Psychological Climacteric Symptoms and Attitudes toward Menopause among Emirati Women

Amira Mohammed Ali, Afaf Hassan Ahmed, Linda Smail, Amira Mohammed Ali, Afaf Hassan Ahmed, Linda Smail

Abstract

Menopause is an inevitable developmental event that women encounter at an age of 42-54 years. The drop of estrogen levels that accompanies cessation of menstruation is associated with multiple vasomotor, physical, neuropsychological, and sexual symptoms, which may hamper quality of life. This study aimed to examine the severity of psychological symptoms and their correlates among peri- and postmenopausal Emirati women (N = 60, mean age = 54.88 ± 6 years). Participants were interviewed using the Menopause-Specific Quality of Life (MENQOL) and attitudes toward menopause scale (ATMS). In four path analysis models, vasomotor symptoms, weight gain, and fatigue had significant direct effects on symptoms of anxiety, depression (only weight gain and fatigue), and psychological distress. Fatigue significantly mediated the effects of vasomotor symptoms and weight gain on symptoms of anxiety, depression (only vasomotor symptoms), psychological distress, and memory problems. These models explained 47.6%, 44.5%, 56.6%, and 29.1% of the variances in anxiety, depression, psychological distress, and memory problems, respectively. Participants with more severe menopausal symptoms expressed more negative attitudes toward menopause though regression analysis revealed that only vasomotor symptoms could significantly contribute to ATMS scores. In conclusion, psychological distress is widespread among menopausal women, and it is associated with vasomotor symptoms, fatigue, and change of body composition (obesity). Psychological symptoms, along with vasomotor symptoms, express a key link to negative attitudes toward menopause. Therefore, interventional strategies that target psychological distress may promote coping with midlife transition and improve mental health among menopausal women.

Keywords: Arab; Emirate; anxiety; attitudes toward menopause; body weight/obesity; depression; fatigue; memory; menopause; psychological distress; quality of life; sexual symptoms; sleep; vasomotor symptoms.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Hypothesized model of the relationships between vasomotor symptoms, weight gain, difficulty sleeping, fatigue, and psychological variables.
Figure 2
Figure 2
Definitions of key variables in this study. MENQOL: Menopause-Specific Quality of Life scale.
Figure 3
Figure 3
Results of trimmed path analysis models with standardized beta weights, standard errors, and significance values depicting relationships of vasomotor symptoms, weight gain, difficulty sleeping, and fatigue with symptoms of anxiety (Panel a), depression (Panel b), psychological distress (Panel c), and memory problems (Panel d) among menopausal women. * p < 0.05, ** p < 0.01. Dotted lines represent trimmed paths.

References

    1. Santoro N., Epperson C.N., Mathews S.B. Menopausal Symptoms and Their Management. Endocrinol. Metab. Clin. N. Am. 2015;44:497–515. doi: 10.1016/j.ecl.2015.05.001.
    1. Smail L., Jassim G.A., Al-Shboul Q.M., Hattawi A.S. Emirati women’s attitudes towards menopause: Implications for health care policy. Post Reprod. Health. 2019;25:71–79. doi: 10.1177/2053369119848888.
    1. Kunugi H., Ali A.M. Royal Jelly and Its Components Promote Healthy Aging and Longevity: From Animal Models to Humans. Int. J. Mol. Sci. 2019;20:4662. doi: 10.3390/ijms20194662.
    1. Smail L., Jassim G., Shakil A. Menopause-Specific Quality of Life among Emirati Women. Int. J. Environ. Res. Public Health. 2020;17:40. doi: 10.3390/ijerph17010040.
    1. Wilbur J., Shaver J., Kogan J., Buntin M., Wang E. Menopausal Transition Symptoms in Midlife Women Living with Fibromyalgia and Chronic Fatigue. Health Care Women Int. 2006;27:600–614. doi: 10.1080/07399330600803741.
