High proportion of menopause symptoms go untreated despite effective therapies
Click Here to Manage Email Alerts
Two studies published in Menopause demonstrated hormone therapy and selective serotonin reuptake inhibitors/serotonin norepinephrine reuptake inhibitors as generally effective therapies for menopausal symptoms.
“Even when women had multiple menopausal symptoms that were bothersome enough to have been reported to their physicians and documented in their medical record, they often delayed seeking care for 6 months or more,” Barbara DePree, MD, NCMP, MMM, director of the Women’s Midlife Services at Holland Hospital, Michigan, told Healio. “About 40% of women with documented symptoms were relying on either nonprescription treatments, for which we have limited supporting evidence, or were using no treatment at all. This was despite health care providers (HCPs) telling us in the qualitative interviews that they perceive prescription therapies for menopausal symptoms to be generally effective and frequently prescribed.”
Therapies for menopausal symptoms
In this study of qualitative interviews with 10 gynecologists and 10 primary care providers in the U.S., participants completed interviews if they consulted with three or more women per week who presented with menopausal symptoms. Researchers collected data on demographics, patients’ symptom information, and health care provider and patient views on prescription and nonprescription therapies for menopausal symptoms.
Overall, 95% participating HCPs agreed that there are effective treatments for menopausal symptoms, specifically for women experiencing vasomotor symptoms, vaginal dryness, atrophy and/or dyspareunia. A high proportion of providers (65%) also said they believed that the range of currently available treatment options for menopausal symptoms was adequate while some reported that more options would be useful.
Providers reported that treatment for menopausal symptoms was generally dictated by symptoms interfering with the woman’s quality of life and/or daily activities. However, women often experienced symptoms months prior to presenting to their provider.
All providers reported prescribing hormone and/or nonhormone therapies, such as selective serotonin reuptake inhibitors/serotonin norepinephrine reuptake inhibitors, while half reported inquiring about nonprescription therapy and 45% reported recommending specific nonprescription therapies for menopausal symptoms.
Regarding barriers to initiating therapy for menopausal symptoms, the most reported were concerns from women about risks and financial considerations, including insurance coverage and cost.
DePree noted that the Women’s Health Initiative in 2002 resulted in a dramatic decline in HT use that has continued to stay low today, which is surprising as women who cannot or choose not to use HT have only a few safe and highly effective alternative treatments. Therefore, these findings highlight a substantial unmet need for these women.
“In the qualitative interviews, physicians said they think patient concerns about treatment risks and financial considerations were the biggest barriers to treatment, but assessment of current treatment barriers from a patient perspective would be good to have,” DePree said.
Proportion of untreated women
In this noninterventional, retrospective, observational cohort study, researchers used data from U.S. patient electronic medical records to identify 283 HCPs, including gynecologists, internal medicine/family physicians or advanced practice providers, who provided data for 1,016 women. All HCPs consulted with three or more women per week aged 40 to 60 years who presented with menopausal symptoms from 2016 to 2019. All women reported experiencing significant hot flashes at least twice within 24 hours.
At initial presentation, the most common symptoms reported were hot flashes among 91.2%, sleep problems among 49.9% and vaginal dryness among 47% of women. Overall, 86.9% of women had used at least one therapy for their menopausal symptoms, and 60.1% of these women had documentation of prescription medications, with HT the most common at 70.4% of women.
Almost 40% of women had no documentation on prescription medication, and about 13% of women had no documentation of any therapy.
Almost 50% of women delayed seeking care for their menopausal symptoms for more than 6 months. Researchers observed a mean of 2.1 office visits related to menopause from initial presentation to review completion with health care utilization not varying by treatment status.
In subgroup analyses, researchers observed nominal differences in treatment use across ethnic groups and varying prescribing patterns for menopausal symptoms by type of practitioner and region in the U.S.
It was good to see that nonprescription therapies were frequently documented in patients’ medical records, DePree said. She noted that this suggests that conversations are taking place between patients and their HCPs, which is important as providers should know what their patients are using due to potential associations with unwanted effects, laboratory abnormalities or drug interactions.
“Chart reviews like this provide good objective evidence of actual practice patterns, but do not necessarily tell us the reasons women choose a particular therapy or no therapy at all,” DePree said. “Menopause is a natural phase of life, and not all symptoms necessarily require treatment. Understanding the extent of the unmet need requires a better understanding of whether women whose symptoms are untreated, or insufficiently treated, desire more treatment options, or if they would make a different choice if other options were available to them.”
Looking ahead
According to DePree, providers should ask women who may be perimenopausal or postmenopausal about their current menopausal status and symptoms and review prescription and nonprescription treatments and assess patient eligibility and interest in these treatments. Then, providers should respect patient preferences while ensuring that patients have the most up-to-date scientifically accurate information about safety and efficacy of treatments to make the best decision for them.
“This remains a significantly undertreated area of women's health, and it has significant impact on their quality of life,” DePree said. “Drawing more attention to the condition and its impact will empower women to advocate for finding a practitioner who can help determine safe and effective management of their symptoms.”
Reference:
Collapse
Click Here to Manage Email Alerts