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0000-0002-3760-7266
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Monash Health
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Monash University
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Publisher: Informa UK Limited
Date: 12-2012
DOI: 10.3109/13697137.2011.603772
Abstract: The aim of this study was to investigate the perception and experience of menopause diagnosis and therapies, the information provided and health behaviors in younger women with breast cancer. The questionnaire study was completed by 114 women, aged 40-51 years, with non-metastatic breast cancer. Women were recruited from outpatient clinics and the community. Descriptive statistics were completed. Most women were satisfied with the manner in which they were informed of the breast cancer (69%) and the menopause (59%) diagnoses. Although 80% of women were given breast cancer information, only 54% were given menopause information at diagnosis. Women were least satisfied (26%) with information regarding the long-term complications of menopause. Women perceived exercise (68%) and improving lifestyle (61%) as most effective in alleviating symptoms of menopause. The majority of women reported that they did not understand the risks/benefits of 'bioidentical' hormones (79%) and herbal therapies (78%), while 58% perceived hormone replacement therapies as associated with an increased risk of breast cancer. Most women reported weight gain (68%) and osteoporosis (67%) as the most common problems/fears regarding menopause. However, regarding health behaviors, only 56% reported having relevant tests including a blood sugar test or a bone density test. While information needs regarding breast cancer appear well met in younger women, unmet information needs regarding menopause after breast cancer persist. Further education and support are required for these women to optimize health screening and prevention behaviors and to ensure informed decision-making regarding menopause treatment options.
Publisher: Wiley
Date: 27-03-2023
DOI: 10.1111/AJO.13670
Abstract: The COVID‐19 pandemic necessitated the rapid change in a dedicated multidisciplinary menopause clinic from in‐person consultations to telehealth. The aim of this study was to explore the impact of COVID‐19 on menopause service delivery and consumer experiences. Two‐part study involving the following. (i) Clinical audit conducted June–July 2019 (pre‐COVID‐19) and June–July 2020 (COVID‐19) assessing practice and service delivery changes. Assessment outcomes included: patient demographics, cause of menopause, presence of menopause symptoms, appointment attendance, medical history, investigations and menopause treatments. (ii) A post‐clinic online survey exploring the acceptability and experience of telehealth, once telehealth models of care had been routinely used in the menopause service (2021). Pre‐COVID ( n = 156) and COVID‐19 ( n = 150) clinic consultations were audited. Menopause care delivery changed significantly from 100% face‐to‐face consultations in 2019 to 95.4% telehealth consultations in 2020. In 2020, fewer women had investigations performed vs 2019 ( P 0.001), although use of menopausal therapies was similar ( P 0.05). Ninety‐four women completed the online survey. Most women (70%) were satisfied with their telehealth consultation and perceived that the doctor effectively communicated with them (76%). Women preferred face‐to‐face consultations for their first menopause clinic visit (69%) and telehealth for review consultations (65%). The majority of women (62%) viewed the continuation of telehealth consultations as ‘moderately’ to ‘extremely useful’ post‐pandemic. The COVID‐19 pandemic caused significant changes to menopause service delivery. Telehealth was perceived as feasible and acceptable by women, supporting the continuation of a hybrid service delivery model incorporating telehealth and face‐to‐face consultation to meet the needs of women.
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.FERTNSTERT.2018.04.028
Abstract: To develop a question prompt list (QPL) for women with polycystic ovary syndrome (PCOS) and explore its acceptability and feasibility. Nationwide online survey, interviews, and clinical pilot test. Australia. Two-hundred and forty-nine women online, 18 women in interviews, and 20 women in clinics. A QPL for PCOS. From survey, women's likeliness to use a QPL and priority topics from interview, QPL user-friendliness and associated feelings from pilot, women's QPL use, perceived helpfulness, and intended future use. Evidence-based guidelines and multidisciplinary experts informed the QPL development. Of 249 survey respondents, 66.7% to 68.7% reported difficulty communicating with health care providers about mood, weight management, and how PCOS affects daily life, and 85.8% indicated they were very likely to use a PCOS QPL. Women were interviewed to explore acceptability the semistructured interviews (n = 18) revealed that the devised QPL was easy to understand, user-friendly, and encouraged information seeking and targeted question asking. The refined QPL was pilot-tested in a clinic setting to explore feasibility between 2016 and 2017: 60.0% of women asked 1 to 2 questions from the QPL, 20.0% asked several questions, and 10.0% reported the QPL helped them generate their own questions. Women agreed the QPL was helpful (95.0%) and that they would use the QPL again (90.0%). The PCOS QPL is acceptable and feasible, and may assist women in information seeking and targeted question asking.
Publisher: Informa UK Limited
Date: 23-03-2017
DOI: 10.1080/13697137.2017.1301920
Abstract: Early menopause (EM), menopause before 45 years, affects up to 10% of women. The internet was perceived by women with EM to be the best source of information regarding EM however, the reality is unknown. The aim of this study was to assess the quality and content of easily accessible websites relating to EM. The keyword 'early menopause' was used for a web search using Google. The first two pages of results, plus an additional five websites, were analyzed for website quality and content by two independent reviewers according to published methodology. After excluding duplicates, 26 websites were analyzed. Geographical origin of Google domain conferred 32-53% search congruity. Commercial websites (10/26) and inclusion of advertisements (50%) were common. Few websites listed authorship (39%) or provided references (54%), and only 35% were quality certified. Most (54%) had a readability level above recommended. Median score for website content was 9/20. Medical society websites did not rank higher than other website categories for content but more frequently provided references/supporting data (p = 0.017). Easily accessible websites regarding EM have significant deficiencies in quality and content. This study indicates the need for higher-quality internet resources for women seeking EM information.
