Tserotas K, Blümel JE, Chedraui P
… +30 more, Vallejo MS, Ñañez M, Ojeda E, Rey C, Valadares AL, Rodríguez-Vidal D, Rodrigues MA, Saavedra J, Salinas C, Sosa L, San-Martín AM, Aguirre MS, Arteaga E, Ayala F, Bencosme A, Calle A, Costa-Paiva L, Dextre M, Díaz K, Elizalde-Cremonte A, Elizalde-Cremonte S, Escalante C, Espinoza MT, García I, Gómez-Tabares G, Gutiérrez-Crespo H, López M, Matzumura-Kasano JP, Meza P, Monterrosa-Castro Á
OBJECTIVE: To explore the association between the severity of menopausal symptoms and work-related outcomes and performance. METHODS: This cross-sectional study involved 3,523 women aged 40-60 from 30 health care centres...OBJECTIVE: To explore the association between the severity of menopausal symptoms and work-related outcomes and performance. METHODS: This cross-sectional study involved 3,523 women aged 40-60 from 30 health care centres across 12 Latin American countries. The severity of menopausal symptoms was assessed with the Menopause Rating Scale (MRS). Work-related outcomes were surveyed, including absenteeism, medical visits, perceived reduced work performance, impact of menopause on work performance, and job loss. Comparisons employed suitable tests based on data distribution, and logistic regression was used to assess associations, adjusting for covariates such as menopausal symptoms, comorbidities, age, and education. RESULTS: Women with severe menopausal symptoms (total MRS score ≥14 points) were significantly older (51.1 ± 5.1 vs 49.7 ± 5.6y), had a higher body mass index (27.4 ± 4.8 vs 26.7 ± 4.6 kg/m 2 ), were postmenopausal in a higher proportion (69.9% vs 52.2%), had more comorbidities (42.8% vs 27.6%), higher smoking prevalence, and lower educational attainment. In addition, these women significantly reported more medical leaves (42.4% vs 29.5%), more medical visits (mean: 3.9 vs 2.5 visits), and a more significant perceived reduction of work performance (82.1% vs 56.7%). They also were more likely to believe that menopause significantly reduced their work capacity (67.0% vs 24.0%), had a higher prevalence of job dismissals (6.9% vs 2.0%), and more voluntary resignations or early retirements (8.1% vs 4.7%). Binary logistic regression determined that severe menopausal symptoms, subsequently adjusted for covariates, were primarily associated with more work absenteeism (aOR: 1.64; 95% CI: 1.41-1.90), more medical visits (aOR: 2.45; 95% CI: 1.97-3.05), decreased work performance (aOR: 3.13; CI 95%: 2.65-3.69), the perception of menopause negatively impacting their work performance (aOR: 5.84; 95% CI: 5.01-6.80), more job dismissals (aOR: 3.23; 95% CI: 2.21-4.72), and more voluntary resignations or early retirements (aOR: 1.44; 95% CI: 1.08-1.93). CONCLUSION: In this large sample of midlife Latin American women, severe menopausal symptoms were associated with reduced work capacity and adverse work-related outcomes.
OBJECTIVES: This study examines the employment trajectories of women experiencing early and surgical menopause over a 10-year period bracketing their final menstruation or surgery, representing for most women the menopau...OBJECTIVES: This study examines the employment trajectories of women experiencing early and surgical menopause over a 10-year period bracketing their final menstruation or surgery, representing for most women the menopause transition. It also investigates the potential mediating role of hormone therapy in early postmenopause in these relationships. METHODS: We used data from 1,386 women in the English Longitudinal Study of Aging (ELSA) who had undergone natural menopause, premenopausal bilateral oophorectomy or hysterectomy. We used sequence analysis of employment histories to define 3 different 10-year employment trajectories. We then carried out regression analysis to assess associations between timing and type of menopause on employment, followed by mediation analysis. Sensitivity analysis was conducted by excluding cases with hysterectomy with preserved ovaries. RESULTS: Women with early menopause, compared with those who undergo menopause at 45 or older, are less likely to have flexible working arrangements (part-time work or self-employment) compared with full-time work during this sensitive period (relative risk ratio [RRR], 0.70; 95% CI: 0.51-0.97). However, the likelihood of leaving the labor market compared with working full-time is similar in women with early and later menopause (RRR, 0.95; 95% CI: 0.62-1.41). Surgical menopause, compared with natural menopause, is associated with an increased risk of labor market exit (RRR, 1.45; 95% CI: 1.01-2.32), particularly for women aged 45 or older at the time of surgery (RRR, 1.50; 95% CI: 0.94-2.38). Hormone therapy use may help reduce the risk of labor market exit for women with both early (RRR NATURAL INDIRECT EFFECT [NIE] , 0.79; 95% CI BIAS-CORRECTED [BC] , 0.58-1.04) and surgical menopause (RRR NIE , 0.73; 95% CI BC , 0.53-1.01). Sensitivity analysis suggests that the potential reduction in labor market exit risk via hormone therapy for early menopausal women holds true only when women with hysterectomy with preserved ovaries are included. CONCLUSIONS: Our study highlights that early menopause and surgical menopause, including hysterectomy with preserved ovaries, impact women's labor market trajectories and suggests that hormone therapy within the early years of the final menstruation may help women remain employed. We advocate for further research on the impact of the timing and type of menopause on women's labor market circumstances and for workplace policies that consider their diverse experiences.
