Menopausal transition and psychological development

It's not as bad as you think: menopausal representations are more positive in postmenopausal women

INTRODUCTION

The menopausal transition is associated with underlying hormonal changes that can contribute to a range of physical and emotional symptoms. Psycho-social factors including attitudes and internal representations play a central role in women's experience of the menopause, but very little is known about how representations might differ across menopausal stages.

METHODS

A sample of 387 women aged 40-60 completed a postal questionnaire that included the menopausal representations questionnaire, the emotional representation subscale adapted from the illness perception questionnaire, and data on menopausal status.

RESULTS

Significant differences across menopausal stages were found for both cognitive [F(2, 381) = 4.32, p < .05, η² = 0.022], and emotional [F(2, 381) = 9.70, p < .01, η² = 0.048] menopausal representations. Postmenopausal women had a significantly more positive cognitive representations of the menopause relative to perimenopausal women (standardised mean difference = 0.25, p > .05). Postmenopausal women held a significantly more positive emotional representation of the menopause than both premenopausal (standardised mean difference = 0.56, p < .05) and perimenopausal (standardised mean difference = 0.43, p < .05) women.

DISCUSSION

Women's emotional and cognitive representations of the menopause are more positive among postmenopausal women, compared to women in the late premenopausal stage. This is consistent with the affective forecasting theory, which proposes the tendency to overestimate the intensity and duration of emotional reactions to future events. Given the association between representations and bothersomeness of menopausal symptoms, clinicians should educate women about their expectations, and challenge their negative beliefs about the menopause.

A new animal model for menopausal transition: combination of ovariectomy and empty bottle stimulation

Previous small animal models for menopausal transition are mainly performed to mimic the biochemical changes of patients with menopausal transition. The psychological symptoms in animal models are often overlooked. To mimic clinical situation, we developed a new mouse model of menopausal transition: the combination of bilateral ovariectomy (OVX) and empty bottle stimulation (EBS). After OVX and 21 days of EBS, behavioral test and pentobarbital-induced sleep test were carried out. Then all the animals were euthanized for further investigations. Compared with the control group, the combination of OVX and EBS group (OVX + EBS) showed higher bodyweight, lower organ index of uteri, and lower concentrations of serum estradiol. In addition, behavioral manifestations, sleep quality, and morphologic features in OVX + EBS group showed significant differences compared with the control group. OVX alone or EBS alone failed to include all the changes of OVX + EBS group. These findings indicate ovariectomy or EBS alone could not well mimic the symptoms of menopausal transition. The combination of bilateral ovariectomy and EBS offers an easy and repeatable method for building comprehensive menopausal transition model in mice.

Body Image in Adult Women: Moving Beyond the Younger Years

In spite of copious literature investigating body dissatisfaction and its correlates in adolescents and young adult women, exploration of body image disturbances in adult women remains an underrepresented domain in the literature. Yet, there are many reasons to suspect that body image in adult women both may differ from and possibly be more complex than that of younger women. Adult women face myriad factors influencing body image beyond those delineated in the body image literature on adolescents and young adult women. For instance, aging-related physiological changes shift the female body further away from the thin-young-ideal, which is the societal standard of female beauty. Further, life priorities and psychological factors evolve with age as well. As such, adult women encounter changes that may differentially affect body image across the lifespan. This paper aims to provide an up-to-date review of the current literature on the relationship between body image and associated mental and physical health problems and behaviors in adult women. In addition, we explore factors that may influence body image in adult women. Lastly, we use this review to identify significant gaps in the existing literature with the aim of identifying critical targets for future research.

Relieving my discomforts safely: the experiences of discontinuing HRT among menopausal women

AIM AND OBJECTIVES

To generate a descriptive theoretical framework about the experiences of women who discontinued hormone replacement therapy.

BACKGROUND

Some menopausal women would depend on hormone replacement therapy for relieving their menopausal symptoms. However, most of them feared of hormone replacement therapy's side effects and tried to discontinue hormone replacement therapy immediately. How did these women self-manage their discomforts without using dependent medicine--hormone replacement therapy? There are few studies conducted on this issue.

DESIGN

A grounded theory research was applied.

