Menopausal symptoms in different substages of perimenopause and their relationships with social support and resilience

Visualized Pattern-Based Hypothesis Testing on Exhaustion, Resilience, Sleep Quality, and Sleep Hygiene in Middle-Aged Women Transitioning Into Menopause or Postmenopause

Exploratory data analysis involves observing data in graphical formats before making any assumptions. If interesting relationships or patterns among variables are identified, hypotheses are developed for further testing. This study aimed to identify significant differences in the levels of exhaustion, resilience, sleep quality, and sleep hygiene according to the personal characteristics of middle-aged women transitioning into menopause or postmenopause through exploratory data analysis. A total of 200 women aged 44 to 55 years were recruited online in August 2023. Data were collected using valid instruments and analyzed through data visualization, pattern identification in the visualized data, and hypothesis establishment based on the visualized patterns. Hypotheses were tested through the independent-samples t test, analysis of variance, and the Kruskal-Wallis test. A total of 11 patterns and corresponding hypotheses were identified. According to the statistically supported pattern-based hypotheses, middle-aged women who were in their perimenopausal period perceived themselves as unhealthy, had professional occupations, and had the highest level of exhaustion and the lowest levels of resilience, sleep quality, and sleep hygiene. This study demonstrated that data visualization is an efficient way to explore relationships or patterns between data. Data visualization should be considered an informatics solution that can provide insight in the field of healthcare.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Unraveling the core and bridge menopausal symptoms of perimenopausal women: a network analysis

OBJECTIVE

Perimenopause is the period from the early menopausal transition to 12 months after the final menstrual period. The clustering of menopausal symptoms poses a challenge for perimenopausal management. Core symptoms are targets for interventions that can alleviate other related symptoms. Bridge symptoms are connectors that link related symptom clusters and can improve the effectiveness of interventions. This study aims to construct a network structure of menopausal symptoms and to identify core and bridge symptoms as a reference for future management.

METHODS

Two hundred forty-two Chinese perimenopausal women were included in the survey. The structure and associations of the menopausal symptoms assessed by the Greene Climacteric Scale were analyzed using a network analysis. We generated the network structure graph using R software and checked its accuracy and stability.

RESULTS

In the menopausal transition, the most prevalent symptoms were feeling tired or lacking in energy, excitability, and irritability. Sexual dysfunction was common among early postmenopausal women. Irritability (S = 7.16, C = 0.0167, B = 8) was a core symptom of the network. The depressive symptom cluster was a core symptom cluster, most of which have high centrality indices. Excitability (B = 6) was a bridge symptom connecting the anxiety and depressive symptom clusters.

CONCLUSIONS

Our study has highlighted the crucial significance of irritability and excitability in perimenopausal management. Overcoming the challenges of perimenopausal management requires the public to ameliorate the prejudice and stigma associated with emotional symptoms.

Climacteric and fibromyalgia: a review

Fibromyalgia (FM) and climacteric conditions share common epidemiological and clinical features, with FM symptoms often beginning during menopause. Musculoskeletal pain, arthralgia, myalgia and other symptoms are frequently seen in both conditions. Some research suggests a link between the cessation of sex hormones and FM symptoms. Women with FM tend to experience more severe symptoms after menopause, and the severity of FM symptoms can worsen in women who have had a hysterectomy with or without oophorectomy. Despite these similarities, it is essential to treat FM and climacteric conditions separately and follow established guidelines for management. However, it is also important to recognize that both conditions can coexist in the same patient. It is crucial to note that there is limited evidence supporting the effectiveness of menopausal hormone therapy for primary FM management. Therefore, menopausal hormone therapy should not be recommended for FM unless the patient also has climacteric syndrome.

Individual and additive-effect relationships of menopausal symptoms and subjective cognitive decline among nurses during menopausal transition: a cross-sectional study

OBJECTIVE

This study aimed to examine the individual and additive-effect relationships between menopausal symptoms and subjective cognitive decline among nurses during menopausal transition.

METHODS

Between February and September 2019, a convenience sampling strategy was used, involving 1,335 Chinese nurses undergoing menopausal transition. A general information survey that included the Subjective Cognitive Decline Scale and the Menopause Rating Scale was completed. Based on a cut-off point of the subjective cognitive decline score of 7.5, the overall sample was divided into mild and severe groups. Propensity score matching was performed to balance covariates of mild and severe subjective cognitive decline. The individual and cumulative effects of menopausal symptoms and subjective cognitive decline were analyzed using binary logistic regression and the Cochran-Armitage trend test, respectively.

RESULTS

After propensity score matching, none of the parameters showed significant differences between the groups. Logistic regression analysis revealed that four menopausal symptoms were closely associated with severe subjective cognitive decline. The Cochran-Armitage trend test indicated odds ratios linking the presence of these symptoms with increased severe subjective cognitive impairment. In addition, nurses simultaneously experiencing two or more core menopausal symptoms were over six times more likely to have severe subjective cognitive decline than nurses experiencing none or one core menopausal symptom during menopausal transition.

CONCLUSIONS

Individual and additive numbers of menopausal symptoms significantly influenced subjective cognitive decline in nurses during their menopausal transition. These findings suggest that interventions aimed at enhancing the cognitive performance of nurses experiencing menopause should consider menopausal symptoms.

Chronic stress, social support, and symptoms at midlife. Is there a buffering effect?

OBJECTIVES

This study was designed to examine associations among measures of stress, social support, and symptoms at midlife. Specifically, the study examined whether support buffered against the negative effects of stress on severity of symptoms grouped via factor analyses into emotional instability, vaso-somatic symptoms, mood disturbances, and aches and pains.

METHODS

We used cross-sectional data from n = 119 women aged 40-55 in Nagaland, India. Midlife symptoms were measured with the help of questionnaires, and factor analysis was used to identify latent factors. Stress and social support were measured by Perceived Stress Scale and Multidimensional Scale of Perceived Social Support, respectively. Chronic stress was measured by fingernail cortisol.

RESULTS

After adjusting for menopausal status, tobacco use, body mass index, and socioeconomic status, cortisol level was positively associated with emotional instability (p < 0.01), vaso-somatic symptom score (p < 0.05), and total symptoms at midlife (p < 0.05). Familial support was negatively associated with emotional instability (p < 0.05) and total symptoms at midlife (p < 0.05). However, no significant associations were observed with spousal or friend support. Although no significant interactions between stress, social support, and symptoms at midlife were observed, spousal support when stratified as high and low support using the means, perceived stress and vaso-somatic symptoms indicated an interaction.

CONCLUSION

Cortisol level and support from family were independently associated with symptoms at midlife. The study highlights the importance of family ties and support for navigating the stressors of everyday life among women in Nagaland.

The effectiveness of psychosocial interventions on non-physiological symptoms of menopause: A systematic review and meta-analysis

BACKGROUND

Menopause, a crucial transitioning stage for women, can significantly impact mood and wellbeing. We aimed to evaluate the effectiveness of psychosocial interventions on non-physiological symptoms of menopause (depression, anxiety, cognition, and quality of life) through systematic review and meta-analysis.

