The hopeless age? A qualitative exploration of the experience of menopause in Arab women in Qatar

Relationship Between Menopausal Symptoms, Cancer Screening Behaviors, and Religion Attitudes of Women in the Climacteric Period: A Cross-Sectional Study

BACKGROUND

Although it is known that religion is used to cope with health problems, there is a lack of information about the effect of religion on menopausal symptoms and cancer screening attitudes of climacteric women.

AIM

This study was conducted to determine the relationship between the religious attitudes of women in the climacteric period and their attitudes toward menopausal symptoms and cancer screening.

MATERIALS AND METHODS

This was a cross-sectional study of 381 women in the climacteric period in the Central Anatolia region of Türkiye. Data collection form, the Menopause Rating Scale (MRS), OK-Religious Attitude Scale (ORAS), and attitude for cancer screening (short form) (ASCS) were used to collect data. Correlation analysis assessed the relationship between MRS, ORAS, and ASCS.

RESULTS

There was a low positive correlation between women's ORAS mean score (35.19 ± 4.80) and MRS mean score (12.68 ± 7.24) (r = 0.284, P < 0.001). There was no statistically significant relationship between the mean ORAS scores of the women and the mean ASCS scores (64.59 ± 10.47) (r = 0.089, P > 0.05).

CONCLUSION

Women who experienced more severe menopausal symptoms had stronger religious attitudes. Women's religious attitudes did not affect their attitudes toward cancer screening. It is therefore recommended that health professionals organize counseling and training activities to protect and improve the health of menopausal women and increase their participation in screening and treatment programs.

Weaving a cocoon on the way to aging transcendence: Grounded theory study on aging perception during menopause transition

During menopause, women experience major changes, including the onset of aging as a natural and inevitable event. The present study aimed to explore and explain the process of aging perception during menopausal transition. This study was a qualitative grounded theory research, which was going to be implemented in 2019–2020 on 18 Baluch women settled in the Sistan & Baluchestan province in South-East Iran and among midlife or older menopause experienced women. Sampling was started first by Purposive sampling, and then it was performed with theoretic sampling. Data analysis was performed according to Corbin and Straus’s approach (2015) in four phases: (1) identifying and developing concepts; (2) analyzing data for the context; (3) entering the process stage into analysis; and (4) integrating categories to build a theory. In this study, seven main categories were obtained: “Sunset of youth”, “aging as the other side of the coin of menopause”, “Weaving a cocoon”, “aging as a mental trap”, “social acceptance”, “aging domino”, and “feeling of transcendence”. It seems that menopause plays an important role in Baluch women’s view toward aging. The practical results of this study can be applied to better understand the middle-aged and older Baluch women’s attitudes toward aging. Also study shows a new evolutionary and situational perspective on the lives of middle-aged menopausal Baluch women. Baluch women in menopause accept the sunset of youth and look forward to experiencing the Feeling of transcendence. Identify and respond to their needs by developing and establishing health policies to change their negative attitudes.

Depressive symptoms and suicidality by menopausal stages among middle-aged Korean women

AIMS

There has been increasing evidence of hormonal changes during reproductive events that lead to mood changes. However, studies on the severity of psychological problems according to the menopausal stage are limited. Thus, this study aimed to investigate the association between menopausal stages, depression and suicidality.

METHODS

A total of 45 177 women who underwent regular health check-ups between 2015 and 2018 at Kangbuk Samsung Hospital were included. Participants were stratified into four groups (pre-menopause, early transition, late transition and post-menopause) based on the Stages of Reproductive Aging Workshop Criteria. The Center for Epidemiological Studies-Depression scale (CESD) was used to evaluate depressive symptoms, and the degree of depressive symptoms was classified as moderate (CESD score 16-24) or severe (CESD score ⩾ 25). To measure suicide risk, we administered questionnaires related to suicidal ideation.

