (active group) and the placebo group (microcrystalline cellulose), with 35 participants in each group. Results The study outcomes showed a positive and significant effect of the active test ingredient over the placebo in terms of reduction in hot flashes, night sweats, insomnia, anxiety, nervousness, vaginal dryness, and loss of libido. The Utian QoL improved significantly in the test group compared to the placebo group. No significant adverse events were recorded in the test group, suggesting the safety of this formulation. Conclusions The test compound could be a safe alternative to modern drugs. The findings of this study support the traditional use of Shatavari. Further clinical and pharmacological studies with longer duration and larger and more diverse sample sizes are required to understand the generalized effect of Shatavari root extract in menopausal women.

Lifestyle Medicine and Vasomotor Symptoms: An Analytic Review

This paper is an literature evaluation of the treatments based on the 6 pillars of Lifestyle Medicine (nutrition, physical activity, restorative sleep, stress management, positive social connection, and avoidance of risky substances) to improve vasomotor symptoms. Main findings were: (1) the Mediterranean diet and other plant-forward approaches may effectively reduce vasomotor symptoms; (2) stress can directly impact menopausal symptoms by increasing the frequency and intensity of hot flashes and other symptoms; (3) the incidence of sleep disturbances are high during the menopause transition; (4) evidence on the impact of physical activity and exercise on vasomotor symptoms is mixed, although moderate activity and strength training may be better for vasomotor symptom optimization than vigorous exercise and part of a healthy aging process; (5) evidence on the impact of social support on VMS is mixed with some studies suggesting benefit; and (6) evidence on the impact of risky substances is mixed but appears stronger for the effects of tobacco cessation than for alcohol cessation. In summary, while there is a variety of quality of evidence depending on the pillar, lifestyle medicine may be generally considered to improve vasomotor symptoms for patients that cannot use or decline hormone therapy.

Role of Social Support in Reducing the Severity of Menopausal Symptoms among Women Living in Rural Mysuru, Karnataka: An Analytical Cross-sectional Study

Introduction

Menopause is an unspoken and unaddressed aspect of a women's life, surrounded by many myths and taboos within the Indian context. Although a majority of menopausal women experience moderate to severe symptoms that can affect their physical, emotional, mental, and social well-being, there is poor health literacy as well as health-seeking behavior among them. The importance of social support, especially at a difficult time like menopause, is bound to minimize the severity of menopausal symptoms.

Objectives

The objective is to assess the severity of menopausal symptoms among women living in rural communities of Mysuru district, and to examine the relationship of perceived social support during menopausal transition to severity of the symptoms.

Materials and Methods

Between May 2022 and December 2022, a cross-sectional study was conducted among 250 women living in rural communities of Mysuru district, Karnataka. An interviewer-administered survey in Kannada was used to record the severity of menopausal symptoms and associated determinants after completion of informed consent process.

Results

The average age of study participants was 50.9 (standard deviation [SD] ±4.6) years. While 77.2% were married, 20.8% were widows. About half (53.6%) belonged to lower socioeconomic class and another 28% belonged to middle class. The mean age at menopause was 47.6 (SD ± 4.24) years; 56.8% reported experiencing moderate-to-severe symptoms; 75.6% reported high social support while 24.4% of women low-to-medium social support. The odds of experiencing moderate-to-severe menopause symptoms were 4.51 (95% confidence interval: 2.337-8.690) times higher among women who received low-to-medium social support as compared to those with high social support. The social support obtained was directly proportional to socioeconomic status and living with spouse.

Conclusion

The health system should emphasize the role of social support while counseling postmenopausal women. There is a dire need for both community and physician education programs on the social and medical needs of postmenopausal women.

Menopausal symptoms and attitudes toward hormone replacement therapy among Israeli women

Menopause occurs around midlife and is an inevitable component of women's aging. The study aimed to investigate the associations between the lifetime prevalence of menopausal symptoms and health-related characteristics among Israeli postmenopausal women aged 55-75 years. Additionally, this study aimed to estimate the use of hormone replacement therapy (HRT) and women's attitudes toward this treatment. Data for this study were extracted from a cross-sectional national telephone survey conducted in Israel between 2018 and 2020. For the current study, only postmenopausal women aged 55-75 years were included. Multivariate analyses were used to identify demographic and health-related characteristics associated with menopausal symptoms. The study included 688 participants. Most (68.8%) reported one or more menopausal symptoms, specifically vasomotor symptoms (50.4%). According to the multivariate logistic regression analysis, menopausal symptoms were associated with moderate-high anxiety and/or depression symptoms (OR = 2.01, 95% CI 1.12-3.58) and with osteoporosis (OR = 1.78, 95% CI 1.08-2.92). Although most (78.3%) symptomatic women were bothered by their symptoms, 29.1% received any treatment for symptom relief and only 12.6% reported current or past use of HRT. The findings show that menopausal symptoms were associated with a higher prevalence of anxiety and/or depression symptoms and osteoporosis in the years following menopause. Most symptomatic women did not receive any treatment and the majority were against HRT. Knowledge and awareness about menopause and treatment options should be increased among Israeli women. Additionally, the promotion of positive attitudes toward menopause and HRT use among women and healthcare providers is strongly recommended.

