Stress,psychological distress,psychosocial factors,menopause symptoms and physical health in women

Objectives

Relatively few studies have evaluated relationships between stress, psychological distress, psychosocial factors and menopause symptoms, and none have evaluated emotional intelligence (EI) in relation to menopause. In this study, direct and indirect relationships were evaluated between stress, psychological distress, psychosocial factors (e.g. social support, coping, EI), menopause symptom severity and physical health in middle-aged women.

Methods

One hundred and sixteen women aged 45–55 years were recruited through women's health centres and community organizations. They completed a short questionnaire asking about stress, psychological distress (i.e. anxiety, depression), EI, attitude to menopause, menopause symptoms and physical health.

Results

Low emotional intelligence was found to be related to worse menopause symptoms and physical health, and these associations were partly mediated by high stress, anxiety and depression, a negative attitude to menopause and low proactive coping.

Conclusions

Women with high EI appear to hold more positive attitudes to menopause and experience less severe stress, psychological distress and menopause symptoms and better physical health. These results suggest that women who expect menopause to be a negative experience or are highly stressed or distressed may be more likely to experience a more negative menopause.     

Stressful life events, psychological appraisal and coping style in postmenopausal women

Objectives

The study aim was to investigate what life events postmenopausal women attending a menopause clinic, report as stressful and how psychological appraisal of these events, menopausal symptoms and general stress mediate coping style.

Methods

An observational design was used to recruit 179 postmenopausal women attending a menopause clinic for the first time. Data was collected using self-report questionnaires assessing socio-demographic information, menopausal symptoms, perceived stress, named stressful event, psychological appraisal and coping styles employed.

Results

All of the women were postmenopausal, with a mean age of 50.74 years (SD = 4.75). Stressful events were categorised into family problems, menopause symptoms, work problems, daily hassles and other health problems. The most commonly reported coping styles were in order, catharsis (68%), direct action (66%), and seeking social support (63%). Logistic regression was used to determine what predicts coping style. Socio-demographic variables, menopausal symptoms and general stress levels were not predictive of coping styles in this study. Specific aspects of psychological appraisal were predictive of distraction, direct action, catharsis and seeking social support.

Conclusions

Coping styles most commonly implemented were also the ones predicted by psychological appraisal of the stressful event in this study and tend to be used more so by older women. This information could be used to develop more appropriate interventions for postmenopausal women.     

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.     

Depressive symptoms in Taiwanese women during the peri- and post-menopause years: Associations with demographic,health, and psychosocial characteristics

ObjectiveThe purpose of this study was to evaluate the prevalence of depressive symptoms in peri- and post-menopausal Taiwanese women, and to investigate the relation between depressive symptoms and demographic variables, chronic disease status, health habits, stress management, menopausal symptoms, and attitudes toward menopause and aging.Study designCross-sectional study, using a purposive sample of 566 women between 45 and 60 years of age from a medical center and residential community in Southern Taiwan.Main outcome measuresDemographic and health habits questionnaire, Women's Health Initiative Symptom Scale, Attitudes Toward Menopause and Aging Scale, and Center for Epidemiological Studies-Depression Scale (CES-D).ResultsThe prevalence of depressive symptoms (CES-D score ≧ 16) was 38.7% in peri- and post-menopausal Taiwanese women. Bivariate correlations and analyses of variance indicated that higher CES-D scores were related to lower family income, younger age, smoking for a greater number of years, consuming more alcohol, having multiple chronic diseases, not exercising regularly, consulting with a specialist for stress management, having more severe menopausal symptoms, and more negative attitudes toward menopause and aging. A stepwise multiple regression analysis indicated that the key predictors, accounting for 33.7% of the variance, were menopausal symptoms, attitudes toward menopause and aging, family income, and chronic disease status.ConclusionsResults highlight the importance of considering psychosocial factors, life style, and chronic disease management in providing health guidance for peri- and post-menopausal women to enhance their quality of life and reduce the risk of depressive symptoms.     

