Development and validation of a menopausal health education training programme for women

Menopause: a review of botanical dietary supplements

This study aimed to evaluate and compare menopausal symptoms and quality of life between women with premature ovarian failure who underwent hematopoietic stem-cell transplantation (HSCT) for hematologic diseases and naturally menopausal women. This observational study enrolled 415 women (215 HSCT women and 200 naturally menopausal women as control group) from June 2017 to November 2019 in the menopause clinic of Peking University People's Hospital. Menopausal symptoms and quality of life were evaluated using the modified Kupperman index (KI), menopause rating scale (MRS), and menopause quality of life questionnaire. The total KI and MRS scores were 12.53 ± 8.27 and 7.69 ± 6.50 in the HSCT group and 21.57 ± 9.23 and 12.05 ± 6.70 in the control group, respectively (P < 0.05). The scores related to sexual problems and vaginal dryness were 1.20 ± 1.24 and 1.07 ± 1.24 in the HSCT group and 1.15 ± 1.01 and 1.01 ± 1.01 in the control group, respectively (P > 0.05). Age was a risk factor for menopausal symptoms (odds ratio 1.70, 95% confidence interval 1.01-1.12). The main reasons for consultations in the HSCT group were amenorrhea and infertility (76.74%). Compared with naturally menopausal women with the same number of years since menopause, the MRS and KI scores of women with premature ovarian failure who underwent HSCT showed milder symptoms. The MRS may be a better alternative to reflect the severity of menopausal symptoms. Age was a risk factor for menopausal symptoms. Oncofertility counseling should be initiated as early as possible before the start of treatment.

The study aim was to translate the Menopause Rating Scale (MRS) to Serbian language and assess its validity and reliability in the population of Serbian menopausal women. The study included 200 peri- and postmenopausal women from two Community Health Centers (city center and outskirts) in the Serbian capital-Belgrade. Women filled out general questionnaire (socio-demographics, habits, medical history), the MRS, Short Form-36 questionnaire (SF-36) and Beck's Depression Inventory (BDI). The MRS was translated according to recommended methodology and its psychometric properties (internal consistency, factor analysis, discriminant, construct and criterion validity) were assessed. The Cronbach's alpha coefficient for the whole scale was 0.884 (psychological α = 0.902, somato-vegetative α = 0.761, urogenital α = 0.734). Values of the CI-TC coefficient for Serbian MRS were adequate for 10 items, proving their suitability in the scale. On factor analysis, we obtained the same 3 factors as in the original scale (73.1 % of variance). Communalities of all items were appropriate (>0.4). There was no common method bias. The MRS total score was correlated positively with BDI score (p = 0.001) and negatively with all SF-36 domains (p = 0.001) except General Health. Based on ROC analysis, MRS scores were more consistent for post- than perimenopausal Serbian women. Similar results of two raters (p > 0.05) implied on adequate translation and reliability of MRS. Serbian version of MRS demonstrated excellent reliability and validity. The MRS in Serbian language can be used in daily clinical work with menopausal women for assessing their symptoms and quality of life.

Introduction:Menopause can cause physical and psychological problems. Menopause is often accompanied by anxiety, irritability, tension, and anxiety. one plant that is thought to reduce Menopausal in menopausal women is fennel seeds. Fennel is a plant that contains phytoestrogens. Purpose: This study was to analyze the effect of steeping fennel seeds (Foeniculum vulgare) on discomfort in menopausal women in Langsa District. Method: The study design used a quasi-experimental design with the pretest-posttest nonequivalent control group Design approach. This research was conducted in the working area of the Langsa District Health Center from September to December 2019 with the population being all menopausal women who met the inclusion criteria. The sample of the control and treatment group in this study was selected by purposive sampling of 32 people. Data analysis was performed using a data normality test, the Shapiro-Wilk test, a variety homogeneity test with the Levene test, and a paired T-test to see a comparison of MRS scores. Result: This study has found a significant effect due to the provision of fennel in menopausal women on decreasing the Menopausal Rating Scale (MRS) score with a p-value of 0.004. There was a decrease in the average MRS score in the group of respondents who consumed fennel at the pretest was 11.81 and dropped at the post-test to 10.19 with an average difference of 1,625. Descriptive there are differences in the average MRS score at the time of the pretest compared with the posttest. Conclusion: There is a difference in the average Menopausal Rating Scale (MRS) score at the pretest and posttest in the control and treatment groups. Fennel is able to reduce the Menopausal Rating Scale (MRS) score in menopausal women.

