Exploring the impact of health education on menopause based on comprehensive bibliometric analysis

Abstract

To comprehensively analyze the research status, hotspots, and trends of the impact of health education on menopause using bibliometric and visualization methods, and to explore future research directions in this field. Articles from 2015 to 2024 in the Web of Science database were retrieved and analyzed using R software, VOSviewer, and CiteSpace to build cooperation, co-citation, and keyword co-occurrence networks. The annual publication volume fluctuated between 2015 and 2024, reaching a low of 48 in 2018 and peaking at 113 in 2024. The United States contributed the most articles (200). Journals such as Menopause were central to the field. Research hotspots focused on preventing menopausal health issues through education. Three distinct keyword clusters were identified. The research trajectory has evolved towards integrating medical practice with broader educational exploration. Health education is expected to be a major focus in menopausal health management. This paper reviewed and analyzed the status and hotspots, providing references for future research.

1. Introduction

Menopause is a critical physiological stage characterized by declining estrogen levels and cessation of menstruation. This transition is frequently accompanied by physiological changes, including reduced bone density, cardiovascular adjustments, and mood fluctuations.^[1–3] Consequently, postmenopausal women face increased risks of osteoporosis, cardiovascular diseases, cognitive decline, and hormone-related cancers.^[4–7] Among these, osteoporosis and cardiovascular diseases exhibit particularly high incidence rates, significantly impacting women’s quality of life.^[8–10]

Health education has emerged as a vital strategy for disease prevention and health promotion. Research indicates that health science popularization enhances health awareness, fosters healthy behaviors, and improves psychological adjustment during menopause.^[11–13] Interventions targeting lifestyle habits and disease knowledge have proven effective in reducing the incidence of menopausal depression, anxiety, and metabolic disorders.^[14,15] Although existing studies suggest that health education alleviates symptoms through mechanisms such as stress reduction and lifestyle modification, the global research landscape remains fragmented.^[16,17]

Bibliometrics utilizes mathematical and statistical methods to analyze academic literature, allowing for the quantitative evaluation of research trends and emerging hotspots within a specific field.^[18–20] While this methodology has been widely applied in medical disciplines,^[21–23] there is a lack of comprehensive bibliometric analyses focusing specifically on health education and menopause. This study utilizes R software, VOSviewer, and CiteSpace to visualize the research landscape from 2015 to 2024, aiming to clarify knowledge evolution trajectories and provide evidence-based directions for future health promotion strategies.

2. Methods

2.1. Data collection

The data used in this study were retrieved and downloaded from Web of Science Core Collection (Guilin Medical College Edition) on January 1, 2025. The search formula is (TS = [Health Education OR Medical Publicity]) AND (TS = [Menopause OR Menopausal Women OR Climacteric]) AND (DT = [Article OR Review]) AND (LA = [English]) AND (DOP = [January 1, 2015/December 31, 2024]). The detailed process is illustrated in Figure 1. Duplicate documents were removed, and the remaining retrieved articles were saved in plain text format, and their cited references were exported as complete records.

Figure 1.

A schematic diagram detailing the screening process. WOSCC = Web of Science Core Collection.

2.2. Data analysis

For the analysis of annual publication trends, Origin 2018 software was utilized. The analysis and visualization of bibliometric data were conducted using R software (version 4.4.2) with the bibliometrix package (version 4.3.0),^[24] VOSviewer (version 1.6.18),^[25] and CiteSpace (version 6.3.1).^[26] These tools were selected to ensure the accuracy and reliability of data extraction and analytical processes.

VOSviewer was employed for creating visualizations such as co-authorship networks of countries and institutions, co-citation analysis, and keyword co-occurrence networks. Specific criteria were applied for these analyses: a minimum of 5 documents for a country and 8 for an organization were required for inclusion in the co-authorship network analysis. For co-citation analysis, only sources cited at least 39 times were considered. In keyword co-occurrence analysis, keywords needed to appear in at least 25 documents to be included, with the terms “menopause” and “health” being deliberately excluded from this analysis. The journal impact factor (IF) data were sourced from the 2023 journal citation reports.

