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Women's knowledge, attitudes, and management of the menopausal transition
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Hormone therapy (HT) has been considered as a safe treatment for menopausal symptoms. Use of HT increased dramatically in the 1980s and 1990s. Results from large randomized clinical trials (RCT) could, around the turn of the century, however not find evidence for long-term benefits with HT. These results attracted great attention from media and the scientific community leading to changed treatment guidelines and decreased use of HT.

Aim: The overall aim of this thesis was to explore Swedish women’s conceptions, knowledge, management, and attitudes regarding the menopausal transition and HT.

Material and methods: To explore and describe women’s conceptions of the menopausal transition women seeking medical advice due to climacteric symptoms were interviewed (n=20) and their statements were analyzed with a qualitative method (paper I). In 1999 (n=1760) and 2003 (n=1733) attitudes to (paper II) and knowledge of (paper III) the menopausal transition and HT among 53- and 54 year old women were investigated with a cross-sectional design using postal questionnaires. We also analyzed if attitudes differed before and after new scientific findings were published on risks and benefits of HT and if knowledge differed between educational levels. Since many women try to abandon use of HT a RCT was performed to study the effect of two different methods to discontinue HT, on recurrence of hot flushes, resumption of HT and on health related quality of life (HRQoL). Women (n=87) with vasomotor symptoms before initiating HT participated.

Results: We found that the majority of the middle aged women in our study viewed the menopausal transition as a natural process the nature of which is affected by both hormonal changes and by ageing. Each woman seems to experience a set of psychological and physical symptoms that are in some sense unique to her experience. Women’s answers to the questions about HT demonstrate that attitudes towards HT held by women going through menopause have changed rather dramatically between 1999 and 2003. These changes probably reflect the influence on the women of media reports based on research that identified risks associated with HT that had not been identified before 1998.

Women’s knowledge of the effects of HT seems to be unsatisfactory from a clinical perspective. No differences in hot flush frequency and resumption of HT were found between the women randomized to two different modes of discontinuation of HT. Almost 50 % of the women restarted HT within one year after discontinuation. Deteriorated wellbeing and severity of hot flushes were important predicting factors for resumption of HT.

Conclusion: It is important to be aware of the individual woman’s conceptions and attitudes about and knowledge of the menopausal transition and HT to be able to individualize the counselling situation. Women who initiate HT due to hot flushes may experience recurrence of vasomotor symptoms and deteriorated HRQoL after discontinuation. A great proportion of them may resume HT. At present knowledge of possible advantages for the taper-down method when discontinuing HT is still lacking.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2009. , 67 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1153
Keyword [en]
Menopause, hormone therapy, knowledge, attitudes, conceptions, management/treatment, climacteric symptoms, hot flushes
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-21896ISBN: 978-91-7393-531-9 (print)OAI: oai:DiVA.org:liu-21896DiVA: diva2:241966
Public defence
2009-10-30, Aulan, Hälsans Hus, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-10-12 Created: 2009-10-06 Last updated: 2009-10-12Bibliographically approved
List of papers
1. Women’s conception of the menopausal transition – a qualitative study
Open this publication in new window or tab >>Women’s conception of the menopausal transition – a qualitative study
2007 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, Vol. 16, no 3, 509-517 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To explore, with a qualitative approach, whether the conception of menopause varies between women seeking medical advice due to climacteric symptoms and, if so, to describe these different conceptions.

Background: For many women, the menopausal transition is a troublesome period of life, often associated with decreased well-being and a number of symptoms. Besides the hormonal changes, many other factors such as psychological, sociological and lifestyle factors affect how women perceive their menopause.

Method: Semi-structured interviews were held with 20 women after their first-time visits at outpatient clinics of gynaecology for discussion of climacteric symptoms. The interviews were audio-taped, transcribed and analysed using a phenomenographic approach.

Results: A wide variation of conceptions was revealed. Two main categories were identified including different physical changes with varying symptoms and both positive and negative psychological changes. The menopausal transition was also described as a natural process and as a developmental phase of life.

