‘We’ve been trained to put up with it’: real women and the menopause

This paper, based on qualitative research among a group of women in South Wales, looks at the meanings they give to the menopause, its effects on their working and family lives and the support currently offered by medicine and health promotion. This study is set against a wider discussion of the medicalization of the menopause, and the organization of work within which the current generation of women are situated. It also argues for a new public health approach including the adoption of more qualitative research techniques that would address the concerns and beliefs of people rather than following the traditional ‘objective’ epidemiological model. The paper concludes that the present generation of women do not share a negative view of the menopause but are struggling against mixed messages from their own cultural background, from promotion of medicalized ‘solutions’ and from contemporary pressures of work.     

Health promotion beliefs and practices of fourth-year medical students

Little is known about medical student beliefs about health promotion issues or about their prevention practices with patients. We administered a questionnaire about health promotion beliefs and practices to fourth-year medical students in a required course, "Preventive Medicine in Clinical Practice," at the University of Maryland School of Medicine. During a three-year period we surveyed 343 students. A majority of students believed that most of 23 health behaviors were of some importance to health promotion, and their responses were similar to those of practicing physicians in prior studies. Most students reported that they assessed preventive practices in their patients but did not feel well prepared to counsel patients about health issues. Students reported they were currently unsuccessful in modifying patient health behaviors and expressed limited optimism about future success in helping patients change health promotion behaviors with further training and support. There were no differences between students entering primary care specialties and other students. Information about medical student health promotion and disease prevention beliefs and practices can be applied in curriculum development.     

Women veterans and menopause: Knowledge and preferences

The increasing number and older age of women Veterans receiving care at Veterans Health Administration (VHA) requires health-care providers to adjust to their changing patient population. We explored women Veterans’ self-reported knowledge of menopause, current/preferred sources of menopausal health information, and perceptions/barriers regarding treatment of menopausal symptoms. Three focus groups were conducted at two South Florida VHA facilities in 2014, which included 30 women Veterans (aged 45–60 years) who visited VHA primary care clinics at least once in the past year. Participants reported using various sources to obtain general and menopausal health information, particularly family, friends, and the internet. Some women also had discussions with their health-care providers, but believed not all VHA providers were knowledgeable about menopause. Most preferred older female providers, thinking they were better informed about menopausal issues. Women favored complementary/alternative therapies and were against using hormone therapy (HT) for symptom relief, although they felt they were insufficiently informed about HT. Menopausal-age women are the fastest growing group at VHA. To provide better care and enhance their experiences, the VHA must educate all primary care providers about menopausal care and strive to address women Veterans’ menopausal concerns and preferences.     

Women's knowledge about menopause, hormone replacement therapy (HRT), and interactions with healthcare providers: an exploratory study

This community mail-based survey received responses from 665 women to questions in three areas: (1) sources of information about menopause, (2) knowledge of health risks associated with menopause, and (3) knowledge about hormone replacement therapy (HRT). Women received information from many sources, including healthcare providers, friends, and mothers, but the number one source of information about menopause was women's magazines (76%). Over half of women surveyed said they had left healthcare appointments with unanswered questions about menopause and HRT. Although women seemed to have a basic understanding of the symptoms of menopause, their knowledge of the long-term health risks affected by menopause was poor. For example, women were much more likely (60%) to know that osteoporosis risk increased with menopause than to know that heart disease risk increased (30%) despite the much higher prevalence and severity of heart disease as a health problem of menopausal women. Many women thought that menopause itself (independent of aging) increased the risk of breast cancer. This finding may help explain the low percentage of women who take HRT for menopause despite proven health benefits. It is clear that better education about menopause needs to be accomplished regarding the long-term risk associated with menopause and the pros and cons of HRT. Strategies for improving education and interactions with healthcare providers are suggested.     

Women's control and choice regarding HRT.

The promotion and use of hormone replacement therapy (HRT) is the focus of much medical activity and a social phenomenon studied by sociology. The decision to prescribe HRT by a doctor may be a response to a woman's distress and is a decision involving uncertainty about risks and benefits. Sociological analysis has seen the promotion and use of HRT as medicalisation of the menopause. Through individual interviews and focus groups, this study hears from women how they approach the decision to take HRT or not, and what influences them. The interviews reveal how women who dislike medication in general may consider HRT, influenced by fear of ill health which may be enhanced by the experience of illness in the family and by medical advice. For the women the media and their social contacts were the major sources of information about HRT. In the focus groups the women explored the control they had over the choice to take HRT and what limited this control and they explored the uncertainties and complexities of the decision to take HRT or not. This study brings lay women's voices to the debate about the use and promotion of HRT. The results are also used to test the limits of the theory of medicalisation and to inform doctors of the issues women may bring to a consultation about HRT.     

