Prevalence of Menopausal Symptoms and its Effect on Quality of Life among Rural Middle Aged Women (40-60 Years) of Haryana, India

Quality of life in postmenopausal women and its association with sarcopenia

OBJECTIVES

With the menopausal transition, there is a decline in estrogen concentration with potential health consequences affecting the quality of life. The loss of muscle mass, strength, and function, known as sarcopenia is common in postmenopausal women. The primary objective of this study is to assess the quality of life in postmenopausal women and its association with sarcopenia.

METHODS

This was a cross-sectional study conducted in 106 postmenopausal women. Menopausal symptoms and risk of sarcopenia were assessed with Menopause Rating Scale (MRS) and Strength Assistance walking Rising from a chair Climbing stairs and Falls (SARC-F) questionnaires, respectively. Sarcopenia was defined and assessed according to the Asian Working Group for Sarcopenia guidelines 2019.

RESULTS

The mean age was 59.34 ± 7.21 years and the mean age at menopause was 49.50 ± 2.67 years. The majority (80.2%) of the women had high MRS scores (≥9). The majority had mild somatic, moderate psychologic, and severe urogenital symptoms. SARC-F score was low in 85.8% of women. Most of the women (45.3%) had sarcopenia. Somatic symptoms were significant in women with sarcopenia. Urogenital symptoms were significant with greater menopausal duration. Appendicular skeletal muscle mass index was significantly less with greater menopausal duration. MRS score positively correlated with both SARC-F score and sarcopenia. Sarcopenia was significantly associated with greater menopausal duration.

CONCLUSIONS

Most of the women had moderate to severe MRS scores suggestive of a poor quality of life. The majority of the women had sarcopenia. Most of the women felt they were strong (according to SARC-F score) despite sarcopenia. Although quality of life did not differ significantly with the duration of menopause, urogenital symptoms were significantly severe with greater menopausal duration. Despite no significant association between quality of life and sarcopenia in postmenopausal women, somatic symptoms were significant in women with sarcopenia. The greater menopausal duration was associated significantly with sarcopenia.

Menopausal wellbeing: navigating quality of life and osteoporosis risk

Background

Multifaceted dimensions influence the quality of life among post-menopausal women. Osteoporosis, a condition characterized by fragile bones, poses a significant risk, potentially leading to fractures and decreased wellbeing. This study aims to assess the quality of life of postmenopausal women, its determinants, and also the risk of osteoporosis among them.

Methods

A cross-sectional study was done among 379 post-menopausal women residing in rural and urban areas of Ernakulam district, Kerala, India. They were selected by probability proportional to size sampling from 10 clusters. Quality of life was measured using MENQOL-I questionnaire and osteoporosis risk assessment was done using OSTA score.

Results

The study participants had a mean age of 60 years, (standard deviation of 6.83 years). On average, menopause occurred at 50.58 years (standard deviation of 4.28 years). The most common symptoms impacting quality of life among postmenopausal women were psychosocial symptoms, followed by physical and vasomotor symptoms. Furthermore, a high proportion (63.6%) of participants were at risk for osteoporosis. History of fracture, concern of falling, marital status and having an insurance, are factors associated with various domains of quality of life.

Conclusion

This study underscores the complex interplay of demographic factors, menopausal experiences, and their impact on the participants' quality of life. The prevalence of psychosocial symptoms and the significant risk of osteoporosis call for tailored healthcare interventions. Postmenopausal women with history of fracture, high concern of fall and single women require special attention. Encouraging women to take up selfcare practices will help during the menopausal transition to have a good quality of life.

Efficacy evaluation of standardized Rheum rhaponticum root extract (ERr 731 ®) on symptoms of menopause: A systematic review and meta-analysis study

Menopause is characterized by various physical, mental and emotional symptoms. ERr 731 ® is a standardized extract from Rheum rhaponticum root and has been clinically studied for its role in reducing menopausal symptoms. The current systematic review and meta-analysis aimed to evaluate the efficacy of ERr 731 ® supplementation in alleviating the severity of menopausal symptoms. In this review, we searched across three online databases up to March 2023, evaluated the quality of the included studies by the Physiotherapy Evidence Database scale, and assessed the risk of bias by the Cochrane Risk of Bias tool. We then performed a meta-analysis using RevMan software to estimate the pooled mean difference (MD). The study protocol was registered in the Prospective Register of Systematic Reviews (CRD42023416808). After screening and evaluation, we included four high-quality studies (a total of 390 participants; the ERr 731 ® group: 193 participants; the control group: 197 participants) in the meta-analysis. The results showed that ERr 731 ® supplementation significantly reduced the Menopause Rating Scale score (MD: -15.12; P < 0.001), compared with control therapy. Sensitivity analysis revealed no effect of individual studies on the overall pooled estimate or overall observed heterogeneity. The current review provides evidence that ERr 731 ® supplementation is effective in reducing menopause symptoms. Potential bias and high heterogeneity in the results warrant further clinical studies.

