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

Objective: The goal of the current study was to better understand autistic people's experiences with the menopause transition, by focusing on their symptoms, healthcare interactions, and receipt of informal support.

Methods: This was a qualitative research study. We conducted one-on-one videotelephone interviews with 21 autistic adults who had experienced, or were currently experiencing, perimenopause in the United States. Data were coded by two independent coders. We used a thematic analysis approach.

Results: The analysts derived several overarching themes related to perimenopausal symptoms, barriers to healthcare, and informal support networks. Participants reported increased sensory sensitivities during perimenopause and reported that these severely impacted their quality of life. These sensory sensitivities also compounded vasomotor symptoms of perimenopause causing an extreme and overwhelming confluence of symptoms and difficulties. Despite this, many participants felt that their healthcare providers supported them insufficiently. Participants felt unprepared for the intensification of sensory sensitivities during the menopause transition due to a lack of information about perimenopause from healthcare providers and because their social support network members lacked information about perimenopause.

Conclusions: Autistic people face unique challenges during the menopause transition, which may include managing sensory sensitivities and navigating healthcare systems. Results highlight the need for education about menopause earlier in life for autistic people. Findings further demonstrate the need for holistic approaches to perimenopausal symptom management and better training for providers on the unique needs of perimenopausal autistic people.

Objectives: This study aimed to explore women's experience of menopause care after breast cancer in the UK.

Methods: An online survey incorporating the validated Shared Decision Making SDM-Q-9 questionnaire was disseminated via social media to breast cancer survivors in the UK.

Results: A total of 1,195 women completed the survey. The menopause symptom burden was high (99.7%). Fear of recurrence was the dominant concern for 55.6% of women, but 44.4% were more concerned about quality of life and future risk of long-term conditions associated with estrogen deficiency. Women further from diagnosis were less concerned about recurrence (fear of recurrence was the dominant concern for 58.6% of women within 2 y of diagnosis vs. 43.1% of women more than 15 y from diagnosis, P = 0.001). Of all women, 68.3% were offered treatment (nonhormone treatment, 58.5%; vaginal hormones, 35.5%; menopause hormone therapy, 13.1%; testosterone, 10.1%). Menopause specialists were more likely to prescribe MHT versus nonmenopause specialists (68.2% vs. 31.8%, P < 0.0001); GP menopause specialists were more likely to prescribe testosterone versus gynecologist menopause specialists (60.8% vs. 39.2%, P < 0.0001). Of all women, 49.6% who were not offered menopause hormone therapy were willing to consider it, and 83.7% wanted more information about menopause hormone therapy. Information provision and time allocated to menopause-related discussion were poor (<10 min for 73.52% of women). Involvement in menopause-related treatment decisions was low (SDM-Q-9 median score, 11.1/100; IQR, 0.0-28.9). Women who consulted a menopause specialist (30.2%) were significantly more able to discuss their concerns (P < 0.001), were given significantly more time (>10 min for 75.6%, P < 0.001), and felt significantly more involved in menopause-related treatment decisions (P < 0.001). Overall, 96% of women wanted more support for menopausal symptoms.

Conclusions: Many women in the study cohort had unmet menopause-related health needs after breast cancer, and the quality of menopause care received was poor. Most women felt uninvolved in menopause-related treatment decisions. Women experienced higher quality menopause care if they had access to a menopause specialist.

Objective: This study aimed to investigate the mediating role of genital self-image in the relationship between postmenopausal women's attitudes toward menopause and their sexual quality of life.

Method: This study is descriptive. The sample consisted of 351 postmenopausal women who met the research criteria. The data were collected online between May and December 2023 using a descriptive information form, the Attitude Towards Menopause Questionnaire, the Female Genital Self-Image Scale, and the Sexual Quality of Life Questionnaire Scale. Data were collected using descriptive statistics, Pearson correlation analysis, and structural equation modeling.

Results: The mean total scale scores of the women were 34.41 ± 9.22 for Attitude Towards Menopause Questionnaire, 16.24 ± 3.40 for Female Genital Self-Image Scale, and 44.46 ± 22.16 for Sexual Quality of Life Questionnaire Scale. Analysis revealed moderate positive relationships: between attitude toward menopause and sexual quality of life (r = 0.451, P < 0.001); between attitude toward menopause and genital self-image (r = 0.520, P < 0.001); and between the genital self-image and sexual quality of life (r = 0.361, P < 0.001). When genital self-image was added as a mediator, there was a direct positive relationship between attitude toward menopause and genital self-image (β = 0.192, P < 0.001) and between genital self-image and sexual quality of life (β = 1.126, P < 0.05). The indirect relationship of attitude toward menopause on sexual quality of life through genital self-image was positive and significant (β = 0.216; P < 0.05; 95% CI, 0.063-0.353). With the inclusion of genital self-image as a mediator, the combined effect of attitude toward menopause and genital self-image explained 22.5% of the variance in sexual quality of life (R2 = 0.225). In comparison, attitude toward menopause explained 27% of the variance in genital self-image (R2 = 0.270).

