Healthcare usage and prevalence of menopause symptoms

Medically documented menopausal symptoms result in a significant increased burden of disease and use of healthcare in Israel, according to a real-world analysis in the International Journal of Women’s Health.

The retrospective cohort study also found that those with menopausal symptoms were much more likely to undergo hysterectomy within 1 year of diagnosis.

The computerized databases of Maccabi Healthcare Services (MHS), a large nationwide healthcare insurer-provider, were used to identify female MHS members, aged 45 to 54, with at least two diagnoses for general menopausal and postmenopausal disorders in their electronic medical records between 2010 and 2015.

Women with a prior cancer diagnosis were excluded.

In the 17,406 included women, the cumulative incidence of menopausal symptoms was 8%.

Symptomatic perimenopausal and postmenopausal women, particularly those under age 52, were more likely to exhibit comorbid conditions like depression (6.1% vs. 5.0%), anxiety (6.5% vs. 4.7%) and insomnia (2.0% vs. 1.3%) (all P < 0.001) in the year following the index date, compared to women with no reported menopausal symptoms.

“Correspondingly, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors and hypnotic drug use were significantly higher in symptomatic women,” wrote the Israeli authors.

The analysis also concluded that symptomatic women were significantly more likely to use healthcare for hospitalization (odds ratio [OR] = 1.10; 95% confidence interval [CI] 1.00 to 1.20); primary care visits (OR = 1.90; 95% CI: 1.73 to 2.08); gyn visits (OR = 24.84; 95% CI: 22.36 to 27.59) and hysterectomy procedures (OR = 2.26; 95% CI: 1.63 to 3.14).

The authors noted that the high proportion of women visiting physicians (8.4 visits annually among symptomatic women) may be due to easily accessible cost-free ambulatory medical services in Israel.

The low number of gyns with a subspecialty in menopause might also cause women to shift from one physician to another to seek appropriate care.

On the other hand, compared to women with no menopausal disorders, symptomatic women had a lower prevalence of smoking (12.4% vs. 14.0%; P < 0.001); diabetes mellitus (3.7% vs. 4.9%; P < 0.001); hypertension (15.4% vs. 16.2%, P = 0.031) and osteoporosis (2.4% vs. 3.4%; P < 0.001).

The annual direct per-person costs of menopausal symptoms in Israel in 2015 are comparable to the $248 calculated in the United States, according to the authors.

Lack of patient knowledge about the natural process of menopause and lifestyle interventions are two major challenges to symptom control. “Management strategies should include empowering women to participate in their care that will improve their sense of control and overall care,” wrote the authors.

Along with empowerment, exercise and diet are important, including isoflavones, calcium and vitamin D, which may favorably impact menopausal symptoms, quality of life, and sexual health.

The authors noted the burden of disease is expected to rise further in response to an increased awareness and social acceptance of perimenopausal and postmenopausal symptoms.

“Better education on menopause for physicians and effective communication between healthcare providers and patients can help to better manage menopausal symptoms,” they wrote. “There is an urgent need for doctors who specialize in menopause in order to help reduce the burden of unnecessary physician visits.”

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Reference

1. Moser SS, Chodick G, Bar-On S, Shalev V. Healthcare utilization and prevalence of symptoms in women with menopause: a real-world analysis. Int J Womens Health. 2020;12:445-454. doi:10.2147/IJWH.S246113