Class, gender and culture in the experience of menopause. A comparative survey in Tunisia and France

The experience of menopause can vary strongly from one society to another: frequency of hot flushes, other somatic and psychological symptoms, and changes in family and social relations. Several studies have shown that country of residence, country of birth, ethnicity, and social class all play roles in these variations. But few comparative anthropological studies have analysed the social processes that construct the experience of menopause or considered menopausal women's social and financial autonomy. To study the impact of the social status accorded to menopausal women and their social resources, during 2007 and 2008 we conducted a series of 75 in-depth interviews with women in different sociocultural settings: Tunisian women in Tunisia, Tunisian women in France, and French women in France, all aged from 45 to 70 years. Our methodological approach to the data included content analysis, typology development and socio-demographic analysis. Quite substantial differences appeared, as a function of social class and cultural environment. We identified three principal experiences of menopause. Tunisian working class women, in Tunisia and France, experience menopause with intense symptoms and strong feelings of social degradation. Among Tunisian middle-class women in both countries, menopause was most often accompanied by a severe decline in aesthetic and social value but few symptoms. For most of the French women, menopause involved few symptoms and little change in their social value. The distribution of types of experiences according to social but not geographic or national factors indicates that, in the populations studied here, the differences in symptoms are not biologically determined. Different experiences of menopause are linked to social class and to the degree of male domination. A given level of independence and emancipation allows women an identity beyond their reproductive function and a status unimpaired by menopause.     

孕妇心理状况及其与个性和应对方式的相关性

目的:探讨孕妇心理状况及其与个性和应对方式的相关性,为进一步的医学干预提供依据。方法:采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、艾森克个性问卷(EPQ)及简易应对方式问卷(SCSQ)对113例孕中期孕妇的心理状况、个性与应对方式进行调查分析。结果:孕妇SAS及SDS总粗分显著高于全国常模(t=7.057,P=0.000;t=2.381,P=0.019),孕妇焦虑和抑郁的发生率分别为20.4%和27.8%。SAS和SDS总分均与EPQ的精神质(P)和神经质(N)维度呈显著正相关(χ2=0.307,P=0.001;χ2=0.496,P=0.000;χ2=0.416,P=0.000;χ2=0.321,P=0.001),与积极应付方式呈显著负相关(χ2=-0.208,P=0.030;χ2=-0.264,P=0.007)。结论:孕中期孕妇焦虑和抑郁的发生率较高。精神质、神经质的个性特点及应对方式的缺陷与孕妇产生焦虑抑郁情绪密切相关。临床上应在综合分析心理状态及其产生的中介机制的基础上,对伴有焦虑抑郁的孕妇进行有效的心理干预。     

Coping with political violence in Northern Ireland

Recent community based research, employing a self-assessed measure of psychological distress, has suggested that people in Northern Ireland may be coping relatively well with the stress of continuing political violence. This paper reports a first direct investigation of coping in Northern Ireland. Using two scales from the Folkman and Lazarus Ways of Coping Questionnaire--Distancing and seeking Social Support--an attempt was made to investigate the role of coping in relation to local levels of violence, the appraisal of violence, gender and trait neutoticism. The results indicated that trait neuroticism was not related to the appraisal of levels of violence, but that appraisal was related to both types of coping. In particular, those who perceived the violence to be more serious reported using less distancing, while they also reported seeking the most social support. In addition more women reported seeking social support compared to men. Finally those who lived in a high violence area were more likely to report using distancing than were those from a less violence prone area. These results were taken to support the contention that some form of denial may be the main form of coping in Northern Ireland, and that coping is related more to the appraisal of violence than to actual violence levels, while the appraisal of violence is in turn not related to trait neuroticism.     

Exploring the prevalence of menopause symptoms in midlife women in methadone maintenance treatment

Menopause is a natural process that occurs in women's lives as part of normal aging. Many women go through the menopausal transition with few or no symptoms, while some have significant or even disabling symptoms. The purpose of this paper is to describe the menopausal symptom experience of 135 urban methadone-maintained midlife women between the ages of 40 and 55 years. A cross-sectional survey comprising sample characteristic questions and a 14-item menopause symptom checklist was administered. Ninety-six percent reported one or more symptoms with a mean of 6.2 symptoms. Symptom reporting was found to be relatively high, with more than half of the sample reporting hot flashes, night sweats, sleep disturbances, joint pains, and fatigue in the two weeks preceding the survey. However, the psychological symptoms (irritability and depression) were the two most common symptoms in this sample. This study documents a relatively heavy burden of symptoms in an aging cohort of methadone-maintained women. The physical and psychological impact of aging and, in particular, the experience of menopause in these women is rarely studied and poorly understood. This gap in critical knowledge is further complicated by the remarkable similarity of many symptoms associated with menopause and opiate withdrawal. Aging, drug-related health problems, and poor access to health care further complicate the picture and underscore the importance of better integration of health care with social work intervention.     

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.     

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.     

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.     