Publisher: Elsevier BV
Date: 04-2019
Publisher: Oxford University Press (OUP)
Date: 2000
Abstract: Progestin-only contraceptives are associated with menstrual bleeding disturbances a major reason why these agents are discontinued. The pathogenesis of such abnormal uterine bleeding associated with progestin-only contraceptives remains ill-defined. Matrix metalloproteinases (MMP)s and mast cells (MC)s are postulated to be involved in endometrial breakdown observed in normal menstruation. In this study comparisons were made of the immunolocalization of MMP-1 and -3 and MC in endometrium from women using Norplant or depot medroxyprogesterone acetate (DMPA) with normal controls. Positive MMP immunostaining was observed focally in stromal cells and adjacent extracellular matrix. Quantitative assessment revealed significantly higher MMP-1 immunostaining associated with the use of Norplant compared with DMPA or menstrual phase controls. Endometrial MMP-1 immunostaining in DMPA users was similar to that in menstrual controls. Positive MMP-3 immunolocalization was observed in a minority of endometrial s les. Activated MC, shown by the presence of extracellular MC tryptase, predominated in the endometrium of Norplant and DMPA users as also observed in menstrual phase controls. There was no correlation between MMP immunostaining, number of MC and number of bleeding days reported. These results indicate that in women using progestin-only contraceptives, endometrial MMP-1, -3 and MC demonstrate similarities to menstrual phase controls but also variation with different progestins.
Publisher: Informa UK Limited
Date: 17-07-2014
DOI: 10.3109/13697137.2014.913284
Abstract: To explore symptoms, understanding of menopausal therapies, medication use and health-related behavior in women with and without premature menopause. Cross-sectional, questionnaire-based study involving a community-based s le of 77 women in Australia: 23 premenopausal, 25 with premature ovarian failure (POF) and 29 with medically induced premature menopause (MIPM). The median (interquartile range) age of each group was: premenopausal = 29 (13) years, POF = 36 (8.0) years and MIPM = 38 (4.0) years (p < 0.001). The reported frequency of menopausal symptoms differed across the groups for difficulty sleeping (premenopausal = 26%, POF = 44%, MIPM = 69%, p = 0.01), some depression symptoms (premenopausal = 4.4-22%, POF = 20-25%, MIPM = 38-59%, p < 0.05), hot flushes (premenopausal = 4.4%, POF = 28%, MIPM = 59%, p < 0.001), sweating at night (premenopausal = 4.4%, POF = 20%, MIPM = 52%, p < 0.001) and loss of interest in sex (premenopausal = 17%, POF = 52%, MIPM = 54%, p = 0.02). More women with premature menopause than premenopausal women reported taking prescription medication (premenopausal = 52%, POF = 92%, MIPM = 86%, p = 0.002), perceived that hormone therapy (HT) was associated with increased breast cancer risk (premenopausal = 43%, POF = 56%, MIPM = 79%, p = 0.03) and that HT prevented fractures (premenopausal = 13%, POF = 56%, MIPM = 39%, p = 0.01). Most women reported not knowing risks/benefits of bioidentical hormone therapy (premenopausal = 86%, POF = 56%, MIPM = 75%, p = 0.06). Regarding health-related behavior around prevention and screening, varying rates of bone densitometry (premenopausal = 4.4%, POF = 64%, MIPM = 59%, p < 0.001), blood glucose testing (premenopausal = 39%, POF = 67%, MIPM = 57%, p = 0.16) and cholesterol testing (premenopausal = 22%, POF = 71%, MIPM = 54%, p = 0.003) were reported. Differences in understanding of menopausal therapies and health-related behavior exist among women with premature menopause of differing etiology and premenopausal women. While perceived understanding of HT was greater than other therapies, targeted education is needed regarding specific risks/benefits of menopausal therapies and regarding preventive health screening after premature menopause.
Publisher: Wiley
Date: 14-06-2018
DOI: 10.1111/CEN.13735
Abstract: To formulate clinical consensus recommendations on bone health assessment and management of women with oestrogen receptor-positive early breast cancer receiving endocrine therapy, representatives appointed by relevant Australian Medical Societies used a systematic approach for adaptation of guidelines (ADAPTE) to derive an evidence-informed position statement addressing 5 key questions. Women receiving adjuvant aromatase inhibitors and the subset of premenopausal woman treated with tamoxifen have accelerated bone loss and increased fracture risk. Both bisphosphonates and denosumab prevent bone loss additionally, denosumab has proven antifracture benefit. Women considering endocrine therapy need fracture risk assessment, including clinical risk factors, biochemistry and bone mineral density (BMD) measurement, with monitoring based on risk factors. Weight-bearing exercise, vitamin D and calcium sufficiency are recommended routinely. Antiresorptive treatment should be considered in women with prevalent or incident clinical or morphometric fractures, a T-score (or Z-scores in women <50 years) of <-2.0 at any site, or if annual bone loss is ≥5%, considering baseline BMD and other fracture risk factors. Duration of antiresorptive treatment can be in idualized based on absolute fracture risk. Relative to their skeletal benefits, risks of adverse events with antiresorptive treatments are low. Skeletal health should be considered in the decision-making process regarding choice and duration of endocrine therapy. Before and during endocrine therapy, skeletal health should be assessed regularly, optimized by nonpharmacological intervention and where indicated antiresorptive treatment, in an in idualized, multidisciplinary approach. Clinical trials are needed to better delineate long-term fracture risks of adjuvant endocrine therapy and to determine the efficacy of interventions designed to minimize these risks.