    1. Casaletto K.B., Elahi F.M., Staffaroni A.M., Walters S., Contreras W.R., Wolf A., Dubal D., Miller B., Yaffe K., Kramer J.H. Cognitive aging is not created equally: Differentiating unique cognitive phenotypes in “normal” adults. Neurobiol. Aging. 2019;77:13–19. doi: 10.1016/j.neurobiolaging.2019.01.007.
    1. Fares M.Y., Fares J., Baydoun H., Fares Y. Sport and exercise medicine research activity in the Arab world: A 15-year bibliometric analysis. BMJ Open Sport Exerc. Med. 2017;3:e000292. doi: 10.1136/bmjsem-2017-000292.
    1. World Population Review Arab Countries 2020. [(accessed on 23 June 2020)]; Available online:
    1. El Hajj A., Wardy N., Haidar S., Bourgi D., Haddad M.E., Chammas D.E., El Osta N., Rabbaa Khabbaz L., Papazian T. Menopausal symptoms, physical activity level and quality of life of women living in the Mediterranean region. PLoS ONE. 2020;15:e0230515. doi: 10.1371/journal.pone.0230515.
    1. Gharaibeh M., Al-Obeisat S., Hattab J. Severity of menopausal symptoms of Jordanian women. Climacteric. 2010;13:385–394. doi: 10.3109/13697130903050009.
    1. Gava G., Orsili I., Alvisi S., Mancini I., Seracchioli R., Meriggiola M.C. Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy. Medicina. 2019;55:668. doi: 10.3390/medicina55100668.
    1. Maki P.M., Henderson V.W. Cognition and the menopause transition. Menopause. 2016;23:803–805. doi: 10.1097/GME.0000000000000681.
    1. Hussain A., Tabrez E.S., Muhammad A., Peela J.R. The Mechanisms of Dietary Phytoestrogen as a Potential Treatment and Prevention Agent against Alzheimer’s Disease. Crit. Rev. Eukaryot. Gene Expr. 2018;28:321–327. doi: 10.1615/CritRevEukaryotGeneExpr.2018025847.
    1. Minami A., Matsushita H., Ieno D., Matsuda Y., Horii Y., Ishii A., Takahashi T., Kanazawa H., Wakatsuki A., Suzuki T. Improvement of neurological disorders in postmenopausal model rats by administration of royal jelly. Climacteric. 2016;19:568–573. doi: 10.1080/13697137.2016.1238452.
    1. Weiser M.J., Grimshaw V., Wynalda K.M., Mohajeri M.H., Butt C.M. Long-Term Administration of Queen Bee Acid (QBA) to Rodents Reduces Anxiety-Like Behavior, Promotes Neuronal Health and Improves Body Composition. Nutrients. 2017;10:13. doi: 10.3390/nu10010013.
    1. Llaneza P., García-Portilla M.P., Llaneza-Suárez D., Armott B.n., Pérez-López F.R. Depressive disorders and the menopause transition. Maturitas. 2012;71:120–130. doi: 10.1016/j.maturitas.2011.11.017.
    1. Soares C.N. Taking a fresh look at mood, hormones, and menopause. Menopause. 2020;27:371–373. doi: 10.1097/GME.0000000000001506.
    1. Shea A.K., Sohel N., Gilsing A., Mayhew A.J., Griffith L.E., Raina P. Depression, hormone therapy, and the menopausal transition among women aged 45 to 64 years using Canadian Longitudinal Study on aging baseline data. Menopause. 2020 doi: 10.1097/GME.0000000000001540.
    1. Erbil N. Attitudes towards menopause and depression, body image of women during menopause. Alex. J. Med. 2018;54:241–246. doi: 10.1016/j.ajme.2017.05.012.
    1. Simon J.A. Depression, anxiety, and “the incredible shrinking vagina”. Menopause. 2020;27:125–126. doi: 10.1097/GME.0000000000001487.
    1. Ali A.M., Hendawy A.O. So, Antidepressant Drugs have Serious Adverse Effects, but what are the Alternatives? Nov. Approaches Drug Des. Dev. 2018;4:555636. doi: 10.19080/NAPDD.2018.04.555636.
