Lotte Hvas

Positive aspects of menopause: a qualitative study.

OBJECTIVEnAs a part of a larger study, Menopause described from the womans perspective, it has been the aim to explore whether women have any positive experiences in relation to menopause, and if so, the nature of these experiences.nnnMETHODSnIn a questionnaire, sent to a random sample of 51 year-old Danish women, there was included an open-ended question concerning the course of menopause. A qualitative approach has been used in the analyses.nnnRESULTSn393 women have answered the open-ended question. One hundred and ninety four women did describe positive aspects of menopause. The total number of different quotations with a positive content was 268. The answers varied from unspecific statements describing a period of well-being or simply a statement of not having problems at all, and concrete descriptions which primarily dealt with the relief of ending menstruating and attached problems, such as PMS and fear of pregnancy. Finally they dealt with the possibility of personal growth and freedom to concentrate on own requirements.nnnCONCLUSIONSnThe positive aspect of menopause is a relevant field to investigate further, quantitatively as well as qualitatively. It is recommended that doctors include positive aspects and womens own resources in counselling, to avoid medicalization and dis-empowerment in this period of life.

Discussing menopause in general practice

UNLABELLEDnThe dual objective is, first, to determine if menopausal women discuss the menopause with a doctor, and if so to which extent; second, to ascertain potential differences between those who do and those who do not.nnnMETHODSnA postal questionnaire was sent to 1251 Danish women randomly selected among all 51-year-old women born and living in Denmark. Completed questionnaires were returned by 972 (77%) women.nnnRESULTS AND CONCLUSIONSnMore than two thirds (71.8%) of the peri and postmenopausal women had discussed the menopause with a doctor; either with the general practitioner (GP) or with another doctor. There were significant differences between women who had discussed the menopause with a doctor and those who had not. The more problematic the symptoms the greater the likelihood that the woman would have discussed the menopause. Women who had not discussed the menopause with a doctor, had fewer symptoms and were more critical of hormone replacement therapy (HRT). Menopausal symptoms do not necessarily create problems for women in their daily lives. For example almost all women reported hot flushes (87.2%), but few felt very bothered by this symptom (13.8%). Doctors most often listen to menopausal women with severe symptoms. This bias may direct the focus upon the negative aspects of menopause. It is suggested that active intervention among women who have not consulted a doctor about menopause is inappropriate, partly because they apparently have chosen non-medical solutions and partly because they have so few symptoms that the use of resources in this way could be considered wasteful.

Awareness of risk of osteoporosis may cause uncertainty and worry in menopausal women.

Aims: A study was undertaken to explore how menopausal women are affected by awareness of potential risk of osteoporosis. Methods: A qualitative interview study, including analysis of in-depth interviews with 17 women who independently gave views on risk, out of 24 women interviewed about their menopausal symptoms. The women were selected on the basis of a survey including 1261 women chosen at random, to cover a broad spectrum of Danish women, their menopausal experiences, and contact with the healthcare system. The study was part of a larger project targeting menopause. Results: Awareness of osteoporosis risk caused a feeling of uncertainty and worry in some women. Only women reacting in this way seemed to act in order to prevent future fractures. The affected women were puzzled to realize that risk-reducing medication could introduce new hazards. Most of the women had heard about osteoporosis related to menopause as culturally embedded knowledge. Conclusions: Making individual women uncertain and worried must be considered a potentially serious side effect of health promotion. The findings raise the question of whether introducing healthy people to the threat of future diseases is ethically justifiable. As hormonal treatment is no longer recommended for long-term use, it is suggested that the strong link between osteoporosis and menopause should be toned down when counselling menopausal women.

Discourses on menopause — Part II: How do women talk about menopause?

