OBJECTIVES: Early-onset menopause has been increasingly observed among women living with HIV (WLWH). However, limited data exist on its prevalence and determinants in sub-Saharan Africa. This study aimed to determine the...OBJECTIVES: Early-onset menopause has been increasingly observed among women living with HIV (WLWH). However, limited data exist on its prevalence and determinants in sub-Saharan Africa. This study aimed to determine the prevalence and predictors of self-reported early-onset menopause among WLWH in Botswana. METHODS: This cross-sectional analysis was conducted as a substudy within the InterCARE cluster-randomized controlled trial among women with HIV and hypertension aged ≥18 years, at 14 HIV clinics in Botswana. Data were collected between January and September 2023 and included sociodemographic, clinical, reproductive history, and HIV parameters. Early-onset menopause was defined as self-reported cessation of menstruation for at least 12 months before the age of 45, unrelated to surgery or pregnancy. A generalized estimating equation model was used to identify independent predictors of early menopause. RESULTS: The mean age (SD) of the 1,088 women enrolled was 59.1 (7.2) years, with 23.7% (n=258) having experienced early-onset menopause. The mean age (SD) at menopause overall was 47.4 (5.5) years and that for early-onset menopause was 40.3 (4.6) years. In adjusted analysis, the only predictor of early-onset menopause was HIV diagnosis before age 35 years (aRR=1.46; 95% CI: 1.06-2.01; P=0.020). CD4 count was inversely associated with the risk of early-onset menopause (aRR 0.98; 95% CI: 0.96-1.00; P=0.045). CONCLUSIONS: Early-onset menopause is relatively common among WLWH in Botswana and is associated with a younger age at HIV diagnosis. These findings highlight the need for integrated reproductive and HIV care, including screening and management of early-onset menopause to prevent menopause-related complications.
OBJECTIVE: To evaluate the efficacy of nonablative capacitive-resistive monopolar radiofrequency on sexual function and vaginal health in postmenopausal women with genitourinary syndrome of menopause. METHODS: This was a...OBJECTIVE: To evaluate the efficacy of nonablative capacitive-resistive monopolar radiofrequency on sexual function and vaginal health in postmenopausal women with genitourinary syndrome of menopause. METHODS: This was a single-blind, randomized, controlled clinical trial. The participants were randomly assigned to receive six weekly sessions of capacitive-resistive monopolar radiofrequency (n=32) or sham treatment (n=30). Sexual function was assessed using the Female Sexual Function Index (FSFI) and vaginal health was assessed using the Vaginal Health Index (VHI). The estrogenic status was determined by vaginal cytology, which involves calculating the proportions of basal, intermediate, and superficial cells. Assessments were conducted at baseline, post-treatment, and 12-week follow-up. RESULTS: Compared with the control group, the intervention group showed significantly greater improvements in the Female Sexual Function Index and Vaginal Health Index at post-treatment and at the 12-week follow-up. FSFI mean changes were 5.86 versus 1.33 at posttreatment ( P <0.001) and 4.41 versus -0.41 at 12-week follow-up ( P =0.011). VHI mean changes were 4.75 versus -0.03 at post-treatment ( P <0.001) and 6.90 versus -0.66 at follow-up ( P <0.001). The effect sizes were moderate to large for the FSFI (Cohen's d >0.77, 95% CI, 0.25-1.29) and large for the VHI ( d >3.49, 95% CI, 2.68-4.28). No significant changes were observed in estrogenic status, and no adverse events were reported. CONCLUSION: Capacitive-resistive monopolar radiofrequency significantly improved sexual function and vaginal health in women with genitourinary syndrome of menopause, thereby supporting its use as a safe, nonhormone treatment option.