Publisher: Wiley
Date: 08-04-2015
DOI: 10.1111/CEN.12762
Abstract: To determine whether maternal vitamin D supplementation, in the vitamin D deficient mother, prevents neonatal vitamin D deficiency. Open-label randomized controlled trial. Metropolitan Melbourne, Australia, tertiary hospital routine antenatal outpatient clinic. Seventy-eight women with singleton pregnancies with vitamin D deficiency/insufficiency (serum 25-OH Vit D < 75 nmol/l) at their first antenatal appointment at 12-16-week gestation were recruited. Participants were randomized to vitamin D supplementation (2000-4000 IU cholecalciferol) orally daily until delivery or no supplementation. The primary outcome was neonatal serum 25-OH vit D concentration at delivery. The secondary outcome was maternal serum 25-OH vit D concentration at delivery. Baseline mean maternal serum 25-OH vit D concentrations were similar (P = 0·9) between treatment (32 nmol/l, 95% confidence interval 26-39 nmol/l) and control groups (33 nmol/l, 95% CI 26-39 nmol/l). Umbilical cord serum 25-OH vit D concentrations at delivery were higher (P < 0·0001) in neonates of treatment group mothers (81 nmol/l, 95% CI 70-91 nmol/l) compared with neonates of control group mothers (42 nmol/l, 95% CI 34-50 nmol/l) with a strongly positive correlation between maternal serum 25-OH Vit D and umbilical cord serum 25-OH vit D concentrations at delivery (Spearman rank correlation coefficient 0·88 P < 0·0001). Mean maternal serum 25-OH Vit D concentrations at delivery were higher (P < 0·0001) in the treatment group (71 nmol/l, 95% CI 62-81 nmol/l) compared with the control group (36 nmol/l, 95% CI 29-42 nmol/l). Vitamin D supplementation of vitamin D deficient pregnant women prevents neonatal vitamin D deficiency.
Publisher: Wiley
Date: 05-07-2019
DOI: 10.1111/CEN.14049
Abstract: Osteoporosis associated with premature ovarian insufficiency (POI) and early menopause (EM) is a major concern for women. We aimed to (a) identify information and knowledge gaps and behaviours regarding bone health in women with POI/EM and (b) co-design an osteoporosis fact sheet. Mixed-methods study: survey of women and online resource appraisals to develop and refine, using semi-structured interviews, an osteoporosis fact sheet. Women with POI/EM (menopause before ages 40 and 45 years respectively). Demographics, comorbidities, information needs, calcium intake, exercise, osteoporosis knowledge (OKAT), beliefs and self-efficacy, DISCERN appraisal (validated scales). descriptive statistics, logistic regression and thematic analysis of interviews. Median age of survey respondents (n = 316) was 54(IQR47-63) years, median age of menopause was 40(IQR38-43) years, and osteoporosis diagnosis was reported in 19%. Most reported inadequate dietary calcium intake (99%) and exercise (65%). Median OKAT score 8 [IQR6-10]/19 indicated knowledge gaps regarding risk factors and treatment options. Adjusting for age and education, OKAT predicted calcium intake (OR 1.126 [CI 1.035-1.225] P = 0.006) and screening (OR 1.186 [CI 1.077-1.305] P = 0.001) beliefs predicted screening (OR 1.027 [CI 1.004-1.050] P = 0.019) and self-efficacy predicted calcium intake (OR1.040 (CI 1.013-1.069) P = 0.003] and exercise (OR 1.117 [CI 1.077-1.160] P < 0.001). Current online resources have deficiencies. Five themes identified from two interview rounds (n = 10/ round) were as follows: content, emotional response, design, perceived usefulness and clinical considerations. The final fact sheet was considered acceptable and useful in addressing knowledge gaps, promoting information-seeking, impacting behaviours and facilitating healthcare discussions. A co-designed fact sheet is acceptable and addresses identified osteoporosis knowledge gaps in women with POI/EM.
Publisher: Georg Thieme Verlag KG
Date: 2018
Abstract: Background Polycystic ovary syndrome (PCOS) is a common yet complex condition, where education is vital. It predominantly affects reproductive-aged women, the age group with peak use of the Internet, now a major source of health information. Women with PCOS are dissatisfied with care, and the lack of useful online information is a key concern. Methods Using a rigorous and systematic methodology, we examined the quality, information content, and user-friendliness of online information about PCOS. Internet searches were conducted in Australia and the United Kingdom in December 2015 using Google, Bing, and Yahoo with different browsers, operating systems, and domain names. A total of 75 Web sites were evaluated and categorized. Results The majority of Web sites were commercial (41%) and not-for-profit (76%) and were aimed at women only. Less than a third of the Web sites were externally accredited. Commercial Web sites and Web sites targeting only women had the lowest quality scores, while professional-society Web sites and Web sites targeting only HPs scored the highest in quality. Accredited Web sites had higher quality and user-friendliness scores than nonaccredited Web sites. Conclusion The majority of PCOS Web sites were commercially derived, targeted women, and were not accredited. There is a significant lack of quality, easy-to-read, evidence-based information online for women with PCOS.
Publisher: Georg Thieme Verlag KG
Date: 2018
Abstract: Background People are increasingly seeking health information and managing their health through electronic technologies. We aimed to determine if women with polycystic ovary syndrome (PCOS) identified a need for PCOS-related mobile health apps and to evaluate related apps currently available. Design A national survey of women and a review of apps available on the iOS and Android platforms. Setting Community recruitment in Australia in 2016 and review of mobile apps available in 2017. S le The survey received 264 responses. Sixteen apps related to PCOS were evaluated. Main Outcome Measures Survey: Women's likeliness to use mobile health apps, specifically a PCOS-related app and preferred features of apps. App review: Mapping of available apps and evaluation using the Mobile Application Rating Scale (MARS). Results Of 264 respondents, almost all women had a smartphone (98%), 72% had previously used an app to manage their health, and most (91%) would use a PCOS-specific app if available. The most important feature was the availability of current, evidence-based information. Current apps on PCOS lack provision of quality information. Conclusion Women with PCOS would use a PCOS-specific app of good quality that responds to their needs and facilitates self-care however, currently available apps are unlikely to meet their information needs.
