Experience of menopause in aboriginal women: a systematic review

The association of race, ethnicity, and socioeconomic status on the severity of menopause symptoms: a study of 68,864 women

OBJECTIVE

This study aimed to evaluate if and how race, ethnicity, and socioeconomic status (SES) are associated with the severity of menopause symptoms in a large, diverse sample of women.

METHODS

For this cross-sectional study conducted between March 24, 2019, and January 13, 2023, a total of 68,864 women were enrolled from the Evernow online telehealth platform. Participants underwent a clinical intake survey, which encompassed demographic information, detailed medical questionnaires, and a modified Menopause Rating Scale. The modified scale was adapted for ease of use online and is available in the supplementary material along with the full intake. Symptom severity was evaluated using a multivariate binomial generalized linear model, accounting for factors such as race, ethnicity, age, body mass index, smoking status, bilateral oophorectomy status, and SES. Odds ratios (OR) and CIs were calculated based on the linear regression coefficients.

RESULTS

Of the participants, 67,867 (98.6%) were included in the analysis after excluding outliers and those with unknown oophorectomy status. The majority of respondents identified as White (77.4%), followed by Hispanic (9.0%), Black (6.7%), two or more races/ethnicities (4.4%), Asian (1.2%), Indigenous/First Nations (0.8%), Middle Eastern (0.3%), and South Asian (0.2%). Notably, individuals identifying as Black (hot flashes OR, 1.91; 97.5% CI, 1.75-2.09; P < 0.001), Hispanic (skin/hair changes OR, 1.58; 97.5% CI, 1.45-1.71; P < 0.001), Indigenous/First Nations (painful sex OR, 1.39; 97.5% CI, 1.19-2.75; P = 0.007), Middle Eastern (weight changes OR, 2.22; 97.5% CI, 1.25-4.37; P = 0.01), or with two or more races/ethnicities (skin/hair changes OR, 1.41; 97.5% CI, 1.26-1.58; P < 0.001) reported higher levels of symptom severity compared with their White counterparts. Conversely, Asian and South Asian participants reported lower symptom severity. Even after incorporating SES into the linear model, racial and ethnic groups with lower SES (Black, Hispanic, Indigenous, and multiple ethnicities) exhibited slight shifts in OR while maintaining high statistical significance (Black [hot flashes OR, 1.87; 97.5% CI, 1.72-2.04; P < 0.001], Hispanic [skin/hair changes OR, 1.54; 97.5% CI, 1.42-1.68; P < 0.001], Indigenous/First Nations [painful sex OR, 1.74; 97.5% CI, 1.17-2.70; P = 0.009], multiple ethnicities [skin/hair changes OR, 1.41; 97.5% CI, 1.26-1.58; P < 0.001]).

CONCLUSIONS

Our study suggests that the relationship between race and ethnicity and the severity of menopause symptoms is not solely explained by differences in SES but is itself an independent factor. Understanding and addressing social, cultural, and economic factors are crucial to reduce disparities in menopausal symptoms.

A meta ethnography of the cultural constructs of menopause in indigenous women and the context of Aotearoa/New Zealand

The researchers aim in this synthesis is to interpret the cultural constructions of menopause in Indigenous women and apply these interpretations to the context of Māori women in Aotearoa/New Zealand. There is a lack of research about Indigenous women's interpretations of health, and how culture mediates understandings and experiences of menopause. There is even less research regarding Māori women's understandings and experiences of menopause, as the discourse is dominated by Western ideology. Using meta ethnography methodology, the researchers selected eight studies, that provided the foundations to enable the interpretation of the cultural constructions of menopause in Indigenous women. The findings were then translated into four metaphors- natural, cultural protection, freedom and idiomatic and then were subsequently translated to Māori concepts mana wahine, Mātauranga Māori, tikanga and pepeha. We suggest that broader mainstream understandings of the cultural constructions of menopause for Indigenous women are necessary to provide equitable health outcomes for Māori and other Indigenous women. The researchers further developed a model that can be used to represent the foundations of Māori women's conscious understandings and experience of 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.

