Influencing factors on women's attitudes toward menopause: a systematic review

Validation of the menopause representation questionnaire (MenoSentations-Q) among Iranian women and cross-cultural comparison with Portuguese women

BACKGROUND

Menopause represents a critical stage in middle. Examining menopausal symptoms within healthcare system requires reliable and valid instruments. The Menopause Representations Questionnaire (Menosentations-Q) is a self-report scale grounded in Leventhal's self-regulation model. This study aimed to explore the psychometric properties of this questionnaire among Iranian women.

METHODS

This study was conducted with women visiting healthcare centers in Saveh, Markazi province, Iran. A total of 320 eligible Iranian women and 354 Portuguese women (aged 45-65) completed the questionnaire. Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency was evaluated through Cronbach's alpha and McDonald's omega. Convergent and divergent validity were determined using average shared variance, maximum shared variance, construct reliability, and Fornell and Larcker's method. Cross-cultural validity was performed by multigroup CFA to assess invariance between two culturally distinct samples (Iranian and Portuguese).

RESULTS

The Content Validity Ratio (CVR) and Content Validity Index (CVI) were 0.96 and 0.98, respectively, indicating strong content and face validity. EFA of 22 items revealed four factors-identity, positive and negative consequences, and control/awareness/cause factors, accounting for 61.29% of the total variance. CFA indicated good model fit (CFI = 0.96, TLI = 0.95, χ2/df = 1.74, GFI = 0.91, AGFI = 0.89, RMSEA = 0.04). Cronbach's alpha (0.90) and McDonald's omega (0.92) indicated good internal consistency. Convergent and discriminant validity values of MenoSentations-Q were also acceptable. Also, the instrument showed invariance between the two cultural groups.

CONCLUSIONS

The Persian adaptation of MenoSentations-Q demonstrated strong validity and reliability. Furthermore, the comparable responses between Portuguese and Iranian participants suggest shared representations of menopause across these cultures. Given the significance of menopause, tailored educational programs and interventions are essential to address potential challenges during this life stage. Employing standardized tools such as the Menopsentations-Q can support the development of effective strategies, including educational initiatives, support programs, and targeted interventions, to empower women and enhance their well-being during this transitional phase.

Comprehensive Management of Menopausal Symptoms

Menopause is an inevitable physiologic process that typically occurs in women between the ages of 45 and 56 years old. It involves the permanent cessation of ovarian function and is recognized to have occurred when there has been no menstrual cycle for 12 consecutive months without another cause. Vasomotor symptoms, such as hot flushes and night sweats, and genitourinary syndrome of menopause, which includes symptoms of vaginal dryness, dyspareunia, and urinary incontinence, are common symptoms of menopause. Symptoms range from mild to severe, and for those interested in treating their symptoms, there are hormonal and nonhormonal options available. Choosing appropriate therapies is based on each individual's health history and personal preferences. Because menopause can affect mental, physical, and emotional health, it is critical for nurses to recognize the changes that occur in menopause so that they can make appropriate inquiries to elicit symptom information. Nurses play an important role in counseling and supporting individuals through the menopause transition with evidence-based guidance.

Development of the Menopause Perception Scale

OBJECTIVE

How women perceive menopause depends on how well they go through that period of time. However, there is no measure that can be used to assess how women perceive menopause. Therefore, we developed a valid and reliable scale (Menopause Perception Scale [MPS]) to assess how women perceive menopause.

METHODS

This methodological research was conducted in three stages. First, we developed items and assessed their content validity. Second, we collected data from 470 women. Third, we assessed the scale for validity and reliability. Exploratory factor analysis and confirmatory factor analysis were used for construct validity. Cronbach's α was calculated for reliability. Pearson's correlation coefficient was used for criterion validity. Mean comparison tests were performed for known-groups validity.

RESULTS

The MPS had a content validity index of 0.90. It had a Kaiser-Meier-Olkin score of 0.768, for which Bartlett's test of sphericity was significant (1,778.047; P < 0.001). The values were acceptable. The exploratory factor analysis yielded an 18-item structure with factor loads greater than 0.40. It also revealed a four-factor model (acceptance, perceived sexuality, normalization, and perceived support) confirmed by the confirmatory factor analysis. The fit indexes were acceptable. The model explained 56.64% of the total variance. The internal consistency was acceptable (Cronbach's α = 0.824). There were positive correlations between the scale and its subscales. Furthermore, the MPS was significantly correlated with the Menopause Attitude Assessment Scale ( r = 0.334, P < 0.001) and the Menopause Rating Scale ( r = -0.286, P < 0.001).

CONCLUSIONS

The MPS is a valid, reliable, user-friendly, and practical self-report measure with satisfactory psychometric properties. Researchers should conduct cross-cultural studies to adapt it to other cultures.

