To bleed or not to bleed: young women's attitudes toward menstrual suppression

The purpose of this study was to investigate women's knowledge about and attitudes toward the medical suppression of menstruation. One hundred and three female undergraduate students completed several questionnaires. Thirty-five percent of the participants were familiar with menstrual suppression, and 12% reported using birth control methods to suppress their menses; oral contraceptive users were more knowledgeable about menstrual suppression than other women. Women who regarded menstruation as bothersome and shameful were more supportive of suppression than women with more positive attitudes. Women who scored higher on measures of body consciousness were not more likely to support menstrual suppression or to report a desire for more information about menstrual suppression. Future investigations of women's attitudes toward menstrual suppression could inform reproductive health care and health education.     

Young Women's Attitudes Toward Continuous Use of Oral Contraceptives: The Effect of Priming Positive Attitudes Toward Menstruation on Women's Willingness to Suppress Menstruation

The present study investigated American women's attitudes toward menstrual suppression and the effect of priming attitudes toward menstruation on women's willingness to suppress menstruation. One hundred college women randomly were assigned to either a positive priming group or a negative priming group. The positive priming group first completed the menstrual joy questionnaire (MJQ) followed by a willingness to suppress menstruation (WSM) questionnaire, the beliefs and attitudes toward menstruation (BATM) questionnaire, the menstrual distress questionnaire (MDQ), and a demographic questionnaire. The negative priming group completed, in the following order: the MDQ, WSM, BATM, MJQ, and demographics. Priming affected women's reports of positive cycle-related changes on the MDQ, but not women's willingness to suppress menstruation. Higher scores on the MJQ, positive attitudes toward menstrual suppression, and previous oral contraceptive (OC) use were predictors of women's willingness to suppress menstruation. Women's primary source of information about menstrual suppression was “media,” and their primary concern was “safety.” Thus, researchers should continue to investigate the long-term effects of continuous OC use and to analyze information about menstrual suppression in the popular press.     

Contextual influences on women's health concerns and attitudes toward menopause

Social factors that affect women's attitudes toward menopause were examined in a sample of 1,037 baby boomer women who took part in two waves of the Midlife in the United States survey. Survey data were collected in 1996 and 2005 from a nationally representative sample of women born between 1946 and 1964 residing in the United States. Women's attitudes toward the effects of menopause on fertility, health, and attractiveness were examined. Analyses supported a two-factor model ofwomen's adaptation to menopause: attitudes concerning the effects of menopause on fertility and the cessation of menstruation had different antecedents than attitudes concerning the impact of menopause on health and attractiveness. Women who had more positive attitudes regarding loss of fertility occupied more roles, were older, less educated, yet more secure financially. Women who had more positive views of the effects of menopause on health and attractiveness reported fewer symptoms of menopause. These analyses were replicated in waves 1 and 2 of the data set. Results may be helpful to social work practitioners and social work policy advocates.     

Attitudes toward menopause in relation to symptom experience in Puebla, Mexico

OBJECTIVE: To examine how attitudes toward menopause were associated with symptom frequencies after controlling for menopause status and level of education. METHODS: Women aged 28-70 (n = 755) were interviewed from May, 1999 through August, 2000 in the city of Puebla, Mexico. Over 90% of the sample were aged 40-60. Participants were asked to select from a set of dichotomies to describe "how a woman feels during menopause." Symptom frequencies were assessed by a checklist of everyday complaints experienced during the two weeks before interview. Symptom presence or absence was examined in relation to attitudes while controlling for menopause status and level of education using binary logistic regression analyses. RESULTS: The majority of respondents said that a menopausal woman feels "insecure" and "unattractive" yet "complete," "necessary," and "successful." Pre-menopausal women and respondents who had undergone a hysterectomy were more likely to express negative attitudes. Post-menopausal women and women with fewer years of education were significantly more likely to report symptoms such as hot flashes, joint aches, and nervous tension. A range of negative attitudes were associated with nervous tension, feeling blue, and head aches; however, only a few negative attitudes were significantly predictive of estrogen-related symptoms (e.g., hot flashes). CONCLUSIONS: There is a high value placed on both external appearance and familial responsibility among menopausal women in Puebla, Mexico, and negative characterizations of menopause reflect these values. Negative attitudes were associated with more frequently reported symptoms compared with positive attitudes. The challenge remains to separate factors related to the hormonal changes of menopause from those not associated with hormonal changes to better understand symptom experience.     