The Change: Yoga, Theology and the Menopause

In this article, I explore the interplay of yoga, theology and the time of perimenopause and menopause. Through an approach centered physically, theologically and philosophically on becoming, I find an integrated web of thinking, feeling and moving that weaves new ways of perceiving and living this time of change; an example, I suggest, of what Keller calls creatio ex profundis, new creation from the depths of a life. I bring aspects of process theology (along with feminist and queer theology), phenomenological materialism, embodiment and somatic psychology/physiology into conversation with personal narrative. I examine ideas of severance, threshold and emergence, and images such as release, holding and breath that resonate helpfully with the holistic embodiment of yoga, theologies of change and (peri)menopause.

Menopausal experiences of South Asian immigrant women: a scoping review

IMPORTANCE AND OBJECTIVE

South Asians make up a significant portion of global immigration. Immigrants often face challenges when navigating the healthcare system, which can influence their experience during the menopausal transition. The purpose of this scoping review is to summarize the existing literature on South Asian immigrant women's menopausal experience.

METHODS

Various electronic databases were systematically searched to identify research articles. The menopausal experiences of South Asian immigrant women were examined.

RESULTS

A total of 11 studies were included in this scoping review. A variety of physical symptoms were reported, including vasomotor symptoms, musculoskeletal symptoms, somatic symptoms, and early onset of menopause. Psychosocial symptoms included anxiety, depression, and decreased memory/concentration. Cultural experiences were both positive and negative, depending on the connotations surrounding menopause. Individual facilitators for a healthy transition included education and employment. Familial barriers included a lack of knowledge and support. Community and societal factors were both positive and negative, depending on the level of acculturation. Self-management was the most widely used intervention.

DISCUSSIONS AND CONCLUSION

Findings of this scoping review can help guide the development and evaluation of menopause interventions for South Asian immigrant women. Culturally sensitive care, increased discussion on sexual health, support networks, and reduction of socioeconomic barriers are needed to address the health needs of South Asian immigrant women. Further research is needed to better understand South Asian immigrant women's menopausal needs and help guide intervention design.

Menopause experience in First Nations women and initiatives for menopause symptom awareness; a community-based participatory research approach

BACKGROUND

Little research has been conducted about menopause in First Nations women. In response to the wishes of Cree women living in Maskwacis, Alberta, to start a dialogue on menopause, we undertook community-based participatory research (CBPR) to explore menopause experience and raise awareness of menopause symptoms in the community.

METHODS

The research adhered to the principles of Ownership, Control, Access and Possession (OCAP™) and was guided by the interest of the participating women. Local women (target age 40-65 years) were invited to participate in workshops using word-of-mouth and community posters in health centers. Five research workshops were held in community settings, attended by experienced women's health researchers and consenting women. The participants guided the informal discussions. They also completed questionnaires which included menopause-related quality of life. The researchers used extensive hand-written field notes to record data; qualitative content analysis was applied to identify themes. Simple descriptive analysis was used for the questionnaire results. The findings were discussed at a community feedback session and laid the basis for further knowledge translation initiatives.

RESULTS

The five workshops included a total of 37, mostly post-menopausal women with 6-11 women/workshop. The main discussion themes were: "experiences of menopause symptoms" including their impact on quality of life; "menopause knowledge prior to their own experience" with most women feeling that they had insufficient information before menopause; "menopause symptom management" which mainly included practical strategies; "impact of menopause on family members" which was of prime concern with uncontrollable mood changes affecting the whole family and sometimes causing matrimonial disharmony. Questionnaire responses corroborated the workshop discussions. Knowledge translation of the research findings produced two information pamphlets specifically for the Maskwacis community: one for husband/partner, the other for women and family members. These pamphlets have been distributed in all areas of the community.

CONCLUSION

This CBPR project addressed a topic identified by the community as being important. Community members developed informative pamphlets in response to the women's concern of lack of understanding for menopause symptoms among families. This simple solution has been widely accepted by community members, opening the possibility of wider discussion about menopause.

