Cultural Barriers Influencing Midwives’ Sexual Conversation with Menopausal Women

( Talat Khadivzadeh ),( Masumeh Ghazanfarpour ),( Robab Latifnejad Roudsari ) 대한폐경학회 2018 대한폐경학회지 Vol.24 No.3

Objectives: The present study aimed to determine the barriers influencing the sexual conversation. Methods: In this descriptive cross-sectional study, 200 midwives were selected through convenience sampling method from private and public clinics in Mashhad, North East of Iran. A self-structured questionnaire was used to collect the study data. Results: The mean age of subjects was 39.58 ± 8.12 years with 13.49 ± 7.59 years of work experience. A number of cultural conditions act as an inhibitory force for the midwives to address sexual issues with menopausal women. Menopausal women visit a doctor at the acute stage when emotional and physical problems make sexual discussion difficult for the midwives (86.5%). Other related causes for not having proper sexual conversation were insufficient knowledge (51.4%), inadequate education provided via public media through health providers (83.5%), midwives or their patient’s shame (51.5%), and attempt to get help from traditional healers, friends, relatives and supplicants instead of midwifery staff (78.5%). Also, we found that sexual workshops, communication workshops, and work experiences had a significant influence in changing the views of midwives. Conclusions: Cultural barriers prevent the patients and providers from communicating effectively with each other, thus highlighting the need for sexual and communication workshops for the health care providers. (J Menopausal Med 2018;24:210-216)

Effect of Fennel on the Health Status of Menopausal Women: A Systematic and Meta-analysis

( Talat Khadivzadeh ),( Mona Najaf Najafi ),( Leila Kargarfard ),( Masumeh Ghazanfarpour ),( Fatemeh Rajab Dizavandi ),( Imaneh Khorsand ) 대한폐경학회 2018 대한폐경학회지 Vol.24 No.1

Objectives: The aim of the present study is the systematic and critical investigation of the effectiveness of fennel on the climacteric symptoms among menopausal females. Methods: A search of the trials studying the effect of fennel on menopausal females was conducted in 2017 using the MEDLINE and Scopus databases and the Cochrane Library with the following keywords: fennel, Foeniculum vulgare, and menopause. Results: Fennel combined with officinalis is more effective in the attenuating of sleep disorders compared to Citalopram. The comparison of these two groups regarding the mean bone mineral density and bone mineral content (P = 0.14, P = 0.504); the total hip femoral (P = 0.42, P = 0.66); the trochanter (P = 0.075, P = 0.07); the intertrochanter (P = 0.84, P = 0.93); and the femoral neck (P = 0.43, P = 0.64) did not show any significant statistical differences; however, a statistically significant difference regarding the vasomotor symptoms (P < 0.01) was found. The other significant differences are related to the values of the total cholesterol (P = 0.103); low-density lipoprotein cholesterol, or LDL-C (P = 0.104); high-density lipoprotein cholesterol, or HDL-C (P = 0.266); triglyceride (P = 0.679); body weight (P = 0.212); body mass index (P = 0.041); waist and hip circumferences (P = 0.365); and fat distribution (P = 0.337) between the two groups. The standardized mean difference (SMD) values of sexual activity (SMD = 0.638; P < 0.001), and maturation value (SMD = 0.601; P = 0.003) are highly significant among the fennel-treated women compared with the placebo group. Conclusions: According to the findings of the present study, fennel is important in the relieving of vasomotor symptoms, vaginal itching, dryness, dyspareunia, sexual function, sexual satisfaction, and sleep distribution. (J Menopausal Med 2018;24:67-74)

Aromatherapy for Sexual Problems in Menopausal Women: A Systematic Review and Meta-analysis

( Talat Khadivzadeh ),( Mona Najaf Najafi ),( Masumeh Ghazanfarpour ),( Morvarid Irani ),( Fatemeh Rajab Dizavandi ),( Khatereh Shariati ) 대한폐경학회 2018 대한폐경학회지 Vol.24 No.1