OBJECTIVES: To evaluate the feasibility and acceptability of a multicomponent intervention to reduce cardiovascular disease (CVD) risk in perimenopausal Latinas. METHODS: Forty-nine perimenopausal Latinas (age 40-60 y) w...OBJECTIVES: To evaluate the feasibility and acceptability of a multicomponent intervention to reduce cardiovascular disease (CVD) risk in perimenopausal Latinas. METHODS: Forty-nine perimenopausal Latinas (age 40-60 y) who spoke Spanish or English were randomized to a multicomponent intervention or waitlist control group. The intervention consisted of 12 weekly sessions (diet education, exercise, and stress management), followed by 3 months of continued support, and 6 months of independent skill maintenance. The primary outcomes were feasibility and acceptability measures, including enrollment and retention rates, intervention attendance, and intervention fidelity. Secondary outcomes included changes in CVD risk factors (eg, anthropometric measures, health behaviors, perceived stress, lipids, glucose, and arterial stiffness) from baseline to 6- and 12-month follow-up. Descriptive statistics, t tests, and χ 2 were used to examine participant characteristics and changes in CVD risk factors. RESULTS: Twenty-six women were randomly assigned to the intervention group and 23 to the waitlist control, who received the intervention after study completion. The mean age of the participants (n=49) was 47.1 ± 4.5 years, 98% were born outside of the United States, and 61% reported financial strain. Women attended an average of eight (53.3%) intervention sessions, with seven participants (26.7%) attending ≥80% of the intervention sessions. Forty-three participants (87.8%) completed the 6-month assessment, and 79.6% returned for 12-month data collection. At 12 months, 94.6% of participants would recommend the study to a friend or relative. CONCLUSIONS: This pilot study found that a culturally tailored intervention consisting of diet education, exercise, and stress management may be feasible and acceptable to reduce CVD risk in perimenopausal Latinas.
OBJECTIVES: Perimenopause is associated with increased anxiety symptoms. However, data is lacking regarding the experiences of women with perimenopausal anxiety. We explored the experiences of women with new onset or wor...OBJECTIVES: Perimenopause is associated with increased anxiety symptoms. However, data is lacking regarding the experiences of women with perimenopausal anxiety. We explored the experiences of women with new onset or worsening of anxiety symptoms during perimenopause to better understand lived experiences and contributing factors. METHODS: Twenty women (aged 43-53 y) who reported new or worsening anxiety symptoms during perimenopause were recruited from online perimenopausal support groups to participate in individual interviews to explore experiences of perimenopausal anxiety in the context of daily lives and perimenopausal symptoms. Inductive thematic analysis was used to develop themes from transcribed data. Analysis was done using MAXQDA software. Codes were developed verbatim from repeating words, ideas, or concepts. Themes were developed from coded data. RESULTS: Six themes were identified to contribute to anxiety symptoms during perimenopause, including uncertainty, anxiety related to health status, mid-life stressors, past medical history, and perimenopausal hormonal and physical changes. Social support and lifestyle interventions were reported as protective against anxiety symptoms. CONCLUSIONS: Women reported a general lack of awareness of perimenopause. This further exacerbated uncertainty, anxiety, and the loss of a sense of control women felt as they experienced perimenopausal changes. This research highlights the potential impact of perimenopausal anxiety on women's quality of life and the complex interaction of physical, psychological, and social factors contributing to perceived worsening anxiety during perimenopause. This exploratory study illustrates the need for further research to identify the contributing factors to perimenopausal anxiety and the development of multifaceted interventions for anxiety during perimenopause.
