Epidemiology of the symptoms of menopause - an intercontinental review

Severe menopausal symptoms and associated factors among post-menopausal women in Ambo town, West Shewa, Ethiopia: a cross-sectional study

BACKGROUND

Post-menopause is the permanent cessation of menstruation for 12 consecutive months at the age of 45 to 55 years. Post-menopausal women all over the world suffer from symptoms associated with menopause. Despite the fact that the population of menopausal women in Ethiopia is growing in parallel with their life expectancy, little is known about the severity and factors associated with menopausal symptoms among post-menopausal women. While previous studies in Ethiopia have primarily focused on the prevalence of severe menopausal symptoms, they have not thoroughly explored the underlying factors that may influence the severity of these symptoms. As a result, the specific factors that contribute to the severity of menopausal symptoms in Ethiopian women remain largely uninvestigated, leaving an important knowledge gap in this area. Therefore, this study was intended to assess severe menopausal symptoms and associated factors among post-menopausal women in Ambo town.

METHODS

A community-based cross-sectional study was conducted from August 3 to September 3, 2022, in Ambo town. The source population encompassed all post-menopausal women residing in Ambo Town. From this broader group, the study population was all post-menopausal women living in the three selected kebeles (the smallest administrative unit of Ethiopia). The sampling unit for this study was the household with post-menopausal women. A simple random sampling method was employed using computer-generated random numbers using the sampling frame taken from the conducted preliminary survey. Data were collected using a structured, interviewer-administered questionnaire. The data were entered using Epi Info version 7.1 and exported to SPSS version 25.0 for analysis. Bivariate analysis was used to examine individual relationships between independent variables and severe menopausal symptoms. Multivariable analysis then evaluated the combined impact of independent variables on severe menopausal symptoms while controlling for confounding factors, offering a comprehensive understanding of the factors that significantly influence symptom severity. Odds ratios with 95% Cl were estimated to identify the associated factors of the outcome variables, and statistical significance was affirmed at a p-value ≤ 0.05.

RESULTS

This study showed that one hundred thirty-three participants (30.4%), with a 95% CI (26.2%-35%), experienced severe menopausal symptoms during the past month. Age greater than 60 years [AOR = 3.2, 95% CI (1.3, 7.7)], not performing physical activity [AOR = 2.1, 95% CI (1.1, 4.4)], consuming alcohol [AOR = 1.8, 95% CI (1.1, 3.1), unfavorable attitude towards menopause [AOR = 1.8, 95% CI (1.1, 3.0)], and BMI > 29.9 kg/m2 [AOR = 6.1, 95% CI (2.7, 14.2)] were associated with severe menopause symptoms.

CONCLUSION AND RECOMMENDATION

According to this study, one in three postmenopausal women experienced severe menopausal symptoms. In conclusion, several factors were significantly associated with severe menopausal symptoms. Positive predictors of severe menopausal symptoms include; age over 60 years, lack of physical activity, alcohol consumption, unfavorable attitudes towards menopause, and a BMI greater than 29.9 kg/m2. These results highlight the role of both lifestyle behaviors and individual characteristics in determining the severity of menopausal symptoms. Therefore, we recommend implementing targeted support programs specifically for post-menopausal women. Promoting regular physical activity through tailored exercise programs and reducing alcohol consumption through education and counseling are essential. Additionally, educational interventions should aim to foster a positive attitude towards menopause. Weight management strategies, including both nutrition and exercise, should be prioritized for post-menopausal women with a BMI greater than 29.9 kg/m2.

Validation of the menopause representation questionnaire (MenoSentations-Q) among Iranian women and cross-cultural comparison with Portuguese women

BACKGROUND

Menopause represents a critical stage in middle. Examining menopausal symptoms within healthcare system requires reliable and valid instruments. The Menopause Representations Questionnaire (Menosentations-Q) is a self-report scale grounded in Leventhal's self-regulation model. This study aimed to explore the psychometric properties of this questionnaire among Iranian women.

METHODS

This study was conducted with women visiting healthcare centers in Saveh, Markazi province, Iran. A total of 320 eligible Iranian women and 354 Portuguese women (aged 45-65) completed the questionnaire. Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency was evaluated through Cronbach's alpha and McDonald's omega. Convergent and divergent validity were determined using average shared variance, maximum shared variance, construct reliability, and Fornell and Larcker's method. Cross-cultural validity was performed by multigroup CFA to assess invariance between two culturally distinct samples (Iranian and Portuguese).

RESULTS

The Content Validity Ratio (CVR) and Content Validity Index (CVI) were 0.96 and 0.98, respectively, indicating strong content and face validity. EFA of 22 items revealed four factors-identity, positive and negative consequences, and control/awareness/cause factors, accounting for 61.29% of the total variance. CFA indicated good model fit (CFI = 0.96, TLI = 0.95, χ2/df = 1.74, GFI = 0.91, AGFI = 0.89, RMSEA = 0.04). Cronbach's alpha (0.90) and McDonald's omega (0.92) indicated good internal consistency. Convergent and discriminant validity values of MenoSentations-Q were also acceptable. Also, the instrument showed invariance between the two cultural groups.

CONCLUSIONS

The Persian adaptation of MenoSentations-Q demonstrated strong validity and reliability. Furthermore, the comparable responses between Portuguese and Iranian participants suggest shared representations of menopause across these cultures. Given the significance of menopause, tailored educational programs and interventions are essential to address potential challenges during this life stage. Employing standardized tools such as the Menopsentations-Q can support the development of effective strategies, including educational initiatives, support programs, and targeted interventions, to empower women and enhance their well-being during this transitional phase.

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.

Associations of menopausal symptoms with job-related stress and social support in Japanese school teachers

OBJECTIVES

Being a school teacher is highly stressful. This study aimed to clarify the prevalence of menopausal symptoms and explore the association between these symptoms and job-related stress among Japanese school teachers.

STUDY DESIGN

A cross-sectional study was conducted among randomly selected elementary and junior high school teachers in Japan. Data from 284 teachers aged 45-60 years were analyzed.

MAIN OUTCOME MEASURES

Menopausal symptoms were measured using the Greene Climacteric Scale, and the Brief Job Stress Questionnaire was used to assess job stressors, social support, and job/family satisfaction. Associations between scores on the Greene Climacteric Scale and on the Brief Job Stress Questionnaire, and demographic information were analyzed.

RESULTS

The most common menopausal symptom was "feeling tired or lacking in energy" (reported by 94.4 % of respondents). The total intensity of menopausal, psychological, and somatic symptoms was significantly correlated with the total level of job stress. Moderate correlations were found between depressive symptoms and job stress regarding suitable jobs, job control, and rewarding jobs, while weak correlations were evident between depressive symptoms and job stress regarding quantitative job overload, interpersonal conflict, and poor physical environment. Higher levels of perceived support from supervisors or co-workers and job satisfaction were associated with less severe psychological and somatic symptoms.

CONCLUSIONS

Most middle-aged school teachers felt tired or lacking in energy. Higher job-related stress and lower levels of support from supervisors or co-workers were correlated with more severe menopausal symptoms. A supportive work environment and stress management are essential for such teachers.

Effects of education given in the menopausal period on the day-to-day impact of vaginal aging, self-efficacy in sexual abstinence and sexual distress: A randomized clinical trial

Despite physiological differences, women have to struggle with many problems related to menopause. It is the responsibility of nurses to provide women with the information and guidance they need during this period. Study was carried out to investigate the effects of education given in the menopausal period on the day-to-day impact of vaginal aging, self-efficacy in sexual abstinence, and sexual distress. This randomized controlled study was conducted at a center operated by a local municipality that provides services only to women, between 01.09.2023-10.12.2023 with 62 women (experimental:31, control:31). The data were collected using a "Personal Information Form," the "Day-to-Day Impact of Vaginal Aging Questionnaire-DIVA," the "Self-Efficacy Scale for Sexual Abstinence-SESSA," and the "Female Sexual Distress Scale-FSDS." ANOVA, independent-samples t-tests, paired-samples t-tests, and regression analyses were used to analyze the data. After the pretest, the experimental group were given education by the researcher in weekly sessions lasting 50/min. each for 5 weeks. In the posttest, the forms were administered 45 days after the last education session. There were significant differences between the experimental group in terms of their mean posttest DIVA (11.10 ± 2.65; 8.94 ± 1.65), FSDS (39.11 ± 9.07; 31.48 ± 10.27) and SESSA (17.85 ± 5.36; 21.25 ± 10.49 total scores (p < .001), while there was no significant difference between the pre-posttest of the control group (p < .05). Additionally, age was found to be a significant predictor of DIVA, whereas education level and marital satisfaction status were significant predictors of their SESSA. Education provided to women reduced the day-to-day impact of vaginal aging and sexual distress levels of the women and increased their self-efficacy in sexual abstinence.

