Journal of Midwifery & Women s Health, Journal Year: 2025, Volume and Issue: 70(1), P. 176 - 185
Published: Jan. 1, 2025
Genitourinary syndrome of menopause (GSM) is a cluster symptoms that affect the genitourinary tract during due to decrease in estrogen and androgens.1,2 Symptoms include vulvovaginal dryness, dyspareunia, loss libido, urinary urgency, frequency, nocturia, dysuria, recurrent infections.2 GSM affects 36.8% 81.3% people menopause.3 The most common symptom vaginal which reported 50% 100% tend increase with advancing age time from menopause.2 Treatments for are focused on replacing or restoring secretions tissue integrity. Typical therapies have included use moisturizers estrogen, more recently, clinicians begun using nonestrogen systemic local hormone manage GSM.4 Given lack consensus best treatment approach, Danan colleagues conducted systematic review these evaluate their effectiveness addressing patients' report GSM.5 authors registered protocol PROSPERO searched 3 major databases inception through December 2023. Studies were if they randomized controlled trials (RCTs) at least 8 weeks' duration 20 participants per group. had hormonal interventions available United States treating one GSM; studies also be published English. evaluated dehydroepiandrosterone (DHEA), oxytocin gel, oral selective receptor modulators, testosterone, moisturizers. chose exclude used estrogen. reviewed by 2 reviewers assistance an artificial intelligence system. met inclusion criteria assessed bias Cochrane Risk Bias tool, only low risk some concerns about final review. Authors identified 70 publications 46 unique RCTs 33 requirements quality evidence. total 8602 participants. (n = 16), Canada 6, 5 States), Australia 3), Brazil 2), each Thailand, India, Norway, Europe, Sweden, Iran, Slovakia, South Korea. Two did not location studies. as possible outcomes therapeutic dyspareunia; dryness; discomfort irritation; dysuria; change bothersome symptoms; distress, bother, interference satisfaction treatment; adverse effects treatment. any outcomes. They conduct meta-analyses findings but provide Grading Recommendations Assessment, Development Evaluation (GRADE) statements therapy based evidence support managing symptoms. GRADE certainty below. Sixteen Overall, found improved dryness when compared both placebo no (10 studies; evidence). This provided higher improvement (6 made difference There was significant between Three cream ring; results showed greater ring preparation (moderate evidence) other preparations (low When considering interventions, 17 criteria. Vaginal DHEA (4 caused than (3 Oral uncertain (1 study; very (2 moderate types modulators considered: ospemifene group raloxifene bazedoxifene another dyspareunia high comparing placebo, there discomfort, patient assessing testosterone produced Lastly, 4 treat evidence), (one effect this comprehensive well-designed mixed effective GSM. consistently demonstrated statistically DHEA, raloxifene, bazedoxifene, oxytocin, These treatments approved Food Drug Administration GSM, off-label them purpose. Serious uncommon all treatments. Notable severe case breast cancer 2930) plus groups 664), deep vein thrombosis participant who received 2802). Less serious bleeding, discharge, tenderness estrogen; increased facial hair, voice changes, headaches DHEA; hot flushes candidiasis ospemifene. endometrial hyperplasia among users 1700) 1093). For caring patients experiencing symptoms, provides somewhat confusing results. Among higher-quality trials, potential benefits (vaginal ospemifene, moisturizers) (oral testosterone) may offer benefit insufficient information can help narrow options offered clinicians. Support mixed. And although supports concern continue appropriate option limited effects. Ultimately, need further research into long-term needed. In meantime, should engage shared decision-making explore options. insecurity defined economic social condition access adequate food.1 does necessarily cause hunger, hunger food insecurity.1,2 It estimated 2023, 13.5% households faced insecurity, 12.8% 2022.3 represents 47.4 million living food-insecure households.3 influenced income, employment, disability.2 Paradoxically, has been associated obesity, particularly