Needs assessment study for management of menopause in the community

Menopause is an inevitable phase in every woman's life. Women may suffer from unpleasant symptoms during perimenopause. Understanding the health needs of the community during this period will help in developing menopause management programs that can improve quality of life.

Aim

To study the symptoms of menopause and perception of women in relation to menopause in order to understand their needs.

Settings and Design

A cross-sectional, multi-centric study was undertaken at three institutions (called DH, SJ, and SK) at two cities in India. The study population comprised women between the ages of 40 and 60. Institutional Ethics Committee approval and consent of participants were ensured.

Material and Methods

Two instruments, a pilot-tested, peer-reviewed, validated, structured questionnaire and the Menopause Rating Scale (MRS) were utilized for the study. The minimum sample size was calculated to be 385 per site. Statistical analysis was conducted using the IBM Statistical Package for Social Sciences.

Results

A total of 1297 forms were analyzed. MRS scores showed psychological symptoms to be most prevalent. Joint and muscular pains were the most common somatic symptoms. Hot flashes and urogenital symptoms were experienced by a lower number. Our MRS scores were significantly higher than those seen in other regions. Urban women, site SJ, those with irregular menstrual cycles, and lower incomes scored higher than their counterparts. Awareness about menopause was patchy, especially regarding medication or support services available.

Conclusions

The high MRS scores emphasize the need to institute awareness programs, providing information on choices available for care (hormone replacement therapy, medications, or counseling) and information on where to access services. Primary care physicians can play a vital role in fulfilling this need by ensuring timely knowledge to the community, providing correct diagnosis and treatment. This will help improve the quality of life and sense of well-being of this community.

D-Pinitol attenuates postmenopausal symptoms in ovariectomized mice

AIMS

Menopause is a natural process in women that can lead to post-menopausal syndrome with symptoms such as hot flushes, weight gain, anxiety, cognitive decline, and depression. Hormonal replacement therapy is commonly prescribed. However, it has serious adverse effects. Herbal medicinal products and isoflavones are used as alternatives. D-Pinitol found in Pinaceae and Fabaceae families has anti-inflammatory and antioxidant effects. However, it has not received as much attention as isoflavones. In this study, we investigated whether D-pinitol could alleviate post-menopausal symptoms using an ovariectomized (OVX) mouse model.

MAIN METHODS

Female ICR mice were divided into six groups: sham (vehicle), OVX (vehicle), OVX + D-pinitol (10, 30, 100 mg/kg, p.o.), and OVX + estradiol (0.5 mg/kg, s.c.). Treatment with vehicle, D-pinitol, and estradiol began at seven weeks post ovariectomy. We employed several behavioral tests, hot-flush test, and Western blot analysis.

KEY FINDINGS

We found that D-pinitol treatment (30, 100 mg/kg, p.o.) reversed cognitive dysfunction in OVX mice (novel object recognition and Y-maze test). Additionally, D-pinitol alleviated anxiety-like behaviors (elevated plus-maze) and reversed depressive-like behaviors (splash test, tail suspension test). It also normalized increased basal tail skin temperature in OVX mice. Moreover, D-pinitol administration reversed decreased expression of ERβ and synaptophysin and phosphorylation of ERK and PI3K-Akt-GSK-3β induced by OVX in the hippocampus and prefrontal cortex.

SIGNIFICANCE

These findings indicate that D-pinitol might be a promising candidate for treating post-menopausal symptoms by increasing ERβ and synaptophysin expression levels and activation of ERK or PI3K-Akt-GSK-3β signaling pathway, at least in part.

Effectiveness of Tibolone in Relieving Postmenopausal Symptoms for a Short-Term Period in Indian Women

Background

Tibolone is an alternative to conventional estrogen and progesterone in relieving post-menopausal symptoms in Indian women.

