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

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Martin-Key, Erin L. Funnell, Jakub Tomasik, Sabine Bahn This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4957731/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Aug, 2025 Read the published version in BMC Women's Health → Version 1 posted 13 You are reading this latest preprint version Abstract Background: While there exist safe hormonal and non-hormonal therapeutic interventions for the menopause, their efficacy profiles are not fully characterized. 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, η 2 = 0.31; psychosocial: F (5,2340) = 75.12, p < 0.001, η 2 = 0.14; physical: F (5,2340) = 65.46, p < 0.001, η 2 = 0.12; sexual: F (5,2340) = 89.34, p < 0.001, η 2 = 0.16). Transdermal HRT performed better at reducing vasomotor symptoms relative to all other 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. HRT hormone replacement therapy women’s health menopause perimenopause post-menopause treatment testosterone MENQOL symptom relief Figures Figure 1 Figure 2 Background The menopause is characterized by the permanent halt of menstruation. While it typically occurs naturally between the ages of 44 and 55 years 1 due to declining ovarian follicular activity, 2 the menopause can, for instance, be induced earlier through surgical procedures, medication, or severe illness. 3 The perimenopause, also known as the menopause transition, marks the period preceding natural menopause and is characterized by a decrease in ovarian function, resulting in less frequent menstrual cycles. 4 The post-menopause refers to the period of time after the menopause, when a woman has not had a menstrual cycle for over one year, with women spending approximately one-third of their lifespan in this stage. 5 Projections indicate that by 2025, the global count of post-menopausal women will surpass 1 billion. 6 Despite its ubiquitousness, the symptoms linked to the menopause and its transition can pose significant challenges. Up to 80% of women experience difficulties during this period, and 25% categorize these challenges as severe. 7 Both the perimenopause and post-menopause phases are commonly linked to vasomotor (e.g., hot flushes and night sweats), physical (e.g., tiredness and bone and joint pain), and sexual symptoms (e.g., loss of libido and vaginal dryness during intercourse) that can profoundly affect an individual's quality of life. 8 – 13 Moreover, the menopause, especially during the transitional period, may elevate the risk of mental health issues, 14 including depression and anxiety 15 – 17 and even suicidal ideation. 18 Certainly, the menopause is a complex phase of life encompassing not just physical changes but also notable psychological challenges. Acknowledging the holistic nature of menopausal experiences is essential for delivering comprehensive care. Critically, significant disparities exist in the global availability and licensing of treatment and support options for the menopause. 19 Previous research has indicated that women frequently view their doctors as overly cautious in prescribing hormone-based treatments such as hormone replacement therapy (HRT). 20 – 22 This is likely due to nearly two decades of pervasive, conflicting, and frequently alarming information about menopause treatment reaching healthcare professionals (HCPs) and the wider public. Notably, HRT remains the most effective treatment for vasomotor symptoms 23 and may also help alleviate menopause-related depressive symptoms, 24 , 25 though there is evidence to suggest that these symptoms could get worse after discontinuation. 26 Antidepressants may be a viable treatment option for mood-related menopause symptoms, 27 particularly in those presenting with contraindications for HRT. However, there exists controversy over the frequent use of antidepressants for the reduction of mental health symptoms associated with the menopause. 28 , 29 Furthermore, a recent study examining perceptions of healthcare provision for the menopause in the UK demonstrated that women tend to feel dissatisfied with the management of their treatment options for the menopause, often reporting instances where they had perceived that HCPs had made potentially inappropriate recommendations for antidepressants or other psychiatric medication instead of HRT. 21 These findings suggest that HCPs may be missing opportunities to explain their rationale for selecting antidepressants as a treatment option for menopause, as well as a lack of menopausal women’s awareness regarding the use of antidepressants for the menopause. For those who prefer non-medical treatment choices for the menopause, cognitive behavioral therapy (CBT) has been deemed a viable option and has been seen to target low mood and anxiety, as well as vasomotor symptoms. 30 Notably, findings on the impact of CBT on subjective reports of hot flash frequency have been variable. While some studies have reported reductions in the subjective frequency of hot flashes following CBT, 31 – 34 others have found no significant effect. 33 , 35 In regards to sexual symptoms related to the menopause, testosterone has been shown to significantly enhance sexual function and is recommended by the National Institute for Health and Care Excellence (NICE) guidelines for menopausal women with low libido when HRT alone is ineffective. 36 , 37 Critically, testosterone therapy for women remains a controversial topic, largely due to the limited long-term safety data available. 37 Additionally, most countries only offer formulations designed for men, which can result in women being exposed to supraphysiological blood levels and an increased risk of adverse events. 38 Evidently, more research is needed in order to fully understand the effects of testosterone therapy in menopausal women and its long-term safety profile. Taken together, while evidence supports the efficacy of various menopause treatments, findings are inconsistent across studies, and controversy persists over certain options. Additionally, there is a lack of understanding about women's perceptions of treatment efficacy for specific menopausal symptoms or symptom profiles. This research aimed to address this gap by using a symptom checklist to examine self-reported symptom relief associated with different treatments in a large, multinational sample of menopausal women. The results of this study have significant implications for refining and enhancing treatment guidelines for menopause. Methods Participants Participants were recruited between December 2023 and February 2024 via email, paid Facebook and Instagram advertisements, free posts on the Cambridge Centre for Neuropsychiatric Research Facebook and X (formerly known as Twitter) websites, and Reddit. Recruitment messages were also disseminated by word-of-mouth and through relevant foundations and support groups. Inclusion criteria for the study 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 (e.g., hot flushes, mood changes, night sweats, irregular or absent periods, decreased sex drive). Participants were also required to not be currently pregnant or breastfeeding or to have given birth in the last year. Participants did not have to have sought help for their menopausal symptoms from a HCP or to have used or taken any treatment or support options for the menopause to take part. Materials and procedure An online survey was created using Qualtrics XM®. The survey questions and accompanying study materials were designed in consultation with an experienced psychiatrist (SB). The survey could be completed in 15-20 minutes and was adaptive in nature, such that only relevant questions were asked based on previous responses. For the purpose of the current analysis, only data pertaining to sociodemographic characteristics and symptom relief per treatment option (i.e., transdermal HRT, oral HRT, vaginal HRT, antidepressants, testosterone, and CBT/other type of therapy/counseling) were included. Menopause status was based on the definitions put forth by the Study of Women’s Health Across the Nation (SWAN), 39 whereby participants were required to select which of the following options best described their experience of the menopause: a) early perimenopause stage: significant change in the length of menstrual bleed or the time between periods that is not due to pregnancy or breastfeeding, stress or a medical condition; b) late perimenopause stage: no menstrual bleeding in 3-11 months not due to pregnancy or breastfeeding, stress, or a medical condition, c) post-menopause: no menstrual bleeding in 12 months not due to pregnancy or breastfeeding, stress or a medical condition, or d) medically induced menopause: no menstrual bleeding due to hysterectomy with one or two ovaries retained or other medical procedure. Symptom relief per individual treatment option (current use ≥3months) was assessed using the 29 symptoms included in the Menopause-Specific Quality of Life (MENQOL) 40 questionnaire, which measures four symptom domains: vasomotor, psychosocial, physical, and sexual. For each treatment option, participants were required to select the symptoms that had improved by ticking a box (ticked=yes, not ticked=no). Data analytic strategy Data were processed and analyzed in SPSS version 28.0.1.1. and R 4.3.0. Symptom domain relief scores were calculated by summing the presence of improvements (yes/no) in symptoms pertaining to each domain. Scores were scaled between 0 and 1 for comparability across the four domains. Differences in symptom domain relief scores by treatment option (current use ≥3months) were analyzed using one-way ANCOVAs, with effect sizes reported as eta-squared (η 2 ; small=0.01, medium=0.06, large=0.14). 41 The analysis was adjusted for age, gender, country of residence, menopause status (perimenopause/post-menopause/medically-induced menopause), ethnicity, education, employment, and concurrent use of menopausal treatments (yes/no; number). Pairwise post-hoc comparisons between treatments were adjusted for multiple comparisons using the Bonferroni correction. To account for the potential use of hormonal treatments in respondents that respondents who did not identify as women may have been taking or using concurrently, analyses were repeated excluding those who identified as men, non-binary, and other, and well as those who selected ‘prefer not to answer’. Ethical approval and informed consent The study was approved by the University of Cambridge Psychology Research Ethics Committee (approval number PRE.2023.123). All participants provided informed consent electronically to participate in the study. Results Overview 3330 respondents consented to participants in the study. 91.95% ( N =3062) who had completed at least 88% of the survey were included in the analysis. Respondents’ sociodemographic and treatment characteristics are shown in Table 1. The mean age was 51.97 ( SD =5.24), with the majority of respondents identifying with the female gender (98.76%, n =3024), being white (90.01%, n =2756), having at least an undergraduate degree (69.17%, n =2118), and being in current employment (i.e., full-time, part-time, self-employed; 80.96%, n =2479). 