Study Aims
The purpose of this study is to explore the perceptions and experiences of black women in the transition to menopause. The specific aims are to: (1) explore perceptions about menopause and midlife health among black women; (2) describe the symptoms urban black women experience and perceive as bothersome or distressing in the transition to menopause; (3) explore health risks black women associate with midlife, such as cardiovascular disease and osteoporosis; and (4) identify menopause symptom and midlife health risk management strategies used by urban black women.
Methods
Black women living in the greater New Haven, CT and Washington, DC were recruited by advertisements and flyers posted and given out at community locations, such as churches, community centers, city hall, the telephone company, women's shelters, health departments, etc and through investigators' health care offices. Participants were encouraged to invite their friends or family members to participate. Information about menopause experiences, self-management strategies for menopause symptom control, perceptions of midlife health risks, and health-promoting behaviors were collected through focus group discussions. Information about menopause symptoms was collected by having participants complete the modified Menstrual Symptom Severity List (MSSL-mod). Information about health-promoting behaviors was obtained by having participants complete the Health Promoting Lifestyle Profile II (HPLP II). Three focus groups were conducted in the New Haven area (n=25) and four in the Washington, DC area (n=18). A range of 2 to 10 women who identified themselves as having menopause symptoms participated in each focus group, providing a total of 43 participants. Transcripts from focus group audiotapes were analyzed and are being compared with responses to the instruments. Comparing focus group information with instrument responses provides an opportunity to identify commonalties and differences in focus group and instrument identified symptoms and health promoting behaviors and reduces the potential for missing menopausal symptoms or health promoting behaviors that may not be captured by using either method alone.
Status
Data collection and entry is completed. Data analysis for qualitative data is completed, and analysis for quantitative data is currently underway.
Results
Black women living in the New Haven, CT and Washington, DC areas, self-described as experiencing menopause symptoms (N=43), participated in 7 focus groups (4 held in DC with 5, 2, 6, and 5 participants, n=18; and 3 in New Haven with 7, 8, and 10 participants, n=25; mean age 52.3 + 6.2 years; mean age of menopause 47.8 + 5.9 years; all reported > high school education).
Menopause was seen as a natural life transition, but most participants did not view it positively. Hot flashes, mood changes (especially "rage"), sleep disruptions, and unpleasant vaginal odors were the most bothersome symptoms experienced by participants. Other symptoms included memory loss, weight gain, skin dryness, vaginal dryness, vaginal discharge, headaches, urinary urgency, dizziness, decreased libido, and depression. Symptoms were exacerbated with stress and ingestion of caffeine and sugar. Strategies most frequently employed to minimize and cope with symptoms included avoidance of caffeine and sugar, attempting to avoid and manage stress, and gaining strength through spirituality or faith in God.
Symptoms such as hot flashes, night sweats, forgetfulness, mood changes/"rage," and body odor were described as "horrible," "life changing," and "unpleasant." Although most had discussed hormone therapy (HT) with their menopause clinician, few elected to take it. HT was generally viewed negatively and described as unnatural, as having too many side effects, or was not considered because the woman wanted to avoid "taking pills." Symptoms were managed by lifestyle changes, alternative therapies, and stress reduction. Despite the severe symptoms reported, a paradox existed - most women said they might use HT if their symptoms "got bad enough."
Dissemination
Presentations
Alexander, IM., Rousseau, ME, White, K, Ruff, C., & McKie, C. "Menopause symptom management in black women." Howard University Division of Nursing 9th Annual M. Elizabeth Carnegie Research Conference. Washington, DC, March 26, 2003.
Alexander, IM. "Menopause symptoms and management strategies identified by black women." (Poster). North American Menopause Society (NAMS) 14th Annual Meeting, Palm Beach, FL, September 17-20, 2003.
Alexander, IM., Motter, S., Ruff, C., Rousseau, ME, & White, K. "Hormone therapy use among black women: Why or why not?" (Poster). Howard University Division of Nursing 10th Annual M. Elizabeth Carnegie Research Conference. Washington, DC, March 11-12, 2004.
Alexander, IM., Ruff, C., Rousseau, ME., White, K., MOtter, S., & McKie, C. "Experiences and perceptions of menopause and midlife health among black women." Eastern Nursing Research Society (ENRS) 16th Annual Scientific Sessions, Partnerships: Advancing the Research Agenda for Quality Care. Quincy, MA, April 1-3, 2004.
Alexander, IM. "Menopause and black women: Understanding the symptoms perceived as most bothersome and identifying strategies for menopause self-management." (Invited Paper Presentation). Mu Beta Chapter, Mu Chi Chapter, and Delta Mu Chapter Sigma Theta Tau Research Dinner. North Haven, CT, April 15, 2004.
Alexander, IM., Ruff, C., Rousseau, ME., & White, K. "Experiences and perceptions of menopause and midlife health among black women: A case example of integrating students into research projects." National Organization of Nurse Practitioner Faculties (NONPF) 30th Annual Meeting, Visioning for the Future - Celebrating the Past. San Diego, CA, April 22-25, 2004.
Alexander, IM., Ruff, C., Rousseau, ME., White, K., Motter, S., & McKie, C. "Experiences and perceptions of menopause and midlife health and self-management strategies identified by black women." Department of Health and Human Services (DHHS) Conference - Women of Color Taking Action for a Healthier Life: Progress, Partnerships and Possibilities. Washington, DC, August 12-15, 2004.
Alexander, IM., Motter, S., & Ruff, C. "Reasons for use, discontinuation, or avoidance of hormone therapy among black women." (Poster) North American Menopause Society (NAMS) 15th Annual Meeting, Washington, DC, October 7-9, 2004. (awarded prize for best clinical research poster).
Alexander, IM. "Reasons for hormone therapy use, discontinuation, and avoidance among black women." Yale Center for Self Management Intervention, October 27, 2004.
Alexander, IM. "The use of focus groups to explore the experiences and perceptions of menopause and midlife health among black women." (Invited Keynote). University of Massachusetts and Beta Zeta Chapter Sigma Theta Tau Research Day. Holyoke, MA, April 13, 2005.
Publications
Alexander, I. M., Ruff, C., Rousseau, M. E., White, K., Motter, S., & McKie, C. (2003). Menopause symptoms and management strategies identified by black women (Abstract). Menopause, 10(6), 601.
Alexander, I. M., Motter, S., Ruff, C., Rousseau, M.E., & White, K. (2004). Reasons for hormone therapy use, discontinuation, or avoidance among black women (abstract). Menopause 11(6), 661.
Alexander, I.M., & Ruff, C.R. (2005). Attitudes and concerns about menopause among black women: What busy clinicians need to know. Menopause Management, 14(2), 22-26 .
Alexander, I. M., & Knight, K. (2005). 100 questions and answers about menopause. Sudbury, MA: Jones and Bartlett.
Ruff, C.R., Alexander, I.M., & McKie, C. (2005, in press). The use of focus group methodology in health disparities research. Nursing Outlook.
Follow-up
Follow-up: Additional study regarding cultural norms among mid-life black women experiencing menopause symptoms is needed to develop an appropriate management intervention. Therefore the next study planned will employ a larger scale instrument asking women about the symptoms they are experiencing, what is most bothersome, and in what activities they are engaging to reduce these symptoms. Additionally, questions regarding mid-life health behaviors will be included. The data gathered in the present study and the follow-up study will contribute to the understanding, development, and future testing of a culturally sensitive self-management intervention for black women to manage menopause symptoms and reduce midlife health risks. The principal investigator is currently using preliminary data from this project to begin development of the follow-up questionnaire.
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