The relationship between management strategies for menopausal symptoms and women's decision making styles during menopausal transition

Long term impact of the WHI studies on information-seeking and decision-making in menopause symptoms management: a longitudinal analysis of questions to a medicines call centre

BACKGROUND

While women are taking a greater role in decisions about menopause symptom management, the legacy of the Women's Health Initiative (WHI) studies persist. Despite hormone therapy (HT) being effective in reducing all-cause mortality, many women seeking relief of menopausal symptoms exaggerate HT harms and overstate the perceived benefits or ignore the risks of alternative therapies. We aimed to explore the longitudinal impact of the widely-publicised WHI 2002 study on women's information-seeking and describe determinants of decision-making about managing menopausal symptoms.

METHODS

In a longitudinal analysis of both quantitative and qualitative data, we explored consumer questions about menopause-related medicines received by two Australian medicines call centres (1996-2010) before, during, and after WHI 2002. We analysed calls by age and gender of caller and patient, their relationship, postcode, enquiry type, and motivation to help-seek. We compared calls regarding HT and herbal medicines (HM) with the rest of calls, and thematically analysed question narratives across the three time-periods.

RESULTS

There were 1,829 menopause-related calls received of over this time-period, with a call surge, primarily from women in their mid-fifties, in the two months after the WHI 2002 publication. Two in three calls were motivated by negative media reports as women sought support for decision-making, primarily reassurance to cease HT. While HT safety concerns persisted for eight years post-publication, the nature of information-seeking changed over time. Callers subsequently sought reassurance to use menopause treatments together with their other medicines; and pursued HT substitutes, including HM, in response to HT product discontinuation.

CONCLUSIONS

Women sought information or reassurance to support a decision, based on dynamic changes in internal (symptom or risk intolerance, attitude towards menopause and treatment preferences) and external factors (perceived source trust and changes in treatment availability). In assessing HT benefit versus risk, women tend to overestimate risk with HT safety concerns persisting over time. Decision-making in managing menopause symptoms is complex and dynamic. Reassurance to reach or justify decisions from a perceived trusted source can support informed decision-making.

Women's knowledge on the menopausal transition in relation to their socio-economic status

Current reports indicate that there is a relationship between women's socio-economic status (SES) and their level of knowledge on the menopausal transition. The aim of the study was to assess the level of knowledge in pre-menopausal women on the most frequent symptoms accompanying the menopausal transition as well as conventional and nonconventional therapies of alleviating symptoms in relation to women's SES. The study was conducted among 114 women with the mean age of about 44 (± 2.51) years. A self-prepared questionnaire was used to investigate their SES and level of knowledge on the most common menopausal symptoms and methods of alleviating them. Most of the women (66.7%) were familiar with the most frequent menopausal symptoms. The women associated menopause with hot flashes (41.2%), mood swings (27.2%) and depression (15.8%). The majority of the women (84.2%) were familiar with hormone replacement therapy (HRT) and 43% of them were familiar with alternative therapies (AT). Better-educated women were more likely to take AT in the future while less-educated women intended to take HRT. Place of residence and income did not differentiate whether women intended to use HRT or AT during the menopausal transition. There was no difference in the level of women's knowledge on HRT in relation to SES. There was an association between the level of knowledge on AT and education as well as place of residence. Better-educated women from medium and large urban centres tended to know unconventional methods of alleviating climacteric symptoms. Education was the most significant predictor of self-assessed level of knowledge on the menopausal transition.

Menopause uncertainty: the impact of two educational interventions among women during menopausal transition and beyond

Introduction

Menopause is a natural part of women's lives, which is associated with physical and mental changes and can lead to uncertainty and consequent undesirable effects in the lives of menopausal women. The present study was conducted to compare the impact of multimedia and booklet educational methods on the uncertainty about menopause during this transition period.

Materials and methods

In a cluster randomized trial 68 women aged 45-55 years were randomly allocated into two groups: multimedia and booklet. Data were collected using knowledge and uncertainty questionnaires about menopause in three stages, i.e. before intervention, immediately after intervention (two weeks later), and one month later. Repeated-measures analysis of variance (rANOVA) was used to compare knowledge and uncertainty scores between two groups for the duration of the study. Data were analysed using SPSS software and p values < 0.05 were considered as statistically significant.

Results

The results of the study indicated a high level of uncertainty in both groups before the implementation of the educational program. There was no significant difference between groups in terms of knowledge and uncertainty about menopause over time (p > 0.05). However, we found a significant increase in knowledge and a significant decrease in uncertainty scores in both groups (p < 0.001) after the interventions.

Conclusions

Although the findings of this study did not show a significant difference between the effect of multimedia and booklet educational methods in postmenopausal women, the high level of uncertainty of women before intervention and its significant reduction after the implementation of the educational programs indicated the importance of education throughout this period.