Publisher: Informa UK Limited
Date: 25-05-2014
DOI: 10.3109/13697137.2014.900745
Abstract: Treatment-induced early menopause occurs in > 80% of premenopausal women diagnosed with breast cancer. This study explored the relationship between vasomotor symptoms (VMS), sleep and mood in women aged 40-51 years with non-metastatic breast cancer. Cross-sectional study using validated questionnaires (Greene Climacteric scale and Hospital Anxiety and Depression Scale, HADS). Women (n = 114) were recruited from the community and hospital outpatient clinics. Frequency determination and structural equation modeling (SEMod) were used to examine the relationship between the latent variables: VMS, anxiety, and depression, and the indicator variable: difficulty sleeping. Participants' mean age was 47 years and 94% became menopausal after breast cancer diagnosis. Difficulty sleeping was reported by 82% of women with 46% reporting (Likert scale) 'quite a bit/extremely'. Most women reported night sweats (77% of women: 47% reporting 'quite a bit/extremely') and hot flushes (84% of women: 50% reporting 'quite a bit/extremely'). HADS scores indicated clinically relevant depression and anxiety in 98% and 99% of women, respectively. SEMod revealed that VMS contributed to difficulty sleeping (standardized coefficient = 0.54 p < 0.001) and difficulty sleeping mediated the relationship between VMS and anxiety (standardized coefficient = 0.34 p = 0.03). However, difficulty sleeping did not have a significant direct impact on depression (standardized coefficient = -0.03 p = 0.8), although anxiety was a strong predictor of depression (standardized coefficient = 0.83 p = 0.015). VMS, sleep and mood disturbance are commonly experienced by younger women with breast cancer. Using SEMod, we demonstrate for the first time that VMS may directly influence sleep in these women. VMS may have an indirect effect on mood, partly mediated by sleep difficulty.
Publisher: Wiley
Date: 21-12-2021
DOI: 10.1111/CEN.14661
Publisher: Informa UK Limited
Date: 04-11-2015
DOI: 10.3109/09513590.2014.975682
Abstract: Depression, anxiety, and inflammation are common in polycystic ovary syndrome (PCOS). Inflammation may adversely impact on mood and vitamin D has been associated with both mood disorders and inflammation in the general population, but these relationships have not been studied in PCOS. The aim of this study was to investigate the association among 25 hydroxy-Vitamin D (25OHVD) status, anxiety, depression, and inflammation in women with and without PCOS. Cross-sectional study in overweight or obese premenopausal women with (n = 50) and without (n = 23) PCOS. Primary outcome measures were 25OHVD, mood (Hospital Anxiety and Depression questionnaire), and inflammation (highly sensitive C-reactive protein (hsCRP)). Vitamin D deficiency (25OHVD<50 nmol/L) (46% versus 39%, p = 0.311) and 25OHVD (50.4 ± 22.2 nmol/L versus 51.6 ± 19.0 nmol/L, p = 0.828) were not significantly different in women with and without PCOS. For all women combined, 25OHVD was the only significant independent predictor of depression (β = -0.063 ± 0.021, p = 0.005) and hsCRP (β = -0.041 ± 0.015, p = 0.010). Vitamin D deficiency is common in both women with and without PCOS with no differences between the groups. Vitamin D is independently associated with depression and inflammation in overweight women both with and without PCOS. Further investigation to clarify the interrelationship among vitamin D, inflammation and depression is required to identify optimal prevention and treatment strategies for psychological and metabolic dysfunction in PCOS.
Publisher: Informa UK Limited
Date: 03-03-2020
Publisher: The Endocrine Society
Date: 17-07-2018
Abstract: Turner syndrome (TS) is associated with short stature, gonadal failure, and fractures. Spinal trabecular bone score (TBS) is a novel bone imaging modality that has not been evaluated in TS. To evaluate TBS in TS and its association with bone mineral density (BMD), prevalent fracture, and risk factors. Longitudinal study of TS from a single tertiary hospital between 2006 and 2017. Fifty-eight subjects with TS aged 20 to 49 years who underwent dual-energy X-ray absorptiometry (DXA). TBS, DXA parameters, and prevalent fractures were investigated. Normal, partially degraded, and degraded TBSs were observed in 39 (67%), 15 (26%), and four (7%) subjects, respectively. High rates of prescribed estrogen replacement therapy (ERT) with stable TBS and BMD were observed during follow-up. TBS was positively correlated with spine and femoral neck (FN) BMD and Z-scores (all P < 0.05) and negatively correlated with age (-0.004 per year P = 0.014) and delay in ERT initiation in women with primary amenorrhea (-0.010 per year P < 0.001). Fractures were present in 17 (31%) subjects. Low TBS had a significantly higher area under the receiver operator curve for predicting prevalent fracture than low bone mass at either the spine or FN (P < 0.05). Subjects with no history of fracture were more likely to have a normal TBS (P = 0.023). BMD and TBS can be preserved with early initiation and continued use of ERT. TBS may provide additional fracture risk prediction to standard DXA parameters in TS and needs to be validated in larger prospective studies.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Informa UK Limited
Date: 29-10-2015
DOI: 10.3109/13697137.2015.1100383
Abstract: Breast cancer and osteoporosis are common conditions affecting women, particularly following menopause. With increasing breast cancer incidence, effects of therapies and decreasing mortality, issues relating to the preservation of bone health with breast cancer therapy have become a priority. Contributing factors to bone loss and fractures in women with breast cancer include tumor effects, estrogen deprivation secondary to breast cancer therapies (chemotherapy, ovarian ablation or aromatase inhibitors), natural menopause and secondary causes of bone loss, typically from concurrently prescribed medications. Management of osteoporosis and other survivorship care is complex, and a multi-disciplinary approach is recommended with assessment of risk factors for bone loss, optimization of bone health through lifestyle approaches and pharmacological interventions based on evidence-based algorithms. This review examines the pathophysiology of bone loss and gives guidelines for the management of bone disease in women with breast cancer.
