Menopause: The Journal of The North American Menopause Society最新文献

Importance: Vulvovaginal atrophy (VVA) is a common manifestation of the genitourinary syndrome of menopause, associated with vaginal dryness, dyspareunia, and reduced quality of life. Despite available therapies, effective, safe, and well-tolerated alternatives remain of interest for symptomatic postmenopausal women.

Objective: To assess the therapeutic efficacy of intravaginal dehydroepiandrosterone (DHEA) for vulvovaginal atrophy in postmenopausal women.

Evidence review: A systematic literature search was performed in PubMed, Embase, and the Cochrane Library for studies published up to July 2025. Search terms included "DHEA," "prasterone," "Intrarosa," and "dehydroepiandrosterone." Randomized controlled trials (RCTs) evaluating intravaginal DHEA in postmenopausal women were included. Data extraction followed predefined inclusion and exclusion criteria. Risk of bias was assessed, and pooled analyses were conducted using random-effects models.

Findings: Six RCTs representing five unique RCTs (n=1,611) involving postmenopausal women with VVA were included. Compared with placebo, intravaginal DHEA demonstrated significant improvements in two primary outcomes: vaginal dryness with a mean difference of -0.23 (95% CI, -0.35 to -0.11) and dyspareunia of -0.40 (95% CI: -0.66 to -0.15). No major safety concerns were reported, and adverse effects were mild and infrequent. The evidence consistently supported both statistical and clinical benefits of DHEA across trials, with low to moderate heterogeneity.

Conclusions and relevance: Intravaginal DHEA significantly improves vulvovaginal symptoms, particularly vaginal dryness and dyspareunia, in postmenopausal women. These findings underscore its role as an effective and well-tolerated therapeutic option for the management of genitourinary syndrome of menopause, with potential to enhance quality of life.

Objective: Those with mental illnesses are likely at higher risk of developing coronavirus disease 2019 (COVID-19), and elderly are disproportionately impacted and as a result suffer more from long COVID. The aim of this analysis was to determine the associations of preexisting depressive and anxiety symptoms with developing COVID-19 positivity, long COVID-19, and compliance with the use of protective measures against contracting COVID-19.

Methods: A subsample (n = 18,820) of the Women's Health Initiative study cohort completed longitudinal questionnaires on depressive and anxiety symptoms between 1993 and 2021 and reported on COVID-19 testing and compliance-related questions in 2020 and 2021. Logistic regression analyses were used to prospectively determine associations of a history of mental health symptoms with COVID-related outcomes.

Results: Reported history of depressive and anxiety symptoms was not associated with COVID-19 positivity. However, higher anxiety scores were associated with higher odds of long COVID (OR = 1.05 [95% CI: 1.03-1.07]). Women with both depressive and anxiety symptoms versus neither symptom had 78% higher odds of long COVID (OR = 1.78 [95% CI: 1.13-2.81 P = 0.001]). The odds of compliance with COVID-19 mitigation measures was significantly lower among women with previous long-term depressive symptoms (OR = 0.67 [95% CI: 0.55-0.82]), with both long-term depressive and anxiety symptoms (OR = 0.75 (95% CI: 0.61-0.93) P < 0.0001), and with higher long-term perceived stress score (OR = 0.94 [95% CI: 0.92-0.97]). However, a higher short-term anxiety score during early COVID was weakly associated with the higher odds of compliance of prevention mitigation measures (OR = 1.03 [95% CI: 1.02-1.03]).

Conclusions: Older women with past mental health symptoms may be at higher risk of developing long COVID and having lower compliance with COVID prevention measures.

Objectives: This study aims to evaluate the quality and reliability of short videos related to premature ovarian failure on two major Chinese short video platforms, TikTok and Bilibili.

Methods: A total of 231 videos related to premature ovarian failure (133 from TikTok and 98 from Bilibili) were analyzed up until March 25, 2025. The video quality was evaluated using the Global Quality Scale (GQS), the modified DISCERN instrument (mDISCERN), and the Journal of the American Medical Association (JAMA) scoring system. Creator categories, content categories, duration, and interaction metrics (likes, comments, shares) were collected and statistically analyzed.

Results: In the overall correlation analysis, there was a high positive correlation between interaction metrics (r>0.7, P<0.05), whereas no significant correlation was found with video duration. A weak correlation was observed between quality scores and interaction metrics. TikTok was dominated by professional individuals (90.23% were verified users), and the content was primarily disease-related (67.67% was knowledge-based), whereas Bilibili was mainly composed of nonprofessional individuals (76.53%) with more diversified themes (such as lifestyle content accounting for 35.71%). The quality and reliability scores of TikTok videos were significantly higher than those of Bilibili (GQS median: 3.0 vs. 2.0; mDISCERN: 3.0 vs. 2.0; JAMA score: 1.0 vs. 0.0; P<0.001). TikTok videos were significantly shorter in duration than Bilibili videos (P<0.001), and interaction metrics (likes, comments, shares, favorites) were significantly higher.