    1. Converso D., Viotti S., Sottimano I., Loera B., Molinengo G., Guidetti G. The relationship between menopausal symptoms and burnout. A cross-sectional study among nurses. BMC Womens Health. 2019;19 doi: 10.1186/s12905-019-0847-6.
    1. Meyer F., Freeman M.P., Petrillo L., Barsky M., Galvan T., Kim S., Cohen L., Joffe H. Armodafinil for fatigue associated with menopause: An open-label trial. Menopause. 2016;23:209–214. doi: 10.1097/GME.0000000000000505.
    1. Chiu H.-H., Tsao L.-I., Lin M.-H. Suffering Exhausted Life Like Burning at Both Ends of a Candle -Women with Menopausal Fatigue. Int. J. Stud. Nurs. 2020;5:95–102. doi: 10.20849/ijsn.v5i1.722.
    1. Doncker W.D., Dantzer R., Ormstad H., Kuppuswamy A. Mechanisms of poststroke fatigue. J. Neurol Neurosurg. Psychiatry. 2017:1–7. doi: 10.1136/jnnp-2017-316007.
    1. Larkin D., Martin C.R. The interface between chronic fatigue syndrome and depression: A psychobiological and neurophysiological conundrum. Neurophysiol. Clin. 2017;47:123–129. doi: 10.1016/j.neucli.2017.01.012.
    1. Elavsky S., Gold C.H. Depressed mood but not fatigue mediate the relationship between physical activity and perceived stress in middle-aged women. Maturitas. 2009;64:235–240. doi: 10.1016/j.maturitas.2009.09.007.
    1. Mofid B., Rezaeizadeh H., Termos A., Rakhsha A., Mafi A.R., Taheripanah T., Ardakani M.M., Taghavi S.M.E., Moravveji S.A., Kashi A.S.Y. Effect of Processed Honey and Royal Jelly on Cancer-Related Fatigue: A Double-Blind Randomized Clinical Trial. Electron. Phys. 2016;8:2475–2482. doi: 10.19082/2475.
    1. Younus J., Simpson I., Collins A., Wang X. Mind control of menopause. Womens Health Issues. 2003;13:74–78. doi: 10.1016/S1049-3867(02)00196-2.
    1. Jenabi E., Shobeiri F., Hazavehei S.M.M., Roshanaei G. Assessment of Questionnaire Measuring Quality of Life in Menopausal Women: A Systematic Review. Oman Med. J. 2015;30:151–156. doi: 10.5001/omj.2015.34.
    1. Welch A.A., Hayhoe R.P.G., Cameron D. The relationships between sarcopenic skeletal muscle loss during ageing and macronutrient metabolism, obesity and onset of diabetes. Proc. Nutr. Soc. 2020;79:158–169. doi: 10.1017/S0029665119001150.
    1. Keller K. Sarcopenia. Wien. Med. Wochenschr. 2019;169:157–172. doi: 10.1007/s10354-018-0618-2.
    1. Sharman M.J., Verdile G., Kirubakaran S., Münch G. Neurodegeneration and Alzheimer’s Disease: The Role of Diabetes, Genetics, Hormones, and Lifestyle. Wiley; Hoboken, NJ, USA: 2019. Inflammation in Alzheimer’s Disease, and Prevention with Antioxidants and Phenolic Compounds—What Are the Most Promising Candidates? pp. 233–266.
    1. Kiecolt-Glaser J.K., Derry H.M., Fagundes C.P. Inflammation: Depression fans the flames and feasts on the heat. Am. J. Psychiatry. 2015;172:1075–1091. doi: 10.1176/appi.ajp.2015.15020152.
    1. Hassan A.M., Mancano G., Kashofer K., Fröhlich E.E., Matak A., Mayerhofer R., Reichmann F., Olivares M., Neyrinck A.M., Delzenne N.M., et al. High-fat diet induces depression-like behaviour in mice associated with changes in microbiome, neuropeptide Y, and brain metabolome. Nutr. Neurosci. 2018:1–17. doi: 10.1080/1028415X.2018.1465713.
