The relationship between spousal support, menopausal symptoms, and sexual attitudes in menopausal women: A cross-sectional study

Abstract

Aim

This study aimed to examine the relationship between spousal support received by women during menopause on menopausal symptoms and sexual attitudes.

Methods

This cross-sectional study was conducted with 490 women in the menopausal period between May 10, 2025, and January 10, 2026, at the Şehit Furkan Yılmaz Healthy Life Center and Karaköy Healthy Life Center, affiliated with the Bartın Central Community Health Center. Data were collected using the Personal Information Form, the Menopausal Spousal Support Scale (MSSS), the Hendrick Sexual Attitude Scale–Short Form (HSAS-SF), and the Menopause Rating Scale (MRS). Data were analyzed using descriptive statistics, Pearson correlation analysis, and multiple linear regression.

Results

The mean total scores of the participants were 54.87 ± 26.94 for the MSSS, 57.07 ± 9.18 for the HSAS-SF, and 20.81 ± 9.12 for the MRS. A statistically significant positive correlation was found between the total MSSS score and the total HSAS-SF score (r = .117, p = .010) and the total MRS score (r = .122, p = .007). According to the regression model, HSAS-SF (β = 0.293, t = 2.200, p = .031) and MRS (β = −0.314, t = − 2.347, p = .021) were significantly associated with predictors of menopausal spousal support. The regression model explained 2.5% of the total variance in menopausal spousal support (R² = 0.025).

Conclusion

Women in the menopausal period participating in the study had low levels of menopausal spousal support and sexual attitudes, and high levels of menopausal symptoms. Higher levels of menopausal spousal support were associated with more positive sexual attitudes and lower menopausal symptom severity. It is recommended that women’s health and gynecology nurses actively assess menopausal spousal support, sexual attitudes, and menopausal symptoms among menopausal women and take an active role in awareness seminars and educational programs. However, the cross-sectional design limits causal interpretation of the findings.

Introduction

Menopause is a natural and inevitable phase in women’s reproductive life cycle, characterized by a transitional process involving physiological, psychological, and somatic changes, primarily associated with fluctuations in sex hormones, particularly estrogen. While this transition is limited to a few years in some women, in others it may extend over a decade. Evidence from the literature indicates that the majority of women experience physical and psychological symptoms of varying severity and duration during the menopausal transition [1–4]. The decline in ovarian function is associated with reduced follicular activity and a concomitant decrease in estrogen levels, resulting in numerous symptoms that adversely affect women’s quality of life. These symptoms include hot flashes, night sweats, irregular menstrual cycles, sleep disturbances, sexual dysfunction, headaches, dizziness, dyspnea, cardiovascular changes, and osteoporosis [5–9]. The prevalence of menopausal symptoms is positively associated with the perimenopausal period onward; it has been reported that approximately 11–45% of women experience menopausal symptoms at varying levels, while 70–80% report symptoms related to estrogen deficiency [3, 10, 11]. The type, severity, and duration of these symptoms are shaped not only by biological factors but also by psychological, cultural, and social determinants, as well as individual perceptions [8, 9, 12]. Consequently, the menopausal experience differs significantly among women and requires individualized approaches.

Menopause typically occurs between the ages of 40 and 60. In Turkey, the mean age at menopause has been reported to range between 46 and 49 years. According to recent data from the Turkish Statistical Institute (TURKSTAT), women’s life expectancy at birth is approximately 81 years; thus, the postmenopausal period constitutes nearly one-third of women’s lifespan [13–16]. During this prolonged postmenopausal phase, the hypoestrogenic state exerts pronounced effects on the genitourinary system, predisposing women to conditions such as vaginal atrophy, vaginal dryness, pelvic organ prolapse, recurrent urinary tract infections, and genital infections [17]. Previous studies have demonstrated significant and strong associations between genitourinary symptoms in the postmenopausal period and female sexual dysfunction. Sexual dysfunction during this stage is commonly manifested as dyspareunia, decreased sexual desire, difficulties in arousal, orgasmic disorders, and overall sexual dissatisfaction [18–20]. Reduced estrogen production directly impairs sexual function by inducing symptoms such as vaginal dryness, hot flashes, and night sweats, and indirectly decreases sexual desire through diminished energy levels [21]. However, the development of sexual problems during menopause is influenced not only by biological mechanisms but also by psychosocial factors [22]. Women’s beliefs about losing sexual attractiveness during menopause may negatively affect body image and self-esteem, leading to sexual disinterest. These psychosexual difficulties are reported to adversely impact not only individual health but also marital relationships and overall quality of life [23].

Menopausal experiences are shaped not only by biological processes but also by sociocultural and religious contexts. Cultural norms influence how women interpret menopausal symptoms, express sexuality, and seek support from intimate partners. In societies where traditional gender roles and conservative sexual attitudes are more prevalent, discussions surrounding sexuality may remain limited or stigmatized, potentially affecting women’s sexual self-perception and relational communication [3, 7, 12]. Consistent with this perspective, research has demonstrated that attitudes toward menopause and sexuality vary across cultural settings and are shaped by religiosity, internalized gender norms, and societal expectations regarding femininity and aging [7, 24]. Within the Turkish context, where family structure and marital roles often constitute central components of women’s social identity, spousal or partner support may represent a particularly salient relational resource during the menopausal transition [25, 26]. Therefore, examining menopausal symptoms and sexual attitudes within a culturally informed relational framework is essential for a comprehensive understanding of women’s menopausal experiences. In this regard, spousal support emerges as a critical factor in women’s adaptation to menopause. Social support systems, defined as interpersonal networks that provide emotional, cognitive, and behavioral assistance, are widely recognized as having a substantial influence on overall well-being [26, 27].

