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

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.

Objective: To analyze the association between decreased bone mineral density (BMD) and dynapenia in postmenopausal women.

Methods: An age-matched case-control study was conducted in postmenopausal women with and without dynapenia. Assessments were carried out by measuring dominant handgrip strength with a Jamar dynamometer; BMI-adjusted cut-off points were applied. BMD was evaluated according to the World Health Organization criteria (T-score ≤-1 SD), using dual-energy x-ray absorptiometry (Hologic Horizon). The study included sociodemographic, anthropometric, body composition, biochemical, and lifestyle variables. Descriptive and inferential statistical analyses were performed, and unconditional logistic regression was used to estimate odds ratios (OR) with 95% confidence intervals (CIs); statistical significance was set at P≤0.05. The study adhered to national and international ethical standards.

Results: A total of 201 women were included in the study: 67 with dynapenia (cases) and 134 without (controls). Median ages were 68 years for cases and 66 years for controls. Dynapenia was significantly associated with decreased BMD (OR=3.89, 95% CI=1.31-11.56), high-very high visceral fat levels (OR=3.12, 95% CI=1.26-7.72), and polypharmacy (OR=2.16, 95% CI=1.05-4.63).

Conclusions: Decreased BMD is associated with dynapenia in postmenopausal women, as well as with high-very high visceral fat levels and polypharmacy. These findings highlight the importance of a comprehensive assessment of musculoskeletal and metabolic risk factors in this population.

Transdermal estradiol is licensed to treat estradiol deficiency symptoms and prevent osteoporosis in postmenopausal women. There is no one-size-fits-all estradiol dose or serum concentration that will achieve symptom relief and bone protection in all women. Dose is usually titrated to symptom response, but measurement of serum estradiol concentration can be used to support or inform dose decisions in certain clinical scenarios. The optimal level for an individual varies according to tissue sensitivity (pharmacodynamic effects), the method used for estradiol quantitation (immunoassay vs. mass spectrometry), the clinical endpoint (symptoms vs. bone protection), and treatment goals, including patient preferences. An understanding of transdermal estradiol pharmacokinetics and pharmacodynamics, and the limitations of the methods used to measure serum estradiol, is essential to ensure that all women who choose to use menopausal hormone therapy (MHT) can reap the benefits and avoid the harms of over-treatment and under-treatment. Achieving and maintaining optimal estradiol levels for all MHT users is consistent with menopause guidelines that promote high-quality, patient-centred, personalized menopause care.

Objective: To explore associations between vasomotor symptoms (VMS), sleep disturbances, and frequent mood changes, and predictors of each, in women transitioning menopause.

Methods: Data were analyzed from the baseline and first 10 annual follow-up visits (1996-2008) from 2,066 participants in the Study of Women's Health Across the Nation who had reached natural menopause. The visit closest to the final menstrual period (FMP) was considered as FMP 0; visits 5 years before/after were relabeled accordingly. Associations between symptoms over time were determined using generalized additive mixed models (GAMMS, for individual symptoms). Predictors of symptom groups were determined using Bayesian multinomial regression.

Results: Prevalence of VMS and sleep disturbances increased up to FMP+1, remaining >50% thereafter; frequent mood changes gradually decreased (47%-33%). In the GAMMs, VMS and sleep disturbances were each associated with double the odds of the other, and VMS and frequent mood changes were associated with ~50%-60% increased odds of the other. In the Bayesian models, the probability of experiencing VMS and sleep disturbances together increased with increasing age at FMP (~1.3 percentage points/year); the strongest predictors of experiencing all symptoms concurrently were high level of depression (an increase of 10 percentage points per 10-point increase in depression score) and high anxiety (46% vs. 15% probability for low anxiety).

Conclusions: Our findings underscore the importance of identifying, monitoring and addressing VMS, sleep disturbances, and frequent mood changes specifically and collectively, and support a personalized approach to menopausal symptom management, with anxiety and depression being important considerations.

Objectives: A urethral caruncle is a common benign vulvar lesion in postmenopausal women. We describe a case of malignant melanoma that originally presented as a caruncle.

Methods: A 73-year-old female presented to the urogynecology office for prolapse. Initially, she was diagnosed with a urethral caruncle that was noted to be enlarging on a subsequent exam. A biopsy was taken, which returned with poorly differentiated malignant melanoma.

Results: The patient was referred to gynecologic oncology and underwent wide local excision of the urethral mass and urethral reconstruction with bilateral sentinel inguinal lymph node biopsy and mapping. The final pathology was consistent with stage pT4b N0 (sn) pMx malignant melanoma. She is currently undergoing adjuvant immunotherapy.