Associated factors with urogenital score in natural and surgical menopause

OBJECTIVE: To anticipate the factors associated with urogenital symptoms in both natural and surgical menopause. METHODS: A retrospective analysis was performed comprising 267 cases with spontaneous menopause and 87 surgical menopause cases without any use of hormone replacement therapy. Sociodemographic characteristics, reproductive and medical history, urogenital scale and psychological subscale of Greene Climacteric Scale were assessed and correlated with the age of menopause, time past since last menstrual period, parity, body mass index (BMI), mode of delivery among two groups. RESULTS: Mean age of women enrolled to the study were 46.8+/-0.3 years and 44.4+/-0.25 years, for natural and surgical menopause cases, respectively. Mean parity had no correlation with urogenital scale in two groups. However, a positive correlation was apparent between the time since last menstrual period, psychological subscore of Green Climacteric Scale and urogenital score in both women with natural and surgical menopause. BMI was negatively correlated with urogenital score among two groups (r(p)=-0.85, p=0.04). CONCLUSIONS: Intensity and frequency of urogenital symptoms and climacteric complaints as expressed in the Greene Climacteric Scale increase during menopausal transition. Care should be taken to ameliorate the quality of life (QOL) and to confront these problems in post-menopausal women.     

广泛焦虑障碍的心理社会因素、免疫学相关研究

目的：研究广泛焦虑障碍(GAD)患者的心理社会因素、免疫学特点及这二者之间的相互关系。方法：研究组为30例GAD患者，对照组为25例抑郁性神经症(DN)患者及32例健康人。所有样本均用生活事件量表(LES)测评生活事件应激，用简易应对方式问卷(SCSQ)评定应对方式，用艾森克个性问卷(EPQ)评定人格特征，测血清白介素-2(IL-2)浓度，自然杀伤细胞(NK)及CD3 细胞比率测定。比较GAD与DN、正常对照组(NCG)二组的差异，并对GAD内部有关指标进行相关分析。结果：GAD组患者LES评定中，负性事件数及LEU值水平小于DN组，生活事件发生的总件数、负性事件数、负性事件LEU值均大于正常组。应对方式中，积极应对维度少于正常组，消极应对维度多于DN组及正常组。EPQ评定中，无论男女N分均大于正常组，与DN组无显著性差异。IL-2大于DN组及正常组。CD3 及NK比例与其它两组均无显著性差异。IL-2与生活事件总件数、EPQ中L分呈负相关，与NK呈正相关。结论：GAD患者有明显的心理社会应激、消极的应对方式、情绪不稳定，存在着部分免疫功能异常。心理社会因素对免疫学有影响。     

Myths and realities of the menopause.

Menopause is a reproductive milestone in a woman's life around which many different myths have developed. We reviewed three sets of myths that middle-aged premenopausal women hold and evaluated those myths according to scientific data from our own work and that of others. First, middle-aged women expect to experience depression, irritability, and vasomotor symptoms during the menopause. It appears that the vast majority of postmenopausal women do not experience depression, but do experience vasomotor symptoms that are uncomfortable and may have secondary effects on psychological well being, especially during the perimenopause. Second, middle-aged women believe that holding negative expectations about the menopause affects the quality of the menopausal experience. Indeed, that appears to be the case, perhaps because myths can function as self-fulfilling prophecy. The third myth is that there are no important changes that occur during the menopause. That is incorrect. Estrogen deficiency during the menopause sets the stage for substantial changes in risk for CHD, which becomes clinically apparent later in life. We discussed how estrogen deficiency may influence both lipids and lipoprotein levels and the magnitude of neuroendocrine and cardiovascular respond to mental stress. That latter pathway is of particular interest because middle-aged women may be exposed more often to interpersonal stress and may respond more emotionally to it, relative to men, suggesting a potential interactive effect of the decline in reproductive hormones and co-occurring social and psychological changes during the menopausal period. This discussion of the myths and realities of the menopause has deliberately not been exhaustive.(ABSTRACT TRUNCATED AT 250 WORDS)     