METHODS

Nineteen Taiwanese women discontinuing hormone replacement therapy for three months, aged 45 to 67 years, participated in face-to-face audio-taped interviews. Data collection, and coding of interviews, and data analysis occurred simultaneously. All conversations were audio-recorded and then transcribed as verbatim text. The constant comparative method was used to analyse the interview data.

RESULTS

'Relieving my discomforts safely' was the core theme for describing and guiding the process of discontinuing hormone replacement therapy. 'Immediately discontinuing hormone replacement therapy--it would hurt my body' was identified as the antecedent condition. Analyses showed five dimensions to the women's relieving my discomforts safely: (1) symptoms bothered me again, (2) negative emotions, (3) learning to let it go, (4) trying to use nonhormone replacement therapy or products and (5) choosing safely therapies as first priority. Finally, some women would choose their suitable nonhormone replacement therapy way, and some women would reuse hormone replacement therapy cautiously.

CONCLUSIONS

'Relieving my discomforts safely' was the first-priority consideration for the menopausal women discontinuing hormone replacement therapy. It is the challenge to establish the health programme or management for helping these women felt safety and security to relieve their menopausal symptoms by using hormone replacement therapy or nonhormone replacement therapy.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers need to empower women the rights of decision-making of using hormone replacement therapy and assist them in monitoring their health status to reduce their fear and uncertainty.

Voices from the Hilo Women's Health Study: talking story about menopause

Our purpose in conducting this qualitative study was to examine how a multiethnic sample of women living in Hilo, Hawai'i, describe menopause. Interviews were conducted with 185 pre-, peri-, and post-menopausal women aged 45 to 55. We found that pre-menopausal women felt anxious compared with peri- and post-menopausal women's more affirmative attitudes of increasing confidence and freedom in this new cycle of life. A dominant theme was the construction of a post-menstrual identity. Peri-and post-menopausal women's attitudes were not biomedically oriented. Local culture and the island lifestyle may provide a positive atmosphere for women going through menopause.

Development of burnout in middle-aged working women: a longitudinal study

OBJECTIVE

The present study had two aims: first, to identify developmental patterns of burnout in middle-aged women from the working population and, second, to evaluate whether work-related and individual factors are associated with concurrent changes in burnout.

METHODS

The study design was longitudinal and used a random, population-based sample of urban middle-aged women. One baseline and two follow-up assessments were carried out during a 9-year period. At baseline, 142 women participated. Complete data were available for 116 women, who constituted the sample of the present study. Burnout was assessed using the Shirom-Melamed Burnout Questionnaire (SMBQ). In order to identify typical developmental patterns (trajectories) hierarchical cluster analysis was used. Within-group changes in burnout levels over time were analyzed using repeated-measures analysis of variance (ANOVA).

RESULTS

When using a variable-based approach, the results showed no significant changes in burnout over time. However, underlying these levels, six trajectories were identified. These clusters represented four different developmental patterns: high levels followed by recovery, increasing levels, increasing and diminishing levels, and stable levels.

CONCLUSIONS

In contrast to previous research suggesting that burnout is a stable construct over time, the present study identified distinct subgroups of women showing different developmental patterns of burnout during a 9-year period. Furthermore, our findings showed that the development of burnout was accompanied by concurrent changes in life stress as well as work-related and individual factors.

The effects of personality traits on quality of life

OBJECTIVE

The aim of this study was to investigate the impact of women's personality traits and some sociodemographic variables on quality of life (QoL).

METHODS

This cross-sectional and correlational study was conducted among 320 Turkish women aged between 45 and 64 years who attended the Menopausal Polyclinic. Data were collected from the Turkish version of the Cervantes Personality Scale and the Turkish version of the Menopause-Specific Quality of Life Questionnaire.

RESULTS

The mean (SD) age of the participants was 51.8 (5.3) years. The average (SD) age since menopause was found to be 46 (3.3) years. The menopausal QoL was correlated with education status, income level, working status, exercise routine, chronic health problems, family's/friends' support, and negative life events. Logistic regression analyses showed that the QoL in vasomotor, psychological, and sexual domains were 6.1, 9.2, and 11.4 times, respectively, lower in neurotic women than in emotionally stable women. In addition, the QoL in sexual domains were 3.3 times lower in introverted women than in extraverted women.

CONCLUSION

These findings indicate that higher levels of introversion and higher levels of neuroticism lead to lower QoL among postmenopausal women. The results of this study support the hypothesis that personality would play an important role in women's QoL during the transition period of menopause.