The 2023 nonhormone therapy position statement of The North American Menopause Society

OBJECTIVE

To update the evidence-based Nonhormonal Management of Menopause-Associated Vasomotor Symptoms: 2015 Position Statement of The North American Menopause Society.

METHODS

An advisory panel of clinicians and research experts in women's health were selected to review and evaluate the literature published since the Nonhormonal Management of Menopause-Associated Vasomotor Symptoms: 2015 Position Statement of The North American Menopause Society. Topics were divided into five sections for ease of review: lifestyle; mind-body techniques; prescription therapies; dietary supplements; and acupuncture, other treatments, and technologies. The panel assessed the most current and available literature to determine whether to recommend or not recommend use based on these levels of evidence: Level I, good and consistent scientific evidence; Level II, limited or inconsistent scientific evidence, and Level III, consensus and expert opinion.

RESULTS

Evidence-based review of the literature resulted in several nonhormone options for the treatment of vasomotor symptoms. Recommended: Cognitive-behavioral therapy, clinical hypnosis, selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors, gabapentin, fezolinetant (Level I); oxybutynin (Levels I-II); weight loss, stellate ganglion block (Levels II-III). Not recommended: Paced respiration (Level I); supplements/herbal remedies (Levels I-II); cooling techniques, avoiding triggers, exercise, yoga, mindfulness-based intervention, relaxation, suvorexant, soy foods and soy extracts, soy metabolite equol, cannabinoids, acupuncture, calibration of neural oscillations (Level II); chiropractic interventions, clonidine; (Levels I-III); dietary modification and pregabalin (Level III).

CONCLUSION

Hormone therapy remains the most effective treatment for vasomotor symptoms and should be considered in menopausal women within 10 years of their final menstrual periods. For women who are not good candidates for hormone therapy because of contraindications (eg, estrogen-dependent cancers or cardiovascular disease) or personal preference, it is important for healthcare professionals to be well informed about nonhormone treatment options for reducing vasomotor symptoms that are supported by the evidence.

Longitudinal associations between sleep quality and menopausal symptoms among community-dwelling climacteric women: A multi-centered study

STUDY OBJECTIVES

Menopausal symptoms exist in most climacteric women, which can harm the quality and satisfaction of life for them. Moreover, a series of ineluctable negative life changes experienced in middle-age usually make the situation more complicated and stressful. We aimed to determine the trajectories and influential factors of sleep quality and menopausal symptoms and their longitudinal interrelationships among climacteric women.

METHODS

A total of 1875 community-dwelling climacteric women were included in this study. The Pittsburgh Sleep Quality Index (PSQI) and the Menopause Rating Scale (MRS) were adopted to assess sleep quality and menopausal symptoms, respectively. Data were collected 4 times from March 2019 to December 2019, at a 3-month interval.

RESULTS

The Cross-lagged analysis showed that worse sleep quality and more severe menopausal symptoms over time after controlling for specified covariates, and more severe menopausal symptoms were predicted by declined sleep quality. The Generalized estimation equation model showed that education level, marital status, chronic diseases, life events, income, and age were the influential factors of sleep quality, while menopausal symptoms were impacted by marital status and income.

CONCLUSIONS

Increasing negative sleep quality and more severe menopausal symptoms over time contribute to the health burden of climacteric women. Menopausal symptoms could be alleviated by sleep quality improvement, which is influenced by education level, marital status, chronic diseases, life events, age, and economic factors.

Effects of health coaching on menopausal symptoms in postmenopausal and perimenopausal women

OBJECTIVE

This study aimed to determine the effects of health coaching on reducing menopausal symptoms in postmenopausal and perimenopausal women.

METHODS

This randomized controlled study was performed on 94 postmenopausal and perimenopausal women aged 45 to 55 years. The participants were randomly divided into intervention and control groups. In the intervention group, health coaching was performed in five coaching sessions biweekly (30-45 minutes each) by a midwifery coach. The primary outcome of this study was the menopausal score based on the modified Kupperman Index at 4 months after randomization. Depression (based on Zung's Self-Rating Depression Scale), physical activity (based on the International Physical Activity Questionnaire), quality of life (based on the 12-Item Short-Form Survey), smoking, alcohol intake, and anthropometric indices were also evaluated as secondary outcomes.