METHODS

Five databases were searched from inception to August 2023 for randomized controlled trials. Pre- and post-test means and standard deviations for groups were extracted and used to calculate effect sizes. The effectiveness of Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Interventions (MBI) on depression and anxiety were examined by subgroup analysis.

RESULTS

Thirty studies comprising 3501 women were included. From meta-analysis, mood symptoms significantly benefited from CBT (anxiety: d = -0.22, 95 % CI = -0.35, -0.10; depression: d = -0.33, 95 % CI = -0.45, -0.21) and MBI (anxiety: d = -0.56, 95 % CI = -0.74, -0.39; depression: d = -0.27, 95 % CI = -0.45, -0.09). Psychosocial interventions were also found to significantly improve cognition (d = -0.23, 95 % CI = -0.40, -0.06) and quality of life (d = -0.78, 95 % CI = -0.93, -0.63). Mean total therapy hours ('dose') was lower for CBT (11.3) than MBI (18.6), indicating reduced costs and burden for women.

LIMITATIONS

Data regarding menopausal status were not collected, limiting our ability to identify the optimal timing of interventions. Potential longer-term, effects of interventions were not investigated.

CONCLUSION

Our review highlighted the value of psychosocial interventions in improving non-physiological symptoms (particularly depression and anxiety) during menopause, noting the heterogeneity of findings and importance of implementing effective interventions.

Treatment-induced menopause symptoms among women with breast cancer undergoing chemotherapy in China: a comparison to age- and menopause status-matched controls

OBJECTIVE

Whether women with breast cancer experience more severe menopause symptoms than comparison women without a history of breast cancer diagnosis remains unclear. We aimed to investigate whether women with breast cancer undergoing chemotherapy experience more severe menopause symptoms than comparison women and explore various factors influencing menopause symptoms in women with breast cancer undergoing chemotherapy.

METHODS

This cross-sectional observational study recruited 423 women with breast cancer undergoing chemotherapy and 1,829 community women without breast cancer. All participants completed a questionnaire assessing menopause symptoms using the Menopause Rating Scale and general characteristics (eg, sociodemographic and clinical data). Propensity score matching was used to reduce the confounders between the two groups. Student's t test or Mann-Whitney U test and chi-square tests were used to compare the differences in menopause symptoms between the two groups. Multivariate linear regression analysis was performed to explore various factors influencing menopause symptoms in women with breast cancer undergoing chemotherapy.

RESULTS

After propensity score matching, 808 participants were included. The mean ages of women with breast cancer undergoing chemotherapy and comparison women were 49.58 and 49.10 years, respectively. Women with breast cancer undergoing chemotherapy experienced significantly more severe vasomotor symptoms than comparison women. However, comparison women had higher Menopause Rating Scale scores and more severe menopause symptoms than women with breast cancer undergoing chemotherapy. Age, occupational status, chemotherapy-induced amenorrhea, family history of cancer, chemotherapy stage, mindfulness, resiliency, and illness perception were associated with menopause symptoms in women with breast cancer undergoing chemotherapy.

CONCLUSIONS

Vasomotor symptoms are prominent among women with breast cancer undergoing chemotherapy. Understanding the factors contributing to menopause symptoms is crucial for healthcare practitioners to develop supportive guidelines for the well-being of women with breast cancer undergoing chemotherapy.

Does hormone therapy exacerbate other venous thromboembolism risk factors?

OBJECTIVE

Postmenopausal symptoms in women at higher risk for venous thromboembolism (VTE) due to comorbidities are often undertreated because of concerns that hormone therapy (HT) may increase VTE risk; however, it is unclear how much HT impacts risk of VTE when compared with other risk factors.

METHODS

This is a case-control study in a commercial claims database from 2007 to 2019. Women aged 50 to 64 years (n = 223,949) were classified as cases if they had an International Classification of Diseases code indicating an acute VTE plus a filled prescription for an anticoagulant, placement of intravascular vena cava filter, or death within 30 days of diagnosis. Controls were matched 10:1 to each case by index date and age. Risk factors and comorbidities present within the year before index were examined. Exposure was defined as a HT prescription within 60 days before index.

RESULTS

There were 20,359 VTE cases and 203,590 matched controls. A conditional logistic regression indicated that the greatest risks for VTE were from metastatic cancer (odds ratio [OR], 13.66; 95% CI, 12.64-14.75), hospitalization/surgery (OR, 8.51; 95% CI, 8.09-8.96), trauma (OR, 3.52; 95% CI, 3.32-3.73), comorbidity burden (OR, 3.51; 95% CI, 3.34-3.69), history of hypercoagulable condition (OR, 3.10; 95% CI, 2.87-3.36), and varicose veins (OR, 2.87; 95% CI, 2.56-3.22). Regarding hormone exposure, we observed ORs of 1.51 (95% CI, 1.43-1.60) for any recent hormone exposure; 1.13 (95% CI, 1.04-1.23; number needed to harm, 4,274) for unopposed estrogen menopausal HT; 1.23 (95% CI, 1.10-1.38; number needed to harm, 2,440) for combined menopausal HT; and 5.22 (95% CI, 4.67-5.84) for combined hormonal contraceptives compared with no recent HT exposure.

CONCLUSIONS

Hormone therapy exposure did not appear to adversely influence other risk factors, and exposure generally played a minor role in VTE risk. Contraceptives, however, were a strong risk factor.

Role of Social Support in Reducing the Severity of Menopausal Symptoms among Women Living in Rural Mysuru, Karnataka: An Analytical Cross-sectional Study

Introduction

Menopause is an unspoken and unaddressed aspect of a women's life, surrounded by many myths and taboos within the Indian context. Although a majority of menopausal women experience moderate to severe symptoms that can affect their physical, emotional, mental, and social well-being, there is poor health literacy as well as health-seeking behavior among them. The importance of social support, especially at a difficult time like menopause, is bound to minimize the severity of menopausal symptoms.

Objectives

The objective is to assess the severity of menopausal symptoms among women living in rural communities of Mysuru district, and to examine the relationship of perceived social support during menopausal transition to severity of the symptoms.

Materials and Methods

Between May 2022 and December 2022, a cross-sectional study was conducted among 250 women living in rural communities of Mysuru district, Karnataka. An interviewer-administered survey in Kannada was used to record the severity of menopausal symptoms and associated determinants after completion of informed consent process.

Results

The average age of study participants was 50.9 (standard deviation [SD] ±4.6) years. While 77.2% were married, 20.8% were widows. About half (53.6%) belonged to lower socioeconomic class and another 28% belonged to middle class. The mean age at menopause was 47.6 (SD ± 4.24) years; 56.8% reported experiencing moderate-to-severe symptoms; 75.6% reported high social support while 24.4% of women low-to-medium social support. The odds of experiencing moderate-to-severe menopause symptoms were 4.51 (95% confidence interval: 2.337-8.690) times higher among women who received low-to-medium social support as compared to those with high social support. The social support obtained was directly proportional to socioeconomic status and living with spouse.