Objective: To determine the role of anti- mullerian hormone (AMH), menstrual hormones and symptoms in predicting final menstrual period (FMP) in menopausal transition (MT). Material and Methods: Eighty-two women aged 37-50 years in MT with any degree of menopausal symptoms were included in this prospective study. At the beginning and at the end of two years; serum AMH and menstrual hormone (Follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol) levels were measured, Menopause Rating Scale (MRS) scores were recorded, then compared. The cut-off of initial AMH level to detect FMP was calculated. Results: Of the 82 patients that were followed for two years, thirty six were in early MT, forty-six were in late MT at the initial. At the end of two years, 15.8 % (13/82) of patients were found to have reached menopause. The rate of AMH decline in two years did not differ significantly between patients who had and did not go through menopause. According to ROC analysis, in patients with menopause the optimal threshold value of baseline AMH to predict FMP over the next 12 months was 0.085 ng/ml (area under curve :0.873, 95% CI: 0.726-0.948, p&lt;.001). There was a significant positive correlation between AMH change rate and MRS score change in two years (r=0.462, p&lt;0.001). A significant negative correlation was observed between baseline AMH levels and second year MRS scores (r=- 0.56, p&lt;0.001). Multivariate regression analysis showed no significant independent effect of age, BMI, baseline AMH level, FSH, estradiol, baseline MRS score on AMH change. Conclusion: In MT, serum AMH level and menopausal symptom scores can help predict FMP and assist in the appropriate management of the MT period to provide women with a long-term healthy life.

BACKGROUND Perimenopausal is the period when women's ovarian function begins to decline before and after menopause. During this period, women experience a series of mental state changes, such as decreased hormone levels, decreased libido, and even female sexual dysfunction (FSD) in severe cases, which reduces their quality of life. Factors affecting the occurrence of FSD include physiological and non-physiological factors, among which physiological factors are uncontrollable. Therefore, it is particularly important to ascertain the related non-physiological factors that affect the occurrence of FSD for improving the quality of sexual life of perimenopausal women. AIM To investigate the mediating effect of depressive mood and body image on menopausal symptoms and sexual function in perimenopausal women. METHODS A total of 186 perimenopausal women were enrolled between January 2019 and January 2021 and divided into the FSD (134 cases) and control (52 cases) groups based on the presence and absence of FSD. Clinical data were compared between the two groups. FSD-related factors were analyzed using logistic regression analysis. Hamilton Depression Scale (HAMD), Body Image Scale (BIS), and Menopause Rating Scale (MRS) scores were compared among women with different FSD scores. The correlation of the MRS score with the BIS and HAMD scores and the mediating effect of the BIS and HAMD scores on the MRS score and female sexual function index (FSFI) were analyzed. RESULTS The HAMD and BIS scores were higher in the FSD group than in the control group, and the difference in monthly income between the two groups was statistically significant (all P &lt; 0.05). Monthly income of &lt; 2000 yuan [odds ratio (OR) = 26.586, P = 0.000], BIS score (OR = 1.590, P = 0.000), and HAMD score (OR = 1.884, P = 0.000) were independent risk factors for FSD. MRS scores were positively correlated with BIS and HAMD scores (r = 0.358 and 0.244, P = 0.000 and 0.001, respectively) and negatively correlated with FSFI scores (r = -0.433, P = 0.000). Body image and depressive mood had partial mediating effects, accounting for 39.90% of the total effect. CONCLUSION Depression and body image play mediating roles between menopausal symptoms and sexual function in perimenopausal women.