OBJECTIVE: Menopausal hormone therapy (HT) is effective for alleviating vasomotor symptoms but remains controversial regarding long-term safety, particularly in women over 65. Despite guidelines recommending initiation b...OBJECTIVE: Menopausal hormone therapy (HT) is effective for alleviating vasomotor symptoms but remains controversial regarding long-term safety, particularly in women over 65. Despite guidelines recommending initiation before age 60, a notable proportion of older women continue or begin HT later in life. The health outcomes of HT in women aged 65 and older, especially those initiating therapy after 65, compared with younger users and nonusers were evaluated. METHODS: This retrospective cohort study included 83,147 women aged 50 years or older enrolled in Clalit Health Services (2000-2022). Women were categorized by age at HT initiation: never-users, initiators at 50-65 years, initiators 65 years or older, or initiators after 50 continuing beyond 65. Outcomes included malignancies, cardiovascular events, osteoporosis, and dementia. Group differences were evaluated using χ 2 tests, and time-to-event associations were examined using Cox proportional hazards models with age as the underlying time scale. To evaluate the health outcomes of HT in women aged 65 and older, especially those initiating therapy after 65, compared with younger users and nonusers. RESULTS: HT use was associated with increased risks of several malignancies, including both hormone-sensitive and non-hormone-sensitive cancers. In crude analyses, women initiating HT at 50-65 years had lower ischemic heart disease/myocardial infarction prevalence (3.6% vs. 9.2%) but higher hypertension (11.0% vs. 6.2%). In adjusted Cox models, initiation at 65 years or older was associated with increased hazards of any cancer (hazard ratio [HR]: 2.216, 95% confidence interval [CI]: 1.833-2.677) and cerebrovascular accident (HR: 2.695, 95% CI: 2.358-3.079). Among women initiating HT at 50-65 years, hazards were markedly elevated for cerebrovascular accident (HR: 16.692, 95% CI: 15.571-17.893), cancer (HR: 8.490, 95% CI: 7.281-9.900), and ischemic heart disease/myocardial infarction (HR: 9.169, 95% CI: 8.321-10.102); the crude cardiovascular advantage was not observed after adjustment. CONCLUSIONS: Initiation of HT after age 65 is linked to significantly increased risks of cancer and vascular events, supporting current guidelines discouraging late initiation. While HT may offer some cardiovascular benefits when started earlier, use in older women should involve individualized risk-benefit assessment and close monitoring. These findings underscore the need to align clinical practice with evolving evidence and guideline recommendations. Given the retrospective design, incomplete pre-2000 medical history, and potential residual confounding, findings should be interpreted with caution.
OBJECTIVE: This study aimed to evaluate the effect of Emotional Freedom Techniques (EFT) on menopausal symptoms, quality of life, and depression. METHODS: The study was designed as a three-arm randomized controlled trial...OBJECTIVE: This study aimed to evaluate the effect of Emotional Freedom Techniques (EFT) on menopausal symptoms, quality of life, and depression. METHODS: The study was designed as a three-arm randomized controlled trial with a pretest-posttest design, conducted among women in menopause. The sample included 35 participants in the EFT group, 35 in the sham group, and 35 in the control group, totaling 105 participants. The intervention was administered to the EFT and sham groups once weekly for four weeks. Data were collected using the Personal Information Form, Menopause Symptoms Rating Scale (MSRS), Menopause-Specific Quality of Life Scale (MSQLS), and Perimenopausal Depression Scale (Meno-D). Data analysis was performed using χ 2 tests, paired-samples t -tests, one-way ANOVA, and two-way mixed ANOVA for repeated measures. RESULTS: After the intervention, statistically significant differences were observed in the mean posttest scores of the MSRS (EFT: 10.14±5.96; sham: 16.80±7.21; control: 17.74±5.79), MSQOL (EFT: 50.31±24.69; sham: 57.91±24.43; control: 75.51±24.87), and Meno-D (EFT: 7.69±5.02; sham: 13.31±7.60; control: 15.40±6.17) among the EFT, sham, and control groups ( P <0.05). The EFT group had the lowest MSRS and Meno-D scores, with significant differences observed between the EFT group and both the sham and control groups ( P <0.05). The EFT group also had the lowest MSQOL score, with significant differences identified between the control group and both the sham and EFT groups ( P <0.05). Repeated measures analyses revealed that the time-dependent changes between groups were statistically significant ( P <0.05). CONCLUSION: EFT can be considered an effective complementary intervention for reducing menopausal symptoms, alleviating depression, and improving quality of life in women. Incorporating low-cost and feasible techniques such as EFT into women's health services is recommended.