81.16% ( n =2485) of participants had discussed their menopausal symptoms with a HCP. Of these, 76.70% ( n =1906) had been prescribed treatment, with the most common treatment options (i.e., current or past use) being transdermal HRT (69.66%, n =1247), oral HRT (47.43%, n =849), and antidepressants (40.46%, n =726). For an overview of respondents’ concurrent treatment use see Supplementary Figure 1 (Supplementary Information). Table 1. Sociodemographic and treatment characteristics ( N =3062) M (SD) Age 51.97 (5.24) n (%) Gender Woman 3024 (98.76) Man 5 (0.16) Non-binary 20 (0.65) Other 3 (0.10) Prefer not to answer 10 (0.33) Country of residence Australia 508 (16.59) Canada 537 (17.54) New Zealand 508 (16.59) United Kingdom 735 (24.00) United States of America 774 (25.28) Menopause status Perimenopause 1387 (45.30) Post-menopause 1218 (39.78) Medically-induced menopause 457 (14.92) Ethnicity White/Caucasian 2756 (90.01) Asian 48 (1.57) Black/Caribbean/African 22 (0.72) Arab/Middle Eastern/North African descent 7 (0.23) Hispanic/Latinx 43 (1.40) Mixed/multiple 133 (4.34) Other 37 (1.21) I am not sure 2 (0.07) Prefer not to answer 14 (0.46) Education ≤ Primary (up to 11 years) 53 (1.73) Lower secondary (up to 16 years) 240 (7.84) Upper secondary (up to 18 years) 448 (14.63) Undergraduate/college degree (i.e., Bachelors) 1207 (39.42) Postgraduate degree (e.g., Masters, PhD) 911 (29.75) Other 146 (4.77) Prefer not to answer 57 (1.86) Employment a Full-time 1536 (49.84) Part-time 574 (18.75) Self-employed 369 (12.05) Parental leave/caring responsibilities 46 (1.50) Homemaker 268 (8.75) Student 40 (1.31) Voluntary work 86 (2.81) Retired 214 (6.99) Unemployed 112 (3.66) Prefer not to answer 70 (2.29) Seen HCP for menopause symptoms Yes 2485 (81.16) No 577 (18.84) Been prescribed treatment/support for the menopause b Yes 1906 (76.70) No 579 (23.30) Transdermal HRT c Yes, currently using 1025 (57.26) Yes, in the past 222 (12.40) No, never 543 (30.34) Oral HRT c Yes, currently using 564 (31.51) Yes, in the past 285 (15.92) No, never 941 (52.57) Vaginal HRT c Yes, currently using 441 (24.64) Yes, in the past 205 (11.45) No, never 1144 (63.91) Antidepressants c Yes, currently using 432 (24.13) Yes, in the past 294 (16.42) No, never 1064 (59.44) Testosterone c Yes, currently using 226 (12.63) Yes, in the past 94 (5.25) No, never 1470 (82.12) CBT/other therapy/counseling c Yes, currently using 210 (11.73) Yes, in the past 354 (19.78) No, never 1226 (68.49) Length of current transdermal HRT use d Less than 3 months 154 (15.02) 3 – 6 months 140 (13.66) 6 months – 1 year 216 (21.07) 1 – 2 years 284 (27.71) More than 2 years 231 (22.54) Length of current oral HRT use e Less than 3 months 92 (16.37) 3 – 6 months 80 (14.24) 6 months – 1 year 106 (18.86) 1 – 2 years 142 (25.27) More than 2 years 142 (25.27) Length of current vaginal HRT use f Less than 3 months 94 (21.32) 3 – 6 months 66 (14.97) 6 months – 1 year 91 (20.64) 1 – 2 years 90 (20.41) More than 2 years 100 (22.68) Length of current antidepressant use g Less than 3 months 76 (17.59) 3 – 6 months 31 (7.18) 6 months – 1 year 66 (15.28) 1 – 2 years 74 (17.13) More than 2 years 185 (42.82) Length of current testosterone use h Less than 3 months 46 (20.35) 3 – 6 months 41 (18.14) 6 months – 1 year 49 (21.68) 1 – 2 years 44 (19.47) More than 2 years 46 (20.35) Length of current CBT/other therapy/counseling use i Less than 3 months 59 (28.64) 3 – 6 months 31 (15.05) 6 months – 1 year 31 (15.05) 1 – 2 years 32 (15.53) More than 2 years 53 (25.73) Note. CBT, cognitive behavioral therapy; HCP, health care professional; HRT, hormone replacement therapy Key. a Percentages add to more than 100% as participants could select multiple options; b includes those who had visited a HCP for their menopausal symptoms ( n =2485); c includes those who had been prescribed treatment/support for the menopause ( n =1790; 116 respondents selected ‘other’ treatment and were not included); d includes those who were currently using transdermal HRT ( n =1025); e includes those who were currently taking oral HRT ( n =562; missing data from two respondents as they had initially selected ‘past use’ but open-ended responses suggested ongoing use); f includes those who were currently using vaginal HRT ( n =441); g includes those who were currently taking antidepressants ( n =432); h includes those who were currently using testosterone ( n =226); i includes those who were currently using CBT/other therapy/counseling ( n =206; missing data from four respondents as they had initially selected ‘past use’ but open-ended responses suggested ongoing use) [Table 1] Symptom relief An overview of menopausal symptom relief per treatment option is shown in Figure 1 and Supplementary Table 1 (Supplementary Information). Response rates for the treatment options differed significantly across the domains (vasomotor: F (5,2340)=204.93, p <0.001, η 2 =0.31; psychosocial: F (5,2340)=75.12, p <0.001, η 2 =0.14; physical: F (5,2340)=65.46, p <0.001, η 2 =0.12; sexual: F (5,2340)=89.34, p <0.001, η 2 =0.16). [Figure 1] For an overview of Bonferroni-corrected pairwise post-hoc comparisons see Figure 2 and Tables 2 and 3. Regarding vasomotor symptoms, the use of transdermal HRT was associated with greater response rates relative to all other treatment options (all p ≤0.02), while the use of oral HRT was related with higher response rates in comparison to vaginal HRT, antidepressants, testosterone, and CBT/other therapy/counseling (all p ≤0.001). In terms of psychosocial symptoms, CBT/other therapy/counseling outperformed all other treatment options (all p ≤0.001), while both transdermal HRT and antidepressant use were associated with significantly higher response rates in comparison to oral HRT, vaginal HRT, and testosterone (all p <0.001). Oral HRT use was seen to be related with greater response rates for psychosocial symptoms than vaginal HRT ( p <0.001). Testosterone medication was associated with significantly greater response rates for physical symptoms relative to oral HRT, vaginal HRT, antidepressants, and CBT/other therapy/counseling (all p ≤0.01). The use of transdermal and oral HRT were related to significantly higher response rates for physical symptoms in comparison to vaginal HRT, antidepressants, and CBT/other therapy/counseling (all p <0.001), while transdermal HRT was further associated with better response rates for physical symptoms relative to oral HRT ( p <0.001). Finally, in terms of sexual symptoms, vaginal HRT and testosterone were both independently associated with significantly higher response rates in comparison to all other treatment options (all p <0.001). Both transdermal and oral HRT significantly outperformed antidepressants, demonstrating greater response rates for sexual symptoms (all p <0.001), while transdermal HRT use was also associated with significantly greater response rates than oral HRT for sexual symptoms ( p <0.001). In order to account for the potential use of hormonal treatments that respondents who did not identify as women may have been taking or using concurrently, analyses were repeated excluding those who identified as men, non-binary, and other, as well as those who selected ‘prefer not to answer’. All findings from the original analysis remained significant. [Figure 2] Table 2. Mean response rate per treatment for each MENQOL symptom domain (current use ≥3months) MENQOL symptom domain Treatment Mean response rate a 95% CI Vasomotor Transdermal HRT 0.46 0.44 – 0.48 Oral HRT 0.41 0.38 – 0.43 Vaginal HRT 0.05 0.02 – 0.08 Antidepressants 0.04 0.01 – 0.07 Testosterone 0.08 0.04 – 0.12 CBT/other therapy/counseling 0.02 -0.03 – 0.07 Psychosocial Transdermal HRT 0.27 0.25 – 0.28 Oral HRT 0.16 0.14 – 0.18 Vaginal HRT 0.02 0.00 – 0.05 Antidepressants 0.27 0.25 – 0.30 Testosterone 0.17 0.13 – 0.20 CBT/other therapy/counseling 0.37 0.33 – 0.41 Physical Transdermal HRT 0.14 0.13 – 0.15 Oral HRT 0.10 0.09 – 0.11 Vaginal HRT 0.04 0.02 – 0.05 Antidepressants 0.03 0.02 – 0.05 Testosterone 0.14 0.12 – 0.16 CBT/other therapy/counseling 0.02 0.00 – 0.04 Sexual Transdermal HRT 0.14 0.12 – 0.15 Oral HRT 0.08 0.06 – 0.10 Vaginal HRT 0.31 0.29 – 0.34 Antidepressants 0.01 -0.01 – 0.04 Testosterone 0.27 0.24 – 0.30 CBT/other therapy/counseling 0.02 -0.02 – 0.06 Note. CBT, cognitive behavioral therapy; CI, confidence interval; HRT, hormone replacement therapy Key. a Scaled to 0-1 and adjusted for the covariates (age, gender, country of residence, menopause status (perimenopause/post-menopause/medically-induced menopause), ethnicity, education, employment, and concurrent use of menopausal treatment (yes/no; number) Table 3. Mean differences in response rates between treatments per MENQOL symptom domain (current use ≥3months) MENQOL symptom domain Treatment comparisons a Mean difference b 95% CI p Vasomotor Transdermal HRT Oral HRT 0.05 0.00 – 0.10 0.023* Transdermal HRT Vaginal HRT 0.41 0.35 – 0.47 <0.001*** Transdermal HRT Antidepressants 0.42 0.36 – 0.47 <0.001*** Transdermal HRT Testosterone 0.38 0.31 – 0.46 <0.001*** Transdermal HRT CBT/other therapy/counseling 0.44 0.36 – 0.52 <0.001*** Oral HRT Vaginal HRT 0.36 0.30 – 0.42 <0.001*** Oral HRT Antidepressants 0.37 0.30 – 0.43 <0.001*** Oral HRT Testosterone 0.33 0.25 – 0.41 <0.001*** Oral HRT CBT/other therapy/counseling 0.39 0.30 – 0.47 <0.001*** Vaginal HRT Antidepressants 0.01 -0.06 – 0.08 1.000 Vaginal HRT Testosterone -0.03 -0.11 – 0.05 1.000 Vaginal HRT CBT/other therapy/counseling 0.03 -0.06 – 0.11 1.000 Antidepressants Testosterone -0.04 -0.12 – 0.04 1.000 Antidepressants CBT/other therapy/counseling 0.02 -0.07 – 0.11 1.000 Testosterone CBT/other therapy/counseling 0.06 -0.04 – 0.15 1.000 Psychosocial Transdermal HRT Oral HRT 0.11 0.07 – 0.15 <0.001*** Transdermal HRT Vaginal HRT 0.24 0.20 – 0.29 <0.001*** Transdermal HRT Antidepressants 0.00 -0.05 – 0.04 1.000 Transdermal HRT Testosterone 0.10 0.04 – 0.16 <0.001*** Transdermal HRT CBT/other therapy/counseling -0.10 -0.16 – -0.04 <0.001*** Oral HRT Vaginal HRT 0.14 0.09 – 0.18 <0.001*** Oral HRT Antidepressants -0.11 -0.16 – -0.06 <0.001*** Oral HRT Testosterone -0.01 -0.07 – 0.05 <0.001*** Oral HRT CBT/other therapy/counseling -0.21 -0.27 – -0.14 <0.001*** Vaginal HRT Antidepressants -0.25 -0.30 – -0.20 <0.001*** Vaginal HRT Testosterone -0.15 -0.21 – -0.08 <0.001*** Vaginal HRT CBT/other therapy/counseling -0.34 -0.41 – -0.27 <0.001*** Antidepressants Testosterone 0.10 0.04 – 0.17 <0.001*** Antidepressants CBT/other therapy/counseling -0.10 -0.16 – -0.03 0.001** Testosterone CBT/other therapy/counseling -0.20 -0.27 – -0.12 <0.001*** Physical Transdermal HRT Oral HRT 0.04 0.02 – 0.06 <0.001*** Transdermal HRT Vaginal HRT 0.10 0.08 – 0.13 <0.001*** Transdermal HRT Antidepressants 0.11 0.08 – 0.13 <0.001*** Transdermal HRT Testosterone 0.00 -0.03 – 0.03 1.000 Transdermal HRT CBT/other therapy/counseling 0.12 0.09 – 0.16 <0.001*** Oral HRT Vaginal HRT 0.06 0.04 – 0.09 <0.001*** Oral HRT Antidepressants 0.07 0.04 – 0.09 <0.001*** Oral HRT Testosterone -0.04 -0.07 – -0.01 0.006** Oral HRT CBT/other therapy/counseling 0.08 0.04 – 0.12 <0.001*** Vaginal HRT Antidepressants 0.00 -0.03 – 0.03 1.000 Vaginal HRT Testosterone -0.10 -0.14 – -0.07 <0.001*** Vaginal HRT CBT/other therapy/counseling 0.02 -0.02 – 0.05 1.000 Antidepressants Testosterone -0.11 -0.14 – -0.07 <0.001*** Antidepressants CBT/other therapy/counseling 0.02 -0.02 – 0.05 1.000 Testosterone CBT/other therapy/counseling 0.12 0.08 – 0.16 <0.001*** Sexual Transdermal HRT Oral HRT 0.06 0.02 – 0.09 <0.001*** Transdermal HRT Vaginal HRT -0.18 -0.22 – -0.13 <0.001*** Transdermal HRT Antidepressants 0.12 0.08 – 0.16 <0.001*** Transdermal HRT Testosterone -0.13 -0.19 – -0.08 <0.001*** Transdermal HRT CBT/other therapy/counseling 0.12 0.06 – 0.18 <0.001*** Oral HRT Vaginal HRT -0.23 -0.28 – -0.19 <0.001*** Oral HRT Antidepressants 0.07 0.02 – 0.11 <0.001*** Oral HRT Testosterone -0.19 -0.24 – -0.13 <0.001*** Oral HRT CBT/other therapy/counseling 0.06 0.00 – 0.12 0.053 Vaginal HRT Antidepressants 0.30 0.25 – 0.35 <0.001*** Vaginal HRT Testosterone 0.04 -0.02 – 0.10 0.459 Vaginal HRT CBT/other therapy/counseling 0.29 0.23 – 0.36 <0.001*** Antidepressants Testosterone -0.26 -0.32 – -0.19 <0.001*** Antidepressants CBT/other therapy/counseling -0.01 -0.07 – 0.06 1.000 Testosterone CBT/other therapy/counseling 0.25 0.18 – 0.32 <0.001*** Note. CBT, cognitive behavioral therapy; CI, confidence interval; HRT, hormone replacement Key. a Post-hoc pairwise comparisons, subject to the Bonferroni-correction method; b Scaled to 0-1 and adjusted for the covariates (age, gender, country of residence, menopause status (perimenopause/post-menopause/medically-induced menopause), ethnicity, education, employment, and concurrent use of menopausal treatment (yes/no; number); * p <0.05; ** p <0.01; *** p <0.001 [Table 3] Discussion The current study aimed to examine self-reported menopausal symptom relief across various treatment options using a symptom checklist in a large multinational sample of menopausal women. The findings from this research highlight differential response rates to menopausal treatments across various symptom domains, underscoring the necessity of a comprehensive, multidimensional approach to menopausal symptom management. Overall, the outcomes of this study hold considerable implications for improving and shaping treatment guidelines for menopause, promoting a more individualized and effective approach to care that enhances the quality of life for menopausal women worldwide. HCPs may want to prioritize the use of transdermal HRT due to its broad symptom response rates and integrate psychological therapies into menopause management for a more holistic approach. In fact, while transdermal HRT and antidepressant use demonstrated similar response rates for psychosocial symptoms, psychological therapies appeared to be associated with even greater response rates. These therapies not only help address psychosocial symptoms but also empower women to develop new coping strategies and adopt more positive thinking styles, offering benefits beyond those provided by purely biological treatments, both hormonal and non-hormonal. 42 , 43 Critically, in the current study, the use of psychological therapies was relatively low. To improve accessibility, alternative delivery methods such as online platforms or hybrid models that combine both in-person and online sessions could be explored. Research has shown that patients appreciate the independence and empowerment provided by online platforms. 44 Online applications offer the convenience of access from anywhere with an internet connection, which is particularly beneficial for individuals in remote locations or those with limited mobility. 