OBJECTIVE: This study examined the effect of a symptom management program developed based on story theory on vasomotor symptoms and sleep quality in postmenopausal women. METHODS: The research was conducted as a mixed me...OBJECTIVE: This study examined the effect of a symptom management program developed based on story theory on vasomotor symptoms and sleep quality in postmenopausal women. METHODS: The research was conducted as a mixed methods study using an interventional design, one of the advanced mixed methods designs. The study population consisted of postmenopausal women who presented to 5 family health centers. A total of 76 women were enrolled, with 38 in the experimental group and 38 in the control group. The symptom management program developed based on story theory was applied individually to women in the experimental group. A personal information form, the Menopause Symptoms Assessment Scale, the Pittsburgh Sleep Quality Index, and a story theory-based semistructured interview form were employed as data collection tools. The independent 2-sample t test, Mann-Whitney U test, generalized linear model, Tukey test, and Robust ANOVA test were used for the analysis of quantitative data, while content analysis was applied to qualitative data. RESULTS: The Menopause Symptoms Assessment Scale total and subdimension scores and the total Pittsburgh Sleep Quality Index score were lower in the experimental group than in the control group at the end of the program. Six themes were identified in the study: thoughts about menopause, symptoms experienced during menopause, perception of femininity in menopause, the effect of menopause on daily life, coping with menopause, and expectations in menopause. CONCLUSIONS: The program reduced vasomotor symptoms and improved sleep quality among the postmenopausal women in the experimental group.
OBJECTIVES: This study explores the relationship between Life's Crucial 9 (LC9), a recently updated cardiovascular health (CVH) assessment tool by the American Heart Association (AHA), and self-reported reproductive life...OBJECTIVES: This study explores the relationship between Life's Crucial 9 (LC9), a recently updated cardiovascular health (CVH) assessment tool by the American Heart Association (AHA), and self-reported reproductive lifespan, as well as pregnancy loss history. METHODS: The analysis utilized data from 2,405 postmenopausal women in the United States collected from the National Health and Nutrition Examination Survey (NHANES) database between 2007 and 2018. LC9 scores, ranging from 0 to 100, were calculated based on AHA's definitions and divided into health behavior and health factor components. The association between LC9 scores, reproductive lifespan, and the self-reported incidence of pregnancy loss was evaluated using weighted multivariable linear and Poisson regression models. RESULTS: Individuals in the highest tertile of the LC9 score experienced a significantly higher age at menopause (0.034 y, [0.009, 0.059)]) and a longer reproductive lifespan (0.045 y, [0.004, 0.085]) compared with those in the lowest tertile. Furthermore, we identified a linear association between the LC9 score and reproductive lifespan. The positive correlation between the LC9 score and reproductive lifespan was notably stronger among non-Hispanic Whites. For self-reported pregnancy loss, the fully adjusted relative prevalence (95% CI) for the LC9 score was 0.699 (0.436-1.120), which remained consistent after further adjustment for reproductive lifespan. However, this association did not reach statistical significance, indicating that there may not be a strong relationship between LC9 scores and pregnancy loss in this cohort. CONCLUSIONS: Our study indicated that a higher LC9 score could potentially extend women's reproductive lifespan and enhance reproductive health, although no significant association was found with pregnancy loss in this population.
