Relationships Between Menstrual and Menopausal Attitudes and Associated Demographic and Health Characteristics: The Hilo Women's Health Study

Abstract

The objective of this study was to examine the relation of menstrual attitudes to menopausal attitudes and the demographic and health characteristics associated with each. This cross-sectional study consisted of a randomly selected sample of 1,824 respondents aged 16 to 100 years in multi-ethnic Hilo, Hawai'i. Women completed questionnaires for demographic and health information, such as age, ethnicity, education, residency in Hawai'i, menopausal status, exercise, and attitudes toward menstruation and menopause. Women more often chose positive terms, such as “natural,” to describe menstruation (60.8%) and menopause (59.4%). In bivariate analyses, post-menopausal women were significantly more likely to have positive menstrual and menopausal attitudes than pre-menopausal women. Factor analyses were used to cluster attitudes followed by linear regression to identify demographic characteristics associated with factor scores. Asian-American ethnicity, higher education, reporting more exercise, and growing up outside of Hawai'i were associated with positive menstrual attitudes. Higher education, older age, post-menopausal status, growing up outside of Hawai'i and having hot flashes were associated with positive menopausal attitudes. Bivariate correlation analyses suggested significant associations between factor scores for menstrual and menopausal attitudes. Both negative and positive menstrual attitudes were positively correlated with the anticipation of menopause, although negative attitudes toward menstruation were negatively correlated with menopause as a positive, natural life event. Demographic variables, specifically education and where one grows up, influenced women's attitudes toward menstruation and menopause and should be considered for inclusion in subsequent multi-ethnic studies. Further research is also warranted in assessing the relationship between menstrual and menopausal attitudes.

KEYWORDS:

• attitudes
• menstruation
• menopause
• ethnicity
• exercise
• hot flashes
• menstrual cramps

Notes

This study was supported by the National Institutes of Health Minority Biomedical Research Support Program, grant S06 GM08073-34. Mahalo to the women of Hilo for participating in our survey. The thoroughness and insightful comments of the reviewers were much appreciated. Thanks to our research staff for all their hard work.

^aEver experienced.

*p < 0.05

**p < 0.01.

1. In concordance with the American Association of Physical Anthropologists (AAPA) Statement on Biological Aspects of Race (http://physanth.org/association/position-statements/biological-aspects-of-race/?searchterm=race), a position statement outlining why the term “race” is scientifically problematic, we asked our participants to identify their ethnicity rather than race. However, we have used the term “race” in this manuscript in reference to other researchers work to acknowledge their use of the term.

2. The choice given in the questionnaire was “relief from PMS” using the acronym only. Because we did not spell out nor give the clinical definition for “premenstrual syndrome,” the intention in the questionnaire was for the colloquial usage of “PMS” referring to symptoms felt around the time of menstruation. Thus, the accurate acronym for premenstrual symptoms, PMSx, is used in this manuscript.