Abstract
Objective
Digital programs dedicated to supporting patients with menopause can provide access to evidence-based information and menopause experts. This analysis evaluated the change in menopause symptom severity before and after using a digital health program.
Methods
A pre/posttest study design was used to examine the impact of a digital health program for menopause over three months. Descriptive statistics and bivariate tests were used to evaluate the change in symptom scores on the Menopause Rating Scale and to evaluate users’ self-reported impact of the digital health program.
Results
After three months, the total Menopause Rating Scale score and the scores for each of the subscales (somatic, psychological, and urogenital) were significantly reduced (p < 0.001 for each). By domain, psychological scores were most reduced, followed by somatic scores, and urogenital scores. Further, 92.2% (166/180) of users experienced a statistically significant reduction in the severity of at least one menopause symptom after three months. On average, the severity score of each symptom was also statistically significantly reduced. Most often, users reported that the program helped them: learn what to expect during menopause and their options for managing symptoms (68.3%, 123/180), advocate for themselves with providers (33.9%, 61/180), and manage their physical symptoms (31.1%, 56/180).
Conclusions
Use of the digital menopause program was associated with improved menopause symptoms. This improvement may be driven by changes in menopause-related knowledge and behaviors.
Introduction
Up to 80% of women develop menopause symptoms, with marked variation in both type and severity of symptoms. 1 People who experience menopause symptoms have lower health-related quality of life, greater work impairment, and higher health care utilization compared to people of the same age who do not experience symptoms. 2 Despite the high prevalence and burden of symptoms, many people do not feel prepared to manage menopause. One study found that more than half of women reported not feeling informed about menopause before the age of 40, and less than 20% were taught about menopause in school. 3 Another study found that among people using a digital program for menopause, at enrollment, only 18% reported having the knowledge and skills to manage their health during menopause. 4
Compounding the problem of the knowledge gap among people experiencing menopause is a parallel care gap within the medical community. A recent study representing 20 US residency programs across obstetrics and gynecology, internal medicine, and family medicine found that over 90% of residents did not feel adequately trained to manage menopause. 5 Another study found that less than one-fourth of patients with menopause symptoms had their symptoms documented in their electronic health record, suggesting that most symptoms are not acknowledged and thus not addressed. 6 In a health care system that is not set up to adequately serve them, many people have resorted to seeking support for menopause on their own, and over half report that their knowledge of menopause has been entirely self-taught.3,7
With rising demand for menopause support, 8 digital health programs are rapidly emerging to provide resources that are convenient and accessible. Digital health programs dedicated to menopause could provide patients with up to date, evidence-based information and access to a curated network of providers who are experts in menopause, free from geographic constraints. Studies have shown that people experiencing menopause are interested in digital menopause interventions, 8 and previous work has demonstrated the desirability, 8 acceptability, 9 and satisfaction 10 of telehealth for menopause. However, to date, there has been limited evidence that a digital program with education and telehealth components can reduce menopause symptoms. A few studies have evaluated the change in menopause symptoms in response to using a digital health product for menopause, demonstrating mixed findings.11–13. Each study has reported reductions in several symptoms or symptom domains, though the domains that improve, as well as the interventions tested, vary by study. Some studies have also evaluated the change in other aspects of the menopause experience, including menopause-related knowledge, 11 health-directed behavior, 11 health empowerment, 14 and menopause symptom management, 14 generally finding that use of digital health tools for menopause is associated with improvement in these domains. As digital health solutions for menopause continue to grow, systematic reviews have called for more rigorous evaluation of the effectiveness of digital resources for menopause.15,16
This research explored the change in symptom severity over three months for people using the digital Menopause Program on Maven. First, we assessed the needs of menopausal people and their reported impact of the program on their menopause management. Second, we evaluated changes in menopause symptoms before and after three months of program use.
Methods
Study design and population
This exploratory pre/posttest study examined the impact of Maven's menopause program, a comprehensive digital women's and family health platform that is offered as an employer or health plan-sponsored benefit. The program offers continuous access to multiple components including, (1) educational materials and articles on managing menopause; (2) virtual classes and webinars; (3) peer support groups; (4) app-based messaging and telehealth appointments with health care providers (e.g., OB-GYNs, mental health providers) and allied health professionals (e.g., nutritionists, physical therapists); and (5) prescriptions for hormonal or nonhormonal medications for management, as indicated.
