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. Author manuscript; available in PMC: 2009 Jun 1.
Published in final edited form as: J Adv Nurs. 2008 Mar 25;62(5):541–550. doi: 10.1111/j.1365-2648.2008.04624.x

AN ONLINE FORUM ON MENOPAUSAL SYMPTOM EXPERIENCE OF WHITE WOMEN IN THE U.S.

PMCID: PMC2430027  NIHMSID: NIHMS52251  PMID: 18373610

Abstract

Aims

Using a feminist approach, the study aimed at exploring menopausal symptom experience of 23 White midlife women through a six-month online forum.

Background

Recent cross-cultural investigations have indicated significant ethnic differences in menopausal symptoms and have challenged the universality of menopausal symptoms. Currently available cultural knowledge on menopausal experience, however, is inadequate to guide appropriate and adequate care even for White midlife women in the menopausal transition.

Data source

Qualitative data collected through an online forum in 2007.

Method

The study was a cross-sectional qualitative online forum study. A total of 23 midlife women who self-identify as non-Hispanic Whites were recruited for the study using a convenience sampling method. Seven topics related to menopausal symptom experience were used to guide the online forum for 6-months. The data were analyzed using thematic analysis involving line-by-line coding, categorization, and theme extraction.

Results

The experience of menopause caused women to redefine themselves within their busy daily life schedules. The women were optimistic about their symptoms, and tried to laugh at the experience to boost their inner strength and motivate themselves persevere. Many women thought that both generational and life styles differences were much more important than ethnic differences in menopausal symptom experience. In seeking assistance with the symptoms of menopause, women were not satisfied with the guidance of their physicians.

Conclusion

Nurses need to carefully listen to what the women themselves talked about their own experience with menopausal symptoms and help them to adequately manage and live with the symptoms.

Keywords: Midlife Women, Menopause, Symptoms

What is already known about the topic?

  • Recent cross-cultural investigations have indicated significant ethnic differences in menopausal symptoms and have challenged the assumption of universality.

  • Recent cross-cultural studies have shown that culture can shape women’s health beliefs related to menopause, and women define their experience of menopause according to their culture.

  • Despite a large number of studies on menopausal symptoms of White women, little is still known about what their own menopausal symptom experience is.

What this paper adds?

  • This paper shows that White midlife women are optimistic about their symptoms and tend to normalize the symptoms while re-thinking about their life and youth to re-define themselves.

  • This paper shows that White midlife women believe both generational and life styles differences are much more important than ethnic differences in menopausal symptom experience.

  • This paper shows that the ignorance of menopausal symptoms may remain and that health care providers still may not carefully listen to what the women are reporting regarding menopause symptoms.

INTRODUCTION AND BACKGROUND

A common assumption about menopause is that it is universally experienced by all women in the same way. Menopause is marked primarily by the final menstrual period in a woman’s life. However, it is also associated with a cluster of symptoms (e.g., hot flashes, night sweats, menstrual irregularities, vaginal dryness)(Avis et al. 2001). Such symptoms are frequently connected to declining levels of estrogen. Although it is assumed that all women in the menopausal transition experience these symptoms regardless of ethnic group (Gill et al. 2002, Riggs 2002), most information regarding symptoms and their management is based on studies of White women (Andrist & MacPherson 2001, Avis et al. 2001).

Recent cross-cultural investigations have indicated significant ethnic differences in menopausal symptoms and have challenged the assumption of universality (McCarthy 1994, Parfitt et al. 1997, Grisso et al. 1999, McCrohon et al. 2000, Probst-Hensch et al. 2000, Lovejoy et al. 2001, Laferrere et al. 2002). For example, Beyene & Martin (2001) found that certain ethnic groups of women report no symptoms as they move through the menopause transition. Culture itself may be the basis of these ethnic differences. Recent cross-cultural studies have shown that culture can shape women’s health beliefs related to menopause, and women define their experience of menopause according to their culture (Lock et al. 1988, Sukwatana et al. 1991, Chompootweep et al. 1993, Ismael 1994, Ramoso-Jalbuena 1994, Samil & Wishnuwardhani 1994, Tang 1994). Attributions women make about the symptom experience are culturally bound. Menopausal changes are perceived, evaluated, and acted upon within a system of culturally determined beliefs. Beliefs about what causes symptoms, sometimes called “explanatory models,” lead women to consider various therapeutic alternatives, which are themselves influenced by cultural beliefs. For example, health and nutrition practices, such as intake of calcium, Vitamin D, or phytoestrogen, are influenced by culture. Currently available cultural knowledge on the menopause experience, however, is inadequate to guide care, even for the well-studied White population of women in the menopause transition. In other words, very little is still known about White women’s own menopausal symptom experience despite the large number of studies among them.

While study populations have influenced what is known about the menopause symptom experience, study designs have also limited what is known. Most of the studies on menopausal symptoms tend to be quantitative with a limited number of White women in a specific setting. Studies have rarely used designs that incorporated women’s own descriptions or voices regarding their experiences (Andrist & MacPherson 2001, Klima 2001, Lock 2001, Murtagh & Hepworth 2003). Furthermore, little is known about how White women’s own menopausal symptom experience has changed with recent reports of the Women’s Health Initiative concerning hormone therapy (Rossouw et al. 2007, U.S. Department of Health and Human Services 2007).

THEORETICAL BASIS

In this study, Im’s (2007) feminist approach theoretically guided data collection and data analysis process. Although a feminist approach might use either quantitative or qualitative methods, a qualitative approach was chosen for this study because a more in-depth exploration of the lived experience of menopausal women was targeted in the study. In addition, a feminist approach should prioritize research participants’ personal views, and help disclose women’s personal experiences of menopausal symptom in the research process. Thus, in this study, women’s voices about their experience of menopausal symptoms were carefully sought throughout the research process, and menopausal symptoms were defined from the women’s own points of view. In this feminist approach, researchers should also view gender and ethnicity as the significant characteristics that circumscribe women’s menopausal symptom experience and carefully examine contexts that may have influenced women’s menopausal symptoms experience. Thus, in this study, women’s descriptions of perceived ethnic differences in their personal experience were also sought. Finally, in the feminist approach, the distance between the researcher and the research participants should be shortened by seeking diverse ways to interact. In this study, the distance between the researchers and the participants was shortened by using a variety of retention strategies (see the data collection procedures).

PURPOSE/AIMS OF THE STUDY

The purpose of the study reported in this paper was to explore menopausal symptom experience of White midlife women within the context of their daily lives through a 6-month online forum.

METHODS

Design

This was a qualitative online forum study, which was a part of a larger study on menopausal symptom experience of four major ethnic groups (Non-Hispanic Whites, Non-Hispanic African Americans, Non-Hispanic Asians, and Hispanics) of midlife women in the U.S. This online forum data were collected in 2007. The online forum was chosen because it is a mechanism commonly used among middle-aged women to provide electronic emotional and informational support (Hsiung 2000). An online forum has been reported to provide a more comfortable forum for some people to discuss sensitive personal health issues, and suggested as a feasible alternative to traditional face-to-face focus groups (Anderson & Kanuka 1997, Hsiung 2000, Kramish et al. 2001).

Sample and Settings

The recruitment settings for the larger study were Internet communities/groups among midlife women (ICMWs) and Internet communities/groups for ethnic minorities (ICEMs). Yet, White midlife women who were the participants of the online forum reported in this paper were recruited only through the ICMWs since the ICEMs targeted only ethnic minorities. Recent studies indicating the popularity of ICMWs have demonstrated the importance of these ICMWs as a resource for researchers who are investigating middle-aged women who reside in different geographical areas (Baehring et al. 1997, Bowker & Liu 2001, Barrera et al. 2002). For example, ICMWs make it possible for a researcher in Washington, DC to reach women in California or in Hawaii.

The 141 White participants in the larger study were recruited in 10 ICMWs identified through Yahoo! (http://groups.yahoo.com/), 20 identified through MSN.com (http://groups.msn.com/), and 26 identified through Google.com (http://www.google.com). Out of these 141 participants, 27 women were recruited to participate in the online forum, using a quota sampling method to assure an adequate number of early peri-menopausal, late peri-menopausal, and post-menopausal women from diverse socioeconomic groups. Quota sampling provides a strategy to ensure the inclusion of subject types that are likely to be underrepresented while it decreases response and selection biases encountered in convenience sampling (Burns & Grove 1997). In general, 6 to 12 participants are thought to be ideal for focus groups including online forums (Stevens 1996). By the end of the 6-month online forum, a total of 23 women remained. Sociodemographic characteristics of the 23 women are summarized in Table 1.

Table 1.

Sociodemographic characteristics of the White participants (N=23)

Characteristics N (%) Characteristics N (%)
Age (years) Body Mass Index (BMI)
 Mean (SD) 50.22 (5.91)  Mean (SD) 33.35 (11.85)
Employment Category of BMI
 Employed 19 (82.6)  Normal 8 (34.8)
 Unemployed 4 (17.4)  Overweight 3 (13)
 Obese 12 (52.2)
Marital Status Education
 Married 13 (56.5)  High school 4 (17.4)
 Partnered 1 (4.3)  Partial College 4 (17.4)
 Divorced/separate 7 (30.4)  College 13 (56.5)
 Single 2 (8.7)  Graduate degree 2 (8.7)
Menopause Status Family Income (to pay for basics)
 Premenopause 3 (13.0)
 Early perimenopause 9 (39.1)  Very hard 4 (17.4)
 Late perimenopause 5 (21.7)  Somewhat hard 9 (39.1)
 Postmenopause 6 (26.1)  Not hard 10 (43.5)
Health (self perceived) Religion
 Very unhealthy 2 (8.7)  Protestant 5 (21.7)
 Unhealthy 4 (17.4)  Catholic 10 (43.5)
 Don’t know 2 (8.7)  Buddhism 1 (4.3)
 Healthy 12 (52.2)  Muslim 2 (8.7)
 Very healthy 3 (13.0)  No religion 2 (8.7)
Number of Children  Others 3 (13)
 None 5 (21.7)
 1–2 14 (60.9)
 3–5 3 (13.0)
 More than 5 1 (4.3)
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Online Forum Topics

Menopause symptom experience was explored using seven discussion topics. The seven topics included: (a) language (terminology) used to describe menopause, symptom, and menopausal symptoms and their linguistic meanings; (b) women’s daily life schedules, and hardships and sufferings in daily lives; (c) culturally universal and specific descriptions of menopausal symptoms; (d) women’s ethnic-specific attitudes and responses to menopausal symptoms; (e) women’s perceived ethnic-specific causes of menopausal symptoms and management strategies for menopausal symptoms; (f) things/life events influencing women’s menopausal symptom experience in their daily lives; and (g) women’s preferences for symptom management strategies. Each topic was posted on the online forum in a serial fashion across the 6-month period of data collection. These topics were originally developed in a former study of the researchers (the authors, 2000), reviewed by five experts in the area of menopause and two experts in qualitative research methods, and revised for the study reported in this paper.