    1. Barth Olofsson A.S., Collins A. Psychosocial factors, attitude to menopause and symptoms in Swedish perimenopausal women. Climacteric. 2000;3:33–42. doi: 10.3109/13697130009167597.
    1. Zhang X., Wang G., Wang H., Wang X., Ji T., Hou D., Wu J., Sun J., Zhu B. Spouses’ perceptions of and attitudes toward female menopause: A mixed-methods systematic review. Climacteric. 2020;23:148–157. doi: 10.1080/13697137.2019.1703937.
    1. Murphy M.M., Verjee M.A., Bener A., Gerber L.M. The hopeless age? A qualitative exploration of the experience of menopause in Arab women in Qatar. Climacteric. 2013;16:550–554. doi: 10.3109/13697137.2013.771330.
    1. Palacios S., Henderson V.W., Siseles N., Tan D., Villaseca P. Age of menopause and impact of climacteric symptoms by geographical region. Climacteric. 2010;13:419–428. doi: 10.3109/13697137.2010.507886.
    1. Rizk D.E.E., Bener A., Ezimokhai M., Hassan M.Y., Micallef R. The age and symptomatology of natural menopause among United Arab Emirates women. Maturitas. 1998;29:197–202. doi: 10.1016/S0378-5122(98)00010-3.
    1. Hilditch J.R., Lewis J., Peter A., van Maris B., Ross A., Franssen E., Guyatt G.H., Norton P.G., Dunn E. A menopause-specific quality of life questionnaire: Development and psychometric properties. Maturitas. 2008;61:107–121. doi: 10.1016/j.maturitas.2008.09.014.
    1. Gazibara T., Kovacevic N., Nurkovic S., Kurtagic I., Radovanovic S., Rancic B., Terzic M., Dotlic J. Menopause-specific Quality of Life Questionnaire: Factor and Rasch analytic approach. Climacteric. 2019;22:90–96. doi: 10.1080/13697137.2018.1535585.
    1. Ali A.M., Ahmed A., Sharaf A., Kawakami N., Abdeldayem S.M., Green J. The Arabic Version of The Depression Anxiety Stress Scale-21: Cumulative scaling and discriminant-validation testing. Asian J. Psychiatry. 2017;30:56–58. doi: 10.1016/j.ajp.2017.07.018.
    1. Ali A.M., Green J. Differential Item Functioning of the Arabic Version of the Depression Anxiety Stress Scale-21 (DASS-21) JOJ Nurse Health Care. 2017;4 doi: 10.19080/JOJNHC.2017.04.555646.
    1. Ali A.M., Green J. Factor structure of the depression anxiety stress Scale-21 (DASS-21): Unidimensionality of the Arabic version among Egyptian drug users. Subst. Abuse Treat. Prev. Policy. 2019;14:40. doi: 10.1186/s13011-019-0226-1.
    1. Harpe S.E. How to analyze Likert and other rating scale data. Curr. Pharm. Teach. Learn. 2015;7:836–850. doi: 10.1016/j.cptl.2015.08.001.
    1. Chedraui P., Pérez-López F.R., Morales B., Hidalgo L. Depressive symptoms in climacteric women are related to menopausal symptom intensity and partner factors. Climacteric. 2009;12:395–403. doi: 10.1080/13697130902718150.
    1. Bryant C., Judd F.K., Hickey M. Anxiety during the menopausal transition: A systematic review. J. Affect. Disord. 2012;139:141–148. doi: 10.1016/j.jad.2011.06.055.
    1. Miura K., Ando S., Imai T. The association of cognitive fatigue with menopause, depressive symptoms, and quality of life in ambulatory breast cancer patients. Breast Cancer. 2016;23:407–414. doi: 10.1007/s12282-014-0578-3.
    1. Wilson N., Lee J.J., Bei B. Postpartum fatigue and depression: A systematic review and meta-analysis. J. Affect. Disord. 2019;246:224–233. doi: 10.1016/j.jad.2018.12.032.