IMPORTANCE AND OBJECTIVES: Many breast cancer survivors struggle with menopausal symptoms due to oncological treatment-induced hormone deficiency, or because they experience menopause some years after completing treatmen...IMPORTANCE AND OBJECTIVES: Many breast cancer survivors struggle with menopausal symptoms due to oncological treatment-induced hormone deficiency, or because they experience menopause some years after completing treatment, but have limited menopause treatment options. Estrogen replacement therapy is the most effective treatment for menopausal symptoms, but is not recommended after breast cancer because it can increase the risk of relapse. Our objectives were to review the evidence and develop a consensus statement to define the role of menopausal hormone therapy after breast cancer, and to highlight evidence gaps to inform future research. METHODS: A 25-member multidisciplinary panel developed the consensus statements using a modified Delphi methodology. The panel consisted of 18 senior doctors who voted (5 GP menopause specialists, 5 gynecologists, 4 medical oncologists, 3 breast surgical oncologists, and 1 breast radiologist), and 7 members who did not vote (4 patient representatives, 1 medical oncologist, 1 urologist and 1 administrator). Consensus was defined as ≥70% agreement with low-to-moderate variation in extent of agreement (mean absolute deviation from median of ≤0.75). We reviewed current evidence relating to use of vaginal and systemic menopausal hormone therapy ("MHT", also known as "hormone therapy," "HT" or "hormone replacement therapy," "HRT") after breast cancer diagnosis, and adjuvant endocrine (anti-estrogen) therapy, and developed a narrative synthesis. Finally, four additional breast cancer specialists peer-reviewed the manuscript. DISCUSSION AND CONCLUSIONS: The panel agreed that some women may choose to take MHT, (off-label use) and accept an increased risk of relapse in exchange for relief from menopausal symptoms and an improved quality of life, and that preferences may vary according to individual circumstances and the absolute risk of relapse. All respondents agreed or strongly agreed with statements supporting shared decision making and individualized menopause care (MADM 0.29).In our review of the literature, we found mainly moderate quality evidence concerning use of vaginal and systemic estrogen after breast cancer, and high quality evidence concerning the benefits of anti-estrogen therapy for estrogen receptor positive breast cancer. Based on the available data, we recommend that shared decisions are based on (1) an individual's menopausal symptoms and impact on quality of life, (2) the potential increase in an individual's risk of relapse by use of menopausal hormone therapy, and (3) patient preferences, views and treatment goals. Clinicians and patients can use our findings to make informed menopause treatment choices after breast cancer. We strongly recommend registering all patients considering MHT after breast cancer in a clinical study (eg, MENopausal hormone therapy and Outcomes After Breast Cancer, the MENO-ABC trial).
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 sympto...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.
The levonorgestrel intrauterine system (IUS) is frequently used in perimenopause for contraception and bleeding control and in both perimenopause and menopause for endometrial protection while using estrogen therapy to c...The levonorgestrel intrauterine system (IUS) is frequently used in perimenopause for contraception and bleeding control and in both perimenopause and menopause for endometrial protection while using estrogen therapy to control bothersome menopause symptoms. The use of an IUS for endometrial protection as part of hormone therapy is off label in the United States but is approved for use in more than 100 countries for up to 5 years. Some IUSs have been approved for contraceptive use for 8 years, and questions remain whether they provide adequate endometrial protection when combined with estrogen therapy beyond 5 years of use.
OBJECTIVE: To evaluate depression in postmenopausal women and to explore the relationship between age at menopause, hormone therapy, and depression, while also identifying potential mediators that may explain these assoc...OBJECTIVE: To evaluate depression in postmenopausal women and to explore the relationship between age at menopause, hormone therapy, and depression, while also identifying potential mediators that may explain these associations. METHODS: This cross-sectional study analyzed data from National Health and Nutrition Examination Survey (NHANES) (2005-2020) for women older than 60 years who completed the Patient Health Questionnaire 9 (PHQ-9) depression questionnaire (n=7,027). Exposures included age at menopause and self-reported hormone therapy; the outcome was depression severity (PHQ-9 ≥10). Covariates included sociodemographics, body mass index, medical conditions, and biomarkers (C-reactive protein, homeostatic model assessment of insulin resistance). Survey-weighted logistic regression, Bayesian modeling, and causal mediation analysis were used. Missing data were handled with multiple imputation and inverse probability weighting. Analyses were conducted with R software, with P <0.05 considered significant. RESULTS: In this NHANES sample of postmenopausal women older than 60 years, earlier age at menopause was associated with depression ( P <0.0001). Hormone therapy did not show a significant association with depression (OR=0.58, 95% CI: 0.23-1.4), while higher education levels were protective (college degree: OR=0.89, 95% CI: 0.85-0.92, P <0.001). C-reactive protein and homeostatic model assessment of insulin resistance partially accounts for the statistical association between menopause and depression ( P <0.0001). CONCLUSION: Age at menopause is inversely associated with depression in women older than 60 years. This relationship is statistically accounted for by the role of inflammation and insulin resistance. Self-reported hormone therapy is not associated with depression in postmenopausal women.