Care during menopause: comparison of a women's health practice and traditional care

Despite the growth in primary care-based women's health centers, little is known about the characteristics of women's health patients and the quality of care provided in women's health centers versus traditional practices. Our objective was to compare a women's health practice and a general internal medicine practice on issues of care during menopause. A cross-sectional survey was administered simultaneously to patients aged 50-70 and their primary care physicians in a women's health practice and an affiliated general internal medicine practice. The survey asked patients about health behaviors, past and current hormone use, menopausal symptoms, and attitudes about menopause. Physicians were asked to estimate their patients' attitudes. Patients in women's health practices were younger, more likely to be smokers, and more likely to have had a prior hysterectomy. Women's health patients were somewhat more likely to report concerns related to menopausal symptoms. Women's health patients and patients attending the general internal medicine practice reported similar rates of past or current use of hormone therapy, after adjusting for prior hysterectomy and age. Physicians in women's health and general medicine were similar in their ability to estimate their patients' attitudes. In the general internal medicine practice, female physicians tended to better estimate their patients' attitudes than their male colleagues. Patients seeking care in a women's health practice differed in symptoms and concerns about the menopause compared with patients in a traditional primary care setting. Physicians' understanding of patients' menopausal concerns did not differ between the two practices. However, there may be gender differences in physicians' understanding of patients' concerns.     

Subjective health, aging, and menopause among native and immigrant Jewish women in Israel

This study compared the perceptions and practices of health between native Israeli women and recent immigrants from the former Soviet Union. A total of 315 respondents (aged 45-65 years, of Ashkenazi, that is, European, origin and middle-class background) were recruited through their workplaces and completed a structured questionnaire, followed by personal interviews (the latter not reported here). While "objective" health profiles of Russian and native Israeli women were rather similar, immigrant women typically perceived themselves as sicker and reported greater health-related damage to their lives than their native Israeli coworkers. More Russian women also reported mental disturbances and family problems, reflecting their vulnerable condition as immigrants. Israeli women were more aware of the "health promotion" discourse, but did not necessarily pursue healthier lifestyles (e.g., more of them smoked). Israeli-socialized women reported a higher number of perimenopausal symptoms and more often adopted the medicalized view of the menopause. The results imply that health interventions aimed at middle-aged women should be specifically tailored, accounting for different cultural constructions of aging and menopause.     

Women with developmental disabilities: health and aging

Major shifts have occurred in the world of disability that have profound implications for health-service provision. Although health researchers and clinicians have begun to address the health needs of women with disabilities, representation of older women with intellectual disabilities in health research and health-care practice remains inadequate. As the visibility of this group continues to grow through policies that support greater community integration and longevity, they and their families, professionals, and advocates will require more information about their health concerns, and appropriate health services and options. This article provides an overview of major issues of women with developmental disabilities within the areas of primary health care, aging, access to health services, and future directions in research and practice.     

'I could have just done with a little more help': an analysis of women's help-seeking from health visitors in the context of domestic violence

Domestic violence is a serious issue that adversely affects large numbers of women and children. Despite having an adverse impact upon health and welfare, women experiencing domestic violence face a number of difficulties seeking help about their situation from statutory health and welfare agencies. The present paper is based upon a study of British health visiting in relation to women experiencing domestic violence. Drawing upon interview data from 16 women who experienced domestic violence and were the mothers of small children, this paper explores their accounts of contact with the health visiting service. All of the 16 women who participated in this research described difficulties in seeking help about domestic violence. These included practical concerns such as fears for their own safety, lack of knowledge regarding appropriate sources of support and protection, and concerns about losing custody of their children. Given these concerns, some women concealed their experiences of domestic violence from their health visitors. For those who disclosed the domestic violence to their health visitors, they did not always receive appropriate support or protection. Of particular concern was the absence of information about accessing more specialist services. The research findings suggest that there is considerable scope for practice development in order to ensure that women experiencing domestic violence are able to receive safe and appropriate responses from health visitors.     