For many women in midlife, as children leave home or parents reach advanced age, spouses become the primary source of daily support. Therefore, spousal support emerges as the fundamental basis of both emotional and practical assistance during menopause [28]. In a study by Murphy et al., Arab premenopausal and postmenopausal women reported that their perceptions of menopause were largely shaped by the level of support received from their spouses, and lack of support was associated with serious psychological outcomes, including depression and suicidal ideation [29]. Similarly, Dillaway, found that active and positive partner interaction during the perimenopausal period contributed to milder menopausal symptoms and increased adherence to recommended health behaviors [30]. These findings suggest that spousal support plays a decisive role not only in emotional well-being but also in health management processes.

Despite these insights, the literature reveals a limited number of quantitative studies examining the impact of perceived spousal support on menopausal symptoms and sexual attitudes. Most existing research focuses primarily on menopausal symptoms or quality of life, while spousal support is often treated as a secondary variable. Studies that integrate sexual attitudes with menopausal spousal support and menopausal symptoms within a comprehensive framework remain scarce. This represents a significant gap in understanding the relational dimension of menopause. Therefore, the aim of the present study is to investigate the effects of spousal support on menopausal symptoms and sexual attitudes among menopausal women. A review of the national and international literature indicates that few, if any, studies have jointly examined menopausal spousal support, menopausal symptoms, and sexual attitudes. In this respect, the present study is expected to make an original and meaningful contribution to the literature by addressing menopause from a holistic perspective that integrates biological, psychosocial, and relational dimensions.

Research questions

This study seeks to address the following research questions:

1. What are the levels of perceived spousal support, menopausal symptoms, and sexual attitudes among menopausal women?

2. Is there a significant relationship between perceived spousal support and menopausal symptoms and sexual attitudes among menopausal women?

3. Is perceived spousal support significantly associated with menopausal symptoms and sexual attitudes?

Methods

Study design and setting

This study was conducted using a cross-sectional design. Data were collected at the Şehit Furkan Yılmaz Healthy Life Center and Karaköy Healthy Life Center, affiliated with the Bartın Central Community Health Center between May 10, 2025, and January 10, 2026.

Population and sample

The study population consisted of menopausal women who attended the Şehit Furkan Yılmaz Healthy Life Center and Karaköy Healthy Life Center, affiliated with the Bartın Central Community Health Center between May 2025 and January 2026. A priori power analysis was performed using the G*Power 3.1.9.7 software. Based on the mean score of the Menopause Rating Scale (MRS) reported in the study by Khunasap et al., assuming an effect size of 0.36, power of 80%, confidence level of 99%, and margin of error of 1%, the minimum required sample size was calculated as 442 menopausal women. Considering a possible attrition rate of 10%, the final target sample size was determined to be 486 participants [31].

During the data collection period, 490 menopausal women who met the inclusion criteria and agreed to participate were recruited using a convenience sampling approach among eligible women attending the centers.

Inclusion criteria

• Aged between 45 and 65 years

• Female

• Literate

• Having been in menopause for at least one year

• No communication difficulties

• Not receiving hormone replacement therapy (HRT)

• Not using antidepressant medication and having no history of antidepressant use

• Willingness to participate voluntarily

Exclusion criteria

• Presence of communication or cognitive impairments

• Current use of hormone replacement therapy (HRT)

• Current use of antidepressant medication or a history of antidepressant use

• Diagnosis of severe psychiatric disorders (e.g., major depressive disorder, psychotic disorders)

• Presence of severe chronic illnesses affecting sexual function or psychological status (e.g., cancer, neurological disorders)

• Unwillingness or inability to provide informed consent

Data collection instruments

Data were collected using the Personal Information Form, the Menopausal Spousal Support Scale (MSSS), the Hendrick Sexual Attitude Scale–Short Form (HSAS-SF), and the Menopause Rating Scale (MRS).

Personal information form

This form consists of a total of 24 items: 14 questions assessing sociodemographic characteristics and 10 questions related to menopause-related characteristics [18, 20, 23, 28].

Menopausal Spousal Support Scale (MSSS)

The scale was originally developed by Intan Idiana et al. in 2022 and adapted into Turkish by Şimşek Küçükkelepçe et al. [32]. It consists of 17 items across four subscales: emotional support (items 1–5), instrumental support (items 6–8), esteem support (items 9–14), and sexual intimacy support (items 15–17). Each item is rated on a visual numeric scale ranging from 1 (never) to 10 (almost always). Higher scores indicated higher perceived spousal support. The original scale demonstrated excellent internal consistency (Cronbach’s α = 0.96). In the present study, internal consistency was also very high, with a total Cronbach’s alpha coefficient of 0.979. The term “spouse” was used in accordance with the original scale terminology and reflects the common usage in the Turkish context, where it typically denotes a legally married partner. However, it is acknowledged that some participants who were not legally married may have had an intimate partner relationship. Therefore, MSSS scores among women without formal marital status may not exclusively represent absence of relational support.