    1. Nunez N.A., Singh B., Romo-Nava F., Joseph B., Veldic M., Cuellar-Barboza A., Cabello Arreola A., Vande Voort J.L., Croarkin P., Moore K.M., et al. Efficacy and tolerability of adjunctive modafinil/armodafinil in bipolar depression: A meta-analysis of randomized controlled trials. Bipolar Disord. 2020;22:109–120. doi: 10.1111/bdi.12859.
    1. Morita H., Ikeda T., Kajita K., Fujioka K., Mori I., Okada H., Uno Y., Ishizuka T. Effect of royal jelly ingestion for six months on healthy volunteers. Nutr. J. 2012;11:77. doi: 10.1186/1475-2891-11-77.
    1. Grosicki G.J., Fielding R.A., Lustgarten M.S. Gut Microbiota Contribute to Age-Related Changes in Skeletal Muscle Size, Composition, and Function: Biological Basis for a Gut-Muscle Axis. Calcif. Tissue Int. 2018;102:433–442. doi: 10.1007/s00223-017-0345-5.
    1. Bleau C., Karelis A.D., St-Pierre D.H., Lamontagne L. Crosstalk between intestinal microbiota, adipose tissue and skeletal muscle as an early event in systemic low-grade inflammation and the development of obesity and diabetes. Diabetes Metab. Res. Rev. 2015;31:545–561. doi: 10.1002/dmrr.2617.
    1. Ali A.M., Kunugi H. Bee honey protects astrocytes against oxidative stress: A preliminary in vitro investigation. Neuropsychopharmacol. Rep. 2019;39:312–314. doi: 10.1002/npr2.12079.
    1. Schmitz N., Deschenes S.S., Burns R.J., Danna S.M., Franco O.H., Ikram M.A., Kivimaki M., Singh-Manoux A., Tiemeier H. Cardiometabolic dysregulation and cognitive decline: Potential role of depressive symptoms. Br. J. Psychiatry. 2018;212:96–102. doi: 10.1192/bjp.2017.26.
    1. Moazzami K., Lima B.B., Sullivan S., Shah A., Bremner J.D., Vaccarino V. Independent and joint association of obesity and metabolic syndrome with depression and inflammation. Health Psychol. 2019;38:586–595. doi: 10.1037/hea0000764.
    1. André C., Catania C., Remus-Borel J., Ladeveze E., Leste-Lasserre T., Mazier W., Binder E., Gonzales D., Clark S., Guzman-Quevedo O., et al. mTORC1 pathway disruption abrogates the effects of the ciliary neurotrophic factor on energy balance and hypothalamic neuroinflammation. Brain Behav. Immun. 2018;70:325–334. doi: 10.1016/j.bbi.2018.03.014.
    1. Pyrzanowska J., Wawer A., Joniec-Maciejak I., Piechal A., Blecharz-Klin K., Graikou K., Chinou I., Widy-Tyszkiewicz E. Long-term administration of Greek Royal Jelly decreases GABA concentration in the striatum and hypothalamus of naturally aged Wistar male rats. Neurosci. Lett. 2018;675:17–22. doi: 10.1016/j.neulet.2018.03.034.
    1. Ghazanfarpour M., Kaviani M., Abdolahian S., Bonakchi H., Najmabadi Khadijeh M., Naghavi M., Khadivzadeh T. The relationship between women’s attitude towards menopause and menopausal symptoms among postmenopausal women. Gynecol. Endocrinol. 2015;31:860–865. doi: 10.3109/09513590.2015.1056138.
    1. Ayers B., Forshaw M., Hunter M.S. The impact of attitudes towards the menopause on women’s symptom experience: A systematic review. Maturitas. 2010;65:28–36. doi: 10.1016/j.maturitas.2009.10.016.
    1. Jahrami H.A., Alsibai J., Clark C.C.T., Faris M.e.A.-I.E. A systematic review, meta-analysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on body weight in healthy subjects aged 16 years and above. Eur. J. Nutr. 2020 doi: 10.1007/s00394-020-02216-1.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe