The menopause: women's psychology and health care

Construction and Validation of the Quality of Maternity Leave Scales (QMLS)

Maternity leave is not federally guaranteed or paid in the United States. Although there has been an increase of women in the workforce, federal maternity leave policy has not changed since the adoption of the Family and Medical Leave Act in 1993. The subjective quality of this maternity leave is likely an important component of what mothers perceive to be decent work. However, no scholars have developed measurements examining mothers’ subjective experiences of the quality of their maternity leave. Therefore, the goal of the current research was to develop scales measuring six domains of quality of maternity leave: time off, flexibility, coworker support, discrimination, microaggressions, and benefits (e.g., pay, health care, disability insurance). In two studies with diverse samples of working, adult mothers, we provide evidence for the factor structure, validity, and internal consistency of the Quality of Maternity Leave Scales.

‘When Ovaries Retire’: Contrasting Women’s Experiences with Feminist and Medical Models of Menopause

Western biomedical paradigms tend to treat health as the absence of disease and the appropriate functioning of biologic and psychophysiologic processes in the individual. Non-biomedical or lay concepts of health often focus on ability to function, or on social or spiritual well-being evidenced by physical fitness, energy, vitality, absence of pain, feeling healthy and the ability to maintain social relationships (Calnan, 1987). Differences between biomedical and lay concepts of health and illness are most pronounced when symptoms are amorphous and ambiguous. Scholarly works on menopausal syndrome traditionally treat the symptoms profile as nonspecific and psychological or psychosomatic (Kaufert, 1982), thus suggesting that there will be little agreement in lay discussions of the experience of menopause. Support group discussions suggest exactly the reverse. Members demonstrate remarkable consistency and agreement in their notions of symptom clusters, cause, and relief, but symptom profiles frequently are presented in highly subjective terms more in keeping with folk medical under-standings of health and illness. This article hopes to demonstrate the importance of using self-help groups to understand experientially constructed notions of health and illness and to argue for greater biomedical attention to lay understandings of menopausal syndrome.

Reliability and validity of the Menopausal Symptom Scale

Menopausal symptom experiences differ by racial/ethnic group. Thus, health care professionals who use instruments to measure menopausal symptoms need to be aware of cultural sensitivities. The purpose of this study was to examine the psychometric properties of the Menopausal Symptom Scale among Korean women. Data from 229 Korean women between the ages of 40 and 65 years, selected by convenience sampling, were collected during 2010-2011. Psychometric properties were evaluated through content validity and item analysis, construct validity, discriminant validity, criterion-related validity, floor/ceiling effects, and internal consistency reliability. Exploratory and confirmatory factor analyses revealed four factors explaining 65% of variance in the items. Discriminant validity and the criterion-related validity were supported. No significant floor/ceiling effects were found. Cronbach's alpha values ranged from 0.90 to 0.95. The Menopausal Symptom Scale developed for Korean menopausal women appeared to be a valid and reliable instrument. It appeared that it measured psychological symptoms more comprehensively and in a culturally-specific or ethnic-specific manner in menopausal women of Asian or traditional cultures. It will be necessary to broaden the scale of research to other ethnic groups and countries to verify the psychometric properties specific to the ethnic group or country.

Perimenopausal risk factors and future health

BACKGROUND

Lifestyle changes around the time of menopause have the potential to impact on morbidity and eventual mortality. Here we review this topic to identify how such changes may improve health at perimenopause and beyond.

METHODS

Searches were performed in Medline and other databases. Each subject summary was presented to the ESHRE Workshop Group, where omissions or disagreements were resolved by discussion.

RESULTS

Body weight increases because the decline in physical activity during the perimenopause is greater than the concomitant decline in energy intake. It is imperative to stop smoking before menopause because the risk of acute myocardial infarction rises sharply thereafter. Cardiovascular events can be reduced by managing risk factors, such as hypertension and increased lipids and body weight. Breast cancer risk is increased to a similar extent by hormone use, decreased physical activity, increased calorie intake and alcohol use, all reflecting lifestyle decisions. Smoking, alcohol and exercise may increase or decrease risk of aging brain disorders, especially dementia and Parkinson's disease, while stress is consistently associated with increased risk and a prudent diet is consistently associated with reduced risk. Osteoarthritis frequency increases after 50 years of age and risk is elevated 3-fold by obesity, while risk of osteoporosis can be minimized by smoking cessation, adequate vitamin D intake and regular weight-bearing exercise.