Human Subjects Considerations

The study was approved by the Institutional Review Board of the establishment where the researchers were affiliated. To assure confidentiality and to protect privacy, participants recruited from the online forums were required to register for the forum. Upon completion of registration, IDs and initial passwords were sent to participants by e-mail with a registration confirmation message. Also, the participants were asked to choose pseudonyms for the online forum discussions so that their real names could not be identified by other participants. The IDs and passwords were required for participants to log in to the online forum sites. Also, their visits at the online forum sites were recorded and monitored. Only those who registered were allowed to enter the online forum to ensure confidentiality and protect privacy.

Data Collection Procedures

When 30 White midlife women were recruited, the online forum was initiated. E-mails were sent to inform the registered participants of the initiation. However, only 27 visited the online forum site at the initiation, and 23 remained by the end of the 6 month period of the forum. The opening page of the online forum sites showed the introductory questions so that participants could introduce themselves when they visited the site for the first time. The introductory questions and seven discussions topics were posted serially on the forum sites and remained there for the entire 6 months. Participants could post messages about the topics at their convenience in any forms they wished (e.g., stories, conversations, responses to others’ messages, etc.). The researchers in charge of online forums steered discussions about Topics 1 to 7 throughout the 6-month period using prompts included in each topic as needed, always considering the content and flow of discussion. The number and length of messages were not limited, yet at least two messages per topic were required for reimbursement of participation. During the 5th month, the participants were asked to add topics that they wanted to discuss with other participants, and the added topics were available on the online forum sites for the remainder of the 6 months. The discussions from the online forum were summarized monthly and posted on the online forum sites so that participants could see and provide feedback.

Specific retention strategies used included: (a) monthly e-mail messages to communicate the research team’s continuing interest, inquire about how participation was going, and encourage continuing participation, (b) personal e-mail sent to participants who had not posted a message for more than 2 months (to ask if there were research participation issues), (c) e-mail birthday and holiday cards to each participant, and (d) e-mailing an electronic newspaper quarterly reporting the ongoing study status and announcing any study related presentations or publications.

Data Analysis

The data analysis using descriptive content and thematic analysis (Boyatzis 1998) was conducted simultaneously with online forum discussions. First, the saved qualitative data in the ASCII files were printed out as transcripts. Then, the printed transcripts were thoroughly read and re-read for line-by-line coding. The codes from the line-by-line coding process were summarized as a coding book. Using the coding book, categories that emerged from the internal cognitive process and reflexive thinking were constructed by analyzing contents and contexts. Then, relationships between categories were formulated by mapping associative links among the categories in order to extract themes representing the women’s menopausal symptom experience. This was also achieved using an interactive process of reading and re-reading text to produce successively more abstract and refined ideas about domains of interest. This procedure served as an ongoing system of checks and balances since it provided opportunities to repetitively consider if specific codes, categories, and themes represented the participants’ own experience throughout the data analysis process.

Rigor of the Study

Adherence to standards of rigor in feminist qualitative research including dependability, reflexivity, credibility, relevance, and adequacy assured scientific adequacy of the study (Hall & Stevens 1999). Dependability was ascertained by examining the methodological and analytic decision trails created by the investigators during the course of the study itself. Reflexivity was supported by maintaining a chronological research diary plus memos, and field notes. Credibility and relevance can be achieved when the study presents such faithful interpretations of participants’ experiences that they are able to recognize them as their own. Thus, in this study, credibility and relevance were met by posting the developing analytic categories on the online forum site and asking for participants’ reactions. Adequacy was assured by continuously questioning research methods, goals, research questions, design, scope, analysis, conclusions, and impact of the study within the social and political environment. Also, group meetings with the research team were held biweekly to ensure the quality of data collection and analysis.

FINDINGS

Four major themes emerged from data analysis of the online forum discussion: “redefining self,” “laughing at suffering,” “differences within sameness,” and “talking to the wall.” The themes are presented in detail in the following subsections.

“Redefining Self”

Menopause served as a stimulus for reflection on their lives and the impact of their busy daily life schedules on themselves. Most of the participants reported that they were never concerned about menopause until they experienced it. Although several women reported that they did not consider themselves as aging, menopause still meant a loss of youth to most of the women. The menopause transition caused women to think that they were not young anymore; they felt like they lost part of themselves. One woman illustrated this perspective:

I am 51 and have been in menopause for 3 years. I can honestly say it was one of the worst times in my life…it was the incredible change from logical, reasonable woman to the stereotypical hysterical female on vast crying jags…I became a stranger in my own skin. I read somewhere it’s called “loss of self” and that describes it exactly.

Menopause was a critical point of the women’s life that made them to re-think their life and redefine themselves. Most of the women perceived that they became more mature as they entered menopause. Menopause was a milestone that reminded the women of meanings of their lives and led them to reflect on life. Many of the women mentioned that menopause freed them from the pressure of striving to meet the expectations of the society and others. They thought that menopause made them to take time for themselves. For example, one woman wrote:

This is part of my life that I’ve always kinda looked forward to. I don’t really like the growing older part but the feeling of being comfortable in my own skin is great! I personally feel that I’ve put in my time, with my kids with my job with society in general and now it’s finally time for just me.