Menopausal symptoms among four major ethnic groups in the United States

The purpose of the study was to explore ethnic differences in symptoms experienced during the menopausal transition among four major ethnic groups in the United States. This study was done via a cross-sectional Internet survey among 512 midlife women recruited using a convenience sampling. The instruments included questions on background characteristics, ethnicity-related factors, health, and menopausal status and the Midlife Women's Symptom Index. The data were analyzed using descriptive and inferential statistics. Significant ethnic differences were found in the total number and severity of the symptoms. The most frequently reported symptoms and predictors of the total number and severity of the symptoms differed by ethnic identity. More in-depth cultural studies are needed to understand the reasons for the ethnic differences in menopausal symptom experience.

Silence, stigma, and shame: a postmodern analysis of distress during menopause

Because of the complexity of a midlife woman's life and the variation of the manifested symptoms of menopause, much remains inconclusive regarding the experience of distress during the menopause transition. The purpose of this narrative analysis study was to examine experiences of distress during the menopause transition using a postmodern feminist framework. Findings include experiences of shame related to symptom experience and prevailing social discourses on menopause and aging. Clinicians must be cautioned of the potential for silencing and withdrawal in women who may not be receiving adequate support, and must advocate for more choices for midlife women.

The effects of perceived stress and attitudes toward menopause and aging on symptoms of menopause

INTRODUCTION

As part of a longitudinal study of midlife women, the aim of this investigation was to describe the intensity of menopausal symptoms in relation to the level of perceived stress in a woman's life and her attitudes toward menopause and aging.

METHODS

Data were collected on 347 women between 40 and 50 years of age in Northern California who began the study while premenopausal. Women self-identified as African American, European American, or Mexican/Central American. Data collected over three time points in the first 12 months were used for this analysis. An investigator-developed tool for the perception of specific types of stress was used. Attitudes toward menopause and aging were measured using the Attitudes Toward Menopause and Attitude Toward Aging scales. Attitudes toward aging and menopause, perceived stress, and income were related to intensity of symptoms.

RESULTS

There was no ethnic group difference in perceived stress or attitude toward menopause. However, European and African Americans had a more positive attitude toward aging than Mexican/Central Americans.

DISCUSSION

A lower income, higher perceived stress, a more negative attitude toward aging, and a more positive attitude toward menopause influenced menopausal symptom experience.

Menopausal symptoms in a hospital-based sample of women in southern Thailand

OBJECTIVE

To evaluate menopausal symptoms and quality of life in middle-aged women.

STUDY DESIGN

Hospital-based, cross-sectional study.

METHODS

A survey was conducted among 270 women aged 45-65 years who attended the gynecological and menopause clinic, Songklanagarind Hospital. We used the MENQOL questionnaire as the instrument.

RESULTS

The average age at menopause of the postmenopausal women was 48.7 years (range 40-57 years). The prevalences of the classical menopausal symptoms--hot flushes, night sweats, and vaginal dryness--in the women aged 45-65 years were 36.8%, 20.8 and 55.3%, respectively. The three most prevalent symptoms in perimenopause were aching in muscles and joints, experiencing poor memory, and change in sexual desire. Within the four domains (vasomotor, psychological, physical, and sexual symptoms), more suffering was reported in the perimenopausal and postmenopausal subjects than in the premenopausal subjects (p < 0.001).

CONCLUSIONS

Peri- and postmenopausal women had a significant decrease in quality of life compared to premenopausal women.

Well-being during the menopausal transition and early postmenopause: a longitudinal analysis

OBJECTIVE

To examine relationships between well-being and the menopausal transition (MT) to determine (1) whether women's well-being varies over the course of the MT and early postmenopause (PM) and (2) whether any observed variation is predicted by MT variables, other midlife transitions, or personal resources.

DESIGN

Women from the Seattle Midlife Women's Health Study (N = 334) provided data for these analyses from at least one annual health questionnaire and a menstrual calendar. A subset of women provided a first morning voided urine specimen from 1997 through 2005. Urine samples were assayed for estrone glucuronide and follicle-stimulating hormone. Mixed-effects modeling using the R library was used to investigate whether MT-related factors, including MT stage, presence of hot flashes, hot flash severity and levels of estrone glucuronide and follicle-stimulating hormone, number of negative life events, or personal resources of mastery and satisfaction with social support are significant predictors of well-being.