The aim of this article is to describe which of the different available discourses women relate to as revealed in the way they talk about menopause. We use a discourse analytic approach, which implies that meaning is ascribed to things according to how we talk about them. Twenty-four menopausal women from Denmark were interviewed. They were selected to cover a broad spectrum of Danish women with different menopausal experiences and social background factors. Seven previously identified discourses could be found in the interviews, though to varying degrees from woman to woman. Nearly all women used terms from the biomedical sphere like `a period of decline and decay, even if they did not necessarily agree with this view. Also the existential discourse permeated most of the interviews, especially when the conversation turned to the ageing process, femininity and self-development. The way the menopause was talked about almost became kaleidoscopic when images speedily changed from the decrepit osteoporotic woman or a woman with lack of vitality and sex-appeal to a healthy and strong woman with control over her body and self. Since many women contact doctors in relation to menopause, and since the way doctors talk about menopause is influential, doctors should carefully consider which words and images they use in the counselling. The medical way of perceiving menopause is just one of many, and doctors must be aware that there are other different and partially contradicting discourses at play in society and in the womens universes.

Metaphorical mediation in women's perceptions of risk related to osteoporosis: A qualitative interview study

When risks affecting the body are identified and made visible through medical technologies, individuals need to find ways to communicate and express them through metaphorical projection. We used cognitive metaphor theory to explore womens conceptions of the risk inherent in osteoporosis. Data were drawn from focus group discussions with women who had no personal experience of osteoporosis, and individual interviews with women perceiving themselves to be at risk of osteoporosis. Women described osteoporosis as a hazard implying physical deviation from the healthy norms. This sense of risk was specifically couched in the metaphorical terms of a collapsing building and loss of the upright position. This image embraced a variety of perceptions of the body related to the hazards of osteoporosis. Findings revealed metaphors about the construction of the skeleton and the material of the bones, explaining the notion of danger. The perception of risk related to osteoporosis was framed by imagery of the destruction of the skeleton, the porous bones, frail bodies, a collapsing backbone and lack of trust in the body. Metaphors can be transformative, shaping the perception of a concrete health risk and changing the meaning of the risk. The metaphorical conception of osteoporosis may have a fundamental impact on womens perception of their bodily identity being at risk and thereby affect the image of their bodily capacities as vulnerable and create negative expectations of old age and health. Womens use of metaphors invites reflections on the use of metaphors in risk communication.

Discourses on menopause - Part I: Menopause described in texts addressed to Danish women 1996-2004

To understand Danish womens very different ways of interpreting menopausal experiences and the way they construct meaning relating to menopause, it is necessary to include the context in which meaning is constructed as well as the background of cultural attitudes to menopause existing in the Danish society. Using documentary material, the aim of this article was to describe different discourses on menopause in Denmark that present themselves to menopausal women, and to discuss how these discourses may affect womens identity and constitute their scope of action. One hundred and thirty-two pieces of text under the heading or subject of `menopause or `becoming a middle-aged woman, published from 1996 to 2004, were included. All material was addressed to Danish women, and consisted of booklets and informational material, articles from newspapers and magazines and popular science books. Seven different discourses on menopause were identified: the biomedical discourse; the `eternal youth discourse; the health-promotion discourse; the consumer discourse; the alternative discourse; the feminist/ critical discourse; and the existential discourse. The biomedical discourse on menopause was found to be dominant, but was expanded or challenged by other discourses by offering different scopes of action and/or resting on different fundamental values. The discourses constructed and positioned individual women differently; thus, the womens position varied noticeably from one discourse to another. Depending on the discourse drawn upon, the womans position could be that of a passive patient or that of an empowered woman, capable of making her own choices in relation to her health.

Women's needs and wants when seeing the GP in relation to menopausal issues.

Objective – To explore womens needs and wants when seeing the GP in relation to menopausal issues. Design – A qualitative interview study. Setting and subjects – The study was part of a larger project, targeting menopause. It included in-depth interviews of 24 women aged 52–53 years who came from all over Denmark. The women showed a great variety of menopausal experience of symptoms and treatment. Main outcome measures – An acquaintance with the womens agendas when seeing the GP about menopausal issues. Results and conclusion – Women consulting their GPs either wanted to discuss treatment for menopausal symptoms, to have an examination for diseases or to get a risk assessment. Their needs for medication or examination were satisfied but several women wanted more information, especially about the pros and cons of hormone therapy (HT). Risk assessment, if not requested, indicated problems, with some women feeling uncomfortable if the GPs started a discussion about HT and osteoporosis, if they only wanted an examination to be reassured that everything was normal. The authors’ findings indicate that GPs encounter a subtle balance in considering the question of risk information to menopausal women who do not request it.