45 Additionally, online psychological therapies allow women to engage in therapy on their own schedules, making it easier for those with busy lifestyles or difficulties attending traditional sessions regularly. 46 The effectiveness of testosterone and vaginal HRT in addressing sexual dysfunction suggests that these treatments could be integral components of care plans for menopausal women experiencing such symptoms. Notably, testosterone appears effective in alleviating both physical and sexual symptoms, making it a valuable option for a comprehensive treatment strategy. However, despite being recognized as a suitable adjunct to menopause care, NICE guidelines lack detailed information on prescribing testosterone, appropriate products and dosages, and monitoring requirements. 27 Furthermore, there is a lack of long-term safety data for use of testosterone for relief of menopausal symptoms, 47 highlighting the need for further research and clearer clinical guidelines. Taken together, expanding treatment plans to include a variety of options may ensure that menopausal women receive tailored care that effectively addresses their specific symptom profiles and preferences. In particular, utilizing a symptom checklist can further enhance the customization of treatment plans by allowing HCPs to accurately identify and address the unique combination of symptoms experienced by each patient. Moreover, completing these checklists prior to appointments could save valuable clinician time, allowing HCPs to focus more on discussing and implementing treatment strategies, as well promoting shared decision-making, rather than the identification of troublesome symptoms. Notably, pre-consultation interventions, such as checklists, have been shown to increase patient satisfaction in healthcare settings. 48 For instance, checklists provide a pragmatic method for identifying issues in post-stroke patients, 49 facilitating referrals to appropriate support services and structuring stroke reviews using a patient-centered approach. Similarly, symptom checklists have been effective in helping clinicians make diagnostic and treatment decisions for primary care patients who report daily cannabis and/or other drug use. 50 By systematically evaluating and tracking symptoms, clinicians can adjust treatments in real-time, ensuring optimal relief and improved patient outcomes. This personalized method not only fosters a more patient-centered approach but is also likely to result in higher levels of satisfaction and adherence to treatment plans. By incorporating symptom checklists and a variety of treatment options, HCPs can deliver more comprehensive and responsive care, ultimately enhancing the quality of life for menopausal women. Limitations The experiences captured in this study may not fully represent the broader populations of the surveyed countries, including ethnic minorities and disadvantaged groups. 51 Additionally, while social media recruitment and online survey delivery were employed to maximize the sample size, this approach likely introduced recruitment bias. For example, individuals with negative experiences of menopausal treatment may have been more inclined to participate. Furthermore, the symptom relief data were self-reported and retrospective, potentially introducing biases and inaccuracies. Additionally, it is worth mentioning that all but one of the symptoms in the MENQOL are negatively worded or presented as unwanted symptoms. It remains unclear whether respondents interpret the remaining item: "a change in sexual desire", as a negative or positive symptom. These factors should be considered when interpreting the findings. Conclusions This study investigated how well different treatments relieve menopausal symptoms across women from multiple countries using a symptom checklist while adjusting for the relevant covariates, with the overall findings highlighting the need for a comprehensive approach to managing menopause symptoms. HCPs should prioritize the use of transdermal HRT for the alleviation of more global menopausal symptoms, while incorporating psychological therapies and vaginal HRT or testosterone as needed for potential psychosocial and sexual symptoms, respectively. Finally, using a menopausal symptom checklist has the potential to facilitate the customization of treatment. Abbreviations CBT: cognitive behavioral therapy HCP: healthcare professional HRT: hormone replacement therapy MENQOL: Menopause-Specific Quality of Life questionnaire NICE: National Institute for Health and Care Excellence SWAN: Study of Women’s Health Across the Nation Declarations Ethics approval and consent to participate The study was approved by the University of Cambridge Psychology Research Ethics Committee (approval number PRE.2023.123). All participants provided informed consent electronically to participate in the study. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests Author SB holds shares in Psyomics Ltd but declares no non-financial competing interests. Author EF is a paid consultant for Psyomics Ltd but declares no non-financial competing interests. Author JT received payment for licensing unrelated research data to Psyomics Ltd. Author NM-K declares no financial or non-financial competing interests. Funding This work was supported by grant 07R-1888 from the Stanley Medical Research Institute. The Stanley Medical Research Institute had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript and decision to submit the manuscript for publication. Authors' contributions Authors NM-K, EF, and JT had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: NM-K, EF, SB. Drafting of the manuscript: All authors. Critical review of the manuscript for important intellectual content: All authors. Statistical analysis: NM-K and JT. 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Glynne S, Newson L. Curb antidepressant use: perimenopausal women may benefit from HRT. BMJ. 2024 Jan 29;384:q220. National Institute for Health and Care Excellence. Clinical knowledge summary. Hormone replacement therapy (HRT). 2022. Available from: https://cks.nice.org.uk/topics/menopause/prescribing-information/hormone-replacement-therapy-hrt/ [Accessed 3 April 2024]. Hunter MS, Liao K-M. Evaluation of a four-session cognitive-behavioral intervention for menopausal hot flushes. Br J Health Psychol . 1996 May;1:113–25. Stefanopoulou E, Hunter MS. Telephone-guided Self-Help Cognitive Behavioural Therapy for menopausal symptoms. Maturitas. 2014 Jan;77(1):73–7. Hardy C, Griffiths A, Norton S, Hunter MS. Self-help cognitive behavior therapy for working women with problematic hot flushes and night sweats (MENOS@Work): a multicenter randomized controlled trial. Menopause. 2018 May;25(5):508–19. Hunter MS, Coventry S, Hamed H, Fentiman I, Grunfeld EA. Evaluation of a group cognitive behavioural intervention for women suffering from menopausal symptoms following breast cancer treatment. Psycho-Oncology. 2009 May;18(5):560–3. Ayers B, Smith M, Hellier J, Mann E, Hunter MS. Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2). Menopause: The Journal of The North American Menopause Society. 2012 Jul;19(7):749–59. Lumsden MA, Davies M, Sarri G; Guideline Development Group for Menopause: Diagnosis and Management (NICE Clinical Guideline No. 23). Diagnosis and Management of Menopause: The National Institute of Health and Care Excellence (NICE) Guideline. JAMA Intern Med. 2016 Aug;176(8):1205-1206. Scott A, Newson L. Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care. British Journal of General Practice. 2020 Mar 26;70(693):203–4. Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. The Lancet Diabetes & Endocrinology. 2019 Jul;7(10). El Khoudary SR, Greendale G, Crawford SL, Avis NE, Brooks MM, Thurston RC, et al. The menopause transition and womenʼs health at midlife. Menopause. 2019 Oct;26(10):1213–27. Hilditch JR, Lewis J, Peter A, van Maris B, Ross A, Franssen E, et al. A menopause-specific quality of life questionnaire: development and psychometric properties. Maturitas. 1996 Jul;24(3):161–75. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. New York: Academic Press; 1988. Spector A, Li Z, He L, Badawy Y, Desai R. The effectiveness of psychosocial interventions on non-physiological symptoms of menopause: A systematic review and meta-analysis. Journal of Affective Disorders. 2024 May 1;352:460–72. Balabanovic J, Ayers B, Hunter MS. Cognitive Behaviour Therapy for Menopausal Hot Flushes and Night Sweats: A Qualitative Analysis of Women’s Experiences of Group and Self-Help CBT. Behavioural and Cognitive Psychotherapy. 2012 Sep 4;41(4):441–57. Knowles SE, Toms G, Sanders C, Bee P, Lovell K, Rennick-Egglestone S, et al. Qualitative Meta-Synthesis of User Experience of Computerised Therapy for Depression and Anxiety. Harris F, editor. PLoS ONE. 2014 Jan 17;9(1):e84323. Kim JH, Yu HJ. The Effectiveness of Cognitive Behavioral Therapy on Depression and Sleep Problems for Climacteric Women: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2024 Jan 15;13(2):412. Martin-Key NA, Spadaro B, Schei TS, Bahn S. Proof-of-Concept Support for the Development and Implementation of a Digital Assessment for Perinatal Mental Health: Mixed Methods Study. Journal of Medical Internet Research. 2021 Jun 4;23(6):e27132. Davis SR, Wahlin-Jacobsen S. Testosterone in women--the clinical significance. The lancet Diabetes & endocrinology. 2015;3(12):980–92. Kinnersley P, Edwards A, Hood K, Ryan R, Prout H, Cadbury N, et al. Interventions before consultations to help patients address their information needs by encouraging question asking: systematic review. BMJ. 2008 Jul 16;337(jul16 1):a485–5. Turner GM, Mullis R, Lim L, Kreit L, Mant J. Using a checklist to facilitate management of long-term care needs after stroke: insights from focus groups and a feasibility study. BMC Family Practice. 2019 Jan 4;20(1). Matson TE, Hallgren KA, Lapham GT, Oliver M, Wang X, Williams EC, et al. Psychometric Performance of a Substance Use Symptom Checklist to Help Clinicians Assess Substance Use Disorder in Primary Care. JAMA network open. 2023 May 26;6(5):e2316283–3. Pershad A, Morris JM, Pace D, Khanna P. Racial disparities in menopausal hormone therapy acceptance: a pilot study. Menopause. 2022 Sep 6;29(11):1263–8. Additional Declarations Competing interest reported. Author SB holds shares in Psyomics Ltd but declares no non-financial competing interests. Author EF is a paid consultant for Psyomics Ltd but declares no non-financial competing interests. Author JT received payment for licensing unrelated research data to Psyomics Ltd. Author NM-K declares no financial or non-financial competing interests. Supplementary Files SupplementaryInformationBMCWH.docx Cite Share Download PDF Status: Published Journal Publication published 04 Aug, 2025 Read the published version in BMC Women's Health → Version 1 posted Editorial decision: Revision requested 02 Jun, 2025 Reviews received at journal 31 May, 2025 Reviewers agreed at journal 30 May, 2025 Reviews received at journal 30 May, 2025 Reviewers agreed at journal 26 May, 2025 Reviewers agreed at journal 22 May, 2025 Reviewers agreed at journal 22 May, 2025 Reviewers agreed at journal 23 Sep, 2024 Reviewers invited by journal 16 Sep, 2024 Editor invited by journal 23 Aug, 2024 Editor assigned by journal 22 Aug, 2024 Submission checks completed at journal 22 Aug, 2024 First submitted to journal 22 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4957731","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":357237236,"identity":"2b77b64b-a07b-4c59-8291-afd348909755","order_by":0,"name":"Nayra A. Martin-Key","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtUlEQVRIiWNgGAWjYHAC9s9/KuCcBKK0sDHwnCFZC28bKVrM2U+nPZCcZyev28D88ANjWxphLZY9udsNDLclG247wGYswdiWQ1iLwYHcDRKJ2w4wbjvAYMbA2FZBhJbzbzdIHJxzwH7bAfZvRGq5kbtNsrHhANAiHpAtxDjsxtvNxgzHkpO3HeYplkg4R4T3Dc7nbnzMUGNnu+14+8YPH8qSCWtBAGYGYiNyFIyCUTAKRgFBAAARjDoz6IN4SAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Cambridge","correspondingAuthor":true,"prefix":"","firstName":"Nayra","middleName":"A.","lastName":"Martin-Key","suffix":""},{"id":357237237,"identity":"f077acdd-bc11-4017-bda9-c6fcce40bed5","order_by":1,"name":"Erin L. Funnell","email":"","orcid":"","institution":"University of Cambridge","correspondingAuthor":false,"prefix":"","firstName":"Erin","middleName":"L.","lastName":"Funnell","suffix":""},{"id":357237238,"identity":"e5bf5401-9ffb-4882-ab2e-b291184babe3","order_by":2,"name":"Jakub Tomasik","email":"","orcid":"","institution":"University of Cambridge","correspondingAuthor":false,"prefix":"","firstName":"Jakub","middleName":"","lastName":"Tomasik","suffix":""},{"id":357237239,"identity":"76692255-3eb4-4da4-a69e-119ee13e7951","order_by":3,"name":"Sabine Bahn","email":"","orcid":"","institution":"University of Cambridge","correspondingAuthor":false,"prefix":"","firstName":"Sabine","middleName":"","lastName":"Bahn","suffix":""}],"badges":[],"createdAt":"2024-08-22 11:35:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4957731/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4957731/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-025-03929-3","type":"published","date":"2025-08-04T15:57:25+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":66676109,"identity":"d74fd6ee-bce9-45f2-83f2-c8f04d046ab3","added_by":"auto","created_at":"2024-10-15 11:13:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":421300,"visible":true,"origin":"","legend":"\u003cp\u003eTreatment response (% responders) for the 29 menopausal symptoms from the Menopause-Specific Quality of Life Questionnaire (MENQOL; grouped by domain) per treatment option. \u003cem\u003e\u003cstrong\u003eKey.