Menopause Rating Scale (MRS)

The Menopause Rating Scale was developed by Schneider et al. in 1992 and later adapted into Turkish by Can Gürkan, [33, 34]. The scale consists of 11 items rated on a 4-point Likert scale (0 = none to 4 = very severe), yielding a total score ranging from 0 to 44. Higher scores indicated more severe menopausal symptoms. Symptom severity was classified according to score as follows: a score of ≥ 35 indicated very severe symptoms, a score of 20–34 severe, a score of 15–19 moderate, a score of 5–14 mild, and a score of 1–4 very mild [34].

The scale includes three subdimensions:

• Somatic symptoms: items 1–2 (maximum score = 8)

• Psychological symptoms: items 3–7 and 11 (maximum score = 24)

• Urogenital symptoms: items 8–10 (maximum score = 12)

In the original Turkish validation study, the overall Cronbach’s alpha was 0.84 [34]. In the present study, the total Cronbach’s alpha coefficient was 0.928.

Hendrick Sexual Attitude Scale–Short Form (HSAS-SF)

The Hendrick Sexual Attitude Scale was developed by Hendrick, Hendrick, and Reich and adapted into Turkish by Karaçam et al. [35, 36]. The short form consists of 23 items and four subscales: permissiveness, birth control, communion, and instrumental attitudes toward sexuality. Responses are rated on a 5-point Likert scale ranging from 1 (strongly agree) to 5 (strongly disagree). Items 1–10 and 19–23 are reverse-coded, while items 11–18 are scored directly. Higher scores indicated more positive, healthy, and balanced sexual attitudes. The Turkish version demonstrated good reliability (Cronbach’s α = 0.85) [36]. In the present study, the total Cronbach’s alpha coefficient was 0.563. Although the internal consistency of the HSAS-SF in the present study was relatively low (Cronbach’s α = 0.563), similar reliability issues have been reported in previous studies using the short form, particularly in older and culturally conservative populations. Measurement error related to low internal consistency may have influenced the strength of associations involving sexual attitudes. Therefore, the results related to sexual attitudes should be interpreted with caution.

Data collection procedure

Prior to data collection, menopausal women who met the inclusion criteria were provided with detailed information about the purpose and procedures of the study. The Voluntary Informed Consent Form was explained, and verbal informed consent was obtained from all participants who agreed to participate. Subsequently, participants were asked to complete the questionnaires and scales individually. Data collection took approximately 15 min per participant.

Ethical considerations

Ethical approval was obtained from the Bartın University Social and Human Sciences Ethics Committee (Date: May 7, 2025; Decision No: 2025-SBB-0323). Institutional approval was also obtained from the Bartın Provincial Directorate of Health to conduct the study at Şehit Furkan Yılmaz Healthy Life Center and Karaköy Healthy Life Center, affiliated with the Bartın Central Community Health Center. Prior to data collection, menopausal women who met the inclusion criteria were informed about the study, and the Voluntary Informed Consent Form was explained; verbal informed consent was obtained from all participants who agreed to take part in the study. Written consent was not obtained due to the sensitive nature of the topic and to ensure participant comfort; this procedure was approved by the ethics committee. The study was conducted in accordance with the principles of the Declaration of Helsinki. As this was a cross-sectional study, the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines were followed. This research was supported by the TÜBİTAK 2209/A Undergraduate Research Projects Support Program (Project No.: 1919B012400802).

Statistical analysis

Statistical analyses were performed using SPSS version 23 (IBM Corp., Armonk, NY, USA). Normality was assessed using skewness and kurtosis coefficients, which were within the acceptable range of − 1.5 to + 1.5. Descriptive statistics (frequency, percentage, mean, and standard deviation), Pearson correlation analysis, and multiple linear regression analysis were used. A multiple linear regression analysis was conducted to examine the associations between menopausal symptoms, sexual attitudes, and perceived spousal support. Statistical significance was set at p < .05 (two-tailed) with a 95% confidence interval.

Results

The socio-demographic characteristics of women in menopause are shown in Table 1. The mean age of the participants was 54.95 ± 11.21 years. The average number of pregnancies was 2.72 ± 1.38, and the mean number of children was 2.53 ± 1.23. Regarding educational status, 30.6% of the women had a high school education, while 21.6% had a university degree or higher. The majority of participants were not employed (70.2%) and were married (84.9%). Most participants lived in nuclear families (75.7%), and 64.1% reported that their income was equal to their expenses. Nearly equal proportions of women resided in urban (40.6%) and district areas (41.2%). With respect to lifestyle characteristics, 46.5% reported smoking and 15.9% reported alcohol consumption, while 46.9% engaged in regular physical exercise. In terms of health status, 41.8% of the participants reported having at least one chronic disease, and 44.3% indicated regular use of medication.

Table 1.

