Menopause Live - IMS Updates

Date of release: 28 May, 2018

Menopause stage may positively affect menopausal representations

Clinicians often find that their patients approach the menopause transition (MT) and its anticipated physiological and psychological symptoms with trepidation, although it is a natural life transition. Research suggests that a woman’s personal experience of the MT informs menopausal representation and, furthermore, this representation affects both her quality of life and the way in which she deals with the various symptoms of the peri- and postmenopause. Although studies measuring cognitive menopausal representations, using the menopause representations questionnaire (MRQ) [1], found that these representations may affect depressive mood and are related to coping, dealing with symptomatology and quality of life in midlife women, Brown and colleagues suggest that these results are limited since emotional menopausal representations were not included; additional research was needed to investigate the affects of both these menopausal representations and also whether menopausal stage may be associated with differences in these representations [2]. Their cross-sectional study examined both cognitive and emotional aspects of the menopausal representations by including two questionnaires: the MRQ and an emotional representation questionnaire specifically modified to focus on menopause. Data were collected from 387 participants and menopause stage was obtained using the Stages of Reproductive Aging Workshop +10 criteria. They found that there was a strong association between both menopausal cognitive and emotional representations (common variance = 37–62%), and that there were significant differences across menopause stages. The cognitive representation was significantly more positive in postmenopausal women in comparison to peri- and premenopausal women (SMD = 0.25, p > 0.05). This difference was also seen in the positive emotional representation of postmenopausal participants when compared to the peri- and premenopausal participants, and this positive response increased across menopause stage.


Midlife women are inundated with information from the media on the trials and tribulations of the menopause, and this often informs their expectation of the experience. These so-called disadvantages may be presented in a stereotypical and alarmist way by many social media sites [3] (i.e. ‘the seven dwarves of menopause’ meme), in conjunction with sites advertising ‘anti-aging’ products. In addition, cultural perceptions may play a role [4], particularly in Western countries. However, this interesting study suggests that, for women, especially those in postmenopause, the experience may not ‘be as bad’ as they initially thought during the late reproductive and perimenopausal stages. The authors explain that women transitioning into menopause focus mainly on the disadvantages of becoming menopausal, instead of paying attention to the advantages that menopause brings, including freedom from birth control and the end of menstruation.

The authors suggest that the clear differences found in menopausal representations across the menopause stages may be as a result of affect optimism, a coping mechanism used by older adults to process experiences positively; in addition, women who have transitioned through menopause may have developed effective coping strategies to deal with the more troubling symptoms of menopause. In spite of the limitations of the cross-sectional design, this is a well thought-out study that examines both the cognitive and emotional menopausal representations in depth in a group of midlife women, where menopause stage has been accurately assessed using the STRAW+10 crieria. The authors suggest that these results, showing that menopause, for many women, may not ‘be as bad as they think’, are relevant from both clinical and theoretical perspectives. This is an important message and is supported by data that show that, although many women complain of mood disorders, including depression in the MT, only some women experience a first-time onset of a major depressive disorder [5]. Other data show that most women transitioning into menopause do not experience serious mood disorders [6], nor that the MT has an impact on their positive quality of life [7].

However, improved psychoeducation and clinicians’ understanding of why women might experience anxious or depressed mood during the MT beg the question of the vital role that estradiol fluctuations play in depressive symptoms during the MT. Several studies have found that a changing hormonal milieu appears to make women more vulnerable to mood disorders and clinical depression, especially during the perimenopausal stage [8], and there is an increase in mood symptoms during this stage. Other research highlights the vulnerability for new-onset depression and mood disorders during this stage [9], so identifying and monitoring this risk in the subgroup of vulnerable women, who are extremely sensitive to changes in hormone levels and may have an increased risk of depression during the MT, and thus this vulnerability should not be underestimated in clinical practice. This vulnerability does not apply to all women transitioning into menopause, and data from a 13-year prospective study, which found that women with no history of depression had less risk of experiencing a major depressive disorder than those women who had a previous history, is relevant [10].

Thus, while this study emphasizes the importance of the psychology underlying cognitive and emotional menopausal representations, care should be taken to examine both physiological and psychological risk factors for increased depression and anxiety during the MT.


Nicole Jaff

Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand; Research Scientist, The Aurum Institute, South Africa


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