RESULTS

Overall, the prevalence of CESD scores of 16-24 and ⩾ 25 was 7.6 and 2.8%, respectively. Menopausal stages were positively associated with depressive symptoms in a dose-dependent manner. Multivariable-adjusted prevalence ratios (PRs, 95% confidence intervals) for CESD scores of 16-24 comparing the stages of the early menopausal transition (MT), late MT and post-menopause to pre-menopause was 1.28 (1.16-1.42), 1.21 (1.05-1.38) and 1.58 (1.36-1.84), respectively. The multivariable-adjusted PRs for CESD scores ⩾ 25 comparing the stages of the early MT, late MT and post-menopause to pre-menopause were 1.31 (1.11-1.55), 1.39 (1.12-1.72), 1.86 (1.47-2.37), respectively. In addition, the multivariable-adjusted PRs for suicidal ideation comparing the early MT, late MT and post-menopause stages to the pre-menopause stage were 1.24 (1.12-1.38), 1.07 (0.93-1.24) and 1.46 (1.25-1.70) (p for trend <0.001), respectively.

CONCLUSIONS

These findings indicate that the prevalence of depressive symptoms and suicidal ideation increases with advancing menopausal stage, even pre-menopause.

Royal Jelly as an Intelligent Anti-Aging Agent-A Focus on Cognitive Aging and Alzheimer's Disease: A Review

The astronomical increase of the world's aged population is associated with the increased prevalence of neurodegenerative diseases, heightened disability, and extremely high costs of care. Alzheimer's Disease (AD) is a widespread, age-related, multifactorial neurodegenerative disease that has enormous social and financial drawbacks worldwide. The unsatisfactory outcomes of available AD pharmacotherapy necessitate the search for alternative natural resources that can target various the underlying mechanisms of AD pathology and reduce disease occurrence and/or progression. Royal jelly (RJ) is the main food of bee queens; it contributes to their fertility, long lifespan, and memory performance. It represents a potent nutraceutical with various pharmacological properties, and has been used in a number of preclinical studies to target AD and age-related cognitive deterioration. To understand the mechanisms through which RJ affects cognitive performance both in natural aging and AD, we reviewed the literature, elaborating on the metabolic, molecular, and cellular mechanisms that mediate its anti-AD effects. Preclinical findings revealed that RJ acts as a multidomain cognitive enhancer that can restore cognitive performance in aged and AD models. It promotes brain cell survival and function by targeting multiple adversities in the neuronal microenvironment such as inflammation, oxidative stress, mitochondrial alterations, impaired proteostasis, amyloid-β toxicity, Ca excitotoxicity, and bioenergetic challenges. Human trials using RJ in AD are limited in quantity and quality. Here, the limitations of RJ-based treatment strategies are discussed, and directions for future studies examining the effect of RJ in cognitively impaired subjects are noted.

Psychological Climacteric Symptoms and Attitudes toward Menopause among Emirati Women

Menopause is an inevitable developmental event that women encounter at an age of 42–54 years. The drop of estrogen levels that accompanies cessation of menstruation is associated with multiple vasomotor, physical, neuropsychological, and sexual symptoms, which may hamper quality of life. This study aimed to examine the severity of psychological symptoms and their correlates among peri- and postmenopausal Emirati women (N = 60, mean age = 54.88 ± 6 years). Participants were interviewed using the Menopause-Specific Quality of Life (MENQOL) and attitudes toward menopause scale (ATMS). In four path analysis models, vasomotor symptoms, weight gain, and fatigue had significant direct effects on symptoms of anxiety, depression (only weight gain and fatigue), and psychological distress. Fatigue significantly mediated the effects of vasomotor symptoms and weight gain on symptoms of anxiety, depression (only vasomotor symptoms), psychological distress, and memory problems. These models explained 47.6%, 44.5%, 56.6%, and 29.1% of the variances in anxiety, depression, psychological distress, and memory problems, respectively. Participants with more severe menopausal symptoms expressed more negative attitudes toward menopause though regression analysis revealed that only vasomotor symptoms could significantly contribute to ATMS scores. In conclusion, psychological distress is widespread among menopausal women, and it is associated with vasomotor symptoms, fatigue, and change of body composition (obesity). Psychological symptoms, along with vasomotor symptoms, express a key link to negative attitudes toward menopause. Therefore, interventional strategies that target psychological distress may promote coping with midlife transition and improve mental health among menopausal women.