Prevalence and impact of vasomotor symptoms due to menopause among women in Canada: A subgroup analysis from an international cross-sectional survey of Women with Vasomotor Symptoms Associated with Menopause (WARM Study)

OBJECTIVE

The aim of the study was to assess the prevalence of postmenopausal vasomotor symptoms (VMS) and the impact of VMS and related treatment patterns among perimenopausal and postmenopausal Canadian women.

METHODS

A subgroup analysis of data from a cross-sectional online survey of women aged 40-65 years conducted November 4, 2021, through January 17, 2022, evaluated the prevalence of moderate/severe VMS among postmenopausal Canadian women. The analysis also assessed survey responses from perimenopausal and postmenopausal Canadian women with moderate/severe VMS who completed the Menopause-Specific Quality of Life questionnaire, Work Productivity and Activity Impairment questionnaire, and the Patient-Reported Outcomes Measurement Information System Sleep Disturbances-Short Form 8b and answered questions about treatment patterns and attitudes toward treatments.

RESULTS

Of 2,456 Canadian postmenopausal women, 360 (14.7%; primary analysis) reported moderate/severe VMS in the previous month. Perimenopausal and postmenopausal women with moderate/severe VMS (n = 400; secondary analysis) reported negative impact on overall quality of life (mean total Menopause-Specific Quality of Life questionnaire score: 4.3/8). VMS impaired overall work and daily activities by 30.2% and 35.7%, respectively. Overall mean (SD) Patient-Reported Outcomes Measurement Information System Sleep Disturbance-Short Form 8b score (scale 8-40) was 28.5 (6.9), confirming sleep disturbances in this population. The majority of women (88% of the total cohort) sought advice, but about half were never treated. Most women had positive or neutral attitudes toward menopause.

CONCLUSIONS

In a survey conducted in Canada, moderate/severe VMS were reported by 14.7% of postmenopausal women and were associated with impairment in quality of life, work productivity, daily activities, and sleep in perimenopausal and postmenopausal women.

Prevalence of Depression and Sleep Disturbances among Postmenopausal and Perimenopausal Women in Ernakulam District

Background

The hormonal shifts and physiological changes during menopause, including perimenopause and postmenopause, significantly affect women's mental health, often causing depression and sleep disruptions. The objectives of this study are to estimate the prevalence of depression and sleep disturbances among perimenopausal and postmenopausal women and to find the associated risk factors.

Materials and Methods

In a community setting, 462 women aged 45-60 years were chosen from 23 clusters using probability proportional to size sampling. Sociodemographic information was collected through standardized surveys, whereas depression levels were measured with Beck's Depression Inventory-II and sleep quality with the Pittsburgh Sleep Quality Index. Statistical analysis was done using SPSS version 21.

Results

The prevalence of depression among the study participants was 33.3% (95% confidence interval [CI]: 29%, 37%), whereas poor sleep quality was found in 37% (95% CI: 36%, 39%). Factors such as low socioeconomic status (adjusted odds ratios [aOR] =1.64), recent negative life events (aOR =2.27), lack of social media usage (aOR =2.77), and being unmarried/widowed (aOR =2.1) were identified as independent predictors of depression. Living in urban areas (aOR =1.69), low socioeconomic status (aOR =1.96), and inadequate intake of fruits and vegetables (aOR =0.43) were identified as independent predictors for sleep disturbances.

Conclusions

This study highlights a notable burden of depression and sleep disruptions among menopausal women. Tackling these challenges necessitates accessible mental healthcare, educational workshops on stress management and sleep habits, nutritional guidance, and peer support networks. Incorporating these measures into health initiatives and policies holds promise for mitigating these concerns and enhancing overall well-being.

Validation and cultural translation for the Brazilian Portuguese version of the Estro-Androgenic- Symptom Questionnaire in Women

Objective

This study aimed to translate and validate the Estro-Androgenic-Symptom Questionnaire in Women (EASQ-W) into Brazilian Portuguese language, as we hypothesized that this tool would be consistent for addressing the specific context of hormonal symptoms in menopause.

Methods

In a cross-sectional study, a total of 119 women with Genitourinary Syndrome of Menopause (GSM) and 119 climacteric women without GSM were included. The EASQ-W was translated, and its psychometric properties were rigorously examined. Participants completed questionnaires covering sociodemographic details, the EASQ-W, and the Menopause Rating Scale (MRS). A subgroup of 173 women was re-invited after 4 weeks for test-retest analysis of the EASQ-W. Additionally, the responsiveness of the questionnaire was evaluated in 30 women who underwent oral hormonal treatment.

Results

The internal consistency of the EASQ-W was found to be satisfactory in both GSM and control groups (Cronbach's alpha ≥ 0.70). Notably, a floor effect was observed in both groups; however, a ceiling effect was only evident in the sexual domain of the GSM group. Construct validity was established by comparing the EASQ-W with the MRS, yielding statistically significant correlations (0.33831-0.64580, p < 0.001). The test-retest reliability over a 4-week period was demonstrated to be satisfactory in both the GSM and control groups (ICC 0.787-0.977). Furthermore, the EASQ-W exhibited appropriate responsiveness to oral hormonal treatment (p < 0.001).

Conclusion

This study successfully translated and validated the Estro-Androgenic-Symptom Questionnaire in Women (EASQ-W) into Brazilian Portuguese, with satisfactory internal consistency, test-retest reliability, and construct validity.

Associations between the severity of menopausal symptoms and musculoskeletal pain in postmenopausal Portuguese women

OBJECTIVE

To analyze the association of the severity of the menopausal symptoms with musculoskeletal pain in Portuguese postmenopausal women.

METHODS

A cross-sectional, observational study was conducted on 167 women (63.85 ± 9.36 years). The Menopause Rating Scale was used to evaluate the menopausal symptoms severity, while the Nordic Musculoskeletal Questionnaire was employed to assess the localization of the musculoskeletal pain, and multi-located pain was determined if two or more body regions were affected. Depression (Hospital Anxiety and Depression Scale), age, body mass index (BMI) and physical activity level were considered as potential confounders.

RESULTS

A greater severity of the somato-vegetative menopausal symptoms was related to the prevention from usual activities because of pain in the neck, shoulders, elbows, wrists/hands and knees (R2 of Nagelkerke = 0.064, 0.043, 0.074, 0.045 and 0.045, respectively). Associations were also observed between greater age and pain in the knees, ankles and feet (R2 of Nagelkerke = 0.036 and 0.034, respectively), and being physically inactive with upper back pain (R2 of Nagelkerke = 0.060). Higher depressive symptoms were linked to pain in the hip/thighs and knees (R2 of Nagelkerke = 0.067 and 0.085, respectively), as well as being physically inactive was related ton in the neck (R2 of Nagelkerke = 0.053). Only a greater BMI was related to multi-located pain in the last 7 days (R2 of Nagelkerke = 0.041).

CONCLUSIONS

The findings of our study showed that, taking into account possible confounders, greater severity of the menopausal symptoms at a somatic-vegetative level was associated with more anatomical regions with musculoskeletal pain.

Efficacy and Safety of Fezolinetant for the Treatment of Menopause-Associated Vasomotor Symptoms: A Meta-analysis

OBJECTIVE

To evaluate the efficacy and adverse events of fezolinetant for treating vasomotor symptoms (VMS) of menopause.

DATA SOURCES

PubMed/MEDLINE, ClinicalTrials.gov , EMBASE, Cochrane Database, Scopus, and WHO International Clinical Trials Registry Platform were searched through June 2023 for publications and randomized controlled trials on fezolinetant compared with placebo in menopausal women who experienced moderate-to-severe VMS.

