Psychological aspects
of menopause
Intensity of
symptoms and
depression in
relations to
personality and
stress
Psychological aspects
of menopause
Intensity of
symptoms and
depression in
relations to
personality and
stress
Menopause - definition
Natural menopause - the permanent
cessation of menstruation resulting
from the loss of ovarian follicular
activity
Inducted menopause - the cessation of
menstruation which follows either the
surgical removal of both ovaries or
iatrogenic ablation of ovarian function
(e.g. chemotherapy, radiation)
Menopause - definition
Natural menopause -
recognized retrospectively after
12 consecutive months of
amenorrhoea
occurs with FINAL MENSTRUAL
PERIOD (FMP)
main mechanism - decreasing
secretion of estrogen
Menopause - definition
P R E M E N O P A U S E
M E N O P A U S E
P O S TM E N O P A U S E
FIN A L M E N S TR U A L P E R IO D
Menopausal
transition
Menopause - concepts
...the mastering of the
psychological reactions to the
organic decline is one of the most
difficult tasks of woman’s life.
Helen Deutsch The Psychology of Women,
1945
You can plan for your menopause
the way pregancies can be planned.
Gail Sheehy The Silent Passage 1998
Menopause - definition
1816 the term was introduced by
C.P.L. de Gardanne la Menespausie
1899 - dr Clouston in a book “A
System of Medicine by Many Writers”
(T.C.Allbutt, ed) used the term in the
context of mental problems (chapter
Climacteric Insanity)
Number of women in
postmenopause in some parts of
the world
Menopause
The proportion
Industrialized
countries
1,5% annual growth
in the number of
women
Developing
countries
2-3,5% annual
growth in the number
of women
Menopause - the
average age
51 years of age in industrialized
countries
in developing countries - 47 - 49
years of age
the average age lowered by:
smoking (most important)
nulliparity
low socioeconomic status (probably)
Life expectancy and
age at menopause
Menopause - symptoms
Vasomotor symptoms
hot flushes, sweats
Urogenital atrophy
pain during sexual intercourse, infections
Other complaints
depression, nervous tension, headaches,
insomnia, lack of energy, difficulty in
concentrating
Menopause - symptoms
(possible cultural
context)
Prevalence of hot flushes varies in
women in different cultures
80% in the Netherlands
45% in North America
23% in Thailand
17% in Japan
10-22 % in Hong Kong
0% in Mayan women in Mexico
Menopause - symptoms
(cultural context)
Hot flushes and sweats more common in
European and North American populations
Different prevalence of hot flushes after
induced menopause
24% in Hong Kong, 70% in US
Hot flushes also in premenopause (10%)
In men (45-55 yrs) – Polish study (2005)
63,3% females
45,8% males
Dietary phytoestrogens
Menopausal symptoms in
Japan (T.Aso, 2000) and
China (B.Xiao et al. 2000)
JAPAN
Fatigue
83%
Stiff neck 80%
Sweats
73%
Cold feet 68%
Irritability67%
Hot flushes 60%
Vaginal atrophy
0%
CHINA
Irrtability
47%
Sweats
37%
Hot flushes
36%
Palpitations
35%
Back pain
34%
Vaginal atrophy10%
Menopause - symptoms
cultural context
In WESTERN cultures - more
negative image of menopause
(sign of aging)
In EASTERN cultures - menopause
connected with many positive
changes in social status
Experience of
menopause
(C. Bowles, 1990)
Social and
cultural
factors
whether in a
specific culture
menopause is
perceived as
positive or
negative event
Individual
factors
individual opinion
on menopause
and evaluation of
its symptoms
Study by L. Gannon &
B. Ekstrom (1993)
3 types of health
problems (broken leg,
peptic ulcer,
menopause) MEDICAL
3 types of life changes
(puberty, leaving home,
menopause) CHANGE
3 signes of aging (grey
hair, retirement,
menopause) AGING
372 K, 209 M
Menopause
evaluated always
in a more
negative way
The older the
person the less
negative was the
view on
menopause
Replication of Gannon &
Ekstrom study in Poland
(2004)
*
t =
-2,16
p =
0,04
F - 175, M -
125
Replication of Gannon &
Ekstrom study in Poland
(2004)
What Polish women
expect at menopause
(OBOP, 2005)
Cessation of menstruation 95%
Hot flushes, sweats 93%
Being anxious & nervous
83%
Mood swings 83%
Less vigorous 80%
Insomnia 66%
Osteoporosis
54%
Loss of lobido 51%
Depressive mood 47%
Poor memory 42%
Becoming less feminine
34%
Attitude to menopause can
be changed
(with E. Jakubowska,
2007)
Hypotheses for the links
of menopause and
depression
Direct effect hypothesis
Domino effect hypothesis
Psychosocial hypothesis
Psychodynamic hypothesis
Direct effect hypothesis
Hormonal changes
(decline of the
estrogen)
Cessation of menstruation
MENOPAUSE
Biochemical processes
in the brain
DEPRESSION
Domino effect
hypothesis
Hormonal changes
(decline of the
estrogen)
Cessation of menstruation
MENOPAUSE
Symptoms
(hot flushes,
sweats)
Insomnia
Fatigue
DEPRESSION
Psychodynamic
hypothesis
1.