OBJECTIVE: The main purpose of the research is to demonstrate the scientific validity and reliability of the Turkish translation of the Menopausal Spousal Support Questionnaire (MSSQ). METHODS: A total of 176 women parti...OBJECTIVE: The main purpose of the research is to demonstrate the scientific validity and reliability of the Turkish translation of the Menopausal Spousal Support Questionnaire (MSSQ). METHODS: A total of 176 women participated in this methodological study. Research data were gathered through the MSSQ and a personal information form. Following the confirmation of language and content validity, analyses such as exploratory and confirmatory factor analysis, item-total correlation, calculation of Cronbach alpha reliability coefficient, test-retest (time invariance), split-half reliability, and comparison of the top and bottom 27% groups were conducted on the data. RESULTS: Factor analyses confirmed the original four-factor structure of the MSSQ. The total explained variance was 70.824%, and factor loadings ranged between 0.65 and 0.84. Confirmatory factor analysis yielded excellent fit indices (χ²/df = 1.60; Goodness of Fit Index = 0.99; Adjusted Goodness of Fit Index = 0.99; Comparative Fit Index = 1.00; Root Mean Square Error of Approximation = 0.059; Standardized Root Mean Square Residual = 0.050), indicating a good model fit without any modifications. The overall Cronbach alpha coefficient was 0.933, and all item-total correlations were above 0.40. The average total MSSQ score was 109.24 ± 33.56. CONCLUSIONS: The Turkish version of the MSSQ is a valid and highly reliable instrument for measuring spousal support in postmenopausal women and is appropriate for use within the cultural context of Turkish society.
OBJECTIVE: This study explored the relationship between age at first childbirth and hypertension-diabetes comorbidity (HDC) risk in postmenopausal women, focusing on whether obesity metrics (BMI, waist-to-hip ratio, and...OBJECTIVE: This study explored the relationship between age at first childbirth and hypertension-diabetes comorbidity (HDC) risk in postmenopausal women, focusing on whether obesity metrics (BMI, waist-to-hip ratio, and lipid accumulation product) mediate this association. METHODS: Data were extracted from the baseline survey of the China Multi-Ethnic Cohort study. The association between age at first childbirth and HDC was examined via logistic regression analysis. Then, the effect of obesity on the association between age at first childbirth and hypertension was determined via mediation analysis. Furthermore, subgroup analyses were conducted, followed by multivariable logistic regression modeling to assess the primary association. RESULTS: Included in this cross-sectional study were 5,741 postmenopausal women, with an average age at first childbirth of 23.56 years and current age of 59.44 years. The prevalence of hypertension-diabetes comorbidity (HDC) was 7.5% (429/5,741). Age at first childbirth was significantly associated with HDC prevalence (OR=0.737; 95% CI: 0.579-0.940). After adjustment, women who first gave birth at 21-25 (OR=0.739), 26-30 (OR=0.591), and >30 (OR=0.417) had lower HDC prevalence than those who first gave birth at ≤20 years. BMI, waist-to-hip ratio, and lipid accumulation product mediated this association, with mediation proportions of 29.42%, 18.97%, and 21.52%, respectively. CONCLUSIONS: In postmenopausal women of minority Chinese descent, age at first childbirth is significantly associated with HDC. Obesity mediates the effect of age at first childbirth on the development of the HDC.