Menopausal knowledge and attitudes of women during the perimenopausal period

OBJECTIVE

This study aims to determine the relationship between knowledge and attitudes about menopause among women in the perimenopausal period.

METHODS

A descriptive and relationship-seeking cross-sectional study was conducted in family health centers in a district of Istanbul between January and March 2023. The study included 300 women in the perimenopausal period. Data were collected through face-to-face interviews using a descriptive information form, a menopause knowledge test, and the Menopause Attitude Scale.

RESULTS

The average age of participants was 45.07 ± 3.50, with 85.3% married, 37.0% having completed primary school, and 55.0% being housewives. The average menopause knowledge score was 12.29 ± 3.75 (out of 20), and the average menopause attitude score was 25.23 ± 6.99 (out of 52). No significant relationship was found between menopause knowledge and attitude scores ( r = 0.06, P > 0.05). Women with an income exceeding their expenses had higher menopause knowledge scores ( P < 0.05). Unmarried women, those with lower education levels, those with higher incomes, and those living alone had higher menopause attitude scores compared with their counterparts ( P < 0.05).

CONCLUSIONS

Women's knowledge and attitudes toward menopause are moderate in the perimenopausal period. There is no significant relationship between menopausal knowledge and attitude of women during the perimenopausal period. It was determined that menopause knowledge level differed according to women's income status, and menopause attitude differed according to marital status, educational status, and cohabitation status in this study.

Menopausal Hormone Therapy, an Ever-Present Topic: A Pilot Survey about Women's Experience and Medical Doctors' Approach

Background and Objective: Menopause can be associated with many clinical manifestations: vasomotor symptoms, urogenital problems, and additional psychological disturbances, such as anxiety, mood changes, and sleep alterations. The prolonged lack of hormones also increases the risk of long-term consequences. Hormone Replacement Treatment (HRT) in menopause consists of the administration of estrogen, alone or associated to progesterone, to relieve these uncomfortable disturbances and to prevent the onset of other pathologic conditions. The aim of this study is to examine the prevalence of HRT use in a sample of menopausal women and their experience with menopause and HRT. This study also investigates the knowledge of general practitioners (GPs) and gynecologists about HRT and its prescription. Materials and Methods: We conducted a cross-sectional population survey on 126 women of 50-59 years in an industrial city in the North of Italy, Vercelli (Novara), in Eastern Piedmont. We also presented a questionnaire on the topic to 54 medical doctors (GPs and gynecologists) of the same area. Results: The prevalence of HRT use in our sample was 11.9%. In total, a good percentage of the users affirmed to be satisfied with HRT. Additionally, a minority of women reported being ideally against the use of replacement hormones, were advised against using HRT by doctors, and did not use it because of the fear of side effects. We found a positive association between patient education, health care attitude, and HRT usage. A significant number of women knew about HRT from the media, and most of them were not informed by a health professional. Despite this, the interviewed doctors considered their knowledge about HRT as 'good' and would recommend HRT: only 5.6% would not prescribe it. Conclusions: Our results highlight the need for information about HRT among patients and health professionals, along with the need for more effective communication, evaluation, and suggestion of treatment.

Needs assessment study for management of menopause in the community

Menopause is an inevitable phase in every woman's life. Women may suffer from unpleasant symptoms during perimenopause. Understanding the health needs of the community during this period will help in developing menopause management programs that can improve quality of life.

Aim

To study the symptoms of menopause and perception of women in relation to menopause in order to understand their needs.

Settings and Design

A cross-sectional, multi-centric study was undertaken at three institutions (called DH, SJ, and SK) at two cities in India. The study population comprised women between the ages of 40 and 60. Institutional Ethics Committee approval and consent of participants were ensured.

Material and Methods

Two instruments, a pilot-tested, peer-reviewed, validated, structured questionnaire and the Menopause Rating Scale (MRS) were utilized for the study. The minimum sample size was calculated to be 385 per site. Statistical analysis was conducted using the IBM Statistical Package for Social Sciences.

Results

A total of 1297 forms were analyzed. MRS scores showed psychological symptoms to be most prevalent. Joint and muscular pains were the most common somatic symptoms. Hot flashes and urogenital symptoms were experienced by a lower number. Our MRS scores were significantly higher than those seen in other regions. Urban women, site SJ, those with irregular menstrual cycles, and lower incomes scored higher than their counterparts. Awareness about menopause was patchy, especially regarding medication or support services available.

Conclusions

The high MRS scores emphasize the need to institute awareness programs, providing information on choices available for care (hormone replacement therapy, medications, or counseling) and information on where to access services. Primary care physicians can play a vital role in fulfilling this need by ensuring timely knowledge to the community, providing correct diagnosis and treatment. This will help improve the quality of life and sense of well-being of this community.