All the women thought that menopause was a natural process that was unstoppable. They learned how to accept it and change with it. Although they sometimes needed to struggle during the menopausal transition, they ultimately dealt with it and then moved on.

“Laughing at Suffering”

To all participants, being a woman meant that they had to manage a number of responsibilities such as running errands, doing laundry, cleaning, cooking, and so on. The women mentioned that their own needs had always been put behind, and that their life had been very stressful. Most of the women agreed that menopause placed an additional dimension to their already stressful life, and their life stress made their menopausal symptoms worsen. One woman wrote:

I have had a couple of major events happen lately. My best friend recently retired and moved far away to care for her elderly parents. She is overwhelmed, so there is little communication between us. Also, my eldest daughter graduated high school this year. Both these things have left me feeling old and somehow alone. I think menopause is so much worse when we become depressed about anything. I seem to be experiencing hot flashes and achiness more often.

Some of the women mentioned how they had struggled with menstrual pain during menopause. However, most of them mentioned that they could embrace menopause much better than menstruation although they suffered from some symptoms from the menopausal process. At menopause, they felt relieved by the fact that they would not need to suffer symptoms and discomfort due to menstruation anymore and that they would not need to worry about pregnancy. One woman reported:

I consider menopause as a great thing! I’m so tired of having periods! Especially since they are more painful and heavy the last couple of years. My breasts hurt so badly for the two weeks before. It feels like I’m pregnant again!

Despite these symptoms and troubles during the menopausal transition, most of the women tried to be humorous and laugh at the odds to boost their inner strength and motivate themselves to go through the hardships during the menopausal transition. Also, many of the women reported that friends, family members, and significant others provided help and support. Through the transition, they laughed together and learned from each other. One woman wrote:

Humor gets me through life. In the past 2 years I’ve been through a lot of heartache and pain but what got me through was my family/friends and my sense of humor. My sense of humor actually got my family/friends through some hard times as well. It’s amazing how people don’t realize what inner strength they have until it’s needed. Life is rough enough. Smile as often as you can. (smiley face) Laughing is healing.

“Differences within Sameness”

Some of the participants viewed menopause as a universal experience that all women would go through and that every woman’s menopausal experience should be the same. Many of them also thought that there would be no cultural differences in menopausal symptom experience because: (1) the cause of menopause and symptoms would be the lack of hormone and aging and (2) they subsequently did not have any control over it. On the opposite, others thought that there would be certain cultural and ethnic differences in menopausal symptoms, especially through expression of symptoms. However, they still believed that there were commonalities among women across ethnic groups. One woman wrote:

I have several Asian friends and I find that they don’t seem to suffer the same physical symptoms as Americans do. I don’t know if it’s the large amount of soy in their diet or that they are very stoic in talking about personal things. Yet, I find that women of all cultures find this a hard time because it means the end of being able to procreate.

Rather than culture, many participants thought that generational differences, specifically difference in women’s attitudes toward menopause, were the basis of variation in menopausal symptom experiences. Their assertion was: in the past menopause was a secret thing that women did not discuss, but women today tended to be more open and talk about their symptoms. One woman wrote:

I openly discuss my feelings with my sons and daughter alike…i think they should be aware of feelings and things so it will be smoother for them later on…for my son’s point of view he will understand his wife better, as well as expect down time for me along way…I think this upcoming generation will be more educated and expectful of the changes we all go through in mid life…or at least that is my hope…

Many of the participants also thought that lifestyles were more important factors that would make differences in women’s menopausal symptoms. Some of the women even had a list of self-help measures that would reduce their menopausal symptoms through changing their life styles. One woman wrote:

…I also believe that symptoms may be intensified in part by some of the things we do or don’t do such as smoking/improper diet/stress etc…hot flashes for me have been set-off by becoming upset or stressed so I try to avoid such instance…I have also experienced hot flashes from certain hot spicy foods and or hot beverages… Not sweats…. I have changed my bed-time clothing attire and now wear cooler pj’s. No more flannel for me. I have noticed if I omit wearing body lotions at nite the sweats don’t seems to be as bad….

“Talking to the Wall”

Few women mentioned a positive experience with their physicians when they visited the doctors’ offices for menopausal symptoms. In contrast, many women reported that they had not been treated well by their physicians. Some even stated that they would not see a doctor for their menopausal symptoms because they did not think doctors would care about the symptoms. One woman mentioned:

My PCP completely unsympathetic, but gave me a prescription for oral HRT…along with a “suck it up” lecture…. I’ve not really found any signs of neglect due to gender, just general feelings that most docs I’ve dealt with don’t seem to care….

While some other women mentioned that gender of their physicians would make a difference, others wrote that it would not make a difference. One woman wrote:

I have not faced any racial discrimination with health care, however, I must say that I was going to a MALE internal medicine for a while. . . .until I noticed that he kept blowing off my Complaints and I started feeling like he was treating me like a fat old lady who had multiple minor complaints!!

While all the participants mentioned that they had never experienced any maltreatment because of their ethnicity, one woman mentioned that she was badly treated because of her low socioeconomic status. The woman reported:

I have experienced neglect from a doctor because I couldn’t pay. I think the exact words were, “Have you considered applying for Medicaid and by the way, we don’t take Medicaid for payment.”