Change in psychological and vasomotor symptom reporting during the menopause

There remains uncertainty regarding what health symptoms can be directly attributed to the menopause. The association between changes in menopausal status and changes in vasomotor symptom and psychological symptom reporting was investigated and the effects of changing menopausal status were compared with those related to life events and difficulties. Reports of common health symptoms, menopausal status and life events and difficulties have been collected prospectively from 1572 British women followed up since their birth in 1946, every year between 47 and 52 years. Regression models for repeated measures were fitted with the change in symptom scores between consecutive years as the outcome. Estimates from these models were obtained using generalised estimating equations, thus allowing appropriately for the correlation between repeated measures on the same woman. Vasomotor symptoms were found to be strongly related to changes in menopausal status with increases being observed as women move through the menopause. Psychological symptoms were more strongly associated with current life events and difficulties, particularly those experienced in family life, than with menopausal status. An increase in symptoms was, however, observed in premenopausal and perimenopausal women starting hormone replacement therapy. These effects were not confounded or modified by previous psychological morbidity, social or behavioural factors. The findings suggest that vasomotor symptoms are dependent on changing hormone levels associated with the menopause, while psychological symptoms are not. The possibility that there is a small subgroup of women who experience increased psychological problems at the time of the menopause, and who in this cohort are identified by their use of HRT, is suggested. The mechanism behind this rise remains unclear. Factors other than the menopause should be considered, such as concurrent life events and past experiences and behaviours, when considering the treatment of psychological symptoms in women during middle life.     

"Am I similar to my mother?" How women make sense of menopause using family background

Feminist social scientists and some epidemiologists suggest that women's family lives may form a backdrop for menopause. Some family contexts for menopause have been ignored by researchers, however. In this article women's discussions of family background were explored in an attempt to broaden social science and epidemiological knowledge of family contexts. Data were collected in 61 in-depth interviews with menopausal women aged 38-60 in a midwest state in 2001. Unprompted by the interviewer, 42 women (69%) discussed mothers' menopause experiences when trying to describe their own; many also discussed other female relatives' experiences. Interview conversations often focused on whether daughters' menopause experiences matched their mothers'. Women's discussions of the importance of mother-daughter ties and their attentions to genetic inheritance suggest that the actual effects of family backgrounds on menopause as well as the importance women place on family background must be explored further, as women are defining and reacting toward menopause within this unexplored social context.     

Well-being and menopause: An investigation of purpose in life,self-acceptance and social role in premenopausal,perimenopausal and postmenopausal women

OBJECTIVES: Many studies have investigated anxiety and depression during the menopausal transition. However, there is little understanding of positive aspects of well-being among menopausal women. This paper reports on two studies which investigated how menopausal stage and age accounted for how women felt about their purpose in life, self-acceptance and social role. METHOD: In Study One, 304 women from a community sample completed structured questionnaires which included questions relating to demographic background and two subscales of the Psychological Well-being Inventory: purpose in life and self-acceptance. In Study Two, 203 participants from Study One returned a follow-up structured questionnaire related to purpose in life and social role. RESULTS: Study One found that the effects of age group and menopausal group could not be separated: All women felt they would be more positive about these well-being measures in the future than they had been in the past and at present. Study Two found that women who were perimenopausal and postmenopausal did not feel as positive about their role/s in life as premenopausal women, regardless of their age. CONCLUSIONS: The results suggest that the menopause may indicate to women that their role/purpose in life is changing. It is important that any understanding of the menopause incorporate psychosocial aspects of women's lives. Further longitudinal studies are needed to explore well-being factors and the menopause.     

Natural history of menopause symptoms in primary care patients: a MetroNet study

BACKGROUND: The association between changes in menopausal status and menopause-related symptom reporting over the course of the menopause transition is not well understood, especially whether there are any racial differences in this association. OBJECTIVE: To determine (1) the prevalence and the natural history of menopause symptoms among primary care patients approaching, or at menopause; (2) the relationship between self-reported symptoms and menopausal status; and (3) whether this relationship varies in African American and white women. STUDY DESIGN: Cross-sectional self-report survey of 342 women aged 40 to 55 years (31.6% African American) were recruited from 8 family practice centers in 2000 and 2001. RESULTS: Among 251 women without surgical menopause, 133 (53.0%) were premenopausal, 72 (28.7%) were peri-menopausal, and 46 (18.3%) were postmenopausal. The most commonly reported symptoms were joint/muscle pain and headache, which did not vary by menopausal status. As many as 28.6% of the women with regular menstruation reported hot flashes, and 18.8% had night sweats; although both symptoms were strongly associated with changes in menopausal status (P < .01). During the natural menopausal transition, white women had increasing trends of nervousness, memory loss, vaginal dryness, loss of sexual interest, hot flashes, and night sweats while African American women only had increasing trend of painful sex and hot flashes. In multivariate analyses, loss of sexual interest was associated with postmenopause status in white but not in African American women. CONCLUSIONS: Symptoms are not uncommon among premenopausal women and become more prevalent as the transition through menopause occurs. The prevalence of vasomotor symptoms in premenopausal women may be an under-recognized aspect of the natural history of the menopause transition. African American and white women may present different symptoms through menopause transition.     