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, compr...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.
OBJECTIVE: The objective of the present work is to: (1) describe the trends in obesity among premenopausal and postmenopausal women in the United States between 1999 and 2018, and (2) describe the effect of aging on body...OBJECTIVE: The objective of the present work is to: (1) describe the trends in obesity among premenopausal and postmenopausal women in the United States between 1999 and 2018, and (2) describe the effect of aging on body mass index in women, using novel BMI-for-age percentile curves. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2018, including self-identified female participants older than 20 years, was used. Menopause status was self-reported, and body mass index (BMI, kg/m 2 ) was calculated based on measured height and weight. Mean BMI across year is described according to menopause status and race/ethnicity. BMI-for-age percentiles and curves were created to describe adult BMI in the context of age. RESULTS: Mean BMI among premenopausal women increased from 27.7 (7.1) kg/m 2 in 1999 to 30.2 (8.8) kg/m 2 in 2018. In postmenopausal women, mean BMI increased from 28.7 (6.2) kg/m 2 in 1999 to 29.7 (7.1) kg/m 2 in 2018. Among premenopausal women, BMI values in the 50th percentile range from 25.0 kg/m 2 at age 20 to 28.6 kg/m 2 at age 60. Among postmenopausal women, BMI values in the 50th percentile range from 27.1 kg/m 2 at age 41 to 28.3 kg/m 2 at age 60, and 26.5 kg/m 2 at age 80. CONCLUSIONS: The present findings describe an increase in BMI by both calendar year and chronological age during the years before menopause leading to higher BMI levels among postmenopausal women. These findings highlight the premenopausal period and the menopause transition as an important opportunity for obesity screening, identification, and prevention.
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 present...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.
IMPORTANCE: Sleep disturbances are common during and after the menopause transition, with potential effects on morbidity and quality of life; however, they may be underdiagnosed and undertreated. OBJECTIVE: We carried ou...IMPORTANCE: Sleep disturbances are common during and after the menopause transition, with potential effects on morbidity and quality of life; however, they may be underdiagnosed and undertreated. OBJECTIVE: We carried out a systematic literature review to investigate the prevalence and impact of sleep disturbances associated with menopause on women's health-related quality of life across the stages of menopause. EVIDENCE REVIEW: Searches were conducted in PubMed and Excerpta Medica Database to identify articles published between 2013 and 2023 containing evidence for the impact of sleep quality on health-related quality of life and the epidemiology of sleep disturbances in women in menopause. FINDINGS: In total, 29 publications focusing on epidemiological outcomes of sleep disturbances and 28 studies focusing on the impact of sleep quality on health-related quality of life were identified. Overall, these studies confirmed the high prevalence of sleep disturbances in postmenopausal women. Risk factors for sleep disturbances included menopausal status, depression, vasomotor symptoms, high glycemic index diets, and age. Notably, sleep disturbances were identified even in the absence of vasomotor symptoms. Sleep disturbances were significantly associated with impaired menopause-specific and general health-related quality of life, including depression, anxiety, and musculoskeletal pain. Sleep disturbances were also associated with reduced work productivity and the ability to perform daily activities. CONCLUSIONS AND RELEVANCE: Healthy sleep is important at all life stages, including during menopause. Our review indicates that sleep disturbances are highly prevalent during postmenopausal years, even among women without vasomotor symptoms, and can severely impact women's well-being and quality of life. This study highlights the importance of promoting increased awareness and developing tailored treatment strategies for sleep disturbances in midlife and beyond.
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 qua...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.