Social Determinants of Health in Menopause: An Integrative Review

Figures & data

Table 1 Combination of Words Used to Search Articles

(“Culture”[Mesh]) AND ((“Menopause”[Mesh]) OR “Post menopause”[Mesh])

(“Life Style”[Mesh]) AND ((“Menopause”[Mesh]) OR “Post menopause”[Mesh])

(“Social Support”[Mesh]) AND ((“Menopause”[Mesh]) OR “Post menopause”[Mesh])

(((“Education”[Mesh]) OR “Educational Status”[Mesh])) AND ((“Menopause”[Mesh]) OR “Post menopause”[Mesh])

(“Employment”[Mesh]) AND ((“Menopause”[Mesh]) OR “Post menopause”[Mesh])

(“Economics”[Mesh]) AND ((“Menopause”[Mesh]) OR “Post menopause”[Mesh])

(“Marital Status”[Mesh]) AND ((“Menopause”[Mesh]) OR “Post menopause”[Mesh])

(“Culture”[Mesh]) OR “Life Style”[Mesh]) OR “Social Support”[Mesh]) OR ((“Education”[Mesh]) OR “Educational Status”[Mesh])) OR “Employment”[Mesh]) OR “Economics”[Mesh]) OR “Marital Status”[Mesh]) AND ((“Menopause”[Mesh]) OR “Post menopause”[Mesh])

Figure 1 Flowchart of study selection progress.

