The meanings of menopause: identifying the bio-psycho-social predictors of the propensity for treatment at menopause
All women will experience menopause by the time they have reached mid life. So it is surprising that, in comparison with other female reproductive experiences such as menarche, pregnancy and childbirth, there is relatively little research from a psychological perspective. The main aims of this study were to explore how women make sense of the menopause, to assess which factors predict symptom severity and treatment utilisation and to explore how women’s beliefs about menopause are located within their social context The study comprised three stages. Study 1 was a quantitative study with 149 women to develop new measures to assess women’s beliefs. The new belief scales were incorporated into study 2 which was a larger study with 344 women recruited from the general population and from specialist menopause clinics. This study sought to identify the factors that predict symptom severity and treatment utilisation. The main analysis was with 295 women who were peri- and postmenopause. A range of validated scales were used and a treatment utilisation scale was created. Hierarchical multiple regression and structural equation modelling were used to identify predictors of symptom severity and treatment utilisation. A sub-sample of 30 women from study 2 went on to participate in study 3 which was a qualitative study designed to explore how beliefs about menopause influence symptom perception and decisions about treatment in the context of women’s daily lives. Diaries were completed and used in interviews in study 3 to enable more accurate recall of the social context of menopause events. Thematic analysis was used to analyse the data. Ninety one percent of the women in this study had sought treatment for menopause symptoms and the main predictors of treatment utilisation was symptom severity and the belief that menopause was a pathological illness. A key finding was that four social constructions of menopause were prevalent in this sample: menopause renders women invisible and unvalued, menopause is an illness that changes women, menopause is amenable to treatment with hormone therapy, and menopause is a temporary phase after which there is recovery. These four beliefs were significantly predictive of perceptions of symptom severity and of treatment utilisation. Furthermore, the social constructions mediated between symptom severity and different categories of treatment utilisation. Qualitative analysis revealed that women have inadequate knowledge of menopause and can be surprised and distressed by its onset, menopause is little talked of and is still ‘taboo, menopause is regarded by women as a significant phenomenon that changes them but this is not often acknowledged publicly, women and clinicians have difficulty in making attributions to menopause and neither women nor clinicians are able to define ‘normality’ at menopause. These findings have major implications for how women interpret their symptoms, for how to manage the expectations of women in their 40s and 50s, and for how clinicians advise women at this stage of their life.
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