Conclusions: TikTok performs better than Bilibili in terms of the dissemination of information on premature ovarian failure on online video platforms, although the overall quality is not ideal. The quality of videos uploaded by verified medical professionals can be considered relatively reliable. Optimizing platform algorithms to prioritize content from verified creators and standardizing content guidelines are crucial for information seekers to make informed medical decisions and improve public health literacy.

Hypoactive sexual desire disorder (HSDD) is the most common sexual dysfunction among women, and its pathogenesis is closely linked to an imbalance in the brain's excitation-inhibition system and underlying hormonal deficiencies. While HSDD is not an inevitable result of aging, postmenopausal women face unique sexual health risks arising from the interplay of endocrine changes and age-related effects. References were identified through systematic searches of PubMed, EMBASE, and the Cochrane Library using relevant search terms. Searches spanned publications from 2000 to June 2025, supplemented by key older studies identified from reference lists. Studies were screened for originality, clinical relevance, and alignment with the definition of HSDD in postmenopausal women; no language restrictions were applied. Despite the high prevalence of HSDD in postmenopausal women, clinical underdiagnosis and undertreatment remain widespread. Structural barriers-including inadequate provider training, limited treatment access, and underdeveloped policies/regulations-and broader societal barriers, encompassing interconnected factors like sexual and gender diversity, racial disparities, cultural contexts, discrimination, and stigmatization, persist. Future research should broaden study population diversity, resolve diagnostic criterion controversies, strengthen health care provider training, improve access to treatment resources, and advance policy reforms and targeted public education. These efforts aim to address systemic barriers, ultimately enhancing healthcare access and outcomes for postmenopausal women affected by HSDD.

Objective: To evaluate the associations between caregivers' climacteric symptoms and adolescent mental health.

Methods: This cross-sectional study analyzed data from the 2023 wave of the Japan Adolescent and Youth (JAY) cohort, a nationally representative survey of caregiver-adolescent dyads. The sample included 1,541 dyads. Caregivers' symptoms were assessed using the Simplified Menopausal Index (SMI), comprising vasomotor, psychological, and somatic domains. Adolescent mental health was measured using the Strengths and Difficulties Questionnaire (SDQ), UCLA Loneliness Scale (UCLA-LS3), short version of the Spence Children's Anxiety Scale (Short-CAS), Patient Health Questionnaire-9 for Adolescents (PHQ-A), and Young's Diagnostic Questionnaire (YDQ) for internet addiction. Multivariable regression analyses assessed associations between SMI scores and adolescent outcomes, adjusting for caregiver age, adolescent age, adolescent sex, and household income.

Results: Among caregivers, 26.4% reported moderate to severe climacteric symptoms (SMI score ≥51), and 4.6% were currently under treatment for menopause. Among caregivers not undergoing treatment, higher SMI scores were significantly associated with greater caregiver-reported difficulties with their adolescents, and increased adolescent reports of loneliness, anxiety, depression, and problematic internet use. Among the three domains of symptoms (vasomotor, psychological, and somatic), psychological climacteric symptoms showed the strongest associations with adolescent health outcomes.

Conclusion: Caregivers' climacteric symptoms are associated with poorer adolescent mental health. Given low care-seeking rates, greater awareness and support for midlife health may benefit both caregivers and children, promoting broader family well-being.

Pelvic organ prolapse, defined as the descent of the vaginal and pelvic organs, can be associated with significant personal, social, and economic burden. Nonsurgical and surgical treatment options are available to women who report bothersome symptoms associated with pelvic organ prolapse. Treatment choices are generally driven by the degree of burden experienced by each individual patient.

Objective: This study aimed to evaluate the impact of a structured midwife-led education program on the severity of menopausal symptoms and menopause-specific quality of life, and to assess the sustainability of this effect over time.

Method: This randomized controlled longitudinal study included 101 women (intervention=51, control=50) aged 45-55 who were in the natural menopausal process. Participants in the intervention group received a structured education program over four weeks, whereas the control group received only routine follow-up. Data were collected using a Personal Information Form and the Menopause-Specific Quality of Life (MENQOL) questionnaire. Evaluations were performed at three time points: before the intervention, immediately after the education program, and at a 6-month follow-up.

Results: After the program, the intervention group had a mean MENQOL posttest score of 111.25±32.51, compared with 173.06±3.31 in the control group, showing a significant difference (P<0.001). The intervention group's posttest mean scores for all MENQOL subscales were also significantly lower than those of the control group (P<0.001). In addition, MENQOL scores in the intervention group decreased over time, indicating an improvement in quality of life (P<0.05).

