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