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Health Services Research & Development

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HSR&D In Progress

September 2022

In This Issue: Women's Health Research

»Table of Contents

Improving Healthcare for Women Veterans: Addressing Menopause and Mental Health

Feature Article


Takeaway: Unaddressed menopause symptoms can contribute to significant healthcare burden, impacting health risk behaviors, chronic health conditions, and mental health concerns. This research will provide an innovative model to help inform the development of resources and interventions for integrated menopause-related care, and will help providers offer effective, gender-sensitive care during women's midlife period.


Women in midlife face increased health risks related to menopause—a period of biological, hormonal, and social change characterized by often-disruptive menopause symptoms. Unaddressed menopause symptoms contribute to significant healthcare burden as they impact health risk behaviors, chronic health conditions, and mental health concerns.

Although little is known about women Veterans' experience of menopause and menopause-related care, almost half of women Veteran VA users are in midlife, with prevalent risk factors for disruptive menopause symptoms and a high rate of medical and mental health comorbidities. This research will answer key questions about depression, anxiety, and PTSD risk during the menopause transition, and will help clarify the experiences, care needs, and care preferences of midlife women Veterans. Specifically, this ongoing study (June 2018–May 2023) aims to:

  • Describe women Veterans' experience of menopause symptoms, and associations between menopause symptom burden and mental health.
  • Examine patient and provider preferences, experiences, and practices seeking and receiving menopause-related care in VA.
  • Develop a Veteran-focused tool to activate self-management of menopause symptoms in the VA setting.

Methods

Study investigators will survey women Veterans aged 45 to 64 enrolled in the VA San Francisco Health Care System to assess their menopause status, menopause symptoms, and current depression, anxiety, and PTSD symptoms. Survey data will be linked to electronic health records, and any associations between self-reported and diagnosed menopause symptoms and treatments, mental health concerns, and medical comorbidities will be identified. The study will also use semi-structured phone interviews with VA primary care providers and women Veterans recruited from gender-specific and general primary care settings in the national Women's Health Practice-Based Research Network to examine preferences, experiences, and practices in menopause-related care. Study findings will inform the development of a VA-tailored, menopause-focused psychoeducation and symptom tracking tool.

Findings

Menopause symptom burden is a novel risk factor for chronic pain and higher-risk patterns of opioid use. In addition, researchers found the following:

  • Racial and ethnic differences in menopause symptom management.
  • Limitations in VA screening for military sexual trauma.
  • High rates of cannabis use to manage menopause symptoms.
  • A desire for increased patient-provider communication and peer support around menopause symptoms and menopause-related health and mental health changes.
  • Associations between trauma and trauma-related sequelae with menopausal symptoms, genitourinary symptoms (i.e., urgency with urination, recurrent UTIs), sexual dysfunction, and clinical insomnia.

Impacts

  • Study findings have been used to inform the design and development of a mobile application to guide and promote collaborative self-management of menopause symptoms among women Veterans.
  • Findings have also supported a Congressional report on the prevalence of intimate partner violence among Veterans.
  • In addition, findings have been used to develop a hybrid algorithm to classify menopause status for research and operations for national VA resources (currently available in the COVID-19 Shared Data Resource and CIPHER phenotype library).

Principal Investigator: Carolyn J. Gibson, PhD, MPH, is an HSR&D Career Development Awardee and is part of the VA San Francisco Health Care System.

Publications

Gibson C, Li Y, Huang A, et al. Menopausal symptoms and higher risk opioid prescribing in a national sample of women Veterans with chronic pain. Journal of General Internal Medicine. October 1, 2019;34(10):2159–2166.

Blanken A, Gibson C, Li Y, et al. Racial/ethnic disparities in the diagnosis and management of menopause symptoms among midlife women veterans. Menopause. July 1, 2022;29(7):877–882.

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