更年期门诊患者的社会人口统计学调查

通过对 1998年 7月～ 2 0 0 0年 7月 5 0 3名在我院更年期门诊就诊的围绝经期、绝经后期妇女进行问卷式社会人口统计学调查 ,并参照其他国家和地区的调查报告进行分析 ,以了解我国的现状及为围绝经期和绝经后期妇女保健工作提供参考。被调查者的年龄为 3 5～ 82岁 (包括外科手术绝经和卵巢早衰绝经者 ) ,平均年龄为 5 1.9± 7岁。4 1.0 %小于 5 0岁 ;3 5 .0 %为 5 0～ 5 4岁 ;12 .0 %为 5 5～ 5 9岁 ;12 .0 %超过 60岁。绝经年限 :5 1%处于绝经过渡期 ;4 9%为绝经后期 ,其中绝经 1～ 5年者为 18% ,6～ 10年者和超过 10年者分别为 16%、15 %。其中有 3 8.8%为手术绝经。教育水平 :5 5 .5 %为大学毕业 ;4 0 .0 %为高中毕业 ,4 .5 %的教育水平相当于或低于小学水平。     

Symptoms, attitudes and treatment choices surrounding menopause among the Q'eqchi Maya of Livingston, Guatemala

The present study explored symptoms, attitudes and treatments surrounding women's health and menopause among the Q'eqchi Maya of the eastern tropical lowlands of Guatemala. Data were obtained through participant observation, semi-structured interviews, focus groups and plant walks with 50 Q'eqchi community members from the state of Izabal, Municipality of Livingston, including five midwives, five traditional male healers and eight postmenopausal women. Results indicate that the Q'eqchi Maya of Livingston possess their own cultural perceptions of women's health which affect attitudes, symptoms and treatment choices during the menopausal transition. Since discussions of menstruation and menopause are considered cultural taboos among the Q'eqchi, many women mentioned experiencing excessive preoccupation when unanticipated and unfamiliar symptoms occurred. Furthermore, many women suffered from additional hardship when their spouse misinterpreted menopausal symptoms (vaginal dryness, sexual disinterest) as infidelity. Seven of the eight postmenopausal women interviewed indicated experiencing one or more symptoms during the menopausal transition, including headaches, anxiety, muscular pain, depression, and hot flashes. These results differ from the lack of symptomatology reported in previous studies in Mexico, but are in line with the result of menopausal research conducted among other Maya groups from the highlands of Guatemala. Although the Q'eqchi did not use a specific term for "hot flash", three Q'eqchi women used the expression "baja presion" or a "lowering of blood pressure" to explain symptoms of profuse sweating followed by chills, heart palpitations, and emotional instability. The Q'eqchi Maya mentioned a number of herbal remedies to treat menopausal symptoms. Further research on these botanical treatments is needed in order to ascertain their safety and efficacy for continued use.     

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.     

Attitude toward menopause among married middle-aged adults

One-hundred and sixty-nine-married couples participated in a study designed to examine the relationship of menopausal attitude to the frequency of menopausal symptoms at midlife. Participants completed the Bowles' (1986a) Menopause Attitude Scale and a modified version of the Menopausal Symptoms Checklist (Neugarten & Kraines, 1965). Wives expressed a more positive attitude toward menopause than their husbands, and wives reported experiencing more menopausal symptoms than their husbands perceived them as having. Post-menopausal women expressed a more positive attitude toward menopause than peri-menopausal women or women who had experienced surgical menopause. For both men and women, a positive attitude toward menopause was associated with women who reported fewer menopausal symptoms. A preliminary Structural Equation Model is presented as an effort to further stimulate the development of a theoretical model of attitude toward menopause among middle-aged married couples.     

HIV感染孕妇抑郁、焦虑状况及其影响因素研究

目的:了解感染人免疫缺陷病毒(HIV)孕妇的抑郁、焦虑情绪现状,探讨其相关影响因素。方法:随机抽取云南省德宏州HIV感染较为集中的农村地区HIV感染孕妇作为样本,采用自编的人口学及社会心理情况调查问卷、自评抑郁量表(SDS)、焦虑自评量表(SAS)、社会支持评定量表(SSRS)、大五人格简易问卷、医学应对问卷(MCMQ),对目标人群进行调查。结果:59.1%存在不同程度抑郁症状(27.3%轻度、25.0%中度、6.8%重度),44.2%存在不同程度焦虑症状(34.1%轻度、6.8%中度、2.3%重度)。总体看来,人口学、感染特征和妊娠特征与抑郁、焦虑相关性不显著。多元逐步回归分析结果表明,宗教事件对其抑郁、焦虑情绪具有正向预测作用(β=0.309、0.432)。神经质、宜人性能显著预测抑郁症状(β=0.536、-0.410),神经质正向预测焦虑症状(β=0.477)。感染HIV孕妇的社会支持度比较低,社会支持利用度能预测抑郁症状(β=-0.420),社会支持与焦虑症状之间无关联。屈服应对方式能预测焦虑症状(β=0.369),而应对方式与抑郁症状无关联。结论:感染HIV孕妇的情绪障碍较为严重,是多因素综合作用的结果,应引起社会关注。     

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.