3. Results

3.1. Overview of the research literature production on health education and menopause

After searching the Web of Science (WoS) database, a total of 839 literature related to health education and menopause were identified. As shown in Figure 2A, the trend of literature publication in this field varies over time. From 2015 to 2018, the number of literature showed a continuous downward trend, reaching a trough of 48 in 2018. However, a research renaissance occurred from 2018 to 2020, with a rapid growth in the number of literature. It remained stable between 2020 and 2024 and reached a peak in 2024 with 113 literatures published. As of December 2024, there are a total of 839 literature.

Figure 2.

Trends in annual publication outputs for health education and menopause research from 2015 to 2024. (A) Trends of annual publication outputs. (B) Distribution of corresponding authors’ countries and cooperation. (C) Map of countries’ scientific production.

According to the analysis of the corresponding country of author affiliation, the research output of 200 literature (the largest proportion) comes from the United States, followed by China (85), Iran (61), and South Korea (60). Singapore and Germany have particularly high international co-authorship rates of 100% and 66.7%, respectively. In contrast, Saudi Arabia (0%) and Turkey (5%) have relatively low international co-authorship rates, as shown in Figures 2B, C and Table 1.

Table 1.

Most relevant countries by corresponding authors in health education and menopause research.

Country	Articles	SCP	MCP	Articles %	MCP %
USA	200	165	35	23.8	17.5
China	85	75	10	10.1	11.8
Iran	61	51	10	7.3	16.4
Korea	60	51	9	7.2	15
United Kingdom	46	32	14	5.5	30.4
Australia	40	28	12	4.8	30
India	34	30	4	4.1	11.8
Canada	32	18	14	3.8	43.8
Brazil	23	17	6	2.7	26.1
Poland	20	17	3	2.4	15
Turkey	20	19	1	2.4	5
Spain	16	11	5	1.9	31.3
Italy	13	9	4	1.5	30.8
Japan	13	12	1	1.5	7.7
Greece	10	6	4	1.2	40
Netherlands	9	4	5	1.1	55.6
Sweden	9	6	3	1.1	33.3
Malaysia	8	7	1	1	12.5
Norway	8	2	6	1	75
Ireland	7	6	1	0.8	14.3
Singapore	7	0	7	0.8	100
Denmark	6	5	1	0.7	16.7
France	6	5	1	0.7	16.7
Germany	6	2	4	0.7	66.7
Saudi Arabia	6	6	0	0.7	0

MCP % = MCP/Articles, MCP = multiple country publications, SCP = single country publications, UK = United Kingdom, USA = United States of America.

Figure 3A visually presents the extensive international cooperation network formed in the research on the impact of health education on menopause. This cooperation network further highlights the United States (254 collaborations) and the University of Pittsburgh (28 collaborations) as key nodes in research cooperation (Fig. 3B and Table 2).

Figure 3.

Map of countries/regions and institutions for health education and menopause research from 2015 to 2024. (A) Map of cooperation between different countries. (B) Map of cooperation between different institutions.

Table 2.

Most relevant affiliations in health education and menopause research.

Affiliation	Articles (n)
Mayo Clinic	87
University of California System	76
Pennsylvania Commonwealth System of Higher Education (PCSHE)	65
Harvard University	64
University of Pittsburgh	59
Tabriz University of Medical Science	46
University of Toronto	45
University of London	40
University of North Carolina	38
Monash University	34
Sungkyunkwan University (SKKU)	33
University of Michigan	33
University of Michigan System	33
University of North Carolina Chapel Hill	32
University College London	30
Tehran University of Medical Sciences	27
University of California San Francisco	26
University of Washington	26
University of Washington Seattle	26
Harvard Medical School	25
Imperial College London	25
Shahid Beheshti University Medical Sciences	25
University of Bergen	25
Johns Hopkins University	24
Institut National De La Sante Et De La Recherche Medicale (INSERM)	22

INSERM = Institut National De La Sante Et De La Recherche Medicale, PCSHE = Pennsylvania Commonwealth System of Higher Education, SKKU = Sungkyunkwan University.

In addition, the institutions that provide major financial support for this research field include the United States Department of Health and Human Services, the National Institutes of Health (NIH) USA, the NIH National Institute on Aging, the NIH National Heart, Lung, and Blood Institute, the NIH National Institute of Nursing Research, and the Canadian Institutes of Health Research, and most of the financial support from these institutions comes from the United States.

In this study, we analyzed 20 institutions that provide funding for health education and menopause research. As shown in Table 3, the United States Department of Health and Human Services has the highest record with a score of 108, indicating the significance of the United States in research investment. It is followed closely by the NIH USA (106) and the NIH National Institute on Aging.^[27]

Table 3.

The top 20 funding agencies in the field of health education and menopause research.

Funding agencies	Record count
United States Department of Health Human Services	108
National Institutes of Health (NIH) USA	106
NIH National Institute on Aging (NIA)	31
NIH National Heart Lung Blood Institute (NHLBI)	30
NIH National Institute of Nursing Research (NINR)	23
Canadian Institutes of Health Research (CIHR)	20
NIH Office of Research on Women’s Health (ORWH)	18
UK Research Innovation (UKRI)	16
National Natural Science Foundation of China (NSFC)	15
Medical Research Council UK (MRC)	14
NIH National Cancer Institute (NCI)	14
NIH National Institute of Diabetes Digestive Kidney Diseases (NIDDK)	13
National Health Medical Research Council (NHMRC) of Australia	10
NIH Eunice Kennedy Shriver National Institute of Child Health Human Development (NICHD)	10
Australian Government	9
Spanish Government	9
European Union (EU)	8
National Research Foundation of Korea	8
NIH National Institute of Environmental Health Sciences (NIEHS)	8
NIH National Institute of Neurological Disorders Stroke (NINDS)	8

CIHR = Canadian Institutes of Health Research, EU = European Union, MRC = Medical Research Council, NCI = National Cancer Institute, NHLBI = National Heart, Lung, and Blood Institute, NHMRC = National Health and Medical Research Council, NIA = National Institute on Aging, NICHD = Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIDDK = National Institute of Diabetes and Digestive and Kidney Diseases, NIEHS = National Institute of Environmental Health Sciences, NIH = National Institutes of Health, NINDS = National Institute of Neurological Disorders and Stroke, NINR = National Institute of Nursing Research, NSFC = National Natural Science Foundation of China, ORWH = Office of Research on Women’s Health, UKRI = UK Research and Innovation.

3.2. Journals and co-cited journals

The journals with the highest number of publications and citations in this field were analyzed using the bibliometrix and ggplot2 packages in R software (version 4.4.2). As shown in Table 4 and Figure 4A, in terms of the number of published articles, “Menopause” (n = 92, IF = 2.8), “Maturitas” (n = 45, IF = 3.9), “Climacteric” (n = 28, IF = 2.9), and “BMC Women’s Health” (n = 22, IF = 2.4) emerged as the top-ranked journals.

Table 4.

Top 10 journals with the most published articles.

Journal	Articles	IF (2023)	Cites
Menopause	92	2.8	1820
Maturitas	45	3.9	1392
Climacteric	28	2.9	908
BMC Womens Health	22	2.4	208
International Journal of Environmental Research and Public Health	17	0	254
PLoS One	17	2.9	377
Journal of Womens Health	15	3.0	239
Mayo Clinic Proceedings	11	7.2	744
BMC Public Health	9	3.5	181
Journal of Sexual Medicine	8	3.3	415

IF = impact factor.

Figure 4.

Journal with the largest number of articles published and the journal with the largest number of citations. (A) Journal with the largest number of articles published. (B) Journals with the largest number of citations. IF = impact factor.

On the other hand, the journal with the highest number of citations was “Menopause” (n = 1820, IF = 2.8), followed by “Maturitas” (n = 1392, IF = 3.9), “Climacteric” (n = 908, IF = 2.9), “Mayo Clinic Proceedings” (n = 744, IF = 7.2), and “Journal of Sexual Medicine” (n = 415, IF = 3.3; Table 5 and Fig. 4B).

Table 5.

Top 10 journals with the most-cited articles.

Journal	Cites	IF (2023)	Documents
Menopause	1820	2.8	92
Maturitas	1392	3.9	45
Climacteric	908	2.9	28
Mayo Clinic Proceedings	744	7.2	11
Journal of Sexual Medicine	415	3.3	8
Journal of Clinical Endocrinology and Metabolism	414	0	3
Journal of the American Medical Association (JAMA)	409	63.5	4
American Journal of Epidemiology	405	5.0	14
PLoS One	377	2.9	17
Obstetrics and Gynecology	364	5.8	1

IF = impact factor.