METHODS OF STUDY SELECTION

Our literature search identified 330 articles, of which five studies with six reports were included in our meta-analysis per our eligibility criteria.

TABULATION, INTEGRATION, AND RESULTS

The risk of bias was evaluated using Cochrane's RoB 2 (Risk of Bias version 2) tool, quality of evidence was graded using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, and outcome measures data for effect size were pooled in random-effects model and rated. A total of 2,168 participants from five randomized clinical trials (six reports) were included. Fezolinetant significantly lowered VMS frequency, with pooled mean difference of 2.62 (95% CI, 1.84-3.41). The pooled mean difference for fezolinetant compared with placebo for the MENQOL (Menopause-Specific Quality of Life) measure was -0.60 (95% CI, -0.92 to -0.28), and the mean percentage improvement in VMS frequency was 22.51% (95% CI, 15.35-29.67). Fezolinetant was associated with improvement in sleep quality when compared with placebo.

CONCLUSION

Fezolinetant is effective in lowering moderate-to-severe VMS frequency and sleep disturbances in postmenopausal women.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42023427616.

Deciphering the relationship between temperature and immunity

Fever is a hallmark symptom of disease across the animal kingdom. Yet, despite the evidence linking temperature fluctuation and immune response, much remains to be discovered about the molecular mechanisms governing these interactions. In patients with rheumatoid arthritis, for instance, it is clinically accepted that joint temperature can predict disease progression. But it was only recently demonstrated that the mitochondria of stimulated T cells can rise to an extreme 50°C, potentially indicating a cellular source of these localized 'fevers'. A challenge to dissecting these mechanisms is a bidirectional interplay between temperature and immunity. Heat shock response is found in virtually all organisms, activating protective pathways when cells are exposed to elevated temperatures. However, the temperature threshold that activates these pathways can vary within the same organism, with human immune cells, in particular, demonstrating differential sensitivity to heat. Such inter-cellular variation may be clinically relevant given the small but significant temperature differences seen between tissues, ages, and sexes. Greater understanding of how such small temperature perturbations mediate immune responses may provide new explanations for persistent questions in disease such as sex disparity in disease prevalence. Notably, the prevalence and severity of many maladies are rising with climate change, suggesting temperature fluctuations can interact with disease on multiple levels. As global temperatures are rising, and our body temperatures are falling, questions regarding temperature-immune interactions are increasingly critical. Here, we review this aspect of environmental interplay to better understand temperature's role in immune variation and subsequent risk of disease.

Menopausal symptoms, exercise practices, and advice received in active women: a multi-country survey of strava app users

The study aimed to identify the prevalence of symptoms, changes in exercise levels, and exercise advice received during the menopausal transition in a large multi-country sample. Using total population sampling, 2.5 percent of female Strava app users (n = 970) from 7 countries completed an online survey between 14 February 2019 and 11 March 2019. The survey discussed menopause status (perimenopausal or postmenopausal), menopausal symptoms, changes to exercise behaviors, and advice received concerning exercise during menopause. Frequencies, chi-square statistics, and linear regressions were used to analyze data. The most commonly reported menopausal symptoms were sexual (18-83 percent) and cognitive/psychological (77-78 percent). 41 percent of women reported no change in exercise behavior since menopause began (46 percent increased and 11 percent decreased behaviors). The majority (88 percent) of women did not receive advice regarding exercise during menopause. Women who received advice were more likely to report an increase in their exercise than those not receiving advice (60 percent vs 46 percent; X2 (df 2, n = 927) = 7.1, p = .03). Exercise behaviors increased the longer it had been since the menopausal onset (X2 (df 8, n = 937) = 77.42, p < .001). The results suggested high menopausal symptom prevalence in active women and a general lack of exercise advice. More women reported higher symptom prevalence and an increase in exercise participation, the longer it had been since menopause onset. Future research should determine whether these increased exercise behaviors are being used as a coping mechanism.

Systematic review and network meta-analysis comparing the efficacy of fezolinetant with hormone and nonhormone therapies for treatment of vasomotor symptoms due to menopause

IMPORTANCE

The neurokinin 3 receptor antagonist fezolinetant 45 mg/d significantly reduced frequency/severity of moderate to severe vasomotor symptoms (VMS) of menopause compared with placebo in two phase 3 randomized controlled trials. Its efficacy relative to available therapies is unknown.

OBJECTIVE

We conducted a systematic review and Bayesian network meta-analysis to compare efficacy with fezolinetant 45 mg and hormone therapy (HT) and non-HT for VMS in postmenopausal women.

EVIDENCE REVIEW

Using OvidSP, we systematically searched multiple databases for phase 3 or 4 randomized controlled trials in postmenopausal women with ≥7 moderate to severe VMS per day or ≥50 VMS per week published/presented in English through June 25, 2021. Mean change in frequency and severity of moderate to severe VMS from baseline to week 12 and proportion of women with ≥75% reduction in VMS frequency at week 12 were assessed using fixed-effect models.

FINDINGS

The network meta-analysis included data from the pooled phase 3 fezolinetant trials plus 23 comparator publications across the outcomes analyzed (frequency, 19 [34 regimens]; severity, 6 [7 regimens]; ≥75% response, 9 [15 regimens]). Changes in VMS frequency did not differ significantly between fezolinetant 45 mg and any of the 27 HT regimens studied. Fezolinetant 45 mg reduced the frequency of moderate to severe VMS events per day significantly more than all non-HTs evaluated: paroxetine 7.5 mg (mean difference [95% credible interval {CrI}], 1.66 [0.63-2.71]), desvenlafaxine 50 to 200 mg (mean differences [95% CrI], 1.12 [0.10-2.13] to 2.16 [0.90-3.40]), and gabapentin ER 1800 mg (mean difference [95% CrI], 1.63 [0.48-2.81]), and significantly more than placebo (mean difference, 2.78 [95% CrI], 1.93-3.62]). Tibolone 2.5 mg (the only HT regimen evaluable for severity) significantly reduced VMS severity compared with fezolinetant 45 mg. Fezolinetant 45 mg significantly reduced VMS severity compared with desvenlafaxine 50 mg and placebo and did not differ significantly from higher desvenlafaxine doses or gabapentin ER 1800 mg. For ≥75% responder rates, fezolinetant 45 mg was less effective than tibolone 2.5 mg (not available in the United States) and conjugated estrogens 0.625 mg/bazedoxifene 20 mg (available only as 0.45 mg/20 mg in the United States), did not differ significantly from other non-HT regimens studied and was superior to desvenlafaxine 50 mg and placebo.

CONCLUSIONS

The only HT regimens that showed significantly greater efficacy than fezolinetant 45 mg on any of the outcomes analyzed are not available in the United States. Fezolinetant 45 mg once daily was statistically significantly more effective than other non-HTs in reducing the frequency of moderate to severe VMS.

RELEVANCE

These findings may inform decision making with regard to the individualized management of bothersome VMS due to menopause.

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.

In silico guided in vitro study of traditionally used medicinal plants reveal the alleviation of post-menopausal symptoms through ERβ binding and MAO-A inhibition

The slumping level of estrogen and serotonin in menopausal women is directly associated with the occurrence of menopausal symptoms where, estrogen receptor-β (ERβ) and monoamine oxidase-A (MAO-A) are directly involved. The present investigation aimed for validation of promising plants traditionally used to alleviate menopausal symptoms with ERβ mediated MAO-A inhibition potential through in silico disease-target network construction using Cytoscape plugins followed by molecular docking of phytomolecules through AutoDock vina. ADMET parameters of identified bioactive phytomolecules were analysed through swissADME and ProTox II. The efficacy of promising plant leads was further established through in vitro ERβ competitive binding, MAO-A inhibition, enzyme kinetics and free radical quenching assays. In silico analysis suggested glabrene (ΔG = -9.7 Kcal/mol) as most promising against ERβ in comparison to 17β-estradiol (ΔG = -11.4 Kcal/mol) whereas liquiritigenin (ΔG = -9.4 Kcal/mol) showed potential binding with MAO-A in comparison to standard harmine (ΔG = -8.8 Kcal/mol). In vitro analysis of promising plants segregated Glycyrrhiza glabra (IC50 = 0.052 ± 0.007 μg/ml) as most promising, followed by Hypericum perforatum (IC50 = 0.084 ± 0.01 μg/ml), Trifolium pratense (IC50 = 0.514 ± 0.01 μg/ml) and Rumex nepalensis (IC50 = 2.568 ± 0.11 μg/ml). The enzyme kinetics of promising plant leads showed reversible and competitive nature of inhibition against MAO-A. The potency of plant extracts in quenching free radicals was at par with ascorbic acid. The identified four potent medicinal plants with ERβ selective, MAO-A inhibitory and free radical quenching abilities could be used against menopausal symptoms however, finding needs to be validated further for menopausal symptoms in in vivo conditions for drug development.Communicated by Ramaswamy H. Sarma.