\u003c/strong\u003e\u003c/em\u003e CBT, cognitive behavioral therapy; HRT, hormone replacement therapy.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4957731/v1/85caf2f3fef79f7d82b29cb9.png"},{"id":66676111,"identity":"6d111882-76eb-4131-b7dc-74cf01e5e13b","added_by":"auto","created_at":"2024-10-15 11:13:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":133463,"visible":true,"origin":"","legend":"\u003cp\u003eDifferential 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. \u003cem\u003e\u003cstrong\u003eKey.\u003c/strong\u003e\u003c/em\u003e CBT, cognitive behavioral therapy; HRT, hormone replacement therapy; MENQOL, Menopause-Specific Quality of Life Questionnaire.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4957731/v1/1349a9fa8fd303552e335ca4.png"},{"id":88814133,"identity":"8a18bd42-6249-4d91-892b-ec9ff432b46e","added_by":"auto","created_at":"2025-08-11 16:07:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1517259,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4957731/v1/265a534a-aaf8-407b-bc85-e757a241c895.pdf"},{"id":66676584,"identity":"5403ed88-c4ce-4fb4-84ba-68a4856b8611","added_by":"auto","created_at":"2024-10-15 11:21:44","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":168274,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryInformationBMCWH.docx","url":"https://assets-eu.researchsquare.com/files/rs-4957731/v1/afbd90153c2388498976d308.docx"}],"financialInterests":"Competing interest reported. Author SB holds shares in Psyomics Ltd but declares no non-financial competing interests. Author EF is a paid consultant for Psyomics Ltd but declares no non-financial competing interests. Author JT received payment for licensing unrelated research data to Psyomics Ltd. Author NM-K declares no financial or non-financial competing interests.","formattedTitle":"Differential symptom relief profiles of menopausal therapies: an online survey study","fulltext":[{"header":"Background","content":"\u003cp\u003eThe menopause is characterized by the permanent halt of menstruation. While it typically occurs naturally between the ages of 44 and 55 years\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e due to declining ovarian follicular activity,\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e the menopause can, for instance, be induced earlier through surgical procedures, medication, or severe illness.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The perimenopause, also known as the menopause transition, marks the period preceding natural menopause and is characterized by a decrease in ovarian function, resulting in less frequent menstrual cycles.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e The post-menopause refers to the period of time after the menopause, when a woman has not had a menstrual cycle for over one year, with women spending approximately one-third of their lifespan in this stage.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Projections indicate that by 2025, the global count of post-menopausal women will surpass 1\u0026nbsp;billion.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDespite its ubiquitousness, the symptoms linked to the menopause and its transition can pose significant challenges. Up to 80% of women experience difficulties during this period, and 25% categorize these challenges as severe.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Both the perimenopause and post-menopause phases are commonly linked to vasomotor (e.g., hot flushes and night sweats), physical (e.g., tiredness and bone and joint pain), and sexual symptoms (e.g., loss of libido and vaginal dryness during intercourse) that can profoundly affect an individual's quality of life.\u003csup\u003e\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Moreover, the menopause, especially during the transitional period, may elevate the risk of mental health issues,\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e including depression and anxiety\u003csup\u003e\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e and even suicidal ideation.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Certainly, the menopause is a complex phase of life encompassing not just physical changes but also notable psychological challenges. Acknowledging the holistic nature of menopausal experiences is essential for delivering comprehensive care.\u003c/p\u003e \u003cp\u003eCritically, significant disparities exist in the global availability and licensing of treatment and support options for the menopause.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Previous research has indicated that women frequently view their doctors as overly cautious in prescribing hormone-based treatments such as hormone replacement therapy (HRT).\u003csup\u003e\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e This is likely due to nearly two decades of pervasive, conflicting, and frequently alarming information about menopause treatment reaching healthcare professionals (HCPs) and the wider public. Notably, HRT remains the most effective treatment for vasomotor symptoms\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e and may also help alleviate menopause-related depressive symptoms,\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e though there is evidence to suggest that these symptoms could get worse after discontinuation.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAntidepressants may be a viable treatment option for mood-related menopause symptoms,\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e particularly in those presenting with contraindications for HRT. However, there exists controversy over the frequent use of antidepressants for the reduction of mental health symptoms associated with the menopause.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Furthermore, a recent study examining perceptions of healthcare provision for the menopause in the UK demonstrated that women tend to feel dissatisfied with the management of their treatment options for the menopause, often reporting instances where they had perceived that HCPs had made potentially inappropriate recommendations for antidepressants or other psychiatric medication instead of HRT.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e These findings suggest that HCPs may be missing opportunities to explain their rationale for selecting antidepressants as a treatment option for menopause, as well as a lack of menopausal women\u0026rsquo;s awareness regarding the use of antidepressants for the menopause.\u003c/p\u003e \u003cp\u003eFor those who prefer non-medical treatment choices for the menopause, cognitive behavioral therapy (CBT) has been deemed a viable option and has been seen to target low mood and anxiety, as well as vasomotor symptoms.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Notably, findings on the impact of CBT on subjective reports of hot flash frequency have been variable. While some studies have reported reductions in the subjective frequency of hot flashes following CBT,\u003csup\u003e\u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e others have found no significant effect.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e In regards to sexual symptoms related to the menopause, testosterone has been shown to significantly enhance sexual function and is recommended by the National Institute for Health and Care Excellence (NICE) guidelines for menopausal women with low libido when HRT alone is ineffective.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e Critically, testosterone therapy for women remains a controversial topic, largely due to the limited long-term safety data available.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e Additionally, most countries only offer formulations designed for men, which can result in women being exposed to supraphysiological blood levels and an increased risk of adverse events.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e Evidently, more research is needed in order to fully understand the effects of testosterone therapy in menopausal women and its long-term safety profile.\u003c/p\u003e \u003cp\u003eTaken together, while evidence supports the efficacy of various menopause treatments, findings are inconsistent across studies, and controversy persists over certain options. Additionally, there is a lack of understanding about women's perceptions of treatment efficacy for specific menopausal symptoms or symptom profiles. This research aimed to address this gap by using a symptom checklist to examine self-reported symptom relief associated with different treatments in a large, multinational sample of menopausal women. The results of this study have significant implications for refining and enhancing treatment guidelines for menopause.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were recruited between December 2023 and February 2024 via email, paid Facebook and Instagram advertisements, free posts on the Cambridge Centre for Neuropsychiatric Research Facebook and X (formerly known as Twitter) websites, and Reddit. Recruitment messages were also disseminated by word-of-mouth and through relevant foundations and support groups.\u003c/p\u003e\n\u003cp\u003eInclusion criteria for the study were: (1) \u0026ge;18 years, (2) assigned female at birth, (3) strong comprehension of the English language, and (4) must be \u003cem\u003ecurrently\u0026nbsp;\u003c/em\u003eexperiencing symptoms of the menopause or menopause transition (e.g., hot flushes, mood changes, night sweats, irregular or absent periods, decreased sex drive). Participants were also required to not be currently pregnant or breastfeeding or to have given birth in the last year. Participants did not have to have sought help for their menopausal symptoms from a HCP or to have used or taken any treatment or support options for the menopause to take part.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn online survey was created using Qualtrics XM\u0026reg;. The survey questions and accompanying study materials were designed in consultation with an experienced psychiatrist (SB). The survey could be completed in 15-20 minutes and was adaptive in nature, such that only relevant questions were asked based on previous responses. For the purpose of the current analysis, only data pertaining to sociodemographic characteristics and symptom relief per treatment option (i.e., transdermal HRT, oral HRT, vaginal HRT, antidepressants, testosterone, and CBT/other type of therapy/counseling) were included.\u003c/p\u003e\n\u003cp\u003eMenopause status was based on the definitions put forth by the Study of Women\u0026rsquo;s Health Across the Nation (SWAN),\u003csup\u003e39\u0026nbsp;\u003c/sup\u003ewhereby participants were required to select which of the following options best described their experience of the menopause: a) early perimenopause stage: significant change in the length of menstrual bleed or the time between periods that is not due to pregnancy or breastfeeding, stress or a medical condition; b) late perimenopause stage: no menstrual bleeding in 3-11 months not due to pregnancy or breastfeeding, stress, or a medical condition, c) post-menopause: no menstrual bleeding in 12 months not due to pregnancy or breastfeeding, stress or a medical condition, or d) medically induced menopause: no menstrual bleeding due to hysterectomy with one or two ovaries retained or other medical procedure.\u003c/p\u003e\n\u003cp\u003eSymptom relief per individual treatment option (current use \u0026ge;3months) was assessed using the 29 symptoms included in the Menopause-Specific Quality of Life (MENQOL)\u003csup\u003e40\u003c/sup\u003e questionnaire, which measures four symptom domains: vasomotor, psychosocial, physical, and sexual. For each treatment option, participants were required to select the symptoms that had improved by ticking a box (ticked=yes, not ticked=no).