Translation, cross-cultural adaptation, and validation of the Persian version of the Attitude Towards Menopause scale

OBJECTIVES

This study describes translation, cross-cultural adaptation, and validation of the Attitude Towards Menopause (ATM) scale in Persian.

METHODS

A standard process was followed for translation and cross-cultural adaptation of the ATM scale into Persian. The content validity index and content validity ratio were used to measure content validity. The construct validity was tested using exploratory factor analysis and confirmatory factor analysis. The average variance extracted and construct reliability were used to indicate convergent and discriminant validity, respectively. Internal consistency and test-retest reliability of the Persian ATM scale were assessed using Cronbach α and intraclass correlation coefficient (ICC).

RESULTS

A revised version of the ATM scale, including 26 items assigned to seven factors, was obtained in exploratory factor analysis. The factors were interpreted as negative affect, postmenopausal recovery, control of symptoms, sexuality, psychological losses, unpleasant confrontation, and menstrual freedom, explaining 66.18% of the total variance. The factor structure of the scale was confirmed using confirmatory factor analysis (Comparative Fit Index = 0.90, Tucker-Lewis Index = 0.88, Goodness-of-Fit Index = 0.90, Adjusted Goodness-of-Fit Index = 0.86, Root Mean Square Error of Approximation = 0.07, χ2 / df = 4.56). The values of Cronbach α coefficient and ICC indicated an acceptable level of reliability ( α = 0.70, ICC = 0.89). The construct reliability for all factors was more than or equal to 0.7 except for psychological losses, indicating good discriminating validity. The values of average variances extracted for subscales varied from 0.48 to 0.99, representing adequate convergent validity.

CONCLUSIONS

The Persian version of the ATM scale is a reliable and valid tool to evaluate the attitudes of Iranian women toward menopause.

Women's understanding and experiences of menopause in low-income and middle-income countries in the Asia Pacific region: a scoping review protocol

INTRODUCTION

Menopause denotes the end of a woman's reproductive life. A woman's experiences of menopause are shaped by her individual circumstances and may vary between social and cultural contexts. Evidence is needed to inform research and programme delivery that supports women's health and well-being throughout the menopausal transition. This scoping review will map evidence of women's experiences of menopause in Asia Pacific countries, where limited research exists.

METHODS AND ANALYSIS

We will follow the five-stage framework of Arksey and O'Malley, further developed by Levac et al and the Joanna Briggs Institute. MEDLINE, CINAHL, PsycINFO and Scopus databases will be systematically searched between February 2022 and May 2022 using subject headings and keywords. The title-abstract and full text of retrieved studies will be assessed against eligibility criteria. The review will focus on studies with a qualitative research component. Citation searching of selected articles will supplement database searching. Data will be extracted, charted, synthesised and summarised. Findings will be presented in narrative format and implications for research and practice reported.

ETHICS AND DISSEMINATION

Ethical approval is not required for this scoping review of selected studies from peer-reviewed journals. Ethical approval has been granted from relevant ethics committees for community consultation. Findings will be shared in peer-reviewed publications, presented at conferences and disseminated with communities, health workers and researchers.

Why are women considering ovarian tissue cryopreservation to preserve reproductive and hormonal ovarian function? A qualitative study protocol

INTRODUCTION

Current fertility preservation options available to women are oocyte cryopreservation (egg freezing) or embryo cryopreservation. A newer procedure, ovarian tissue cryopreservation (OTC), has become available in some centres, which offers another option for women and girls considering fertility preservation. These procedures are commonly offered to women about to undergo treatments for cancer. OTC involves removing sections of ovarian tissue and cryopreserving it for future reimplantation, often several years later. OTC offers girls and women who may become infertile with optionality and the possibility of pregnancy. OTC has potential for other applications, including restoring ovarian endocrine function beyond biological menopause. This is not without controversy but has led to some women considering undergoing the procedure for purposes of ovarian hormonal preservation (conservation of ovarian endocrine function). OTC is invasive, involves two surgical procedures with concomitant risks and can be costly. Understanding why women may consider and ultimately undergo OTC is timely, so that evidence-based and women-centred care can be provided.

METHODS

A pragmatic narrative qualitative design will be used. A purposive sample of women aged 18-45 who are considering, or have sought, OTC will be recruited over 1-year period. Potential participants will be approached via a clinic that offers OTC on a private basis or via social media.

ANALYSIS

Participant interviews will be audio and, if consented, video recorded. These will be conducted face-to-face or virtually. The recordings will be transcribed verbatim and analysed using a thematic analysis approach supported by NVivo software.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the Institutional Ethical Review ERN_19-1578A. We expect to disseminate the findings of this study through journal articles, conference presentations and multimedia to public.