Publisher: AMPCo
Date: 18-07-2019
DOI: 10.5694/MJA2.50280
Abstract: Representatives appointed by relevant Australian medical societies used a systematic approach for adaptation of guidelines (ADAPTE) to formulate clinical consensus recommendations on assessment and management of bone health in women with oestrogen receptor-positive early breast cancer receiving endocrine therapy. The current evidence suggests that women receiving adjuvant aromatase inhibitors and pre-menopausal woman treated with tamoxifen have accelerated bone loss and that women receiving adjuvant aromatase inhibitors have increased fracture risk. Both bisphosphonates and denosumab prevent bone loss additionally, denosumab has proven anti-fracture benefit in post-menopausal women receiving aromatase inhibitors for hormone receptor-positive breast cancer. Women considering endocrine therapy need fracture risk assessment, including clinical risk factors, biochemistry and bone mineral density measurement, with monitoring based on risk factors. Weight-bearing exercise and vitamin D and calcium sufficiency are recommended routinely. Anti-resorptive treatment is indicated in women with prevalent or incident clinical or morphometric fragility fractures, and should be considered in women with a T score (or Z score in women aged < 50 years) of < - 2.0 at any site, or if annual bone loss is ≥ 5%, considering baseline bone mineral density and other fracture risk factors. Duration of anti-resorptive treatment can be in idualised based on absolute fracture risk. Relative to their skeletal benefits, risks of adverse events with anti-resorptive treatments are low. Skeletal health should be considered in the decision-making process regarding choice and duration of endocrine therapy. Before and during endocrine therapy, skeletal health should be assessed regularly, optimised by non-pharmacological intervention and, where indicated, anti-resorptive treatment, in an in idualised, multidisciplinary approach.
Publisher: BENTHAM SCIENCE PUBLISHERS
Date: 17-01-2013
Publisher: Informa UK Limited
Date: 02-09-2020
Publisher: Wiley
Date: 25-06-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2012
DOI: 10.1097/GME.0B013E31825FD14E
Abstract: The aim of this study was to investigate and compare symptom experiences, beliefs, attitudes, and understanding of menopause and menopausal therapies in Australian and Laotian women. This was a cross-cultural, questionnaire-based study involving 108 women (56 Australian women and 52 Laotian women aged 40-65 y) attending outpatient clinics in Australia and Laos. Descriptive statistics and univariate analysis were conducted using Student's t test or Mann-Whitney U test, where appropriate. Psychological symptoms, depression, vasomotor symptoms, and sexual dysfunction were significantly higher in Australian women compared with Laotian women (P < 0.05). Australian women perceived the meaning of menopause as aging (57%), whereas most Laotian women reported not knowing what menopause meant to them (81%). Australian women's fears about menopause included weight gain (43%), aging (41%), and breast cancer (38%), whereas Laotian women reported not knowing about potential menopausal problems (85%). Exercise (55%), education and awareness (46%), and improving lifestyle (41%) were reported by Australian women as being effective in alleviating menopausal symptoms, with only 21% reporting not knowing what was effective compared with 83% of Laotian women. Many women reported not knowing the risks/benefits of hormonal therapies (50% of Australian women and 87% of Laotian women) and herbal therapies (79% of Australian women and 92% of Laotian women). General practitioners were the most common source of menopause information for both Australians (73%) and Laotians (67%). Sociocultural factors influence women's perception of menopause. Psychological symptoms, sexual dysfunction, and vasomotor symptoms are more commonly reported by Australian women than by Laotian women. Women have a limited understanding of the risks/benefits of menopausal therapies, and culturally appropriate education is needed.
Publisher: Informa UK Limited
Date: 19-05-2017
DOI: 10.1080/13697137.2017.1325461
Abstract: Turner syndrome (TS) is associated with hypogonadism, osteoporosis and fractures. We investigated the prevalence and risk factors for low bone density and fractures in a TS cohort. We included 76 TS patients (median age 28.5 years) attending a tertiary hospital between 1998 and 2015 who underwent dual-energy X-ray absorptiometry. Spine and femoral neck (FN) areal bone mineral density (aBMD) were compared with those of a control group. To adjust for smaller bone size, bone mineral apparent density (BMAD) was calculated. Primary amenorrhea was common (83%) in the TS cohort the median age of pubertal induction was 15 years (range 11-30 years), and non-continuous estrogen therapy (ET) recorded in 40%. Almost one-third of TS patients reported fractures. TS patients had lower median spinal aBMD (1.026 g/cm Delay in ET commencement was an independent risk factor for the lower bone density observed in women with TS. Early pubertal induction and ET compliance are important targets to optimize aBMD.
Publisher: Informa UK Limited
Date: 21-08-2011
DOI: 10.3109/13697137.2011.566390
Abstract: To compare experience of premature menopause (PM), information sources, treatments, depression, anxiety, body image, sexual function and self-efficacy, between women with premature ovarian failure (POF), surgically induced menopause (SIPM), chemically induced menopause (CIPM), and controls. Cross-sectional observational pilot study using validated and devised questionnaires in 77 Australian women (POF, n = 25 SIPM, n = 17 CIPM, n = 12 controls, n = 23). The average age of all women was 34.8 years (standard deviation (SD) ± 5.7 years), and time since PM diagnosis was 3.8 years (SD ± 4.4 years, p = 0.19). The gynecologist (69%) and internet (67%) were the best expected sources of information. Women with PM feared osteoporosis more than controls (p < 0.0001). Women with SIPM (p = 0.006) and POF (p = 0.01) had higher rates of depression compared to controls. SIPM women were more anxious than women with POF (p = 0.04) and both SIPM (p = 0.002) and CIPM (p = 0.02) women were more anxious than controls. Women with POF had higher health evaluation (p = 0.03), fitness evaluation (p = 0.01) and fitness orientation (p = 0.01) than women with SIPM. Controls had higher health evaluation than women with SIPM (p = 0.001) and CIPM (p = 0.04), higher fitness evaluation than women with SIPM (p = 0.02) and CIPM (p = 0.04), and higher fitness orientation than SIPM women (p < 0.0001). Sexual dysfunction (p < 0.0001) and dyspareunia (p = 0.001) were higher in CIPM women than controls. Controls were more sexually responsive than POF women (p = 0.008). SIPM (p = 0.008) and POF (p = 0.04) women reported decreased confidence to manage disease. Depression, anxiety, body image, sexual dysfunction and self-confidence are compromised for women across different groups of premature menopause. Understanding these differences is important to the development of in idual management plans based on the needs of women.