Sociodemographic characteristics of menopausal women (n = 490)

Variables		Mean ± SD
Age (years)		54.95 ± 11.21
Number of pregnancies		2.72 ± 1.38
Number of children		2.53 ± 1.23
		n	%
Educational level	Primary school	117	23.9
	Middle school	117	23.9
	High school	150	30.6
	University and above	106	21.6
Employment status	Employed	146	29.8
	Unemployed	344	70.2
Marital status	Married	416	84.9
	Single, but has a partner	74	15.1
Spouse’s educational level	Primary school	65	13.3
	Middle school	106	21.6
	High school	146	29.8
	University and above	99	20.2
	No spouse	74	15.1
Spouse’s employment status	Employed	304	62.0
	Unemployed	112	22.9
	No spouse	74	15.1
Family Type	Nuclear family	371	75.7
	Extended family	119	24.3
Income Status	Income less than expenses	83	16.9
	Income equal to expenses	314	64.1
	Income greater than expenses	93	19.00
Place Lived the Longest	Province (city center)	199	40.6
	District	202	41.2
	Village	74	15.1
	Abroad	15	3.1
Smoking Status	Smoker	228	46.5
	Non-smoker	262	53.5
Alcohol Consumption Status	Consumes	78	15.9
	Does not consume	412	84.1
Physical Exercise Status	Yes	230	46.9
	No	260	53.1
Chronic Disease Status	Yes	205	41.8
	No	285	58.2
Regular Medication Use	Yes	217	44.3
	No	273	55.7

The characteristics related to the menopausal period of women are presented in Table 2. The mean age at menopause was 46.38 ± 4.12 years. The majority of women experienced natural menopause (92.0%), and 60.8% perceived menopause as neither positive nor negative. While 38.2% of the participants reported attending menopause clinics for regular follow-up, 61.8% stated that they did not receive any follow-up care. Regarding follow-up frequency, 48.8% of the women reported having no regular monitoring related to the menopausal period. In terms of self-perceived knowledge, 54.3% of the participants indicated that they did not consider their knowledge about menopause to be sufficient. Nevertheless, 63.1% reported having received information about menopause. Physicians were identified as the most common source of information (37.7%), followed by family members (19.5%) and nurses (10.7%). With respect to sexual activity during the menopausal period, 37.3% of the women reported engaging in sexual intercourse once a month or less, while 27.6% reported no sexual activity.

Table 2.

Menopause-related characteristics of menopausal women (n = 490)

Variables		± SS
Age at menopause (years)		46.38 ± 4.12
		n	%
Type of menopause	Surgical menopause	39	8.0
	Natural (spontaneous) menopause	451	92.0
Perception of menopause	Positive	115	23.5
	Neither positive nor negative	298	60.8
	Negative	77	15.7
Attendance at menopause clinics for follow-up	Yes	187	38.2
	No	303	61.8
Frequency of follow-up at menopause clinics	No follow-up	239	48.8
	Every 6 months	79	16.1
	Once a year	73	14.9
	Irregular	99	20.2
Perceived adequacy of knowledge about menopause	Yes	224	45.7
	No	266	54.3
Receipt of information about menopause	Yes	309	63.1
	No	181	36.9
Source of information about menopause	Physician	116	37.7
	Nurse	33	10.7
	Midwife	13	4.2
	Family	60	19.5
	Friends	19	6.2
	Internet	35	11.4
	Television / newspapers	32	10.4
Frequency of sexual intercourse during menopause	Daily	18	3.7
	1–3 times per week	57	11.6
	Once every two weeks	97	19.8
	Once a month or less	183	37.3
	None	135	27.6

The results of the Menopausal Spousal Support Scale, the Menopause Rating Scale, and the Hendrick Sexual Attitude Scale–Short Form among women in the menopausal period are presented in Table 3. The mean total score of the Menopausal Spousal Support Scale was 54.87 ± 26.94. The mean scores of its subdimensions were 9.72 ± 2.52 for emotional support, 11.20 ± 6.62 for instrumental support, 22.76 ± 13.14 for esteem support, and 10.88 ± 6.49 for sexual intimacy support. The mean total score of the Menopause Rating Scale was 20.81 ± 9.12. Regarding its subdimensions, the mean scores were 12.15 ± 5.36 for psychological symptoms, 3.61 ± 1.79 for somatic symptoms, and 5.05 ± 3.01 for urogenital symptoms. The mean total score of the Hendrick Sexual Attitude Scale–Short Form was 57.07 ± 9.18.

Table 3.

Descriptive statistics of the menopausal spousal support scale, menopause rating scale, and sexual attitude scale scores

	Mean ± SS	Min - Max
Menopausal Spousal Support Scale (MSSS)	54.87 ± 26.94	17.00–123.00
Emotional Support	9.72 ± 2.52	5.00–17.00
Instrumental Support	11.20 ± 6.62	3.00–27.00
Esteem Support	22.76 ± 13.14	6.00–54.00
Sexual Intimacy Support	10.88 ± 6.49	3.00–27.00
Menopause Rating Scale (MRS)	20.81 ± 9.12	0.00–44.00
Somatic Symptoms	3.61 ± 1.79	0.00–8.00
Psychological Symptoms	12.15 ± 5.36	0.00–24.00
Urogenital Symptoms	5.05 ± 3.01	3.00–12.00
Hendrick Sexual Attitude Scale – Short Form (HSAS-SF)	57.07 ± 9.18	31.00–87.00

The correlations between the total and subdimension scores of the Menopausal Spousal Support Scale, the Menopause Rating Scale, and the Hendrick Sexual Attitude Scale–Short Form among women in the menopausal period are presented in Table 3. The total score of the MSSS showed strong positive correlations with its subdimensions, including emotional support (r = .958, p < .001), helping support (r = .933, p < .001), valuing support (r = .960, p < .001), and sexual intimacy support (r = .877, p < .001). A weak but statistically significant positive correlation was found between the total scores of the MSSS and the MRS (r = .122, p = .007). Similarly, weak positive and statistically significant correlations were observed between the total and subdimension scores of the MSSS and the subdimensions of the MRS, including somatic, psychological, and urogenital symptoms (p < .05). The total score of the MRS was strongly positively correlated with its subdimensions, namely somatic symptoms (r = .793, p < .001), psychological symptoms (r = .959, p < .001), and urogenital symptoms (r = .853, p < .001). In addition, weak but statistically significant positive correlations were identified between the total score of the HSAS–Short Form and the total score of the MRS (r = .158, p < .001), as well as the somatic symptom subdimension (r = .095, p = .035).