Young women's attitudes toward continuous use of oral contraceptives: the effect of priming positive attitudes toward menstruation on women's willingness to suppress menstruation

The present study investigated American women's attitudes toward menstrual suppression and the effect of priming attitudes toward menstruation on women's willingness to suppress menstruation. One hundred college women randomly were assigned to either a positive priming group or a negative priming group. The positive priming group first completed the menstrual joy questionnaire (MJQ) followed by a willingness to suppress menstruation (WSM) questionnaire, the beliefs and attitudes toward menstruation (BATM) questionnaire, the menstrual distress questionnaire (MDQ), and a demographic questionnaire. The negative priming group completed, in the following order: the MDQ, WSM, BATM, MJQ, and demographics. Priming affected women's reports of positive cycle-related changes on the MDQ, but not women's willingness to suppress menstruation. Higher scores on the MJQ, positive attitudes toward menstrual suppression, and previous oral contraceptive (OC) use were predictors of women's willingness to suppress menstruation. Women's primary source of information about menstrual suppression was "media," and their primary concern was "safety." Thus, researchers should continue to investigate the long-term effects of continuous OC use and to analyze information about menstrual suppression in the popular press.     

Menstruation across time: Menarche, menstrual attitudes, experiences, and behaviors

This study explored the relationship between early and current menstrual experiences. The primary hypothesis was that women who reported positive menarcheal experiences (including menstrual education and menarche) would tend to report positive current menstrual attitudes, experiences, and/or behaviors, and vice versa for women who reported negative menarcheal experiences. In this survey-based study, college-aged women (n = 327) were screened by completing a questionnaire concerning their menarcheal experiences. Women who had extremely negative ("negative group," n = 46) or extremely positive ("positive group," n = 38) early menstrual experiences returned to complete questionnaires concerning current menstrual attitudes, experiences, and behaviors. Early and current menstrual experiences were most strongly associated in the domain of menstrual attitudes. Women in the negative group reported more negative menstrual attitudes than did women in the positive group. There were additional associations between early menstrual experiences and measures of body image and health behaviors. Positive group participants reported more positive body image and better general health behaviors. Results suggest that early menstrual experiences may be related to menstrual experiences later in life. This study invites further investigation of the psychology of menstruation and suggests connecting menstruation with other women's health issues.     

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.     

Age-related differences in health complaints: the Hilo women's health study

The purpose of this study was to determine the age distribution of health-related complaints and symptom groupings from a random postal survey carried out in the multi-ethnic city of Hilo, Hawaii. Symptom frequencies and factor analyses were compared across three age categories: < 40 (32%), 40-60 (48%), and > 60 years (19%), (n = 1,796). Younger women were most likely to report headaches, menstrual complaints, irritability, and mood swings.Women at midlife were most likely to report fluid retention, trouble sleeping, loss of sexual desire, vasomotor symptoms, and nervous tension. Older women reported the least number of symptoms overall. Using multiple linear regression, menopause status, ethnicity, and alcohol intake were significantly associated with the factor scores for symptoms of menopause, after controlling for age, education, BMI, exercise, smoking habits, and financial comfort.     

Is menopausal status related to women’s attitudes toward menopause and aging?

