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

Objective: To evaluate the documentation of menopause-related International Classification of Diseases-10 (ICD-10) codes in the electronic health record (EHR) among midlife women with moderate or greater menopause symptoms receiving primary care.

Methods: This cross-sectional study from the Hormones and Experiences of Aging (HERA) cohort included women aged 45-60 years receiving primary care at one of 4 Mayo Clinic sites who completed a one-time survey between March 1, 2021 and June 30, 2021. The survey captured demographic data, menopause symptoms using the Menopause Rating Scale (MRS), health care utilization, and treatment. Women with an MRS score ≥12 were included. The primary outcome was documentation of a menopause-related ICD-10 code in the EHR in the 12 months before survey completion.

Results: Of 5,254 women with completed surveys, 2,414 (49%) had an MRS score ≥12 and were included. Among these, 1,519 (63%) reported seeking care for their menopause symptoms in the past 12 months, but only 345 (23%) had a menopause-related ICD-10 code. Women with an ICD-10 code had higher MRS scores (18 [IQR: 14-22] vs 17 [IQR: 14-20]; P = 0.002) and were more likely to use systemic hormone therapy (HT; 26% vs 9%; P < 0.001), and vaginal HT (20% vs 6%; P < 0.001).

Conclusions: Menopause-related ICD-10 diagnosis codes were under-documented in women with significant menopause symptom burden. Those with a code were more likely to report menopause treatment. These findings highlight a critical gap between symptom burden and diagnosis coding in the EHR, underscoring the need to improve identification and management of menopause symptoms.

Objective: Our study aimed to compare premenopausal and postmenopausal women in terms of choroidal thickness and choroidal vascularity index.

Methods: This cross-sectional study included 96 eyes of 96 participants, comprising 48 premenopausal and 48 postmenopausal women. Enhanced depth image optical coherence tomography (EDI-OCT) was used to visualize the choroid. Choroidal thickness measurements were performed at three points, including the subfoveal region (subfoveal choroidal thickness [SFCT]), 1500 μm nasal to the fovea (nasal choroidal thickness [NCT]), and 1500 μm temporal to the fovea (temporal choroidal thickness [TCT]) from EDI-OCT images. The choroidal vascularity index (CVI), total choroidal area (TCA), luminal area (LA), and stromal area (SA) were measured in the subfoveal 3000 μm area by the binarization technique via ImageJ software. Measurements of premenopausal and postmenopausal women were compared after adjusting for age.

Results: The comparison of axial length, spherical equivalent, and body mass index values revealed no significant differences (P>0.05 for all). SCFT, NCT, TCT, LA, and TCA values were statistically significantly lower after adjusting for age in the postmenopausal group compared with the premenopausal group (P=0.002, 0.020, 0.004, 0.020, 0.043) respectively. There was no statistically significant difference in SA and CVI values (P>0.05 for all).

Conclusion: The decreased choroidal thickness in postmenopausal women likely resulted from the reduction in the vascular component of the choroid, while the stromal component remained unchanged. Further prospective long-term studies are needed to evaluate women before and during menopause to investigate the relationship between choroidal vascular structure and the risk of ischemic vascular diseases.

Objectives: This study aimed to examine the relationship between vaginal aging and sexual quality of life in postmenopausal women.

Methods: A descriptive, cross-sectional study was conducted with 210 postmenopausal women aged 45 to 59 years. Data were collected using a Personal Information Form, the Daily Effects of Vaginal Aging Scale, and the Sexual Quality of Life Scale. Descriptive statistics, Pearson correlation analysis, and multiple regression analysis were used to analyze the data.

Results: A statistically significant negative correlation was found between vaginal aging and sexual quality of life ( r =-0.533, P <0.001). A one-unit increase in vaginal aging was associated with a 0.506-unit decrease in sexual quality of life score (B=-0.506, P <0.001).

Conclusions: Vaginal aging was significantly associated with lower sexual quality of life in postmenopausal women. These findings suggest that addressing vaginal aging may contribute to enhancing sexual well-being in this population.

Objective: Endometrial cancer (EC) and epithelial ovarian cancer (EOC) affect women of all ages, and the incidence of endometrial cancer in premenopausal women is rising. Menopause can be detrimental to longevity and quality of life, but evidence suggests estrogen therapy (ET) is safe in these patients. The purpose of this study was to evaluate the practice patterns of gynecologists and gynecologic oncologists (GYO) in the United States in regards to prescription of ET to gynecologic cancer patients. It was hypothesized that ET is underused in this population.

Methods: In 2024, a web-based survey was administered through email or postcard mailer to members of the Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists. Participants were asked demographic questions and whether they provide ET for patients with a history of EC, EOC, and cervical cancer.

Results: A total of 293 participants answered questions about at least one type of cancer. When asked if willing to provide ET, 63.82% (187/293) selected "yes" for EC, 65.19% (176/270) for EOC, and 96.8% (274/283) for cervical cancer. Due to lack of heterogeneity, cervical cancer was omitted from analysis. Gynecologic oncology providers were more likely than OBGYNs to prescribe ET for EC (P = 0.0006) and EOC patients (P = 0.0009). Those in practice for 10 or more years (P = 0.022), or who identified as male (P = 0.019), were more likely to prescribe ET to EC patients. Of those who do not prescribe ET, the most common reasons were belief that hormones are contraindicated, better options exist, and risk outweighs benefits. These options were selected more frequently by OBGYNs than GYOs.