Background: The prevalence of the metabolic syndrome (METS) increases after the menopause. Reports indicate that the METS and its components, especially obesity, enhance the intensity of menopausal symptoms.Objective: Assess the frequency and severity of menopausal symptoms in postmenopausal women. Factors related to the symptom severity were also analyzed including depressive and metabolic status.Methods: A total of 204 natural postmenopausal women (40–65 years) participating in a METS screening program were asked to fill out the Menopause Rating Scale (MRS), the Hospital Anxiety and Depression Scale (HADS), and a general socio-demographic questionnaire containing personal and partner data. Criteria of the American Heart Association were used to define the METS.Results: Median age of the whole sample was 56 years. A 52.9% presented the METS, with 37.3% presenting hyperglycemia, 51.5% hypertension, 58.3% abdominal obesity, 45.6% high triglyceride and 56.4% low HDL-C levels. Total and subscale MRS scores did not differ in accordance to the presence or not of the METS. The three top prevalent menopausal symptoms were muscle and joint problems (87.2%), physical and mental exhaustion (72%) and depressive mood (64.7%). A 19.6% of women presented total MRS scores above 16 defined as severe. Multivariate linear regression analysis determined that anxiety (higher HADS anxiety subscale scores) was significantly and positively correlated with all components of the MRS (Total and subscale scores). Higher total MRS scores correlated positively with abdominal perimeter and higher parity. Somatic scores correlated inversely with female education and positively with psychotropic drug use; and psychological MRS scores positively correlated depressed mood (higher HADS depressive subscale scores) and abdominal perimeter.Conclusion: In this postmenopausal sample, severity of menopausal symptoms correlated to abdominal obesity, mood and other personal aspects.

Purpose: This study aimed to determine the effect of health-promoting lifestyle education given to menopausal women in accordance with Pender’s Health Promoting Model (HPM) on reducing the menopausal symptoms.Materials and Methods: This study is a semi-experimental research with pre-test and post-test control groups. In the first stage of the study, Socio-demographic Information Form (SIF) and Menopause Rating Scale (MRS) were applied to 401 menopausal women to determine the severity of their menopausal symptoms. In the second phase of the study, women with intense menopausal symptoms were randomly divided into two groups. 32 menopausal women in initiative group and 32 menopausal women were in the control group. One group, the experimental group, received Health-Promoting Lifestyle Education (HPLE), while the other group was the control group. Menopause Rating Scale (MRS), Health Promoting Lifestyle Profile II (HPLP II), and Self-Efficacy Scale (SES) were applied as pretests in both groups. Health-promoting lifestyle education was given to the experimental group twice with a one-week break between the sessions and the sessions were completed in four weeks.Results: Statistically significant decreases were found in the total MRS scores and subdimension scores of the menopausal women in experimental group after the education.Conclusion: Health-promoting lifestyle education was found to be effective in reducing the severity of menopausal symptoms.

Women living in rural areas of Turkey experience difficulties in accessing healthcare services, and this is attributed to distance from urban healthcare centers, financial barriers and poverty, a low education level, and gender discrimination. The purpose of this study was to test the applicability of the menopause rating scale (MRS) as a screening tool by primary healthcare professionals for identifying women with severe menopausal symptoms. The objectives of the study were to test the validity and reliability of the MRS in rural areas of Turkey, to determine estimation values for referral to the secondary level of healthcare, and to assess the prevalence of severe menopausal symptoms among rural Turkish women. The sample size was 600 women. The Turkish version of the MRS and the Kupperman index were used to evaluate the severity of symptoms. The internal consistency coefficient (Cronbach's alpha) of the MRS was computed using the test-retest method. The influence of the MRS with regard to the decision to seek medical advice due to menopausal symptoms was considered the validity criterion, and the sensitivity and specificity of the test were established according to this criterion. Estimation values of the test were determined by ROC analysis. Independent variables for the severity of menopausal symptoms were determined using a logistic regression model. A positive correlation between the MRS and the Kupperman index was revealed (r=0.86, p=0.000). The estimation value or the MRS score that would predict whether a woman had visited a gynecologist at least once due to the severity of menopause symptoms was found to be 16, its sensitivity and specificity were both 60%. The MRS score was higher among participants who evaluated their general health as 'unfit' or who had advanced age, chronic disease, a history of dysmenorrhea, or who had had two or more miscarriages. This evaluation of the MRS indicates that the instrument is a comprehensible, useable, reliable screening test for the identification of women with severe menopausal symptoms. By screening using the MRS it is possible for primary healthcare workers in rural areas to identify women in need of referral to an upper-level healthcare institution.

