Menopause Quiz: Understanding Key Concepts

RCSI: Menopause: Psychosocial Impact

• Class: Year 2 Direct Entry Medicine Bahrain
• Course: Endocrinology and Breast
• Lecturer: Dr Sally Doherty
• Date: February 2024

Case Study: Samah

• Patient Profile: A 33-year-old woman experiencing tiredness, irritability, and hot flashes.
• GP Findings: The patient is experiencing premature ovarian insufficiency, not pregnancy.
• Family History: Her mother has a history of early menopause.
• Pressure: Significant pressure from her mother-in-law to have children.
• Impact: The news of premature ovarian insufficiency significantly upset the patient.

Learning Outcomes

• Menopause Definition: Permanent cessation of menstruation due to ovarian follicular activity loss.
• Menopause Stages: Includes perimenopause, menopause, and postmenopause.
• Psychosocial Impact: Addresses the emotional and social effects of menopause, encompassing meanings, reactions, cognitive responses, and behaviours.
• Strategies: Describes strategies to support patients in managing the psychosocial effects of menopause.

What is Menopause?

• WHO Definition: Permanent cessation of menstruation attributed to the loss of ovarian follicular activity.
• Comprehensive Term: Menopause includes various stages like perimenopause, postmenopause, early menopause, and induced menopause.
• Natural Process: Menopause is an unavoidable part of life for women experiencing menstruation, influenced by hormonal changes.
• Age Range: Typically occurs between ages 45 and 55, with an average age of 51 in Ireland and Europe.
• Life Expectancy: Menopause occurs for approximately one-third of a woman's life expectancy.

Menopause is Not an Illness

• Natural End of Fertility: Menopause signifies the natural end of female fertility.
• Hormonal Changes: The production of estrogen and progesterone declines with age.
• Menstrual Cessation: Menopause officially begins when menstruation has ceased for 12 consecutive months.
• Age Range: Can occur as early as in the 30s and as late as the 60s.

Stages of Menopause

• Perimenopause: Period from approximately eight to ten years before menopause where the ovaries produce less estrogen.
• Menopause: The cessation of menstruation for 12 consecutive months.
• Postmenopause: The time following menopause where the symptoms may subside.

Menopause Symptoms

• Physical symptoms: Includes hair loss, weight gain, brittle nails, vaginal dryness, dyspareunia, sleep disorders, fatigue, dizziness, recurrent urinary tract infections, incontinence, breast pain, headaches, joint pain, irregular periods, palpitations.
• Psychological symptoms: Include mood swings, depression, anxiety, irritability, difficulty concentrating, memory lapses, and loss of libido.
• Vasomotor symptoms: Hot flashes and night sweats.

Psychosocial Impact of Menopause

• Psychological Perspectives: Assesses the meanings and appraisals of menopause symptoms along with emotional, cognitive, and behavioral responses.
• Social Factors: Considers socioeconomic and demographic factors, lifestyle choices, careers, roles, and various life stressors.

Psychosocial Impact: Knowledge

• Degree of Understanding: Refers to the extent of a person's understanding of changes in their body during the transition from potential reproductive function to non-reproductive state.
• Knowledge and Quality of Life: Higher knowledge leads to improved quality of life, and lower knowledge is associated with negative attitudes.
• Knowledge Barriers: Include lack of information, social stigma, and shame.

Psychosocial Impact: Attitudes

• Evaluative Opinions: Menopause attitudes encompass evaluative opinions, expressions of feelings, and mental changes toward the transition.
• Mental Attitude and Readinesss: Includes readiness to respond to certain events and situations.
• Negative Attitudes and Symptoms: Negative menopause attitudes are linked to worse symptom management/experiences.
• Positive Attitudes and Symptom Management: Positive attitudes are associated with better management of menopause symptoms.