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analytic strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were processed and analyzed in SPSS version 28.0.1.1. and R 4.3.0. Symptom domain relief scores were calculated by summing the presence of improvements (yes/no) in symptoms pertaining to each domain. Scores were scaled between 0 and 1 for comparability across the four domains. Differences in symptom domain relief scores by treatment option (current use \u0026ge;3months) were analyzed using one-way ANCOVAs, with effect sizes reported as eta-squared (\u0026eta;\u003csup\u003e2\u003c/sup\u003e; small=0.01, medium=0.06, large=0.14).\u003csup\u003e41\u0026nbsp;\u003c/sup\u003eThe analysis was adjusted for age, gender, country of residence, menopause status (perimenopause/post-menopause/medically-induced menopause), ethnicity, education, employment, and concurrent use of menopausal treatments (yes/no; number). Pairwise post-hoc comparisons between treatments were adjusted for multiple comparisons using the Bonferroni correction.\u003c/p\u003e\n\u003cp\u003eTo account for the potential use of hormonal treatments in respondents that respondents who did not identify as women may have been taking or using concurrently, analyses were repeated excluding those who identified as men, non-binary, and other, and well as those who selected \u0026lsquo;prefer not to answer\u0026rsquo;.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and informed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the University of Cambridge Psychology Research Ethics Committee (approval number PRE.2023.123). All participants provided informed consent electronically to participate in the study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eOverview\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e3330 respondents consented to participants in the study. 91.95% (\u003cem\u003eN\u003c/em\u003e=3062) who had completed at least 88% of the survey were included in the analysis.\u003c/p\u003e\n\u003cp\u003eRespondents\u0026rsquo; sociodemographic and treatment characteristics are shown in Table 1. The mean age was 51.97 (\u003cem\u003eSD\u003c/em\u003e=5.24), with the majority of respondents identifying with the female gender (98.76%, \u003cem\u003en\u003c/em\u003e=3024), being white (90.01%, \u003cem\u003en\u003c/em\u003e=2756), having at least an undergraduate degree (69.17%, \u003cem\u003en\u003c/em\u003e=2118), and being in current employment (i.e., full-time, part-time, self-employed; 80.96%, \u003cem\u003en\u003c/em\u003e=2479).\u003c/p\u003e\n\u003cp\u003e81.16% (\u003cem\u003en\u003c/em\u003e=2485) of participants had discussed their menopausal symptoms with a HCP. Of these, 76.70% (\u003cem\u003en\u003c/em\u003e=1906) had been prescribed treatment, with the most common treatment options (i.e., current or past use) being transdermal HRT (69.66%, \u003cem\u003en\u003c/em\u003e=1247), oral HRT (47.43%, \u003cem\u003en\u003c/em\u003e=849), and antidepressants (40.46%, \u003cem\u003en\u003c/em\u003e=726). For an overview of respondents\u0026rsquo; concurrent treatment use see Supplementary Figure 1 (Supplementary Information).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Sociodemographic and treatment characteristics (\u003cem\u003eN\u003c/em\u003e=3062)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.78369384359401%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"70.21630615640599%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eM\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e51.97 (5.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.78369384359401%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"70.21630615640599%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"5\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eWoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e3024 (98.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eMan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e5 (0.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eNon-binary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e20 (0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e3 (0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003ePrefer not to answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e10 (0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"5\"\u003e\n \u003cp\u003eCountry of residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eAustralia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e508 (16.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eCanada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e537 (17.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eNew Zealand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e508 (16.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eUnited Kingdom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e735 (24.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eUnited States of America\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e774 (25.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"3\"\u003e\n \u003cp\u003eMenopause status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003ePerimenopause\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e1387 (45.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003ePost-menopause\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\" valign=\"top\"\u003e\n \u003cp\u003e1218 (39.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eMedically-induced menopause\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\" valign=\"top\"\u003e\n \u003cp\u003e457 (14.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"9\"\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eWhite/Caucasian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e2756 (90.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eAsian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e48 (1.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eBlack/Caribbean/African\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e22 (0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eArab/Middle Eastern/North African descent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e7 (0.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eHispanic/Latinx\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e43 (1.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eMixed/multiple\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e133 (4.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e37 (1.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eI am not sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e2 (0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003ePrefer not to answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e14 (0.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"7\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003e\u0026le; Primary (up to 11 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e53 (1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eLower secondary (up to 16 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e240 (7.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eUpper secondary (up to 18 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e448 (14.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eUndergraduate/college degree (i.e., Bachelors)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e1207 (39.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003ePostgraduate degree (e.g., Masters, PhD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e911 (29.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e146 (4.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003ePrefer not to answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e57 (1.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"10\"\u003e\n \u003cp\u003eEmployment \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eFull-time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e1536 (49.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003ePart-time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e574 (18.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e369 (12.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eParental leave/caring responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e46 (1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eHomemaker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e268 (8.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e40 (1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eVoluntary work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e86 (2.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e214 (6.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e112 (3.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003ePrefer not to answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e70 (2.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"2\"\u003e\n \u003cp\u003eSeen HCP for menopause symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e2485 (81.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e577 (18.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"2\"\u003e\n \u003cp\u003eBeen prescribed treatment/support for the menopause \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e1906 (76.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e579 (23.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"3\"\u003e\n \u003cp\u003eTransdermal HRT \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eYes, currently using\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e1025 (57.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eYes, in the past\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e222 (12.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eNo, never\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e543 (30.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"3\"\u003e\n \u003cp\u003eOral HRT \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eYes, currently using\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e564 (31.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eYes, in the past\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e285 (15.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eNo, never\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e941 (52.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"3\"\u003e\n \u003cp\u003eVaginal HRT \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eYes, currently using\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e441 (24.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eYes, in the past\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e205 (11.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eNo, never\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e1144 (63.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"3\"\u003e\n \u003cp\u003eAntidepressants \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eYes, currently using\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e432 (24.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eYes, in the past\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e294 (16.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eNo, never\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e1064 (59.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"3\"\u003e\n \u003cp\u003eTestosterone \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eYes, currently using\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e226 (12.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eYes, in the past\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e94 (5.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eNo, never\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e1470 (82.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"3\"\u003e\n \u003cp\u003eCBT/other therapy/counseling \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eYes, currently using\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e210 (11.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eYes, in the past\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e354 (19.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eNo, never\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e1226 (68.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"5\"\u003e\n \u003cp\u003eLength of current transdermal HRT use \u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eLess than 3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e154 (15.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e3 \u0026ndash; 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e140 (13.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e6 months \u0026ndash; 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e216 (21.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e1 \u0026ndash; 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e284 (27.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eMore than 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e231 (22.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"5\"\u003e\n \u003cp\u003eLength of current oral HRT use \u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eLess than 3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e92 (16.