Conclusions: Malignant melanoma of the urogenital tract is more common in postmenopausal women and can present as a urethral caruncle. When urethral caruncles are not responsive to initial medical therapy, providers should maintain a broad differential, including vulvar malignancies and biopsy when indicated.

Objective: Fezolinetant (Veozah) was approved as a nonhormone treatment for moderate-to-severe vasomotor symptoms of menopause in May 2023, providing a novel treatment option for women with contraindications to menopausal hormone therapy. The objective of the study was to characterize the uptake and utilization of fezolinetant in a real-world setting.

Methods: We conducted a retrospective cohort study using TriNetX data, which includes 108 health care organizations and over 156 million patients. Females with an initial prescription for fezolinetant between May 1, 2023, and December 31, 2024, were included. We described baseline clinical and demographic characteristics and assessed the uptake of fezolinetant over time.

Results: Our cohort included 9,853 women, including 1,315 (13.3%) who were over the age of 65 and 2,022 (20.5%) with a breast cancer diagnosis. Among the 7,222 individuals with at least 3 months of continuous enrollment, 1,477 (20.5%) had persistent use, defined as having a second fezolinetant prescription between 28 and 90 days of the initial fezolinetant prescription. Among persistent users, 42% received liver function testing in the 3 months after initiating fezolinetant, though regular monitoring is required after starting treatment. The total number of fezolinetant prescriptions increased over time, from 233 prescriptions between May 1 through July 31, 2023, to 1,871 prescriptions between May 1 and July 31, 2024.

Conclusions: Our findings highlight a need for future postmarketing safety and effectiveness studies, especially among survivors of breast cancer and women 65 years and older, who were excluded from the randomized controlled trials.

Objective: Menopause can result in significant transformations in a woman's life and sexuality. A limited number of studies have investigated women's perceptions at the time of menopause and their potential impact on their sexuality. The aim of this study is to explore women's perceptions of menopause and their impact on their sexuality from a multidimensional perspective, using a qualitative approach.

Methods: We conducted 13 semistructured individual interviews with postmenopausal women aged 49 to 63 years. The interviews were recorded, transcribed, and coded by 2 investigators. These codes were then classified into themes and subthemes.

Results: With regard to menopause, the participants first emphasized the physical and psychological symptoms (hot flashes, genitourinary disorders, weight gain, depression, mood swings) that they experienced during this time, which were sometimes incapacitating. They also reported a complex psychosocial context at the onset of menopause. Most of them went through this experience alone. The combination of these various factors resulted in a highly variable menopausal experience. Their sexuality was primarily influenced by the severity of the genitourinary disorders and the quality of the relationship with their partner, and sexual desire levels varied as a result.

Conclusions: The overall experience of menopause widely varies from one woman to another, mainly depending on the intensity of the physical and psychological symptoms, as well as on their life context. Sexuality and sexual desire may change quantitatively and qualitatively. Some women are at greater risk for a negative menopause experience and require special attention from health care professionals.

Objective: Although premature ovarian insufficiency (POI) diagnosis can be devastating, few studies focused on women's experiences of the disclosure. The objective of EMPOIHER study was to evaluate women's satisfaction with POI disclosure and the association with subsequent adherence to the treatment plan and medical follow-up.

Methods: We studied a cohort of 101 women diagnosed with spontaneous POI who attended two French University Hospitals between 2017 and 2024. Standardized interviews collected gynaecologic history, experience of POI diagnosis, etiological and comorbidities assessment, POI follow-up and menopause hormone therapy (MHT) use. Women's satisfaction with POI disclosure was evaluated using a five-item scale assessing the health care provider's emotional responsiveness, clarity of communication, amount of information provided, opportunity for questions and relevance of discussed topics to the women's concerns.

Results: Sixty-four percent of participants declared they were globally satisfied or very satisfied with the way they were informed of their POI diagnosis. However, 70% sought more information using the internet or asked for the opinion of another practitioner. Surprisingly, psychological support was offered to only 19.8% of women. Solely 63.4% of participants benefited from MHT at inclusion. No association was found between women's satisfaction regarding POI disclosure and their adherence to follow-up and MHT.

Conclusions: While participants expressed general satisfaction with the communication of their POI diagnosis, there is room for improvement in clinicians' communication skills regarding providing information and empathy. Furthermore, women should be offered psychological support following POI diagnosis. Our findings emphasise the need for guidelines concerning the POI disclosure process. In this study, no association was found between women's satisfaction with POI announcement and their adherence to MHT and gynecologic follow-up.