For the co-citation journal analysis, VOSviewer (version 1.6.18) was used, which revealed a total of 839 literature published in 391 academic journals. The network analysis of the co-citation patterns (as shown in Fig. 5) highlighted “Menopause,” “Maturitas,” and “Climacteric” as the core cooperation hubs.

Figure 5.

Co-cited journals involved in health education and menopause research.

3.3. Most-cited references and reference burst

We utilized the bibliometrix package (version 4.3.0) within the R software framework to identify the top 20 most-cited references in the field of the preventive role of health education in menopause (Table 6). Our analysis revealed that these references were cited more than 170 times and were distributed across 13 different journals. Notably, there was no dominant journal among the top 20 most-cited references. Specifically, the top 3 most-cited references were “Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient data,” “COVID-19 and Sex Differences: Mechanisms and Biomarkers,” and “Menstruation: science and society.” Upon careful examination, we found that these references explored menopause-related health issues and their impacts on women’s health.

Table 6.

Top 20 cited references related to health education and menopause research.

Paper	DOI	Total citations	TC per year
Zhu DS, 2019, Lancet Public Health	10.1016/S2468-2667(19)30155-0	272	45.33
Haitao T, 2020, Mayo Clin Proc	10.1016/j.mayocp.2020.07.024	193	38.60
Critchley HOD, 2020, Am J Obstet Gynecol	10.1016/j.ajog.2020.06.004	151	30.20
Kingsberg SA, 2017, J Sex Med	10.1016/j.jsxm.2017.01.010	147	18.38
Clavel-Chapelon F, 2015, Int J Epidemiol	10.1093/ije/dyu184	147	14.70
Edwards D, 2016, Climacteric	10.3109/13697137.2015.1124259	140	15.56
Major TJ, 2018, BMJ-Brit Med J	10.1136/bmj.k3951	139	19.86
Goldstein I, 2017, Mayo Clin Proc	10.1016/j.mayocp.2016.09.018	135	16.88
Young K, 2015, J Fam Plan Reprod H	10.1136/jfprhc-2013-100853	134	13.40
Kapoor E, 2017, Mayo Clin Proc	10.1016/j.mayocp.2017.08.004	121	15.13
McCurry SM, 2016, JAMA Intern Med	10.1001/jamainternmed.2016.1795	96	10.67
Kingsberg SA, 2019, J Womens Health	10.1089/jwh.2018.7352	94	15.67
Clayton AH, 2018, Mayo Clin Proc	10.1016/j.mayocp.2017.11.002	94	13.43
Allaire C, 2018, Am J Obstet Gynecol	10.1016/j.ajog.2017.10.002	89	12.71
James-Todd TM, 2016, Environ Health-Glob	10.1186/s12940-016-0136-x	88	9.78
Faubion SS, 2015, Am Fam Physician	NA	86	8.60
Krychman M, 2017, J Sex Med	10.1016/j.jsxm.2017.01.011	82	10.25
Gartoulla P, 2015, Menopause	10.1097/GME.0000000000000383	80	8.00
Upchurch DM, 2015, Psychosom Med	10.1097/PSY.0000000000000175	80	8.00
Minkin MJ, 2019, Obstet Gyn Clin N Am	10.1016/j.ogc.2019.04.008	78	13.00

DOI = digital object identifier, TC = total citations.

To identify prominent citation burst patterns in the realm of health education’s preventive role against menopause disease, we used CiteSpace (criteria: top 21; state count: 2; minimum duration: 2). A total of 25 citations were generated, and all of them are shown in Figure 6. These citations indicated that “Symptoms of menopause – global prevalence, physiology and implications (strength: 5.23),” “The 2017 hormone therapy position statement of The North American Menopause Society (strength: 4.83),” and “Socioeconomic position, lifestyle factors and age at natural menopause: a systematic review and meta-analyses of studies across 6 continents (strength: 4.26)” became the 3 references with the strongest citation dynamics. Notably, the titles of these 3-frontier citation burst literatures were “Menopause Management Knowledge in Postgraduate Family Medicine, Internal Medicine, and Obstetrics and Gynecology Residents: A Cross-Sectional Survey,” “Evaluation of the Effectiveness of Health Education on Menopause Symptoms and Knowledge and Attitude in Terms of Menopause,” and “Menopausal Vasomotor Symptoms and Risk of Incident Cardiovascular Disease Events in SWAN.”