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e3 \u0026ndash; 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e80 (14.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e6 months \u0026ndash; 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e106 (18.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e1 \u0026ndash; 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e142 (25.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eMore than 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e142 (25.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"5\"\u003e\n \u003cp\u003eLength of current vaginal HRT use \u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eLess than 3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e94 (21.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e3 \u0026ndash; 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e66 (14.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e6 months \u0026ndash; 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e91 (20.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e1 \u0026ndash; 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e90 (20.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eMore than 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e100 (22.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"5\"\u003e\n \u003cp\u003eLength of current antidepressant use \u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eLess than 3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e76 (17.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e3 \u0026ndash; 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e31 (7.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e6 months \u0026ndash; 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e66 (15.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e1 \u0026ndash; 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e74 (17.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eMore than 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e185 (42.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"5\"\u003e\n \u003cp\u003eLength of current testosterone use \u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eLess than 3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e46 (20.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e3 \u0026ndash; 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e41 (18.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e6 months \u0026ndash; 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e49 (21.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e1 \u0026ndash; 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e44 (19.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eMore than 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e46 (20.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.833333333333332%\" rowspan=\"5\"\u003e\n \u003cp\u003eLength of current CBT/other therapy/counseling use \u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.833333333333336%\"\u003e\n \u003cp\u003eLess than 3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e59 (28.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e3 \u0026ndash; 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e31 (15.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e6 months \u0026ndash; 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e31 (15.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003e1 \u0026ndash; 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e32 (15.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.49406175771971%\"\u003e\n \u003cp\u003eMore than 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.50593824228029%\"\u003e\n \u003cp\u003e53 (25.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNote.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eCBT, cognitive behavioral therapy; HCP, health care professional; HRT, hormone replacement therapy\u0026nbsp;\u003cbr\u003e\u003cstrong\u003e\u003cem\u003eKey.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003ePercentages add to more than 100% as participants could select multiple options; \u003csup\u003eb\u0026nbsp;\u003c/sup\u003eincludes those who had visited a HCP for their menopausal symptoms (\u003cem\u003en\u003c/em\u003e=2485); \u003csup\u003ec\u0026nbsp;\u003c/sup\u003eincludes those who had been prescribed treatment/support for the menopause (\u003cem\u003en\u003c/em\u003e=1790; 116 respondents selected \u0026lsquo;other\u0026rsquo; treatment and were not included); \u003csup\u003ed\u003c/sup\u003e includes those who were currently using transdermal HRT (\u003cem\u003en\u003c/em\u003e=1025); \u003csup\u003ee\u003c/sup\u003e includes those who were currently taking oral HRT (\u003cem\u003en\u003c/em\u003e=562; missing data from two respondents as they had initially selected \u0026lsquo;past use\u0026rsquo; but open-ended responses suggested ongoing use); \u003csup\u003ef\u003c/sup\u003e includes those who were currently using vaginal HRT (\u003cem\u003en\u003c/em\u003e=441); \u003csup\u003eg\u003c/sup\u003e includes those who were currently taking antidepressants (\u003cem\u003en\u003c/em\u003e=432); \u003csup\u003eh\u003c/sup\u003e includes those who were currently using testosterone (\u003cem\u003en\u003c/em\u003e=226);\u003csup\u003e\u0026nbsp;i\u003c/sup\u003e includes those who were currently using CBT/other therapy/counseling (\u003cem\u003en\u003c/em\u003e=206; missing data from four respondents as they had initially selected \u0026lsquo;past use\u0026rsquo; but open-ended responses suggested ongoing use)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e[Table 1]\u003c/em\u003e\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSymptom relief\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn overview of menopausal symptom relief per treatment option is shown in Figure 1 and Supplementary Table 1 (Supplementary Information). Response rates for the treatment options differed significantly across the domains (vasomotor: \u003cem\u003eF\u003c/em\u003e(5,2340)=204.93, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001, \u0026eta;\u003csup\u003e2\u003c/sup\u003e=0.31; psychosocial: \u003cem\u003eF\u003c/em\u003e(5,2340)=75.12, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001, \u0026eta;\u003csup\u003e2\u003c/sup\u003e=0.14; physical: \u003cem\u003eF\u003c/em\u003e(5,2340)=65.46, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001, \u0026eta;\u003csup\u003e2\u003c/sup\u003e=0.12; sexual: \u003cem\u003eF\u003c/em\u003e(5,2340)=89.34, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001, \u0026eta;\u003csup\u003e2\u003c/sup\u003e=0.16).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e[Figure 1]\u003cbr\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cbr\u003eFor an overview of Bonferroni-corrected pairwise post-hoc comparisons see Figure 2 and Tables 2 and 3. Regarding vasomotor symptoms, the use of transdermal HRT was associated with greater response rates relative to all other treatment options (all \u003cem\u003ep\u003c/em\u003e\u0026le;0.02), while the use of oral HRT was related with higher response rates in comparison to vaginal HRT, antidepressants, testosterone, and CBT/other therapy/counseling (all \u003cem\u003ep\u003c/em\u003e\u0026le;0.001).\u003c/p\u003e\n\u003cp\u003eIn terms of psychosocial symptoms, CBT/other therapy/counseling outperformed all other treatment options (all \u003cem\u003ep\u003c/em\u003e\u0026le;0.001), while both transdermal HRT and antidepressant use were associated with significantly higher response rates in comparison to oral HRT, vaginal HRT, and testosterone (all \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001). Oral HRT use was seen to be related with greater response rates for psychosocial symptoms than vaginal HRT (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eTestosterone medication was associated with significantly greater response rates for physical symptoms relative to oral HRT, vaginal HRT, antidepressants, and CBT/other therapy/counseling (all \u003cem\u003ep\u003c/em\u003e\u0026le;0.01). The use of transdermal and oral HRT were related to significantly higher response rates for physical symptoms in comparison to vaginal HRT, antidepressants, and CBT/other therapy/counseling (all \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), while transdermal HRT was further associated with better response rates for physical symptoms relative to oral HRT (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eFinally, in terms of sexual symptoms, vaginal HRT and testosterone were both independently associated with significantly higher response rates in comparison to all other treatment options (all \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001). Both transdermal and oral HRT significantly outperformed antidepressants, demonstrating greater response rates for sexual symptoms (all \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001), while transdermal HRT use was also associated with significantly greater response rates than oral HRT for sexual symptoms (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eIn order to account for the potential use of hormonal treatments that respondents who did \u003cem\u003enot\u003c/em\u003e identify as women may have been taking or using concurrently, analyses were repeated excluding those who identified as men, non-binary, and other, as well as those who selected \u0026lsquo;prefer not to answer\u0026rsquo;. All findings from the original analysis remained significant. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e[Figure 2]\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eMean response rate per treatment for each MENQOL symptom domain (current use \u0026ge;3months)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMENQOL symptom domain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean response rate \u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" rowspan=\"6\"\u003e\n \u003cp\u003eVasomotor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e0.44 \u0026ndash; 0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.38 \u0026ndash; 0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.02 \u0026ndash; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.01 \u0026ndash; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.04 \u0026ndash; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e-0.03 \u0026ndash; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" rowspan=\"6\"\u003e\n \u003cp\u003ePsychosocial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e0.25 \u0026ndash; 0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.14 \u0026ndash; 0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.00 \u0026ndash; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.25 \u0026ndash; 0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.13 \u0026ndash; 0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.33 \u0026ndash; 0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" rowspan=\"6\"\u003e\n \u003cp\u003ePhysical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e0.13 \u0026ndash; 0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.09 \u0026ndash; 0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.02 \u0026ndash; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.02 \u0026ndash; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.12 \u0026ndash; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.00 \u0026ndash; 0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" rowspan=\"6\"\u003e\n \u003cp\u003eSexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e0.12 \u0026ndash; 0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.06 \u0026ndash; 0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.29 \u0026ndash; 0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e-0.01 \u0026ndash; 0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.24 \u0026ndash; 0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e-0.02 \u0026ndash; 0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNote.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eCBT, cognitive behavioral therapy; CI, confidence interval; HRT, hormone replacement therapy\u003cbr\u003e\u003cstrong\u003e\u003cem\u003eKey.