Migration and symptom reporting at menopause: a comparative survey of migrant women from Turkey in Berlin, German women in Berlin, and women in Istanbul

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.

Menopausal experiences of South Asian immigrant women: a scoping review

IMPORTANCE AND OBJECTIVE

South Asians make up a significant portion of global immigration. Immigrants often face challenges when navigating the healthcare system, which can influence their experience during the menopausal transition. The purpose of this scoping review is to summarize the existing literature on South Asian immigrant women's menopausal experience.

METHODS

Various electronic databases were systematically searched to identify research articles. The menopausal experiences of South Asian immigrant women were examined.

RESULTS

A total of 11 studies were included in this scoping review. A variety of physical symptoms were reported, including vasomotor symptoms, musculoskeletal symptoms, somatic symptoms, and early onset of menopause. Psychosocial symptoms included anxiety, depression, and decreased memory/concentration. Cultural experiences were both positive and negative, depending on the connotations surrounding menopause. Individual facilitators for a healthy transition included education and employment. Familial barriers included a lack of knowledge and support. Community and societal factors were both positive and negative, depending on the level of acculturation. Self-management was the most widely used intervention.

DISCUSSIONS AND CONCLUSION

Findings of this scoping review can help guide the development and evaluation of menopause interventions for South Asian immigrant women. Culturally sensitive care, increased discussion on sexual health, support networks, and reduction of socioeconomic barriers are needed to address the health needs of South Asian immigrant women. Further research is needed to better understand South Asian immigrant women's menopausal needs and help guide intervention design.

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.

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.

The influence of selected socio-demographic variables on symptoms occurring during the menopause

Introduction

It is considered that the lifestyle conditioned by socio-demographic or socio-economic factors determines the health condition of people to the greatest extent. The aim of this study is to evaluate the influence of selected socio-demographic factors on the kinds of symptoms occurring during menopause.

Material and methods

The study group consisted of 210 women aged 45 to 65, not using hormone replacement therapy, staying at healthcare centers for rehabilitation treatment. The study was carried out in 2013-2014 in the Silesian, Podlaskie and Lesser Poland voivodeships. The set of tools consisted of the authors’ own survey questionnaire and the Menopause Rating Scale (MRS).

Results

The most commonly occurring symptom in the group of studied women was a depressive mood, from the group of psychological symptoms, followed by physical and mental fatigue, and discomfort connected with muscle and joint pain. The greatest intensity of symptoms was observed in the group of women with the lowest level of education, reporting an average or bad material situation, and unemployed women.

Conclusions

An alarmingly high number of reported psychological symptoms in the group of menopausal women was observed, and in particular among the group of low socio-economic status. Career seems to be a factor reducing the risk of occurrence of psychological symptoms. There is an urgent need for health promotion and prophylaxis in the group of menopausal women, and in many cases for implementation of specialist psychological assistance.

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

OBJECTIVE

What are the differences between the occurrence of menopausal symptoms in German women, migrant Chinese women in Germany and Chinese women in their native country? Can these potential discrepancies be explained by sociocultural differences? What are the differences in menopausal symptoms in connection with the consumption of soya?

PATIENT STUDY GROUP AND METHODS

Cross-sectional study 2005-2008. Survey of three groups of women aged between 45 and 60 years (native German women in Berlin, migrant Chinese women in several German cities, Chinese women in Beijing) with an evaluated set of questionnaires surveying socio-demographic data, use of hormone therapy, migration/acculturation, MRS II and other areas.

RESULTS

A total of 2,109 questionnaires were sent out and a 41 % response rate was achieved, although this varied greatly across the three individual study groups. The results of the MRS II factor analysis were almost identical for German women and migrant Chinese women, but there were some differences in content compared to the Chinese study group. Chinese women surveyed in Beijing reported severe symptoms significantly less frequently in all three symptom groups (factors) of MRS II than the German women and the migrant Chinese women, but the values from the German women and migrant Chinese women surveyed are relatively similar. In all three study groups there are no significant differences in the stated severity of the symptoms, regardless of whether soya is consumed frequently or less frequently.

CONCLUSION

The question whether the differences found are solely cultural or migration-related must be examined in further studies. The special experiences and situation in life of migrant women should be taken into particular account by attending physicians during the care and treatment of women in this phase of life.