Conclusion

The health system should emphasize the role of social support while counseling postmenopausal women. There is a dire need for both community and physician education programs on the social and medical needs of postmenopausal women.

Minding menopause in patients with cognitive impairment: a patient's perspective and reflections on clinical practice

Many women experience impairment in cognitive function during perimenopause. These symptoms are often not attributed to perimenopause by women themselves, by family and friends, or by healthcare professionals. In this article, we present a case in which perimenopausal complaints were attributed to early dementia and discuss mechanisms contributing to the low level of awareness of perimenopausal symptoms amongst patients and clinicians. Stigma amongst women and healthcare professionals impairs the recognition of perimenopausal complaints, and consideration of treatment options by clinicians. We advocate raising awareness in patients and physicians with more education, and the incorporation of potential menopause-related symptoms in general clinical guidelines.

The effects of physical activity on depression and quality of life in Chinese perimenopausal women

BACKGROUND

Women are more likely to experience depressive symptoms and poor quality of life (QoL) during perimenopause. The effectiveness of physical activity (PA) in perimenopause on mental well-being and health outcomes has been frequently reported. This study aimed to investigate the mediating effect of PA on the relationship between depression and QoL in Chinese perimenopausal women.

METHODS

A cross-sectional study was performed, and participants were recruited through a multistage, stratified, probability proportional to size sampling method. Depression, PA, and QoL were measured by Zung Self-rating Depression Scale, Physical Activity Rating Scale-3, and World Health Organization Quality of Life Questionnaire. The direct and indirect effects of PA on QoL were analyzed by PA in a mediation framework.

RESULTS

1100 perimenopausal women participated in the study. PA mainly plays partial mediating roles in the relationship between depression and physical (ab = -0.493, 95 % CI: -0.582 to -0.407; ab = -0.449, 95 % CI: -0.553 to -0.343) and psychological (ab = -0.710, 95 % CI: -0.849 to -0.578; ab = -0.721, 95 % CI: -0.853 to -0.589; ab = -0.670, 95 % CI: -0.821 to -0.508) domains of QoL. Additionally, intensity (ab = -0.496, 95 % CI: -0.602 to -0.396; ab = -0.355, 95 % CI: -0.498 to -0.212) and duration (ab = -0.201, 95 % CI: -0.298 to -0.119; ab = -0.134, 95 % CI: -0.237 to -0.047) intermediated the relationship between moderate-to-severe depression and physical domain; frequency (ab = -0.130, 95 % CI: -0.207 to -0.066) only had a mediation influence between moderate depression and physical domain; intensity (ab = -0.583, 95 % CI: -0.712 to -0.460; ab = -0.709, 95 % CI: -0.854 to -0.561; ab = -0.520, 95 % CI: -0.719 to -0.315), duration (ab = -0.433, 95 % CI: -0.559 to -0.311; ab = -0.389, 95 % CI: -0.547 to -0.228; ab = -0.258, 95 % CI: -0.461 to -0.085), and frequency (ab = -0.365, 95 % CI: -0.493 to -0.247; ab = -0.270, 95 % CI: -0.414 to -0.144) all interceded between the psychological domain and all levels of depression, except for the frequency between severe depression and psychological domain; in terms of social relationship and environment domains, intensity (ab = -0.458, 95 % CI: -0.593 to -0.338; ab = -0.582, 95 % CI: -0.724 to -0.445), duration (ab = -0.397, 95 % CI: -0.526 to -0.282; ab = -0.412, 95 % CI: -0.548 to -0.293), and frequency (ab = -0.231, 95 % CI: -0.353 to -0.123; ab = -0.398, 95 % CI: -0.533 to -0.279) were mediators only on mild depression.

LIMITATIONS

The cross-sectional study and self-reported data are major limiting factors.

CONCLUSION

PA and its components partially mediated the association between depression and QoL. Suitable prevention methods and interventions for PA may improve the QoL for perimenopausal women.

"They see me as mentally ill": the stigmatization experiences of Chinese menopausal women in the family

BACKGROUND

Menopausal women are regarded as "abnormal people" in China and are often discriminated against and ostracized, especially in the privacy of their homes. However, research on the stigmatization of menopausal women in China is limited. The aim of this study is to explore and describe the stigmatization experiences of Chinese menopausal women in the family and their feelings about these experiences.

METHODS

A phenomenological qualitative research design involving in-depth semi-structured interviews was selected. Our data analysis adopted Colaizzi's methodology.

RESULTS

Fourteen menopausal women participated in this study. Four themes and 12 subthemes emerged: (1) violent treatment (verbal and physical violence); (2) lack of attention and companionship (lack of understanding of physical and psychological suffering, neglect of the value of labour and difficulty finding someone to talk to and accompany them); (3) coping struggles (keeping quiet, fighting back, changing inappropriate perceptions and developing a menopausal transition management plan); and (4) despair (deep-rooted perceptions, restrictions on travel and consumption, and unknown "healing" times).

CONCLUSION

Our results suggest that Chinese menopausal women suffer physically and mentally within their families. The stigma of menopause is both a symptom of the broad societal lack of knowledge regarding menopause and a reflection of the patriarchal oppression of women in a specific cultural context. Accordingly, this study can help menopausal women and society in general better understand the former's stigmatization experiences and amplify their inner voices. Moreover, it can serve as a reference for the formulation of menopause-related health policies in China and for advocating and promoting humanistic care for menopausal women.

Menopausal symptoms in breast cancer patients receiving adjuvant endocrine therapy and their relationships with health-promoting behaviors and social support

OBJECTIVE

To investigate the prevalence and severity of menopausal symptoms in patients with breast cancer undergoing adjuvant endocrine therapy and explore the relationships of these symptoms with health-promoting behaviors and social support.

METHODS

This cross-sectional study investigated 226 participants from December 2020 to December 2021 in China. Data were collected using the sociodemographic information questionnaire, Menopause Rating Scale, the Health-Promoting Lifestyle Profile II, and Perceived Social Support Survey. Multivariate step regression was used to analyze the potential factors of menopausal symptoms.

RESULTS

In our sample of 226 patients, 92.9% reported at least one menopausal symptom with a mean score of 13 points (interquartile range, 9-18 points). The highest prevalence of most symptoms included hot flashes/night sweats, fatigue, joint and muscular discomfort, irritability, and sleep problems. In the regression models, health responsibility ( β = -0.15, P = 0.03), spiritual growth ( β = -0.28, P < 0.01), friend support ( β = -0.43, P < 0.01), and other support ( β = -0.31, P = 0.01) were negatively associated with menopausal symptoms.

CONCLUSIONS

The prevalence and severity of menopausal symptoms are high in breast cancer patients undergoing adjuvant endocrine therapy. Higher health-promoting behaviors and social support are associated with fewer menopausal symptoms. The findings highlight the clinical implications in terms of developing appropriate strategies for managing menopausal symptoms.