OBJECTIVE: Perimenopause is the time leading up to a woman's last menstrual cycle and includes the 12 months afterward. Studies that systematically compare perimenopause symptoms across diverse cultural and geographic se...OBJECTIVE: Perimenopause is the time leading up to a woman's last menstrual cycle and includes the 12 months afterward. Studies that systematically compare perimenopause symptoms across diverse cultural and geographic settings are lacking. This study, utilizing data from Flo, an international mobile health application, aimed to assess global knowledge and symptom experiences related to perimenopause. METHODS: This cross-sectional survey was conducted via the Flo application, offered to users aged 18 years and above. The primary endpoints were knowledge of perimenopause symptoms from all survey participants, and self-reported perimenopause symptoms for survey participants aged 35 years and above. Secondary analyses compared knowledge scores and symptoms across geographic regions. RESULTS: A total of 17,494 women from 158 countries were included. Commonly recognized perimenopause symptoms included hot flashes (71%), sleep problems (68%), and weight gain (65%). Of the participants, 12,681 were aged 35 years or above, with the most common self-reported symptoms being fatigue (83%), physical and mental exhaustion (83%), irritability (80%), depressive mood (77%), sleep problems (76%), digestive issues (76%), and anxiety (75%). This pattern of symptoms was similar among those who self-reported being in perimenopause, though higher than in those not in perimenopause. International variation in perimenopause symptom knowledge and symptoms experienced was noted ( P <0.001). CONCLUSIONS: This survey highlights a discordance between perimenopause knowledge and actual symptoms experienced across diverse global populations. While hot flashes were the most widely recognized symptom, respondents aged 35 years or above most commonly reported experiencing fatigue, physical and mental exhaustion, and irritability.
OBJECTIVE: To identify factors associated with climacteric symptoms and quality of life in women with and without a history of gynecological cancer. METHODS: A cross-sectional study was conducted from November 2022 to Ma...OBJECTIVE: To identify factors associated with climacteric symptoms and quality of life in women with and without a history of gynecological cancer. METHODS: A cross-sectional study was conducted from November 2022 to May 2024 in a tertiary hospital's menopause clinic in Campinas, Brazil. Women aged 30 years or above with climacteric symptoms were included, excluding those undergoing treatment for these symptoms or with debilitating conditions. Climacteric symptoms were assessed using the Menopause Rating Scale (MRS), and quality of life by the Women's Health Questionnaire (WHQ). Statistical analyses included descriptive tests, χ 2 , Mann-Whitney, and Poisson regression ( P <0.05). RESULTS: A total of 184 women (mean age 49.6±9.5 y) were included, of whom 54.3% had a history of cancer (29.3% breast, 14.1% cervical, 7.6% ovarian, 2.7% endometrial, 0.5% vulvar). The mean age at menopause was 44.2±6.7 years; 58.5% had treatment-induced menopause. Median MRS and WHQ scores were 27 and 0.58, respectively. No association was found between a history of cancer and overall symptom severity or reduced quality of life. In multivariate analysis, worse quality of life was independently associated with higher severity of somatovegetative symptoms (PR: 2.10; 95% CI: 1.16-3.79) and psychological symptoms (PR: 1.90; 95% CI: 1.07-3.36). CONCLUSION: A history of gynecological cancer was not associated with increased climacteric symptoms or poorer quality of life. Menopausal symptoms, especially vasomotor and psychological domains, were the main factors related to lower quality of life.
OBJECTIVES: Timely identification of endometrial nonbenign lesions led to improved outcomes, but there was a lack of effective predictive models for asymptomatic endometrial thickening. The aim of this study was to devel...OBJECTIVES: Timely identification of endometrial nonbenign lesions led to improved outcomes, but there was a lack of effective predictive models for asymptomatic endometrial thickening. The aim of this study was to develop a strong machine learning (ML) model for assessing the risk of endometrial malignancy in asymptomatic patients after menopause. METHODS: This retrospective study was designed to collect data from 971 postmenopausal asymptomatic women with endometrial thickening. The bootstrap resampling method was used for model training, internal validation, and external validation. With 41 easily accessible characteristics, multifactor regression and least absolute shrinkage and selection operator regression were performed for feature selection. Nine ML algorithms were applied to build a model. To explain the final model and rank feature importance, the SHapley Additive exPlanation (SHAP) method was utilized. Meanwhile, a nomogram was developed to facilitate model interpretation. RESULTS: The comprehensive methodologies identified parity, Doppler flow signals, endometrial thickness, cancer antigen 125, and D-dimer as significant predictors. The logistic regression (LR) model demonstrated superior performance compared with other ML algorithms, achieving an accuracy of 88%, a sensitivity of 78%, a specificity of 98%, and an area under the receiver operating characteristic curve of 0.81. Furthermore, individualized predictions of endometrial malignancy were visualized through a force plot generated by SHAP analysis. A nomogram based on the LR model was subsequently constructed, showing area under the receiver operating characteristic curve values of 0.82, 0.82, and 0.81 for the training, internal validation, and external validation cohorts, respectively. The calibration curve demonstrated excellent consistency. CONCLUSIONS: We developed an LR-based nomogram model and interpreted using the SHAP method, which provided visual insights for detecting endometrial nonbenign lesions in asymptomatic postmenopausal women. This approach would aid clinicians in providing individualized treatment and help avoid unnecessary invasive surgeries.