Conclusion and relevance to clinical practice: Women’s conceptions of the menopausal transition were individual and contained both physical and psychological symptoms but also expressed a more holistic view of the menopausal transition. The transition was described as a natural process affected by endocrine and life-style factors as well as by the psychosocial situation and by aging per se. It is important that health care providers are aware of women’s conceptions about the menopausal transition to be able to communicate optimally, support and empower middle-aged women in different health care situations and thereby optimise the result of care.

Place, publisher, year, edition, pages
Institutionen för klinisk och experimentell medicin, 2007
Keyword
Phenomenography, conceptions, menopausal transition, qualitative study, nurses, nursing.
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-11699 (URN)10.1111/j.1365-2702.2005.01547.x (DOI)
Note
The definitive version is available at www.blackwell-synergy.com: Lotta Lindh-Åstrand, Mikael Hoffmann, Mats Hammar and Karin I Kjellgren, Women’s conception of the menopausal transition – a qualitative study, 2007, Journal of Clinical Nursing, (16), 3, 509-517. http://dx.doi.org/10.1111/j.1365-2702.2005.01547.x. Copyright: Blackwell Publishing www.blackwell-synergy.comAvailable from: 2008-04-29 Created: 2008-04-29 Last updated: 2009-10-12Bibliographically approved
2. Attitudes towards the menopause and hormone therapy over the turn of the century
Open this publication in new window or tab >>Attitudes towards the menopause and hormone therapy over the turn of the century
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2007 (English)In: Maturitas, ISSN 0378-5122, Vol. 56, no 1, 12-20 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To assess attitudes and beliefs about the menopausal transition in a population of peri- and postmenopausal women, and if these attitudes differed before and after publication of studies on risks and benefits with hormone therapy (HT).

Material and methods: In 1999 and 2003 all women aged 53 and 54 years in the community of Linköping, Sweden, were sent a questionnaire about use of HT, menopausal status and attitudes regarding menopause and HT.

Results: Most women regarded menopause as a natural process characterized by both hormonal deficiency and aging and these views did not differ between 1999 and 2003. A majority of women thought that significant climacteric symptoms were a good reason to use HT, but not that women without symptoms should use HT. The fraction of women who supported HT use was, however, significantly lower in 2003 than in 1999. Most women agreed that menopause leads to increased freedom and that it is a relief not to have to think about contraception and pregnancies.

Conclusions: Most Swedish women had a mainly biological view on menopause but nevertheless they thought that only women with climacteric symptoms should use HT. Women’s attitudes towards HT have changed after recent reports on risks from long-term use of HT whereas the attitudes towards the menopausal transition were stable. Other factors than attitudes towards menopause affect women’s actual use of HT. Probably women’s and health care provider’s apprehension of the risk-benefit balance of HT use is one such factor.

Place, publisher, year, edition, pages
Institutionen för klinisk och experimentell medicin, 2007
Keyword
Menopause transition, climacteric, attitudes to menopause, attitudes to hormone therapy, population-based questionnaire
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-11697 (URN)10.1016/j.maturitas.2006.05.002 (DOI)
Note
Original publication: Lotta Lindh-Åstrand, Jan Brynhildsen, Mikael Hoffmann, Susanne Liffner and Mats Hammar, Attitudes towards the menopause and hormone therapy over the turn of the century, 2007, Maturitas, (56), 1, 12-20. http://dx.doi.org/10.1016/j.maturitas.2006.05.002. Copyright: Elsevier B.V., http://www.elsevier.com/Available from: 2008-04-29 Created: 2008-04-29 Last updated: 2009-10-12Bibliographically approved
3. Knowledge of reproductive physiology and hormone therapy in 53- to 54-year-old Swedish women: a population-based study.
Open this publication in new window or tab >>Knowledge of reproductive physiology and hormone therapy in 53- to 54-year-old Swedish women: a population-based study.
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2007 (English)In: Menopause, ISSN 1072-3714, Vol. 14, no 6, 1039-1046 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate knowledge of hormone therapy (HT), reproductive physiology, and menopause in a population of 53- to 54-year-old women. Further aims were to determine whether the knowledge differed between users and nonusers of HT and between groups with different levels of education.

