Predictors of menopausal symptoms: psychosocial aspects

The most relevant factors influencing a woman's quality of life during the menopausal transition appear to be her previous emotional and physical health, her social situation, her experience of stressful life events (particularly bereavements and separations), as well as her beliefs about the menopause. Specific predictors of vasomotor symptoms include surgical menopause and possibly current cigarette smoking. The role of stress, past menstrual problems and reports of hot flushes earlier in life as predictors requires further study. There are considerable cultural differences in the reporting of vasomotor symptoms which may be explained by the meaning ascribed to them and the value of older women in societies, as well as possible dietary, lifestyle and genetic differences. Those who seek medical help for menopausal problems tend to report more physical and psychological problems in general. They are more likely to be under stress and to hold particular beliefs about the menopause. These personal and social issues need to be addressed in their own right and should not be automatically attributed to the menopause. Clinical psychologists and counsellors, ideally working as part of the team, can help women and couples to clarify the nature of the problems and to help them to explore solutions. In contrast to childbirth, preparation for the menopause has been neglected in the development of services, as well as in research (Notelovitz, 1988; Hunter, 1990c). The studies reviewed here do suggest some pointers for health promotion; these are being evaluated in a current study by Hunter and Liao and can be summarized as follows: 1. Providing balanced information about the menopause, to women and their families. 2. Discussion of attitudes towards the menopause, with reassurance of overly pessimistic beliefs. 3. Health promotion sessions focusing upon diet, exercise and smoking (factors which are associated with general health and the development of osteoporosis). 4. Stress management sessions. 5. Group discussion of personal, health and social issues met by women during midlife.