RESULTS

The model that best fit the data showed that mastery and satisfaction with social support predicted increases in well-being, whereas negative life events predicted decreases in well-being. None of the MT-related factors predicted change in well-being.

CONCLUSION

The variability in women's well-being in this study was more affected by life events other than the MT and early PM and by the personal resources available to meet transition demands. These findings suggest that for most women, the MT is not a predictor of level of well-being when considered in a broader life context.

A challenge to the menopause stereotype: young Australian women's reflections of 'being diagnosed' as menopausal

This paper reports on a qualitative study designed to examine (i) possible explanations for difficulties young Australian women (under 40 years) encountered in the process of gaining a diagnosis of premature menopause and (ii) to address issues underpinning this aspect of menopause. Drawing on hermeneutic phenomenology, face-to-face interviews were carried out with 35 women who consented to share their experiences of 'being diagnosed' with premature menopause. The participants responded to an advertisement in a newspaper article, a radio announcement or through a menopause support centre. While all participants were located in Australia, larger numbers were from the metropolitan areas of Sydney, New South Wales, and Perth, Western Australia. This research reports that the process of finding an explanation for the physical and emotional symptoms the women were experiencing was very complex. The findings varied regarding the psychological and physical symptoms experienced, described feelings, and reasons that led to a diagnosis of menopause. This paper suggests that the age of the women and the non-specific symptoms experienced by them contributed significantly to the delay and uncertainty surrounding the experience of being diagnosed with premature menopause. There was uncertainty of the origin of symptoms, which led the women to feel as though they were 'going insane' or that it was 'all in their heads'. This frequently led to symptoms of menopause being attributed (by health professionals) to a psychiatric basis and menopause being overlooked for varying lengths of time.

The roles of biologic and nonbiologic factors in cultural differences in vasomotor symptoms measured by surveys

OBJECTIVE

To review evidence of cultural differences in both biologic and nonbiologic factors as possible explanations for variation across cultures in self-reported vasomotor symptoms from surveys.

DESIGN

Literature review and cross-sectional and longitudinal comparisons of ethnic groups with respect to patterns of symptom reporting from the Study of Women's Health Across the Nation (SWAN).

RESULTS

The evidence to date indicates that cultural differences in vasomotor symptom reporting on surveys reflect both differences in the underlying biology, which ar likely to influence vasomotor symptom occurrence, and differences in nonbiologic sociocultural factors such as attitudes toward menopause, which are likely to be related to vasomotor symptom perception and reporting,

CONCLUSIONS

It is important to consider interactions of culture and biology in studies of vasomotor symptoms. Recommendations for future studies include using both open- and closed-ended questions, including measurements of objective indicators such as reproductive hormone concentrations, measuring both culturally related biologic and nonbiologic factors related to vasomotor symptom occurrence or reporting, and using the same general study protocol for multiple cultural groups being compared.

Women's conception of the menopausal transition--a qualitative study

AIM

To explore, with a qualitative approach, whether the conception of menopause varies between women seeking medical advice because of climacteric symptoms and, if so, to describe these different conceptions.

BACKGROUND

For many women, the menopausal transition is a troublesome period of life, often associated with decreased well-being and a number of symptoms. Besides the hormonal changes, many other factors such as psychological, sociological and lifestyle factors affect how women perceive their menopause.

METHOD

Semi-structured interviews were held with 20 women after their first-time visits at outpatient clinics of gynaecology for discussion of climacteric symptoms. The interviews were audio-taped, transcribed and analysed using a phenomenographic approach.

RESULTS

A wide variation of conceptions was revealed. Two main categories were identified including different physical changes with varying symptoms and both positive and negative psychological changes. The menopausal transition was also described as a natural process and as a developmental phase of life.

CONCLUSION

Women's conceptions of the menopausal transition were individual and contained both physical and psychological symptoms but also expressed a more holistic view of the menopausal transition. The transition was described as a natural process affected by endocrine and life-style factors as well as by the psychosocial situation and by ageing per se.

RELEVANCE TO CLINICAL PRACTICE

It is important that health care providers are aware of women's conceptions about the menopausal transition to be able to communicate optimally, support and empower middle-aged women in different health care situations and thereby optimize the result of care.