The study was a secondary analysis conducted on existing data from the digital health program. Menopause program users were included in this analysis if they were based in the United States, enrolled between 29 November 2023 and 7 July 2024, completed the enrollment questionnaire, and completed a three-month follow-up questionnaire. We did not collect data on nor exclude users on the basis of prior use of hormone therapy, use of other digital health programs, or interaction with in-person care. All users provided virtual written informed consent to the use of their deidentified data for scientific research upon creating an account. This study used deidentified data, and the protocol was designated as exempt by WCG IRB, an independent ethical review board.
The research team is employees of Maven Clinic. While the team is employed by Maven, the employer did not influence the study's design, methodology, or interpretation of results.
Data collection
User characteristics and engagement
The enrollment questionnaire asked users to report their demographics (including age, race, and ethnicity) and the areas in which they want support from a list of support topics. Race and ethnicity was categorized as Hispanic/Latinx, Non-Hispanic White, Non-Hispanic Black, Non-Hispanic Asian, and Other, with an option of “I prefer not to say.” Due to small sample sizes, users who identified as either multiracial or Non-Hispanic American Indian were categorized together with “Other.” Engagement with the program, including provider appointments attended, articles read, and classes attended, was automatically recorded.
Menopause Rating Scale
The Menopause Rating Scale (MRS) assessed users’ menopause symptoms at enrollment and three months after enrollment. The MRS is a widely used, validated scale that asks respondents to rate the severity of 11 menopause symptoms on a Likert scale from no symptoms (0 points) to extremely severe symptoms (4 points). 17 The MRS has three subscales: Somatic, Psychological, and Urogenital, which are scored as a sum of their symptom scores, and a total score which sums the scores of every symptom. The total score showed adequate internal consistency (Cronbach's α > 0.80). Total scores are continuous and range from 0 to 44, with higher scores indicating greater menopause symptomatology.
Impact of digital health
To evaluate the impact of the program, users were surveyed at three months postenrollment. Users were asked: “Please indicate the way(s) that [the digital program] has helped you so far,” and options included “learn what to expect during menopause and my options for managing symptoms”, “advocate for myself with my provider,” “manage my physical menopause symptoms,” “manage anxiety,” “manage depression,” “manage symptoms at work or ask for support from my employer,” and “none of the above.”
Statistical analysis
Descriptive statistics were used to examine user demographics, support interests, impact of the program, and engagement with the program. Descriptive statistics and bivariate tests were used to evaluate the change in symptom scores on the MRS over three months. In the evaluation of the change in each symptom score, users were included only if they reported the severity of that symptom to be at least mild (>0) at baseline, so sample sizes vary by symptom. When differences between each of the paired observations were normally distributed (which was only the case for the total composite MRS score), we used a paired t-test and Cohen's d to determine statistical significance and measure effect size of changes in scores between the baseline and three-month follow-up. When the differences between each of the paired observations were not normally distributed (p < 0.05 in Shapiro–Wilk tests), we used Wilcoxon signed-rank tests and Cliff's delta to reflect these measures. Cliff's delta effect estimates are categorized as: negligible (|d| < 0.15), small (0.15 < |d| < 0.33), moderate (0.33 < |d| < 0.47), or large (|d| > 0.47). 18 To control for Type I error due to multiple comparisons, p-values for change in symptoms were adjusted using the Bonferroni method. Regression to the mean (RTM) was evaluated using three complementary approaches: 1) regression of change scores on baseline scores, 2) regression of postintervention scores on baseline scores to adjust for baseline severity, and 3) calculation of the Reliable Change Index to identify statistically reliable change, 19 using a test–retest reliability (r) of 0.9 (informed by Heinemann et al. 2004 17 ). An individual's symptom scores were categorized as “reduced” if their score on the three-month follow-up MRS was less than their score for that symptom on the baseline MRS, and as “not reduced” if their score was the same or higher at follow-up. All analyses were performed in R Studio Version 4.3.1.
Results
User characteristics, support interests, program use, and impact
The analytic sample included 180 users. The average age was 50.8 years, and the majority of the sample identified as Non-Hispanic White (64.4%). At baseline, the most selected areas for which users wanted support were: symptoms and discomfort (66.5%), mental and emotional well-being (62.0%), and understanding what to expect during menopause (60.9%) (Table 1).
User characteristics.
The race/ethnicity category, “Other” is comprised of users who identified as either multiracial or non-Hispanic American Indian. Undisclosed represents users who selected that they “prefer not to say” their race/ethnicity. These categories were combined due to small sample sizes.
During the three months between baseline and follow-up questionnaires, users averaged 6.7 article reads, and 38.9% of users took a virtual class. Half (50.0%) of users attended at least one provider appointment. Among all users, the most commonly used providers were OB/GYNs (31.7%), nutritionists (13.9%), and mental health providers (9.4%). At the three-month follow-up, the top three ways that users reported that the digital program helped them were to: 1) learn what to expect during menopause and options for managing symptoms (68.3%); 2) advocate for themselves with their provider (33.9%); and 3) manage physical menopause symptoms (31.1%) (Table 1).
Menopause Rating Scale symptoms at baseline
At baseline, the most commonly reported menopause symptoms were sleep problems (95.6%), physical and mental exhaustion (92.8%), and depressive moods (89.4%), and the least reported symptoms were heart discomfort (60.0%) and vaginal dryness (59.4%). The percentage of respondents who reported a score of >0 was high across each domain: somatic symptoms (100%), psychological symptoms (96.7%), and urogenital symptoms (91.1%) (Table 2).
Change in Menopause Rating Scale scores from baseline to three-month follow-up.a
Sample sizes vary by row, since users were only included if they reported their symptom severity was mild (1 point), moderate (2 points), severe (3 points), or extremely severe (4 points) at baseline.
Bonferroni correction was applied to adjust p-values for multiple comparisons.
Effect estimate is derived from Cliff's delta (except for MRS composite score), where estimates are categorized as: negligible (|d| < 0.15), small (0.15 < |d| < 0.33), moderate (0.33 < |d| < 0.47), or large (|d| > 0.47). The effect estimate for the MRS composite score was evaluated with Cohen's d.
The effect estimate for the MRS composite score was evaluated with Cohen's d.
At baseline, users had a mean MRS total score of 16.20 (standard deviation (SD): 6.63). Among the subscales, the highest mean was observed for psychological symptoms (6.75, SD: 2.99), followed by somatic symptoms (5.75, SD: 2.46) and urogenital symptoms (4.28, SD: 2.40) (Table 2).
Three-month change in MRS symptoms
At follow-up, the total MRS score and each subscale score were significantly reduced (p < 0.001 for each). After three months, the mean MRS total score was 13.60 (SD: 6.76). Among the subscales, the highest mean was observed for psychological symptoms (5.58, SD: 3.18), followed by somatic symptoms (4.89, SD: 2.48), and urogenital symptoms (3.47, SD: 2.45) (Table 2).
Average symptom severity scores were significantly reduced for each symptom and each domain from baseline to three-month follow-up (p < 0.05 for each) (Table 2). Based on the effect estimate, the symptoms that were reduced the most were heart discomfort, hot flashes, sexual problems, and bladder problems. By domain, psychological scores were most reduced (|d| = 0.23), followed by somatic scores (|d| = 0.20) and urogenital scores (|d| = 0.20).
To evaluate the influence of RTM on observed symptom changes, we conducted three analyses. Change scores were significantly negatively associated with baseline severity across all symptoms and domains, consistent with RTM. However, baseline-adjusted regressions of postintervention scores on baseline values showed that improvements remained statistically significant after adjustment, suggesting that the observed effects are not fully attributable to RTM and likely reflect true symptom improvement. Reliable Change Index results further indicated that a meaningful proportion of participants (well above the 5% threshold expected by chance) exceeded the ±1.96 cutoff, particularly in symptoms such as sleep problems, depressive moods, anxiety, and physical and mental exhaustion, where over 50% of participants showed reliable improvement (Supplemental Table 1). These findings suggest that the observed effects are not fully attributable to RTM.