The associations between menopausal symptoms and sexual attitudes on spousal support received by women during menopause are presented in Table 5. The regression model was statistically significant (R = .157, R² = 0.025, adjusted R² = 0.021), explaining 2.5% of the variance in spousal support. The Durbin–Watson value of 1.909 indicated no autocorrelation among the residuals. Menopause Rating Scale scores were positively associated with spousal support (β = 0.314, standardized β = 0.134, t = 2.347, p < .05). Similarly, Hendrick Sexual Attitude Scale–Short Form scores showed a significant positive effect on spousal support (β = 0.293, standardized β = 0.133, t = 2.200, p < .05). Both variables contributed independently to the model.

Table 5.

The associations between spousal support received by women during menopause on menopausal symptoms and sexual attitudes

Variables	β	Standardized β	T	F	p	95% Confidence
						Lower	Upper
Constant	28.178	8.181	3.444	6.146	0.002	12.104	44.253
Menopause Rating Scale	0.314	0.134	2.347			0.051	0.577
Hendrick Sexual Attitude Scale–Short Form	0.293	0.133	2.200			0.031	0.554

R: 0.157, R² = 0.025; Adjusted R² = 0.021. The value of Durbin Watson was 1.909, suggesting the independence of these variables

Discussion

The present study examined the associations between perceived spousal support, menopausal symptoms, and sexual attitudes among menopausal women. The findings indicated weak but statistically significant correlations between spousal support and both menopausal symptoms and sexual attitudes. In addition, menopausal symptoms and sexual attitudes were statistically associated with spousal support in the regression model; however, the explanatory power of the model was limited (R² = 0.025). These results suggested modest relational associations rather than strong predictive relationships.

Although sociodemographic characteristics were described to contextualize the sample, these variables were not included in the multivariate regression model (Table 1). Previous research has demonstrated that menopausal symptoms and related psychosocial outcomes are significantly influenced by sociodemographic factors such as age, educational level, employment status, marital status, income level, and presence of chronic disease [3, 10, 37]. For example, Zhao et al., reported that social support and symptom severity vary across educational and socioeconomic strata [3], while Li et al., identified associations between perimenopausal symptoms and demographic as well as psychosocial risk factors [10]. Similarly, Polat et al., emphasized that perceived social support during menopause is shaped by sociodemographic context [37]. Given this evidence, the exclusion of these variables from the multivariate analysis may limit the ability to account for potential confounding effects and may partially explain the low explanatory power of the regression model. Future studies incorporating broader sociodemographic and relational variables into multivariate models may provide a more comprehensive understanding of the complex dynamics underlying menopausal experiences. The majority of menopausal women participating in this study experienced menopause naturally, perceived menopause as neither positive nor negative, did not receive regular follow-up care at menopause clinics, considered their knowledge about menopause to be insufficient, reported having received information about menopause, primarily from physicians, and reported engaging in sexual intercourse once a month or less (Table 2). In the study by Darici Koçan and Cangöl, which examined menopausal symptoms and coping strategies among menopausal women, 39.6% of participants had been menopausal for ≥ 10 years, all had experienced natural menopause, 39.3% had received menopause-related education, and 44.3% of those who received education reported health professionals as their primary source of information [38]. Similarly, Karacan et al., investigated the relationship between menopausal complaints, attitudes, and quality of life and found that 90.0% of women experienced natural menopause, 42.0% had been menopausal for 11 years or longer, 88.0% had not received hormone therapy, and 66.0% perceived menopause as a natural life process [39]. These findings suggested that perceiving menopause as a “natural” process may limit women’s health-seeking behaviors and reduce their likelihood of seeking professional healthcare services. Nappi et al., emphasized that sexual dysfunction during menopause is frequently associated with inadequate counseling, hormonal changes, and psychosocial factors [40]. Similarly, Avis et al., reported that individualized education and continuous support from healthcare professionals significantly improve both women’s ability to cope with menopausal symptoms and their sexual satisfaction [41]. In particular, the low rate of regular attendance at menopause clinics may lead to menopause-related problems remaining unrecognized and being internalized as part of “normal aging,” thereby delaying appropriate interventions.