OBJECTIVE: Mood and anxiety symptoms at the menopause transition are common. However, most cognitive-behavioral treatments focused on perimenopause center on managing physical symptoms such as hot flashes, and not mood s...OBJECTIVE: Mood and anxiety symptoms at the menopause transition are common. However, most cognitive-behavioral treatments focused on perimenopause center on managing physical symptoms such as hot flashes, and not mood symptoms. In this case series, we assessed the impact of a CBT intervention program on anxiety and depressive symptoms among individuals in perimenopause or postmenopause, who reported mood symptoms. METHODS: The intervention included eight 45-minute sessions of individual CBT with a clinical psychologist, and included CBT skills training (eg, behavioral activation, reframing negative automatic thoughts). The intervention was a general CBT intervention not tailored to perimenopause. Chart abstractions were performed for individuals who completed at least one session of the CBT program. RESULTS: Twenty participants completed at least one session, and sixteen completed all eight sessions. Symptoms of depression (Patient Health Questionnaire 9 scores) decreased by 42.1% from session 1 (M=8.74 [5.48]) to session 8 (M=5.06 [4.77]) (t=3.98, P=0.001). Similarly, symptoms of anxiety (GAD-7 scores) decreased by 56.2% from session 1 (M=6.98 [4.38]) to session 8 (M=3.06 [4.34]) (t=3.39, P=0.004). CONCLUSIONS: A standardized CBT intervention, not tailored to perimenopause, reduced depressive and anxiety symptoms in a small case cohort of women in perimenopause and postmenopause. Further research in a larger sample with a clinical trial design is needed.
OBJECTIVE: Those with mental illnesses are likely at higher risk of developing coronavirus disease 2019 (COVID-19), and elderly are disproportionately impacted and as a result suffer more from long COVID. The aim of this...OBJECTIVE: Those with mental illnesses are likely at higher risk of developing coronavirus disease 2019 (COVID-19), and elderly are disproportionately impacted and as a result suffer more from long COVID. The aim of this analysis was to determine the associations of preexisting depressive and anxiety symptoms with developing COVID-19 positivity, long COVID-19, and compliance with the use of protective measures against contracting COVID-19. METHODS: A subsample (n = 18,820) of the Women's Health Initiative study cohort completed longitudinal questionnaires on depressive and anxiety symptoms between 1993 and 2021 and reported on COVID-19 testing and compliance-related questions in 2020 and 2021. Logistic regression analyses were used to prospectively determine associations of a history of mental health symptoms with COVID-related outcomes. RESULTS: Reported history of depressive and anxiety symptoms was not associated with COVID-19 positivity. However, higher anxiety scores were associated with higher odds of long COVID (OR = 1.05 [95% CI: 1.03-1.07]). Women with both depressive and anxiety symptoms versus neither symptom had 78% higher odds of long COVID (OR = 1.78 [95% CI: 1.13-2.81 P = 0.001]). The odds of compliance with COVID-19 mitigation measures was significantly lower among women with previous long-term depressive symptoms (OR = 0.67 [95% CI: 0.55-0.82]), with both long-term depressive and anxiety symptoms (OR = 0.75 (95% CI: 0.61-0.93) P < 0.0001), and with higher long-term perceived stress score (OR = 0.94 [95% CI: 0.92-0.97]). However, a higher short-term anxiety score during early COVID was weakly associated with the higher odds of compliance of prevention mitigation measures (OR = 1.03 [95% CI: 1.02-1.03]). CONCLUSIONS: Older women with past mental health symptoms may be at higher risk of developing long COVID and having lower compliance with COVID prevention measures.
