17 August, 2015

In contrast to the large body of literature on psychological symptoms during the menopause transition, relatively little is known about positive well-being including happiness, satisfaction with life and self-actualization at this time. Our recent review article 'Positive well-being during the menopausal transition' [1] responded to this issue though synthesizing quantitative work on positive functioning across the menopause transition. Nineteen relevant studies were identified, and the vast majority found that both menopausal stage and the presence/frequency of vasomotor symptoms were independent of positive well-being. Four studies using aggregate scales of menopausal symptoms such as the Greene Climacteric Scale (GCS), however, demonstrated that symptoms were strong predictors of diminished well-being. These findings demonstrate the importance of delineating menopausal factors in order to clearly determine which aspects of menopause are most likely to have an impact on positive well-being.

Comment

In my clinical work with midlife women, I am well aware of the potential toll that menopause can have on well-being. Indeed, both hot flushes – the hallmark symptom of menopause – and the underlying hormonal changes that drive these symptoms have been found to contribute to elevated depressive symptoms for some women [2, 3].

However, mental health involves not just the absence of distressing symptoms but also the presence of positive qualities, including positive emotions, a sense of satisfaction and purpose in life [4]. Does menopause pose a similar window of susceptibility to diminished positive well-being alongside the well-known vulnerability to depression? Fortunately, results from our review indicate that there may be a dissociation whereby positive well-being is largely unaffected by menopausal stage and core vasomotor symptoms. Positive mental qualities may therefore be available on which women can draw to meet the challenges that menopause can present.

An interesting proviso is that four studies in the review that used aggregate scales of menopausal symptoms found strong links between menopause symptoms and diminished well-being. A problem with using aggregate menopause symptom scales is that around 30–52% of scale items measure psychological symptoms (e.g. crying spells) that are not necessarily specific to the menopause.

So, while aggregate menopause scales can be helpful to identify women who may benefit from treatment during the menopause, when used for research purposes they may run the risk of overpathologizing the menopause, for instance through using evidence of an association between GCS symptoms and low purpose in life to unduly claim that menopause contributes to diminished positive well-being.

Clinicians could use the finding that positive well-being is relatively unaffected by both menopausal stage and also the experience of vasomotor symptoms to advantage when working with midlife women. For example, clinicians could encourage women to draw on their strengths through asking them to reflect on what is going well in their lives. Clinicians could also help women to bolster their positive emotions through evidence-based techniques such as loving-kindness meditation [5], alongside honoring and treating psychopathology as appropriate.

Following our review of positive well-being during the menopause, we are now beginning to model positive well-being, in order to identify resilience factors that might further bolster happiness, satisfaction and purpose during the menopause.

Recently, we demonstrated that both self-compassion and feeling a sense of control over menopausal symptoms are two important themes that may promote positivity during menopause [6]; however, longitudinal and experimental research is now needed to expand and reinforce this budding area of research.

New work into the positive well-being of midlife women is not just of theoretical interest. Importantly, it may serve to inform clinical practice with women – enabling clinicians to provide an informed opinion on how menopause can relate to the full spectrum of negative and positive well-being, and ultimately to help women make the most out of the second half of their lives.

Lydia Brown
School of Psychological Sciences, University of Melbourne, Australia

References

1. Brown L, Bryant C, Judd F. Positive well-being during the menopause transition: a systematic review. Climacteric 2015;18:456-69
http://www.ncbi.nlm.nih.gov/pubmed/25417543 
2. Judd FK, Hickey M, Bryant C. Depression and midlife: Are we overpathologising the menopause? J Affect Disorders 2011;136:199–211
http://www.ncbi.nlm.nih.gov/pubmed/21269707 
3. Worsley R, Bell R, Kulkarni J, Davis SR. The association between vasomotor symptoms and depression during perimenopause: A systematic review. Maturitas 2014;72:111-17
http://www.ncbi.nlm.nih.gov/pubmed/24365649 
4. Seligman M, Csikszentmihalyi M. Positive psychology: an introduction. Am Psychol 2000;55:5-14
http://www.ncbi.nlm.nih.gov/pubmed/11392865 
5. Fredrickson BL, Cohn MA, Coffey KA, Pek J, Finkel SM. Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources. J Pers Soc Psychol 2008;95:1045-62
http://www.ncbi.nlm.nih.gov/pubmed/18954193 
6. Brown L, Bryant C, Brown V, Bei B, Judd F. Investigating how menopausal factors and self-compassion shape well-being: An exploratory path analysis. Maturitas 2015;81:293-9
http://www.ncbi.nlm.nih.gov/pubmed/25818770