Management Of Postmenopausal Symptoms Research Articles

Prevalence, impact and management of postmenopausal symptoms among postmenopausal women in Rwanda

Objective This study aimed at evaluating the prevalence and management of postmenopausal symptoms among Rwandan women. Methods A descriptive cross-sectional study was conducted at the four largest Rwandan referral hospitals from August 2017 to March 2018 among postmenopausal women. Data on postmenopausal symptoms were collected using the Modified Blatt–Kupperman Menopausal Index and score ranges of 0–6, 7–15, 16–30 and >30 were used to rate the degree of severity as none, mild, moderate, and severe, respectively. Results Six hundred participants were recruited. The mean age at natural menopause was 51.7 ± 5.6 years. Common symptoms were hot flushes (82%), sexual complaints (66%) and headache (61%). The mean Blatt–Kupperman index score was 21.2 (1–58). Participants’ symptoms were classified as severe (35.8%), moderate (49.0%), mild (11.3%) and none (3.8%). Among 41.2% who had sought medical care, 1.7% were given hormonal replacement and 36% were given only pain medications. Age >50 years and lack of a male partner were significantly associated with higher scores. Conclusions Postmenopausal symptoms remain a burden among Rwandan women and little consideration is given for optimal management. There is a need for health managers to consider this inevitable phase of life on the health policy agenda for equitable healthy aging.

Effectiveness of tibolone in the management of postmenopausal symptoms

Background: Tibolone is a synthetic hormone relplacemert therpy prepration with estrogenic, progestogenic and androgenic tissue selective mechanism of action. It has advantages over traditional preparations of estrogen and progesterone considering the risks and adverse effects.
 Objective: To evaluate the extent of effectiveness and adverse effects of Tibolone.
 Method: This clinical trial was done in Khulna Medical College Hospital between January to December 2019. Postmenopusal women were selected by inclusion and exclusion criteria. Alternate participant was included in two different group. Participants of group A was treated with Tibolone for 6 months and participants of group B was treated with placebo for 6 months. Each participant was followed up after 3 and 6 months. Four categories of postmenopausal symptoms (hot flushes, night sweats, sleep disturbance and mood swinging) were evaluated. Participants were monitored for any adverse effects. Severity of postmenopausal symptoms was measured by using menopausal visual analogue scale.
 Results: Total 90 partcipants, were enrolled in this study, half of them were included in each group. Baseline assessment in group A participants revealed mild, moderate and severe symptoms in 05 (12%), 29 (64%) and 11 (24%) women respectively. After 6 months of treatment with tibolone, 35 (78%) participants became asymptomatic. This improvement is statistically significant (p<0.001). In group B, participant's baseline assessment revealed mild, moderate and severe symptoms in 07 (16%), 28 (62%) and 10 (22%) cases respectively. After 6 months of treatment with placebo, 02 (05%) women were asymptomatic. This improvement is not statistically significant. No adverse event was observed during treatment with tibolone. Comparison between the tibolone and placebo treatment group showed, tibolone treatment is better.
 Conclusion: Tibolone effectively relieves the postmenopausal symptoms and improves the quality of women's health at menopause.
 Bang Med J Khulna 2020: 53 : 31-34

The comparison of paroxetine and gabapentin in the management of postmenopausal symptoms

Objective: To compare the clinical efficacy of gabapentin, an anticonvulsant agent, and paroxetine, a selective serotonin reuptake inhibitor in the management of post-menopausal symptoms. Methods: In this clinical trial, two groups of patients with menopause who had hot flashes were included. One group received gabapentin (600 mg daily, 23 cases) for 8 weeks. The other group received paroxetine (one capsule daily at the morning or at bedtime, 23 cases) for 8 weeks. The MRS (Menopause Rating Scale) as well as the Beck’s Depression Inventory were used to assess the efficacy of the studied medications. Results: In paroxetine and gabapentin groups, hot flashes, sleep problems, muscle/joint pains, depression, irritability, anxiety, memory problems, and lack of concentration severity significantly decreased after 8 weeks of treatment. Only urinary problems in two treatment groups did not show any significant difference. There was no significant difference in dryness and burning sensation before and after gabapentin (P> 0.05). However, these changes were significant in paroxetine group (P <0.05). Conclusion: Both paroxetine and gabapentin were effective options in decreasing the severity of menopausal symptoms namely hot flashes, heart discomfort, sleep problems, and muscle/joint pains. In addition, the two medications had favorable results regarding psychological aspects of menopause.