OBJECTIVE: To investigate the association between changes in body mass index (BMI) from adolescence to middle age and osteoporosis risk among participants in the Japan Nurses' Health Study (JNHS), a nationwide prospectiv...OBJECTIVE: To investigate the association between changes in body mass index (BMI) from adolescence to middle age and osteoporosis risk among participants in the Japan Nurses' Health Study (JNHS), a nationwide prospective cohort study. METHODS: Data were reviewed for 15,019 participants in the JNHS. After excluding 6,511 participants aged below 40 years or diagnosed with osteoporosis at baseline, 8,508 participants were included. The mean age at baseline was 47.5±5.4 years, and the mean follow-up period was 15.5±6.3 years. Low body weight (L) was defined as BMI <18.5 kg/m 2 , normal weight (N) as BMI ≥18.5 to <25 kg/m 2 , and overweight (O) as BMI ≥25 kg/m 2 . RESULTS: Age-adjusted hazard ratios for new-onset osteoporosis according to change in BMI from age 18 years to baseline compared with N to N were L to L, 1.65 (95% CI: 1.10-2.47), N to L, 1.44 (1.08-1.91) and N to O, 0.65 (0.54-0.79). Multivariable-adjusted hazard ratios for osteoporosis compared with N to N were L to L, 1.51 (0.98-2.33), N to L, 1.29 (0.95-1.76) and N to O, 0.68 (0.55-0.82). Regarding age at diagnosis of osteoporosis compared with N to N, the HR for L to L was 1.97 (1.04-3.72) for participants in their 50s, and the HR for N to O was 0.56 (0.42-0.76) for participants in their 60s. CONCLUSIONS: Persistent underweight status in women from adolescence to middle age is a risk factor for developing earlier osteoporosis in menopause.
IMPORTANCE: Vulvovaginal atrophy (VVA) is a common manifestation of the genitourinary syndrome of menopause, associated with vaginal dryness, dyspareunia, and reduced quality of life. Despite available therapies, effecti...IMPORTANCE: Vulvovaginal atrophy (VVA) is a common manifestation of the genitourinary syndrome of menopause, associated with vaginal dryness, dyspareunia, and reduced quality of life. Despite available therapies, effective, safe, and well-tolerated alternatives remain of interest for symptomatic postmenopausal women. OBJECTIVE: To assess the therapeutic efficacy of intravaginal dehydroepiandrosterone (DHEA) for vulvovaginal atrophy in postmenopausal women. EVIDENCE REVIEW: A systematic literature search was performed in PubMed, Embase, and the Cochrane Library for studies published up to July 2025. Search terms included "DHEA," "prasterone," "Intrarosa," and "dehydroepiandrosterone." Randomized controlled trials (RCTs) evaluating intravaginal DHEA in postmenopausal women were included. Data extraction followed predefined inclusion and exclusion criteria. Risk of bias was assessed, and pooled analyses were conducted using random-effects models. FINDINGS: Six RCTs representing five unique RCTs (n=1,611) involving postmenopausal women with VVA were included. Compared with placebo, intravaginal DHEA demonstrated significant improvements in two primary outcomes: vaginal dryness with a mean difference of -0.23 (95% CI, -0.35 to -0.11) and dyspareunia of -0.40 (95% CI: -0.66 to -0.15). No major safety concerns were reported, and adverse effects were mild and infrequent. The evidence consistently supported both statistical and clinical benefits of DHEA across trials, with low to moderate heterogeneity. CONCLUSIONS AND RELEVANCE: Intravaginal DHEA significantly improves vulvovaginal symptoms, particularly vaginal dryness and dyspareunia, in postmenopausal women. These findings underscore its role as an effective and well-tolerated therapeutic option for the management of genitourinary syndrome of menopause, with potential to enhance quality of life.