Publisher: Elsevier
Date: 2004
Publisher: Informa UK Limited
Date: 24-10-2022
DOI: 10.1080/13697137.2022.2127351
Abstract: This study aimed to explore women's and clinician's experiences and acceptability of telehealth use within a specialized multidisciplinary menopause service during the COVID-19 pandemic. In-depth qualitative semi-structured interviews were analyzed via thematic inductive approaches. Telehealth acceptability was guided by the Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies (NASSS) framework. A heterogeneous group of 18 women who had attended the menopause service and six clinicians (gynecologists and endocrinologists) were interviewed. The majority of women and clinicians perceived telehealth as an acceptable way to deliver menopause care. Benefits of telehealth delivery were identified themes centered around convenience, greater access to care and improved safety. Telehealth challenges included perceived impacts on personalized quality of care, patient-related logistical issues and system/organizational-related issues. A hybrid flexible delivery model combining telehealth and face-to-face care was recommended, following the easing of COVID-19 restrictions. Improvements to support embedding and adaptation of telehealth into routine care were described. In this study, telehealth was viewed as acceptable, supporting the ongoing delivery of a hybrid service model of telehealth and face-to-face menopause care. The findings provide valuable information to improve the menopause service to meet the needs of women during the ongoing current pandemic and beyond.
Publisher: S. Karger AG
Date: 23-12-2017
DOI: 10.1159/000455233
Abstract: Polycystic ovary syndrome (PCOS) is a common and complex endocrinopathy with reproductive, metabolic, and psychological features and significantly increased cardiometabolic risks. PCOS is underpinned by inherent insulin resistance and hyperandrogenism. Obesity, more common in PCOS, plays an important role in the pathophysiology, exacerbating hyperinsulinaemia and hyperandrogenism, leading to recommended first-line lifestyle intervention. Significant traditional and non-traditional risk factors are implicated in PCOS in addition to obesity-exacerbated cardiometabolic risks and are explored in this review to promote the understanding of this common metabolic and reproductive condition.
Publisher: Elsevier BV
Date: 09-2022
Publisher: Informa UK Limited
Date: 02-2011
DOI: 10.3109/13697137.2010.495424
Abstract: Premature surgical menopause is becoming increasingly common in the setting of both benign and malignant disease. These women are at an increased risk of all-cause and cardiovascular mortality, cognitive dysfunction and metabolic bone disease. We present the case of a 28-year-old woman with premature surgical menopause due to bilateral oophorectomy, following ovarian torsion occurring on two separate occasions, one episode during her second trimester of pregnancy. The decision regarding hormone replacement therapy in this lady was complicated due to the presence of Factor V Leiden heterozygosity. A brief discussion and review of the literature follow.
Publisher: Georg Thieme Verlag KG
Date: 09-2020
Abstract: Premature ovarian insufficiency (POI) and early menopause, defined as loss of ovarian activity prior to 40 years or menopause between the ages of 40 and 45 years, respectively, is associated with significant adverse health impacts. Recent data indicate that the prevalence of POI and early menopause is greater than was previously thought, affecting more than 10% of women. Biopsychosocial risk factors including genetic, autoimmune, reproductive, lifestyle, early-life, social/environmental, and iatrogenic have been associated with POI/early menopause or earlier age at menopause. However, establishing a causal role and the underlying mechanisms remains elusive. Understanding and clarification of these risk factors will facilitate prevention and risk minimization strategies to optimize women's health.
Publisher: Elsevier BV
Date: 06-2022
Publisher: The Endocrine Society
Date: 2016
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.MATURITAS.2019.07.021
Abstract: Osteoporosis is a key concern of women with premature ovarian insufficiency (POI) but there are gaps in clinicians' knowledge of bone health. 1) To systematically evaluate the quality of clinical practice guidelines (CPGs) related to POI and bone health 2) to formulate a management algorithm. Systematic search for English-language clinical practice guidelines (CPGs) from August 2012 to August 2017 (PROSPERO registration number CRD42017075143). Four reviewers independently evaluated the methodological quality of included CPGs using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument (comprising 23 items across 6 domains) using the My AGREE PLUS platform. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). In idual domain and total percentage scores were calculated for each CPG. Data from high-scoring CPGs were extracted and summarised to develop the algorithm, with subsequent refinement via expert and end-user clinician feedback. The systematic search yielded 16 CPGs for appraisal. ICC values were 0.71 (good) to 0.95 (very good). The quality of the CPGs was appraised as "high" in 4 cases, "average" in 8 and "low" in 4. High-quality CPGs had mean total scores of 82-96%. Recommendations from high-quality CPGs were summarised into 6 categories: screening risk factors initial assessment diagnosis subsequent assessment and management. Only "management" had recommendations (moderate-quality to low-quality evidence) from all four high-quality CPGs. Limitations are reflected in the algorithm. Most CPGs regarding bone health and POI are of average to poor quality. High-quality CPGs have evidence limitations and recommendation gaps indicating the need for further research.