Attitudes towards the menopause and hormone therapy over the turn of the century

OBJECTIVE

To assess attitudes and beliefs about the menopausal transition in a population of peri- and postmenopausal women, and if these attitudes differed before and after publication of studies on risks and benefits with hormone therapy (HT).

MATERIALS AND METHODS

In 1999 and 2003 all women aged 53 and 54 years in the community of Linköping, Sweden, were sent a questionnaire about use of HT, menopausal status and attitudes regarding menopause and HT.

RESULTS

Most women regarded menopause as a natural process characterized by both hormonal deficiency and aging and these views did not differ between 1999 and 2003. A majority of women thought that significant climacteric symptoms were a good reason to use HT, but not that women without symptoms should use HT. The fraction of women who supported HT use was, however, significantly lower in 2003 than in 1999. Most women agreed that menopause leads to increased freedom and that it is a relief not to have to think about contraception and pregnancies.

CONCLUSIONS

Most Swedish women had a mainly biological view on menopause but nevertheless they thought that only women with climacteric symptoms should use HT. Women's attitudes towards HT have changed after recent reports on risks from long-term use of HT whereas the attitudes towards the menopausal transition were stable. Other factors than attitudes towards menopause affect women's actual use of HT. Probably women's and health care provider's apprehension of the risk-benefit balance of HT use is one such factor.

Women's work stress and cortisol levels: a longitudinal study of the association between the psychosocial work environment and serum cortisol

OBJECTIVE

The aim of the present study was to investigate whether there is an association between serum cortisol and work-related stress, as defined by the demand-control model in a longitudinal design.

METHODS

One hundred ten women aged 47-53 years completed a health questionnaire, including the Swedish version of the Job Content Scale, and participated in a psychological interview at baseline and in a follow-up session 2 years later. Morning blood samples were drawn for analyses of cortisol.

RESULTS

Multiple stepwise regression analyses and logistic regression analyses showed that work demands and lack of social support were significantly associated with cortisol.

CONCLUSIONS

The results of this study showed that negative work characteristics in terms of high demands and low social support contributed significantly to the biological stress levels in middle-aged women. Participation in the study may have served as an intervention, increasing the women's awareness and thus improving their health profiles on follow-up.

Hormone therapy after the Women's Health Initiative: a qualitative study

Background

Publication of results from the Women's Health Initiative study in July 2002 was a landmark event in biomedical science related to postmenopausal women. The purpose of this study was to describe the impact of new hormone therapy recommendations on patients' attitudes and decision-making in a primary care practice.

Methods

A questionnaire including structured and open-ended questions was administered in a family practice office waiting room from August through October 2003. Rationale for taking or not taking hormone therapy was specifically sought. Women 50–70 years old attending for office visits were invited to participate. Data were analyzed qualitatively and with descriptive statistics. Chart review provided medication use rates for the entire practice cohort of which the sample was a subset.

Results

Respondents (n = 127) were predominantly white and well educated, and were taking hormone therapy at a higher rate (38%) than the overall rate (26%) for women of the same age range in this practice. Belief patterns about hormone therapy were, in order of frequency, 'use is risky', 'vindication or prior beliefs', 'benefit to me outweighs risk', and 'unaware of new recommendations'. Twenty-eight out of 78 women continued hormones use after July 2002. Of 50 women who initially stopped hormone therapy after July 2002, 12 resumed use. Women who had stopped hormone therapy were a highly symptomatic group. Responses with emotional overtones such as worry, confusion, anger, and grief were common.

Conclusion

Strategies for decision support about hormone therapy should explicitly take into account women's preferences about symptom relief and the trade-offs among relevant risks. Some women may need emotional support during transitions in hormone therapy use.

Qualities and attributes desired in menopause clinicians

OBJECTIVE

To assess the qualities and attributes desired in menopause clinicians.

DESIGN

Women > or =45 years of age (n=72) were surveyed about the qualities and attributes desired in their physician. Surveys were performed in physician waiting rooms in Connecticut.