The objective of this study was to explore the relationship between menopausal status and attitudes toward menopause and aging. We identified 1,400 Bengali Hindu women aged 40–55 years (early perimenopausal n = 445; late perimenopausal n = 240; early postmenopausal n = 285; late postmenopausal n = 430) from West Bengal, India. Information on attitudes toward menopause and aging was collected from March 2009 to July 2012 using ten agree/disagree statements, of which three were positive, four were negative, and the rest were neutral. We used only the positive and negative statements in the analyses. The participants were given three response options for each statement: (1) agreed, (2) disagreed, and (3) felt neutral. Agreement with positive statements and disagreement with negative statements were scored as 3. The converse responses were scored as 1. Neutral responses were not scored. Thus, the total attitude score for each participant ranged from 7 to 21. Additionally, data on sociodemographic and reproductive variables, menopausal symptoms, and perceptions toward menopause were also collected. Multivariable analyses (ANCOVA) showed that postmenopausal women had more positive attitudes toward menopause and aging than perimenopausal women. Providing balanced information about menopause and aging might help to foster positive attitudes toward menopause.     

Quality of Life in Diverse Groups of Midlife Women: Assessing the Influence of Menopause, Health Status and Psychosocial and Demographic Factors

This paper examines whether menopausal status is associated with global quality of life (QOL) among women aged 40-55 and whether this association varies by race/ethnicity. We further examine the contributions of other health-related and psychosocial factors to QOL and whether these associations vary by racial/ethnic group. Analyses are based on 13,874 women who participated in the multi-ethnic, multi-race study of mid-aged women called the Study of Women's Health Across the Nation (SWAN). Study participants completed a 15-min telephone or in-person interview that contained questions on a variety of health-related topics. Items of interest for these analyses include global QOL, menstrual history (to assess menopausal status), sociodemographics, health status, lifestyle, and psychosocial variables. Results showed that in unadjusted analyses, early perimenopausal women reported lower QOL compared with premenopausal women, but menopausal status was no longer associated with QOL when analyses were adjusted for other variables. In multivariable models, being married and having low levels of perceived stress were associated with better QOL across all racial/ethnic groups. While there were many consistencies across racial/ethnic groups, we also found that the nature of the associations between QOL and education, marital status, perceived stress and social support varied across racial/ethnic groups.     

"Nobody told me nothin": communication about menstruation among low-income African-American women

The purpose of this study was to explore communication about menstruation among low-income African American women and the impact of this communication on their understanding of and attitudes toward the menstrual events that will occur throughout their lives. This is of particular importance since minority women disproportionately face greater menstrual problems than those experienced by majority women in the United States. A grounded theory design was used for this study. Seventeen African American women from a public housing project were interviewed. The core theme that emerged from the qualitative data was the avoidance or negative discussion of menstrual events throughout the women's lives. The women had few sources of and very limited menstrual learning from school, their mothers, and other women. This led to confusion and inaccurate beliefs about and negative attitudes toward menstruation, menopause, and menstrual-related health conditions. While these women desired to have better communication, their history of avoidance of and negative discussions surrounding menstruation will likely continue to make it difficult for them to have positive and informative discussions with others in the future unless some type of educational intervention occurs.     

Sociocultural Attitudes Surrounding Menstruation and Alternative Menstrual Products: The Explanatory Role of Self-Objectification

We extend objectification theory research to consider the relationship between self-objectification and attitudes toward an alternative menstrual product in a diverse sample of female undergraduates from the United States (N = 151). We use a survey design to investigate attitudes toward one's menstruation as a potential mechanism that may explain this relationship. Reactions to an alternative menstrual product were predominantly negative, supporting prior research on stigma and shame surrounding menstruation. Exploratory structural equation modeling revealed attitudes toward one's menstruation mediated the relationship between self-objectification and participants’ reactions to an alternative menstrual product. Implications for women's health are discussed.     

Queer periods: attitudes toward and experiences with menstruation in the masculine of centre and transgender community

Menstruation has long been viewed as an important aspect of women’s health. However, scholars and healthcare providers have only recently begun to recognise that transgender men and people with masculine gender identities also menstruate, thus little is known about their attitudes toward and experiences with menstruation. A sample of masculine of centre and transgender individuals with a mean age of 30 years was recruited online to complete measures of attitudes toward menstruation and menstrual suppression and to answer exploratory questions about their experiences managing menstruation. Participants reported mixed attitudes toward menstruation, but generally positive attitudes toward menstrual suppression. Many participants said that they try to avoid public restrooms during menstruation because of practical and psychological concerns. Implications of our findings for the transgender health are discussed.     