Safety of Fezolinetant for Vasomotor Symptoms Associated With Menopause: A Randomized Controlled Trial

OBJECTIVE

To evaluate the safety, tolerability, and effect of fezolinetant on endometrial health over 52 weeks.

METHODS

We conducted a phase 3, randomized, double-blind, 52-week safety study (SKYLIGHT 4 [Study to Find Out How Safe Long-term Treatment With Fezolinetant is in Women With Hot Flashes Going Through Menopause]) of placebo, fezolinetant 30 mg, and fezolinetant 45 mg once daily (1:1:1). Participants were postmenopausal and seeking treatment for vasomotor symptoms associated with menopause. Primary endpoints were treatment-emergent adverse events, percentage of participants with endometrial hyperplasia, and percentage with endometrial malignancy. Endometrial hyperplasia or malignancy was evaluated according to U.S. Food and Drug Administration guidance (point estimate of 1% or less with an upper bound of one-sided 95% CI of 4% or less). Secondary endpoints included change in bone mineral density (BMD) and trabecular bone score. A sample size of 1,740 was calculated to enable observation of one or more events (≈80% probability for events with background rate of less than 1%).

RESULTS

A total of 1,830 participants were randomized and took one or more medication dose (July 2019-January 2022). Treatment-emergent adverse events occurred in 64.1% (391/610) of the placebo group, 67.9% (415/611) of the fezolinetant 30-mg group, and 63.9% (389/609) of the fezolinetant 45-mg group. Treatment-emergent adverse events leading to discontinuation were similar across groups (placebo, 26/610 [4.3%]; fezolinetant 30 mg, 34/611 [5.6%]; fezolinetant 45 mg, 28/609 [4.6%]). Endometrial safety was assessed in 599 participants. In the fezolinetant 45-mg group, 1 of 203 participants had endometrial hyperplasia (0.5%; upper limit of one-sided 95% CI 2.3%); there were no cases in the placebo (0/186) or fezolinetant 30 mg (0/210) group. Endometrial malignancy occurred in 1 of 210 in the fezolinetant 30-mg group (0.5%; 95% CI 2.2%) with no cases in the other groups. Liver enzyme elevations more than three times the upper limit of normal occurred in 6 of 583 placebo, 8 of 590 fezolinetant 30 mg, and 12 of 589 fezolinetant 45 mg participants; no Hy's law cases were reported (ie, no severe drug-induced liver injury with alanine aminotransferase or aspartate aminotransferase more than three times the upper limit of normal and total bilirubin more than two times the upper limit of normal, with no elevation of alkaline phosphatase and no other reason to explain the combination). Changes in BMD and trabecular bone score were similar across groups.

CONCLUSION

Results from SKYLIGHT 4 confirm the 52-week safety and tolerability of fezolinetant and support its continued development.

FUNDING SOURCE

Astellas Pharma Inc.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT04003389.

The Current Strategy in Hormonal and Non-Hormonal Therapies in Menopause—A Comprehensive Review

Menopause is a natural stage of hormonal aging in women, accompanied by a series of symptoms that reduce the quality of life of a fully active person. As no therapy is entirely satisfactory, the race for a better option is in full swing. Our study objective is to investigate the most recent menopause studies on pharmacological resources, emerging therapies, and the particularities of hormonal replacement therapy (HRT). For this purpose, a comprehensive search was conducted in two main databases (PubMed and Web of Science) guided by the specific keywords “menopause” and “therapy” or “estrogen” or “progesterone” or “hormone replacement” during the last ten years period. Studies were eligible if they met certain criteria: randomized controlled trials (RCT) in adult women with menopause and hormonal or non-hormonal therapies. We selected 62 RCTs, which are focused on four main topics: (a) epidemiology of menopause-related symptoms, (b) hormonal replacement therapy (HRT) selective estrogen receptor modulators, (c) emerging therapies, and (d) menopause. HRT has proven a real health benefit for menopausal women; besides, complementary interventions must be considered. Further studies are needed on menopause and menopause-related therapies. The continuous updating of clinical experience will strengthen the therapeutic benefit and the decision to treat patients safely. This goal will fully access all therapeutic resources to address an unresolved health issue of active adult women.

Acupuncture for comorbid depression and insomnia in perimenopause: A feasibility patient-assessor-blinded, randomized, and sham-controlled clinical trial

Background and objective

Whilst acupuncture is widely used for treating psychosomatic diseases, there is little high-quality evidence supporting its application in comorbid perimenopausal depression (PMD) and insomnia (PMI) which are common complaints during climacteric. This feasibility, patient-assessor-blinded, randomized, sham-controlled clinical trial addresses this gap by investigating the efficacy and safety of acupuncture on depressed mood and poor sleep in women with comorbid PMD and PMI.

Methods

Seventy eligible participants were randomly assigned to either real-acupuncture (RA) or sham-acupuncture (SA) groups. Either RA or SA treatment were delivered in 17 sessions over 8 weeks. The primary outcomes for mood and sleep were changes on 17-items Hamilton Depression Rating Scale (HAM-D₁₇) and Pittsburgh Sleep Quality Index (PSQI) scores, from baseline to 16-week follow-up. Secondary outcome measures involved anxiety symptoms, perimenopausal symptoms, quality of life, participants' experience of and satisfaction with the acupuncture treatment. Blood samples were taken to measure reproductive hormone levels. Intention-To-Treat and Per-Protocol analyses were conducted with linear mixed-effects models. The James' and Bang's blinding indices were used to assess the adequacy of blinding.

Results

Sixty-five participants completed all treatment sessions, and 54 and 41 participants completed the eight- and 16-week follow-ups, respectively. At post-treatment and 8-week follow-up, the RA group showed a significantly greater reduction in PSQI scores than the SA group did; although the reduction of HAM-D₁₇ scores in RA group was significant, the change was not statistically different from that of SA. There were no significant mean differences between baseline and 16-week follow-up in either HAM-D₁₇ or PSQI in either group. There were no significant between-group differences in serum reproductive hormone levels. All treatments were tolerable and no serious adverse events were reported, and the blinding was successful.

Conclusion

Acupuncture is safe and can contribute to clinically relevant improvements in comorbid PMD and PMI, with satisfactory short-and medium-term effects. Whether the anti-depressive benefit of acupuncture is specific or non-specific remains to be determined. No evidence was found for any longer-term benefit of acupuncture compared to sham at 16 weeks. Further research is required to elucidate mechanisms underlying the short to medium term effects of acupuncture.

Prevalence of sexual dysfunctions in women in their early and middle adulthood from the Pokarpackie Voivodeship

Background: Sexual dysfunctions are disorders related to the physiology of sexual responses. Aim of the study: Our study aimed to assess the prevalence of sexual dysfunctions in women in their early and middle adulthood. Material and methods: The early adulthood group consisted of 125 women aged 20–30, and out of these 100 questionnaires qualified for the final analysis. The middle adulthood group consisted of 275 women aged 45–55 in which 200 complete questionnaires were analyzed. The study was conducted in 2016 using a diagnostic survey method and the author's own survey questionnaire, the Mell-Krat Scale for Women and the Female Sexual Function Index (PL-FSFI). Results: Only 38.0% of respondents from the early adulthood group and 25.0% from the middle-adult group interviewed with a gynecologist about their sex life, possible disorders, and problems. Additionally, only 1.0% of women in the middle adulthood group benefited from the advice of a sexologist. According to the interpretation of the Mell-Krat scale, 41.0% of respondents in the early adulthood group and 76.0% of women in the middle adulthood group had a suboptimal score. These results indicate the possibility of sexual response disorders. All women in the early adulthood group and middle adulthood group scored below normal on the PL-FSFI scale indicating that the respondents are at risk for sexual disorders. Conclusions: According to the PL-FSFI scale, all women in the study may be at risk of sexual disorders. According to the Mell-Krat scale, as many as ¾ of women might suffer from sexual response disorders or are at risk of sexual disorders. Taking into account the significance of a sex life, it is necessary to take action to provide women with professional medical and psychological help to improve their intimacy sphere of life.