Publisher: Informa UK Limited
Date: 10-08-2018
DOI: 10.1080/13697137.2018.1476969
Abstract: Turner syndrome (TS) is the most common chromosomal abnormality in females, affecting up to 1/2000 live female births. TS is associated with partial or complete loss of the second X-chromosome in phenotypic females and is associated with increased morbidity and mortality. There are many challenges in providing optimal care for the adult TS women. This review highlights uncertainties that remain in hormone replacement therapy, bone health and cardiovascular optimization and discusses current management recommendations based on the recently published international guidelines and the experience at the TS clinic at Monash Health.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.MATURITAS.2018.03.001
Abstract: The benefits of lifestyle interventions for women who have survived gynaecological cancer (GC) remain unclear. This systematic review aimed to determine the effect of lifestyle interventions on cancer recurrence, overall survival and quality of life (QoL) in women with GC. We searched Medline, Embase, PsycINFO and EBM Reviews from June to July 2016 to identify relevant literature. We included randomized controlled trials in which a lifestyle intervention (diet, weight loss, physical activity and/or behavioural interventions) were compared with a control condition (usual care, placebo or other lifestyle interventions) in women who had survived endometrial or ovarian cancer. Primary outcomes included cancer recurrence and overall survival and the secondary outcome was QoL. Data extraction and risk-of-bias assessment were performed by two independent reviewers. A random-effects meta-analysis model was used to calculate mean differences (md) and 95% confidence intervals (CI). The literature search yielded 928 citations and three trials met the inclusion criteria. No randomized controlled trial assessed the effect of lifestyle interventions on cancer recurrence or survival. Meta-analysis of two randomized controlled trials on the effect of lifestyle interventions on total QoL at 3 or 6 months post-intervention showed no significant difference between intervention and control groups [(md 1.60 95% CI, -1.65 to 4.85) and (md 2.07 95% CI, -1.80 to 5.94), respectively]. That is, lifestyle intervention had no effect on overall QoL or in idual QoL domains (physical, emotional, social wellbeing and fatigue) in GC survivors. Systematic review registration: PROSPERO CRD42016043719.
Publisher: Elsevier BV
Date: 11-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2011
DOI: 10.1097/GME.0B013E318204AF9D
Abstract: The aims of this study were to investigate menopausal symptoms, psychological function, sexual function, and body image as experienced by younger Australian women with breast cancer and to examine the effect of different breast cancer treatments on these parameters. A questionnaire study was completed by 114 women aged 40 to 51 years with nonmetastatic breast cancer. Women were recruited from outpatient clinics or the community. Descriptive statistics and univariate analyses were conducted using Student's t tests and nonparametric tests, where appropriate. The mean age of breast cancer women was 47.2 years. The most common symptoms reported were as follows: feeling tired/lacking energy (88%), loss of libido (87%), and hot flushes (83%). Anxiety and depression scores were high (18.00 ± 2.53 and 15.56 ± 1.56, respectively). Psychological symptoms (13.25 ± 6.91 vs 8.52 ± 5.61 P = 0.009), vasomotor symptoms (4.00 ± 1.90 vs 2.74 ± 1.91 P = 0.035), and sexual dysfunction scores (2.25 ± 0.86 vs 1.58 ± 1.01 P = 0.031) were significantly higher in breast cancer women with ovariectomy compared with breast cancer women without ovariectomy. Sexual feelings for partners (P = 0.02) and sexual frequency (P = 0.01) were less in women with ovariectomy compared with women without ovariectomy. Feelings of physical health, attractiveness, overall appearance, and satisfaction were significantly lower in ovariectomized women (P < 0.05). Menopausal symptoms, anxiety, and depression are common in younger breast cancer women. Importantly, ovariectomy in breast cancer women is associated with significant adverse menopausal physical symptoms, psychological impact, and sexual function. Both healthcare providers and women with breast cancer need to be aware of the impact of ovariectomy in younger women with breast cancer, and further education resources and support for these women should be targeted.
Publisher: Informa UK Limited
Date: 26-09-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2012
DOI: 10.1097/GME.0B013E318246AB45
Abstract: The aim of this study was to describe the partners' perceptions, understanding, and personal experiences of early menopause and menopausal therapy in women with breast cancer. A questionnaire study was completed by 50 partners of women with diagnoses of breast cancer, recruited via outpatient clinics and the community. Descriptive statistics and χ tests were applied. Most (68%) of the partners perceived hot flushes as the meaning of menopause. Most (60%) partners perceived that loss of sexuality was the key problem/fears about being menopausal. Partners perceived that exercise (72%) and reducing stress (64%) were most effective in alleviating symptoms of menopause. Most partners reported that they did not understand the risks/benefits of hormone therapy (50%), bioidentical hormones (90%), and herbal therapies (84%). The general practitioner was considered the best source of information on menopause (68%). Partners expected menopause to affect a women's everyday life and relationships with family and partner and, particularly, to cause intermittent stress on the relationship (66%) and to decrease libido or sexual interest (64%). Forty-four percent of partners reported that there was some difficulty in communication/discussion about menopause with family and partners. This pilot study highlights (1) the lack of understanding of menopause and menopausal therapies that partners of women with breast cancer have, (2) the personal experience of having a female partner with breast cancer, and (3) the partners' attitudes and responses toward menopause in women with breast cancer.
Publisher: Informa UK Limited
Date: 24-02-2015
DOI: 10.3109/13697137.2014.996749
Abstract: Increasing breast cancer incidence and decreasing mortality have highlighted the importance of survivorship issues related to breast cancer. A consideration of the issues related to menopause is therefore of great importance to both women and clinicians. Menopause/menopausal symptoms, with significant negative effects on quality of life and potential long-term health impacts, may in women with breast cancer be associated with: (1) natural menopause occurring concurrently with a breast cancer diagnosis (2) recurrence of menopausal symptoms following cessation of hormone replacement therapy (3) treatment-induced menopause (chemotherapy, ovarian ablation/suppression) and adjuvant endocrine therapy. A variety of non-hormonal pharmacological and non-pharmacological therapies have been investigated as therapeutic options for menopausal symptoms with mixed results, and ongoing research is required. This review presents a summary of the causes, common problematic symptoms of menopause (vasomotor, genitourinary and sexual dysfunction), and longer-term consequences (cardiovascular disease and osteoporosis) related to menopause. It proposes an evidenced-based multidisciplinary approach to the management of menopause/menopausal symptoms in women with breast cancer.