Lack of menstruation – lack of
reproductive abilities
2.
Lack of reproductive abilities –
feeling less feminine
1 + 2 creates a situation when
depression becomes more likely
Psychodynamic hypothesis
t = - 2,502; p = 0,001
Psychosocial hypothesis
J. Greene’s model (1999)
Psychosocial
mechanism
Hormonal
mechanism
Menopausal
vulnerability
DEPRESSION
Stress
Polish study of the Greene‘s
model (paths analysis)
DEPRESSION
Level of
experienced
stress
Negative attitude
towards
menopause
Intensity of
symptoms
Social
support
Negative life
events
-0,23*
0,28*
0,49*
0,14
0,13
0,38*
0,27
*
Chi
2
=6,
8
p=0,44
1
IGP=1,
0
SIGP=1
,0
0,39*
Study by L. Dennerstein
et.al.
(1997, 1999)
438 women, aged 45 - 55, studies
during 6 years
Measures: questionnaires, tests,
levels of hormones
Improvement in mood over time
No relationship between hormones
level and depression
Study by L. Dennerstein
et.al.
(1997, 1999)
Depression incresed when:
negative attitude towards ageing /
menopause
only 1 child
many menopausal symptoms
negative subjective evaluation of health
poor marital relationships
daily hassles
smoking, lack of physical exercise
Biopsychosocial approach
to
menopause
Psycholo-
gical
factors
Social factors
Biological
factors
Cultural
factors
Meaning
of
menopause
Symptoms
Emotional reactions
Help-seeking
behaviour
Coping strategies
Based on
Veeninga &
Kraaimaat (1995)
and Hunter
(1994)
Cultural
factors
Psycholo-
gical
factors
Social factors
Perception of bodily
sensation
Evaluation and labelling
them as SYMPTOMS
Reporting them
as SYMPTOMS
Biological
factors
Factors with effect on
menopausal symptoms
Hypotheses for studies on
menopausal symptoms
conducted in Lodz
Psychological variables moderate
reporting of symptoms by menopausal
women
These moderators are:
Temperament
Personality
Coping style
Sense of coherence
Study I – Personality and
symptoms
SAMPLE
211 women aged
45-55
12 years of
education or more
With families
51 Ss on HRT
METHODS
NEO-FFI by Costa
& McCrea
Menopause
Symptoms List
(MSL) adapted
from J. Perz
Personality (NEO-FFI) and
frequency of symptoms
*
p = 0,001
Personality (NEO-FFI) and
intensity of symptoms
*
p =
0,001
Study II – Temperament,
coping and symptoms
SAMPLE
95 women aged
45-55
12 years of
education or more
With families
17 Ss on HRT
METHODS
Menopause Symptoms
List (MSL) by Perz
Coping Inventory for
Stressful Situations
(CISS) by Endler &
Parker
Temperament Inventory
(FCZ-KT) by Strelau
Effects of Menopause
Scale (EMS) by
Czarnecka
Menopausal symptoms
and coping and
temperament
Frequency of
symptoms
Menopausal symptoms
and coping and
temperament
Intensity of
symptoms
Study III – sense of
coherence and symptoms
Sample
51 women (49-55 yrs)
20 on HRT (for
average 3.7 yrs)
76% in stable
relationships
96% at least
secondary education
76% in permanent
employment
Methods
Sense of Coherence
Scale (SOC-29) by A.
Antonovsky
Women’s Health
Questionnaire (WHQ)
by M. Hunter
Sense of coherence and menopausal
symptoms
(Bielawska-Batorowicz & Gorzela,
2002)
Job status and menopausal
symptoms (with A. Rytych,
2007)
All differences at p
< 0,01
Menopause in Poland and in
Ghana (with K. Akyea, 2003)
Women aged 45 – 55 yrs
Poland M=50,8 yrs
Ghana M=49,5 yrs
(p=0.09)
Professionals living in big
cities with similar level of
education
Measures
MSL by J. Perz
Rating scales, interviews
Family situations
In Poland – more often
married (p = 0.01)
Number of children
(p = 0,001)
Poland 1.64
Ghana 2.67
p = 0.008
Menopause in Poland and
Ghana
(Symptoms intensity)
*
p =
0.02
*
Menopause – several perspectives,
one system
Joint decissions
Individu
al
concept
of
menopa
use
Professio
nal
concept
of
menopau
se
Professional
knowledge
ACTIONS
Soc
io-
cul
tur
al f
act
ors
Effects for
a woman,
her life
situation,
perception
of
menopaus
e
Type M personality?
High neuroticism
Emotions-oriented
coping
High reactivity
Low
sense of coherence
MORE
INTENSE
&
MORE FREQUENT
SYMPTOMS