Menopausal Symptoms, Postural Balance, and Functional Mobility in Middle-Aged Postmenopausal Women

The aim of the present study was to determine the associations between the severity of the menopausal symptoms and postural balance and functional mobility in middle-aged postmenopausal women. A cross-sectional study was performed (171 participants, 57.18 ± 4.68 years). Severity of the menopausal symptoms (on the Menopause Rating Scale), postural balance (stabilometric platform) with eyes open and closed, and functional mobility (timed up and go test) were determined. A multivariate linear regression was performed, with body mass index, waist to hip ratio, age and fall history as possible confounders. Our findings showed that a greater severity of the menopausal symptoms at a psychological level was associated, under both eyes open and closed conditions, with worse postural control assessed by the length of the stabilogram (adjusted R2 = 0.093 and 0.91, respectively), the anteroposterior center of pressure displacements (adjusted R2 = 0.051 and 0.031, respectively) and the center of pressure velocity (adjusted R2 = 0.065 for both conditions). Older age was related to greater mediolateral displacements of the center of pressure with eyes open and closed (adjusted R2 = 0.45 and 0.58, respectively). There were no associations between the menopausal symptoms' severity and functional mobility. We can conclude that a greater severity of psychological menopausal symptoms was independently associated with worse postural balance in middle-aged postmenopausal women.

Neurokinin 3 Receptor Antagonists Compared With Serotonin Norepinephrine Reuptake Inhibitors for Non-Hormonal Treatment of Menopausal Hot Flushes: A Systematic Qualitative Review

Introduction

Hot flushes/flashes (HFs) or other vasomotor symptoms affect between 45 and 97% of women during menopause. Hormone replacement therapy (HRT) is effective at alleviating menopausal symptoms, but some women cannot or prefer not to take HRT. Since current non-hormonal options have suboptimal efficacy/tolerability, there is a pressing need for an effective, well-tolerated alternative. The neurokinin 3 receptor (NK3R) has recently been implicated in the generation of menopausal HFs and represents a novel therapeutic target to ameliorate HF symptoms. This review aims to assess if NK3R antagonists (NK3Ras) are more effective than Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)—currently a common choice for non-hormonal treatment of menopausal HFs.

Methods

Studies were identified after systematically searching Ovid MEDLINE and EMBASE databases based on PRISMA guidelines. Trial quality and bias were assessed. Key efficacy outcomes (HF frequency, HF severity and number of night-time awakenings/night-sweats) and selected safety outcomes were extracted and analysed.

Results

Seven SNRI and four NK3Ra placebo-controlled randomised trials (plus four follow-up reports) were included in this review. NK3Ra administration resulted in a larger reduction from baseline in HF frequency, HF severity and night-sweats compared to SNRIs. Five of seven SNRI trials showed a reduction in HF frequency that was statistically significant (by 48–67% from baseline at weeks 8 or 12) whereas all NK3Ra trials showed a statistically significant reduction in HF frequency (by 62–93% from baseline at weeks 2, 4 or 12). While SNRI trials reported poor tolerability, particularly nausea, NK3Ra trials reported good tolerability overall, although two trials reported elevation in transaminases.

Conclusion

NK3Ras trials show encouraging efficacy and tolerability/safety. Completion of phase 3 NK3Ra trials are required to confirm efficacy and uphold safety/tolerability data but phase 2 results suggest that NK3Ras are more effective than SNRIs for non-hormonal treatment of menopausal HFs.

Prescription patterns of herbal medicine for menopausal disorders in major Korean medicine hospitals: a multicenter retrospective study

BACKGROUND

This study aimed to obtain the symptom, prescription and therapeutic patterns for the treatment of patients with menopausal syndrome in major Korean medicine (KM) hospitals.

METHODS

We used a retrospective chart review of climacteric disorder and postmenopausal syndrome patients by examining medical records (ICD-10, menopausal and female climacteric states: N95.1, Menopausal and perimenopausal disorder, unspecified: N95.9) from eight university KM hospitals in South Korea.

RESULTS

The main symptoms of 1,682 patients with menopausal disorders visiting eight college-affiliated oriental medicine hospitals were hot flush, hyperhidrosis, fatigue, insomnia, and chest tightness. Guipi decoction, Si-wu guipi decoction, Qing-xin lianzi-yin, Jiawei xiao-yao-san and Guipi wen-dan decoction were the most commonly prescribed treatments for menopausal disorders. Patients were most often treated with a combination of herbal medicine and acupuncture.

CONCLUSION

Our study shows that the current prescribed herbal medicines were used for treating menopausal disorders in Korean medicine hospitals. However, the objectivity of the efficacy assessment should be studied further.

Factors affecting suicidal ideation among premenopausal and postmenopausal women

WHAT IS KNOWN ON THE SUBJECT?: Pre- and postmenopausal women (PPW) experience changes in physical, psychological and social health. South-East Asia's female suicide rate is the highest compared with other countries, and the suicide rate of PPW in these countries continues to increase. The most influential factor in Asian women's suicidal ideation is family conflict; specifically, if PPW in South Korea cannot express their anger, it results in a culture-bound syndrome called "Hwa-Byung." However, there is a lack of research on Asian PPW. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study found differences in individual- and community-level factors affecting suicidal ideation between pre- and postmenopausal women. Individual factors that commonly affected suicidal ideation were experiencing violence, stress and depression. Individual factors that affected the suicidal ideation of premenopausal women more than postmenopausal women were religious beliefs, alcohol use and chronic disease. Community level factors affecting suicidal ideation were locational depression and locational counselling for stress in premenopausal women and locational counselling for depression in postmenopausal women. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses could help prevent suicide by developing and applying community-based programmes for PPW, considering the specific socio-economic and cultural context and characteristics of Asian women. Mental health nurses could help PPW participate in programmes by preparing various interventions such as case management, personal counselling, physical activity, home-based mental health services, cognitive behavioural therapy and digital interventions for self-management. Mental health nurses need to prepare various methods such as online, offline, individual and group methods to work effectively in any social situation. ABSTRACT: Introduction Pre- and postmenopausal women (PPW) experience physical and psychological changes with hormonal changes. Among Asian middle-aged women, family and culture affect suicidal ideation, and the suicide rate among this population is increasing. There are few existing research on suicidal ideation among Asian PPW. Aim We examined individual- and community-level factors that predict suicidal ideation among PPW. Method Large-scale panel data from 5,154 South Korean PPW aged 35-64 years were used in a series of multilevel logistic regression analyses to examine factors associated with suicidal ideation at individual and community levels. Results Among premenopausal women, religious beliefs, alcohol use, chronic disease, experience of violence, stress and depression were individual-level factors. Locational depression and locational counselling for stress were community-level factors. Among postmenopausal women, experience of violence, stress, depression and perceived health status were individual level factors, and locational counselling for depression was a community level factor. Discussion Suicidal ideation among PPW is affected by both individual and community level factors. Nurses must comprehensively determine what risk factors affect suicidal ideation through various intervention methods-including online, offline, individual and group methods-while considering socio-economic situations. Implications for Practice Mental health nurses should provide targeted biopsychosocial interventions targeting psychosocial and physical problems and promoting the use of community resources to reduce PPW's suicidal ideation.

Using Digital Health Technologies to Manage the Psychosocial Symptoms of Menopause in the Workplace: A Narrative Literature Review

Many women experience vasomotor, psychosocial, physical and sexual symptoms during their menopausal life-stage. Specifically, the psychosocial symptoms of menopause can include loss of confidence, issues with self-identity and body image, inattention and loss of memory, increased levels of stress, and a higher risk of developing anxiety and depression. In the workplace, such symptoms can impact the woman's capacity to perform to her optimal levels. Even so, many women do not seek help to manage their symptoms due to feelings of embarrassment, the possibility of experiencing adverse reactions from others, or the cultural taboos that are attached to the condition.Digital health technologies, including virtual consultations, therapeutic interventions, and participation in online communities of support, provide an important means by which women can obtain information about menopause. In the field of mental health, digital technologies have an increasing evidence base. This paper considers how mental health practitioners can adapt, utilise or recommend digital health strategies to support older women in occupational settings to manage their psychosocial symptoms of menopause.