Menopausal transitions,symptoms and country of birth: the Australian Longitudinal Study on Women's Health

OBJECTIVE: To assess differences among the menopausal transitions and symptoms experienced by women participating in the Australian Longitudinal Study on Women's Health, according to their countries of birth. METHODS: Data from 8,466 women aged 45-50 in 1996, who responded to surveys in 1996 and 1998 and had not had a hysterectomy, were analysed. Women were categorised by country of birth and cross-sectionally by menopausal status at Survey 1 and 2, as well as longitudinally by transition through menopause between Surveys 1 and 2. Four endocrine-related and 10 general symptoms were assessed. RESULTS: Women bom in Asia were twice as likely as Australian-bom women to be post-menopausal at Survey 1, twice as likely to become post-menopausal between surveys, less likely to remain peri-menopausal, and less likely to report hot flushes and night sweats. Odds ratios for each symptom at Survey 2 were near unity for all country of birth groups compared with Australian bom women, with or without adjustment for symptoms at Survey 1, menopausal transition category, behaviour, lifestyle and demographics. CONCLUSIONS: Asian-born women entered menopause earlier and passed through it more quickly, but once this was taken into account all women showed the same prevalences of symptoms. There may be differences between ethnic groups that influence the timing of menopause, but the subjective experience appears similar. IMPLICATIONS: The timing of menopause may be affected by biological or dietary differences. Asian-bom women's lower reported prevalence of symptoms may be explained by a more rapid peri-menopausal transition. With increasing numbers of Asian-Australian women reaching menopause, an understanding of country-of-birth differences has implications for public health.     

Staging the menopausal transition: Data from the TREMIN Research Program on Women’s Health

The present study was conducted to test the assumptions of a staging system of reproductive aging that was proposed at the Stages of Reproductive Aging Workshop (STRAW) in 2001. Using longitudinal data provided by 100 women over a period of 3-12 years, we asked whether midlife women move in a uniform progression from pre- to peri- to postmenopause, as refuted by earlier studies but proposed by the STRAW model, or whether they differ from this assumed pattern. Participants were recruited from the TREMIN Research Program on Women's Health, the oldest ongoing study of menstruation and women's health in the world. Eligibility criteria included reaching menopause during the course of the study and not using exogenous hormones. Participants provided annual self-reports of menopausal stage based on observations of their menstrual cycles ("regular," "changing," and "menopausal"). Findings revealed a lack of uniformity as women progressed toward menopause. From 8 to over 20 different perimenopausal stage patterns were observed, depending on the analysis. While the most common pattern was to progress from regular to changing to menopause, some women experienced menstrual bleeding after a year or more of amenorrhea, others flip-flopped between stages, and still others skipped directly from regular bleeding to menopause. We conclude that there is considerable variation in women's movement across menopausal status categories and urge researchers to accommodate such findings in their model building.     

THE OHIO MIDLIFE WOMEN'S STUDY

The Ohio Midlife Women's Study was longitudinal with measurements occurring at three, 9-month intervals. Our purpose in doing this research was to examine predictors, moderators, and outcome variables associated with the transition to midlife in Caucasian and African American women. Predictor variables included loss and gain of resources. Moderators included menopause symptoms, menopausal status, attitude toward menopause, coping, and demographic characteristics. Outcome variables included anxiety, depression, and health promoting activities. To obtain the proposed final sample of 160 midlife women, an initial sample of 103 African American and 105 Caucasian "healthy" women were recruited in the community. Consistent predictors of anxiety were loss of resources, coping effectiveness, and education. Consistent predictors of depression were loss of resources and education. Health promoting activities were consistently predicted by attitude toward menopause and coping effectiveness. Stress is a better predictor of negative health outcomes than menopausal status.     