Incidental Findings in a Federally-Sponsored Cancer Screening Program

The volume of non-cancer related clinical services and referrals for medical care of women as a consequence of their enrollment in a federally-sponsored breast and cervical cancer screening program was examined. We randomly sampled 100 medical records from among 389 individuals who received cancer screening services through the Connecticut Breast and Cervical Cancer Early Detection Program. Medical record audits tabulated occasions when women were offered or received diagnostic or therapeutic procedures as a by product of their program participation. Breast screening was provided to 100 women and 49 individuals received cervical cancer screening. In addition, 87 percent of the sample were offered or received one or more non-cancer related health services. Physical exams were provided to 86 women, laboratory tests were ordered for 11 individuals and 55 referrals were made to address a myriad of specific medical needs that were uncovered incidental to breast and cervical cancer screening. Among 26 women who did not heed recommendations for follow-up care, cost, inconvenience and beliefs that medical problems were not immediate concerns were cited. Local screening program sponsors should be cognizant that the health care needs and limited resources of some target populations may be substantial. Mechanisms to assure that needed health care is available to individuals should be built and into all categorical health service programs.     

The Unified National Health System and public policies: psychological care for menopausal women in the Federal District, Brazil

This study focused on psychological care for middle-aged women in public health services in the Federal District (Brasilia), Brazil. The article discusses women's health and more specifically menopause and its place in Brazilian public health policies. The survey confirmed the lack of psychological support for menopausal women. In most cases only outpatient medical care was offered. No psychologist had been designated in any of the units surveyed to assist these women. The study concludes that this period of women's life has failed to receive psychological care in Brazil, thus neglecting the principles of the Unified National Health System. Menopausal women deserve comprehensive health care, including attention to conflicts related to biological, psychological, and socio-cultural dimensions of aging, thus contributing to the process of working through maturity.     

A vision for older adults and health promotion

Our rapidly aging population is expected to place heavy demands on all segments of society, particularly the health care resources needed to attend to health concerns associated with aging. Is this a looming crisis, as some predict, or a challenge to use resources more wisely and to help older adults and their caregivers share in the responsibility for health promotion and chronic disease self-management activities? Community-based organizations serving older adults are uniquely positioned to augment health care providers' health promotion counseling activities and to bridge the gap between the research and practice of health promotion in older adults. They already play a crucial role by providing appropriate health promotion education, screening and referral, service planning, and reinforcement to facilitate self-care activities and behavior changes that promote healthy aging. By increasing teamwork across the network of services for the aging, the health sector, public and private organizations, and academe, there is a great opportunity to enhance the health and well-being of all older Americans.     

Perimenopausal vaginal bleeding: diagnostic evaluation and therapeutic options

While significant awareness has been raised about menopause, less attention has been focused on the perimenopausal or "menopausal transition" period. Many women and their physicians remain unaware of the impact of this transitional phase into menopause. Specifically, heavy and unpredictable perimenopausal bleeding is extremely common. It is a normal phenomenon of aging and tends to improve over time. However, about one quarter of perimenopausal women will have heavy flow that persists beyond 3 months and will require medical assistance. The purpose of this review is to focus on the hormonal and physiologic changes that are associated with perimenopausal heavy vaginal bleeding, to present the essential evaluation of causes for this heavy flow, and to outline the evidence for effective medical and surgical treatments. Advances in the understanding of the normal physiology of perimenopause have led to medical therapies that may lead to fewer surgical procedures and hysterectomies and should be of interest to health care practitioners focusing on women's health. Although these issues are addressed in the gynecologic literature, there is relatively less published in other disciplines.     

Older alcoholics: professional, family education programs aid treatment

The identification and treatment of older alcoholics often are complicated by negative stereotypes and inaccurate information about the aging process. these misconceptions may result from incomplete statistical data, lack of attention to the subjects of alcoholism and aging in medical and gerontological journals, disagreement concerning the disease's origin and treatment, and conflict over whether to differentiate between alcoholism and alcohol abuse. In recent professional literature, however, some of these concerns are being addressed. A wider dissemination of information is essential for health professionals as well as for alcoholics and their families. Both groups must understand the changes associated with aging so that existing programs for alcoholism treatment can be adapted to serve the elderly. Results of an informed, enlightened attitude toward older alcoholics would be: Awareness that alcoholism--at any age--is a treatable disease; Increased attention to the special communication and mobility needs of the elderly; Availability of printed and audiovisual materials about aging and alcoholism in locations where older adults gather; and The training of family members and health care workers in alcoholism identification and intervention.     