Prevalence of pain in women living with HIV aged 45-60: associated factors and impact on patient-reported outcomes

As the population of women with HIV ages, an increasing proportion are experiencing the menopause, with potential associated pain. Among 844 participants in the Positive Transitions Through the Menopause (PRIME) study (72.3% black African; median age 49 (interquartile-range 47-53) years; 20.9%, 44.0% and 35.1% pre-, peri- and post-menopausal), 376 (44.6%) and 73 (8.7%) reported moderate or extreme pain. Women had been diagnosed with HIV for 14 (9-18) years, 97.7% were receiving antiretroviral therapy and 88.4% had a suppressed viral load. In adjusted ordinal logistic regression, peri-menopausal status (adjusted odds ratio (1.80) [95% confidence interval 1.22-2.67]), current smoking (1.85 [1.11-3.09]), number of comorbid conditions (1.95 [1.64-2.33] /condition) and longer duration of HIV (1.12 [1.00-1.24]/5 years) were independently associated with increased reported pain, whereas being in full-time work (0.61 [0.45-0.83]) and having enough money for basic needs (0.47 [0.34-0.64]) were associated with decreased pain reporting. Increasing pain was independently related to insomnia symptoms (moderate: 2.76 [1.96-3.90]; extreme: 8.09 [4.03-16.24]) and severe depressive symptoms (PHQ4 ≥ 6; moderate: 3.96 [2.50-6.28]; extreme: 9.13 [4.45-18.72]). Whilst our analyses cannot determine the direction of any associations, our findings point to the importance of eliciting a history of pain and addressing symptoms in order to improve wellbeing.

"There's a problem, now what's the solution?": suggestions for technologies to support the menopausal transition from individuals experiencing menopause and healthcare practitioners

OBJECTIVE

To elicit novel ideas for informatics solutions to support individuals through the menopausal transition. (Note: We use "individuals experiencing menopause" and "experiences" rather than "symptoms" when possible to counter typical framing of menopause as a cisgender women's medical problem.).

METHODS

A participatory design study was conducted 2015-2017 in the Western US. Two sessions were held with individuals experiencing menopause recruited from the general public; and 3 sessions with healthcare practitioners (HCPs) including nurses, physicians, and complementary and integrative health (CIH) practitioners were held. Participants designed technologies addressing informational needs and burdensome experiences. HCPs reflected on designs from participants experiencing menopause. Directed content analysis was used to analyze transcripts.

RESULTS

Eight individuals experiencing menopause (n = 4 each session) and 18 HCPs (n = 10 CIH, n = 3 nurses, n = 5 physicians) participated. All participants provided ideas for solution purpose, hardware, software, features and functions, and data types. Individuals experiencing menopause designed technologies to help understand and prevent burdensome menopause experiences. HCPs designed technologies for tracking and facilitating communication. Compared to nurses and physicians, CIH practitioners suggested designs reframing menopause as a positive experience and accounted for the complex lives of individuals experiencing menopause, including stigma; these ideas corresponded to comments made by participants experiencing menopause. Participants from both populations were concerned about data confidentiality and technology accessibility.

CONCLUSIONS

Participant generated design ideas included novel ideas and incorporated existing technologies. This study can inform the development of new technologies or repurposing of existing technologies to support individuals through the menopausal transition.

Relationship Between Frequency and Intensity of Menopausal Symptoms and Quality of Life Among Polish Nurses

PURPOSE

The study aims to compare the quality of life of nurses in the somatic, mental, social and environmental dimensions in the full reproductive and perimenopausal period and to determine the relationship between the frequency and intensity of menopausal symptoms and the quality of life of nurses aged 45-55.

PATIENTS AND METHODS

The study involved 334 nurses, of which: 158 (47.31%) were aged 25-35 and 176 (52.69%) aged 45-55, included in the perimenopausal group. A diagnostic survey was used as the research method and the WHOQoL-Bref Questionnaire and the Menopause Symptom List were used to collect data.

RESULTS

Nurses aged 25-35 achieved a significantly (p < 0.02) higher level of satisfaction with overall health quality (M = 3.9; SD = ±0.7) than nurses in the 45-55 age group (M = 3.7; SD = ±0.7). A variation in the frequency (F = 62.64; p < 0.0001) and intensity (F = 130.18; p < 0.0001) of menopausal symptoms was identified. It was found that the frequency and intensity of psychological symptoms were significantly higher than vasomotor (p < 0.0001) and somatic (p < 0.0001) symptoms. Additionally, negative relations between the frequency and intensity of menopausal symptoms and the quality of life of nurses in the 45-55 age group in the somatic, mental, social and environmental domains were demonstrated, with their value ranging from r = -0.19 to r = -0.48.

CONCLUSION

The quality of life of the examined nurses varies. In the perimenopausal period, the frequency and intensity of psychological, vasomotor and somatic symptoms have a significant negative impact on the quality of life of nurses.

Lifestyle practices and menopause-related symptoms among women in rural communities of Ado-Ekiti local government area, Nigeria

OBJECTIVE

Lifestyle modification is consistently recommended for healthy living during menopause; nonetheless, there is paucity of data on menopausal experiences and lifestyle practices of women in rural communities of Nigeria. This study assessed the lifestyle practices of menopausal women, their experiences of menopause-related symptoms and the influence of lifestyle practices on their experiences of menopause-related symptoms.

METHOD

A descriptive cross-sectional design was used in this study. Systematic random sampling was used to select 271 menopausal women at household level in rural communities of Ado-Ekiti Local Government Area in Ekiti State, Nigeria. A self-developed structured questionnaire was used to assess lifestyle practices while modified menopause rating scale was used to assess menopausal-related symptoms of the women. Data were analysed using descriptive and inferential statistics in SPSS version 22 at 0.05 level of significance.

RESULTS

Findings revealed that 58.3% had poor lifestyle, while 41.0% and 0.7% had moderate and good lifestyle, respectively. Findings showed that 66.4% of the women experienced moderate menopause-related symptoms, while 15.5% and 0.4% of the women had severe and very severe menopause-related symptoms respectively. Result of the multiple regression indicated that Exercise (β = 0.22, t = 3.63, p = .01), Nutrition (β = 0.13, t = 2.23, p = .02) and Substance use (β = 0.04, t = 2.25, p = .02) were major predictors of menopause-related symptoms.

CONCLUSION

The study concluded that positive lifestyle modification could help reduce menopausal-related symptoms.

Prognostic factors for future mental, physical and urogenital health and work ability in women, 45-55 years: a six-year prospective longitudinal cohort study

BACKGROUND

Impaired health due to stress is a common cause of long-term illness in women aged 45-55 years. It is a common cause for visits to primary health care (PHC) and may influence work-ability. The aim of this study was to investigate prognostic factors for future mental, physical and urogenital health as well as work-ability in a population of average women aged 45-55 years.

METHODS

This longitudinal cohort study initially assessed 142 women from PHC centers in southwestern Sweden. One houndred and ten accepted participation and were followed for 6 years. They were assessed using the self-reported questionnaires: the Menopause Rating Scale (MRS), the Montgomery-Asberg Depression Rating Scale (MADRS-S), the Short-Form Health Survey (SF-36). Descriptive data are presented of health, education, relationships and if they are working. Multicollinearity testing and logistic regression were used to test the explanatory variables.

RESULT

Severity of symptoms in the MRS somatic and urogenital domains decreased while they increased in the psychological and depressive domains. Having tertiary education was associated with decreased overall mental health, vitality and social role functioning. Living with a partner was associated with increased physical role functioning, social role functioning and emotional role functioning.

CONCLUSION

Quality of life seems to be enhanced by a good relationship with the partner, social support and work/life balance. Therefore, to improve women health women should early discuss ways in which these issues can be incorporated as they pursue their academic or career goals. Hence, we emphasize the importance of supporting women to gain increased awareness about a healthy life balance and to have realistic goals in work as well as in their social life.