Another woman who reported that she was badly treated by her physician was a lesbian woman. She mentioned that she was discriminated at multiple levels in the health care system because of sexual identity. The woman wrote:

…essentially I get ignored either because it’s perceived that, as a woman I know nothing, or as a very educated woman…my concerns (when there were any), don’t get taken seriously (surely I could handle what ever it was, yadda, yadda, yadda,) & when it was obvious that I was not a heterosexual woman, it was completely ignored.

Based on their negative experiences with physicians, many of the women had a surprisingly similar desire: they wanted health care providers to start “listening to what the women report”. The women tried to justify their perception of not being heard. They identified their belief that physicians rushed into a decision for treatment without listening to what the women were reporting partially because of busy clinic schedules.

DISCUSSION

The findings indicated that White women themselves were optimistic about their menopausal symptoms and tended to normalize their symptoms while re-thinking about their life and youth and re-defining themselves. In contrast, the findings showed that the women perceived that physicians ignored menopausal symptoms that they reported. Some of the findings reported in this paper agree with the findings from previous studies while other findings are somewhat different.

The first and second themes of “redefining self” and “laughing at suffering” reported in this paper indicated that the women re-thought their life and youth while redefining themselves as middle-aged women, and that the women were optimistic about their menopausal symptom experience. These findings are somewhat different from those by Sampselle, Harris, Harlow, and Sowers (2002) who found that White women were primarily concerned with menopause as a harbinger of physical aging and the ensuing disadvantage of diverging from society’s youthful ideal. One of the possible reasons for these findings would be recent women’s health movement that might have educated women to accept menopause as a normal developmental process, allowing them to refocus on themselves. For example, in the U.S., increasing numbers of women’s health groups, projects, health centers and clinics, and health professionals are reported to provide education and to change health policy legislation to improve the quality of women’s health care (Boston Women’s Health Collective 1998, National Women’s Health Network 2002). Furthermore, the recent menopause medical management reports such as the Women’s Health Initiative (Rossouw et al. 2007, U.S. Department of Health and Human Services 2007) may have influenced the women’s attitudes toward hormone therapy in the U.S.

The third theme of “differences within sameness” reflects changes in women’s thinking about menopausal symptom experience. Both researchers and women themselves have believed that menopausal symptom experience is universal across ethnic groups since the symptoms are due to biological hormonal changes. Recently, however, researchers have reported ethnic differences in menopausal symptoms (Wilbur et al. 1998, McCrohon et al. 2000, Probst-Hensch et al. 2000, Avis et al. 2001, Lovejoy et al. 2001, Lasley et al. 2002, Fu et al. 2003, Kravitz et al. 2003, Randolf et al. 2003). With the changes due to recent women’s health movement, these study findings might have influenced women’s perception on ethnic differences in menopausal symptoms in the U.S. Thus, some of the participants of this study still believed that there would be no ethnic differences in menopausal symptom experience while others began to acknowledge ethnic differences in menopausal symptom experience.

The third theme of “differences within sameness” also indicates that the women themselves thought that generational differences and life styles differences were much more important than ethnic differences in menopausal symptom experience. This may also reflect educational effects of the recent women’s health movement and the mass-media reports on management strategies for menopausal symptoms in the U.S. Indeed, studies have reported that, other than ethnicity and race, menopausal symptoms were significantly correlated with life style factors including diet (soy consumption), body size, body weight, body mass, alcohol consumption, smoking, level of physical activity, exercise, and calcium supplement (Sommer et al. 1999, Barrett-Connor et al. 2000, Matthews et al. 2001, Sowers et al. 2001, Chim et al. 2002, Huang et al. 2002, Brett & Cooper 2003, Keegan et al. 2003, Lau et al. 2003, Lawlor et al. 2003, Sajatovic et al. 2003, Samsioe 2003, Whiteman et al. 2003).

The final theme of “talking to wall” may indicate changes in physicians’ attitudes toward menopausal symptoms reported by women. Even about 10 years ago, feminists strongly critiqued that gynecologists and psychiatrists in the U.S. directed and profited from the transformation of menopause into a disease (National Women’s Health Network [NWHN],). Feminists also critiqued that modern medicine pathologized menopause and that modern medicine made women dependent on the medical profession and pharmaceutical industries (Coney, 1994). Maybe after the land marking repots on hormonal therapy, physicians in the U.S. may not prescribe hormones as they have usually done so far or women themselves in the U.S. may begin to reject hormone therapy if they are given a choice. However, the final theme of “talking to wall” may not indicate positive changes at all. Rather, the theme implies that the ignorance of menopausal symptoms reported by Im (1997) may be still going on and that health care providers in the U.S. still may not carefully listen to what the women themselves are talking about their menopausal symptom experience.

CONCLUSIONS

Based on these findings, this paper concludes with the following implications for nursing practice and research. First, nurses working with menopausal women should practice in a manner that is open to active listening to hear women’s expressed concerns. Nurses also should strive to avoid imposing predetermined symptom management strategies. Developing supportive, caring relationships with menopausal women will also foster sense of mutual respect and facilitating the role of nurses as important resources for the women at menopause. Equally important during the menopause transition is the development of a support network among women. Women serve as information resources and role models for each other. Women in this study found the understanding and wisdom of a support network of others who have been through menopause essential to diminish stress associated with the transition.

More studies with diverse groups of White women are also needed to confirm the findings reported in this paper. Additional research is particularly important since the findings are somewhat different from research reported in the literature. Women in this study acknowledged the importance of life style factors on their menopausal symptom experience. This information may be helpful in motivating women to change their life styles to manage menopausal symptoms. Further studies of women’s perception of life style influences are needed to provide directions for life style modification for symptom management. In addition, studies regarding generational changes in menopausal symptom experience are needed. As these findings indicated, there may be certain generational changes in menopausal symptom experience among White women.

