Menopausal symptoms in an intercultural context: a comparison between German women, Chinese women and migrant Chinese women using the Menopause Rating Scale (MRS II)

Menopause in a globalized world - A systematic literature review focussing on the challenge of health problems associated with menopausal transition among women with a migration background

Globalization and international migration movements have massively changed the population structure of most industrial nations in recent decades. The ever-increasing proportion of people with a migration background also poses a challenge for the medical sector. A particular problem is the stressful phase of the menopausal transition, which - although not a pathological phenomenon but part of the female life history - can lead to psychological and physical symptoms due to hormonal changes, which significantly impair the quality of life of the women affected. However, treatment concepts, as well as access to medical facilities and information, are geared towards Western women from high-income countries. Women with a history of voluntary or forced migration originating from non-Western countries represent a particularly vulnerable group. To enable personalized treatment, studies on menopausal transition in women with a migration background are required. The present review shows that studies on menopausal women with a migration background have been conducted primarily in classic immigration countries such as the USA, Australia, or the UK, but that there is a lack of such studies in countries with no long tradition as an immigration country, such as Austria or Germany. This is becoming a growing problem, as the number of menopausal women with a migration background is increasing.

[Study to improve the quality of life in perimenopausal women from the community pharmacy. Research protocol pilot study -m+45]

The menopause is a stage in a woman's life, characterised by oestrogen and progestogen deficiency, which can cause a series of symptoms of varying intensity among women. When they appear, their quality of life can be affected to a greater or lesser extent, so it is important to identify them and intervene by offering appropriate solutions. There are different validated scales, although in recent years the Menopause Rating Scale (MRS) has been one of the most widely used in global research.Taking into account the healthcare work of the community pharmacist, it is appropriate to suggest a project to measure the perception of quality of life in women aged from 45 to 64 years before and after a structured intervention to assess its impact on general wellbeing.A study was proposed in community pharmacies that were be randomly distributed into intervention and control groups. The study was offered to women who came to collect medication related to this stage or requested information or recommendations as long as they signed the informed consent form and did not suffer cognitive or language difficulties that would not allow them to understand the study. Two questionnaires were carried out on the first visit, which were repeated on the second visit, after 3 months, as well as a third, only on the second visit, on sources of information. The intervention group received on the initial visit, after data collection, health education and recommendations of commercially available products related to the characteristic symptoms.

Identifying the different subtypes in menopausal symptoms among middle-aged women in China: a latent class analysis

OBJECTIVE

Many studies have focused on the severity and prevalence of menopausal symptoms among middle-aged women, which are limited by heterogeneity and diversity of subtypes. Subtyping facilitates the adaptation to prevention and clinical intervention strategies that target women. To determine the existence of significant subgroups of women with similar menopausal symptoms, a person-centered approach was used to identify potential profiles of women during the menopausal transition. In addition, we aimed to examine the association between latent subtypes and individual factors.

METHODS

This cross-sectional study included 797 middle-aged women, aged 40 to 60 years, who were recruited from Shandong Province, China, between December 2017 and August 2018. We identified the subtypes in menopausal symptoms by performing a latent class analysis according to the self-reported Menopause Rating Scale and evaluated the robustness of our identified subtypes using a sensitivity analysis. Multinomial logistic regression was performed to explore the association between emergent latent subtypes and sociodemographic, clinical, and psychosocial characteristics.

RESULTS

The mean age of participants was 49.83 ± 5.05 years. (1) Four potential classes were identified in middle-aged women: "severe symptoms" (14.9%), "dominant sleep-emotion symptoms" (31.4%), "physical/mental exhaustion symptoms" (32.5%), and "no symptoms" (21.2%). The four classes were also verified using a sensitivity analysis according to age and menopause status subgroups, which revealed the robust subtypes of menopausal symptoms. (2) The odds ratio of neuroticism, chronic diseases, and gynecological diseases were significantly higher for the "severe symptoms," "dominant sleep-emotion symptoms," and "physical/mental exhaustion symptoms" classes, compared to the "no symptoms" class, while the odds ratio of mindfulness and social support were lower.

CONCLUSIONS

A person-centered approach for middle-aged women could address the unmet need to understand the heterogeneity of menopausal symptoms. Subtyping facilitates the identification of the potential causes of menopausal symptoms and the development of personalized interventions.

Review of menopausal palpitations measures

Palpitations are reported commonly by women around the time of menopause as skipped, missed, irregular, and/or exaggerated heartbeats or heart pounding. However, much less is known about palpitations than other menopausal symptoms such as vasomotor symptoms. The objective of this review was to integrate evidence on menopausal palpitations measures. Keyword searching was done in PubMed, CINAHL, and PsycINFO for English-language, descriptive articles containing data on menopause and palpitations and meeting other pre-specified inclusion criteria. Of 670 articles, 110 met inclusion criteria and were included in the review. Results showed that 11 different measures were used across articles, with variability within and between measures. Inconsistencies in the wording of measurement items, recall periods, and response options were observed even when standardized measures were used. Most measures were limited to assessing symptom presence and severity. Findings suggest that efforts should be undertaken to (1) standardize conceptual and operational definitions of menopausal palpitations and (2) develop a patient-friendly, conceptually clear, psychometrically sound measure of menopausal palpitations.