CONCLUSIONS

Lifestyle changes around the time of the perimenopause can reduce the likelihood and severity of heart disease and chronic illness in later years and the cost of care of elderly women.

The menopausal transition: does it induce women's worries about aging?

OBJECTIVE

This study examines whether patterns of worries about aging change in women during the menopausal transition.

DESIGN

A population-based sample of 261 Australian-born women aged 45-55 years at baseline participated in a longitudinal study. Data were collected at baseline and in the 5th year of annual follow-up interviews. Measures included the Attitudes to Aging Scale which is based on a scale developed by Kaufert and Syrotuik and contained the six-item version which examines worries about specific losses. Menopausal status was determined by menstrual status as follows: late reproductive, early menopausal transition, late menopausal transition, and postmenopause.

RESULTS

Data analysis carried out by cross-tabulation found that 36% of participants did not change their attitudes over the 5-year follow-up period, 30% became more worried and 33% became less worried and there was no significant difference between those who had or had not experienced the menopausal transition. There was no significant association between the scores on the Attitudes to Aging Scale and changes in the self-rated health, work status and marital status.

CONCLUSION

The menopausal transition does not induce an overall increase in worries about aging.

Quality of Sexual Life and Menopause

The importance of female sexual fulfillment is increasingly recognized in today's society. Women's sexual lives continue well into the menopausal years and beyond; however, the impact of menopause on the quality of that sexual life has not been comprehensively studied in the medical literature. This review attempts to clarify the impact of the physiological, psychological and psychosocial changes occurring at midlife that may affect women's quality of sexual life. Pharmaceutical and psychological interventions that may assist in improving the quality of sexual life of menopausal women are discussed. Female sexuality is complex and not fully understood and, consequently, controversy frequently arises in the discussion of female sexual problems and their treatment. This article highlights some of these controversies and provides a future perspective on how the impact of menopause on the quality of sexual life may be more cohesively investigated.

Documentation of self-care actions taken for somatic complaints by postmenopausal Malay women living in Kelantan Malaysia

OBJECTIVE

The aim of this study was to document some of the self-care actions taken by women in Kelantan to manage their somatic symptoms associated with menopause.

METHOD

A verified semi-structured questionnaire in the Malay language was administered to 326 naturally menopaused healthy women (mean age of 57.01+/-6.58 (S.D.) years) residing in Kelantan to determine the prevalence and types of self-care actions taken for their somatic complaints.

RESULTS

Mean age at menopause was 49.4+/-3.4 (S.D.) years and 75% of these women were within the first 10 years of menopause. Of the four somatic symptoms, tiredness was the most prevalent followed by reduced level of mental concentration, musculoskeletal aches and pains, and backache. The prevalence of self-care actions was highest for backache (91%) and the lowest for reduced level of concentration (47.7%), and both prevalence and type of self-care action appear to depend upon the area of residence, and the educational level of the subject. Of those who took self-care actions, majority were from urban areas and with a higher educational level. Although HRT was used for all the four complaints, the use of pain relief tablets and traditional body massage was more commonly used for musculoskeletal aches and pains and backache than HRT. There was also a small fraction of women who had used the traditional herbs like 'akar kayu' and 'jamu' for these two complaints.

CONCLUSION

It appears that the self-care actions used by postmenopausal women in Kelantan for their somatic complaints ranged from HRT to a combination of conventional, traditional, and alternative remedies. The fraction of women taking self-care action varied from symptom to symptom and the choice of self-care action also depended upon the education level, socio-economic status and place where the respondents were domiciled. There was a tendency for the more affluent and educated women to use more of the modern practices and slightly less of the traditional remedies whereas the rural women did the opposite. This is the first study of its kind in Kelantan documenting the self-care practices of menopausal women for their somatic complaints. Clearly more studies are needed to document these practices and the effectiveness of these self-care remedies.

