Pragya Gartoulla

Moderate to severe vasomotor and sexual symptoms remain problematic for women aged 60 to 65 years.

ObjectiveThis study aims to determine the prevalence and severity of menopausal symptoms in older postmenopausal women and, hence, the need for treatment options for women of this age. MethodsThis is a cross-sectional questionnaire-based study conducted between October 2013 and March 2014 among 2,020 women aged 40 to 65 years and living independently across Australia. The main outcome measures were the prevalence of moderate to severe vasomotor symptoms (VMS), as measured by the Menopause-Specific Quality of Life Questionnaire, and the current use of prescription therapy for menopausal symptoms. ResultsThe prevalence of moderate to severe VMS was as follows: 2.8% in premenopausal women, 17.1% in perimenopausal women, 28.5% in postmenopausal women younger than 55 years, 15.1% in postmenopausal women aged 55 to 59 years, and 6.5% in postmenopausal women aged 60 to 65 years. Prescription therapy for menopausal symptoms was used by 135 women: 120 (5.9%) women using hormone therapy and 15 (0.7%) women using nonhormonal medication. The factors positively associated with moderate to severe VMS were smoking (odds ratio, 1.6; 95% CI, 1.1-2.3; P < 0.05) and a body mass index of 25 to 29.9 kg/m2 (odds ratio, 1.7; 95% CI, 1.1-2.5; P < 0.05); education beyond high school was inversely associated (odds ratio, 0.7; 95% CI, 0.5-0.9; P < 0.05). ConclusionsIn this large, representative, community-based sample of women, there is a high prevalence of untreated moderate to severe VMS even in women aged 60 to 65 years. The use of vaginal estrogen and nonhormonal prescription therapy with proven efficacy for treatment of menopausal symptoms is strikingly low, suggesting that menopause remains an undertreated condition.

Moderate-severely bothersome vasomotor symptoms are associated with lowered psychological general wellbeing in women at midlife

OBJECTIVES The extent to which menopause influences wellbeing is unclear. We investigated the association between moderate-severely bothersome vasomotor symptoms (VMS) and psychological general wellbeing in women, aged 40-65 years, taking into account socio-demographic and lifestyle factors. STUDY DESIGN/MAIN OUTCOME MEASURES This was a cross-sectional survey of 2020 Australian women, aged 40-65 years, recruited from the community between July 2013 and March 2014. Wellbeing was assessed by the Psychological and General Wellbeing questionnaire (PGWB) and VMS by the Menopause-specific Quality of Life Questionnaire. RESULTS Moderate-severely bothersome VMS had a strong significant negative association with psychological general wellbeing [regression coefficient (β)=-8.17, 95% confidence interval (CI) -10.90 to -5.45]. Socio-demographic factors associated with lower wellbeing included being un-partnered (β=-2.80, 95% CI -4.74 to -0.86), obese (β=-5.46, 95% CI -7.24 to -3.68) and a smoker (β=-3.47, 95% CI -6.10 to -0.84). Older age (β=0.29, 95% CI 0.06-0.42) and participation in paid and/or volunteer work (β=2.72, 95% CI 0.61-4.82) were positively associated with wellbeing. For those with insecure housing, being a carer was associated with better wellbeing. CONCLUSIONS Moderate-severely bothersome VMS are significantly and independently negatively associated with psychological general wellbeing in women at midlife. This is an important consideration when assessing psychological wellbeing in women during this life phase.

Prevalence of menopausal symptoms in Asian midlife women: a systematic review

Abstract Objective To systematically review published articles for the prevalence of menopausal symptoms in Asian women. Methods A comprehensive and systematic literature search was performed using MEDLINE, EMBASE, PsycINFO, CINAHL, SCOPUS and Google scholar in June 2013 to retrieve all English-language studies that included information on the prevalence of menopausal symptoms in women living in Asian countries. Risk of bias of included studies was assessed using a risk-of-bias tool explicitly designed for the systematic review of prevalence studies. Results Twenty-three independent studies met our inclusion criteria. Physical symptoms were the most prevalent symptoms compared to psychological, vasomotor and sexual symptoms. There was a wide variation in the prevalence of all symptoms across the menopausal stages due to the differences in modes of recruitment, study design, sampling procedures, the time frame over which symptoms were assessed and use of different diagnostic or screening tools. A high level of bias was observed for both external and internal validity for most studies. Conclusion Although there is a wide variation in the reported prevalence of menopausal symptoms, physical symptoms predominate, followed by psychological symptoms, vasomotor symptoms and sexual symptoms. Further studies of representative samples are necessary to understand whether the variations in prevalence reporting are a function of methodological issues or due to ethnic, cultural or other socioeconomic differences.

