Patricia A. Kaufert

The Manitoba Project: a re-examination of the link between menopause and depression

This paper re-examines the association between menopause and depression using data from a study in which 477 women were interviewed 6 times over a 3-year period. Menopause is examined as one of a series of factors which may increase the risk of depression for women in middle age, such as children leaving home, the death and illness of family members, the stresses of daily living, health and the onset of chronic disease. Rather than hormonal changes, it seems to be her health coupled with the shifts and stresses of family life in a womans menopausal years which may trigger her depression.

Cultural construction of the menopausal syndrome: the Japanese case

Europe and North America have been the focus of most research on the menopause and its symptoms. In this study, in the course of in-depth interviews Japanese physicians and women were asked to describe the menopausal experience. A cross-sectional survey concerning women and their health at midlife was then distributed to 1738 women. The analysis in this paper is based on the replies received from 1141 non-hysterectomized women aged 45-55. Factor analysis was used to group the symptoms these women had experienced in the previous 2 wk. After constructing an index based on the factor scores, one-way analysis of variance was used to examine the relationship between symptom experience and the epidemiological menopausal status as well as the self-defined menopausal status. Symptom experience was always significantly related to self-defined menopausal status.

Researching the symptoms of menopause: An exercise in methodology

This paper deals with the methodological problems involved in the measurement of physical and psychological morbidity among menopausal women. A sample of 477 women were interviewed six times over a 3-yr period. In addition to questions about their menstrual status, the women were asked at each interview to complete a checklist of physical, menopausal, and psychological symptoms. Factor analysis was performed on the symptom experience to determine if symptoms could be grouped together in ways which would demonstrate clinically useful constructs and be stable over time. One-way analysis of variance showed a significant relationship only between the vasomotor symptoms and menopausal status.

Defining menopausal status: The impact of longitudinal data

A population of 324 women who were over 45 and still menstruating were followed for a period of 3 yr. They were interviewed 6 times at 6-mth intervals. This paper presents data on the changes in menstrual status that occurred over the period of the study and relating these changes in menstruation to a womans age and symptom experience.

Menopause research: The Korpilampi workshop

A workshop on menopause research focused on three topics: (1) problems and issues in the definition of menopausal status: (2) problems and issues in cross-cultural research: (3) the contributions which research in the behavioural sciences can make to clinical research and practice. Among the conclusions reached by the workshop was the recommendation that researchers should adopt a standard definition of menopause based on the cessation on menses. Yet, while standard definitions are essential to scientific comparison, it is also important to determine how women decide on their own status, particularly when working cross-culturally.

Health policy and the new genetics.

The purpose of this paper is to stimulate debate on the implications of the new genetics for health policy. Although there are different streams within the social science literature on the new genetics, the primary focus has been on the meaning of genetic testing from the perspective of the individual tested. While essential to understand, it does not add much to the health policy debate. A very different type of information has been produced by the public health and epidemiological literature, focused on screening for genetic disease and concerned with rates of detection, costs and benefits, and evaluation criteria. These data are very important to planning and implementing the type of prenatal screening program already in existence; they do not deal with issues central to the new genetics, such as commercialization, patenting and insurance. The problem is how best these topics should be researched. The final section of the paper suggests that given a phenomenon--the new genetics--which is both multifaceted and very complex, very new and yet with strong historical and cultural roots, we need a matching research agenda. One that breaks out of traditional paradigms separating one method from another and seeks information on the new genetics wherever it may be found.

The social and cultural context of menopause

This paper discusses menopause in relation to its social and cultural context, treating the end of menstruation as a singular event within the general fabric of women’s health and well-being. The focus is on women from countries outside the standard orbit of Western Europe, North America and Australia. These countries differ profoundly from each other in terms of their political, economic and social structures, the organization of their health care system, and the conditions of life they provide for women of all ages. One of their characteristics in common, however, is the increase number of women who survive childhood and childbirth. At the UN World Assembly on Aging in Vienna in 1982 [l], it was estimated that 12% of world population will be women over 45 by the year 2000 and that half billion will be living in developing countries. Diczfalusy wrote, in 1986, ‘a urgent task of high priority is therefore to establish on a country by country basis the age distribution and sociocultural significance of the menopause and of the prevalence of various menopausal disorders,

Women and their health in the middle years: A Manitoba project

‘Women and their Health in the Middle Years’ (NHRDP project 6607-1240-42) is examining issues relating to the health and health behaviour of women in the 4G59 age group. Whether seen from the perspective of physicians with patients in middle age or from the perspective of feminist health consumer groups [ 11 the image of women at this stage in the life cycle is a negative one. Information on women’s health behaviour in middle age comes largely from community surveys in which they have been compared with women in other age groups in terms of their patterns of morbidity and levels of health care utilization. Midlife women have emerged as high users of medical services [2-4] and of various forms of medication, particularly the psychotropic drugs [5-71. They are more likely to have been treated for psychological problems and their symptoms to have been diagnosed as neurotic or psychosomatic in origin [8]. In the medical literature [1], explanations of this pattern of health behaviour focus on midlife as a phase in the life cycle marked by hormonal change (culminating in menopause) and by changes in the familial environment of a woman as her parents age and her children grow into adulthood. Other characteristics of women in this age group are less often discussed: e.g. that many work and, therefore, their physical and psychological health is subject to the balance between the demands of family life and the demands of labour force participation [9]. Changes in support and network characteristics also have relevance to health. Middle age is a life stage in which some women expand their social network as their family responsibilities decrease, while other women maintain a home centred but contracting network as family members move out of the domestic core. Finally. a woman’s support system may be threatened in midlife by divorce, illness or death of a partner. In sum. midlife women operate in a context marked by change in their socio-psychological environments and under conditions in which their network and support systems are themselves subject to fluctuation.

Anthropology and the menopause: the development of a theoretical framework

A theoretical framework has been presented in which the menopause was treated as an event for which the definition and meaning must vary from one socio-cultural context to another. Depending on whether the stereotype of the menopause and the peri-menopausal woman in a society is positive or negative, it will offer either a benefit or a threat to the self-esteem of women as they enter the peri-menopause. Women whose self-esteem is already high will not be as susceptible to a negative stereotype as women whose self-esteem is low. Among the latter, the further fall in their self-image will be the key aetiological factor accounting for psychological distress among women in the peri-menopause.

The perimenopausal woman and her use of health services

This study investigated whether perimenopausal women had higher physician contact rates and a more negative self-assessment of their health than nonmenopausal women in the same 40--50 band. It also examined the relationship between subjective health status, physician contact rates and scores on a set of vasomotor and a set of psychological symptoms. One group of women were more likely to have seen a physician within the previous 2 wk, to report psychological symptoms and to take a negative veiw of their own health. However, perimenopausal women were no more likely to belong to this group than other women. Most perimenopausal women had seen a physician at least once in the preceding 12 mth, but were rarely women with high levels of physician contact.