Self-concept and menopause among mid-life women: a survey in southern Taiwan

The purpose of this study was to understand the self-concept of community women in southern Taiwan during mid-life and its relationship with menopause symptoms. Women between 45 and 55 years of age were selected by simple cluster random sampling process from a name list obtained from the Household Registrar Office in one city of southern Taiwan. A total of 266 women were enrolled. The Chinese version of the Tennessee Self-Concept Scale and Greene Climacteric Symptom Scale were used for assessment.

RESULTS

(1) (a) 92.5% of women's total self-concept scores were within normal range; (b) the scores of the physical self-concept, psychological self-concept, and academic attainment self-concept in women with higher educational levels were significantly higher than those in women with lower educational levels; (c) among six subscales, only the score of the psychological self-concept of those women with a history of using hormone replacement therapy (HRT) was significantly lower than that in women who had never taken any. (2) Women with chronic disease history and with a history of using HRT (no. 54) showed significantly more menopause symptoms (physiological and psychological). (3) (a) Stepwise regression analysis showed that the physical self-concept, family self-concept and academic attainment self-concept were the best predictors for menopause symptoms (both psychological and physiological) for pre-menopausal women; (b) for peri- and post-menopausal women, only physical self-concept could significantly predict psychological and physiological symptoms. Our findings suggest that self-concept is an important factor for mid-life women to adjust to their menopause.

Hot Flash, Hot Topic: Conceptualizing Menopausal Symptoms From a Cognitive-Behavioral Perspective

While most healthy women report that the menopausal transition is nondistressing, a subset of women does report that symptoms significantly interfere in their lives. The most common reason that women seek treatment during this time is for vasomotor symptoms, namely, hot flashes and night sweats. Research has suggested that reports of distress during flashing are only weakly related to more objective measures of the flash, including duration and frequency and that differences in treatment-seeking during the menopausal transition may be better accounted for by differences in symptom awareness mediated by a variety of personality and stress factors. This paper discusses hot flashes and night sweats from a cognitive-behavioral perspective, taking into account individual difference variables that may also affect the experience of menopausal symptoms.

A Behavioral Group Treatment Program for Menopausal Hot Flashes: Results of a Pilot Study

In the present study, we tested the effectiveness of a cognitive-behavioral group treatment (CBGT) for hot flashes in menopausal women. Treatment was administered over 8, 90 min weekly sessions and consisted of education, relaxation training and cognitive restructuring. Nineteen women meeting STRAW staging criteria for the menopause transition (stages -1 to +1) were randomly assigned to immediate or delayed treatment (wait list) and were asked to monitor their hot flashes and night sweats prospectively. They also completed questionnaires, including the Women's Health Questionnaire and the Menopause Specific Quality of Life Questionnaire to determine psychosocial benefits of treatment. Results suggested that the CBGT was moderately successful in reducing the frequency of total vasomotor symptoms [F (1, 17) = 6.16, p < .01], as measured by daily symptom diaries. While there were arithmetic improvements in psychosocial functioning in this sample, these results were not significant. Despite the limitations of small sample size and possible placebo effect, this pilot study supports the notion that cognitive-behavioral interventions aimed at reducing vasomotor symptoms may be of value for menopausal hot flashes when administered in a small-group format.

Factors associated with the difference in score between women's and doctors' decisional conflict about hormone therapy: a multilevel regression analysis

OBJECTIVE

To explore factors associated with the difference in score between women's and doctors' decisional conflict about hormone therapy (HT).

DESIGN

Secondary analysis.

SETTING AND PARTICIPANTS

family doctors were randomized to prepare women for counselling about HT using either a decision aid or a pamphlet.

MAIN VARIABLES STUDIED

After each counselling session, decisional conflict was assessed in women and doctors using the Decisional Conflict Scale (DCS) and the Provider Decision Process Assessment Instrument (PDPAI), respectively. The difference in score between the DCS and PDPAI was computed and entered as the dependent variable in a multilevel regression analysis.