RESULTS

Although fewer men are entering the practice of ObGyn, more than 88% of peri- and post-menopausal women believe that gender does not affect the quality of their women's health provider. Among the 68 women from whom valid data were obtained, experience (95.6%), knowledge (95.6%), and ability (92.6%) were the most important qualities. Only 4.2% listed gender in the top three most important qualities. If the patient's visit was for wellness- and screening-related issues, 6.6% (n=4) preferred a male, 13.1% (n=8) preferred a female, and 80.3% (n=49) had no preference for gender. The percentage of patients preferring to see a female was slightly higher (29.2%) if the visit was for a pelvic exam, while the percentage preferring to see a male (14.5%) was greater if care involved gynecological surgery.

CONCLUSIONS

As medical practices meet the increasing demand of menopausal women, it is helpful to know the qualities and attributes that patients desire. Menopause clinicians should seek to convey experience, knowledge, and competence to their patients. A menopause practice should strive for a well-diversified team that will bring these qualities to menopausal patients. Given the shifting balance of male and female ObGyn providers, when hiring providers or establishing a menopause clinic, it is helpful to know that gender diversification is of minor importance.

Menopausal women's positive experience of growing older

OBJECTIVE

This paper aims to describe menopausal women's positive experience of growing older and becoming middle-aged.

METHODS

Qualitative interviews with 24 menopausal women, selected on the basis of a questionnaire, covering a broad spectrum of Danish women in terms of experience of menopausal symptoms, treatment, contact with the health care system, and social background.

RESULTS

The women expressed varied and many-facetted views on ageing and clearly connected the fact that they were menopausal to the ageing process. All, except one, mentioned positive aspects of growing older: 1. they had become more experienced and competent; 2. they had gained more freedom; 3. they perceived possibilities of personal development that made them able to hold on to their own opinions and better speak their minds. The described positive effects were the result of having lived a long life, of good and evil, not of the menopause itself. The women also mentioned negative aspects: 1. negative expectations; 2. negative experiences. Positive aspects, often of psychological or existential nature, seemed to outweigh the negative experiences which were mostly related to bodily changes or losses.

CONCLUSION

This paper discusses the importance of avoiding unnecessary negative expectations of ageing and menopause and of focusing, instead, on the positive aspects of growing older. Health professionals should reconsider the necessity to talk about future risks with healthy women, and instead support the women's agenda when they try to cope with real-life problems.

A universal menopausal syndrome?

A variety of symptoms are reported frequently as being part of a menopausal syndrome. These include hot flashes, night sweats, menstrual irregularities, vaginal dryness, depression, nervous tension, palpitations, headaches, insomnia, lack of energy, difficulty concentrating, and dizzy spells. The question of whether and how symptoms occur together is important for women who want to know which symptoms can be attributed to menopause and which to aging generally or to other physical or psychosocial factors. To address this question, the present article examines the following avenues of research: (1) the clustering or grouping of symptoms; (2) the temporal association of different symptoms with stages of the menopausal transition; (3) the consistency of symptom reporting across cultures, race, and ethnicity; and (4) the consistency of risk factors for symptoms. Results of the factor analysis studies do not support a single syndrome consisting of menopausal and psychological or somatic symptoms. The prevalence of symptom reporting across the transition also argues against a menopausal syndrome because vasomotor symptoms follow a unique pattern that differs from that of other symptoms. Cross-cultural differences suggest that symptom reporting is not universal. Finally, although there is some overlap in risk factors for symptoms, menopausal status is more consistently related to vasomotor symptoms than to psychological or physical ones. Results of these investigations all argue against a universal menopausal syndrome. Future research should focus on how symptoms are interrelated, what factors are uniquely related to vasomotor symptoms, and identifying whether there is a subgroup of women who are more likely to report symptoms.

Physical activity, symptoms, esteem, and life satisfaction during menopause

OBJECTIVE

The present study examined the relationships among physical activity (PA), symptom reporting, self-esteem, and satisfaction with life (SWL) in 133 women (M age=51.12, S.D.=4.10) of varying menopausal status.

RESULTS

Multivariate analyses of co-variance (MANCOVA) revealed that independent of menopausal status, women who were more physically active reported significantly less severe vaso-somatic and general somatic symptoms, and higher levels of physical self-worth (PSW). Subsequent hierarchical regression analyses indicated that expended MET-h/week, reported symptoms (frequency and severity, respectively), and PSW accounted for significant variance in SWL (R2 model=0.32, for symptom frequency, and 0.33, for symptom severity). Physical activity was significantly related to SWL through the mediation of PSW. However, both reported symptom frequency and severity retained significant association with SWL after controlling for PSW, although the original associations were significantly reduced. Finally, both symptoms and MET-h/week were independent contributors to the variance in PSW (R2 model=0.33 and 0.34).