Assessment of the variation in menopausal symptoms with age, education and working/non-working status in north-Indian sub population using menopause rating scale (MRS)

OBJECTIVE: To study the variation of the menopause rating scale (MRS) scores with age, working/non-working and educated/uneducated status in a cohort of north-Indian subpopulation and to look for the possible reasons for the incurred variations. MRS is a well-known and validated instrument for assessing the frequency and intensity of menopausal symptoms. METHOD: A menopause clinic was organized in collaboration with a primary care centre (under the guidance of a gynecologist). A random sample of 208 women aged 35-65 years participated in the study. The MRS scale, a self-administered standardized questionnaire was applied with additional patient related information (age at menopause, level of education, working/non-working and exercising or not). RESULTS: The results were evaluated for psychological (P), somatic (S), and urogenital (U) symptoms. The average age at which menopause set in, in the cohort was found to be 48.7+/-2.3 years (46.4-51 years). Based on the average age at the menopause, the cohort was divided into peri (35-45), menopausal/early menopause (46-51) and the postmenopausal (52-65) groups. A significantly higher % of perimenopausal women (36%) showed a P score of > or =7; while a higher % of postmenopausal showed S score and U score > or =7 (>40%; p< or =0.001). Working women seem to suffer more from psychological symptoms whereas non-working women showed a greater incidence of somatic symptoms. Educated women showed a lower incidence of psychological and somatic symptoms. CONCLUSIONS: Present study indicates that age, level of education and working/non-working status (in a group of women with same socio-cultural background) may also contribute to significant variations in menopausal symptoms.     

Impact of menopause on quality of life in community-based women in China

OBJECTIVE: To assess the impact of menopause, age, and other factors on quality of life (QOL). DESIGN: Generally healthy women aged 35 to 64 years were recruited from a general community in Beijing, People's Republic of China. An instrument including the Chinese version of the Menopause-Specific Quality of Life Questionnaire was used to obtain data. RESULTS: A gradual decline of QOL was seen from pre- to peri- and postmenopausal women in the same age group. Statistically impaired QOL was associated with the peri- and postmenopausal women in vasomotor and physical domains but only with the postmenopausal women in psychosocial and sexual domains. Early postmenopausal women presented the worse QOL in vasomotor, psychosocial and physical domains. The gradually declining sexual QOL was related to the advance of menopause. Age had a negative impact on QOL in vasomotor and sexual domains. Women who assessed their own health as common (fair) or weak (poor) reported worse QOL than those who decribed themselves as healthy. Women with a higher body mass index reported more vasomotor symptoms. CONCLUSIONS: Menopause might have a negative impact on QOL independent of age in community-based women in China. There seemed to be a potential model of the relationship of menopause status to change in QOL, but this needs supporting evidence from longitudinal studies. The association of QOL with age and other factors also should be considered.     