RESULTS

There was a significant mean difference between the coaching and control groups in terms of change in the scores of menopausal symptoms from baseline (T0) to 4 months after the intervention (T1; -12.51; 95% confidence interval [CI], -10.59 to -14.42; P = 0.001). Moreover, a significant mean difference was observed between the two groups in terms of change in depression symptoms from T0 to T1 (-5.72; 95% CI, -7.61 to -3.83; P < 0.001) and in terms of quality of life (4.13; 95% CI, 2.95 to 5.31; P < 0.001). Health coaching, however, had no effects on the physical activity of the participants.

CONCLUSION

Based on the present results, the coaching intervention is a suitable method to improve quality of life by reducing weight, waist circumference, body mass index, depression, and menopausal symptoms in postmenopausal and perimenopausal women. It can have important effects on the development of health promotion programs to reduce menopausal symptoms in menopause clinics.

Clinical Efficacy of Curcumin and Vitamin E on Inflammatory-Oxidative Stress Biomarkers and Primary Symptoms of Menopause in Healthy Postmenopausal Women: A Triple-Blind Randomized Controlled Trial

Aims of the Study. Reducing estrogen levels due to menopause activates oxidative and inflammatory processes, which causes symptoms of menopause, anxiety, and sexual dysfunction. As a suggestion, potential anti-inflammatory and antioxidant agents such as curcumin and vitamin E could be used as an effective alternative treatment due to parsimony, suitable access, and fewer side effects. Therefore, the present study was conducted to find out whether supplementation with curcumin and vitamin E affects inflammatory-oxidative stress biomarkers and primary symptoms of menopause in healthy postmenopausal women. Methods Used to Conduct the Study. The present study is a triple-blind parallel randomized controlled trial. Eighty-four eligible postmenopausal women aged 40 to 60 years old were randomly assigned into three groups using block randomization with an allocation ratio of 1 : 1 : 1. The curcumin group received one capsule containing 500 mg curcumin twice a day, the vitamin E group received one 500 mg capsule of vitamin E twice a day, and the placebo group took two placebo capsules containing 500 mg of microcrystalline cellulose (MCC) daily for eight weeks. Demographic and anthropometric characteristics, dietary intake, and early symptoms of menopause were collected at baseline. Serum levels of total antioxidant capacity (TAC), malondialdehyde (MDA), and high sensitivity C-reactive protein (hs-CRP) were measured at baseline and after the intervention. Intervention safety and satisfaction with the intervention were also evaluated. Results of the Study. Eighty-one participants completed the trial and were finally analyzed. There were no statistically significant differences in demographic characteristics and dietary intake of participants (except for vitamin C intake, P=0.023) between the groups at baseline. The mean ± standard deviation (SD) score of total menopause symptoms, depression, anxiety, psychological, vasomotor, and physical domains significantly decreased within all groups (P < 0.05). Between-group analyses indicated that decreasing the mean score of anxiety in the vitamin E group was significantly more than in the placebo group (P=0.026). The mean (SD) serum levels of MDA and hs-CRP significantly decreased only in the curcumin group (P=0.009 and P=0.025, respectively). Serum levels of TAC significantly increased in curcumin and vitamin E groups (P < 0.001 and P=0.006, respectively). Conclusions Drawn from the Study and Clinical Implications. Curcumin could improve the oxidative stress (MDA and TAC) and inflammatory (hs-CRP) biomarkers. Vitamin E may also improve the antioxidant status by increasing the TAC levels. The alleviation of anxiety in the vitamin E group was more than in the placebo group. Clinical Trial Registration. The trial was registered at the Iranian Registry of Clinical Trials (https://irct.ir/IRCT20131009014957N6).

Effects of aerobics training on anxiety, depression and sleep quality in perimenopausal women

OBJECTIVE

To investigate the effect of aerobics training on anxiety, depression and sleep disturbance in perimenopausal women.

MATERIALS AND METHODS

A total of 289 perimenopausal women with anxiety, depression or sleep disorder in Lishi district of Luliang city were treated with aerobics training. Self-rating anxiety scale, self-rating depression scale and Pittsburgh sleep scale were used to investigate the anxiety, depression and sleep status of perimenopausal women before and after intervention.

RESULTS

After aerobics training, the scores of self-rating anxiety scale, self-rating depression scale and Pittsburgh sleep questionnaire were 48.26 ± 6.47, 50.27 ± 6.54 and 10.64 ± 4.38, respectively. The levels of anxiety, depression and sleep disorder in 289 subjects were significantly lower than those before intervention (t = 3.865, 4.541, 5.596, P < 0.01). The remission rate of symptoms was significantly different in subjects with different frequency of spontaneous practice (P < 0.01), and the higher the number of spontaneous practice, the higher the remission rate of anxiety, depression and sleep disorders in subjects (P < 0.01).