An analysis of menopause in the popular press

With the increased interest in menopause, it is imperative that midlife women be given reliable information. An analysis of the lay literature on menopause over the past ten years in the United States was conducted in order to determine the content of the articles, their source, and their credibility. Most articles were found to blend opinion with fact, and many of the authors of these articles did not have any stated qualifications in midlife women's health. Physicians, particularly those espousing the medicalization of menopause, were the most often quoted experts, and few nurses or other health care workers were cited as experts. It is suggested that nurses become more involved in health education for midlife women.     

Feminist ethics and menopause: autonomy and decision-making in primary medical care

The construction of menopause as a long-term risk to health and the adoption of discourses of prevention has made necessary a decision by women about medical treatment; specifically regarding the use of hormone replacement therapy. In a study of general practitioners' accounts of menopause and treatment in Australia, women's 'choice', 'informed decision-making' and 'empowerment' were key themes through which primary medical care for women at menopause was presented. These accounts create a position for women defined by the concept of individual choice and an ethic of autonomy. These data are a basis for theorising more generally in this paper. We critically examine the construct of 'informed decision-making' in relation to several approaches to ethics including bioethics and a range of feminist ethics. We identify the intensification of power relations produced by an ethic of autonomy and discuss the ways these considerations inform a feminist ethics of decision-making by women. We argue that an 'ethic of autonomy' and an 'offer of choice' in relation to health care for women at menopause, far from being emancipatory, serves to intensify power relations. The dichotomy of choice, to take or not to take hormone replacement therapy, is required to be a choice and is embedded in relations of power and bioethical discourse that construct meanings about what constitutes decision-making at menopause. The deployment of the principle of autonomy in medical practice limits decision-making by women precisely because it is detached from the construction of meaning and the self and makes invisible the relations of power of which it is a part.     

社区更年期女性自我保健意识现状调查

目的了解社区更年期妇女对更年期症状、更年期保健知识、态度和行为的知晓情况,为开展更年期妇女的保健及健康教育提供参考依据。方法用随机整群抽样的方法,选择200名分别在济南市天桥区、槐荫区及其周边郊区的44—55岁妇女,以问卷形式进行调查,询问有关更年期症状相关了解情况及保健知识。结果平均绝经年龄为45．67岁,以询问法获得的更年期症状发生率51．5％。68．5％的妇女知道有关的更年期保健知识,农村妇女的知晓率明显低于城市妇女,两者差异有显著性（P〈0．05）。在城乡更年期妇女中,有36．3％人去医院就诊,有47．9％人在控制饮食方面较强,48．0％人经常锻炼身体。结论更年期女性缺乏更年期保健知识和保健意识,存在不健康的生活方式。因此,应加强有关更年期保健的健康教育并提高自我保健意识。     

The high prevalence of sexual concerns among women seeking routine gynecological care

BACKGROUND: Sexuality is an important part of health, quality of life, and general wellbeing. Studies indicate that less than half of patients' sexual concerns are known by their physicians, and physicians are unaware of how common these sexual concerns are in their practices. Our objective was to determine the prevalence and type of sexual concerns among women seeking routine gynecological care. METHODS: We mailed the survey in waves. Of 1480 women seeking routine gynecological care from the departments of Family Practice and Obstetrics and Gynecology at Madigan Army Medical Center between August 1992 and January 1993, 964 responded. The main outcome measures were self-reported sexual concerns and their experiences with discussing these concerns with a physician. RESULTS: A A total of 98.8% of the women we surveyed reported one or more sexual concerns. The most frequently reported concerns were lack of interest (87.2%), difficulty with orgasm (83.3%), inadequate lubrication (74.7%), dyspareunia (71.7%), body image concerns (68.5%), unmet sexual needs (67.2%), and needing information about sexual issues (63.4%). More than half reported concerns about physical or sexual abuse, and more than 40% reported sexual coercion at some point in their lives. CONCLUSIONS: Our results suggest that sexual health concerns are prevalent for women seeking routine gynecological care. Sexual health inquiry should be a regular and important part of health care maintenance.