Pregnancy and birth history influence women's experience of menopause

OBJECTIVE: The determinants of experiencing menopausal symptoms are complex, representing biological, psychological, and social factors. We report the impact of one such factor, fertility, on the experience of menopausal symptoms. We hypothesize that nulliparous women will have more dissatisfaction with childbearing choices and more negative attitudes toward menopause but will experience fewer menopausal symptoms. DESIGN: Women aged 40 to 65 years were recruited from a single internal medicine practice to participate in a 5-year longitudinal study of the impact of menopause on health-related quality of life. Women completed questionnaires including the RAND-36, attitudes toward menopause, menopausal symptoms, and fertility and childbearing. Based on self-reported pregnancy and birth history, we categorized women as parous (one or more live births), nulligravida (no pregnancies or births), and nulliparous (one or more pregnancies and no live births). Categorical variables were analyzed using univariable and multivariable ordered logistic and logistic regression. Continuous variables were analyzed using Student's t test and multivariable linear regression techniques. RESULTS: The 728 participants were, on average, 50.8 years old with 2.4 pregnancies and 1.7 live births. Compared with parous women, nulligravida and nulliparous women were more likely to report being very dissatisfied with childbearing choices (odds ratio [OR] [95% CI]: 3.3 [2.3-4.6] and 4.0 [2.5-6.4], respectively). Nulliparous, but not nulligravida, women expressed more negative attitudes toward menopause compared with parous women (P<0.001). Nulligravida and nulliparous women were half as likely to report hot flashes as parous women (OR [95% CI]: 0.6 [0.4-0.9] and 0.5 [0.3-0.9], respectively). Compared with parous women, nulligravida women were less likely to report vaginal dryness (OR [95% CI]: 0.5 [0.3-0.7]). CONCLUSIONS: Our study examined the impact of pregnancy and birth history on menopausal symptoms, and the findings support the hypothesis that women who experience infertility may find menopause to be a time of normalcy and experience fewer hot flashes. Both physiologic and psychosocial mechanisms deserve further study.     

Current considerations of the menopause

Menopause occurs in approximately 50 percent of women by the time they reach the age of 50. Increased lifespan owing to modern medical achievement allows women to spend more than one-third of their life time in menopausal period. Although mechanism of ovarian aging is not fully understood, menopause associated clinical problems can be controlled and improved. Estrogen replacement therapy in conjunction with a progestin regimen not only controls hot flashes, osteoporosis, dyspareunia, and other estrogen-deficiency symptoms, but also prevents the potential risk of estrogen treatment such as endometrial and/or breast carcinoma and cardiovascular disorders. In addition to hormonal therapy, nutritional supplements such as calcium and vitamin D, and physical exercise are essential to the well-being of women in the post-menopausal period.     

Available medical choices for the management of menopause

The age at which menopause occurs is a critical factor in the magnitude of its consequences. Most of the medium-to-long-term effects of oestrogen deprivation depend on their duration. The timing of the last menstruation is therefore important, but hypoestrogenic amenorrhoea during the reproductive age is also a relevant factor in the evaluation of individual risks. In recent years, moving post-menopausal women from the lowest point of ovarian hypofunction has been the most important motivation for developing guidelines for the hormonal management of menopause. However, recent data suggest that this may be associated with an unacceptable increase in morbidity in a number of women. Concerns about long-term hormone replacement therapy (HRT) at menopause have recently enhanced interest in a group of molecules that act on the oestrogen receptor with selective effects, known as selective oestrogen receptor modulators (SERMs). Of these, Raloxifene has been approved for the treatment and prevention of osteoporosis, and exhibits a pattern of actions particularly well matched to the needs and concerns of post-menopausal women. Further studies on SERMs may open up new vistas in patient-specific management of post-menopausal health. Finally, debates on the specific health consequences of menopause deal mainly with the risk of chronic disease. Gynaecologists and other health professionals would be advised to develop intervention strategies at menopause according to the continuum of a woman's life, beginning at the post-menarche and extending into later life.     

Diabetes and the menopause

Diabetes mellitus is the commonest chronic disease in post-menopausal women and is a predisposing factor for cardiovascular disease, which is the leading cause of death in this cohort in Western societies. Diabetes and the menopause are two independent risk factors for development of cardiovascular disease. Risk factor modification in terms of diabetes appears straightforward; however, correction of oestrogen deficiency which hallmarks the menopause appears complex. Our aim is to discuss this question based on the evidence available. Co-morbid diseases are common in post-menopausal diabetics. Hence, it not easy to either conduct or establish clear causal relationships in randomised controlled trials. Consequently, making decisions about treatment becomes difficult. However, it is important adopt strategies to help post-menopausal diabetic women alleviate their menopausal symptoms and to minimise the adverse consequences of their condition. We conclude that the low-risk diabetic post-menopausal women should be offered appropriate hormone replacement therapy, whereas non-oestrogen-based treatments should be the treatment of choice for high-risk women.     