Psychosocial Impact: Cultural Attitudes

• Cultural Variations: Cultural influences vary the ways in which societies perceive menopause, impacting the social context of menopause.
• Beliefs and Experiences Differences between Middle East (Bahrain) and Ireland/UK: Beliefs between these regions, such as viewing it as a "Year of Hope" or "the change," are contrasted.
• Cultural Attitudes on Symptom Rates: Cultural differences influence rates of reported symptoms, as seen in an example study between Japan and European countries.

Psychosocial Impact: Workplace

• Fawcett Report (2022): UK survey of 4,000 participants revealing high rates of "brain fog," difficulties managing symptoms (especially in semi/unskilled workers), job loss, reduced hours, avoidance of promotions due to menopause symptoms.
• Lack of Workplace Support: Many workplaces lack adequate menopause absence policies.

Psychosocial Impact: Depression

• Long History: Depression associated with menopause has long been recognized.

Diathesis-Stress Model

• Pre-Dispositional Vulnerabilities (Diathesis): Includes changes in hormone levels.
• Negative Life Events (Stress): Factors that negatively impact a person's life
• Increased Risk of Depressive symptoms: Combination of pre-existing vulnerabilities and negative impacts leads to higher risk of depression.
• Behavioral Interventions: Addressing depressive symptoms requires a combination of hormone treatments and behavioral, cognitive, and emotional interventions.

Physical Interventions

• Impacting Quality of Life: Sleep disturbances, trauma, and hot flashes can significantly negatively impact a person's quality of life.
• Cognitive Behavioral Therapy (CBT): effective interventions like CBT-I and BBT-I have been effective in managing sleep disturbances, hot flashes and other menopause symptoms.

Cognitive Behavioural Therapy (CBT)

• Non-medical Approach: A short-term, non-medical approach to help with anxiety, stress, depressed mood, and symptoms including hot flashes and night sweats, sleep problems,
• Practical Management Techniques: CBT helps develop practical management strategies and coping skills.

CBT for Anxiety and Stress

• Links Between Physical Symptoms, Thoughts and Feelings: CBT understands that how one thinks about physical symptoms affects one's emotions, behaviors, and ultimately experiences.

Hot Flushes

• Triggers: Stimulants, changes in temperature, daily stress, and activities (e.g., rushing to work).
• Diary Tracking: Tracking triggers can lead to better symptom management.
• CBT Approach: CBT helps to address factors that influence emotional responses to the experience of hot flushes.

Conclusions

• Individual Variation: Menopause is unique to each individual and is often associated with challenging symptoms.
• Influence of Knowledge/Attitudes: Individual and societal knowledge and attitudes impact how experiences are defined and managed.
• Disruptive Impact: Menopause can be disruptive, impacting psychological and social well-being.

Resources

• Specific Links: Include verified weblinks.

Workplace and Practical Social Interventions

• High Priority: Recognising the importance of workplace support for menopause symptoms and mental health.
• Specific Interventions: Describes specific interventions such as easy access to toilet facilities, sufficient breaks, provision of quiet spaces, and ergonomic improvements.

6 Unexpected Benefits of Menopause

• End of Periods/PMS relief: No more periods and/or PMS-related stress.
• End of Menstrual Headaches: No more menstrual pain.
• Stress-Free sex: No longer worrying about unplanned pregnancies.
• Sexual Health Improvement: Potential for improved sexual health as pregnancies are no longer a concern.
• Reduced Uterine Fibroids: Reduced stress and impact of fibrous tissues in the uterus.
• Increased Confidence/Inner Strength: Increased self-confidence and personal strength.

Evidence-Based Research Studies

• Survey Findings: Significant instances where individuals do not connect with their GPs about symptoms or receive proper diagnoses.
• Longitudinal Study (SWAN): Ongoing study across seven locations and various sites.

Test your knowledge on menopause with this comprehensive quiz covering definitions, symptoms, psychosocial impacts, and the biopsychosocial model. Learn about the average age of menopause in Europe and how various factors can influence experiences. Ideal for those looking to enhance their understanding of this natural process.