In the present study, menopausal women reported low levels of perceived spousal support (Table 3). In contrast, Tuncer et al., who examined the relationship between spousal support and quality of life among postmenopausal women, reported a mean total MSSS score of 116.39 ± 17.88, with relatively higher scores in the esteem support (41.35 ± 7.21) and emotional support (35.10 ± 5.16) subscales, compared to instrumental support (18.42 ± 3.62) and sexual intimacy support (21.52 ± 3.91) [42]. These findings suggest that in samples with stronger spousal support, the menopausal transition may be experienced within a more supportive relational context. However, the lower level of spousal support observed in the present study may be associated with the sociocultural characteristics of the sample, as well as spouses’ levels of knowledge and awareness regarding the menopausal process. Similarly, in the study by Bayrı Bingöl et al., which investigated the effects of pelvic floor muscle exercises on sexual function and spousal support among postmenopausal women with urinary incontinence, pre-intervention MSSS scores were also relatively low, with a mean total score of 109.80 ± 32.55. Subscale mean scores were 39.64 ± 13.17 for esteem support, 35.38 ± 9.70 for emotional support, 15.92 ± 6.71 for instrumental support, and 18.86 ± 6.57 for sexual intimacy support [43]. The particularly low scores in the instrumental and sexual intimacy support subscales suggested that spouses may play a limited role in providing practical assistance and physical intimacy during the menopausal period. These findings are consistent with the low levels of spousal support identified in the present study.

In the present study, menopausal women reported low levels of sexual attitudes (Table 3). In the study conducted by Gül and Çetinkaya (2024), which examined the relationship between sexual myths and sexual attitudes among women in Turkey, the mean total score of the Hendrick Sexual Attitude Scale was reported as 80.58 ± 7.59 [44]. Similarly, Evli (2024), who evaluated religiosity, internalized sexism, and sexual attitudes among late female adolescents (aged 18–25 years), reported Hendrick scale scores across different subgroups; for instance, women living in nuclear families had a mean score of 80.38 ± 15.80, while those who reported discussing sexual issues with their families had a mean score of 74.29 ± 14.81 [45]. The low level of sexual attitudes observed in the present study may be attributed to factors such as insufficient knowledge about menopause, lack of regular menopausal follow-up, low levels of spousal or partner support, and decreased sexual satisfaction during the menopausal period, all of which may collectively contribute to more negative or restrictive sexual attitudes.

In the present study, participants reported high levels of menopausal symptoms (Table 3). In the study conducted by Karacan et al., the mean total score of the Menopause Rating Scale was reported as 31.81 ± 9.12, with subscale mean scores of 18.15 ± 5.36 for psychological symptoms, 5.61 ± 1.79 for somatic symptoms, and 8.05 ± 3.01 for urogenital symptoms [39]. Similarly, Darici Koçan and Cangöl, reported lower mean scores, with a total MRS score of 8.37 ± 5.42, and subscale scores of 3.14 ± 2.67 for psychological symptoms, 3.54 ± 2.58 for somatic symptoms, and 1.69 ± 2.03 for urogenital symptoms [38]. Polat et al., who examined the effects of social support on menopausal symptoms, reported a mean total MRS score of 20.63 ± 8.16, with subscale scores of 12.48 ± 5.02 for psychological symptoms, 3.79 ± 1.86 for somatic symptoms, and 4.35 ± 2.86 for urogenital symptoms [37]. In the study by Arar and Erbil, which investigated the impact of menopausal symptoms on daily life activities, the mean total MRS score was 16.11 ± 10.34, while somatic, psychological, and urogenital subscale scores were 6.28 ± 3.74, 6.09 ± 4.25, and 3.72 ± 3.08, respectively [46]. Similarly, Erbaş and Zerkinli, reported a mean total MRS score of 22.72 ± 4.82, with subscale scores of 9.07 ± 1.86 for somatic symptoms, 8.04 ± 2.30 for psychological symptoms, and 5.60 ± 2.05 for urogenital symptoms [47]. Koçak and Beji, who modeled risk factors for severe and very severe menopausal symptoms, reported a mean total MRS score of 16.83 ± 9.31, and subscale scores of 3.14 ± 2.12 for somatic symptoms, 10.11 ± 5.66 for psychological symptoms, and 3.58 ± 2.90 for urogenital symptoms [48]. Overall, the findings of the present study indicated that menopausal women experience substantial levels of menopausal symptoms, which are largely consistent with results reported in the existing literature. Previous studies have demonstrated that reduced perceived social support is associated with increased severity of menopausal symptoms. Accordingly, the high level of menopausal symptoms observed in this study may be related to insufficient spousal support and limited overall social support.

The results demonstrated that increased perceived spousal support was positively associated with sexual attitudes and the severity of menopausal symptoms (Table 4). This finding supports the view that menopause is not merely a biological process, but rather a multifaceted transitional period with relational and psychosocial dimensions. In a cross-sectional study conducted in Turkey, a strong negative relationship was identified between spousal support and menopausal symptoms, indicating that higher levels of spousal support were associated with a lower symptom burden and improved psychological well-being [49]. Similarly, an analytical cross-sectional study carried out in rural areas of India reported that women with low or moderate perceived social support had a significantly higher likelihood of experiencing moderate-to-severe menopausal symptoms, with the risk increasing by approximately 4.5 times [50]. These findings suggested that social and spousal support may serve as important protective factors that substantially shape women’s symptom experiences during menopause. From the perspective of sexual attitudes, previous studies have emphasized that women’s experiences of sexuality during the menopausal period are closely related to relationship dynamics, emotional intimacy, quality of communication, and supportive partner behaviors. However, it has also been reported that women frequently lack access to adequate healthcare support and counseling services regarding sexual well-being during menopause [51]. On the other hand, it should be acknowledged that the relationship between social support and menopausal symptoms may not be uniform across all contexts. Some studies have suggested that the symptom-reducing effect of social support is limited and may vary depending on individual and environmental factors such as perceived stress levels [51, 52]. This highlights the multidimensional nature of the menopausal process and underscores the importance of considering individual differences in menopausal experiences.