Figure 6.

Top 25 references with the strongest citation bursts on health education and menopause research.

To gain a deeper understanding of the research frontiers and hotspots regarding the preventive role of health education in menopause diseases, we associated the digital object identifiers of the 25 citations in Figure 6 with the titles in Annex 1, Supplemental Digital Content, https://links.lww.com/MD/R671. Among these citations, “Importance of Health Education on Menopause” accounted for the largest proportion (45.78%), followed by “Relationship Between Health Education and Menopause” (26.31%).

3.4. Keyword clusters and evolution

In this study, 3166 keywords were identified using the VOSviewer analysis tool. As shown in Table 7, the top 20 keywords appeared more than 36 times. These keywords include “prevalence” (n = 120), “women” (n = 118), “risk” (n = 117), “symptoms” (n = 107), “postmenopausal women” (n = 95), “association” (n = 86), and “age” (n = 85).

Table 7.

Top 20 keywords related to health education and menopause research.

Rank	Words	Occurrences
1	Prevalence	120
2	Women	118
3	Risk	117
4	Symptoms	107
5	Postmenopausal women	95
6	Association	86
7	Age	85
8	Quality-of-life	82
9	Impact	72
10	Risk-factors	59
11	Transition	58
12	Physical-activity	52
13	Population	51
14	Vasomotor symptoms	51
15	Depression	44
16	Management	44
17	Disease	39
18	Cardiovascular-disease	38
19	Knowledge	36
20	Menopausal symptoms	36

Subsequently, 53 keywords were carefully selected based on the criterion that the keyword appearance frequency was ≥25 times (Fig. 7A). This subset formed the basis for the construction of the keyword clustering visualization, as shown in Figure 7. The visualization of the results revealed 3 distinct clusters, each distinguished by a unique color scheme. Notably, the cluster represented by red dots and focused on health science popularization and menopause contains 19 keywords, covering terms such as “prevalence,” “risk,” “association,” “natural menopause,” and “metabolic syndrome.” In addition, the cluster represented by green dots and focused on health science popularization and menopause contains 18 keywords, including “anxiety,” “menopausal symptom,” and “menopausal transition.” Finally, the cluster related to health science popularization and menopause and represented by blue dots contains 14 keywords, such as “breast cancer,” “education,” and “postmenopausal women” (Annex 2, Supplemental Digital Content, https://links.lww.com/MD/R671). Meanwhile, Figure 7B suggests the citation bursts of “validation,” “severity,” and “early menopause” from 2022 to 2024.

Figure 7.

Keyword analysis map of health education and menopause research. (A) Keyword co-occurrence map of publications on health education and menopause research. (B) Top 10 keywords with the strongest citation bursts on health education and menopause research.

Furthermore, this study also generated a hot topic map using the bibliometrix package in the R software environment (Fig. 8). A detailed analysis of the hot topic map, as shown in Figure 8, revealed the trajectory of the development stage and the dynamic changes in research foci regarding the role of health education in menopausal health and the prevention of menopausal-related diseases. Our research results indicate that since the beginning of 2016, the initial research focus was placed on women’s menopause and its associated risks, and then gradually shifted to the comprehensive health needs of menopausal women, the interrelationships of how to meet these needs through health science popularization, and the mechanisms behind these associations.

Figure 8.

Trend topics on health education and menopause research.

4. Discussion

4.1. Global research landscape and publication characteristics

The sustained growth in publication volume over the past decade highlights the increasing prioritization of health education in menopausal care. This upward trend suggests a shift in the medical community’s perspective, moving from treating menopause solely as a biological event to managing it through comprehensive lifestyle and educational interventions.

Geographically, the United States maintains a clear leadership position in this field. This dominance is likely driven by substantial funding support from major agencies and a well-established focus on women’s health issues, particularly breast cancer and cardiovascular prevention, within the US healthcare system. While other nations contribute significantly to the literature, the research landscape in the United States appears more institutionally concentrated and financially supported. Conversely, despite a high volume of research from emerging contributors like China, the absence of Chinese institutions among the top global contributors suggests a more fragmented research output. This indicates a potential need for stronger institutional collaboration and centralized research platforms in these regions to enhance global impact.

