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

Importance and objective: Menopause is a reproductive transition affecting half the world's population. Stigma and limited availability of evidence-based treatments that support biopsychosocial well-being mean that this life stage is often associated with challenging symptoms and reduced quality of life (QoL). The aim of this review was to examine the extent literature on psychological and mind-body interventions to manage perimenopausal and postmenopausal symptoms, and apply an interdisciplinary clinical, research, and cultural knowledge framework to guide recommendations for improving QoL and healthy aging in this population. We also aimed to understand the ideal delivery mode for such interventions.

Methods: Using Scopus, Medline, and PubMed, a review of systematic reviews, guidelines, and randomized controlled trials was undertaken to examine the use of psychological and mind-body interventions to improve menopause-related QoL and symptoms, including hot flushes, depression, anxiety, fatigue, pain, and sleep; conclusions were based on an analysis of this available evidence and linked to clinical and cultural considerations.

Discussion and conclusion: Empirical support exists for a number of psychological and mind-body approaches to support QoL and symptoms during the menopause transition. The literature also identifies the need for menopause care that is culturally responsive.An online multimodal model of menopause care is thus recommended, incorporating evidence-based treatments (eg, cognitive behavioral therapy, yoga, hypnosis) and treatment techniques (eg, mindfulness, and education including nutrition support), as well as First Nations wisdom. We also recommend financial well-being approaches to support people undergoing menopause. Integrated, multimodal approaches should be available online to remove time, location, and healthcare access barriers, and be designed with diverse consumers to ensure equity for those underserved due to region, LGBTIQ+ assigned female at birth status, and for multicultural and First Nations people.

Objective: The aim of this study was to examine how depressive symptoms change in midlife and across the menopause transition.

Methods: We conducted a secondary analysis of data from a prospective population-based cohort, the Coronary Artery Risk Development in Young Adults study. We included women (n = 2,160) with ≥3 responses to the Center for Epidemiologic Studies Depression Scale (CES-D) beginning at examination year 5, at approximately 30 years of age, and again at years 10, 15, 20, 25, 30, and 35 (ages 35 through 60 years). We modeled trajectories of CES-D by chronologic age and compared these to trajectories of depressive symptoms by relation to age at menopause.

Results: We identified three trajectories of depressive symptoms: women with minimal (n = 1,328, 61%, mean CES-D 8.1); intermediate (n = 675, 31%, mean CES-D 15.6); or persistent depressive symptoms (n = 157, 7%, mean CES-D 26.1). Trajectories were stable over time, among women who had undergone natural menopause (n = 1,153), Black race (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.43 to 2.40), less than a high school education (OR, 1.83; 95% CI, 1.38 to 2.41), and low income (OR, 1.60; 95% CI, 1.18 to 2.18), along with tobacco use (OR, 1.35; 95% CI, 1.04 to 1.77), alcohol consumption (OR, 1.01; 95% CI, 1.004 to 1.02), estrogen use for vasomotor symptoms (OR, 1.71; 95% CI, 1.06 to 2.77), and higher body mass index (OR, 1.03; 95% CI, 1.01 to 1.05) that were also associated with persistent depressive symptoms. Hormonal contraceptive use at year 2 was associated with lower odds of persistent depressive symptoms (OR, 0.69; 95% CI, 0.51 to 0.93). Similar patterns were observed among women who underwent surgical menopause.

Conclusions: Depressive symptoms in the premenopause were similar to those in postmenopause, and risk factors could be identified early in reproductive life. Studies with more frequent assessments of depressive symptoms during the menopause transition are needed.

Objective: Menopause symptoms affect quality of life and financial well-being but are often unaddressed in primary care clinics. Therefore, we evaluated the extent of menopause symptom documentation in electronic health records (EHRs) by primary health care professionals.

Methods: We retrospectively reviewed adult women who reported moderate or higher vasomotor symptoms on a Mayo Clinic survey conducted from March 1, 2021, through June 30, 2021. We then assessed adequacy of menopause symptom documentation in the EHRs of these women who had primary care visits during the survey period. We reviewed the percentage of documented vasomotor symptoms from May 1, 2019, through May 1, 2021.

Results: In the Mayo Clinic Health System-Northwest Wisconsin Region, 229 women self-reported moderate or higher vasomotor symptoms in the Mayo Clinic survey. Although only 23% of these women had vasomotor symptoms listed in the EHR clinical problem lists, 60% of these women had vasomotor symptoms documented in their clinic notes from the primary care visit. Approximately 6% of women reported hormone therapy use for management of menopause symptoms, and nearly 15% reported use of nonhormone prescription therapies for vasomotor symptoms.

Conclusions: A greater proportion of women in our study had EHR documentation of bothersome menopause symptoms than those reported in other studies, but vasomotor symptoms remain generally untreated. We need better methods for identifying midlife women with bothersome menopause symptoms in primary care clinics so that appropriate treatment options, including hormone therapy, can be discussed and offered.

Objective: To determine unmet need for menopause care in Oregon and evaluate if insurance type is associated with receipt of care.

Methods: We conducted a cross-sectional survey of patients using an Oregon Listserv. Our primary outcome was use of medication for the treatment of moderate or severe symptoms of menopause. We used the Menopause Rating Scale to evaluate respondents' symptoms: 0-4 none or little symptoms; 5-8 mild symptoms; 9-16 moderate symptoms; and 17+ severe symptoms. We abstracted demographic and clinical information including age, rurality, race, ethnicity, primary language, and insurance type. We used a regression model to determine the association between public insurance and treatment for moderate to severe menopause symptoms. We examined reasons for nonuse of therapy.

Results: Our sample included 845 perimenopausal or postmenopausal individuals who were predominantly White (93.0%), aged 45-49 (32.8%) or 50-54 years (39.1%), and privately insured (81.3%). Overall, 62.4% of individuals with moderate and severe symptoms of menopause were not receiving any therapy. After adjustment for age and rurality, public insurance was associated with an average of 47% increased odds of nontreatment for moderate or severe menopause symptoms (adjusted odds ratio: 1.47, 95% CI: 0.99-2.19). The most common reasons for nontreatment in both groups were "therapy was not recommended by a provider" (43%) and worries about safety or side effects (40%).

Conclusions: Even in well-insured persons, the majority of people with moderate and severe symptoms of menopause are not receiving treatment. People who are publicly insured are more likely to go untreated than privately insured individuals.

Objective: This study aimed to investigate the association between age at natural menopause and incidence of asthma among postmenopausal Canadian women.

Methods: Women between the ages of 45-85 yr were followed for a 10-yr period. Analysis was restricted to naturally postmenopausal women who are nonsmokers and did not have asthma prior to menopause. Age at natural menopause was examined using the following categories: 40-44, 45-49, 50-54 (reference), and ≥55. Survival analysis was utilized to determine time to onset of asthma. Multivariable Cox regression analysis was performed to assess the relationship between age at natural menopause and asthma after adjusting for covariates.

Results: The multivariable Cox regression analysis showed a 30% decreased risk of asthma in women with age at natural menopause of 40-44 yr compared with age at natural menopause of 50-54 yr with a hazard ratio of 0.7 (95% confidence interval: 0.49-0.95).

Conclusions: Women with later ages at natural menopause may be at increased risk for asthma.