Objectives: The aim of the present systematic review and meta-analysis is the exploration of the potential evidence of the effectiveness of aromatherapy products on the sexual function of menopausal women. Methods: From inception to December 2017, the search process was performed using the MEDLINE and Scopus databases and the Cochrane Library regarding the trials on the effectiveness of herbal-medicine aromatherapy on the sexual function of menopausal women. Results: Three of the trials comprise suitable data for inclusion in the meta-analysis. According to the meta-analysis, it is possible to improve the standardized mean difference (SMD) of the sexual desire up to 0.56 in the aromatherapy group compared with the control group (SMD = 0.56; P < 0.001; heterogeneity; I² = 42%; P = 0.141). According to one of the trials, the serum-estrogen level of two different doses did not change in the neroli oil inhalation group compared with the almond-oil group. Conclusions: Both aromatherapy with neroli oil or lavender (monopreparation) and combined-oil aromatherapy with lavender, fennel, geranium, and rose significantly improved human sexual function; however, a significant change of the serum-estrogen level was not detected. The findings of the present review should be presented cautiously because of the corresponding limitations such as the lack of a standardized tool, the lack of intention-to-treat reporting, the low study amount, and the short-term follow-up. (J Menopausal Med 2018;24:56-61)

A Systematic Review and Meta-analysis on the Effect of Herbal Medicine to Manage Sleep Dysfunction in Periand Postmenopause

( Talat Khadivzadeh ),( Somayeh Abdolahian ),( Masumeh Ghazanfarpour ),( Leila Kargarfard ),( Fatemeh Rajab Dizavandi ),( Imaneh Khorsand ) 대한폐경학회 2018 대한폐경학회지 Vol.24 No.2

Objectives: Some conventional medications used to treat insomnia, such as benzodiazepine, non-benzodiazepine, and hormone therapy, are associated with side effects. Therefore, there is a growing interest in the use of herbal medicine. The aim of this systematic review is to assess the effects herbal medicines have on sleep disorders of peri- and postmenopausal women. Methods: Three databases were searched including MEDLINE, Scopus, and the Cochrane Library from inception to March 2018. Results: Six trials assessed the effect of soy on sleep disorders. Forrest plot for 2 studies showed that the standardized mean difference (SMD) of the sleep problems was lower in the soy group than the placebo group (SMD = -0.996; P < 0.001; 95% confidence interval, -1.42 to -0.563). Three trials showed soy had no significant effect on sleep disorders and one study showed a positive effect on sleep disorders. Accordingly, it is difficult to reach a definite conclusion regarding the effects of soy on sleep disorders based on these findings. According to a trial, significant beneficial effect associated with taking Schisandra chinensis. Findings suggested that some herbal medicines like red clover, lavender combined with bitter orange and pin bark extract had attenuating effects on sleep disorders. After intake of 530 mg of valerian twice a day for one month, statistically significant effects were observed regarding the quality of sleep of postmenopausal women. Conclusions: The present systematic review and meta-analysis found inadequate evidence to draw conclusions regarding the effectiveness of herbal medications, especially soy. (J Menopausal Med 2018;24:92-99)

Sexual Disharmony in Menopausal Women and Their Husband: A Qualitative Study of Reasons, Strategies, and Ramifications

( Masumeh Ghazanfarpour ),( Talat Khadivzadeh ),( Robab Latifnejad Roudsari ) 대한폐경학회 2018 대한폐경학회지 Vol.24 No.1

Objectives: The goal of this study was to explore perceptions and experiences of general practitioners and midwives during sexual dialogue with menopausal women. Methods: In a descriptive exploratory qualitative study, 13 midwives and 12 general practitioners were selected using a semi-structured interview and purposive sampling method. Data analysis was conducted using qualitative content analysis adopted by Graneheim and Lundman. Results: Through data analysis “sexual disharmony” emerged as a central theme, which included three categories of reasons, strategies, and ramifications of sexual disharmony. Reasons for sexual disharmony included subcategories of aging and health related-problems, marital problems, and stereotypical perceptions regarding menopause and sexuality and daily concerns. Strategies used by couples to address sexual disharmony consisted of changing roles and values, pretending to reach orgasm, suppressing sexual desire, meeting sexual needs of husbands in accordance with religious rules, seeking help of peers, seeking friends or traditional medicine and health providers, seeking a help charmer, engaging in sex with other women to fulfill sexual needs, pretending to be moody to alleviate sexual tension. Sexual disharmony may lead to spending money on a prostitute instead of engaging in sex out of wedlock or a surge in social pathologies such as sexually transmitted disease. Conclusions: Healthcare providers must be aware of various sexual behavior of menopausal women and their husbands when they detect sexual disharmony in their patients. Results of this study can facilitate development of restricted guidelines for sexual discussion with menopausal women. (J Menopausal Med 2018;24:41-49)