The Relationship between Social Support and Mental Health Problems of Peri- and Postmenopausal Women during the SARS-CoV-2 Pandemic

The COVID-19 pandemic affects women's mental health, because they are more predisposed to vulnerabilities and adverse impacts. Therefore, is important to find strategies for preventing and treating these mental health consequences in the female population. The main purposes of our study were to determine the level of social support received by peri- and postmenopausal women during the SARS-CoV-2 pandemic, as well as factors related to this level with reference to health status and sociodemographic variables. A total of 218 women in peri- and postmenopausal status participated in the study. The study assessed depression (Beck Depression Inventory), anxiety (the Spielberg State-Trait Anxiety Scale), climacteric symptoms (the Blatt-Kupperman Index), social support (the Inventory of Social Supportive Behaviors). The majority of the respondents had a moderate level of anxiety as a state (40.8%), a low level of anxiety as a trait (51.4%), no depressive symptoms (75.2%) and no climacteric symptoms (52.3%). Age was found to significantly correlate with anxiety as a state (p = 0.036). The anxiety as state was significantly stronger in people with higher education than in people with secondary education (p = 0.019). Professionally inactive women had more emotional (p = 0.05) and appraisal (p = 0.014) support than women who work. The analysis demonstrated no statistically significant correlation between social support and depression, anxiety or climacteric symptoms (p > 0.05). The majority of peri- and postmenopausal women had no depressive symptoms and/or anxiety symptoms. Professionally inactive women had more emotional and appraisal support than women who work. The analysis demonstrated no statistically significant correlation between social support and depression, anxiety or climacteric symptoms.

The structure of menopausal syndrome: Using network analysis to understand unique symptomatic relationships

OBJECTIVE

To explore the network structure underlying the symptoms of menopausal syndrome and to identify the central and bridge symptoms of menopause among middle-aged women.

METHODS

This is a cross-sectional survey study conducted in the Chinese community with a total of 1829 women aged 40-65 years. The Menopause Rating Scale (MRS) was used to assess the menopausal syndrome, including somato-vegetative, psychological, and urogenital subdomains. The network analysis was performed to determine the central and bridge symptoms of menopause.

RESULTS

In the network of menopausal symptoms, anxiety, vaginal dryness, depressive mood, and irritability were the most central symptoms. Depressive mood, anxiety, and vaginal dryness were also detected as the bridge symptoms. The estimated network between the symptoms had good stability (CS-strength = 0.75 and CS-edge = 0.75).

CONCLUSION

The present network analysis provided unique insights into the inner structure of menopausal symptoms. Psychological symptoms should be considered as the core symptoms in developing relevant interventions to improve the health and well-being of middle-aged women.

Higher perceived stress during the COVID-19 pandemic increased menstrual dysregulation and menopause symptoms

BACKGROUND

The increased stress the world experienced with the coronavirus disease (COVID-19) pandemic affected mental health, disproportionately affecting females. However, how perceived stress in the first year affected menstrual and menopausal symptoms has not yet been investigated.

OBJECTIVES

This study evaluates the effect that the first year of the COVID-19 pandemic had on female reproductive and mental health.

METHODS

Residents in British Columbia, Canada, were surveyed online as part of the COVID-19 Rapid Evidence Study of a Provincial Population-Based Cohort for Gender and Sex. A subgroup of participants (n = 4171), who were assigned female sex at birth (age 25-69 years) and were surveyed within the first 6-12 months of the pandemic (August 2020-February 2021), prior to the widespread rollout of vaccines, was retrospectively asked if they noticed changes in their menstrual or menopausal symptoms, and completing validated measures of stress, depression and anxiety.

DESIGN

This is a population-based online retrospective survey.

RESULTS

We found that 27.8% reported menstrual cycle disturbances and 6.7% reported increased menopause symptoms. Those who scored higher on perceived stress, depression and anxiety scales were more likely to report reproductive cycle disturbances. Free-text responses revealed that reasons for disturbances were perceived to be related to the pandemic.

CONCLUSION

The COVID-19 pandemic has highlighted the need to research female-specific health issues, such as menstruation. Our data indicate that in the first year of the pandemic, almost one-third of the menstruating population reported disturbances in their cycle, which was related to percieved stress, depression and anxiety scores.

The Effect of Resilience and Family Support Match on Psychological Distress among Women in the Menopausal Transition Based on Polynomial Regression and Response Surface Analysis

Menopausal transition (MT) is a natural process in women from reproductive decline to aging. During this period, women present with an increased prevalence of psychological distress. The aim of this study was to investigate how resilience and family support interact to influence psychological distress among women during MT. A convenience sampling method was used to recruit 858 women during MT from Shandong Province. All participants completed the 10-item Connor-Davidson Resilience Scale, the family care degree questionnaire, and the Kessler Psychological Distress Scale. Data were analyzed by using SPSS 24.0. Response surface analysis was used for polynomial regression and response surface analysis. The results of response surface analysis show that in the case of agreement between resilience and family support, the joint effect manifested as a negative curve (inverted U shape) related to the psychological distress of women during MT. In the case of disagreement, the joint effect manifested as a negative curve (inverted U shaped) related to psychological distress. Specifically, with increased variance in the degree of resilience and family support, women experienced less psychological distress. Both resilience and family support play an important role in protecting women from psychological distress, either alone or in combination. Future intervention studies targeting women during MT should consider the coordinated actions of resilience and family support.

Does social support affect menopausal symptoms in menopausal women?

PURPOSE

To determine the effect of perceived social support of menopausal women on their menopausal complaints.

DESIGN AND METHODS

This descriptive and correlational study was conducted with 505 women. The data were obtained using personal information form, menopause rating scale, and multidimensional scale of perceived social support. Frequency, percentage, t test, analysis of variance Skewness and Kurtosis (±1) and correlation were used in the analysis of the data.

FINDINGS

In the study, it was found that there was a positive and significant relationship between menopausal symptoms and social support, and menopausal symptoms decreased as social support increased.

PRACTICE IMPLICATIONS

Nurses should provide consultancy for women to increase their social support systems to decrease their menopausal complaints.

Menopause-Related Symptoms and Influencing Factors in Mosuo, Yi, and Han Middle-Aged Women in China

Although previous studies showed that women’s menopause-related symptoms varied in different ethnic groups and countries, and were affected by specific social and cultural factors, few studies have been conducted to explore menopause-related symptoms and its influencing factors in middle-aged women among ethnic groups in China. This study aimed to explore the characteristics of menopause-related symptoms and its influencing factors among Mosuo, Yi, and Han women in Yongning area of Yunnan province, China. A cross-cultural design by snowball sampling method was used to recruit 208 women aged 40–60 from Yongning Township, Ninglang County, Yunnan province, China. The 11-item Menopause Rating Scale (MRS) was used to assess menopause-related symptoms. Compared with Yi and Han women, Mosuo women were accorded the highest family status. Multiple linear regression analyses showed that ethnicity, age, family support, and family decision-making patterns were associated with the severity of menopause-related symptoms. Yi and Han women had more severe menopause-related symptoms than Mosuo women. Among the three groups, women living in “female-dominated” and “co-deliberated” households had significantly lower scores of menopause-related symptoms than those in “male-dominated” households. This study indicates that menopause-related symptoms vary among middle-aged women in different ethnic groups. A higher level of female status in the family and family support may be protective factors of menopause-related symptoms in middle-aged women.