The Persian Version of Menopause Rating Scale (MRS): A Psychometric Study

Objective

Menopause-related symptoms can strongly affect health-related quality of life (HRQOL) in most peri-menopausal women. The aim of the present study was to explore the psychometric properties of a culturally adapted and translated Persian version of the Menopause Rating Scale (MRS).

Study Design

The study was conducted on a random sample of 270 middle-aged women (age range 40-60 yrs) selected from 25 urban health service centers across Tabriz, Iran. Content validity was evaluated by a panel of 11 experts. Construct validity was assessed by exploratory factor analyses with Varimax rotation and principal axis factoring extraction method and by confirmatory factor analyses. Internal consistency and test-retest reliability were assessed with Cronbach's alpha and intra-class correlation coefficient (ICC), respectively. In addition, the feasibility of the measure was judged based on ceiling and floor effects.

Results

Content validity of the measure was good with a mean content validity index (CVI) and mean content validity ratio (CVR) of 0.88 and 0.94, respectively. Exploratory factor analyses identified three factors accounting for 47.69% of the variance. Confirmatory factor analyses found the original three-factor model to have the best fit to the data. Cronbach's alpha coefficient (0.85) and the test-retest reliability score (0.91) indicated good internal consistency.

Conclusion

The Persian version of the MRS demonstrated excellent reliability and validity. It can therefore be used in both clinical and research settings to assess menopause-related symptoms and associated quality of life.

"I did not know it was a medical condition": Predictors, severity and help seeking behaviors of women with female sexual dysfunction in the Volta region of Ghana

Objectives

The study’s main objective was to describe the prevalence and severity of female sexual dysfunction (FSD) amongst a group of Ghanaian women in the outpatient setting of the predominantly rural Volta region of Ghana. Additionally we determine the predictors of FSD severity and care seeking behaviors of women with the condition.

Study design and setting

This was a cross sectional study conducted in the outpatient setting of the Ho Teaching Hospital in the rural-savannah, agro-ecological zone of Volta Region, Ghana.

Methods and procedures

FSD was assessed using the Female Sexual Function Index (FSFI) questionnaire. FSD was defined with a cutoff of ≤23 so as not to under-estimate the prevalence in this conservative setting. FSFI score >23 was designated “no FSD”. We further categorized women with FSD as having mild (FSFI Total score 18–23), moderate (FSFI Total score <18 to >10) or severe (FSFI Total score ≤10) FSD. Due to sample size restrictions, we combined the moderate and severe FSD groups in our analyses and defined “moderate/severe FSD” as an FSFI Total score < 18. Participants with FSD were further asked to indicate whether or not they sought help for their conditions, the reasons they sought help, and the types of help they sought. We used p<0.05 to determine statistical significance for all analyses and logistic regression models were used to determine crude and age-adjusted effect estimates.

Results

FSD Prevalence: Out of 407 women approached, 300 (83.8%) agreed and consented to participate in the study. The prevalence of FSD was 48.3% (n = 145). Compared to those without FSD, over a third of the FSD women resided in rural settings (37.90% vs 20.60%; p = 0.001) and tended to be multiparous, with a significantly greater proportion having at least three children (31.70% vs 18.10%; p = 0.033).

FSD Severity: Over a quarter of the sample (27.6%, n = 40) met the cut-off for moderate to severe FSD. In age-adjusted models, lubrication disorder was associated with 45 times the odds of moderate/severe FSD (age-adj. OR: 45.38, 95% CI: 8.37, 246.00; p<0.001), pain with 17times the odds (age-adj. OR: 17.18, 95% CI: 4.50, 65.50; p<0.001) and satisfaction almost 5times the odds (age-adj. OR: 4.69, 95% CI: 1.09, 20.2; p = 0.04). Compared to those with 1–3 children, nulliparous women had 3.5 times higher odds of moderate/severe sexual dysfunction as well (age-adj. OR:3.51, 95% CI:1.37,8.98; p = 0.009).

FSD-related Health Seeking Behaviors: Statistically significant predictors of FSD-related care seeking included having FSD of pain disorder (age-adj. OR: 5.91, 95% CI:1.29, 27.15; p = 0.02), having ≥4 children (age-adj. OR: 6.29, 95%CI: 1.53, 25.76; p = 0.01). Of those who sought help, seven in 10 sought formal help from a healthcare provider, with General Practitioners preferred over Gynecologist. About one in 3 (31.3%) who did not seek help indicated that they did not know their sexual dysfunction was a medical condition, over a quarter (28.9%) “thought it was normal” to have FSD, and interestingly, 14.1% did not think a medical provider would be able to provide them with assistance.

Conclusions

Sexual dysfunctions are prevalent yet taboo subjects in many countries, including Ghana. Awareness raising and efforts to feminize the physician workforce are necessary to meet the healthcare needs of vulnerable members of Ghanaian society.

Brain Morphological Changes With Functional Deficit Associated With Sexual Arousal in Postmenopausal Women

INTRODUCTION

We have not known how menopause synchronously influences brain morphology and function associated with visually stimulated sexual arousal in postmenopausal women.

AIM

This study used a combination of functional magnetic resonance imaging and voxel-based morphometry to evaluate menopause-related brain morphological and functional changes in postmenopausal women.

METHODS

Nineteen premenopausal women and 19 postmenopausal women underwent functional and structural magnetic resonance imaging. Brain function activity was measured while the subjects viewed an erotic video clip.

MAIN OUTCOME MEASURES

A 2-sample t-test was used for cross-analysis of the 2 groups for comparison of gray matter volumes (corrected P < .05) and brain activation (uncorrected P < .01).

RESULTS

Our study revealed a relationship between sexual function and morphological changes in postmenopausal women. Compared with premenopausal women, the postmenopausal group showed significantly lower brain activations in the major parts of the limbic system and basal ganglia, including the parahippocampal gyrus, head of caudate nucleus, insula, putamen, hippocampus, hypothalamus, amygdala, and globus pallidus, which are involved in sexual behavior and emotional responses. In morphometric analyses, postmenopausal women showed significantly decreased gray matter volumes of the insula, putamen, parahippocampal gyrus, amygdala, and anterior cingulate gyrus, most of which were associated with decreased functional activity during visual sexual arousal in postmenopausal women. In addition, the premenopausal group alone showed a positive correlation between the activity of the insula and the level of estradiol (Pearson correlation r = 0.588; P = .008).

CONCLUSION

This study demonstrates an association between menopause-related brain function and morphological changes in postmenopausal women. This finding provides insight into the neural mechanisms associated with the sexual functional deficit in postmenopausal women. Baek H-S, Kim G-W, Sundaram T, et al. Brain Morphological Changes with Functional Deficit Associated with Sexual Arousal in Postmenopausal Women. Sex Med 2019;7:480-488.

The association between hormones and antipsychotic use: a focus on postpartum and menopausal women

During the postpartum and menopausal periods of women's lives, there is a well-established and significant drop of circulating estrogens. This may be the reason why both these periods are associated with an increased risk for onset or exacerbation of psychiatric disorders. Whether symptoms are mainly affective or mainly psychotic, these disorders are frequently treated with antipsychotic medications, which calls for an examination of the relationship between hormone replacement and antipsychotic agents at these time periods. The aim of this narrative review is to summarize what is known about the association of hormones and antipsychotics in the postnatal period and at menopause. In the review, we focus on estrogen and oxytocin hormones and include, for the most part, only papers published within the last 10 years. Both estradiol and oxytocin have at various times been implicated in the etiology of postpartum disorders, and estrogens, sometimes combined with progesterone, have been tested as potential treatments for these conditions. The role of estradiol as an adjunct to antipsychotics in the prevention of postpartum relapses is currently controversial. With respect to oxytocin, studies are lacking. Psychosis in menopausal and postmenopausal women has been successfully treated with estrogens and selective estrogen-receptor modulators, mainly raloxifene, in addition to antipsychotics. Some symptoms appear to respond better than others. No oxytocin study has specifically targeted postmenopausal women. Because of feedback mechanisms, there is a theoretical danger of therapy with exogenous hormones interfering with endogenous secretion and disturbing the balance among inter-related hormones. When used with antipsychotics, hormones may also affect the metabolism and, hence, the brain level of specific antipsychotics. This makes treatment with antipsychotics plus hormones complicated. Dose, timing and route of intervention may all prove critical to efficacy. While much remains unknown, this literature review indicates that, within standard dose ranges, the combination of hormones and antipsychotics for postnatal and menopausal women suffering severe mental distress can be beneficial, and is safe.