Overall, 69.4% of users had a reduced total MRS score at follow-up, with 92.2% reporting improvement in at least one symptom. The greatest reduction was seen in the psychological domain (60.3%), followed by the urogenital (54.9%) and somatic (53.9%) domains. The symptom that was reduced for the highest proportion of users was sexual problems, with 51.5% of users reporting reduced symptoms, followed by depressive moods (46.0%), vaginal dryness (44.9%), anxiety and restlessness (44.4%), and hot flashes (44.1%) (Table 2).
Discussion
Our study found that menopause symptoms were reduced after three months of using a comprehensive, multicomponent digital menopause program. This is consistent with findings from other studies that evaluated the impact of digital menopause programs. One of these studies found that one month after viewing digital education resources on early menopause, women had lower severity scores on somatic and vasomotor symptom subscales on the symptom screening device used. 11 Unlike our study, that study did not observe reductions in the severity scores for the psychological subscale. Another recent education-based study found that higher engagement with a menopause app was associated with greater reductions in total symptom score over a two-month period. 12 Last, a recent randomized control (RCT) trial found that people who received a mobile-based digital care program had greater improvement in hot flashes after 6 weeks, and greater improvement in depression, anxiety, and sleep quality after 3 weeks compared to people in the control arm. 13 The digital care program assessed in the RCT included an artificial intelligence chatbot, lessons in cognitive behavioral therapy, mindfulness and mobility exercises, and a community discussion forum. 13 The effect sizes observed in these studies are not directly comparable to those included in our results due to differences in symptom screening tools and in analytic methods used to evaluate change. Our study builds on these findings by evaluating the impact of a comprehensive digital program for menopause that not only includes educational resources (articles, classes) but also includes access to virtual support groups with others experiencing menopause, as well as telehealth providers specializing in menopause, with the ability to receive hormonal or nonhormonal medications for symptom management, as appropriate. Unlike previous studies on digital resources to reduce menopause symptoms, our study observed reductions across each of the 11 menopause symptoms assessed with the MRS, reflecting improvements in somatic, psychological, and urogenital symptom domains, as well as a reduction in total symptom score.
In addition to examining the reduction in severity of menopause symptoms, the present study examined users’ perceived benefits from the menopause program itself, offering insight into the potential mechanisms behind the improvements observed in symptoms from enrollment to follow-up. In our study, increased knowledge, improved self-advocacy, and symptom management emerged as potential drivers of symptom reduction. Similarly, previous work has found that after using a digital menopause program, more users self-reported having: 1) the knowledge and skills to manage menopause, and 2) the confidence to improve their health, comfort, and well-being. 4 One of the aforementioned studies that evaluated impact on symptoms also found that users had lower emotional distress and higher health-directed behavior scores (a measure of lifestyle changes 20 ), illness perception scores, menopause-related knowledge, and risk perception of menopause treatment one month after viewing digital education resources on early menopause. 11 Together, these results suggest that digital menopause programs may be beneficial in driving change in knowledge, behaviors, and attitudes related to menopause.
The positive results of the present study may in part be due to the varied and comprehensive resources included in the program. In addition to offering asynchronous resources such as provider-vetted articles and videos, similar to the resources offered by other digital resources that have been evaluated in previous research,11,12 the program evaluated here offered live features, including support groups and webinars, and virtual visits and messaging with providers, who could provide prescriptions for hormonal or nonhormonal medications for symptom management, as appropriate. In the present study, users most commonly wanted support for: symptoms and discomfort, mental and emotional well-being, and understanding what to expect during menopause. As the industry for digital menopause support expands, it will be important for programs to consider the needs of program users.