The Association of Menopausal Symptoms and Social Support Among Saudi Women at Primary Health Care Centers in Taif, Saudi Arabia

Background

Menopause is a challenging period for all women. The severity of menopausal symptoms hurts their quality of life and daily activity. The aim of this study was to investigate whether the severity of menopausal symptoms are associated with social support and lifestyle factors among Saudi women to help policymakers develop the appropriate intervention health program.

Methods

A cross-sectional study of 361 middle-aged Saudi women was conducted through interviews using a valid and reliable questionnaire. The menopause rating scale (MRS) was used to determine the severity of menopausal symptoms and the multidimensional scale of perceived social support (MSPSS) was used to assess perceived social support among females. Linear regression was conducted to assess the association between MRS scores and MSPSS scores after adjustment of covariates.

Results

The mean total menopause rating scale was 13.7 ± 8.3. Physical and mental exhaustion (80.3%), joint and muscular discomfort (79.2%), and irritability (75.9%) were the most prevalent menopausal symptoms for all women. The mean MSPSS was calculated as 4.3 ±1.8. Perceived social support and lifestyle factors were significant predictors of menopausal symptoms.

Conclusions

Postmenopausal Saudi women complain of a variety of physical and psychological symptoms. The current study shows that social support, quitting smoking, losing weight, and increasing physical exercise can help to alleviate or reduce many of the unpleasant symptoms of menopause. This evidence will help policymakers design health intervention for this age group.

Relationship between Self-Perception of Aging and Quality of Life in the Different Stages of Reproductive Aging in Mexican Women

Biological aging has an abrupt beginning in women, changing their body and perceptions, which are not accepted easily because the actual stereotypes are focused on youth and anti-aging. Our interest was to explore what the self-perception of aging (SPA) is in middle-aged women throughout the reproductive aging stages and their association with the quality of life. A cross-sectional study was conducted with 240 women (40−69 years) living in Mexico City, who were separated according to their reproductive aging stage. An electronic version of the Spanish version of the Self-rated Attitudes Towards Old Age (SATO) and the WHO Quality of Life-Bref (WHOQoL) was applied to these women and was sent by WhatsApp or email. Seventeen women of the total sample (7%) had a negative self-perception of aging. There is an association between SATO and WHOQoL (r = −0.273, p < 0.0001), but in the menopausal transition stage, the association is strong in the psychological subscale, and after menopause, early and late postmenopausal women show a better association in the social subscale. Negative SPA impacts the WHOQoL psychological dimension and not the total WHOQoL score. Our findings suggest an association between SPA and quality of life in different reproductive aging stages.

Associations of sleep quality, anxiety symptoms and social support with subjective well-being among Chinese perimenopausal women

BACKGROUND

Few studies have explored the internal pathway of the association between sleep quality and subjective well-being among perimenopausal women.

METHODS

A survey was performed of 1063 perimenopausal women aged 40 to 60 years who participated in a regular health examination conducted at the First Hospital of Jilin University, China. Participants were asked to complete a study questionnaire. The Pittsburgh Sleep Quality Index, Zung Self-rating Anxiety Scale, Perceived Social Support Scale and Subjective Well-being Scale for Chinese Citizens were used to assess sleep quality, anxiety symptoms, social support and subjective well-being, respectively. The data were analyzed using t-tests, analysis of variance, Pearson correlation analysis, multiple linear regression analysis and the PROCESS macro.

RESULTS

The mean total subjective well-being score was 90.14 ± 12.80. The correlation analyzes showed that sleep quality (r = -0.341, P < 0.001) and anxiety symptoms (r = -0.490, P < 0.001) were negatively correlated with subjective well-being. Social support was positively correlated with subjective well-being (r = 0.480, P < 0.001). The effect of sleep quality on subjective well-being was partially mediated by anxiety symptoms (Effect = -0.462, 95% CI = [-0.577, -0.363]). In addition, social support moderated the association between anxiety symptoms and subjective well-being (Index = -0.006, 95% CI = [-0.012, -0.001]).

LIMITATIONS

This was a cross-sectional study.

CONCLUSIONS

The effect of sleep quality on subjective well-being was partially mediated by anxiety symptoms, and social support moderated the association between anxiety symptoms and subjective well-being among perimenopausal women.

Psychological well-being of midlife women: a structural equation modeling approach

OBJECTIVE

Women experience menopause at approximately 50 to 52 years of age, when reproductive aging causes various somatic, psychological, and urogenital symptoms. Women's changing lifestyles and increasing lifespan make it difficult to pinpoint the factors affecting their well-being during menopause, warranting continuous research in this field. Therefore, this study developed a structural equation model, based on the transactional model of stress and coping, to test the significance of positive and negative factors associated with psychological health during menopause.

METHODS

This study validated a structural equation model based on the empirical data collected using a crosssectional study. We analyzed 300 questionnaire responses completed between May 15 and July 10, 2020, by South Korean middle-aged women (aged 45-60 y) who agreed to participate. The study's structural equation model used self-efficacy as an exogenous variable and perceived stress, menopausal management, self-compassion, menopausal symptoms, and psychological well-being as endogenous variables. Educational and economic levels were set as control variables.

RESULTS

We observed statistical support for 9 out of 10 hypotheses; the predictor variables had an explanatory power of 79.5% for psychological well-being. Self-efficacy was positively associated with the psychological wellbeing of middle-aged menopausal women and appeared to be mediated by perceived stress, menopausal management, menopausal symptoms, and self-compassion.

CONCLUSIONS

To improve the psychological well-being of middle-aged women, it is important to increase their self-efficacy and minimize stress. Moreover, managing menopausal symptoms and increasing self-compassion through effective coping may maximize psychological well-being.

VIDEO SUMMARY

http://links.lww.com/MENO/A933.

How perimenopause shaped perspectives on life during the pandemic: A study on india's working and non-working women

The menopausal transition is a challenging phase in a woman's life and has been compounded by the COVID-19 pandemic. This study aimed to examine the association between meaning in life, quality of life, and satisfaction with life among perimenopausal women during the pandemic, as well as to determine if there was a difference in attitudes towards life between working and non-working perimenopausal women. The study sample consisted of 114 perimenopausal women, with 64 being employed and 50 being non-employed. A quantitative cross-sectional design was employed, and the results showed that satisfaction with life was positively correlated with both meaning in life and quality of life. Working perimenopausal women had a higher level of satisfaction with life (mean score of 63.24) as compared to non-working perimenopausal women (mean score of 50.14), but there was no significant difference in quality of life or meaning in life between the two groups. The study highlights the impact of various social and personal factors on how women perceive their lives during the pandemic and underscores the need for increased support and resources for perimenopausal women in the workplace. Additionally, promoting menopause awareness in general and in the workplace could help to reduce social barriers and improve women's perspectives on life, leading to an improvement in their overall quality of life and satisfaction with life. This study insisted on the need for giving importance to this stage in women's life-rather passing it just like that. Policy makers in the HR field should make a note to the finding and incorporate necessary amendment in terms of the female workforce.