women high-income countries.4,5 Gender plays important role insecurity; gender minorities likely men experience inequities wages, single-parent status.6,7 Pregnant especially because nutritional demands pregnancy combined gender-based risks being woman minority.8-10 Bell rereview meta-analysis relationship outcomes, specifically physical mental health pregnant person neonatal health.11 interested impact 2008 global recession subsequent lasting poverty insecurity. systems followed Preferred Reporting Items Systematic Reviews Meta-Analyses (PRISMA) guidelines reporting 9 January 1, 2008, November 21, gray literature performed citation chaining (a process researchers reference lists identify additional relevant literature) avoid publication bias. countries (defined having gross national income capita ≥$12,696) eligible inclusion. Included Newcastle-Ottawa scale. All rated medium quality. 25 criteria; 22 peer-reviewed journals graduate theses. cohort 15 prospective 10 retrospective Twenty States, Canada, 1 France Kingdom. Most US Department Agriculture Security Survey Model define tools Meta-analyses outcome evaluating maternal pregnancy, gestational diabetes cesarean birth. odds significantly experienced those (8 ratio [OR], 1.64; 95% CI, 1.37- 1.95). association birth OR, 1.42; 0.78- 2.60). meta-analyses. stress 4.07; 1.22-13.55) mood disorders 2.53; 1.46-4.39) Narrative analysis positive variety such depression, anxiety, could heterogeneity measurement several find mean weight difference, −58.26; −128.02 11.50), small 1.20; 0.88-1.63) large 0.88; 0.70- 1.12). preterm (5 1.18; 0.98-1.42) intensive care unit admission 2.01; 0.85-4.78). diabetes, stress, disorders. conditions Considering well-being newborns, mindful sequalae facing pregnancy. Referring instability community programs improve outcomes.12 valuable policy makers consider importance Women, Infant, Children's program families Addressing substantial portion States. Pelvic floor dysfunction (PFD), includes issues related incontinence, pelvic organ prolapse, chronic pain, involving ligaments, musculature, connective tissues, up 25% 40% States.1,2 PFD mechanical genetic predisposition, body mass index, factors.1-3 Certain characteristics childbirth likelihood instrumental birth, fetal macrosomia, births.2 Notably, PFD, might exacerbate postpartum incontinence commonly postpartum.4 addition medical aspects management, must cope impacts personal relationships, sexual activity, recovery, leisure activities, overall self-confidence.2,4 Peinado et al2 insight prevalence depression anxiety PFDs. fecal prolapse operational definition analysis. Their 54 observational 2000 2023 presented data 632,605 Seventeen remaining 5) China 4). Depression measured study validated instruments; hospital scale (HADS) questionnaire (PHQ-9) frequently instruments. HADS contains 7 items assess depression; it scored maximum 21 points condition. PHQ-9 score 27 assesses presence previous weeks. Other selected Generalized Anxiety Disorder 7-item Beck's Inventory, Edinburgh Postnatal Scale, Center Epidemiologic Composite International Diagnostic Interview Short Form. Diagnosis via self-report history cited Each 7-criteria tool created measuring PFD. Of contributing analysis, 29,844 40,507 indicated diagnostic implemented across how many diagnoses. Data 12 representing pain rate 26.8% 4798; 19.2-34.4). 26 26.3% 346,114; 19.4-33.2). Fecal similar 25.3% 6 14,663; 0.7-49.9). Although 34.9% 297; 24.3–45.6), comprised rates Participants 46.6%. Across individual studies, ranged 3.4% 86%. PFD-related 29.5% 2483; 16.3-42.7), 46.9% 198,491; 39.1-54.6), 28% 355; 13.6-42.4). highlighting limitation Furthermore, type disorder, nor assessments anxiety. measure varied distinction degrees severity health. Despite limitations, captured assessment intervention. Future aim correlate different Additionally, examine correlation changes scores improvements would insights life, gynecologic perinatal providers validate challenges screen regular intervals follow-up visits. management requires investment including commitment behavior modifications recovery surgical procedures. Emotional ongoing advocacy network services essential component individuals
Language: Английский