[Sexuality in postmenopausal women in sub-Saharan Africa: example from Senegal]

Introduction

En Afrique, la vie sexuelle après la ménopause reste un domaine mal exploré du fait de son caractère tabou. L'objectif de cette étude était d'apprécier la qualité de la sexualité du couple au cours de la ménopause.

Methodes

Il s'agissait d'une une enquête transversale concernant un échantillon représentatif de 320 femmes ménopausées. Les critères d'inclusion étaient la ménopause naturelle. N'étaient pas incluses de l'étude les patientes ayant fait l'objet d'une ménopause précoce ou iatrogène. La fiche d'enquête était divisée en 4 chapitres : les caractéristiques socio-culturelles de la femme, les données cliniques, les données psycho-sexuelles et les données thérapeutiques. Nous avons utilisé la comparaison des proportions et le test du Chi 2 avec un seuil de signification inférieur à 0,05.

Resultats

L'âge moyen des femmes était de 60 ans. L'âge moyen de survenue de la ménopause était de 48 ans et l'ancienneté de la ménopause était de 11,3 ans. Aucune femme de notre étude n'était épargnée par les manifestations du syndrome climatérique. Les bouffées de chaleur étaient présentes dans 85,9%, la sècheresse vaginale dans 62,8% et les troubles urinaires dans 52,5%. Seules les femmes mariées déclaraient avoir des rapports sexuels avec leurs conjoints (62,1%). Ces rapports sexuels étaient occasionnels dans 68,9% des cas alors que 18,1% des femmes n'avaient plus d'activité sexuelle. La diminution de l'activité sexuelle était due aux troubles de l'érection du conjoint (62% des couples) et au manque de désir sexuel (83,5% des femmes). Une absence d'excitation sexuelle et d'orgasme étaient également retrouvée respectivement dans 92% et 100%. Cependant, 93,5 % des femmes mariées jugeaient supportable leur vécu.

Conclusion

Le statut marital, la dyspareunie, la sècheresse vaginale et les troubles érectiles du conjoint ont un impact réel sur la sexualité de la femme ménopausée au Sénégal.

Menopausal Hot Flashes: A Concise Review

Hot flashes (HFs), defined as transient sensations of heat, sweating, flushing, anxiety, and chills lasting for 1-5 min, constitute one of the most common symptoms of menopause among women though only a few seek treatment for these. The basis of HFs lies in abnormal hypothalamic thermoregulatory control resulting in abnormal vasodilatory response to minor elevations of core body temperature. Recent data suggest an important role for calcitonin gene-related peptide, hypothalamic kisspeptin, neurokinin B and dynorphin signal system, serotonin, norepinephrine in causation of HFs in addition to estrogen deficiency which plays a cardinal role. The mainstay of treatment includes hormonal replacement therapy, selective serotonin, and norepinephrine reuptake inhibitors in addition to lifestyle modification. In this review, we address common issues related to menopause HFs and suggest a stepwise approach to their management.

Differential analysis of quantitative proteome and acetyl-proteome profiling between premenopausal and postmenopausal ovarian tissues

BACKGROUND

Natural menopause is always accompanied by specific signs and symptoms, suggesting physiological changes in this peoriod. However, no systematic study has assessed the changes at molecular level in the ovaries during the menopausal transition so far. This study integrated quantitative proteome and acetyl-proteome to comprehensively uncover the changes of ovarian protein and protein-acetylation profiles in this transitional period. The findings would provide novel insights into the biology of menopause and help relieve and treat the associated signs and symptoms, further improving the women's health care.

METHODS

Freshly thawed ovarian tissue samples obtained from premenopausal and postmenopausal women were assessed with Tandem Mass Tags for the quantitative analysis of the global profile and acetyl-proteomes by 2-dimensional separation and LC-MS/MS.

RESULTS

Comprehensively, 4210 types of protein, with 3551 types quantifiable were detected. 3047 acetylated sites in 1583 types of protein with 2256 quantifiable in 1248 proteins were detected. By comparing the global and acetylated proteome profiles for postmenopausal women and premenopausal women, 151 types of proteins were found upregulated and 65 were downregulated, along with 23 acetylated sites upregulated and 220 sites downregulated. For Immune response, the complement and coagulation cascades plus the citrate cycle and cellular detoxification were found to be significantly enhanced, while the extracellular structure and matrix organization, ECM-receptor interactions plus the infections were markedly suppressed. In addition, the amino acids around the acetylated sites were enriched by motif analysis, which can help us uncover amino acid sequence and search for the specific target in the subsequent study.

CONCLUSION

Global and acetylated proteome Profiles in ovary differ between the premenopausal and postmenopausal groups. These proteomic-level changes may offer some potential biological markers to identify the pathological changes in ovary and help relieve and treat the associated signs and symptoms, and ultimately improve women's health care.

Views of family physicians on heterosexual sexual function in older adults

Background

Sexual functioning among older adults has received little attention in research and clinical practice, although it is an integral part of old age. As older adults tend to consume health services and to visit family physicians more frequently, these care-providers serve as gatekeepers in the case of sexual concerns. The present study evaluated the perceptions of family physicians regarding sexuality in older adults.

Method

Qualitative interviews with 16 family physicians were conducted. We used in-depth, semi-structured interviews.

Results

Three main themes emerged: 1. Family physicians described having difficulty in raising questions about sexuality to older patients. 2. Family physicians tended towards the biological side of the spectrum, focusing on the patient’s medical problem and asking physiological questions. 3. Family physicians mainly related to medication administered to their male patients, whereas a minority also described the guidance they provided to older individuals and couples.

Conclusions

The study shows that family physicians tend not to initiate discourse with older patients on sexuality, but rather discuss sexuality mostly in conjunction with other medical conditions. Implications for research and practice are discussed.

Morinda citrifolia L. Leaf Extract Protects against Cerebral Ischemia and Osteoporosis in an In Vivo Experimental Model of Menopause

We aimed to determine the protective effects against cerebral ischemia and osteoporosis of Morinda citrifolia extract in experimental menopause. The neuroprotective effect was assessed by giving M. citrifolia leaf extract at doses of 2, 10, and 50 mg/kg BW to the bilateral ovariectomized (OVX) rats for 7 days. Then, they were occluded in the right middle cerebral artery (MCAO) for 90 minutes. The neurological score, brain infarction volume, oxidative stress status, and ERK1/2 and eNOS activities were assessed 24 hours later. M. citrifolia improved neurological score, brain infarction, and brain oxidative stress status in the cortex of OVX rats plus the MCAO. No changes in ERK 1/2 signal pathway and NOS expression were observed in this area. Our data suggested that the neuroprotective effect of the extract might occur partly via the improvement of oxidative stress status in the cortex. The antiosteoporotic effect in OVX rats was also assessed after an 84-day intervention of M. citrifolia. The serum levels of calcium, osteocalcin, and alkaline phosphatase and osteoblast density in the tibia were increased, but the density of osteoclast was decreased in OVX rats which received the extract. Therefore, the current data suggested that the extract possessed antiosteoporotic effect by increasing bone formation but decreasing bone resorption.

8-Prenylnaringenin from hop (Humulus lupulus L.) – a panacea for menopause?

8-Prenylnaryngenin (8-PN) is the strongest known phytoestrogen (PE). Its main source is the female inflorescences of hops (Humulus lupulus L.). 8-PN, which, in contrast to other PEs, is proven to have stronger activity and higher affinity for the α subtype of estrogen receptor (ER). Therefore, it may be an effective substitute for hormone replacement therapy (HRT). The studies in postmenopausal women have shown its particular effectiveness in reducing hot flashes. However, a strong stimulation of uterus by 8-PN may be associated with the occurrence of adverse effects (eg. bleeding) and increase the risk of carcinogenesis. The H. lupulus extracts preparations are currently supplements which makes control of the doses used and thus increases the occurrence of uncontrolled self-treatment difficult. This paper presents the current knowledge on 8-PN and discusses the potential risks associated with use of hops to alleviate the symptoms of menopause.