"Moving from uncertainty toward acceptance": a grounded theory study on exploring Iranian women's experiences of encountering menopause

Purpose: Menopause as a universal phenomenon is influenced by social norms so that women's experiences during menopausal transition are related to the social values and cultural symbols. This qualitative study was conducted to discover the Iranian women's experiences of encountering menopause.Materials and Methods: In this grounded theory study 27 women living in Mashhad and Gonabad, North East of Iran, from May 2013 to July, 2016 were selected using purposive and theoretical sampling. Semi structured in-depth interviews were conducted for data collection until data saturation was achieved. Data was analyzed using Strauss and Corbin's (1998) recommended method through open, axial and selective coding. MAXQDA 2007 software was used for organizing data and managing the process of analysis.Results: The analysis revealed the core category of "moving from uncertainty toward acceptance". The interrelated categories subsumed under the core category included challenging aging, observing the symptoms of menopause, responding to the menopausal symptoms, understanding the need for preparation, and assessing the right time to prepare.Conclusion: Moving from uncertainty toward acceptance was identified as the core concept in the Iranian women's experiences of encountering menopause. Modifying the beliefs of people about menopause and aging as well as increasing their knowledge and information about menopause can help women to experience the menopausal transition with more ease.

An empowerment model of Iranian women for the management of menopause: a grounded theory study

Background and Objectives: There is still no clear portrayal of women's empowerment in managing menopause. The present study was conducted to design a model for the empowerment of Iranian women in managing menopause. Materials and Methods: This qualitative study was conducted using the grounded theory on  40-60-year-old women who were first selected through purposive sampling and then by theoretical sampling from November 2013 to July 2016. Data were collected using 33 in-depth, semi-structured, individual interviews with 30 participants. Data were analyzed using the Strauss and Corbin(2008) approach and organized in MAXQDA-10. Results: The analysis of the data led to the emergence of "active coping with menopause" as the core variable with four themes. The two themes "threat to feminine identity" and "latent opportunity" explained the context of the study, and "redefining the feminine identity" and "self-retrieval" explained its process. Conclusion: In our social context, the phenomenon of menopause is a coin with two sides and its experience leans more on the threat to feminine identity and less on latent opportunity. The model of postmenopausal women's empowerment for managing menopause might offer health policy-makers a realistic and divergent understanding of the challenges of empowering women by explaining key concepts.

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.

Feeling an Invisible Wall: The Experience of Iranian Women's Marital Relationship After Surgical Menopause: A Qualitative Content Analysis Study

Sexual relationships after surgical menopause matter when talking about sex is taboo and marriage is the only justified way to meet sexual needs. In this qualitative research study, 22 surgical menopausal women shared their experiences of sexual/marital relationship after surgery through in-depth, face-to-face, semi-structured interviews. Qualitative content analysis technique was used for data analysis. An overarching theme entitled "feeling an invisible wall" reflected this experience. It comprised three categories: (1) declined marital intimacy, (2) disarming, and (3) transformation of societal norms into concerns. This study proposed new contextual information about the marital relationship of Iranian women after surgical menopause that was not openly articulated before and which may be applicable for others in such contexts. Women's main concern was the emotional separation because of the sexual consequences of the surgery. Healthcare providers should be aware of women's concerns, which may alter their marital relationship. They must provide individualized care, education, and support for couples to make thoughtful decisions about rebuilding their sexual relationship. Results may also have implications for psychiatrists, sex/marital therapists, and probably clergy who have the authority to openly address this important issue to the public.

Cultural issues in menopause: an exploratory qualitative study of Macedonian women in Australia

OBJECTIVE

This study explored the attitudes to, and experience of, menopause among Macedonian women living in Australia, including attitudes and responses to hormone therapy (HT) and complementary therapies, as well as related psycho-sexual, relationship and other midlife issues.