Supplementary Material

Title page

References

  1. Anderson T, Kanuka H. Online forums: New plateforms for professional development and group collaboration. Journal of Computer-Mediated Communication. 1997;3 NP. [Google Scholar]
  2. Andrist LC, MacPherson KL. Conceptual models for women’s health research: reclaiming menopause as an exemplar of nursing’s contributions to feminist scholarship. Annual Review of Nursing Research. 2001;19:29–60. [PubMed] [Google Scholar]
  3. Avis NE, Stellato R, Crawford S, Bromberger J, Ganz P, Cain V, Kagawa-Singer M. Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups. Social Science and Medicine. 2001;52:345–356. doi: 10.1016/s0277-9536(00)00147-7. [DOI] [PubMed] [Google Scholar]
  4. Baehring TU, Schulze H, Bornstein SR, Scherbaum WA. Using the world wide web- a new approach to risk identification of diabetes mellitus. International Journal of Medical Informatics. 1997;46:31–39. doi: 10.1016/s1386-5056(97)00049-x. [DOI] [PubMed] [Google Scholar]
  5. Barrera MJ, Glasgow RE, McKay HG, Boles SM, Feil EG. Do Internet-based support interventions change perceptions of social support?: An experimental trial of approaches for supporting diabetes self-management. American Journal of Community Psychology. 2002;30:637–654. doi: 10.1023/A:1016369114780. [DOI] [PubMed] [Google Scholar]
  6. Barrett-Connor E, Espeland MA, Greendale GA, Trabal J, Johnson S, Legault C, Kritz-Silverstein D, Einhorn P. Postmenopausal hormone use following a 3-year randomized clinical trial. Journal of Women’s Health and Gender-Based Medicine. 2000;9:633–643. doi: 10.1089/15246090050118161. [DOI] [PubMed] [Google Scholar]
  7. Beyene Y, Martin MC. Menopausal experiences and bone density of Mayan women in Yucatan, Mexico. Am J Human Biol. 2001;13(4):505–511. doi: 10.1002/ajhb.1082. [DOI] [PubMed] [Google Scholar]
  8. Boston Women’s Health Collective. A book by and for women. Simon & Schuster; New York: 1998. Our bodies, ourselves for the new century. [Google Scholar]
  9. Bowker NI, Liu JH. Are women occupying positions of power online? Demographics of chat room operators. Cyberpsychology and Behavior. 2001;4:631–644. doi: 10.1089/109493101753235232. [DOI] [PubMed] [Google Scholar]
  10. Boyatzis RE. Thematic analysis and code development. Sage; Thousand Oaks: 1998. Transforming qualitative information. [Google Scholar]
  11. Brett KM, Cooper GS. Associations with menopause and menopausal transition in a nationally representative US sample. Maturitas. 2003;45:89–97. doi: 10.1016/s0378-5122(03)00139-7. [DOI] [PubMed] [Google Scholar]
  12. Burns N, Grove SK. The practice of nursing research: Conduct, critique, & utilization. WB Sauders; Philadelphia: 1997. [Google Scholar]
  13. Chim H, Tan BHI, Ang CC, Chew EMD, Chong YS, Saw SM. The prevalence of menopausal symptoms in a community in Singapore. Maturitas. 2002;41:275–282. doi: 10.1016/s0378-5122(01)00299-7. [DOI] [PubMed] [Google Scholar]
  14. Chompootweep S, Tankeyoon M, Yamarat K, Poomsuwan P, Dusitsin N. The menopausal age and climacteric complaints in Thai women in Bangkok. Maturitas. 1993;17:64–71. doi: 10.1016/0378-5122(93)90124-z. [DOI] [PubMed] [Google Scholar]
  15. Coney S. How the medical establishment exploits women. Hunter House; Alameda, CA: 1994. The menopause industry. [Google Scholar]
  16. Fu SY, Anderson D, Courtney M. Cross-cultural menopausal experience: Comparison of Australian and Taiwanese women. Nursing & Health Sciences. 2003;5:77–84. doi: 10.1046/j.1442-2018.2003.00139.x. [DOI] [PubMed] [Google Scholar]
  17. Gill S, Lavoie HB, Bo-Abbas Y, Hall JE. Negative feedback effects of gonadal steroids are preserved with aging in postmenopausal women. Journal of Clinical Endocrinology and Metabolism. 2002;87:2297–2302. doi: 10.1210/jcem.87.5.8510. [DOI] [PubMed] [Google Scholar]
  18. Grisso JA, Freeman EW, Maurin E, Garcia-Espana B, Berlin JA. Racial differences in menopause information and experience of hot flashes. Journal of General Internal Medicine. 1999;14:98–103. doi: 10.1046/j.1525-1497.1999.00294.x. [DOI] [PubMed] [Google Scholar]
  19. Hall JM, Stevens PE. Rigors in feminist research. Advances in Nursing Science. 1999;13:16–29. doi: 10.1097/00012272-199103000-00005. [DOI] [PubMed] [Google Scholar]
  20. Hsiung RC. The best of both worlds: An online self-help group hosted by a mental health professional. Cyberpsychology and Behavior. 2000;3:935–950. [Google Scholar]