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.     

Profile of menopausal women in west Anatolian rural region sample

OBJECTIVES: The aim of this study was to evaluate age at menopause, climacteric symptoms and related factors in women living in west Anatolian rural region of Turkey. METHOD: This study included 761 menopausal women living in three rural towns. Questionnaires regarding to 10 climacteric symptoms, menopausal status, sociodemographic characteristics, parity, breastfeeding, presence of chronic illness, direct sun exposure, smoking, caffeine use and hormone replacement therapy (HRT) were filled out by face-to-face interview. Logistic regression analysis was used to assess confounding factors on the age of menopause and menopausal status. RESULTS: Mean age at menopause was 44.38+/-5.30 years. Breastfeeding more than one year, low level of direct sun exposure and mother's early age at menopause were associated with early onset of menopause. The most prevalent climacteric symptoms were urine leakage, decreased libido, lack of energy and poor memory in post-menopausal and hot flushes in peri-menopausal women. Somatic and psychological symptoms were associated with hot flushes. HRT and osteoporosis treatment usage were higher in surgical menopause group. Osteoporosis and Type 2 Diabetes Mellitus (DT) were more common in natural menopause group. No association was found with onset of menopause and smoking, excess caffeine use, BMI, marital status and presence of chronic illness. Cardiovascular risk factors such as hypertension (HT), diabetes and obesity were common in post-menopausal women. CONCLUSION: Onset of menopause in Turkish women living in rural region is earlier on average women living in western or industrialized countries. Hot flushes in peri-menopausal, and urogenital, and psychological in post-menopausal women are the most prevalent symptoms. Primary care services in rural districts should focus on cardiovascular risks of menopausal women.     

Determinants of age at menopause in women attending menopause clinics in Italy

OBJECTIVE: We analysed the mean age at menopause and its determinants in 31,000 women attending menopause clinics in Italy. DESIGN: Between 1997 and 2003 we conducted a large cross-sectional study on the characteristics of peri- and post-menopausal women attending a network of first-level outpatient menopause clinics in Italy for general counseling or treatment of menopausal symptoms. Spontaneous menopause was defined as natural cessation of menses for 12 or more months. A total of 31,834 women with spontaneous menopause entered the study. RESULTS: The mean age at spontaneous menopause was 51.2. The age at menopause did not markedly changed with cohort of birth. Higher education was associated with lower age at menopause (51.1 in women with low education versus 51.3 for women with high school or university degree, p<0.05). A higher body mass index (BMI) was associated with later age at menopause. Smokers reported a lower age at menopause (51.2 in nonsmokers versus 51.1 in smokers, p<0.05). A later age at menarche was associated with a later age at menopause. Likewise, lifelong irregular menstrual cycles and higher parity were related with later age at menopause. No association emerged between ever oral contraceptive use and age at menopause. CONCLUSIONS: Low educational level, lower BMI, smoking, early menarche, nulliparity and regular cycles are independently associated with lower age at natural menopause in a large sample of women attending menopause clinics in Italy. However, in absolute terms the effect of these factors in our sample is very small.     

Psychological distress around menopause

The authors sought to identify a subgroup of women who are likely to experience psychological distress in the period around menopause. A sample of 189 women (mean age=49.49) was selected from the general population and rated for menopausal status, menopausal symptoms, depression, anxiety, perceived control, body image, and sex role. Menopausal symptoms were not found to discriminate between pre-, peri-, and postmenopausal women. Factor analysis of the symptoms yielded a specific somatic factor that correlated with menopausal status but not with psychological variables and a nonspecific psychosomatic factor that correlated with psychological variables but not with menopausal status. This suggests that psychological distress during the menopausal transition may indicate a personal psychological or physiological vulnerability rather than a specific reaction to the menopausal events.     

农村妇女输卵管结扎术与神经症的三年随访

目的 :探索农村妇女输卵管结扎术后神经症的心理社会因素及预后的相关性。方法 :对输卵管结扎术后确诊为神经症患者和健康者各 60例 ,采用一般心理测验问卷、症状自评量表、心理社会应激调查表、社会支持量表、心理健康测查表、艾森克人格问卷 ,作为随访三年前后的评定工具。结果 :输卵管结扎术后神经症者的个性具有明显的神经质倾向 (P <0 0 1) ;术前有较多的对手术后遗症和术后劳动力影响方面的担心 (P <0 0 1) ;主观社会支持较低 ,具有明显的消极情绪和消极应对方式 (P <0 0 1) ;心身症状严重 ,以躯体化症状为主 (P <0 0 1)。多因素回归分析提示心身症状程度、社会心理应激水平、情绪反应与应对方式等是术后神经症相关的危险因子 (P <0 0 5 )。结论 :输卵管结扎术后神经症的发生与个体的不良认知、情绪、应对和个性特征有关 ,提示减少输卵管结扎术后神经症的发生必须加强术前的心理咨询、辅导 ,提高受术妇女认知水平。     

Safety and efficacy of oestriol for symptoms of natural or surgically induced menopause

To assess the safety and efficacy of oestriol in relieving post-menopausal symptoms 53 post-menopausal Japanese women with climacteric symptoms, 27 with natural menopause (group I) and 26 with surgically induced menopause (group II), received oral oestriol, 2 mg daily for 12 months. Clinical parameters including Kupperman index (KI) and the degree of satisfaction with symptomatic relief; serum concentrations of oestradiol, FSH and LH; serum lipids; blood pressure; bone mineral density, serum calcium (Ca), alkaline phosphatase (ALP), and urinary Ca were compared between the two groups. Oestriol improved KI in groups I and II by 49 and 80% respectively. Satisfaction with treatment was 85% in group I and 93% in group II. For both parameters, values were significantly different between groups I and II (P < 0.05 for both). Serum concentrations of oestradiol, FSH and LH changed in group I versus group II 6 months after initiation. A significant decrease in serum ALP and Ca/Cr was observed in group I at 6 months. Except for serum triglycerides, oestriol had no significant effect on lipids. Systolic and diastolic blood pressures were significantly decreased in group I at 3 months versus baseline. Slight vaginal bleeding occurred in 14.3% of group I. Histological evaluation of the endometrium in all women of group I and ultrasound assessment of the breasts following 12 months of oestriol treatment found normal results in all women. Therefore, oestriol appeared to be safe and effective in relieving symptoms of menopausal women. The beneficial biochemical effects of oestriol were marked in the natural menopause. Overall, oestriol may serve as a good choice for hormone replacement therapy to protect against other climacteric symptoms in post-menopausal women who do not need medication for osteoporosis or coronary artery disease.     

Comparing the attitudes of urban and rural Iranian women toward menopause

OBJECTIVES: This study was designed to compare the attitudes of urban and rural Iranian women toward menopause. The socio-cultural context of urban Tehranian women is considerably more westernized than that of rural Semiromian women. Our original hypothesis was that urban Tehranian women would have a more negative outlook on menopause than rural women. This hypothesis was drawn from previous work implicating the youth-oriented culture of the west as responsible for the negative attitude of western women toward menopause. METHODS: A questionnaire with eight questions regarding major psychosocial issues that are of importance to menopausal women was prepared and administered to a group of 70 Tehranian and 49 Semiromian women. RESULTS: In contrast to the initial hypothesis, analysis revealed that rural Iranian women have a more negative attitude towards menopause than urban Iranian women. CONCLUSION: The more negative attitude of the rural women toward menopause in large part reflected the higher priority they placed on fertility than did their urban counterparts. Further, cross-cultural studies will illuminate exactly which social and cultural factors play a role in both the physical and psychological aspects of menopause.