Strengths and limitations
This study found that users experienced reduced menopause symptoms after three months using a digital menopause program. Experts in menopause have recognized that amid a proliferation of digital solutions for menopause, there has been a lack of formal evaluation for their effectiveness in reducing symptoms,15,16 and this study provides preliminary evidence that helps to fill that gap. This study has several notable strengths. First, the study sample represents users who live across the United States. Second, we have taken multiple steps to increase rigor and reduce bias in this work, including using a validated screener (the MRS), which reduces the risk of leading respondents to a preferred answer, and incorporating adjustments for error, including Bonferroni adjusted p-values to correct for multiple comparisons and evaluations of RTM. These analyses revealed that all pre/post changes in symptoms remain statistically significant after adjustment and that the observed improvements are unlikely to be fully attributable to RTM, and may reflect genuine symptom improvement associated with the intervention. Third, information was collected on ways that the digital health platform may have contributed to reduced symptoms, which enables insights into the mechanisms driving the improvements detected with the validated symptom screener.
This study also has several limitations. First, this study has a small sample size and a short follow-up period (three months) that does not account for the full menopause experience, and results should be considered formative and exploratory. While our follow up period is longer than other studies, future work should include longer follow-ups that capture the broader trajectory of menopause. Second, while the findings suggest promising outcomes associated with the use of a digital menopause platform, the generalizability of this study is limited by the composition of the sample, which is commercially insured. As such, results may not reflect the experiences or needs of more diverse populations, including those who are uninsured or publicly insured. Digital health platforms may hold particular promise in improving access and outcomes for historically marginalized groups, and future research should examine how digital health interventions for menopause can be adapted, scaled, and implemented to address the needs of broader populations. Third, while the comprehensive nature of the program likely contributed to the program's success in reducing symptoms, it is difficult to isolate the effects of any one component of the multicomponent intervention. Last, while we observed that users reported many ways that the digital program helped them manage menopause alongside their observed reduction in symptoms, it is possible that the users were also seeking support and drawing benefits from other resources during this same time, limiting our ability to make claims about causality. However, this is difficult to disentangle, as benefits from nonprogram resources may be the result of education and information received from the program as well. Future work should consider using more RCTs to evaluate the effectiveness of digital health programs for menopause.
Conclusion
Our results add to a small but growing literature that provides preliminary evidence suggesting that use of telehealth and digital resources for menopause are associated with a reduction in menopause symptoms. While providers in traditional health settings often lack expertise in menopause, digital health programs that curate evidence-based information on menopause and provide direct access to menopause specialists and support groups present an opportunity for people experiencing menopause to find answers, get care, and resolve their symptoms in a timely and convenient way.
Supplemental Material
sj-docx-1-dhj-10.1177_20552076251395567 - Supplemental material for Reduction in menopause symptoms after engagement in a digital health program
Supplemental material, sj-docx-1-dhj-10.1177_20552076251395567 for Reduction in menopause symptoms after engagement in a digital health program by Hannah R. Jahnke, Alison Brinson, Stacey Silverman Fine and Natalie Henrich in DIGITAL HEALTH
Supplemental Material
sj-docx-2-dhj-10.1177_20552076251395567 - Supplemental material for Reduction in menopause symptoms after engagement in a digital health program
Supplemental material, sj-docx-2-dhj-10.1177_20552076251395567 for Reduction in menopause symptoms after engagement in a digital health program by Hannah R. Jahnke, Alison Brinson, Stacey Silverman Fine and Natalie Henrich in DIGITAL HEALTH
Footnotes
Ethical considerations
This study used de-identified data only, and the protocol was designated as exempt by WCG Institutional Review, an independent ethical review board.
Consent to participate and publication
All users consented to the use of their de-identified data for scientific research upon creating a Maven account.
Contributorship
NH researched literature and conceived the study. NH and HJ designed the methodology. HJ completed the formal analysis of the data, and HJ, NH, AB, and SSF provided interpretation of the results. HJ drafted the majority of the manuscript, with contributions from SSF. All authors reviewed and edited the manuscript and approved the final version of the manuscript.
Funding
This study was funded by Maven Clinic.
Declaration of conflicting interests
All authors are employees of and receive equity options in Maven Clinic.
Data availability
In accordance with Maven's data privacy policy for its users, data cannot be shared.
Supplemental material
Supplemental material for this article is available online.
References
Supplementary Material
Please find the following supplemental material available below.
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