The comparison of paroxetine and gabapentin in the management of postmenopausal symptoms

The comparison of paroxetine and gabapentin in the management of postmenopausal symptoms

Menopause: up the stairs leading down

Postmenopause is an important stage in physiological aging of women, which is associated with a whole complex of vegetative-vascular, mental, and metabolic-endocrine disorders that develop against the background of the ovarian failure and general age-related involution of the body. While there are general mechanisms of development, the clinical symptoms of postmenopause are quite individual and their severity depends not only on endocrine changes, but also on the external factors (living conditions, health status, social functioning and subjective perception of aging). The review describes the most typical symptoms of the menopausal transition: vasomotor (hot flashes and excessive sweating), urogenital (vaginal dryness, dyspareunia, dysuria), psychoemotional (irritation, unfounded aggression, sleep disturbances), cognitive disorders (memory loss, concentration problems). The management of postmenopausal symptoms is important and should be carried out using hormone replacement therapy. The combined drugs containing 17p-estradiol and drospirenone have proved to be effective in reducing menopausal symptoms and safe in use, therefore they can be the drugs of choice to treat menopausal symptoms. The multicentre post-marketing study showed that the long-term use of low-dose E2 and DRSP in postmenopausal women significantly improved menopausal symptoms in 86% of respondents. In addition to prescribing pathogenetic therapy, an important aspect of specialized medical care provided to women in the peri- and postmenopausal period is the need to raise their awareness of the menopause problems, change their attitude to their own health, manage menopausal symptoms and improve the quality of life.

Profile, Morbidities and Symptoms Management of Menopausal Women, in Cotonou

Objective: In Benin, as life expectancy continues to increase, the number of postmenopausal women increases. Menopause is a physiological phenomenon that can be quiet for some+, tumultuous in others. Few studies are devoted to menopause in Africa and Benin in particular. The objective of this study was to describe the profile, clinical symptoms of menopausal women as well as management of postmenopausal symptoms in Cotonou, Benin. Materials and method: This is an analytical cross-sectional study in Cotonou, the capital city of Benin Republic during the month of August 2014. 2021 women were included in the study out of a female population of 11,669 people aged 40 and older. Results: 52.7% of the participating women 40 or older were postmenopausal. The mean age at menopause in the sample was 47.5 years, and the largest age group was 50 to 59 years old. Clinically, the most frequent menopausal side effects were hot flashes (58.7%), libido disorders (67%), and joints pain (38.8%). The most frequent associated pathology was hypertension in 37.7% of cases. Factors that limit access to hormonal treatment of menopause in Cotonou include lack of information (66.17%) and financial barriers (19.65%). Conclusion: Health promotion must address obesity, hypertension and smoking to reduce the negative effects of menopause in Sub Saharan Africa.

Efficacy of Tibolone and Isoflavones in the Management of Postmenopausal Symptoms

Efficacy of Tibolone and Isoflavones in the Management of Postmenopausal Symptoms

Knowledge and attitude of primary care doctors towards management of postmenopausal symptoms

BackgroundAccording to the current recommendations, women with post-menopausal symptoms should be managed. Knowledge and perception of primary care physicians towards management of postmenopausal symptoms are deficient. AimThe aim of the present study was to explore knowledge and attitude of primary care doctors towards management of postmenopausal symptoms. MethodsThis study is a cross-sectional survey that was conducted from October to December 2010 in the five health regions in Kuwait. Two centers were selected randomly from each health region. All physicians who were currently working in the selected centers were asked to participate in the study. Out of 209 physicians, 142 agreed to participate and completed a self-administered questionnaire. ResultsThe study revealed that 82.4% of physicians had moderate knowledge about treatment options for postmenopausal symptoms, 88.0% discussed postmenopausal symptoms with their patients, and 45.1% of them either described or referred their patients for hormonal replacement therapy (HRT). The correct answers regarding 10 statements related to the Women Health Initiative finding were ranging from 2.8% to 78.9% which indicated low level of knowledge. Regarding the effectiveness of hormonal replacement therapy in postmenopausal women, the majority of the physicians agreed correctly that HRT is effective in prevention of osteoporosis (87.3%), treatment of vasomotor symptoms (83.7%), and treatment of vulvo-vaginal symptoms (82.4%). There was a variation among physicians opinion about the effectiveness of certain treatment options for managing hot flushes in postmenopausal women. ConclusionThe results suggest that there is a lack of primary care physicians knowledge and confidence in recognizing signs and symptoms of menopause and in identifying and prescribing appropriate management.