Table 4.

Correlations between total and subscale scores of the menopausal spousal support scale, menopause rating scale, and sexual attitude scale among menopausal women

	1	2	3	4	5	6	7	8	9	10
Menopausal Spousal Support Scale (MSSS) (1)	1	0.958 0.000	0.933 0.000	0.960 0.000	0.877 0.000	0.122 0.007	0.102 0.024	0.109 0.016	0.117 0.010	0.117 0.010
Emotional Support (2)		1	0.860 0.000	0.870 0.000	0.836 0.000	0.117 0.009	0.105 0.020	0.113 0.012	0.092 0.041	0.089 0.048
Instrumental Support (3)			1	0.861 0.000	0.812 0.000	0.108 0.016	0.084 0.062	0.079 0.079	0.137 0.002	0.161 0.000
Esteem Support (4)				1	0.867 0.000	0.109 0.015	0.083 0.067	0.102 0.024	0.101 0.025	0.107 0.018
Sexual Intimacy Support (5)					1	0.114 0.011	0.077 0.089	0.087 0.056	0.147 0.001	0.134 0.003
Menopause Rating Scale (MRS) (6)						1	0.793 0.000	0.959 0.000	0.853 0.000	0.158 0.000
Somatic Symptoms (7)							1	0.707 0.000	0.551 0.000	0.095 0.035
Psychological Symptoms (8)								1	0.707 0.000	0.077 0.088
Urogenital Symptoms (9)									1	0.286 0.000
Hendrick Sexual Attitude Scale – Short Form (HSAS-SF) (10)										1

Pearson Correlation

In our study, higher levels of sexual attitudes and menopausal symptoms were associated with higher perceived spousal support during menopause (Table 5). However, the fact that the regression model explained only 2.5% of the total variance indicated that spousal support cannot be sufficiently explained by menopausal symptoms or sexual attitude alone and represents a multidimensional and complex construct. Although statistically significant, the effect sizes were weak and the regression model explained only a small proportion of variance. This finding suggested that spousal support is not limited solely to women’s individual experiences, but is shaped by the interaction of multiple factors such as relationship quality, communication style, the spouse’s level of knowledge and awareness regarding the menopausal process, and cultural norms. Indeed, Yeşildağ and Altunbaş (2024) reported that as the severity of menopausal symptoms decreased, women’s perceived spousal support increased; however, the explanatory power of this relationship remained limited [49]. In the same study, it was emphasized that spousal support was more strongly associated not only with symptom severity but also with spouses’ level of knowledge about menopause and their empathic approaches [49]. Similarly, the literature indicated that improvements in sexual attitudes during menopause create a feedback loop that enhances spouses’ supportive behaviors; however, this effect is not a strong predictor when considered alone [53, 54]. This study contributes to the literature by examining spousal support, sexual attitudes, and menopausal symptoms within the same analytical framework. While in the literature spousal support during menopause is mostly evaluated as a predictor of menopausal symptoms or as a unidirectional variable affecting quality of life, this study statistically demonstrates that spousal support forms a dynamic structure together with women’s sexual attitudes and symptom experiences. The low explanatory power indicated that additional unmeasured relational and contextual variables may play a more substantial role.

The regression model demonstrated limited explanatory power (R² = 0.025), indicating that perceived partner support during menopause cannot be sufficiently explained solely by menopausal symptoms and sexual attitudes (Table 5). Although statistically significant, the observed effect sizes were small but meaningful in psychosocial context and should not be interpreted as evidence of strong predictive relationships. Rather, these findings suggested modest statistical associations. The limited variance explained by the model may reflect the multidimensional nature of partner support. Previous research indicated that relational and contextual factors—such as marital duration, relationship quality, communication patterns, spouse characteristics (e.g., age and education), and broader cultural beliefs—play a substantial role in shaping perceived support and relational dynamics in midlife couples [20, 27]. In addition, chronic disease status and psychosocial stressors have been shown to influence both menopausal symptom severity and perceived social support [3]. The omission of such variables from the present regression model may have resulted in residual confounding and contributed to the low proportion of variance explained. Despite these limitations, this study contributes to the literature by quantitatively examining sexual attitudes, menopausal symptoms, and partner support within the same analytical framework. While sexual function and sexual satisfaction are frequently explored in menopause research, fewer studies have evaluated sexual attitudes in relation to partner support and symptom experiences simultaneously. In this sense, the findings support the view that sexuality during menopause extends beyond physiological functioning and is embedded within relational and attitudinal contexts.

The findings of the present study may be interpreted within the broader Turkish sociocultural context. In cultural settings where traditional gender roles and conservative attitudes toward sexuality are relatively prominent, menopause may be perceived not only as a biological transition but also as a transformation in femininity, attractiveness, and marital expectations. Previous research conducted in Turkey has shown that women’s sexual attitudes and perceptions of menopause are closely associated with internalized gender norms and societal expectations regarding aging and sexuality [19, 44]. Furthermore, qualitative evidence suggested that sexual communication between partners during menopause may be shaped by cultural norms of modesty and limited openness in discussions of sexual health [23]. Within this framework, perceived partner support may reflect not only individual relational dynamics but also broader cultural scripts that define marital roles, emotional expression, and intimacy. Nevertheless, given the cross-sectional design of the present study, these interpretations should be regarded as contextual rather than causal.