Effects of aerobics training on anxiety, depression and sleep quality in perimenopausal women

OBJECTIVE

To investigate the effect of aerobics training on anxiety, depression and sleep disturbance in perimenopausal women.

MATERIALS AND METHODS

A total of 289 perimenopausal women with anxiety, depression or sleep disorder in Lishi district of Luliang city were treated with aerobics training. Self-rating anxiety scale, self-rating depression scale and Pittsburgh sleep scale were used to investigate the anxiety, depression and sleep status of perimenopausal women before and after intervention.

RESULTS

After aerobics training, the scores of self-rating anxiety scale, self-rating depression scale and Pittsburgh sleep questionnaire were 48.26 ± 6.47, 50.27 ± 6.54 and 10.64 ± 4.38, respectively. The levels of anxiety, depression and sleep disorder in 289 subjects were significantly lower than those before intervention (t = 3.865, 4.541, 5.596, P < 0.01). The remission rate of symptoms was significantly different in subjects with different frequency of spontaneous practice (P < 0.01), and the higher the number of spontaneous practice, the higher the remission rate of anxiety, depression and sleep disorders in subjects (P < 0.01).

CONCLUSION

aerobics training can effectively improve the anxiety and depression of perimenopausal women, improve sleep quality, the more frequency of practice, the more obvious the effect. It can be used as an intervention to improve the mental health level of perimenopausal women in terms of anxiety, depression and sleep quality in clinical promotion.

The Relationship Between Psychosocial Factors and Adherence to Treatment in Men, Premenopausal and Menopausal Women with Type 2 Diabetes Mellitus

Introduction

Type 2 Diabetes Mellitus (T2DM) is a chronic disease that begins in adulthood, and is caused by multiple factors. The onset of menopause involves changes that predispose women to the development of T2DM, which can worsen if the adherence to treatment is inadequate due to psychosocial factors or medications. The present study aims to describe the psychosocial factors that may affect adherence to treatment among men and premenopausal and menopausal women with T2DM.

Methods

This was a cross-sectional study of 96 patients with T2DM, who were divided into three groups: 1) men (n=32); 2) premenopausal women (n=32); and 3) menopausal women (n=32). Somatometric and metabolic control data were obtained. Adherence to treatment and psychosocial factors were evaluated: social support, belief in conventional medicine, disease denial, and depressive symptoms.

Results

Adherence to medication had a negative correlation with depressive symptoms in men (p <0.001) and menopausal women (p <0.021). Dietary adherence had a positive correlation with belief in conventional medicine in men (p <0.037) and premenopausal women (p <0.029).

Conclusion

Medication adherence in men and menopausal women was correlated with fewer depressive symptoms. Adherence to diet in men and premenopausal women was correlated with greater belief in conventional medicine. The results show the diversity of psychosocial factors among the groups that must be addressed in order to improve adherence.

Identifying the different subtypes in menopausal symptoms among middle-aged women in China: a latent class analysis

OBJECTIVE

Many studies have focused on the severity and prevalence of menopausal symptoms among middle-aged women, which are limited by heterogeneity and diversity of subtypes. Subtyping facilitates the adaptation to prevention and clinical intervention strategies that target women. To determine the existence of significant subgroups of women with similar menopausal symptoms, a person-centered approach was used to identify potential profiles of women during the menopausal transition. In addition, we aimed to examine the association between latent subtypes and individual factors.

METHODS

This cross-sectional study included 797 middle-aged women, aged 40 to 60 years, who were recruited from Shandong Province, China, between December 2017 and August 2018. We identified the subtypes in menopausal symptoms by performing a latent class analysis according to the self-reported Menopause Rating Scale and evaluated the robustness of our identified subtypes using a sensitivity analysis. Multinomial logistic regression was performed to explore the association between emergent latent subtypes and sociodemographic, clinical, and psychosocial characteristics.

RESULTS

The mean age of participants was 49.83 ± 5.05 years. (1) Four potential classes were identified in middle-aged women: "severe symptoms" (14.9%), "dominant sleep-emotion symptoms" (31.4%), "physical/mental exhaustion symptoms" (32.5%), and "no symptoms" (21.2%). The four classes were also verified using a sensitivity analysis according to age and menopause status subgroups, which revealed the robust subtypes of menopausal symptoms. (2) The odds ratio of neuroticism, chronic diseases, and gynecological diseases were significantly higher for the "severe symptoms," "dominant sleep-emotion symptoms," and "physical/mental exhaustion symptoms" classes, compared to the "no symptoms" class, while the odds ratio of mindfulness and social support were lower.

CONCLUSIONS

A person-centered approach for middle-aged women could address the unmet need to understand the heterogeneity of menopausal symptoms. Subtyping facilitates the identification of the potential causes of menopausal symptoms and the development of personalized interventions.

"It just makes me feel a little less alone": a qualitative exploration of the podcast Menopause: Unmuted on women's perceptions of menopause

OBJECTIVE

Menopause can negatively impact women's quality of life, with many women reporting inadequate information and support. Podcasts have grown in popularity in recent years and have been found to be accessible methods for increasing knowledge and challenging perceptions of stigmatized topics. The current research aimed to understand the impact of the podcast "menopause: unmuted" on women's menopause-related knowledge, understanding, and communication practices.

METHODS

A diverse sample of 30 women aged 40 to 60 years listened to the podcast series, which focused on menopause stories, before taking part in semistructured interviews to discuss the impact of the podcast on how they understood and communicated about menopause. The interviews were analyzed thematically.

RESULTS

Two overarching themes were identified in the data. A "journey of knowledge gain" explores participants' understanding of menopause before listening to the podcast and describes how this is deepened by hearing and connecting with women's stories. "Reframing menopause" describes the impact of the podcast, where women reflect on the value of communication amongst women, challenge and re-evaluate the stigmatization of menopause, and discuss ways to make positive behavioral changes in their lives.

CONCLUSIONS

The podcast "menopause: unmuted" helped women to learn about the menopause experience, have a greater sense of belonging to a community of women, and feel empowered to make changes in their own lives. Sharing stories via podcasts has potential as an accessible and impactful medium to educate women and reduce the widespread stigma associated with menopause.