The Effect of Foeniculum Vulgare (Fennel) on Body Composition in Postmenopausal Women with Excess Weight: A Double-blind Randomized Placebo-controlled Trial

( Nafiseh Saghafi ),( Masumeh Ghazanfarpour ),( Talat Khadivzadeh ),( Masoudeh Babakhanian ),( Maliheh Afiat ) 대한폐경학회 2017 대한폐경학회지 Vol.23 No.3

Objectives: The goal of this study was to evaluate the effect of fennel on body composition. Methods: This study is a secondary analysis of a double-blind, randomized, placebo-controlled trial. Fifty-four out of 60 patients were able to successfully complete the original study. Seven out of 54 patients were excluded because they were not overweight and obese. Thus, 47 women were included in this secondary analysis. Of these 47 women, 22 were in the fennel group and 25 were in placebo group. Body weight, body mass index (BMI) as well as fat distribution was measured at the baseline and after a three-month follow-up. Results: Comparison of fennel and placebo groups did not reveal any significant effect in terms of body weight, BMI, waist and hip circumferences and fat distribution. Also, the results of paired t-test did not variation of these parameters across groups before and after 12-week treatment. Conclusions: Menopausal women in fennel group experienced a slight increase in body weight and fat distribution, which was not significant. Further studies with larger sample sizes are recommended to validate the results of this study. (J Menopausal Med 2017;23:166-171)

The Effect of Short-term Treatment with Fennel on Bone Density in Postmenopausal Women: A Randomized Controlled Trial

( Masumeh Ghazanfarpour ),( Elham Amini ),( Talat Khadivzadeh ),( Masoudeh Babakhanian ),( Bahareh Nouri ),( Hassan Rakhshandeh ),( Maliheh Afiat ) 대한폐경학회 2017 대한폐경학회지 Vol.23 No.2

Objectives: The goal of this study is to assess the effect of fennel on bone density. Methods: This was a double-blind, randomized, placebo-controlled trial, which studied sixty eligible postmenopausal women, who were randomly assigned to fennel and placebo groups. Then, the dual energy X-ray absorptiometry was utilized to measure bone mineral density (BMD) and bone mineral content (BMC) of the spine, femoral neck, intertrochanter, and trochanter at the baseline and after three-month follow-up. Results: The mean BMD and BMC at lumbar spine (P = 0.14, P = 0.504), total hip femoral (P = 0.427, P = 0.471), trochanter (P = 0.075, P = 0.07), intertrochanter, (P = 0.864, P = 0.932) and femoral neck (P = 0.439, P = 0.641) was not significantly different between the fennel and placebo groups. Conclusions: The results of this study did not approve the effect of fennel on bone density in post-menopausal women. However, to gain deeper insights, further studies with longer durations and larger sample sizes are recommended. (J Menopausal Med 2017;23:124-130)

Effect of Lavender on Sleep, Sexual Desire, Vasomotor, Psychological and Physical Symptom among Menopausal and Elderly Women: A Systematic Review

Nasibeh Roozbeh,Masumeh Ghazanfarpour,Talat Khadivzadeh,Leila Kargarfard,Fatemeh Rajab Dizavandi,Khatereh Shariati 대한폐경학회 2019 대한폐경학회지 Vol.25 No.2