"There's a problem, now what's the solution?": suggestions for technologies to support the menopausal transition from individuals experiencing menopause and healthcare practitioners

OBJECTIVE

To elicit novel ideas for informatics solutions to support individuals through the menopausal transition. (Note: We use "individuals experiencing menopause" and "experiences" rather than "symptoms" when possible to counter typical framing of menopause as a cisgender women's medical problem.).

METHODS

A participatory design study was conducted 2015-2017 in the Western US. Two sessions were held with individuals experiencing menopause recruited from the general public; and 3 sessions with healthcare practitioners (HCPs) including nurses, physicians, and complementary and integrative health (CIH) practitioners were held. Participants designed technologies addressing informational needs and burdensome experiences. HCPs reflected on designs from participants experiencing menopause. Directed content analysis was used to analyze transcripts.

RESULTS

Eight individuals experiencing menopause (n = 4 each session) and 18 HCPs (n = 10 CIH, n = 3 nurses, n = 5 physicians) participated. All participants provided ideas for solution purpose, hardware, software, features and functions, and data types. Individuals experiencing menopause designed technologies to help understand and prevent burdensome menopause experiences. HCPs designed technologies for tracking and facilitating communication. Compared to nurses and physicians, CIH practitioners suggested designs reframing menopause as a positive experience and accounted for the complex lives of individuals experiencing menopause, including stigma; these ideas corresponded to comments made by participants experiencing menopause. Participants from both populations were concerned about data confidentiality and technology accessibility.

CONCLUSIONS

Participant generated design ideas included novel ideas and incorporated existing technologies. This study can inform the development of new technologies or repurposing of existing technologies to support individuals through the menopausal transition.

#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.

The experiences and needs of Asian women experiencing menopausal symptoms: a meta-synthesis

OBJECTIVE

The aim of the study was to explore the experiences and needs of Asian women who were experiencing or had experienced menopause and to determine possible differences in experiences due to acculturation by comparing Asian women living in Asia and those living in Western countries.

METHODS

Six electronic databases were systematically searched: PubMed, CINAHL, Embase, Scopus, PsycINFO, and ProQuest. The search resulted in 17 qualitative studies that met the inclusion and exclusion criteria. Quality appraisal was conducted using the Critical Appraisal Skills Programme Checklist. All 17 studies were analyzed using meta-summaries and, then, using meta-synthesis.

RESULTS

Five themes were identified from the 17 included studies (United States, n = 5; Asia, n = 12): (1) perceptions and attitudes toward menopause (n = 14), (2) physical and emotional experiences during menopause (n = 16), (3) changes in life and relationships (n = 11), (4) needs and coping strategies (n = 13), and (5) unique Asian experiences in Western societies (n = 5). Asian women generally had neutral or positive attitudes toward menopause, but their negative physical, emotional, and psychosocial experiences highlighted their unmet needs and unpreparedness for this phase of life. Diverse self-management strategies were adopted, but there was a high demand for more trustworthy informational resources. Asian women in Western societies were not highly acculturated and retained traditional practices.

CONCLUSIONS

Although cultural influences serve as a protective factor against menopausal symptoms, the traditional and conservative nature of the Asian society poses as a help-seeking barrier. Therefore, to ensure the healthy well-being of postmenopausal women, the implementation of culturally appropriate mitigation and management strategies is necessary.

Experiences of menopause, self-management strategies for menopausal symptoms and perceptions of health care among immigrant women: a systematic review

OBJECTIVE

To systematically review the published literature relating to experiences of menopause, self-management strategies for menopausal symptoms and health-care needs among immigrant women.

METHODS

A systematic literature search of English-language publications was performed using Medline, Embase, PsychInfo, Cinahl and Scopus. Twenty-four papers reporting on 19 studies met our inclusion criteria and investigated immigrant women's experiences of menopause and/or their self-management strategies for menopausal symptoms and/or their perceptions of menopause-specific health care.

FINDINGS

Of the 19 studies, 15 reported symptoms experienced during the menopausal transition. Three studies included questions regarding self-management strategies for menopausal symptoms and four enquired about perceptions of menopause-specific health care. Although the heterogeneity of the studies makes comparison difficult, their findings are broadly consistent. Immigrant women reported more vasomotor symptoms and other physical symptoms and poorer mental health than non-immigrant women. The few studies that investigated self-management strategies for menopausal symptoms found that these were influenced by culture and those that assessed perceptions of menopause-specific health care found that they were mostly dissatisfied with the care they had received.