CONCLUSION

aerobics training can effectively improve the anxiety and depression of perimenopausal women, improve sleep quality, the more frequency of practice, the more obvious the effect. It can be used as an intervention to improve the mental health level of perimenopausal women in terms of anxiety, depression and sleep quality in clinical promotion.

Severity and factors of menopausal symptoms in middle-aged women in Gansu Province of China: a cross-sectional study

OBJECTIVE

To investigate the severity and risk factors of menopausal symptoms in the middle-aged women in Gansu Province of China.

METHODS

In this cross-sectional study, a total of 7319 women (aged 40-55 years) attended the health survey in Gansu Province in China were enrolled. Information on demographics, menopausal status, reproductive history, and history of chronic diseases was collected via a structured questionnaire. Severity of menopausal symptom was evaluated by the Modified Kupperman Menopausal Index. Ordinal logistic regression model was applied to explore its risk factors.

RESULTS

A total of 7319 participants were included in present study, among them, 3606 (49.27%) had moderate or severe menopausal symptom. Compared with premenopausal women, perimenopausal and postmenopausal women have a higher mKMI score. We observed that older age, higher BMI, non-married status, longer duration of menstruation (≥ 7 days), number of pregnancy (> 3 times), longer duration of breastfeeding (> 12 months), peri- or post-menopausal status, and menopause hormone therapy was positively associated with menopausal symptom score, while higher level of family income, educational and physical activity, and history of gynecological, breast or chronic disease were negatively associated with the score.

CONCLUSIONS

Numerous factors were associated with the severity of menopausal symptom among the Chinese women. Because it was gradually increased with aging, more attention is warranted to manage the menopausal symptom.

Influencing factors on women's attitudes toward menopause: a systematic review

IMPORTANCE

Menopause is a natural stage of the reproductive life of a woman. This natural event might affect activities of daily living and cause problems for women. Positive attitudes toward menopause can improve women's quality of life and reduce the severity of menopausal symptoms.

OBJECTIVE

The aim of this systematic review was to assess the factors influencing women's attitudes toward menopause.

EVIDENCE REVIEW

This systematic review was conducted based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline in medical databases including PubMed, Web of Science, Scopus and Google Scholar, as well as Magiran, and SID until October 2020.

FINDINGS

A total of 7,512 articles were identified. Eight articles were included in the review after excluding the duplicates and screening the articles based on the inclusion and exclusion criteria. The majority of the studies used the Attitude Toward Menopause Scale to assess the attitudes toward menopause. This variable differed between the studies conducted in different regions and countries. Furthermore, postmenopausal women had more positive attitudes toward menopause compared with peri- or premenopausal women. Other influencing factors of attitudes toward menopause included age, menopausal symptoms, psychological and socioeconomical status, and profession and ethnicity.

CONCLUSION AND RELEVANCE

The findings showed that menopausal stage, menopausal symptoms, and psychological and socioeconomic status can influence the attitude of women toward menopause. Therefore, these factors should be considered in interventions that aim to improve women's attitudes toward menopause.

Genitourinary syndrome of menopause in Chinese perimenopausal and postmenopausal women

OBJECTIVE

The aim of this study was to investigate genitourinary syndrome of menopause (GSM) in a large cohort, analyzing the dependency on age and menopausal status and possible differences between non-hysterectomized and hysterectomized women.

METHODS

Data were assessed by validated questionnaires, collected over 2 years for all eligible women attending our 'Menopause Clinic' from 31 Chinese provinces. Simple and unconditional logistic regression analysis was used with adjustments by all analyzed factors.

RESULTS

A total of 4063 women (mean age 50.53 ± 6.57 years), 2107 perimenopausal and 1956 postmenopausal, were included. Almost all GSM symptoms were more frequent and severe in postmenopausal women. GSM was more frequent in hysterectomized women compared to non-hysterectomized women. Independent of menopausal status, low sexual interest (92.78%), urinary incontinence (91.65%) and vaginal dryness (91.60%) were the top three GSM symptoms. Most severe were low sexual interest (21.01%), vaginal pain (20.10%) and decreased sexual pleasure (17.13%). Prevalence and severity of GSM were not related to age, but were related to menopausal status and increased with time since menopause.

CONCLUSIONS

Within 2 years, more than 4000 women with GSM traveled from all over China to our specialized clinic, indicating the great importance of GSM. Hysterectomy can increase the risk of GSM, and GSM symptoms increase from perimenopause to postmenopause and with an increase of time since menopause, pointing to the dependency on the loss of ovarian function.