Objectives: The present systematic review was conducted to compare the effect of lavender on the quality of sleep, sexual desire, and vasomotor, psychological and physical symptoms among menopausal and elderly women. Methods: There were five electronic databases which selected to search respective articles which included were Scopus, PubMed, Web of Science, Google Scholar, and the Cochrane Library without any language restriction since the study inception to March 10, 2018. The quality of studies was assessed in accordance with a jaded scale. Results: According to three trials, the lavender as utilized in a capsule form or aromatherapy could significantly improve the measured Pittsburgh Sleep Quality Index score (P < 0.05) in the menopausal and elderly women. The aromatherapy with lavender improved sexual function (P < 0.001), depression (P < 0.001), anxiety (P < 0.001), and physical (P < 0.001) symptoms. Based on a trial, 66.7%, 70.0%, and 53.3% of subjects reported feelings of relaxation, happiness, and cleanness effects of having used lavender respectively. Conclusions: The results suggested the effectiveness of the use of lavender either in capsule form or aromatherapy on the improved quality of sleep, depression, anxiety, sexual desire, and psychological and physical symptoms. These results, however, should be interpreted with caution considering the limitations of the study.

Effect of Aromatherapy on the Treatment of Psychological Symptoms in Postmenopausal and Elderly Women: A Systematic Review and Meta-analysis

( Masoudeh Babakhanian ),( Masumeh Ghazanfarpour ),( Leila Kargarfard ),( Nasibeh Roozbeh ),( Leili Darvish ),( Talat Khadivzadeh ),( Fatemeh Rajab Dizavandi ) 대한폐경학회 2018 대한폐경학회지 Vol.24 No.2

Objectives: To critically assess the effect of aromatherapy on the psychological symptoms as noted in the postmenopausal and elderly women. Methods: Three following databases were systematically searched: MEDLINE, Scopus and Cochrane Library (Cochrane Central Register of Controlled Trials) from inception to January 2018. The search keywords included ‘menopause’ AND (aromatherapy), without language restrictions. Results: In this study, 4 trials were included which fit into our systematic review. The findings demonstrated that the aromatherapy massage have significantly improved psychological symptoms in menopausal and elderly women as compared to the control group (standardized mean difference [SMD] = -1.24; 95% confidence interval, -0.188 to -0.606; P < 0.001 random effect model; 3 trials, moderate to high heterogeneity, I2 = 0.76; P = 0.028). According to 1 of the trials, the aromatherapy oil massage was no more effective than the untreated group regarding their experience of symptoms such as nervousness. Conclusions: The aromatherapy may be beneficial in attenuating the psychological symptoms that these women may experience, such as anxiety and depression, but it is not considered as an effective treatment to manage nervousness symptom among menopausal women. This finding should be observed in light of study limitations. (J Menopausal Med 2018;24:127-132)

Effect of Isoflavones and Genistein on Glucose Metabolism in Peri- and Post-Menopausal Women: An Overview of Meta-Analysis

Afiat Maliehe,Sara Ghahremani,Sara Kharghani,Masumeh Ghazanfarpour,Khatereh Shariati,Maryam Kazemi,Talat Khadivzadeh 대한폐경학회 2019 대한폐경학회지 Vol.25 No.2

The purpose of the present overview of meta-analysis is to summarize and critically assess the effect of isoflavones and genistein on glucose metabolism among the peri- and post-menopausal women. Two independent authors searched the databases of MEDLINE, Scopus and Cochrane Library for meta-analysis. Three databases were searched from inception to January 2018. Methodological quality of each meta-analysis of randomized controlled trials was evaluated using the AMSTAR (a measurement tool used to assess systematic reviews). Four meta-analyses were included to the current overview. Fasting insulin levels and homeostatic model assessment of insulin resistance (HOMA-IR) values were significantly lower in peri-menopausal and postmenopausal. Two meta-analyses showed that treatment with isoflavones could not alter fasting blood glucose. However, one meta-analysis depicted that isoflavones significantly improved blood glucose levels in non-Asian postmenopausal women. Treatment with genistein could have significant beneficial effects on fasting insulin, blood glucose and HOMA-IR in comparison to the control group. Regardless of the population, the treatment with genistein is effective in improving fasting insulin, HOMA-IR and glucose levels. Nevertheless, the high heterogeneity among studies and poor methodology of reviews made it difficult to draw a definite conclusion on the positive impacts of soy on glucose metabolism.