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eScaled to 0-1 and adjusted for the covariates (age, gender, country of residence, menopause status (perimenopause/post-menopause/medically-induced menopause), ethnicity, education, employment, and concurrent use of menopausal treatment (yes/no; number)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eMean differences in response rates between treatments per MENQOL symptom domain (current use \u0026ge;3months)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.307820299500833%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMENQOL symptom domain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.60066555740433%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment comparisons \u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.9783693843594%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean difference \u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.133111480865225%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.980033277870216%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.307820299500833%\" rowspan=\"15\"\u003e\n \u003cp\u003eVasomotor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.302828618968388%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.29783693843594%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.9783693843594%\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.133111480865225%\"\u003e\n \u003cp\u003e0.00 \u0026ndash; 0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.980033277870216%\"\u003e\n \u003cp\u003e0.023*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.35 \u0026ndash; 0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.36 \u0026ndash; 0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.31 \u0026ndash; 0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.36 \u0026ndash; 0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.30 \u0026ndash; 0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.30 \u0026ndash; 0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.25 \u0026ndash; 0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.30 \u0026ndash; 0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.06 \u0026ndash; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.11 \u0026ndash; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.06 \u0026ndash; 0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.12 \u0026ndash; 0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.07 \u0026ndash; 0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.04 \u0026ndash; 0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.307820299500833%\" rowspan=\"15\"\u003e\n \u003cp\u003ePsychosocial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.302828618968388%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.29783693843594%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.9783693843594%\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.133111480865225%\"\u003e\n \u003cp\u003e0.07 \u0026ndash; 0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.980033277870216%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.20 \u0026ndash; 0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.05 \u0026ndash; 0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.04 \u0026ndash; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.16 \u0026ndash; -0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.09 \u0026ndash; 0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.16 \u0026ndash; -0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.07 \u0026ndash; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.27 \u0026ndash; -0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.30 \u0026ndash; -0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.21 \u0026ndash; -0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.41 \u0026ndash; -0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.04 \u0026ndash; 0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.16 \u0026ndash; -0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.27 \u0026ndash; -0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.307820299500833%\" rowspan=\"15\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePhysical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.302828618968388%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.29783693843594%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.9783693843594%\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.133111480865225%\"\u003e\n \u003cp\u003e0.02 \u0026ndash; 0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.980033277870216%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.08 \u0026ndash; 0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.08 \u0026ndash; 0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.03 \u0026ndash; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.09 \u0026ndash; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.04 \u0026ndash; 0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.04 \u0026ndash; 0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.07 \u0026ndash; -0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e0.006**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.04 \u0026ndash; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.03 \u0026ndash; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.14 \u0026ndash; -0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.02 \u0026ndash; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.14 \u0026ndash; -0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.02 \u0026ndash; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.08 \u0026ndash; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.307820299500833%\" rowspan=\"15\"\u003e\n \u003cp\u003eSexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.302828618968388%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.29783693843594%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.9783693843594%\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.133111480865225%\"\u003e\n \u003cp\u003e0.02 \u0026ndash; 0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.980033277870216%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.22 \u0026ndash; -0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.08 \u0026ndash; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.19 \u0026ndash; -0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTransdermal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.06 \u0026ndash; 0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.28 \u0026ndash; -0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.02 \u0026ndash; 0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.24 \u0026ndash; -0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eOral HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.00 \u0026ndash; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.25 \u0026ndash; 0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.02 \u0026ndash; 0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eVaginal HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.23 \u0026ndash; 0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.32 \u0026ndash; -0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e-0.07 \u0026ndash; 0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.611001964636543%\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.147347740667975%\"\u003e\n \u003cp\u003eCBT/other therapy/counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.324165029469548%\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.772102161100197%\"\u003e\n \u003cp\u003e0.18 \u0026ndash; 0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.145383104125736%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNote.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eCBT, cognitive behavioral therapy; CI, confidence interval; HRT, hormone replacement\u003cbr\u003e\u003cstrong\u003e\u003cem\u003eKey.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003ePost-hoc pairwise comparisons, subject to the Bonferroni-correction method; \u003csup\u003eb\u0026nbsp;\u003c/sup\u003eScaled to 0-1 and adjusted for the covariates (age, gender, country of residence, menopause status (perimenopause/post-menopause/medically-induced menopause), ethnicity, education, employment, and concurrent use of menopausal treatment (yes/no; number); * \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05; ** \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01; *** \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e[Table 3]\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study aimed to examine self-reported menopausal symptom relief across various treatment options using a symptom checklist in a large multinational sample of menopausal women. The findings from this research highlight differential response rates to menopausal treatments across various symptom domains, underscoring the necessity of a comprehensive, multidimensional approach to menopausal symptom management. Overall, the outcomes of this study hold considerable implications for improving and shaping treatment guidelines for menopause, promoting a more individualized and effective approach to care that enhances the quality of life for menopausal women worldwide.\u003c/p\u003e \u003cp\u003eHCPs may want to prioritize the use of transdermal HRT due to its broad symptom response rates and integrate psychological therapies into menopause management for a more holistic approach. In fact, while transdermal HRT and antidepressant use demonstrated similar response rates for psychosocial symptoms, psychological therapies appeared to be associated with even greater response rates. These therapies not only help address psychosocial symptoms but also empower women to develop new coping strategies and adopt more positive thinking styles, offering benefits beyond those provided by purely biological treatments, both hormonal and non-hormonal.\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e Critically, in the current study, the use of psychological therapies was relatively low. To improve accessibility, alternative delivery methods such as online platforms or hybrid models that combine both in-person and online sessions could be explored. Research has shown that patients appreciate the independence and empowerment provided by online platforms.\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e Online applications offer the convenience of access from anywhere with an internet connection, which is particularly beneficial for individuals in remote locations or those with limited mobility.\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e Additionally, online psychological therapies allow women to engage in therapy on their own schedules, making it easier for those with busy lifestyles or difficulties attending traditional sessions regularly.\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe effectiveness of testosterone and vaginal HRT in addressing sexual dysfunction suggests that these treatments could be integral components of care plans for menopausal women experiencing such symptoms. Notably, testosterone appears effective in alleviating both physical and sexual symptoms, making it a valuable option for a comprehensive treatment strategy. However, despite being recognized as a suitable adjunct to menopause care, NICE guidelines lack detailed information on prescribing testosterone, appropriate products and dosages, and monitoring requirements.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Furthermore, there is a lack of long-term safety data for use of testosterone for relief of menopausal symptoms,\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e highlighting the need for further research and clearer clinical guidelines.\u003c/p\u003e \u003cp\u003eTaken together, expanding treatment plans to include a variety of options may ensure that menopausal women receive tailored care that effectively addresses their specific symptom profiles and preferences. In particular, utilizing a symptom checklist can further enhance the customization of treatment plans by allowing HCPs to accurately identify and address the unique combination of symptoms experienced by each patient. Moreover, completing these checklists prior to appointments could save valuable clinician time, allowing HCPs to focus more on discussing and implementing treatment strategies, as well promoting shared decision-making, rather than the identification of troublesome symptoms.\u003c/p\u003e \u003cp\u003eNotably, pre-consultation interventions, such as checklists, have been shown to increase patient satisfaction in healthcare settings.\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e For instance, checklists provide a pragmatic method for identifying issues in post-stroke patients,\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e facilitating referrals to appropriate support services and structuring stroke reviews using a patient-centered approach. Similarly, symptom checklists have been effective in helping clinicians make diagnostic and treatment decisions for primary care patients who report daily cannabis and/or other drug use.\u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e By systematically evaluating and tracking symptoms, clinicians can adjust treatments in real-time, ensuring optimal relief and improved patient outcomes. This personalized method not only fosters a more patient-centered approach but is also likely to result in higher levels of satisfaction and adherence to treatment plans. By incorporating symptom checklists and a variety of treatment options, HCPs can deliver more comprehensive and responsive care, ultimately enhancing the quality of life for menopausal women.