Material and Methods

A prospective short-term observational study was done at a tertiary care teaching hospital in New Delhi from November 2019 to September 2021. Fifty-three women, less than 60 years of age, presenting with moderate to severe intensity of menopausal symptoms as assessed by measuring menopausal rating score (MRS > 8) were enrolled and given Tibolone 2.5 mg daily for 3 months. Improvements in symptoms were seen at 1 month and 3 months. Side effects were also noted.

Results

Marked improvement was seen as reduction in scores of psychological, somatic and genitourinary symptoms was noted. The psychological symptoms reduced from 8.92 ± 1.959 to 2.905 ± 1.042, the somatic symptoms decreased from 8.33 ± 2.299 to 3.4 ± 1.167, and genitourinary symptoms decreased from 3.64 ± 1.42 to 2.150 ± 0.948 after 3 months of treatment with Tibolone. Only 3 patients (5.6%) experienced vaginal spotting with no major side effects.

Conclusions

Tibolone is a highly effective and well accepted drug to reduce moderate to severe menopausal symptoms, especially psychological symptoms including depression.

Health-related quality of life among menopausal women: A cross-sectional study from Pokhara, Nepal

INTRODUCTION

Menopause is the permanent cessation of menstruation. Quality of life is a broad concept affected by an individual's physical health, psychological state, level of independence, societal relationship, and environmental features. During the menopausal period, women can experience various symptoms affecting their quality of life. This study assesses the factors associated with health-related quality of life among menopausal women.

MATERIALS AND METHODS

A community-based cross-sectional study was carried out among 249 menopausal women to assess their health-related quality of life, associated factors, and self-reported health problems. A pre-tested structured interview schedule was used to conduct face-to-face interviews to obtain the information per the study's objective. The Menopausal Rating Scale (MRS) was used to assess the health-related quality of life. Data was entered in Epi-data, and analysis was done using the Statistical Package for Social Sciences (SPSS). Univariate, bivariate, and multivariate analyses were carried out to obtain results per our objectives.

RESULTS

The study found that 51.4% of menopausal women had poor quality of life. The mean and standard deviation of the total MRS score was found to be 9.5±5.3. Ultimately, the factors such as educational attainment {Adjusted Odds Ratio (AOR) = 5.779, 95% Confidence Interval (CI): 2.029-16.459}, medication/treatment of the health problems (AOR = 4.828, 95% CI: 1.662-14.023), alcohol intake status (AOR = 8.006, 95% CI: 2.016-31.785) and physical activity (AOR = 5.746, 95% CI: 1.144-28.872) were significant determinants of quality of life among menopausal women.

CONCLUSION

There is a need to pay proper attention to factors affecting the quality of life to improve the status of menopausal women.

Metabolite Profiling of the Environmental-Controlled Growth of Marsilea crenata Presl. and Its In Vitro and In Silico Antineuroinflammatory Properties

This study was aimed to evaluate the metabolite contents and antineuroinflammatory potential of Marsilea crenata Presl. grown under a controlled environmental condition. The antineuroinflammatory test has been carried out in vitro using ethanolic extract of M. crenata leaves on HMC3 microglia cells. An in silico approach was applied to predict the active compounds of the extract. The HMC3 microglia cells were induced with IFNγ to create prolonged inflammatory conditions and then treated with 96% ethanolic extract of the M. crenata leaves of 62.5, 125, and 250 μg/mL. The expression of MHC II was analyzed using the ICC method with the CLSM instrument. Metabolites of the extract were profiled using UPLC-QToF-MS/MS instrument and MassLynx 4.1 software. In silico evaluation was conducted with molecular docking on 3OLS protein using PyRx 0.8 software, and physicochemical properties of the compounds were analyzed using SwissADME webtool. The ethanolic extract of M. crenata leaves could reduce the MHC II expression in HMC3 microglia cells in all concentrations with the values 97.458, 139.574, and 82.128 AU. The result of metabolite profiling found 79 compounds in the extract. In silico evaluation showed that 19 compounds gave agonist interaction toward 3OLS, and three met all parameters of physicochemical analysis. The ethanolic extract of the environmental-controlled growth of M. crenata leaves antineuroinflammatory activity on HMC3 microglia cells. The extract was predicted to contain some phytoestrogen compounds which act as 3OLS agonists.

Correlates of palpitations during menopause: A scoping review

Objective:

Palpitations during peri- and post-menopause are common. It is unclear what variables are related to palpitations in peri- and post-menopausal women. The purpose of this scoping review was to summarize potential correlates of palpitations in women transitioning through menopause.