  21. Huang MH, Schocken M, Block G, Sowers M, Gold E, Sternfeld B, Seeman T, Greendale GA. Variation in nutrient intakes by ethnicity: Results from the study of women’s health across the nation (SWAN) Menopause. 2002;9:309–319. doi: 10.1097/00042192-200209000-00003. [DOI] [PubMed] [Google Scholar]
  22. Im EO. University of California; San Francisco: 1997. [Google Scholar]
  23. Ismael NN. A study on the menopause in Malaysia. Maturitas. 1994;19:205–209. doi: 10.1016/0378-5122(94)90073-6. [DOI] [PubMed] [Google Scholar]
  24. Keegan TH, Gopalakrishnana G, Sidney S, Quesenberry CP, Kelsey JL. Hormone replacement therapy and risk for foot, distal forearm, proximal humerus, and pelvis fractures. Osteoporosis International. 2003;14:469–475. doi: 10.1007/s00198-003-1379-2. [DOI] [PubMed] [Google Scholar]
  25. Klima CS. Women’s health care: A new paradigm for the 21st century. Journal of Midwifery and Women’s Health. 2001;46:285–291. doi: 10.1016/s1526-9523(01)00164-7. [DOI] [PubMed] [Google Scholar]
  26. Kramish CM, Meier A, Carr C, Enga Z, James AS, Reedy J, Zheng B. Health behavior changes after colon cancer: A comparison of findings from face-to-face and online focus groups. Family and Community Health. 2001;24:88–103. doi: 10.1097/00003727-200110000-00010. [DOI] [PubMed] [Google Scholar]
  27. Kravitz HM, Ganz PA, Bromberger J, Powell LH, Sutton_Tyrrell K, Meyer PM. Sleep difficulty in women at midlife: A community survey of sleep and the menopausal transition. Menopause. 2003;10:19–28. doi: 10.1097/00042192-200310010-00005. [DOI] [PubMed] [Google Scholar]
  28. Laferrere B, Zhu S, Clarkson JR, Yoshioka MR, Krauskopf K. Race, menopause, health-related quality of life, and psychological wellbeing in obese women. Obesity Research. 2002;10:1270–1275. doi: 10.1038/oby.2002.172. [DOI] [PubMed] [Google Scholar]
  29. Lasley BL, Santoro N, Randolf JF, Gold EB, Crawford S, Weiss G, McDonnell DS, Sowers MF. The relationship of circulating dehydroepiandrosterone, testosterone, and estradiol to stages of the menopausal transition and ethnicity. Journal of Clinical Endocrinology and Metabolism. 2002;87:3760–3767. doi: 10.1210/jcem.87.8.8741. [DOI] [PubMed] [Google Scholar]
  30. Lau EMC, Lynn H, Woo J, Melton LJ. Areal and volumetric bone density in Hong Kong Chinese: A comparison with Caucasians living in the United States. Osteoporosis International. 2003;198:1402–1407. doi: 10.1007/s00198-003-1402-7. [DOI] [PubMed] [Google Scholar]
  31. Lawlor DA, Ebrahim S, Smith GD. The association of socio-economic position across the life course and age at menopause: The British women’s heart and health study. International Journal of Obstetrics and Gynaecology. 2003;110:1078–1087. [PubMed] [Google Scholar]
  32. Lock M. The tempering of medical anthropology: troubling natural categories. Medical Anthropology Quarterly. 2001;15:478–492. doi: 10.1525/maq.2001.15.4.478. [DOI] [PubMed] [Google Scholar]
  33. Lock M, Kaufert P, Gilbert P. Cultural construction of the menopausal syndrome: the Japanese case. Maturitas. 1988;10:317–332. doi: 10.1016/0378-5122(88)90067-9. [DOI] [PubMed] [Google Scholar]
  34. Lovejoy JC, Champagne CM, Smith SR, DeJong L, Xie H. Ethnic differences in dietary intakes, physical activity, and energy expenditure in middle-aged, premenopausal women: the Healthy Transitions Study. American Journal of Clinical Nutrition. 2001;74:90–95. doi: 10.1093/ajcn/74.1.90. [DOI] [PubMed] [Google Scholar]
  35. Matthews KA, Abram B, Crawford S, Miles T, Neer R, Powell LH, Wesley D. Body mass index in mid-life women: Relative influence of menopause, hormone use, and ethnicity. International Journal of Obesity and Related Metabolic Disorders. 2001;25:863–873. doi: 10.1038/sj.ijo.0801618. [DOI] [PubMed] [Google Scholar]
  36. McCarthy T. The prevalence of symptoms in menopausal women in the far east: Singapore segment. Maturitas. 1994;19:199–204. doi: 10.1016/0378-5122(94)90072-8. [DOI] [PubMed] [Google Scholar]
  37. McCrohon JA, Woo KS, Celermajer DS. A comparison of endothelial function in Caucasian and Chinese women before and after the menopause. Maturitas. 2000;35:31–37. doi: 10.1016/s0378-5122(00)00102-x. [DOI] [PubMed] [Google Scholar]
  38. Murtagh MJ, Hepworth J. Feminist ethics and menopause: Autonomy and decision-making in primary medical care. Social Science and Medicine. 2003;56:1643–1652. doi: 10.1016/s0277-9536(02)00172-7. [DOI] [PubMed] [Google Scholar]
  39. National Women’s Health Network. The truth about hormone replacement therapy : How to break free from the medical myths of menopause. Prima Pub; Roseville, CA: 2002. [Google Scholar]