Facilitators and Barriers to Healthy Midlife Transition among South Asian Immigrant Women in Canada: A Qualitative Exploration

Background: South Asian immigrant women make up the largest visible minority in Canada, where visible minorities include persons, other than Aboriginal peoples, who are non-Caucasian in race or non-white in colour, and approximately half of these women are above the age of 35. Few studies have investigated the factors that impact the midlife transition for these women. This study aims to identify the facilitators and barriers experienced by South Asian immigrant women during the midlife transition. Methods: Two focus groups and ten one-on-one interviews about the midlife transition were held with South Asian first-generation immigrant women in the Greater Toronto Area, Ontario, Canada; discussions were analyzed thematically. Findings: Personal facilitators to the midlife transition included being employed and possessing adequate life skills. Personal barriers consisted of financial strain, overwhelming demands, and limited life skills. Familial facilitators were stable financial status and support. Familial barriers included limited understanding and support and high expectations. Community facilitators included a close social circle and adequate healthcare. Community barriers were limited social support and cultural expectations. Fair and respectful societies were a facilitator, whereas inadequate policy support and acculturative stress were societal barriers. An environmental barrier was the colder Canadian climate. Discussion: Employment and education programs for South Asian immigrant women need to be prioritized to help them integrate into society. Family-centred assessment and education can improve familial support. Communities need to foster peer support groups and culturally sensitive healthcare. Social and employment policies should accommodate the midlife transition. Conclusions: South Asian immigrant women experience unique facilitators and barriers to their midlife transition that should be considered by healthcare providers, policymakers and society to support them.

The relationship between social support, stressful events, and menopause symptoms

Many women going through the menopausal transition experience vasomotor symptoms (VMS), and research has shown that there is a large amount of variation in their frequency and severity. Many lifestyle factors have been found to co-vary with VMS, including the level of social support received by the woman, and how stressed she is. Stress is well documented to worsen menopause symptoms, and there is some evidence that support eases them; however, there is little research into whether support is an effective buffer against the negative effects of stress on VMS. Using nine years of data from the Study of Women’s Health Across the Nation (n = 2718), we use multilevel Poisson regression with random effects to test: 1) if more social support is associated with decreased VMS frequency, 2) if increased life stress worsens VMS, and 3) if support acts as a buffer against stress. After adjusting for age, marital status, smoking, self-perceived overall health, ethnicity, and menopausal status, we find that stress increases the frequency of VMS. Contrary to our hypothesis, we did not find strong evidence that emotional support led to lower VMS frequency, or that support buffers against the effects of stress. Experience of a stressful event, but not amount of social support, was included in the best fitting model; with the degree to which the woman was upset by the life stressor having the largest effect on menopause symptoms. Here, women who said they were currently upset by a stressful event experienced 21% more VMS than women who had experienced no life stressor. This research highlights that social factors may impact the menopausal transition.

Individual and additive-effect relationships of sleep problems and severe menopausal symptoms among women in menopausal transition

OBJECTIVE

Sleep problems and menopausal symptoms are both common complaints among midlife women. However, the associations of the quality and quantity of sleep problems with the severity of menopausal symptoms have not been well studied. Thus, this study aims to examine the relationships between individual sleep problems and the additive number of sleep problems with severe menopausal symptoms among women during the menopausal transition.

METHODS

Using the convenience sampling, a total of 848 middle-aged women in China were investigated from December 2017 to August 2018. All participants completed a questionnaire on sleep problems, Menopause Rating Scale, and the general information questionnaire. Based on the cutoff of the Menopause Rating Scale, participants were divided into the nonsevere menopausal symptom group and severe menopausal symptoms group. Propensity score matching was used to balance covariates between the two groups. Stepwise binary logistic regression and restricted cubic spline were applied to analyze the associations of individual and additive sleep problems with severe menopausal symptoms.

RESULTS

After propensity score matching, no significant difference was observed between the nonsevere menopausal symptoms group and severe menopausal symptoms group (Ps > 0.05). Logistic regression analysis showed that five sleep problems ("feeling too hot," "having pain," "restless legs syndrome," "taking medicine to help sleep," and "having trouble staying awake") were closely associated with severe menopausal symptoms. The restricted cubic spline curve showed an upward trend in odds ratios between the number of these five sleep problems and severe menopausal symptoms, and women were more than twice as likely to suffer severe menopausal symptoms when they experienced more than three of these individual sleep problems.

CONCLUSION

Both the individual and additive number of sleep problems exerted significant effects on severe menopausal symptoms. It might be useful for healthcare providers to set guidelines to support a healthy menopausal transition for midlife women.

#Menopause on Instagram: a mixed-methods study

OBJECTIVE

The aims of this study were to: (1) characterize the menopause transition (MT) on social media and (2) determine if concordance or discordance exists when comparing MT-focused social media posts and biomedical research literature.

METHODS

We analyzed 440 sequential Instagram posts with the hashtag #menopause over 2 weeks from January to February 2019. Posts were composed of 299 unique accounts, resulting in an average of 1.7 posts per account (standard deviation [SD] 1; range 1-9; median 1 and interquartile range [IQR] 1-2). Each account had an average of 2,616 followers (SD 11,271; range 3-129,000; median 421.5 and IQR 177-1,101). Content and thematic analyses were completed for posts, images, and videos to identify codes related to the MT. The top 15 codes were then searched along with the key term "menopause" in PubMed to ascertain the level of concordance between Instagram content and peer-reviewed literature on the MT.

RESULTS

We identified 69 codes in our corpus of Instagram content, resulting in 9 categories: physical health, mental health, complementary and integrative health, advertising, social, advice, self-care, nature, and self-expression (kappa 0.95-1.00). The most prevalent codes were related to weight loss/fitness (20.5%) and hormones (18.4%). The majority of frequent codes identified in Instagram posts were infrequently listed in biomedical literature related to menopause. However, there were two codes, Weight loss/Fitness and Hot flashes, that were frequently discussed in Instagram posts and the biomedical literature.

CONCLUSIONS

The examination of #menopause on Instagram provides novel insights for researchers and clinicians. Our findings provide a better understanding of the experiences and support needs of individuals experiencing menopause. Furthermore, codes related to menopause have low prominence in the biomedical literature, suggesting key topics that could be explored in the future.

A spatiotemporal analysis of urban resilience to the COVID-19 pandemic in the Yangtze River Delta

The COVID-19 pandemic has severely affected the normal socioeconomic operation of countries worldwide, causing major economic losses and deaths and posing great challenges to the sustainable development of cities that play a leading role in national socioeconomic development. The strength of urban resilience determines the speed of urban social and economic recovery. This paper constructed a comprehensive evaluation index system for urban resilience under the COVID-19 pandemic scenario considering four dimensions-economy, ecology, infrastructure, and social systems-conducted a quantitative evaluation of urban resilience in the Yangtze River Delta of China, revealed its spatiotemporal differences and change trends, and proposed targeted strategies for improving urban resilience. The results show that (1) the Yangtze River Delta urban resilience system is growing stronger every year, but there are significant differences in the level of urban resilience, its spatial distribution and regional urban resilience. (2) In the Yangtze River Delta urban agglomeration, there is less distribution of areas with a higher resilience index, while those with high and medium resilience levels are more distributed. However, the resilience of most cities is low. (3) The resilience index of eastern coastal cities is significantly higher, and the resilience of cities under the COVID-19 scenario presents obvious east-west differentiation. (4) When constructing urban resilience, the individual situation of cities should be taken into account, measures adjusted according to local conditions, reasonable lessons drawn from effective international urban resilience construction, and reasonable planning policies formulated; it is important to give play to the relationship between the whole and the parts of resilience to achieve unified and coordinated development.

Chinese women's health and wellbeing in middle life: Unpacking the influence of menopause, lifestyle activities and social participation

OBJECTIVES

To examine Chinese middle-aged women's health and wellbeing and the associated biosocial correlates.

STUDY DESIGN

This study used a cross-sectional design, including selected retrospectively collected information on the final menstrual period, drawn from the 2013 wave of the China Health and Retirement Longitudinal Study (CHARLS). Women aged 45 to 59 were selected.

MAIN OUTCOME MEASURES

Factor analysis of 16 menopausal symptom ratings yielded four different and independent measures of pre-/peri-menopausal and early postmenopausal women's health. These were: negative mood (feel frustrated, sad, lonely, worried, bored, angry, tired and stressed), positive emotions (feel enthusiastic, content and happy), musculoskeletal pain (shoulder/neck pain, knee and other joint pain, and back pain), and sleep and memory problems (trouble sleeping and poor memory).

RESULTS

Menopausal status was positively associated with sleep and memory problems, whilst the number of years since the final menstrual period was positively associated with musculoskeletal pain. In contrast, lifestyle activities and social participation were linked to positive emotions. The association between selected biosocial factors and negative mood was not significant after controlling for other demographic and social background factors.

CONCLUSIONS

Musculoskeletal health as well as sleep and memory problems are positively associated with menopausal biological factors amongst Chinese mid-life women. Maintaining active social engagement contributes to positive wellbeing among middle-aged women.

Acupuncture for menopausal symptoms in Chinese women: a systematic review

Menopause-related symptoms are common problems of middle-aged women that can seriously affect their quality of life. Menopausal hormone therapy (MHT) for climacteric symptoms is the first choice recommended by the International Menopause Society and likewise by other societies and institutions covering this field. However, non-hormonal therapies can be an alternative effective option, especially for women who are not suitable for MHT. Acupuncture is one of the most important methods. With deepening experience of the use of traditional Chinese acupuncture and moxibustion in the improvement of menopause symptoms, more clinical evidence has been obtained to support the effectiveness and safety of this treatment concept that is very often used in China. This review summarizes the evidence for effective treatment of climacteric complaints by acupuncture in recent years, shares the clinical experience of the authors of this review, all of whom head or work in units with daily large numbers of outpatients, and includes, in particular, results from studies performed in the Department of Acupuncture--Moxibustion of Tsinghua University Chuiyangliu Hospital, Beijing, China. In addition, there is a summary about the safety of acupuncture treatment in traditional Chinese medicine.

Spouses' perceptions of and attitudes toward female menopause: a mixed-methods systematic review

Objective: Menopausal women experience physical and psychological discomfort, which may be affected by their spouses' perceptions of and attitudes toward menopause. The purpose of this review is to summarize men's perceptions of and attitudes toward female menopause in different cultural contexts.Method: A sequential integrated design method was used in this mixed-methods systematic review. PubMed, Web of Science, PsycINFO, Cochrane, Embase, China National Knowledge Infrastructure, and the Wanfang database were searched. Studies on spousal perceptions of and attitudes toward female menopause were included in the analysis.Results: A total of 12 articles met the inclusion criteria. Men have little knowledge of menopause and health-care status. Men have different attitudes toward wives' changes during menopause. A large proportion of them cannot cope with these changes, possibly due to poor knowledge about menopause; aging and disease; psychological changes; religious and other internal factors; and external factors, including family life, work stress, and wives' menopausal symptoms. In addition, spouses' perceptions of and attitudes toward menopause may affect women's menopausal symptoms, attitudes toward menopause, and marriage relationships.Conclusion: Although there was little evidence, it seems that male spouses' perceptions of and attitudes toward female menopause are important factors affecting menopausal women's quality of life.

The relationship between menopausal symptoms and burnout. A cross-sectional study among nurses

Background

Despite the growing presence of menopausal women in workplaces, studies aimed at exploring the link between menopausal symptoms and job well-being are scarce. In the interest of addressing this gap, the present study aimed to explore whether menopausal symptoms might contribute to increased levels of burnout and whether this relationship can be moderated by social or personal resources.

Method

The study design was cross-sectional and non-randomized. Ninety-four menopausal nurses completed a self-report questionnaire including scales aimed at measuring menopausal symptoms, burnout, social (i.e., support from superiors and colleagues) and personal (i.e., self-efficacy, resilience, and optimism) resources. Moderated regression analyses were performed to test study hypotheses.

Results

Whereas menopausal symptoms were associated significantly with emotional exhaustion, no social or personal resources were found to moderate this relationship. Regarding depersonalization, our study indicated that it was affected by menopausal symptoms only among nurses who reported low social support (from superiors and colleagues), optimism, and resilience.

Conclusion

The present study highlights the importance of organizations that employ a growing number of menopausal women to seek solutions at the individual and social levels that help these women deal with their menopausal transition while working.

The association between hormones and antipsychotic use: a focus on postpartum and menopausal women

During the postpartum and menopausal periods of women's lives, there is a well-established and significant drop of circulating estrogens. This may be the reason why both these periods are associated with an increased risk for onset or exacerbation of psychiatric disorders. Whether symptoms are mainly affective or mainly psychotic, these disorders are frequently treated with antipsychotic medications, which calls for an examination of the relationship between hormone replacement and antipsychotic agents at these time periods. The aim of this narrative review is to summarize what is known about the association of hormones and antipsychotics in the postnatal period and at menopause. In the review, we focus on estrogen and oxytocin hormones and include, for the most part, only papers published within the last 10 years. Both estradiol and oxytocin have at various times been implicated in the etiology of postpartum disorders, and estrogens, sometimes combined with progesterone, have been tested as potential treatments for these conditions. The role of estradiol as an adjunct to antipsychotics in the prevention of postpartum relapses is currently controversial. With respect to oxytocin, studies are lacking. Psychosis in menopausal and postmenopausal women has been successfully treated with estrogens and selective estrogen-receptor modulators, mainly raloxifene, in addition to antipsychotics. Some symptoms appear to respond better than others. No oxytocin study has specifically targeted postmenopausal women. Because of feedback mechanisms, there is a theoretical danger of therapy with exogenous hormones interfering with endogenous secretion and disturbing the balance among inter-related hormones. When used with antipsychotics, hormones may also affect the metabolism and, hence, the brain level of specific antipsychotics. This makes treatment with antipsychotics plus hormones complicated. Dose, timing and route of intervention may all prove critical to efficacy. While much remains unknown, this literature review indicates that, within standard dose ranges, the combination of hormones and antipsychotics for postnatal and menopausal women suffering severe mental distress can be beneficial, and is safe.