Challenges in menopausal care of immigrant women

This systematic review summarises the available evidence about how migrant women perceive and manage their menopausal and postmenopausal health and their experiences with healthcare services; and healthcare providers' views about delivering menopause-related healthcare to migrant women. Medline, PsychInfo, Embase and Cinahl were searched for peer-reviewed papers published in English. Thirty-one papers were identified reporting on 25 studies. Twenty-three studies reported on investigations examining migrant women's perceptions about menopause, their self-care strategies and their experiences with menopause-related healthcare. Only two papers reported on healthcare providers' views about providing menopause-related healthcare to migrant women. Most studies with migrant women found that their experiences of menopause and self-care strategies were culturally informed; that migrant women are unlikely to seek out menopause-related healthcare or to initiate conversations about menopause with their healthcare providers; and that most of those who seek menopause-related healthcare are disappointed with the care they receive. Studies assessing menopause-related knowledge found that many migrant women have limited knowledge about menopause and postmenopausal health, and that family and friends are their most common sources of information about menopause. Although healthcare providers were aware that migrant women use traditional remedies to manage their menopausal health and are likely to source menopause-related information from within their communities, they were reluctant to actively promote menopause-related health information due to consultation time constraints and lack of confidence in culturally competent communication. More research with healthcare providers is needed to improve understanding about barriers and facilitators to provide comprehensive menopause-related care to migrant women.

Factors influencing healthy menopause among immigrant women: a scoping review

Background

Many factors influence the menopausal transition and the complexity of this transition increases with the addition of immigration transition. This review aims to identify the factors that influence the menopausal transition for immigrant women based on ecosocial theory.

Methods

A scoping review of English publications was conducted according to PRISMA guidelines using CINAHL, AgeLine, MEDLINE, PsycINFO, ERIC, Nursing and Allied Health Database, PsycARTICLES, Sociology Database, and Education Research Complete. Thirty-seven papers were included for this review.

Results

The factors which influence the menopausal transition for immigrant women were grouped into three categories: (a) personal factors, (b) familial factors, and (c) community and societal factors. Personal factors include income and employment, physical and psychological health, perceptions of menopause, and acculturation. Familial factors include partner support, relationships with children, and balancing family, work, and personal duties. Community and societal factors encompassed social network, social support, healthcare services, traditional cultural expectations, and discrimination in host countries.

Conclusions

Interventions addressing the menopausal transition for immigrant women should be designed considering different psychosocial factors and actively work to address systemic barriers that negatively impact their transition.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01327-z.

Menopausal transition experiences and management strategies of Chinese immigrant women: a scoping review

IMPORTANCE AND OBJECTIVE

Chinese immigrants are among some of the fastest growing groups in many Western countries, and experience challenges such as language barriers, education gaps, and gender discrimination, which highlights the need for special attention and consideration in Western health care. The purpose of this scoping review is to summarize existing research on the menopausal experiences of Chinese immigrant women (CIW).

METHODS

This scoping review was written in accordance with PRISMA guidelines. MEDLINE, PsycINFO, CINAHL, AgeLine, ERIC, ProQuest, Nursing and Allied Health Database, PsycARTICLES, Sociology Database, and Education Research Complete were utilized for the literature search. Articles were included if they examined CIW experiencing menopausal transition. A total of 18 studies were included for review.

DISCUSSION AND CONCLUSION

Findings suggested that CIW experienced a variety of physical symptoms, including muscle and joint pain, urogenital symptoms, vasomotor symptoms, weight gain, decreased physical strength, vision changes, and skin changes. Muscle and joint pain were particularly prevalent and emphasized. CIW also experienced psycho-behavioral symptoms including emotional changes, depression, memory loss, and sexual dysfunction. However, they had a decreased concern regarding symptoms of sexual dysfunction and decreased libido when compared with women from Western cultures. CIW interpreted menopause as a natural aging process involving the next step in life. Cultural expectations of stoicism and silence may cause immigrant women to be less vocal about their menopause experiences and result in feelings of loneliness. Acculturation may be both a facilitator and a barrier to a healthy menopausal transition. CIW were resistant to Western Medicine management such as hormone therapy but were willing to incorporate traditional medicine into their health care. They believed that a healthy mentality was important and used various psychocognitive strategies to maintain a good quality of life. Healthcare providers, researchers, and policymakers need to consider the unique characteristics of CIW's menopausal transition in research, intervention innovation, and practice.

