Differential symptom relief profiles of menopausal therapies: an online survey study

Abstract

Background: While there exist safe hormonal and non-hormonal therapeutic interventions for the menopause, their efficacy profiles are not fully characterized. This study sought to use a symptom checklist to examine menopausal symptom relief associated with different treatments.

Methods: An online survey study was conducted between December 2023 and February 2024. Convenience sampling was conducted, with participants recruited via social media, email, through relevant foundations and support groups, and by word-of-mouth. Inclusion criteria were: (1) ≥ 18 years, (2) assigned female at birth, (3) strong comprehension of the English language, and (4) must be currently experiencing symptoms of the menopause or menopause transition. 3330 respondents consented to participate in the study and of these, 91.95% (N = 3062) who had completed at least 88% of the survey were included in the analysis. Symptom relief per treatment (transdermal hormone replacement therapy (HRT), oral HRT, vaginal HRT, antidepressants, testosterone, cognitive behavioral therapy (CBT)/other therapy/counseling) was assessed using the symptoms included in the Menopause-Specific Quality of Life (MENQOL) questionnaire, which measures four symptom domains: vasomotor, psychosocial, physical, and sexual.

Results: Data from a total of 3062 respondents were included for analysis (mean age = 51.97, SD = 5.24). Treatment response rates differed significantly across the domains (vasomotor: F(5,2340) = 204.93, p < 0.001, η² = 0.31; psychosocial: F(5,2340) = 75.12, p < 0.001, η² = 0.14; physical: F(5,2340) = 65.46, p < 0.001, η² = 0.12; sexual: F(5,2340) = 89.34, p < 0.001, η² = 0.16). Transdermal HRT performed better at reducing vasomotor symptoms relative to all other treatment options. Regarding psychosocial symptoms, CBT/other therapy/counseling outperformed all other treatment options. The use of transdermal HRT and testosterone was associated with greater response rates in physical symptoms relative to other treatments. Finally, vaginal HRT and testosterone were associated with significantly higher response rates in sexual symptoms in comparison to all other treatments.

Conclusions: The findings demonstrate differential response rates to menopausal treatments across symptom domains, underscoring the importance of a comprehensive, multidimensional approach to menopausal symptom management. Utilizing a symptom checklist can facilitate the tailoring of treatment plans for specific symptom profiles and patient needs. The outcomes of this study hold considerable implications for improving and shaping treatment guidelines for the menopause.

Keywords: HRT; Hormone replacement therapy; MENQOL; Menopause; Perimenopause; Post-menopause; Symptom relief; Testosterone; Treatment; Women’s health.

Fig. 1

Differential responses to treatment across the MENQOL symptom domains. Shown are pairwise comparisons of treatment options per domain: (A) vasomotor, (B) psychosocial, (C) physical, and (D) sexual. The size of the circles corresponds to the mean response rate across symptoms within a domain, scaled to 0–1 and adjusted for the covariates. Lines represent significant (Bonferroni-adjusted) differences in response rates between treatments. Key. CBT, cognitive behavioral therapy; HRT, hormone replacement therapy; MENQOL, Menopause-Specific Quality of Life Questionnaire

Fig. 2

Treatment response (% responders) for the 29 menopausal symptoms from the Menopause-Specific Quality of Life Questionnaire (MENQOL; grouped by domain) per treatment option. Key. CBT, cognitive behavioral therapy; HRT, hormone replacement therapy