"I am not the person I used to be": Perceptions and experiences of menopausal women living in Karachi, Pakistan

Menopause knowledge, attitudes and experiences of women in Saudi Arabia: a qualitative study

BACKGROUND

Menopause can be seen as a complex phenomenon influenced by an individual's cultural norms, belief systems, and lifestyle choices. In conservative societies such as Saudi Arabia, some women silently struggle with menopause due to cultural taboos and social stigma, making their experiences invisible and lowering their quality of life. The aim of this study was to explore in-depth the knowledge, attitudes, and experiences of middle-aged Saudi women with menopause.

METHODS

The study employed qualitative methods using semi-structured interviews with middle-aged women undergoing menopause in Saudi Arabia from February to May 2023. The interviews were conducted online in Arabic, recorded and transcribed verbatim. The data were analysed inductively using thematic analysis.

RESULTS

A total of twenty-nine women, aged 40-64 years, were interviewed. Three key themes were identified: mixed emotions towards menopause; experiencing biopsychosocial changes; and adapting to the transition. Overall, most participants had mixed perspectives on menopause. Negative aspects included feelings of uncertainty and the loss of fertility while positive aspects included a sense of relief from menstruation and the newfound freedom to engage in religious activities at any time. Notably, during the interviews, many participants reconsidered their initial negative views and voiced predominantly positive perspectives. Several women reported inconvenient menopausal symptoms, such as hot flashes, night sweats, disturbed sleep, and fatigue. Concerns about being perceived as less attractive led many to keep their symptoms private, and societal expectations played a significant role in influencing how women managed these symptoms and sought help. Many women opted to seek information discreetly online rather than seeking support from others. Self-care practices were favoured for managing menopause, with medical care being undervalued or at times deemed unsatisfactory.

CONCLUSION

In Saudi Arabia, menopause is generally seen as a natural phase of life. Many women appreciate the positive aspects it brings, such as relief from menstrual pain and an enhanced ability to participate in religious practices. However, they also encounter challenges, including hot flashes and concerns about perceived decreases in attractiveness. A notable trend is the preference for self-care strategies over medical interventions or hormone replacement therapy (HRT). There is a need to raise awareness about menopausal symptoms to reduce negative perceptions and experiences and to develop health promotion and educational interventions to support and empower women during this transition. Future research with healthcare professionals would extend these findings.

Treatment of menopausal skin - A narrative review of existing treatments, controversies, and future perspectives

Menopause is a state of estrogen deficiency that affects numerous estrogen-dependent tissues in the female body. Skin is one of the most affected organs. Many consider menopausal skin changes to be merely an aesthetic problem; however, they can significantly affect women's quality of life. Currently, there are no approved effective treatments to prevent or alleviate skin changes associated with estrogen deficiency. Standard systemic hormone replacement therapy used to treat menopausal symptoms may be effective to some degree for skin treatment. In addition, compounded bioidentical hormone replacement therapy, selective estrogen receptor modulators, and phytoestrogens could also be used for skin treatment, although this is only hypothetical due to lack of data. Many questions therefore remain unanswered. On the other hand, topical, low-dose estrogen that would act only on the skin without systemic effects could be a possible option, as could be skin-only acting topical phytoestrogens. Such topical products without systemic effects could play a role in the treatment of menopausal skin. However, they are not currently approved because there is insufficient data on their safety and efficacy. A healthy lifestyle could have a positive effect on the menopausal skin. In this review, we provide an overview of the characteristics of menopausal skin, an outlook on the future treatment of menopausal skin with estrogens and other approaches, and the associated controversies and speculations. Overall, the importance of menopausal skin changes should not be neglected, and high-quality research is needed to gain new insights into the treatment of menopausal skin.