Hormone replacement therapy uptake and discontinuation trends from 1996‐2023: An observational study of the Welsh population

Objective: To analyse prescribing trends for oral and transdermal hormone replacement therapy (HRT) in Wales from 1996 to 2023, including predictors of discontinuation within one year of initiation. Design: Observational study using the Secure Anonymised Information Linkage (SAIL) databank. Setting: Primary and secondary care data from Wales, encompassing 86% of the population. Population: Annual HRT prescription rates from 1996 to 2023 were assessed for all women in Wales. Predictors of HRT discontinuation within one year were assessed in women aged 40–65 (n = 103 114), excluding those with oophorectomy, hysterectomy, or premature menopause. Methods: HRT prescription rates were calculated per 1000 women per year and stratified by HRT type, age groups and deprivation quintiles. Predictors of discontinuation were assessed using a zero‐inflated negative binomial regression. Main Outcome Measures: Annual HRT prescription rates and predictors of discontinuation, including age, deprivation, time period and HRT type. Results: From 1996 to 2023, 292 707 women were prescribed oral or transdermal HRT in Wales. Transdermal prescriptions rose exponentially post‐2021, whereas oral prescriptions declined post‐2002. Discontinuation rates followed a curvilinear trend: increasing at ages 40–43 and mid‐50s onwards and decreasing in mid‐40s to early 50s. Oral formats were linked to decreased discontinuation, whereas transdermals showed increased discontinuation. Deprivation reduced HRT prescriptions overall. Prescriptions post‐2000 predicted increased discontinuation, with highest rates seen post‐2021. Conclusions: Disparities in HRT prescribing patterns reflect GP and patient perceptions of safety. Women in their mid‐40s to early 50s, often at a natural menopause stage, adhered better, particularly to oral tablets, suggesting that administration route and symptom relief influence adherence. Socio‐economic deprivation remains a barrier to HRT access. Time trends highlight the influence of widely publicised studies and media on uptake, albeit adherence has continually declined since 2001. Additional research is needed to tackle socio‐economic inequalities and assess strategies for achieving cost‐effective and efficient HRT prescribing practices

Does Health & Her app use improve menopausal symptoms? A longitudinal cohort study

Objectives: The Health & Her app provides menopausal women with a means of monitoring their symptoms, symptom triggers and menstrual periods, and enables them to engage in a variety of digital activities designed to promote well-being. This study aimed to examine whether sustained weekly engagement with the app is associated with improvements in menopausal symptoms. Design: A pre–post longitudinal cohort study. Setting: Analysed data collected from Health & Her app users. Participants: 1900 women who provided symptom data via the app across a 2-month period. Primary and secondary outcome measures: Symptom changes from baseline to 2 months was the outcome measure. A linear mixed effects model explored whether levels of weekly app engagement influenced symptom changes. Secondary analyses explored whether app-usage factors such as total number of days spent logging symptoms, reporting triggers, reporting menstrual periods and using in-app activities were independently predictive of symptom changes from baseline. Covariates included hormone replacement therapy use, hormonal contraceptive use, present comorbidities, age and dietary supplement use. Results: Findings demonstrated that greater engagement with the Health & Her app for 2 months was associated with greater reductions in symptoms over time. Daily use of in-app activities and logging symptoms and menstrual periods were each independently associated with symptom reductions. Conclusions: This study demonstrated that greater weekly engagement with the app was associated with greater reductions in symptoms. It is recommended that women be made aware of menopause-specific apps, such as that provided by Health & Her, to support them to manage their symptoms

The role of menopausal symptoms on future health and longevity: A systematic scoping review of longitudinal evidence

Women live longer than men but spend more years in poor health. Menopausal symptoms are not generally associated with adverse health outcomes. However, increasingly, evidence suggests they can significantly impact future health and longevity. Understanding the long-term effects of menopausal symptoms will enable clinicians to identify risk factors and intervene with modifications to support healthy aging. This review examined the scope of research investigating the association between menopausal symptoms and future health outcomes. We searched for longitudinal cohort studies. Date and geographical restrictions were not applied. Articles were screened and data extracted using standardised methods. Included studies examined the role of menopausal symptoms on future health developments using a sample who had experienced menopause and were deemed healthy at baseline, with clear reporting of their menopausal status at symptom assessment. We identified 53 eligible studies with data from over 450,000 women enrolled in 28 longitudinal cohorts. Cardiovascular disease, psychiatric disorders, diabetes, and reduced bone mineral density were positively associated with menopausal symptoms. Breast cancer was associated with an asymptomatic menopause. Psychological menopausal symptoms and cognitive decline improved after menopause, except among women from low socioeconomic backgrounds. These findings demonstrate that menopausal symptoms are important indicators for future health risks. Future work should investigate the impact of underexplored menopausal symptoms on future health, such as sleeping problems and urogenital issues, and evaluate whether treating menopausal symptoms could lead to improvements in future health outcomes. Should future research continue to support these findings, clinical guidelines should be updated to support clinical decision-making in menopause care. [Abstract copyright: Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.