Sexual Function Assessment in Postmenopausal Women with the 14‐Item Changes in Sexual Functioning Questionnaire

Background Endocrine therapy (ET) is the most important treatment for hormone receptor (HR)-positive breast cancer (BC) patients. Each of the endocrine medications, such as aromatase inhibitors (AIs), luteinizing hormone-releasing hormone (LHRH) analogs, and selective estrogen receptor modulators, has its own set of side effects, and these might lead to poor drug adherence and eventual discontinuation. There are few systematic monitoring systems for menopausal symptoms of patients on ET. We conducted a prospective, pilot study through the mobile platform-based monitoring solution which contains a questionnaire about menopausal symptoms to assess the feasibility of the solution. Methods We screened and collected data from HR-positive BC patients who underwent surgery at a single institution from May 2022, until recruiting a total of 20 patients. Patients scheduled for postoperative ET at age 50 or younger were included. Preoperatively confirmed metastatic BC patients were excluded. A total of 19 patients were enrolled, excluding one patient who self-discontinued medication. Menopause Rating Scale (MRS) surveys were periodically administered to the patients using a mobile platform-based solution to collect responses during first 3 months of ET. The primary endpoint of this study was the response rate of the patients, and the second endpoint was MRS scores and patient satisfaction. At the time of initial enrollment before the start of ET, MRS was collected using a paper questionnaire. The concordance rate of MRS response using a paper questionnaire and this solution was compared. We also conducted a user evaluation at the end of the third month of ET to determine satisfaction. The data collected from the solution were used by physicians to assist in patient care for clinical use. Results The median age of the cohort was 39 (range 29-47). Six patients were treated with Tamoxifen alone, Tamoxifen with LHRH analog in 12 patients, and AI with LHRH analog in 1 patient. There were 3 (15.8%) of pTis, 13 (68.4%) of pT1, and 3 (15.8%) of pT2, as well as 18 (94.7%) of pN0 and 1 (5.3%) patients of pN1. The total response rate of patients to the solution during the study period was 84.5%. Each symptom has different response rates and MRS scores, from 70.2% for sex-related symptoms to 95.4% for joint pain, and from 1.24 out of 4 for sleep disturbances to 0.45 out of 4 for vaginal dryness. The match rate between mobile and paper surveys was 90.0%. The overall satisfaction score for the solution of patients was 8.06 out of 10, with the highest score (8.79 out of 10) given in terms of using patients’ responses in outpatient appointments with the physician. Conclusion The analysis of MRS using this mobile solution in premenopausal BC patients undergoing postoperative ET is expected to be feasible for clinical use and should be analyzed in a large-scale study in the future. Citation Format: Dong Seung Shin, Jai Min Ryu, Byung Joo Chae, Jeong Eon Lee, Seok Won Kim, Seok Jin Nam, Jonghan Yu. The pilot study for a mobile-based monitoring solution to manage menopausal symptoms of premenopausal breast cancer patients with endocrine therapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-12-06.