Menopausal vasomotor symptoms are associated with poor self-assessed work ability

OBJECTIVES It has been hypothesised that vasomotor symptoms (VMS), the hallmark of menopause, may affect womens workplace performance. The aim of this study was to investigate the association between VMS and self-reported work ability, taking into account socio-demographic characteristics. Study design/Main Outcome measures: A national cross-sectional survey of women, aged 40-65 years, was conducted between October 2013 and March 2014. Participants provided socio-demographic and lifestyle factors and completed the Menopause Specific Quality of Life Questionnaire (MENQOL) and the Work Ability Index (WAI). RESULTS Of 2020 women who comprised the study sample, 1274 were in paid employment and 1263 completed the WAI. The WAI score was good-excellent for 81.5% of women and poor-moderate for 18.5%. After adjustment for socio-demographic characteristics, having any VMS was associated with greater likelihood of poor-moderate work ability [odds ratio (OR)=2.45, 95% CI 1.69-3.54]. Poorer work ability was significantly and independently associated with being un-partnered, obese or overweight, smoking, being carer and having insecure housing finance, but not with age. CONCLUSIONS Overall, most women functioned well at work. We observed an association suggesting a relationship not only between menopausal VMS and personal wellbeing, but also between VMS and self-assessed work ability. Although 4 in 5 women functioned well at work, recognition of the association with VMS may improve wellbeing and work performance of working women at midlife.

Low use of effective and safe therapies for moderate to severe menopausal symptoms: a cross-sectional community study of Australian women.

Objective:Given the global decline in the use of hormone therapy among women, aimed to determine the prevalence of use of prescription therapies for menopausal symptoms. Methods:A cross-sectional questionnaire-based study of 2,020 Australian women was conducted between October 2013 and March 2014. Women aged 40 to 65 years who were able to complete a questionnaire in English were recruited from a large dynamic database derived from the Australian electoral roll. The main outcome measures were use of prescription therapies for menopausal symptoms and the Menopause-specific Quality of Life questionnaire. Results:A total of 5,850 women were invited (by telephone) to participate: 2,911 agreed to participate, and 2,020 completed questionnaires were returned. Demographic characteristics show that participants were representative of all Australian women of this age. For this analysis, only 1,491 perimenopausal and postmenopausal women were included. Moderate to severe vasomotor symptoms (VMS) were reported by 17% of women, and 18.3% of women reported moderate to severe sexual symptoms. Among all participants, 11.3% used hormone therapy, mostly oral estrogen (68.5%). Among all women, 1.1% used compounded estrogen and/or compounded progesterone, 0.9% used androgen therapies (dehydroepiandrosterone or testosterone), 0.9% used tibolone, 0.9% used nonhormone therapies, and 4.5% used vaginal estrogen. Hormone therapy use was associated with surgical menopause (adjusted odds ratio [AOR], 3.27; 95% CI, 2.0-5.44), and moderate-severe psychological symptoms (AOR, 1.83; 95% CI, 1.19-2.80. Current smoking (AOR, 0.53; 95% CI, 0.29-0.96) and a BMI ≥ 40 (AOR, 0.35; 95% CI, 0.14-0.87 were inversely associated with hormone therapy use. Extrapolating our findings to 3.7 million Australian women aged 40 to 64 years, we found that 455,000 women are likely to have moderate to severe VMS, with most women (385,000) remaining untreated. Conclusions:Most women with severe menopausal symptoms remain untreated despite the availability of safe nonhormone therapies and safer low-dose transdermal hormone therapies. Vaginal estrogen therapy is underprescribed.

Prevalence of menopausal symptoms in Australian women at midlife: a systematic review

Abstract Aim To systematically review the published data for the prevalence and severity of menopausal symptoms in Australian women. Method A comprehensive and systematic literature search was done using six databases to extract all English-language, peer-reviewed studies that contained information on the prevalence of menopausal symptoms among women living in Australia. Risk of bias of included studies was assessed using a risk-of-bias tool specifically designed for the systematic review of prevalence studies. Results Eight independent studies met our inclusion criteria. There was no consistent pattern of vasomotor, psychological, physical or sexual symptom prevalence for the studies that reported symptoms across the menopausal stages. The ranges of the prevalences for the various outcomes were wide. A high level of bias was observed related to both external and internal validities for the included studies. Conclusion The available data for the prevalence of menopausal symptoms in Australian women are not sufficient to allow conclusive findings. A large, appropriately sampled study using a validated questionnaire is needed to establish the prevalence and severity of menopausal symptoms in Australian women.

Use of complementary and alternative medicines for menopausal symptoms in Australian women aged 40-65 years.

Objective: To document the prevalence of, and factors associated with, the use of complementary and alternative medicines (CAMs) for vasomotor symptoms (VMS) and other symptoms of menopause in Australian women aged 40–65 years.

Red clover extract for alleviating hot flushes in postmenopausal women: a meta-analysis.

The safety and efficacy of red clover for alleviating menopausal hot flushes are yet to be established. The aim of this meta-analysis was to generate evidence from published literature regarding red clover as a treatment option for menopausal hot flushes. The results showed that red clover when compared to placebo was effective in reducing menopausal hot flushes when administered for 3-4 months (MD=-1.34, 95% CI=-1.90 to -0.77, p<0.00001), but their effect did not persist at 12 months (MD=0.89, 95% CI=-0.07 to 1.85, p=0.07).