Repetitive Behavior in Rubinstein–Taybi Syndrome:Parallels with Autism Spectrum Phenomenology

Syndrome specific repetitive behavior profiles have been described previously. A detailed profile is absent for Rubinstein–Taybi syndrome (RTS). The Repetitive Behaviour Questionnaire and Social Communication Questionnaire were completed for children and adults with RTS (N = 87), Fragile-X (N = 196) and Down (N = 132) syndromes, and individuals reaching cut-off for autism spectrum disorder (N = 228). Total and matched group analyses were conducted. A phenotypic profile of repetitive behavior was found in RTS. The majority of behaviors in RTS were not associated with social-communication deficits or degree of disability. Repetitive behavior should be studied at a fine-grained level. A dissociation of the triad of impairments might be evident in RTS

Investigating the effects of probiotics during the menopause transition: A systematic review & meta-analysis

This review investigated the impact of probiotics during the menopause transition and explored their potential to enhance the effectiveness of estrogenic substances in perimenopausal or recently postmenopausal women. A thorough literature search of EMBASE, MEDLINE, Cochrane Library, Scopus, and Web of Science was conducted, identifying 39 studies involving 3187 women. Quality assessments were conducted using the relevant Cochrane Risk of Bias tools. The results demonstrated that probiotics had positive effects on menopausal symptoms, urogenital health, bone health, and the efficacy and safety of estriol and isoflavones. Meta analysis of 7 studies comparing probiotics versus placebo demonstrated large effects of probiotics on menopausal symptoms (total score) [standardized mean difference (SMD) = 0.82, 95 % CI -0.52 to −1.09], vasomotor symptoms (SMD = −0.96, 95 % CI -1.25 to −0.68), psychological symptoms (SMD = −0.51, 95 % CI -0.95 to −0.08), vaginal dryness (SMD = 0.95, 95 % CI -1.40 to −0.49), and vaginal microbiome health (Nugent score) (SMD = −0.91, 95 % CI -1.32 to −0.49). Meta-analysis results were nonsignificant for reducing somatic and sexual symptoms. Probiotics hold promise in addressing symptoms related to low estrogen levels and may enhance the effects of estriol and isoflavones, offering potential benefits as part of the management of menopausal women. It's important to note that the included studies had a high risk of bias, emphasising the need for further rigorous research in this area. Should findings continue to show promise, clinicians should consider incorporating probiotics into their strategies for managing menopausal symptoms

Self-injurious behaviour in people with intellectual disabilities and genetic syndromes

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The Health & Her App is Associated with Improved Symptom Outcomes Among 1,900 Menopausal Women

Background: The Health & Her app provides menopausal women with a means of monitoring their symptoms, symptom triggers, and menstrual periods, and enables them to engage in a variety of digital activities designed to promote health and wellbeing. The aim of the present study was to examine whether sustained weekly engagement with the app is associated with improvements in menopausal symptoms. Methods: This quasi-experimental study used routinely collected data provided by 1,900 Health & Her app users across a 2-month period. Symptom change from baseline over a period of up to 2 months was the outcome measure. A linear mixed effects model explored whether app engagement was predictive of symptom changes. Secondary analyses explored whether app-usage factors such as total number of days spent logging symptoms, logging triggers, reporting menstrual periods, and using in-app activities were independently predictive of symptom reductions from baseline. Covariates included HRT (Hormone Replacement Therapy) use, hormonal contraceptive use, present comorbidities, age, and dietary supplement use. To examine which types of symptoms were associated with the largest changes in total symptom scores, symptom scores at baseline were evaluated and were split according to specific symptom domains (i.e., psychological, urogenital, vasomotor, and physical). Results: Findings demonstrated that greater engagement with the Health & Her app for 2-months was associated with greater reductions in symptoms over time. Moreover, daily use of in-app activities and logging symptoms and menstrual periods were each independently associated with symptom reductions. Of the four symptom domains assessed, reporting psychological symptoms at baseline were associated with the greatest reductions in total symptom scores. Conclusions: This study has demonstrated that greater weekly engagement with the app was associated with greater reductions in symptoms. It is recommended that women be made aware of menopause-specific apps, such as that provided by Health & Her, to support them to manage their symptoms

The Health & Her App is Associated with Improved Symptom Outcomes Among 1,900 Menopausal Women

Background: The Health &amp;amp; Her app provides menopausal women with a means of monitoring their symptoms, symptom triggers, and menstrual periods, and enables them to engage in a variety of digital activities designed to promote health and wellbeing. The aim of the present study was to examine whether sustained weekly engagement with the app is associated with improvements in menopausal symptoms. Methods: This quasi-experimental study used routinely collected data provided by 1,900 Health &amp;amp; Her app users across a 2-month period. Symptom change from baseline over a period of up to 2 months was the outcome measure. A linear mixed effects model explored whether app engagement was predictive of symptom changes. Secondary analyses explored whether app-usage factors such as total number of days spent logging symptoms, logging triggers, reporting menstrual periods, and using in-app activities were independently predictive of symptom reductions from baseline. Covariates included HRT (Hormone Replacement Therapy) use, hormonal contraceptive use, present comorbidities, age, and dietary supplement use. To examine which types of symptoms were associated with the largest changes in total symptom scores, symptom scores at baseline were evaluated and were split according to specific symptom domains (i.e., psychological, urogenital, vasomotor, and physical). Results: Findings demonstrated that greater engagement with the Health &amp;amp; Her app for 2-months was associated with greater reductions in symptoms over time. Moreover, daily use of in-app activities and logging symptoms and menstrual periods were each independently associated with symptom reductions. Of the four symptom domains assessed, reporting psychological symptoms at baseline were associated with the greatest reductions in total symptom scores. Conclusions: This study has demonstrated that greater weekly engagement with the app was associated with greater reductions in symptoms. It is recommended that women be made aware of menopause-specific apps, such as that provided by Health &amp;amp; Her, to support them to manage their symptoms.</p