Publisher: Informa UK Limited
Date: 05-04-2017
DOI: 10.1080/13697137.2017.1304906
Abstract: To evaluate the knowledge and attitudes of Australian health professionals (HPs) including general practitioners (GPs), gynecologists and endocrinologists, to menopausal hormone therapy (MHT). Participants were recruited from medical societies/colleges and a national GP conference. An online survey containing devised and previously published questions was used. Data analysis included frequencies, ANOVA, χ A total of 745/888 responses were analyzed. Fewer HPs (52%) reported being knowledgeable regarding non-hormonal therapies compared with menopause physiology or MHT (72%), with no significant knowledge differences between specialties. Most HPs (91%) would offer MHT to symptomatic menopausal women. The combined oral contraceptive pill (52%) was preferred for women with premature menopause. Transdermal MHT was preferred for women >50 years, although differences were observed between specialties (p = 0.005). HPs varied regarding duration of MHT for women with premature menopause (p = 0.009) and women over 50 years (p = 0.001). Menopause society members were more likely to prescribe MHT and for longer duration (p < 0.05). Consumer concern regarding breast cancer was considered the main barrier in prescribing MHT. Although most HPs will recommend MHT, when indicated, for symptomatic menopausal women, variations exist between specialties in prescribing practices. HPs' knowledge gaps and perceived consumer concerns are barriers to prescribing MHT.
Publisher: Informa UK Limited
Date: 06-05-2021
DOI: 10.1080/13697137.2021.1917539
Abstract: Premature ovarian insufficiency (POI), defined as a loss of ovarian function before the age of 40 years, is a life-changing diagnosis that has numerous long-term consequences. Musculoskeletal complications, including osteoporosis and fractures, are a key concern for women with POI. The risk of bone loss is influenced by the underlying etiology of POI, and the degree and duration of estrogen deficiency. A decline in muscle mass as a result of estrogen and androgen deficiency may contribute to skeletal fragility, but has not been examined in women with POI. This article aims to review musculoskeletal health in POI summarize the traditional and novel modalities available to screen for skeletal fragility and muscle dysfunction and provide updated evidence for available management strategies.
Publisher: Informa UK Limited
Date: 12-02-2013
DOI: 10.3109/13697137.2013.765842
Abstract: Investigation of clinicians' understanding of early menopause diagnosis/management in women with breast cancer. A cross-sectional study of 176 randomly recruited Australian clinicians (35 gynecologists, 35 endocrinologists, 36 oncologists, 35 breast surgeons and 35 general practitioners (GPs)) involved in the care of women with breast cancer. This questionnaire study utilized an index case to assess understanding of early menopause diagnosis and management. Analysis involved descriptive statistics, χ² tests and Student's t-test. Significant differences between clinician groups regarding diagnostic criteria for early menopause were observed gynecologists, endocrinologists and GPs selected amenorrhea > 12 months, whereas oncologists and breast surgeons selected elevated serum follicle stimulating hormone level (p < 0.05). Non-hormonal treatment was preferred by most clinician groups. Complementary/alternative medicines were more commonly prescribed by breast surgeons (57%), gynecologists (54%) and endocrinologists (49%) compared to oncologists (28%) or GPs (9%) (p = 0.0001). Exercise (63%) and nutrition (66%) were selected by most gynecologists for treatment of hot flushes, whereas endocrinologists (91%), oncologists (94%), breast surgeons (69%) and GPs (63%) prescribed venlafaxine. Hormone therapy was mainly prescribed by breast surgeons (43%) compared to other groups (p = 0.001). Most clinicians reported that the main problem with menopausal therapies was failure to resolve hot flushes. Exercise, lifestyle and stress management were recommended by all clinician groups for treatment of anxiety/depression. This exploratory study demonstrated a lack of consensus between clinician groups in their investigation, diagnosis and management of early menopause in women with breast cancer, with implications for both diagnosis and treatment.
Publisher: Informa UK Limited
Date: 28-07-2017
DOI: 10.1080/13697137.2017.1350841
Abstract: Turner syndrome (TS), resulting from complete artial X chromosomal monosomy, is associated with multiple co-morbidities and increased mortality. Although multidisciplinary management is recommended, TS women's health care is sub-optimal. This study evaluates a multidisciplinary adult TS service. Retrospective cohort study of 82 patients attending the quarterly TS clinic from December 2003 to December 2014. Evaluation included (1) demographics, (2) TS standardized co-morbidity screening, and (3) estrogen therapy use. Data analysis involved frequency statistics, T tests and polychoric correlation analysis. Median age at TS diagnosis was 14 years (range 0-65 years), with 12% of women aged >18 years. Median age at initial consultation was 31 years (range 16-65 years). Only 14% of patients were transition program referrals. XO karyotype occurred in 30%. Primary amenorrhea predominated however, 37% of TS women were not taking estrogen therapy. The proportion of patients not previously screened (44-76%) and those with positive screening diagnoses (5-53%) varied according to co-morbidity. The mean (± standard deviation) number of co-morbidities identified increased following TS clinic screening (7.0 ± 2.6 post-screening vs. 4.4 ± 2.3 pre-screening p < 0.0001). Polychoric correlation analysis identified particular co-morbidity groupings (including metabolism-related) and increased co-morbidities with primary amenorrhea. A multidisciplinary adult TS clinic improves health surveillance with increased identification of co-morbidities and initiation of estrogen therapy.
No related grants have been discovered for Amanda Vincent.