Relationships between menopausal symptoms, sense of coherence, coping strategies, and quality of life

OBJECTIVES

The aims of this study were to examine the relationships between menopausal symptoms, sense of coherence (SOC), coping strategies, and quality of life, and to test the mediating effects of SOC and coping strategies on the relationships between menopausal symptoms and quality of life among Chinese women during menopausal transition.

METHODS

Two hundred one women aged 40 to 60 years and currently undergoing menopausal transition were recruited at community centers between June and August 2017. Menopausal symptoms, SOC, coping strategies, and quality of life were assessed by the Menopause Rating Scale, the Sense of Coherence Scale, the Brief COPE Inventory, and the Medical Outcomes Study Short-Form-36, respectively. Data were analyzed by path analysis.

RESULTS

Menopausal symptoms were associated with poorer quality of life, and both SOC and maladaptive coping were found to mediate the effects of menopausal symptoms on quality of life. The results suggest that SOC might alleviate the adverse effects of menopausal symptoms on quality of life, whereas maladaptive coping strategies might aggravate the adverse effects of menopausal symptoms on quality of life.

CONCLUSIONS

The results provide new insights into the importance of considering SOC and coping strategies and their interactions with menopausal symptoms and quality of life in the situation of menopausal transition.

Experiences of menopause, self-management strategies for menopausal symptoms and perceptions of health care among immigrant women: a systematic review

OBJECTIVE

To systematically review the published literature relating to experiences of menopause, self-management strategies for menopausal symptoms and health-care needs among immigrant women.

METHODS

A systematic literature search of English-language publications was performed using Medline, Embase, PsychInfo, Cinahl and Scopus. Twenty-four papers reporting on 19 studies met our inclusion criteria and investigated immigrant women's experiences of menopause and/or their self-management strategies for menopausal symptoms and/or their perceptions of menopause-specific health care.

FINDINGS

Of the 19 studies, 15 reported symptoms experienced during the menopausal transition. Three studies included questions regarding self-management strategies for menopausal symptoms and four enquired about perceptions of menopause-specific health care. Although the heterogeneity of the studies makes comparison difficult, their findings are broadly consistent. Immigrant women reported more vasomotor symptoms and other physical symptoms and poorer mental health than non-immigrant women. The few studies that investigated self-management strategies for menopausal symptoms found that these were influenced by culture and those that assessed perceptions of menopause-specific health care found that they were mostly dissatisfied with the care they had received.

CONCLUSION

More research is needed to improve understanding of how immigrant women manage the menopausal transition and how to provide culturally relevant menopause-specific health care.

"Is it menopause or bipolar?": a qualitative study of the experience of menopause for women with bipolar disorder

Background

Menopause can be a time of change for women and may be marked by disturbances in mood. For women living with a mental illness, such as bipolar disorder, little is known about how they experience mood changes during menopause. This study aimed to explore how women with bipolar disorder constructed mood changes during menopause and how this impacted on treatment decisions.

Methods

Semi-structured interviews were undertaken with fifteen women who reported they had been diagnosed with bipolar disorder. Data was analysed using thematic analysis guided by a social constructionist framework.

Results

Themes identified included ‘Constructions of mood change: menopause or bipolar disorder?’,‘ Life events, bipolar disorder and menopause coming together’; ‘Treatment choices for mood change during menopause’.

Conclusions

The accounts suggested that women related to the experience of mood changes during menopause through the lens of their existing framework of bipolar disorder, with implications for understanding of self and treatment choices.

Electronic supplementary material

The online version of this article (10.1186/s12905-017-0467-y) contains supplementary material, which is available to authorized users.

Validation of the traditional Chinese version of the Menopausal Rating Scale with WHOQOL-BREF

Objective To assess the criterion validity, construct validity and test-retest reliability of the traditional Chinese language version of the Menopause Rating Scale (MRS-TC version). Methods This was an observational, cross-sectional study covering hospital and community samples of 317 women aged 39-62 years. Two questionnaires were administered, namely, the MRS-TC version, made up of 11 items in three dimensions, and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). The intraclass correlation coefficient was used to examine the test-retest reliability of the questionnaire on two separate occasions, 2 weeks apart. The internal consistency was assessed with Cronbach's α. To evaluate criterion validity, the relationship between the individual items and dimension scores of both instruments was estimated. Pearson's correlation was used to assess convergent and discriminant validity; construct validity was evaluated by comparing the mean scores of menopausal and non-menopausal women for each of the MRS dimensions. Results The final questionnaire comprised 11 items in three dimensions. The intra-class correlation (ICC) for the test-retest reliability ranged from 0.83 to 0.93; values of Cronbach's α for psychological, somatic, and urogenital symptom domains were 0.88, 0.68, and 0.59, respectively. For the convergent and discriminant validity, the correlations between the individual questionnaire and the WHOQOL-BREF were significant; those with the MRS dimensions were significantly negatively associated for the physical, psychological, social and environmental domains. Conclusion The MRS-TC version using the traditional Chinese language is a reliable and valid questionnaire for assessing menopausal symptoms and global quality of life in climacteric women.