Conclusion: The structured menopause education program delivered under midwife guidance was identified as an effective and sustainable intervention for reducing the severity of menopausal symptoms and enhancing women's quality of life.

Objective: The aim of this study was to explore women's experiences during the climacteric, focusing on physical and psychological symptoms, coping strategies, and the role of sociocultural and contextual factors in shaping their lived experience.

Methods: This descriptive qualitative study explored the experiences of 18 women in premenopause, menopause, or postmenopause in Spain, recruited through purposive sampling. Individual semi-structured interviews were conducted, audio-recorded, and transcribed verbatim. Data were analyzed thematically using ATLAS.ti software, with credibility ensured through triangulation and member checking.

Results: Three themes emerged: (1) facing the climacteric: body and emotions in transition, encompassing vasomotor symptoms, sleep disturbances, musculoskeletal pain, vaginal dryness, loss of libido, and psychological changes such as anxiety, sadness, and irritability; (2) coping and resilience during the climacteric stage, reflecting the use of personal strategies (exercise, diet changes, relaxation techniques) and social support, alongside dissatisfaction with limited and superficial health care responses; and (3) sociocultural perception of the climacteric, including stigma, lack of visibility, and insufficient understanding from family and workplace contexts.

Conclusions: The climacteric is a multifaceted transition that impacts physical, emotional, social, sexual, and cultural well-being. Participants developed various coping strategies; however, they frequently described inadequate health care support and persistent social stigma, which contributed to isolation and invisibility. These findings underscore the need for gender-sensitive, empathetic health care, improved public education, and policies that normalize and support this natural life stage.

Objective: To examine diagnostic and treatment patterns of premature ovarian insufficiency (POI) in tertiary care settings in Saudi Arabia, with a focus on hormone therapy (HT) use.

Methods: A retrospective chart review was conducted at three hospitals from February 2002 to May 2024. POI was defined as follicle-stimulating hormone (FSH) > 25 IU/L. Patients aged 40 years or below, who underwent FSH testing on the basis of classic symptoms, were identified. Inclusion criteria were limited to women 40 years or below who had undergone FSH testing with a FSH concentration level of >25 IU/L; exclusion criteria included incomplete demographic or clinical data and duplicate test records. Among 255,204 eligible patients, 22,420 underwent FSH testing, of whom 1,132 met POI criteria. We performed a sample size calculation based on a pilot dataset (prevalence of HT use = 35.7%). Based on this, 205 notes were analyzed using descriptive statistics and comparative analysis.

Results: POI prevalence among tested women was 5.05% (95% CI: 4.77-5.34). Only 35.6% of women with POI received HT. Uptake was highest in genetically confirmed cases (62.1%) and lowest in cases with XY chromosomal abnormalities (8.3%) or iatrogenic causes (0%). Amenorrhea (42.4%) was the most common presenting symptom and significantly associated with HT use (P = 0.001). HT uptake remained low despite diagnoses of osteopenia (6.8%) and osteoporosis (4.9%).

Conclusions: HT is underutilized among women with POI in Saudi Arabia. Variability in prescription reflects systemic barriers, lack of national guidance, and insufficient physician training. Standardized protocols and structured follow-ups are urgently required to improve long-term health outcomes.

Objectives: Early and premature menopause are positively associated with coronary heart disease and stroke, but there is less evidence regarding its relationship with the onset of diabetes. The primary objective of this study is to assess the association between the timing and type of menopause and the possible development of type 1 or 2 diabetes.

Methods: Participants from the UK Biobank were enrolled between 2006 and 2010, with follow-up to the end of 2023. The outcome variable was diagnosis of type 1 or 2 diabetes during follow-up, and the main explanatory variable was age at menopause (normal above 45 y, early 40-45 y, and premature below 40 y). Behavioral factors, comorbidities, and blood tests were also collected. Survival models with Weibull distribution were fitted to the time of diabetes onset.

Results: Of the 146,764 women analyzed over a mean follow-up of 14.5 years, 6,598 women developed diabetes (cumulative incidence 4.5%). Rates were higher in women with earlier menopause (4.2% at age above 45 y, 5.2% at ages 40-45 y, and 7.4% before age 40); however, the multivariate analysis showed no independent association (40-45 y: hazard ratio: 1.00; <40 y, hazard ratio: 0.97), taking the normal age of menopause as the reference. Surgical menopause was likewise not associated with a greater risk of diabetes compared with natural menopause.

Conclusions: In a large cohort of women with long-term follow-up, no independent or clinically significant relationship between age or type of menopause and the onset of diabetes was observed.