Further evidence for promoting transdermal estrogens in the management of postmenopausal symptoms

After a use in permanent increase until the end of the 90’ [1], prescription rates of postmenopausal hormone therapy (HT) have dramatically reduced in the wake of the findings from Women’s Health Initiative (WHI) clinical trials [2]. Yet, HT remains the most effective treatment to correct menopausal symptoms and therefore, many women are still prescribed this treatment worldwide. Nevertheless, medical guidelines have been modified and now recommend that only women suffering from moderate to severe symptoms be prescribe the lowest effective dose for the shortest possible duration [3]. In this context, middle-aged postmenopausal women represent the main candidate for this treatment and cardiovascular disease, including venous thromboembolism and stroke, becomes the major harmful effect of short-term oral HT. By contrast, short term use of HT little affects the risk of breast cancer and could be beneficial for coronary heart disease (CHD) among recently postmenopausal women [4]. In addition, HT reduces the risk of colorectal cancer and osteoporotic fractures [2]. Based on these observations, reducing the excess risk of venous thromboembolism appears as a relevant strategy to improve the benefit/risk profile of HT. In 2003, the EStrogen and THromboEmbolism Risk (ESTHER) study, a French case/control study, showed for the first time a differential association of oral and transdermal estrogens with the risk of venous thromboembolism. Contrary to oral estrogens, transdermal estrogens were not associated with an increased risk of venous thromboembolism [5]. Few years later, final results of the ESTHER study and the E3N French cohort study confirmed the potential safety of transdermal estrogens with respect to thrombotic risk [6, 7]. Recently, a large cohort study set-up in a United-Kingdom health insurance database provided further evidence for a better thrombotic profile of transdermal estrogens as compared to oral estrogens [8].

Postmenopausal hormone therapy and cognition: effects of timing and treatment type

Setting Hormone therapy used for the management of postmenopausal symptoms in older women appears to result in variable effects on cognitive function, depending on study design, subjects, tests used, and types of therapy.Objective To determine the effects of estrogen-only and estrogen plus progestogen preparations on cognitive performance (cognitive status, general and working memory) when taken ‘early’ and ‘late’ from the onset of menopause.Method The study consisted of 410 women who were participants in a longitudinal study, first recruited at age 40–80 years. They were tested for change over 5 years as an observational cohort by the Mini-Mental State Examination, National Adult Reading Test and the Wechsler Memory Scale Version 3. Cognitive decline, measured by age-adjusted scores, was defined as ≥10% negative change in each individual woman.Results Controlling for age and lifestyle factors, and using the criterion of decrease in score ≥10% over 5 years for ‘cognitive decline’, ‘early start’ of hormone therapy (<3 years from menopause) was strongly associated with reduction in risk by the Mini-Mental State Examination (estrogen-only preparation, p = 0.005) but with increase in risk for general memory (with estrogen plus progestogen preparation, p = 0.02). Overall, there were no major effects on subgroups with type/timing of hormone therapy in relation to testing for a negative change in cognitive function.Conclusion ‘Early start’ of estrogen-only hormone therapy was associated with reduced risk of global cognitive decline, and ‘early start’ estrogen-only and estrogen/progestogen hormone therapies showed increased risks of general memory decline. Even though this study did not have the power to discriminate between minor and mixed effects, it suggests that cognitive effects of hormone therapies may be mixed, depending on cognitive domain and timing of use/type of preparation.

Management of Postmenopausal Symptoms in Breast Cancer Survivors

With the increasing numbers of breast cancers survivors, menopause, its symptoms, and its physical complications are becoming more prevalent problems in this patient population. Hormonal replacement, which has been the cornerstone therapy of menopausal related symptoms for decades, recently has been shown to increase breast cancer incidence as well as risk of recurrence and no longer should be recommended. Menopausal symptoms and complications such as hot flashes, vaginal dryness, dyspareunia, and osteoporosis leading to fractures have a negative impact on the quality of life of both breast cancer survivors and the general postmenopausal population. The purpose of this review is to discuss the evidence for the use of alternative therapies for menopausal symptoms, thus providing guidance and recommendations that should facilitate therapeutic decisions in the daily practice of medical oncologists and primary care physicians.