Improving the health of women at midlife: health behaviours, wellbeing and work performance

Background Menopause is defined as the permanent cessation of menstrual cycles resulting from the depletion of ovarian follicles. Menopause is described as “natural” when due to biological ageing. Iatrogenic causes of early menopause include removal of both ovaries (surgical menopause), chemotherapy and radiotherapy. The major consequences of menopause are due to oestrogen deficiency and include: vasomotor symptoms (VMS, hot flushes and night sweats), urogenital atrophy (vaginal dryness, dyspareunia, and urinary tract infections), sleep disturbance, mood changes, and arthralgia. Some women are mildly symptomatic, whereas others can have debilitating symptoms. Little is known about the prevalence and severity of menopausal symptoms in Australian women, or how such symptoms are associated with women’s wellbeing and work ability. Aims The primary aim of this doctoral thesis was to systematically review the existing data on the prevalence of menopausal symptoms in Australian women at midlife, establish the prevalence and severity of menopausal symptoms in Australian women at midlife, evaluate an association between VMS and wellbeing, and self-assessed work ability and report on the uses of menopausal hormone therapy (MHT) and complementary and alternative medicines (CAMs) for menopausal symptoms. Methods This thesis reports on findings from the cross-sectional questionnaire-based “Improving the Health of Women at Midlife” national survey which was conducted between October 2013 and March 2014. Participants were randomly recruited from a large database derived from the Australian electoral roll. The sample size estimation of 2020 was based on a 95% Confidence Interval (CI) of ± 2% around an estimated prevalence of 30% for moderate-severely bothersome VMS. Detailed information was collected on demographics, use of MHT and use of CAMs. Menopausal symptoms, wellbeing and self-reported work ability were assessed using validated questionnaires. Results Findings from the “Prevalence of Menopausal Symptoms in Australian Women at Midlife: a Systematic Review” Few studies documenting the prevalence of menopausal symptoms in Australian women have been published. A review of these demonstrated sampling and data collection issues and a high risk of bias. The overall findings were inconsistent and inconclusive and highlighted the need for further research in this area. Findings from the “Improving the Health of Women at Midlife Study” Prevalence and severity of symptoms, and use of treatment: 5850 women were contacted and invited to participate in the survey. Of these, 2020 women comprised the final study sample. Overall, 5.3% were using MHT, 0.7% non-hormonal prescription medication for menopausal symptoms and 3.4% vaginal oestrogen. The prevalence of VMS was reported for the 1727 women not using MHT, and sexual symptoms were reported for the 1656 women not using MHT or vaginal oestrogen. The prevalence of moderate-severely bothersome VMS was: 2.8% in premenopausal women, 17.1% in perimenopausal women 28.5% in postmenopausal women younger than 55 years, 15.1% in postmenopausal women aged 55 to 59 years, and 6.5% in postmenopausal women aged 60 to 65 years. Sexual symptoms were reported by 62.5% of the women aged 60-65 years. Association with wellbeing: A strong, significant negative association was found between moderate-severely bothersome VMS and psychological general wellbeing [regression coefficient (β) = -8.17, 95% CI -10.90 to -5.45]. Socio-demographic factors independently associated with lower wellbeing included being un-partnered, obese and a smoker. Older age and participation in paid and/or volunteer work were each independently positively associated with wellbeing. Association with self-assessed work ability: VMS were associated with a greater likelihood of having a poor-moderate self-reported work ability compared with good-excellent work ability (odds ratio [OR] 2.45, 95% CI 1.69-3.54). Poorer self-reported work ability was also independently associated with being un-partnered, obese or overweight, smoking, being a carer and having insecure housing. Prevalence of use of CAMs: The prevalence of use of CAMs for VMS was 13.2%. With premenopausal women as the reference group, being perimenopausal (OR 2.09, 95% CI 1.42-3.06) or postmenopausal aged <55 years (OR 1.83, 95% CI 1.21-2.76) was positively associated with use of any CAM for VMS. Conclusions The research undertaken for this thesis demonstrates that a substantial proportion of Australian women experience menopausal symptoms at midlife and into their 7th decade. It has shown that moderate-severely bothersome VMS are independently associated with lower psychological general wellbeing and poorer self-reported work ability. The research has revealed that, in relation to the low usage of MHT, the prevalence of use of CAMs for menopausal symptoms is considerable. That moderate-severe VMS is associated with reduced wellbeing is an important consideration for practitioners caring for women at midlife. It is important that women understand about the efficacy of MHT for VMS. Minimising work-related factors that might exacerbate VMS, such as inadequate cooling of the workplace, has the potential to alleviate symptom severity and enhance work ability. Health care practitioners also need to know what types of CAMs women are taking, so that they can understand side-effects and potential drug interactions.