DESIGN: In 2003, all 53- and 54-year-old women (N = 1,733) in Linköping, Sweden, were sent a questionnaire containing questions about reproductive physiology related to menopause and HT. Answers from 73% of the women were analyzed.

RESULTS: Swedish women had limited knowledge of HT, reproductive physiology, and menopause irrespective of HT use or educational level. Most of the women knew that hot flashes are common around menopause and decreasing estrogen production causes the menopause. They knew little about the effects of progestagens and the effects of HT on fertility. Women with low educational level were more likely to answer the questions by stating that they were unsure than did women with high educational level. Ever-users of HT knew more than never-users about risks and benefits of HT in relation to breast cancer and osteoporosis, and ever-users thought that the risks of thrombosis and myocardial infarction were lower than did never-users.

CONCLUSIONS: Women need improved knowledge of the risks and benefits of HT as well as education about the reproductive system around menopause. This would probably better support and empower women to manage an important period of their lives.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-20096 (URN)10.1097/gme.0b013e31803816ca (DOI)17519805 (PubMedID)
Note
This is a non-final version of an article published in final form in: Lotta Lindh-Åstrand, Jan Brynhildsen, Mikael Hoffmann, Karin I Kjellgren and Mats Hammar, Knowledge of reproductive physiology and hormone therapy in 53- to 54-year-old Swedish women: a population-based study., 2007, Menopause, (14), 6, 1039-1046. http://dx.doi.org/10.1097/gme.0b013e31803816ca Copyright: Raven Press, Ltd. Available from: 2009-08-28 Created: 2009-08-28 Last updated: 2009-10-12Bibliographically approved
4. A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms.
Open this publication in new window or tab >>A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms.
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2010 (English)In: Menopause (New York, N.Y.), ISSN 1530-0374, Vol. 17, no 1, 72-79 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:: The aim of this study was to investigate whether tapering down of combined estrogen plus progestogen therapy (EPT) reduced the recurrence of hot flashes and resumption of therapy compared with abrupt discontinuation. A secondary aim was to evaluate whether health-related quality of life (HRQoL) was affected after discontinuation of EPT and to investigate the possible factors predicting resumption of EPT.

METHODS:: Eighty-one postmenopausal women undergoing EPT because of hot flashes were randomized to tapering down or abrupt discontinuation of EPT. Vasomotor symptoms were recorded in self-registered diaries, and resumption of hormone therapy (HT) was asked for at every follow-up. The Psychological General Well-being Index was used to assess HRQoL.

RESULTS:: Neither the number nor the severity of hot flashes or HRQoL or frequency of resumption of HT differed between the two modes of discontinuation of EPT during up to 12 months of follow-up. About every other woman had resumed HT within 1 year. Women who resumed HT after 4 or 12 months reported more deteriorated HRQoL and more severe hot flashes after discontinuation of therapy than did women who did not resume HT.

CONCLUSIONS:: Women who initiate EPT because of hot flashes may experience recurrence of vasomotor symptoms and impaired HRQoL after discontinuation of EPT regardless of the discontinuation method used, abrupt or taper down. Because, in addition to severity of flashes, decreased well-being was the main predictor of the risk to resume HT, it seems important to also discuss quality of life in parallel with efforts to discontinue HT.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-20552 (URN)10.1097/gme.0b013e3181b397c7 (DOI)19675505 (PubMedID)
Note
This is a non-final version of an article published in final form in: Lotta Lindh-Åstrand, Marie Bixo, Angelica Hirschberg, Inger Sundström-Poromaa and Mats Hammar, A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms., 2009, Menopause (New York, N.Y.). http://dx.doi.org/10.1097/gme.0b013e3181b397c7 Copyright: Raven Press, Ltd. Available from: 2009-09-11 Created: 2009-09-11 Last updated: 2011-01-19Bibliographically approved

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