Methods:

The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Authors included English-language, full-length, peer-reviewed, cross-sectional research articles on palpitations in menopausal women published through December 18, 2021, from PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO searches. Following de-duplication, screening of titles and abstracts, and review of full-texts, independent reviewers extracted data on variables studied in relationship to palpitations from 84 articles and resolved discrepancies. Authors extracted data on (1) demographic, clinical, biomarker, and symptom/quality of life variables and (2) data analysis method (bivariate, multivariate). Authors classified each variable as a likely, unlikely, or unclear correlate of palpitations.

Results:

Articles were diverse in region of origin, sample sizes, and variables assessed in relationship to palpitations. Evidence for any one variable was sparse. Likely correlates of palpitations included race/ethnicity, lower physical activity, worse vasomotor symptoms (VMSs), worse sleep, and worse quality of life. Unlikely correlates included age, employment, education, marital status, socioeconomic status, comorbidities, body mass index, and sexual difficulties. Unclear correlates due to equivocal evidence were menopausal status, smoking, and depression. Unclear correlates due to insufficient evidence (less than three articles) included all of the assessed biomarkers, anxiety, and stress.

Conclusion:

Likely correlates were identified including race/ethnicity, physical activity, VMS, sleep, and quality of life. However, additional research is needed to better understand potential correlates of palpitations.

Experience and Perceptions Regarding Menopause among Rural Women: A Cross-Sectional Hospital-Based Study in South Karnataka

Background:

There is a culture of silence around menopause in India, more so among rural women. This study was conducted to assess the prevalence of menopausal symptoms, factors associated with the severity of menopausal symptoms, and perceptions regarding menopause among rural perimenopausal women.

Methodology:

A cross-sectional study was conducted at a rural hospital, among women aged 40 years or more, having experienced at least one menstrual cycle in the past 1 year. Structured interview schedule was administered to capture perceptions of menopause. Symptoms of menopause and severity were assessed using the Menopause Rating Scale (MRS) and participants screened for depression using patient health questionnaire-9.

Results:

Among 200 women, the prevalence of symptoms of menopause was 70%. Commonly reported symptoms were somatic symptoms: Joint/muscular pain, hot flushes, and psychological symptoms: Physical/mental exhaustion, anxiety. Median overall MRS score was low (4 [interquartile range = 1, 7]), pointing out to lesser severity. Significant association was found between MRS score and higher body mass index (P = 0.007), tobacco-chewing (P = 0.023), and depression (P < 0.001). Perception of menopause was generally positive, but we also documented some myths and misconceptions regarding menopause that indicate a need for health awareness in this population.

Conclusion:

This study found high prevalence but low severity of menopausal symptoms. Our findings point to a need for mitigating symptoms of menopause through diet, physical activity, tobacco cessation, and counseling for depression. Targeted interventions using community women's groups and village-level health workers are recommended to provide not only awareness regarding menopause but also an opportunity to screen for comorbidities with appropriate referrals.

The Association Between the Subjective Exercise Experience of Chinese Women Participating in Square Dance and Group Cohesion: The Mediating Effect of Income

Background: Chinese square dance has become well known worldwide in recent years, and most participants are women who dance with a group in their communities. In particular, middle-aged women may have physical and mental health problems, and participating in square dance may increase women's positive subjective well-being and decrease their negative emotions, which may improve their health over the long term. In addition, participating in square dance can promote group cohesion. Our study aimed to examine the relationship between the subjective exercise experience of participating in square dance and group cohesion and whether some variables (e.g., age, education, duration, income level, and work) play a role as mediators in the association with subjective exercise experience and group cohesion. Methods: In total, 1,468 Chinese women from 31 provinces and 82 cities participated in this study by completing an online questionnaire. The questionnaire consisted of a subjective exercise experience questionnaire and a group environment questionnaire. We analyzed the collected data and built a statistical model. Results: (a) Square dance satisfied women's physical and psychological needs partly; (b) positive well-being (PWB) was positively correlated with group cohesion, and fatigue was negatively correlated with group cohesion; and (c) the income level was a partial mediator of the relationship between group cohesion and subjective exercise experience. Conclusion: Chinese women have different motivations for participating in square dance. Because this activity can help meet women's physical and psychological needs, an increasing number of individuals worldwide participate in square dance. As women's subjective well-being increases, group cohesion increases, and vice versa. Moreover, the subjective exercise experience remains a significant predictor of group cohesion after including income level as a mediator, suggesting that the model indicates partial mediation.