Limitations

This study has several limitations that warrant consideration. First, the cross-sectional design precludes causal inference and restricts the findings to correlational interpretations; therefore, conclusions regarding directionality should be avoided. Second, as the study was conducted in a single center in Bartın within a specific sociocultural context, the generalizability of the results may be limited. Additionally, convenience sampling from two centers may have introduced selection bias, as women willing to participate in research addressing sexuality and partner relationships may systematically differ from those who declined participation. The reliance on self-report measures further introduces the possibility of social desirability and recall biases, particularly in sensitive domains such as sexuality and spousal relationships, where cultural norms may shape responses. Moreover, spousal support was assessed solely from women’s perspectives, precluding a dyadic evaluation of partner dynamics. Third, the relatively low internal consistency of the HSAS-SF represents a methodological limitation and may have attenuated the magnitude of the observed associations. The low explanatory power of the regression model (R² = 2.5%) also suggested that spousal support is influenced by factors beyond those included in the present analysis. Furthermore, the omission of potentially relevant confounding variables (e.g., marital duration, relationship quality, and spouse characteristics) may have resulted in omitted variable bias. However, the limited explanatory power likely reflects the inherently multidimensional and context-dependent nature of spousal support rather than solely a methodological shortcoming. Fourth, perception of menopause and perceived adequacy of knowledge were measured using single-item indicators. Although included for descriptive purposes, such measures may not fully capture the complexity of these constructs; thus, related findings should be interpreted cautiously. Future research should employ validated multidimensional instruments to provide a more comprehensive assessment. Finally, although the Menopausal Spousal Support Scale was developed to assess support from legally married partners, some unmarried participants may have had intimate partners. Consequently, lower MSSS scores in this group may reflect differences in marital status rather than a true absence of partner support. This potential misclassification may have attenuated the observed associations and should be considered when interpreting the results.

Conclusion and recommendations

This study revealed that menopausal women had low levels of menopausal spousal support and sexual attitudes, while experiencing high levels of menopausal symptoms. The findings suggested that higher perceived spousal support was associated with more positive sexual attitudes and lower menopausal symptom severity; furthermore, sexual attitudes and menopausal symptom severity are in a reciprocal and dynamic relationship with spousal support. The results of the regression analysis demonstrate that menopausal spousal support is a multidimensional construct that cannot be adequately explained solely by symptom severity or sexual attitudes, but rather is shaped by the interaction of emotional, behavioral, and relational components. In this respect, the present study makes an original contribution to the literature by conceptualizing menopausal spousal support not as a static outcome, but as a dynamic process interacting with women’s biopsychosocial experiences.

Based on these findings, healthcare services for menopausal women should not be limited to the management of biological symptoms, but should be structured using holistic approaches that also address sexual attitudes, spousal relationships, and psychosocial support. It is particularly important for obstetrics and gynecology nurses to systematically assess not only menopausal symptoms, but also women’s perceptions of spousal support and their attitudes toward sexuality. The development of couple-based education and counseling programs aimed at strengthening spousal support may represent an effective strategy for improving menopausal adaptation. In addition, the dissemination of evidence-based and culturally sensitive educational materials to increase societal awareness of menopause is strongly recommended. Future studies incorporating dyadic data from both partners may yield higher explanatory power and provide a more comprehensive understanding of spousal support dynamics. Additionally, future research should employ longitudinal and mixed-method designs and examine, in greater depth, variables such as relationship quality, communication patterns, and cultural norms that may influence spousal support.

Authors’ contributions

BK: Writing – review & editing, Writing – original draft, Supervision, Resources, Methodology, Formal analysis, Conceptualization.BY: Writing – review & editing, Writing – original draft, Methodology, Investigation, Resources, Data curation, Funding acquisition, Conceptualization.AS: Writing – review & editing, Writing – original draft, Methodology, Investigation, Resources, Data curation, Conceptualization.AG: Writing – review & editing, Writing – original draft, Methodology, Investigation, Data curation, Conceptualization.

Funding

This study was supported by TÜBİTAK within the scope of TÜBİTAK 2209-A University Students Research Projects Support Programme (2024/1) (Project Number: 1919B012400802).

Data availability

Data is available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval was obtained from the Social and Human Sciences Ethics Committee of a public university (Date: May 7, 2025; Decision No: 2025-SBB-0323). Institutional approval was also obtained from the Bartın Provincial Directorate of Health to conduct the study at Şehit Furkan Yılmaz Healthy Life Center and Karaköy Healthy Life Center, affiliated with the Bartın Central Community Health Center. Verbal informed consent was obtained from all participants prior to data collection. Written consent was not obtained due to the sensitive nature of the topic and to ensure participant comfort; this procedure was approved by the ethics committee. The study was conducted in accordance with the principles of the Declaration of Helsinki. As this was a cross-sectional study, the STROBE guidelines were followed. This research was supported by the 2209/A University Students Research Projects Support Program (Project No.: 1919B012400802) for the 2024/1 period.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.