Conclusion: Many gynecologists, and some gynecologic oncologists, are uncomfortable prescribing hormone therapy to patients with a history of endometrial or epithelial ovarian cancer, despite evidence suggesting its safety. This indicates a need for clinician education to ensure patients are counseled appropriately about options for treating menopausal symptoms.

Importance and objective: Voice changes during menopause affect patients' communication and quality of life. This narrative review aims to provide a comprehensive exploration of voice changes during menopause. It presents objective and subjective/symptomatic changes as well as treatment options for this population. Lastly, it identifies areas of research and future directions needed to serve this population through collaboration between voice experts and gynecologists.

Methods: To inform this narrative review, a literature review was conducted using the PubMed database, encompassing publications from January 2005 to January 2025. The review synthesized research on hormonal influences, acoustic analyses, laryngeal imaging, and patient-reported outcomes, with a focus on understanding the physiological mechanisms underlying menopausal voice alterations.

Results: The review reveals a complex narrative of vocal transformation during menopause. Hormonal decline-characterized by reduced estrogen and progesterone levels-precipitates significant laryngeal changes. Up to 46% of menopausal women experience perceptible vocal modifications, including decreased fundamental frequency (by 0.94 semitones), increased vocal instability, and reduced phonation capabilities. Particularly vulnerable are professional voice users, who face unique challenges in maintaining vocal performance. Hormone therapy demonstrates potential protective effects, though findings remain inconsistent.

Discussion and conclusion: Menopause-related voice disorders represent a nuanced and underexplored medical phenomenon. This review underscores the critical need for interdisciplinary research that integrates gynecology, otolaryngology, endocrinology, and speech pathology. Future investigations could focus on developing AI-driven voice biomarkers, conducting longitudinal studies, and creating targeted interventions that recognize the voice and respiratory transitions women experience during menopause.

Objective: To describe treatment patterns for menopausal symptoms in women taking endocrine therapy for breast cancer treatment/prevention from the United States (US), United Kingdom (UK), and Germany.

Methods: We undertook a retrospective cohort study using data from the US Market Scan Commercial Claims and Encounters Data database, and electronic health records from the UK's Clinical Practice Research Database Aurum and the German Disease Analyzer. Women aged 18-65 years with a first prescription/dispensation for endocrine therapy for breast cancer treatment or prevention (index date) from 2010 to 2022 were followed up, and the following treatment classes were evaluated: antidepressants, benzodiazepines, anticonvulsants, antihypertensives, and hormone therapy.

Results: Treatments were recorded in 32.7% (39,137/119,717) US women, 20.4% (8,350/40,956) UK women, and 8.3% (1,031/12,388) German women. Among these, ~80% in the US and UK, and all in Germany, received one treatment class; switches occurred in 20.5% (US) and 16.5% (UK). The most frequent initial treatment classes were antidepressants (31.7% US, 45.3% UK, 38.1% Germany); the second most frequent were benzodiazepines (30.3% US), anticonvulsants (24.3% UK), and hormone therapy (27.2% Germany). Among antidepressants, the most common were venlafaxine (US and Germany), and amitriptyline, sertraline, and citalopram (UK). Six-month continuation rates for antidepressants were 42% (US), 12% (UK), and 7% (Germany); continuation rates for other treatments were even lower.

Conclusions: Continuation rates with available treatments for menopausal symptoms in women receiving endocrine therapy for breast cancer treatment/prevention are very low. This indicates a clear unmet need for safe, effective, and well-tolerated treatments in this patient population.

Objective: We aimed to assess the relationship between hysterectomy and/or bilateral oophorectomy and the risk of stroke-a topic of ongoing debate in current research.

Methods: We utilized data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 to estimate both crude and multivariable-adjusted hazard ratios (HRs) and 95% CIs, applying survey-weighted Cox proportional hazards regression model. The modeling incorporated sampling weights and design variables to address NHANES's multistage probability sampling framework. In addition, a meta-analysis was conducted, incorporating findings from NHANES with those from other cohort studies identified through database search.

Results: This unweighted NHANES cohort included 21,240 women with 8.3 median follow-up years, documenting 193 stroke-related deaths. Compared with no hysterectomy, hysterectomy was not significantly associated with stroke mortality (HR: 1.28, 95% CI: 0.89-1.85). However, a meta-analysis of 2,065,490 participants from NHANES and 15 other studies demonstrated hysterectomy was linked to a 9% higher stroke risk (HR: 1.09, 95% CI: 1.04-1.15) compared with no hysterectomy. Similar finding was identified for bilateral oophorectomy (HR: 1.13, 95% CI: 1.09-1.17) compared with no bilateral oophorectomy. Subgroup analyses stratified by surgical indication, ovarian conservation status, and reference population consistently demonstrated elevated risks.

Conclusions: In summary, the data from NHANES and other studies indicate women with hysterectomy and/or bilateral oophorectomy may be associated with an increased stroke risk. Additional prospective studies are needed to confirm the association between hysterectomy and/or bilateral oophorectomy and stroke risk.