Efficacy of Tribulus terrestris L. (fruits) in menopausal transition symptoms: A randomized placebo controlled study

Objectives 1. To study the prevalence of hypothyroidism in peri- and postmenopausal women 2. To study the correlation of menopausal symptoms with hypothyroidism. Methods Hospital based cross-sectional study carried out at Lata Mangeshkar Hospital, 200 women relatives of indoor patients in obstetrics and gynecology ward were included in study. Subjects included in study were in peri- and postmenopausal age group between 40 to 55 years, provided they fulfilled inclusion and exclusion criteria. History was noted, menopause rating scale (MRS) score was obtained and height and weight was measured and serum TSH estimation was done. Results were noted and analyzed. Results Out of 200 women 25 women had raised TSH levels. Three women had overt hypothyroidism (TSH high, free T4 low), and 22 women had subclinical hypothyroidism (TSH high, free T4 normal). It was observed that out of 94 women who had MRS score, more than 8, 16 (16.6%) women had hypothyroidism and out of 106 women with lower MRS score (1 to 8), nine (8.49%) women had hypothyroidism. Conclusions Prevalence of hypothyroidism is high in peri- and postmenopausal age group (12.5%). Though women with high score are more likely to suffer from hypothyroidism, low score does not preclude the possibility of hypothyroidism. Screening should be done in this age group to prevent complications of hypothyroidism.

The purpose of this study was to address the difference menopausal symptoms according to sasang constitution and menopausal status among perimenopausal women. Data for this cross-sectional study was collected by administering questionnaires that elicited general information. The menopause rating scale (MRS) and Questionnaire for the Sasang Constitution Classification II (QSCC II) was given to 284 perimenopausal women who met the eligibility criteria and agreed to participate in the study. The study subjects were composed of 27.5% so-yangin, 24.6% so-eumin, 18.7% tae-eumin, and 29.6% undefined category. The total MRS and all subscales were significantly higher for postmenopausal women in comparison to premenopausal women. Especially, so-eumin and tae-eumin displayed significantly higher scores in urogenital symptoms. The MRS score in postmenopausal women who belonged to the group of tae-eumin and so-eumin was significantly higher than those for premenopausal women. However, so-yangin displayed higher scores in psychological and urogenital symptoms than tae-eumin for premenopausal women. So-eumin presented significantly higher scores in urogenital symptoms in comparison to the undefined category for postmenopausal women. These findings suggest that sasang constitution could be an important factor in understanding the woman's menopausal symptoms and identify the best treatment.

Background: Menopause imposes a significant physical and emotional burden on women, affecting their quality of life and overall health. Beyond these challenges, the decline in estrogen levels during menopause is closely associated with adverse changes in bone health and an increased risk of developing metabolic syndrome (MetS), both of which contribute to long-term morbidity. The primary hypothesis of the current study was that the co-existence of low bone mineral density (BMD) and MetS would exacerbate the severity of menopausal symptoms. As the most bothersome menopausal symptoms typically emerge one year before the final menstrual period and gradually subside thereafter, we investigated BMD, MetS, and menopause-related symptoms in postmenopausal women within 10 years of menopause onset. Methods: A total of 193 postmenopausal women were included in this cross-sectional study, which was conducted at a university hospital in Istanbul. At baseline, participants were categorized into MetS and non-MetS groups based on the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. For comparative analyses, participants were stratified according to MetS status and BMD. Women with osteopenia or osteoporosis based on BMD measurements were combined into the low BMD group. Menopausal symptoms were assessed using the Menopause Rating Scale (MRS). Results: Women with MetS were significantly older and had a longer duration of menopause than those without MetS. All MRS scores were comparable between the MetS and non-MetS groups. Women with low BMD were older, had a longer duration of menopause, and a lower body mass index (BMI) compared to those with normal BMD. The MRS urogenital symptom subscale score was significantly higher among women with low BMD (p = 0.019). Severe urogenital symptoms were observed among women with co-existence of MetS and low BMD. Correlation analyses between MRS scores and other variables yielded negligible negative correlations with age. Conclusions: Low BMD was associated with higher scores on the urogenital subscale of the MRS, whereas MetS showed no significant relationship with menopausal symptoms. Women with both low BMD and MetS experienced more severe urogenital symptoms.