Page 315 - Encyclopedia of Nursing Research

282 n MENOPAUSE

of factors associated with symptom severity
MenoPause during the menopausal transition, including
M biomarkers related to glucose metabolism; (5)
experiences of menopause among popula-
Menopause is the final menstrual period, said tions of women with special health problems;
to have occurred after a woman has not had (6) nonpharmacological approaches to symp-
menses for at least 1 year. Nurse researchers tom management; and (7) relationship of the
have developed an approach using a men- menopausal transition to healthy aging.
strual calendar to determine women’s pro- Holistic frameworks for understand-
gress through the menopausal transition ing women’s experience of menopause have
(Mitchell, Woods, & Mariella, 2000), which permeated nursing research contributions,
has been influential in stimulating a Staging in particular in studies focused on symp-
Reproductive Aging Workshop sponsored toms. Among the constructs that organize
by the National Institutes of Health. The investigation of symptoms during the men-
staging criteria have been subsequently opausal transition and early postmenopause
validated by a multi-investigator interna- are age and age-related factors, menopause-
tional collaborative in the ReSTAGE Study related factors including hormone levels and
(Harlow et al., 2007). For women who have patterns across the menopausal transition
had regular cycles, the time before the onset stages, perceived stress, social factors, health-
of persistent menstrual irregularity dur- related factors such as perceived health, and
ing midlife is labeled the late reproductive health-related behaviors and symptoms that
stage. The early menopausal transition stage co-occur. Reference to nursing and related
is defined as persistent irregularity of more theory about symptoms has enriched under-
than 6 days absolute difference between any standing of the menopausal transition
two consecutive menstrual cycles during the experiences (Lenz, Pugh, Milligan, Gift, &
calendar year, with no skipped periods, and Suppe, 1997). For example, results from anal-
late transition stage is defined as persistent yses using these frameworks reveal that per-
skipping of one or more menstrual periods ceived stress is not related directly to the
(having double the modal cycle length or menopausal transition or endocrine changes,
more for the calendar year). In the absence but perceived stress is related to experienc-
of a modal cycle length, a population-based ing more severe symptoms (Woods, Mitchell,
cycle length of 29 days was used. Persistence Percival, & Smith-DiJulio, 2009).
meant the event, irregular cycle or skipped Staging the menopausal transition
period, occurred one or more times in the has enabled investigators to determine the
subsequent 12 months. The time following sequence of events taking place as women
the final menses is postmenopause. progress through the early and late meno-
Nursing scholars have contributed to the pausal transition period and experience the
field of menopause research in many ways, early postmenopause. In the Seattle Midlife
including (1) development of holistic frame- Women’s Health Study, a longitudinal study
works for understanding women’s experi- of the natural history of the menopausal
ences of menopause; (2) understanding of the transition, use of the menopausal transition
normative experience of menopause, includ- staging system allowed identification of pre-
ing an approach to staging progress through dictable stages related to endocrine changes
the menopausal transition described above (follicle-stimulating hormone and estrogen)
and the chronology of symptom experiences and symptoms such as hot flashes, depressed
across the menopausal transition and post- mood, and nighttime awakening, which are
menopause; (3) comparative approaches to most severe during the late menopausal tran-
measurement of symptoms; (4) identification sition stage (Smith-DiJulio, Percival, Woods,