In terms of academic dissemination, the field relies heavily on a select group of specialized journals. High-impact publications such as Menopause and Maturitas serve as the primary platforms for discourse. The high concentration of citations in these journals underscores their critical role in shaping consensus and establishing clinical guidelines regarding menopausal health education.

4.2. Hotspots and development trends

Through keyword clustering and burst analysis, we identified key research hotspots and the evolving frontiers in menopausal health education.

Firstly, interventions principally target the management of specific comorbidities. Our analysis reveals that “osteoporosis,” “anxiety disorders,” “postmenopausal hot flashes,” and “cardiovascular diseases” are the primary clinical issues addressed by health education. Existing literature emphasizes that accurate knowledge dissemination regarding disease prevention is critical for reducing the incidence of these conditions.^[28,29] For instance, health education has been shown to inversely correlate with the severity of hot flashes^[30,31] and effective management of psychological distress.^[27,32] Furthermore, education targeting obesity management is highlighted as a key strategy to diminish the incidence of postmenopausal metabolic diseases.^[33,34]

Secondly, there is a significant research concentration on nonhormonal and nutritional interventions. The frequent occurrence of keywords related to “phytoestrogens,” “calcium supplements,” and “vitamin D” reflects a shift towards lifestyle-based management. Rather than solely focusing on pharmacological treatments, current research trends prioritize educating women on dietary adjustments. This includes the role of phytoestrogens in modulating estrogen levels^[35–37] and the critical importance of calcium and vitamin D intake for maintaining bone density and preventing osteoporosis.^[38–41] The prominence of these topics suggests that empowering women with nutritional knowledge is becoming a cornerstone of menopausal care.

Finally, the goal of health science popularization is to foster long-term self-management capabilities. The research landscape indicates a move towards comprehensive health management that integrates symptom relief with disease prevention. This involves educating patients on the benefits of physical exercise for weight control and cardiovascular health,^[42,43] as well as cognitive-behavioral strategies for improving sleep and mood.^[44,45] In addition, promoting health literacy regarding regular gynecological examinations and the risks versus benefits of hormone replacement therapy enables women to make informed medical decisions in partnership with healthcare providers.^[46,47]

4.3. Strengths and limitations

This study contributes to researchers’ understanding of the field and exploration of new directions, yet it has certain limitations. Firstly, our data was solely sourced from the WoS database, which might have led to the omission of some publications. However, the WoS database is a widely recognized high-quality digital literature database and one of the top choices for bibliometric analysis,^[48–50] thus ensuring the reliability of the data source. Secondly, only English publications were analyzed, which might introduce a source bias. Despite these limitations, this study still comprehensively presents the overall situation, hotspots, and research trends in this field.

Acknowledgments

We were grateful to everyone who participated in the study and helped with data analyses and preparation of the manuscript. We would also like to thank the editor and reviewers for their valuable insights and assistance.

Author contributions

Data curation: Li Jiang, Xinxiang Su, Jintao Chen.

Formal analysis: Li Jiang, Xinxiang Su, Jintao Chen.

Methodology: Li Jiang, Xinxiang Su, Jintao Chen.

Resources: Li Jiang, Xinxiang Su, Kailiang Tan, Xi Wang, Junjun Pu, Jinxia Liao.

Software: Li Jiang, Xinxiang Su, Kailiang Tan, Xi Wang, Junjun Pu, Jinxia Liao.

Writing – original draft: Li Jiang, Xinxiang Su, Kailiang Tan, Xi Wang, Junjun Pu, Jinxia Liao, Jintao Chen.

Writing – review & editing: Li Jiang, Xinxiang Su, Kailiang Tan, Xi Wang, Junjun Pu, Jinxia Liao, Jintao Chen.

Supervision: Kailiang Tan, Xi Wang, Junjun Pu, Jinxia Liao.

Conceptualization: Jintao Chen.

Investigation: Jintao Chen.

Supplementary Material

medi-105-e48322-s001.pdf ^{(137.8KB, pdf)}