  40. Parfitt AM, Han ZH, Palnitkar S, Rao DS, Shih MS, Nelson D. Effects of ethnicity and age or menopause on osteoblast function, bone mineralization, and osteoid accumulation in iliac bone. Journal of Bone and Mineral Research. 1997;12:1864–1873. doi: 10.1359/jbmr.1997.12.11.1864. [DOI] [PubMed] [Google Scholar]
  41. Probst-Hensch NM, Pike MC, McKean-Cowdin R, Stanczyk FZ, N KL, Henderson BE. Ethnic differences in post-menopausal plasma oestrogen levels: high oestrone levels in Japanese-American women despite low weight. British Journal of Cancer. 2000;82:1867–1870. doi: 10.1054/bjoc.1999.1082. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Ramoso-Jalbuena J. Climacteric Filipino women: A preliminary survey in the Philippines. Maturitas. 1994;19:183–190. doi: 10.1016/0378-5122(94)90070-1. [DOI] [PubMed] [Google Scholar]
  43. Randolf JF, Sowers M, Gold EB, Mohr BA, Luborsky J, Santoro N, McConnell DS, Finkelstein JS, Korenman SG, Matthews KA, Sternfeld B, Lasley BL. Reproductive hormones in the early menopausal transition: Relationship to ethnicity, body size, and menopausal status. Journal of Clinical Endocrinology and Metabolism. 2003;88:1516–1622. doi: 10.1210/jc.2002-020777. [DOI] [PubMed] [Google Scholar]
  44. Riggs BL. Endocrine causes of age-related bone loss and osteoporosis. Novartis Foundation Symposium. 2002;242:247–259. [PubMed] [Google Scholar]
  45. Rossouw JE, Prentice RL, Manson JE, Wu LL, Barad D, Barnabei VM, Ko M, LaCroix AZ, Margolis KL, Stefnick ML. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. Journal of American Medical Association. 2007;297:1465–1477. doi: 10.1001/jama.297.13.1465. [DOI] [PubMed] [Google Scholar]
  46. Sajatovic M, Rosenthal MB, Plax MS, Meyer ML, Bingham CR. Mental illness and menopause: A patient and family perspective. Journal of Gender-Specific Medicine. 2003;6:31–34. [PubMed] [Google Scholar]
  47. Samil RS, Wishnuwardhani SD. Health of Indonesian women city-dwellers of perimenopausal age. Maturitas. 1994;19:191–197. doi: 10.1016/0378-5122(94)90071-x. [DOI] [PubMed] [Google Scholar]
  48. Sampselle CM, Harris V, Harlow SD, Sowers MF. Midlife development and menopause in African American and Caucasian women. Health Care for Women International. 2002;23:351–363. doi: 10.1080/0739933029008928. [DOI] [PubMed] [Google Scholar]
  49. Samsioe G. HRT and cardiovascular disease. Annals of the New York Academy of Sciences. 2003;997:358–372. doi: 10.1196/annals.1290.039. [DOI] [PubMed] [Google Scholar]
  50. Sommer B, Avis N, Meyer P, Ory M, Madden T, Kagawa-Singer M, Mouton C, Rasor NO, Adler S. Attitudes toward menopause and aging across ethnic/racial groups. Psychosomatic Medicine. 1999;61:868–875. doi: 10.1097/00006842-199911000-00023. [DOI] [PubMed] [Google Scholar]
  51. Sowers M, Pope S, Welch G, Sternfeld B, Albrecht G. The association of menopause and physical functioning in women at midlife. Journal of the American Geriatircs Society. 2001;49:1485–1492. doi: 10.1046/j.1532-5415.2001.4911241.x. [DOI] [PubMed] [Google Scholar]
  52. Stevens PE. Focus groups: Collecting aggregate-level data to understand community health phenomena. Public Health Nursing. 1996;13:170–176. doi: 10.1111/j.1525-1446.1996.tb00237.x. [DOI] [PubMed] [Google Scholar]
  53. Sukwatana P, Meekhangvan J, Tamrongterakul T, Tanapat Y, Asavarait S, Boonjitrpimon P. Menopausal symptoms among Thai women in Bangkok. Maturitas. 1991;13:217–228. doi: 10.1016/0378-5122(91)90196-w. [DOI] [PubMed] [Google Scholar]
  54. Tang GWK. The climacteric of Chinese factory workers. Maturitas. 1994;19:177–182. doi: 10.1016/0378-5122(94)90069-8. [DOI] [PubMed] [Google Scholar]
  55. The Authors. Meanings of menopause to low income Korean immigrant women. Western Journal of Nursing Research. 2000;22(1):84–102. [Google Scholar]
  56. U.S. Department of Health and Human Services. NIH News. Additional analyses from the women’s health initiative. NHLBI media availability: Effect of hormone therapy on risk of heart disease may vary by age and years since menopause. U.S. Department of Health and Human Services; Washington DC: 2007. [Google Scholar]
  57. Whiteman MK, Staropoli CA, Benedict JC, Borgeest C, Flaws JA. Risk factors for hot flashes in midlife women. Journal of Womens Health. 2003;12:459–472. doi: 10.1089/154099903766651586. [DOI] [PubMed] [Google Scholar]
  58. Wilbur J, Miller AM, Montgomery A, Chandler P. Sociodemographic characteristics, biological factors, and symptom reporting in midlife women. Menopause. 1998;5:43–51. [PubMed] [Google Scholar]

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