METHODS

Using qualitative methodology, the study was based on seven unstructured, nondirective group discussions. Natural social groups were recruited, meeting wherever each group felt most at home. A total of 81 participants ranged in age from 45 to 75 years. The women included both first-generation immigrants and women born in Australia to Macedonian parents. A bilingual Macedonian researcher conducted the fieldwork.

RESULTS

Participants typically claimed they lacked information about menopause in their native language, and their knowledge of HT was highly variable. Some women only felt comfortable approaching Macedonian doctors. Others reported an easing of symptoms when they revisited their homeland. Deeply religious participants claimed their faith helped them through this phase of life, and that they were as likely to consult a priest as a doctor. A recurring theme was that Macedonian men tended to regard their wives differently after menopause, sometimes treating them as "non-sexual." Women regarded this shift in male attitudes as a precipitating factor in domestic violence, extramarital affairs and divorce. Symptoms such as hot flashes and mood swings were associated with negative attitudes toward menopause.

CONCLUSIONS

Culturally determined attitudes appear to affect the perception and experience of menopause. Other influencing factors include migration, women's roles, marital status, religion, use of herbal and traditional remedies, social situation, access to information, knowledge and experience of menopausal symptoms.

Age of despair or age of hope? Palestinian women's perspectives on midlife health

There is limited evidence about women's experiences of the midlife, beyond a narrow - frequently biomedical - focus on the menopause. The broader (physical, social, cultural, political) dimensions of women's midlife health are poorly understood, particularly in low and middle-income countries. Our study seeks to understand how women in the West Bank (occupied Palestinian territories) conceptualise, experience and manage their health in the midlife. We generated qualitative evidence using in-depth life history interviews in 2015 with women (n = 35) living in the West Bank, analysed thematically. Women's understandings of good health draw on indigenous and biomedical knowledge and include a calm psychological state, ease of movement, as well as physical appearance and complexion. Exposure to political violence was understood as impacting mental and physical well-being. Most women articulated a positive view about midlife and ageing as a natural process. A range of terms and expressions were suggested by women experiencing this transition, internalised differently according to marital and motherhood status. For many women, the menopause was merely one - often relatively unimportant - aspect of changes associated with ageing. In dealing with midlife health issues women used multiple strategies, or health pluralism, sequentially or simultaneously; drawing on multiple sets of accrued resources. For never-married or childless women, formal healthcare services represented a site of social exclusion. Our evidence highlights the importance of considering the broader dimensions related to midlife health for understanding women's health maintaining and care-seeking behaviours as they age.

Bone mineral density in midlife women: the Study of Women's Health in Qatar

OBJECTIVES

The aim of this study is to investigate bone mineral density (BMD) for a large cross-section of midlife Arab women living in Qatar and to evaluate the association of body mass index (BMI), menopause status, and nationality, on BMD of the spine and femur.

STUDY DESIGN

A cross-sectional study was conducted among women aged 40-60 years recruited from nine primary-care health centers in Qatar. BMD (g/m(2)) was assessed at the lumbar spine and the femur.

RESULTS

The combined prevalence of osteopenia and osteoporosis was 4% at the femur and 16.2% at the spine. BMI and menstrual status were both independently associated with BMD at the spine and at the femur (all p values < 0.001). As BMI increased, BMD increased at both the spine and femur. Women who menstruated in the past 12 months had 0.82 g/cm(2) and 0.61 g/cm(2) greater BMD at the spine and femur, respectively, compared with women who had not menstruated in 12 months. Nationality was not associated with mean BMD of the spine or the femur.

CONCLUSIONS

No significant differences were observed between Qatari and non-Qatari women in terms of mean BMD values at the spine and the femur except for the femur in the age group 55-60, where values were lower among non-Qataris (p = 0.04). Multivariable analyses showed that BMI and menstrual status were found to be strongly associated with BMD levels at the spine and femur. The high prevalence of obesity observed in this sample may explain the low levels of osteopenia and osteoporosis observed.