Conclusion: There is an inverse relationship between postmenopausal women's negative attitudes toward menopause and their genital self-image and quality of sexual life.

Objective: This study aimed to evaluate the effects of intravaginal prasterone treatment on urge urinary symptoms in women affected by genitourinary syndrome of menopause.

Methods: The study was conducted on postmenopausal women with vulvovaginal atrophy and symptoms of increased urinary frequency and urgency with an Overactive Bladder Screener score of >8. Participants underwent urodynamic examination and completed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire before and after 3 months of treatment. Wilcoxon signed rank test for the paired sample was used to compare continuous non parametric variables.

Results: Twenty women were prospectively enrolled (January 2022 to January 2024). The median age and menopausal age were 59 years (interquartile range, 56.0-66.5 y) and 50 years (interquartile range, 49.0-52.5 y), respectively. According to the ICIQ-SF, the mean scores before and after treatment were 9.6 (SD, 5.1) and 2.63 (SD, 2.24), respectively (P > 0.001). According to the urodynamic examination, the median volume infused increased from 70 to 123 mL (P = 0.001) for the first stimulus, from 115 to 202 mL (P = 0.001) for the normal stimulus, from 199 to 290 mL (P = 0.001) for the urge stimulus, and from 251 to 343 mL (P = 0.001) for the maximal bladder filling capacity. At the end of the study, the 42.1% of women reported very much and much better improvement according to the Patient Global Impression of Improvement score.

Conclusions: After 3 months of prasterone treatment, women reported a statistically significant objective increase in bladder compliance through a later voiding stimulus and a subjective reduction in urge incontinence episodes through the validated ICIQ-SF questionnaire.

Objective: This study aimed to determine the prevalence and predictors of genitourinary syndrome of menopause (GSM) in Brazilian women.

Methods: A cross-sectional population-based household survey was conducted among 749 women aged 45 to 60 years. The dependent variable was the presence of GSM, which was assessed using a pretested structured questionnaire. The independent variables included sociodemographic data, health-related habits and morbidities, self-perception of health, and gynecological background.

Results: The mean age of the participants was 52.5 ± 4.4 years, and the mean age of menopause was 46.4 ± 6.2 years. GSM was prevalent in 51.4% of the women. The most prevalent symptoms were dyspareunia (35%), daily vaginal dryness (25.1%), and intercourse vaginal dryness (24%). Poisson regression analysis demonstrated that global GSM was associated with having a partner, topical estrogen treatment (TET), depression/anxiety, and rheumatological diseases. The genital symptoms of GSM were related to peri/postmenopausal status, TET, multimorbidity, sexual activity, and the absence of vaginal birth. Factors associated with GSM urinary symptoms were negative self-perception of health, having at least one vaginal birth, depression/anxiety, and rheumatological diseases. Sexual symptoms were associated with having a partner, using TET, depression/anxiety, and rheumatic disease. GSM affected the lives of 42.8% of the women to some degree, and 43% discussed their symptoms with their gynecologists.

Conclusions: GSM was prevalent in half of the women in this study, and several factors were associated with its presence. These results highlight the compelling need to understand these factors, improve diagnoses, and increase access to treatment.

Objectives: The aims of the study were to identify conditions diagnosed in at least 10% of midlife women living in the US upper midwest and to assess prevalence by age, race, ethnicity, and sociodemographic status.

Methods: The Rochester Epidemiology Project was used to conduct a cross-sectional prevalence study of 86,946 women between 40 and 59 years residing in a 27-county region of the United States on January 1, 2020. Diagnostic billing codes were extracted and grouped into broader condition categories using the Clinical Classification System Refined. The prevalence of 424 conditions was calculated by age, race, ethnicity, and area deprivation index quartiles. Logistic regression was used to examine associations between participant characteristics and conditions that affected 10% or more of the study population.

Results: Twenty-eight conditions affected ≥10% of women, and eight conditions increased by ≥45% between the ages of 40 and 59 (disorders of lipid metabolism, hypertension, sleep/wake disorders, thyroid disorders, esophageal disorders, osteoarthritis, tendon and synovial disorders, and menopausal disorders; all test for trend P < 0.01). Black women had a significantly higher prevalence of hypertension and esophageal disorders at all ages (adjusted P values <0.05). Women living in more deprived areas had a significantly higher prevalence of hyperlipidemia, hypertension, sleep/wake disorders, and esophageal disorders (adjusted P values <0.05). Women living in less deprived areas had a significantly higher prevalence of thyroid disorders at age 40 to 44 and menopausal disorders at ages 50 to 59 (adjusted P values <0.05).

