Ann M. Voda

Woman-centered information on menopause for health care providers: findings from the Midlife Women's Health Survey.

Despite their growing numbers, midlife women continue to feel marginalized by a health care system that is unresponsive to their needs for current information about the perimenopausal experience and for egalitarian, woman-centered care. In this article, the authors call upon physicians, health educators, nurses, counselors, and other health providers to meet the consumer needs of this ever-growing clientele. To this end, they provide data-based information derived from the responses of more than 400 middle-aged women from across the United States to annual Midlife Womens Health Surveys from 1990 to 1993. The authors focus on enhancing the sensitivity of health care providers toward their midlife clients by offering data describing the normal menopausal transition and the feelings and concerns of this group.

Chinese Midlife Women's Perceptions and Attitudes about Menopause

ObjectiveThe purpose of this research was to discover and describe the meaning of and attitudes toward menopause in midlife Chinese women in Taiwan. How these women learned about menopause was also explored. DesignQuestionnaires were distributed to a convenience sample of 208 Chinese women aged 35 to 55 living in Taiwan; 168 responded. Qualitative data were analyzed using content analysis. Percentage and chi-square were used to examine the quantitative data. ResultsThe findings revealed that 154 (91.7%) women perceived menopause as a natural phenomenon. No statistically significant differences in attitude toward menopause were found between women grouped by different menopausal levels, by use or not use of hormones, or by religious preference. Some women described menopause as, “no longer young, getting old.” Others described menopause as, “wisdom and maturation,” “a symbol of achievement,” and “a time to start enjoying life.” Sixty-eight (40.5%) of the sample indicated they obtained menopausal information from friends and printed materials such as books, newspapers, and magazines. ConclusionsStudy findings indicate that Chinese women in Taiwan perceive menopause in a positive and holistic way. Culturally sensitized Western practitioners can utilize this studys findings to more appropriately individualize care for Chinese midlife women.

Keeping up Appearances: The Basic Social Process of the Menopausal Transition

Sixty-one perimenopausal women experiencing changes in menstrual bleeding were interviewed by phone and were asked about the changes they were experiencing, how they felt about the changes, and how the changes affected their lives. Womens responses indicated that they perceived certain changes (unpredictable or unexpectedly heavy bleeding, intense hot flashes, and sudden emotional outbursts) as potentially embarrassing or disruptive. Womens attempts to conceal and maintain control of changes led to the discovery of the core variable, keeping up appearances. The results of this study emphasize the need for a greater specificity in correlating womens feelings and behaviors with particular changes as well as the need for a better understanding of the ways in which social and cultural expectations influence womens feelings and behavior.

MIDLIFE WOMEN'S ATTRIBUTIONS FOR THEIR SEXUAL RESPONSE CHANGES

This study focused on the sexual response changes of 280 mostly White, married, highly educated midlife women and on the attributions they made for these changes. In a U.S. sample of women participating in the Midlife Womens Health Survey (MWHS), women whose sexual response had changed in the past year (40%) reported more decrements than increases in sexual response. When asked how they accounted for these changes, women referred most often to the physical and emotional changes of menopause and to life circumstances, and less often to their relationships with their partners. The attributions showed a distinct pattern: Most of the decrements were explained by physical events related to menopause, whereas most of the increases were explained by life circumstances. These findings are discussed in terms of a need for studying womens sexuality from a biopsychosocial perspective.This study focused on the sexual response changes of 280 mostly White, married, highly educated midlife women and on the attributions they made for these changes. In a U.S. sample of women participating in the Midlife Womens Health Survey (MWHS), women whose sexual response had changed in the past year (40%) reported more decrements than increases in sexual response. When asked how they accounted for these changes, women referred most often to the physical and emotional changes of menopause and to life circumstances, and less often to their relationships with their partners. The attributions showed a distinct pattern: Most of the decrements were explained by physical events related to menopause, whereas most of the increases were explained by life circumstances. These findings are discussed in terms of a need for studying womens sexuality from a biopsychosocial perspective.

Circadian Rhythms in Hot Flashes in Natural and Surgically-Induced Menopause

The aim of this study was to investigate circadian and ultradian variations in menopausal hot flash. The number of hot flashes per 2-hr period was collected from 25 diurnally-active, perimenopausal women for 1 week in January or February of each year for 3 consecutive years. Fourteen women were experiencing natural menopause (NM) (mean age 51.9 years) and 11 were experiencing surgically-induced menopause (SIM) (mean age 52.0 years). The difference in the number of hot flashes between the two types of menopause at each clock time was not statistically significant; neither was the mean number of hot flashes per 24 hr different between the two groups (Students t-test). Data when normalized for each woman and placed end-to-end revealed by cosinor analysis circadian rhythmicity in the SIM group (P = 0.02) but not in the NM group. A 12-hr periodicity was detected in both groups (P less than 0.001 for both). An 8-hr rhythm was detected only for the NM group (P = 0.04). Both groups combined exhibited statistically significant rhythmicities with periods of 24 hr (P = 0.003), 12 hr (P less than 0.001) and 8 hr (P = 0.005). Regardless of the type of menopause, the women could be separated into two groups based on the temporal pattern of hot flashes during the day. One group was defined by the occurrence of peak frequency of flashes during the morning (0400-0959), while the second group was defined by the occurrence of the peak in the evening (1600-2159).(ABSTRACT TRUNCATED AT 250 WORDS)

Seasonal Characteristics of and Age at Menarche

Several patterns in menarche are evident over time and across populations which vary by ethnicity, socioeconomic status and altitude of residence: peak occurrence of menarche in January and August with a possible minor peak in April; troughs in the occurrence of menarche to either side of the peak months; and secular trends in season and age patterns of menarche. Contradictory patterns in season of menarche with respect to age at menarche and season of menarche with respect to season of birth are still unresolved. Further research is yet required to evaluate the role of the variety of endogenous and exogenous variables and their interactions on menarche in order to more fully develop an appropriate understanding of the chronobiology of developmental and reproductive phenomena in women and their dependence upon environmental quality and temporal cues.

Experiencing Changes in Menstrual Bleeding During the Menopausal Transition

This qualitative study of 61 womens perceptions of their experiences of changes in bleeding during the menopausal transition revealed great variation in the pattern of changes each woman experienced. Using grounded theory methods, four dominant processes experienced by women during the transition of going from a menstruating woman to a nonmenstruating woman were uncovered. These were: noticing menstrual cycle changes, relinquishing familiar patterns, taking precautions, and wanting it to end. The process of relinquishing familiar patterns was comprised of two phases: losing ones baseline and searching for validation. As menstrual cycle changes obscured a womans familiar menstrual pattern, her focus shifted from what was normal for her to what was normal for women going through menopause. Variability and uncertainty replaced predictability and familiarity, traits that gave women an illusion of control over menstruation, the loss of which created more discord for some women than for others. These findings underscore how important it is for clinicians to understand the ways in which women perceive the changes in bleeding they experience during the menopausal transition. The findings also demonstrate the need for continued investigation and documentation of variations in bleeding patterns during perimenopause.

Coping with the menopausal hot flash

No data are available regarding alternatives to estrogens to help women cope with the menopausal hot flash, a condition labeled vasomotor instability of unknown etiology. This article answers questions most frequently asked by women about the hot flash, places the menopause and associated body changes within a normal growth and developmental framework, and describes methods other than estrogens that women use to cope with the hot flash.