Menopause is the point in a woman’s life when her periods stop; this typically happens around the age of 51 but it can happen much earlier for a small number of women. Perimenopause is defined as the time around the menopause when a person might experience symptoms such as hot flushes, ‘brain fog’, mood swings, feeling tired, aches and pains, or symptoms like repeated urinary tract infections (UTIs). Due to a combination of there being so many different symptoms and there not being a test that doctors can use to diagnose perimenopause, it can be difficult for them to tell if someone is experiencing it. Women might be being diagnosed with other conditions incorrectly such as anxiety and depression, or Long Covid. It also means that we do not know how many people experience perimenopause.
We plan to use the Clinical Practice Research Datalink database which contains an anonymised proportion of GP records to work out how many people have been diagnosed with perimenopause, how many people have been started on treatment for perimenopause, and how many people might have perimenopause based on the symptoms that they have. We plan to see how much these people are using NHS resources such as GP appointments and medications. This will be useful to doctors who need to diagnose perimenopause, researchers hoping to research it, and those who allocate NHS resources to understand how common perimenopause it is and how much money it costs when people are or are not diagnosed with it.
Perimenopause is the time around menopause (often many years) that may be associated with a range of symptoms including vasomotor symptoms, cognitive impairment, mood changes, fatigue, urogenital symptoms, and low libido. The breadth of these symptoms, their often extended chronological incidence, and the lack of a gold standard diagnostic test means that precise prevalence rates are not known. This study aims to describe the prevalence of perimenopause and to estimate resource utilisation and costs associated with the condition. This will be achieved by considering four groups of people (three cohorts and one control group) who have differing likelihood of a diagnosis of perimenopause.
The study will be conducted in the Clinical Practice Research Datalink (CPRD) dataset linked to the Office of National Statistics Index of Multiple Deprivation dataset. Three cohorts of patients of acceptable research quality will be selected from CPRD AURUM and CPRD Gold datasets included by:
1) frank diagnosis,
2) proxy diagnosis based on prescription history,
3) proxy diagnosis based on an algorithm related to presenting symptoms.
Point prevalence will be calculated for each group from 2004-2021. Patients will be matched by primary care practice, age, gender and current practice registration to controls without a frank or proxy diagnosis. Primary care contacts and medication prescriptions will be costed using standard NHS tariffs. Rates will be compared between groups and with non-exposed controls using Poisson distribution and associated costs will be compared using the Gamma distribution. Prevalence rates by each method will be compared by ethnicity and indices of material deprivation. For those patients selected by the proxy of symptom combinations, alternate diagnoses in their patient history will be summarised. This study will provide valuable data to inform clinical practice and healthcare decision making.
Prevalence of perimenopause based on frank diagnosis measures; prevalence of perimenopause based on proxy measure of prescriptions of hormone replacement therapy; prevalence of perimenopause based on proxy measure of symptoms; prevalence of a selected group of differential diagnoses that are clinically similar to symptoms of perimenopause (including change in menstrual cycle, vasomotor symptoms such as hot flushes, new mental health issues such as anxiety or depression, new cognitive issues such as ‘brain fog’, new muscle or joint pains, or new genitourinary symptoms such as recurrent UTIs); primary care contacts; primary care prescriptions; primary care costs; primary care prescription costs.
Yvette Pyne - Chief Investigator - University of Bristol
Yvette Pyne - Corresponding Applicant - University of Bristol
Abigail Fraser - Collaborator - University of Bristol
Brendan Delaney - Collaborator - Imperial College London
Christopher Morgan - Collaborator - Pharmatelligence Limited t/a Human Data Sciences
Patient Level Index of Multiple Deprivation