Conclusions: These data suggest that additional attention should focus on Black women and women with a lower socioeconomic status to ensure that common midlife conditions are diagnosed and treated.

Objective: The aim of the study was to explore the immediate effects of slow-paced breathing (SPB) on cognitive performance and postural control in middle-aged postmenopausal women.

Methods: Thirty-four middle-aged women were recruited and assigned to either an experimental group (EG), who practiced SPB, or a control group (CG), who watched an educational video. Both groups had their cognitive functions and postural control assessed using validated tools during both pre-intervention and post-intervention sessions.

Results: Simple reaction time, congruent reaction time, incongruent reaction time, and incongruent reaction accuracy improved ( P ≤ 0.01) in the EG in the post-intervention compared to the pre-intervention. The incongruent reaction time improved ( P ≤ 0.05) among the EG compared to the CG in the post-intervention session. Postural control improved ( P ≤ 0.05) post-intervention compared to pre-intervention in the EG, on a firm surface in the eyes closed condition. On the foam surface, postural control improved ( P ≤ 0.001) in the post-intervention compared to pre-intervention in the EG irrespective of the vision conditions.

Conclusions: Our findings highlight the potential benefits of SPB as a nonpharmacological, cost-effective, and easily accessible intervention to improve cognitive performance and postural control among postmenopausal women. Hence, this technique should be taken into consideration when designing preventive and therapeutic strategies for these women. Additionally, women are encouraged to incorporate this exercise into their daily activities to enhance their quality of life.

Objective: This exploratory study aimed to determine the possible role of sleep in the relationships of depression and anxiety, with early surrogate markers of subclinical atherosclerosis, such as brachial artery (BA) diameter and carotid intima media thickness (CIMT) in women.

Methods: We included 1,075 self-reported postmenopausal women, 45 to 75 years from the Heart Strategies Concentrating on Risk Evaluation Study. Exposure variables were depression and anxiety assessed using the Center for Epidemiologic Studies Depression Scale and the State-Trait Anxiety Inventory, respectively. Outcome variables were BA diameter and CIMT measured using ultrasonography. The mediator, sleep, was assessed with the Pittsburgh Sleep Symptom Questionnaire-Insomnia. Ordinary least squares regression was used for mediation analyses.

Results: Of the 1,075 participants, 56.3% were White and 43.7% were Black. Our analyses revealed significant associations of depression and anxiety with sleep ( P < 0.001 for all). After adjusting for confounders, depression was associated with max CIMT (R 2 = 0.15, P = 0.004), but not BA diameter (R 2 = 0.09, P = 0.083). Although the mediating role of sleep in the association between anxiety and BA diameter was not statistically significant [proportion mediated (CI); 0.41 (-2.77, 4.06); P = 0.219], we observed differential results within each racial group. Sleep appeared to partially mediate the association of anxiety with BA diameter in White [0.21 (0.54, 0.80); P = 0.044] women only.

Conclusions: We found preliminary indications that sleep might mediate the association of anxiety with BA diameter in White women but does not appear to serve as a mediator in all the other relationships we examined.

Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) and vasomotor symptoms (VMS) are associated with increased cardiovascular disease risk. Although visceral adiposity has been linked to MASLD and VMS independently, this study aimed to evaluate associations between the two in midlife women.

Methods: A cross-sectional study of women aged 45-60 years receiving primary care at one of four sites was conducted from March 1 through June 30, 2021. MASLD diagnosis was obtained utilizing the International Classification of Diseases , Ninth Revision and Tenth Revision codes. VMS burden was evaluated with the Menopause Rating Scale and categorized as severe/very severe versus none/mild/moderate. Logistic regression models were used to assess the association between VMS and diagnosed MASLD both univariately and after individually adjusting for several risk factors.

Results: A total of 4,599 women were included in the final analysis, 304 (7%) of whom had an MASLD diagnosis. On univariate analysis, women with an MASLD diagnosis were more likely to have severe/very severe VMS (odds ratio [OR], 1.50; 95% CI, 1.08-2.08; P = 0.015). However, the association between MASLD diagnosis and severe/very severe VMS was no longer statistically significant after individually adjusting for body mass index (adjusted OR, 1.36; 95% CI, 0.97-1.92) and hypertension (adjusted OR, 1.38; 95% CI, 0.99-1.93).

Conclusions: The relationship between MASLD and VMS appears to be best explained by other variables including BMI and hypertension. Although they do not appear to be directly linked, given the prevalence of bothersome VMS in midlife women, addressing VMS may enable greater adherence to lifestyle modifications as part of MASLD management.