CONCLUSION

More research is needed to improve understanding of how immigrant women manage the menopausal transition and how to provide culturally relevant menopause-specific health care.

Climacteric symptoms and their relation to feminine self-concept

OBJECTIVES

To investigate women's subjective experiences in the climacteric transition, especially the impact of self-concept, quality of life and depression on the severity of climacteric symptoms.

METHOD

Non-experimental, cross-sectional study, purpose sampling. To analyze the results, we proposed a three-way interaction, in which the direct effect of depression on the severity of climacteric symptoms would be buffered by perceived sexual quality of life, and mediated by self-concept.

RESULTS

As hypothesized, depression significantly predicted self-concept, which in turn mediated the severity of climacteric symptoms. In a second stage of the model, sexual quality of life moderated the direct effect of depression on climacteric symptoms, such that women with a better sexual quality of life would perceive less severity of climacteric symptoms than those with a less favorable sexual quality of life. Physical quality of life did not significantly buffer the direct effect of depression on climacteric symptoms, nor did vasomotor or psychosocial quality of life.

CONCLUSIONS

Our study confirmed the impact of subjective factors such as satisfaction, self-concept, and quality of life on climacteric symptoms; specifically, we observed the moderating effect of the sexual quality of life on the previously established correlation between depression and aggravation of climacteric symptoms.

Breast Cancer in Australian Indigenous Women: Incidence, Mortality, and Risk Factors

The Indigenous people of Australia face significant health gaps compared with the general population, with lower life expectancies, higher rates of death, and chronic illness occurring more often than in non-indigenous Australians. Cancer is the second largest contributor to the burden of disease with breast cancer being the most common invasive cancer diagnosed for females. Despite a lower breast cancer incidence compared with non-indigenous women, fatalities occur at an elevated rate and breast cancers have an earlier age of onset. For indigenous women there are also more advanced and distant tumours at diagnosis, fewer hospitalisations for breast cancer, and lower participation in breast screening. Concomitantly there are demographic, socio-economic and lifestyle factors associated with breast cancer risks that are heavily represented within Indigenous communities. The aim of this two-part narrative review is to examine the available evidence on breast cancer and its risk factors in Australian Indigenous women. Part One presents a summary of the latest incidence, survival and mortality data. Part Two presents the risk factors most strongly associated with breast cancer including age, place of residence, family risk, genetics, reproductive history, tobacco use, alcohol intake, physical activity, participation in screening and breast density. With increasing emphasis on personalized health care, a clear understanding of breast cancer incidence, survival, mortality, and causal agents within the Indigenous population is required if breast cancer prevention and management is to be optimized for Indigenous Australians.

Evolutionary considerations in the development of chronic pelvic pain

Chronic pelvic pain is common among women of reproductive age and is associated with significant morbidity and comorbidities. In this Viewpoint, we explore the evolutionary cause of pelvic pain and summarize evidence that supports a menstruation-related evolutionary cause of chronic visceral pelvic pain: (1) lifetime menstruation has increased; (2) severe dysmenorrhea is common in the chronic pelvic pain population, particularly among those with pain sensitization; and (3) a potential biological mechanism can be identified. Thus, chronic pelvic pain may arise from the mismatch between the slow pace of biological evolution in our bodies and the relatively rapid pace of cultural changes that have resulted in increased menstrual frequency due to earlier menarche, later mortality, and lower fecundity. One possible mechanism that explains the development of persistent pain from repeated episodes of intermittent pain is hyperalgesic priming, a physiological process defined as a long-lasting latent hyperresponsiveness of nociceptors to inflammatory mediators after an inflammatory or neuropathic insult. The repetitive severely painful menstrual episodes may play such a role. From an evolutionary perspective the relatively rapid increase in lifetime menstruation experience in contemporary society may contribute to a mismatch between lifetime menstruation and the physiological pain processes, leading to a maladaptive state of chronic visceral pelvic pain. Our current physiology does not conform to current human needs.