MAIN OUTCOME RESULTS

A total of 40 doctors and 167 women were included in the analysis. The intra-doctor correlation coefficient was 0.25. Factors associated with women experiencing higher decisional conflict than their doctor were: age of doctor >45 years, women who were undecided about the best choice after the counselling session, women with a university degree and women who said that their doctor usually does not give them control over treatment decision. Factors associated with doctors experiencing more decisional conflict than women were: doctors who were undecided about the quality of the decision, length of visit <30 min and women who thought that the decision was shared with their doctor.

CONCLUSION

In order to reduce the disparities between women's and doctors' decisional conflict about HT, interventions aimed at raising awareness of doctors about shared decision-making should be encouraged.

Exploring self-image during hot flushes using a semantic differential scale: associations between poor self-image, depression, flush frequency and flush distress

OBJECTIVES

This study developed a semantic differential scale for assessing self-image during hot flushes, based on a previously published scale (Nursing Res. 35 (1986) 81). The objectives were to explore the sensitivity and validity of this scale, and to examine whether poor self-image during hot flushes is linked to flush distress, perceived control, flush frequency, flush chronicity, self-esteem and depression.

METHOD

Two community samples of women with current experience of hot flushes completed a postal questionnaire.

RESULTS

The semantic differential scale was sensitive to individual differences in self-image, and was validated through its association with measured self-esteem using a standardised scale. Defining the self in negative ways during flushes was highly predictive of flush distress. Poor self-image was also closely associated with depression. Correlations with perceived control, and flush frequency were weaker and did not reach significance in the second, smaller sample.

CONCLUSION

The study extends previous findings that women low in self-esteem have more difficulty coping with menopausal changes, by showing that negative self-appraisal during flushes (e.g. defining self as unattractive or dirty) are highly demoralising and associated with distress. The findings suggest that cognitive behavioural strategies of challenging and re-interpreting thoughts about self could be helpful in moderating the discomfort and stressfulness of hot flushes for women not taking HRT. However, the findings are based on relatively small, volunteer samples and require further replication.

The healing web

We focused on the computer-mediated communication (CMC) of social support in an electronic health discussion group dealing with menopause and midlife transition to show how vital support is to women who are trying to make sense of the change in their lives. We analyzed 2,000 messages, examining the type and frequency of support messages, how support was demonstrated, and how support was recognized by participants. We then provided evidence to show that a community of support had developed.

Discourse about menopause in selected print media

OBJECTIVE

In Western societies, menopause has negative connotations with variable effects for women at midlife. To assess the power of the stereotype, selected popular print media were surveyed for their depiction of menopause.

METHOD

Ten years' output of two daily newspapers and four women's magazines was surveyed for menopause-related copy. Both content and discourse analyses were applied to quantify retrieved copy (using SPSS) and identify dominant discourse (using NUD.IST).

RESULTS

A database of 302 items was analysed. No consistency in reporting trends was found although there were thematic peaks for 'menopause' in the late 1980s and 'hormone replacement therapy' three years later. With few exceptions, discourse about menopause drew on and reinforced schemata of ill-health, psychological disturbance, vulnerability, decrepitude, biological determinism and disease management.

CONCLUSIONS

The limited discourse about menopause in the surveyed media was characterised by strong themes of illness, medical management and fear. A general perception that menopause affects women's health and competence from midlife was reflected by this public discourse.

IMPLICATIONS

Public health awareness that menopause is not synonymous with dysfunction will contribute to a paradigmatic shift in public discourse that affords value to all of women's lifespan, not just the procreative.

Las ciencias sociales como discurso de la salud reproductiva. El ejemplo del climaterio femenino

Tomando como ejemplo la construcción del climaterio femenino por parte de la medicina, de la opinión profana y de las ciencias sociales, se examinan los modelos de interrelación entre estos discursos y se propone la tesis de que la aportación de las ciencias sociales consiste en una reformulación de la base cognitiva de las profesiones de la salud en un nivel de integración.