YOUNG WESTERN WOMEN'S EXPERIENCES OF MENARCHE AND MENSTRUATION

A qualitative approach was used to examine young women's experiences of menarche and menstruation that were included in personal stories of growing up sexually. The personal experiences were examined by cross-case analysis to learn more about the narrators' attitudes toward menarche and their menstrual-related education. This was a secondary analysis using data collected for a study of common themes in the stories gathered in a 1998 study by Beausang. The data came from 332 stories written by students taking a sexuality course in a Midwestern community college. Of 227 stories written by women, 85 stories included menstrual experiences. Eleven narrators described menarche as a positive experience. In 10 of these stories, the mother was the primary teacher. The two most frequently identified sources of information by narrators were mothers and schoolteachers, with most narrators having a primarily negative view of their menstrual education regardless of the source. Problems with menstrual-related education were described as perceptions of unwillingness by teachers to discuss menstruation, time limits for education, unclear instruction leading to misconceptions, and the presence of peers in group learning situations that lead to embarrassment.     

Measures of menopausal status in relation to demographic, reproductive, and behavioral characteristics in a population-based study of women aged 35-49 years.

The purpose of this cross-sectional analysis of women aged 35-49 years from the Third National Health and Nutrition Examination Survey, conducted between 1988 and 1994, was to assess associations with menopausal status based either on menstrual cycle patterns or on elevated (>20 IU/liter) follicle-stimulating hormone. Menstrual cycle-based menopausal status was defined for women who had not had surgical menopause by months since the last period (<2, 2-12, and >12 months for pre-, peri-, and postmenopause, respectively). Logistic regression was adjusted for age, smoking, and unilateral oophorectomy. Higher body mass index (> or =30 kg/m(2) compared with < 25.0 kg/m(2)) was associated with a lower likelihood of elevated follicle-stimulating hormone (odds ratio (OR)=0.6, 95% confidence interval (CI): 0.4, 0.9) but this association was not seen with the menstrual measure of menopause. Exercise (three or more times per week) was associated with a lower likelihood of being postmenopausal on the basis of menstrual (OR = 0.3, 95% CI: 0.2, 0.7) and hormonal (OR = 0.6, 95% CI: 0.4, 1.0) measures. Alcohol use also tended to be associated with postmenopausal status by either measure, but not significantly so. There was little evidence of associations with ethnicity, education, age at menarche, number of livebirths, and oral contraceptive use. Menstrual-based definitions of menopause can be misclassified for women with menstrual irregularity. This might explain why obese women were classified menstrually as menopausal while remaining hormonally premenopausal.     

Psychosocial correlates of emotional responses to menarche among Chinese adolescent girls.

PURPOSE: To determine the psychosocial correlates of emotional responses to menarche among Chinese adolescent girls. METHODS: A large sample of 1573 post-menarcheal Chinese junior high school students in Hong Kong completed questionnaires on knowledge and preparation of menarche, attitudes toward menstruation, gender-role attitudes, body image, self-esteem, and emotional responses to the onset of the first menstruation. Pearson correlation and hierarchical regression analyses were conducted to determine associations among variables. RESULTS: Participants' mean age at menarche was 11.67 years. Their emotional reactions to menarche were largely negative, with almost 85% reporting feeling annoyed and embarrassed. In spite of these negative feelings, about two-thirds of the participants also reported feeling grown up and another 40% felt as if becoming more feminine. Results of the hierarchical regression analyses showed that negative emotional responses to menarche were correlated with perceptions of menstruation as a negative event, inadequate preparation for menarche, endorsement of indigenous negative menstrual attitudes, and poor self-esteem (24.5% variance explained). Positive emotional responses to menarche were correlated with perceptions of menstruation as a natural event, rejection of indigenous negative menstrual attitudes, positive body image, and adequate preparation for menarche (13.4% variance explained). CONCLUSIONS: This study illustrates the need to attend to various psychosocial and cultural factors in the understanding of Chinese adolescent girls' responses to their first menstruation. In particular, general and indigenous menstrual attitudes, which may have been internalized by Chinese adolescent girls at an early age, are found to be the most salient correlates of their emotional responses to menarche.