CONCLUSION

The results suggest that being physically active may reduce perceived severity of menopausal symptoms and enhance psychological well-being, and that the relationship between physical activity and QOL in mid-life women may be mediated by factors such as physical self-perceptions and menopausal symptoms.

Pilot study of menopause symptoms in a clinic population

OBJECTIVE

Studies analyzing menopause symptoms have primarily focused on white women of higher socioeconomic status. With an aging population and a longer life expectancy, we can anticipate a significant rise in women presenting with menopause symptoms and issues related to quality of life. It is important to know whether current data regarding menopause symptoms are applicable to all women seeking care.

DESIGN

Data from the first 80 consecutive women, predominantly Hispanic and of lower socioeconomic status, presenting to the Women's Life Center at Hartford Hospital were analyzed for demographic and socioeconomic variables, depression, factors related to quality of life, and menopause symptoms.

RESULTS

Although hot flashes (63.8%) and night sweats (55.1%) occurred at a frequency similar to that reported in the literature, mood swings (77.9%), decrease in energy (75.9%), sleeping problems (73.4%), and memory problems (67.1%) were the four most common symptoms. Although there were many symptoms that could impact negatively on their quality of life, 82.3% felt that it was wonderful to be alive during menopause, 73% were satisfied with their life, and the cumulative depression score did not fall into the depressed category.

CONCLUSIONS

This sample of predominantly Hispanic women of lower socioeconomic status experienced negative quality-of-life-related symptoms at a much higher frequency than has been previously reported. The menopause years, although feared by many, can be a wonderful time in a woman's life. Whether the differences identified are due to ethnicity, socioeconomic factors, or a combination of the two has yet to be determined.

Women's needs and wants when seeing the GP in relation to menopausal issues

OBJECTIVE

To explore women's needs and wants when seeing the GP in relation to menopausal issues.

DESIGN

A qualitative interview study.

SETTING AND SUBJECTS

The study was part of a larger project, targeting menopause. It included in-depth interviews of 24 women aged 52-53 years who came from all over Denmark. The women showed a great variety of menopausal experience of symptoms and treatment.

MAIN OUTCOME MEASURES

An acquaintance with the women's agendas when seeing the GP about menopausal issues.

RESULTS AND CONCLUSION

Women consulting their GPs either wanted to discuss treatment for menopausal symptoms, to have an examination for diseases or to get a risk assessment. Their needs for medication or examination were satisfied but several women wanted more information, especially about the pros and cons of hormone therapy (HT). Risk assessment, if not requested, indicated problems, with some women feeling uncomfortable if the GPs started a discussion about HT and osteoporosis, if they only wanted an examination to be reassured that everything was normal. The authors' findings indicate that GPs encounter a subtle balance in considering the question of risk information to menopausal women who do not request it.

Calidad de vida relacionada con la salud en la mujer española durante la perimenopausia y posmenopausia. Desarrollo y validación de la Escala Cervantes

BACKGROUND AND OBJECTIVE

There are numerous health-related quality of life questionnaires but only a few are specific for the menopause. The objective of this study was to develop and validate a specific scale, the Cervantes Scale, for menopause in Spanish women.

SUBJECTS AND METHOD

This cross-sectional study included a pilot phase, construction of the questionnaire, validation, and test-retest reliability. A population-based sample of 2,274 women ponderated by age groups and education levels was used in the validation phase. Internal consistency was assessed with the Cronbach's alpha analysis.

RESULTS

The final questionnaire included 31 items ("menopause and health" with 15 items made up of vasomotor symptoms, health and aging, "sexuality" with 4 items, "couple relationship" with 3 items and "psychical domain" with 9 items). The Cronbach's (coefficient of the scale was 0.9092. The correlation coefficient of the test-retest was r=0.847 (p<.001). The Cervantes Scale is short, easy to administer (about 7 minutes), has a minimal score of 0 and a maximal score of 155 (from better to worse quality of life) and scores can be compared to reference values in younger women and women of the same age.

CONCLUSIONS

The Cervantes Scale is included in the new generation of instruments of health-related quality of life specific for the menopause and is intended to be used in Spanish women aged between 45 and 64 years.