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe experiences captured in this study may not fully represent the broader populations of the surveyed countries, including ethnic minorities and disadvantaged groups.\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e Additionally, while social media recruitment and online survey delivery were employed to maximize the sample size, this approach likely introduced recruitment bias. For example, individuals with negative experiences of menopausal treatment may have been more inclined to participate. Furthermore, the symptom relief data were self-reported and retrospective, potentially introducing biases and inaccuracies. Additionally, it is worth mentioning that all but one of the symptoms in the MENQOL are negatively worded or presented as unwanted symptoms. It remains unclear whether respondents interpret the remaining item: \"a change in sexual desire\", as a negative or positive symptom. These factors should be considered when interpreting the findings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study investigated how well different treatments relieve menopausal symptoms across women from multiple countries using a symptom checklist while adjusting for the relevant covariates, with the overall findings highlighting the need for a comprehensive approach to managing menopause symptoms. HCPs should prioritize the use of transdermal HRT for the alleviation of more global menopausal symptoms, while incorporating psychological therapies and vaginal HRT or testosterone as needed for potential psychosocial and sexual symptoms, respectively. Finally, using a menopausal symptom checklist has the potential to facilitate the customization of treatment.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCBT: cognitive behavioral therapy\u003c/p\u003e\n\u003cp\u003eHCP: healthcare professional\u003c/p\u003e\n\u003cp\u003eHRT: hormone replacement therapy\u003c/p\u003e\n\u003cp\u003eMENQOL: Menopause-Specific Quality of Life questionnaire\u003c/p\u003e\n\u003cp\u003eNICE: National Institute for Health and Care Excellence\u003c/p\u003e\n\u003cp\u003eSWAN: Study of Women\u0026rsquo;s Health Across the Nation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the University of Cambridge Psychology Research Ethics Committee (approval number PRE.2023.123). All participants provided informed consent electronically to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor SB holds shares in Psyomics Ltd but declares no non-financial competing interests. Author EF is a paid consultant for Psyomics Ltd but declares no non-financial competing interests. Author JT received payment for licensing unrelated research data to Psyomics Ltd. Author NM-K declares no financial or non-financial competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by grant 07R-1888 from the Stanley Medical Research Institute. The Stanley Medical Research Institute had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript and decision to submit the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors NM-K, EF, and JT had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: NM-K, EF, SB. Drafting of the manuscript: All authors. Critical review of the manuscript for important intellectual content: All authors. Statistical analysis: NM-K and JT. Obtained funding: SB.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eHardy C, Hunter MS, Griffiths A. Menopause and work: an overview of UK guidance. Occupational Medicine. 2018 Dec;68(9):580\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. \u003cem\u003eWorld Health Report 2008: Women, Ageing and Health: A Framework for Action.\u0026nbsp;\u003c/em\u003e2008.\u003cem\u003e\u0026nbsp;\u003c/em\u003eAvailable from:\u003cem\u003e\u0026nbsp;\u003c/em\u003ehttps://apps.who.int/iris/bitstream/handle/10665/43810/9789241563529_eng.pdf [Accessed 24 March 2024].\u003c/li\u003e\n \u003cli\u003eHoga L, Rodolpho J, Gon\u0026ccedil;alves B, Quirino B. Womenʼs experience of menopause: a systematic review of qualitative evidence. 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Self-help cognitive behavior therapy for working women with problematic hot flushes and night sweats (MENOS@Work): a multicenter randomized controlled trial. Menopause. 2018 May;25(5):508\u0026ndash;19.\u003c/li\u003e\n \u003cli\u003eHunter MS, Coventry S, Hamed H, Fentiman I, Grunfeld EA. Evaluation of a group cognitive behavioural intervention for women suffering from menopausal symptoms following breast cancer treatment. Psycho-Oncology. 2009 May;18(5):560\u0026ndash;3.\u003c/li\u003e\n \u003cli\u003eAyers B, Smith M, Hellier J, Mann E, Hunter MS.\u0026nbsp;Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2). Menopause: The Journal of The North American Menopause Society. 2012 Jul;19(7):749\u0026ndash;59.\u003c/li\u003e\n \u003cli\u003eLumsden MA, Davies M, Sarri G; Guideline Development Group for Menopause: Diagnosis and Management (NICE Clinical Guideline No. 23). Diagnosis and Management of Menopause: The National Institute of Health and Care Excellence (NICE) Guideline.\u0026nbsp;JAMA Intern Med. 2016 Aug;176(8):1205-1206.\u003c/li\u003e\n \u003cli\u003eScott A, Newson L. Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care. British Journal of General Practice. 2020 Mar 26;70(693):203\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eIslam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. The Lancet Diabetes \u0026amp; Endocrinology. 2019 Jul;7(10).\u003c/li\u003e\n \u003cli\u003eEl Khoudary SR, Greendale G, Crawford SL, Avis NE, Brooks MM, Thurston RC, et al. The menopause transition and womenʼs health at midlife. Menopause. 2019 Oct;26(10):1213\u0026ndash;27.\u003c/li\u003e\n \u003cli\u003eHilditch JR, Lewis J, Peter A, van Maris B, Ross A, Franssen E, et al. A menopause-specific quality of life questionnaire: development and psychometric properties. Maturitas. 1996 Jul;24(3):161\u0026ndash;75.\u003c/li\u003e\n \u003cli\u003eCohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. New York: Academic Press; 1988.\u003c/li\u003e\n \u003cli\u003eSpector A, Li Z, He L, Badawy Y, Desai R. The effectiveness of psychosocial interventions on non-physiological symptoms of menopause: A systematic review and meta-analysis. Journal of Affective Disorders. 2024 May 1;352:460\u0026ndash;72.\u003c/li\u003e\n \u003cli\u003eBalabanovic J, Ayers B, Hunter MS. Cognitive Behaviour Therapy for Menopausal Hot Flushes and Night Sweats: A Qualitative Analysis of Women\u0026rsquo;s Experiences of Group and Self-Help CBT. Behavioural and Cognitive Psychotherapy. 2012 Sep 4;41(4):441\u0026ndash;57.\u003c/li\u003e\n \u003cli\u003eKnowles SE, Toms G, Sanders C, Bee P, Lovell K, Rennick-Egglestone S, et al. Qualitative Meta-Synthesis of User Experience of Computerised Therapy for Depression and Anxiety.\u0026nbsp;Harris F, editor. PLoS ONE. 2014 Jan 17;9(1):e84323.\u003c/li\u003e\n \u003cli\u003eKim JH, Yu HJ. The Effectiveness of Cognitive Behavioral Therapy on Depression and Sleep Problems for Climacteric Women: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2024 Jan 15;13(2):412.\u003c/li\u003e\n \u003cli\u003eMartin-Key NA, Spadaro B, Schei TS, Bahn S. Proof-of-Concept Support for the Development and Implementation of a Digital Assessment for Perinatal Mental Health: Mixed Methods Study. Journal of Medical Internet Research. 2021 Jun 4;23(6):e27132.\u003c/li\u003e\n \u003cli\u003eDavis SR, Wahlin-Jacobsen S. Testosterone in women--the clinical significance. The lancet Diabetes \u0026amp; endocrinology. 2015;3(12):980\u0026ndash;92.\u003c/li\u003e\n \u003cli\u003eKinnersley P, Edwards A, Hood K, Ryan R, Prout H, Cadbury N, et al. Interventions before consultations to help patients address their information needs by encouraging question asking: systematic review. BMJ. 2008 Jul 16;337(jul16 1):a485\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003eTurner GM, Mullis R, Lim L, Kreit L, Mant J. Using a checklist to facilitate management of long-term care needs after stroke: insights from focus groups and a feasibility study. BMC Family Practice. 2019 Jan 4;20(1).\u003c/li\u003e\n \u003cli\u003eMatson TE, Hallgren KA, Lapham GT, Oliver M, Wang X, Williams EC, et al. Psychometric Performance of a Substance Use Symptom Checklist to Help Clinicians Assess Substance Use Disorder in Primary Care. JAMA network open. 2023 May 26;6(5):e2316283\u0026ndash;3.\u003c/li\u003e\n \u003cli\u003ePershad A, Morris JM, Pace D, Khanna P. Racial disparities in menopausal hormone therapy acceptance: a pilot study. Menopause. 2022 Sep 6;29(11):1263\u0026ndash;8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HRT, hormone replacement therapy, women’s health, menopause, perimenopause, post-menopause, treatment, testosterone, MENQOL, symptom relief","lastPublishedDoi":"10.21203/rs.3.rs-4957731/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4957731/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eWhile there exist safe hormonal and non-hormonal therapeutic interventions for the menopause, their efficacy profiles are not fully characterized. To use a symptom checklist to examine menopausal symptom relief associated with different treatments.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eAn 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)\u0026thinsp;\u0026ge;\u0026thinsp;18 years, (2) assigned female at birth, (3) strong comprehension of the English language, and (4) must be \u003cem\u003ecurrently\u003c/em\u003e experiencing symptoms of the menopause or menopause transition. 3330 respondents consented to participate in the study and of these, 91.95% (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;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.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eData from a total of 3062 respondents were included for analysis (mean age\u0026thinsp;=\u0026thinsp;51.97, SD\u0026thinsp;=\u0026thinsp;5.24). Treatment response rates differed significantly across the domains (vasomotor: \u003cem\u003eF\u003c/em\u003e(5,2340)\u0026thinsp;=\u0026thinsp;204.93, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.31; psychosocial: \u003cem\u003eF\u003c/em\u003e(5,2340)\u0026thinsp;=\u0026thinsp;75.12, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.14; physical: \u003cem\u003eF\u003c/em\u003e(5,2340)\u0026thinsp;=\u0026thinsp;65.46, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.12; sexual: \u003cem\u003eF\u003c/em\u003e(5,2340)\u0026thinsp;=\u0026thinsp;89.34, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.16). Transdermal HRT performed better at reducing vasomotor symptoms relative to all other 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.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e","manuscriptTitle":"Differential symptom relief profiles of menopausal therapies: an online survey study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-15 11:13:39","doi":"10.21203/rs.3.rs-4957731/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-02T09:28:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-31T16:43:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96237122696611367721769972271411643324","date":"2025-05-30T18:11:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-30T16:17:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213038657554017362620473217727792495579","date":"2025-05-26T14:24:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88198519843291117015945862527927118693","date":"2025-05-23T00:03:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51508894906211294529075583891785568009","date":"2025-05-22T09:56:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2487581021814370237998067796497635960","date":"2024-09-23T08:08:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-16T14:18:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-08-23T06:24:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-23T00:06:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-23T00:03:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2024-08-22T11:34:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4f15b59d-fe67-4b7a-8585-1cca61b7e2ca","owner":[],"postedDate":"October 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-11T16:00:54+00:00","versionOfRecord":{"articleIdentity":"rs-4957731","link":"https://doi.org/10.1186/s12905-025-03929-3","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2025-08-04 15:57:25","publishedOnDateReadable":"August 4th, 2025"},"versionCreatedAt":"2024-10-15 11:13:39","video":"","vorDoi":"10.1186/s12905-025-03929-3","vorDoiUrl":"https://doi.org/10.1186/s12905-025-03929-3","workflowStages":[]},"version":"v1","identity":"rs-4957731","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4957731","identity":"rs-4957731","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}