Table 2 Studies on Social Determinants of Health in Menopause

First Author	Year	Country	Title	Study Design	Results
Gold^Citation30	2001	United States	Factors Associated with Age at Natural Menopause in a Multiethnic Sample of Midlife Women.	Cross-sectional	Smoking, lower educational level, being single, unemployment, and history of heart disease were all independently associated with earlier age at menopause, while parity, prior use of oral contraceptives, and Japanese race/ethnicity were associated with later age at menopause.
Lawlor^Citation40	2003	United Kingdom	The association of socioeconomic position across the life course and age at menopause: the British Women’s Heart and Health Study.	Cross-sectional	Adverse socioeconomic conditions in childhood are associated with an earlier age at menopause.
Shiu-Yun Fu^Citation14	2003	Australia and Taiwan	Cross-Cultural Menopausal Experience: A Comparison Of Australian and Taiwanese Women.	Cross-sectional	There were no significant differences between areas of social functioning, mental health, and menopause status. The results suggest that cultural factors may affect the menopausal experience.
Melby^Citation13	2005	–	Culture and symptom reporting at menopause.	Systematic Review	Both biological variation and cultural differences contribute to the menopausal experience.
Hardy^Citation39	2005	England, Scotland, Wales.	Social and environmental conditions across the life course and age at menopause in a British birth cohort study.	Birth cohort study	There is a relationship between socio-economic circumstances in childhood, but not in adulthood and age at natural menopause.
Parvin^Citation4	2007	Iran	The effect of supportive care therapy on the mental health of postmenopausal women.	Quasi-experimental research	The supportive therapeutic group has an impact on the mental health of postmenopausal women.
Dratva^Citation42	2007	Switzerland	Variability of reproductive history across the Swiss SAPALDIA cohort–patterns and main determinants.	Birth cohort study	Smoking, parity and physical activity noticeably affect the age at menopause.
Parsons^Citation43	2007	Lebanon, Morocco, Spain, the United States	Women’s midlife health across cultures: DAMES comparative analysis	Mixed method research	Menopausal symptoms may, in many cases, be affected by some health concerns of middle-aged women.
Schwars^Citation5	2007	Pomerania	Menopause and determinants of quality of life in women at midlife and beyond: the study of health in Pomerania (SHIP).	Cross-sectional	Age, socioeconomic status, physical and sexual abuse, perceived social support, nutrition, BMI and chronic diseases affect QOL at menopause.
Hess^Citation44	2008	Pittsburgh	Pregnancy and birth history influence women’s experience of menopause	Longitudinal cohort study	Nulliparous women expressed more negative attitudes toward menopause than multiparous women.
Dratva^Citation27	2009	9 European countries	Is age at menopause increasing across Europe? Results on age at menopause and determinants from two population-based studies.	Cohort study	Current smoking was the most critical‏ determinant of age at menopause. Besides, obesity and low physical activity were dramatically associated with earlier age at menopause.
Ansari^Citation35	2009	Iran	Evaluation of socio-economic factors related to the natural menopause age in Zahedan, southeastern Iran	Cross-sectional	The sociocultural factors that significantly related to the early age of menopause were: never married, low-income level, low social status, early married women, and illiterate women.
Delshad^Citation33	2009	Iran	Effect of husband’s education on social support perceived by postmenopausal women	Clinical trial	Husband’s education can affect the understanding of women’s social support.
Jamshidi manesh^Citation12	2009	Iran	Women’s experience of menopause: Qualitative study	Qualitative research	Women consider menopause as a natural occurrence, but concern about the complications affects their quality of life.
Goberna^Citation45	2009	Spain	Sexual experiences during the climacteric years: what do women think about it?	Qualitative research	Social, family, and structural factors had the most significant influence on the sexual relationship during menopause.
Lee^Citation19	2010	Korea	Factors Influencing the Severity of Menopause Symptoms in Korean Post-menopausal Women	Cross-sectional	Sociocultural factors, lifestyle, attitudes to menopause, and psychological status can be associated with the severity of menopause symptoms, specifically in Korean menopausal women.
Sheykhan^Citation38	2010	Iran	Sexual satisfaction and some factors are affecting it in postmenopausal women	Descriptive research	The overall level of sexual satisfaction was related to the age of menopause, female education, and husband’s education.
Delavar^Citation21	2011	Iran	Factors affecting the age in healthy menopause and frequency of menopausal symptoms in northern Iran	Cross-sectional	Low educational level, early age at menarche, and oral contraceptive use were Significantly related to menopausal symptoms.
Noroozi^Citation2	2012	Iran	Using the behavioral analysis model for assessing the quality of life in menopause women in Birjand	Cross-sectional	The quality of life of menopausal women was related to educational level, economic level, and health status.
Jones^Citation15	2012	–	Menopause and the influence of culture: another gap for Indigenous Australian women?	Systematic Review	Research shows a significant difference across cultures in the menopausal experience. Biological, psychological, social, and cultural factors are associated with either positive or negative attitudes of menopause in different cultures.
Giannuli^Citation25	2012	Greece	Determinants of quality of life in Greek middle-aged women: a population survey	Cross-sectional	Normal BMI, married status, higher education, employment, good financial status, physical activity, and a healthy diet were associated with higher QOL.
Abdollahi^Citation29	2013	Iran	The menopausal age and associated factors in Gorgan, Iran	Cross-sectional study	Menstrual and fertility factors affect menopausal age while socioeconomic factors are not effective
Wang^Citation20	2013	Taiwan	Depressive symptoms in Taiwanese women during the pre- and post-menopause years: Associations with demographic, health, and psychosocial characteristics	Cross-sectional	Depressive symptoms were related to lower-income, smoking, consuming alcohol, having chronic diseases, not exercising regularly, having more severe menopausal symptoms, and more negative attitudes toward menopause.
Shobeiri^Citation36	2013	Iran	The study of the relationship between some socioeconomic factors and menopause in Hamedan health centers	Cross-sectional	There is a significant relationship between the age of menopause and physical activity, income level, smoking in the family, and education.
Barat^Citation37	2013	Iran	Factors affecting the life process of menopause women.	Cross-sectional	There is a significant relationship between educational level, economic status, and age with two dimensions of psychosocial and physical quality of life
Makvandi^Citation7	2013	Iran	Frequency and severity of menopausal symptoms and their relation with individual factors in women before and after menopause in Ahvaz city	Cross-sectional	Female athletes, non-smokers with higher incomes, and higher education had higher scores.
Jalili^Citation24	2014	Iran	The relationship between physical activity and the severity of menopausal symptoms in postmenopausal women in Ahvaz	Cross-sectional	Exercise plays an essential role in stabilizing the natural circulation and other physiological activities of the body during menopause.
Shariat^Citation18	2014	Iran	Relationship of perceived social support with women’s experiences in menopause	Descriptive research	Perceived social support has a positive effect on the experiences of menopause, and supporting is the best predictor of experiences in menopause.
Ghorbani^Citation3	2014	Iran	Attitudes toward menopause among middle-aged women in Semnan, Iran.	Cross-sectional	Menopausal status, educational level, marital status, place of residence, and employment were not related to women’s attitude.
Bahri^Citation16	2015	Iran	A look at menopausal studies over time: from a biomedical approach to comprehensive approaches	Systematic Review	The psychosocial approaches affecting menopause were evaluated.
Alizadeh^Citation10	2015	Iran	Social determinants and reproductive factors of the menopausal symptoms among women in Tabriz-Iran	Cross-sectional	The quality of life of the women during menopause has a negative relationship with age and number of children, whereas it improves with higher educational levels and employment.
Sehati^Citation1	2015	Iran	Individual-social predictors of public health in postmenopausal women in Langrud: a population-based study	Cross-sectional	Marital status variables, chronic diseases, economic status, and education are the main predictors of general health in postmenopausal women.
Ghorbani^Citation28	2015	Iran	Association between the quality of life, menopausal status, and sociodemographic factors among middle-aged women in Iran	Cross-sectional	Sociodemographic characteristics including age, number of children, household income, and BMI were related to QOL.
Mirhaghjou^Citation23	2016	Iran	Quality of life and its determinants in postmenopausal women: a population-based study	Cross-sectional	Age, husband education, and BMI were related to QOL in menopause.
Golmakani^Citation6	2016	Iran	Body mass index and its relationship with quality of life in postmenopausal women	Descriptive research	Body mass index did not affect the quality of life of postmenopausal women. Athletic women were more likely to have a better quality of life.
Ahuja^Citation26	2016	India	Age of menopause and determinants of menopause age: A PAN India survey by IMS	Cross-sectional	There was a correlation between the age of menopause and socio-economic situation, married status and number of childbirth.
Bahri^Citation34	2016	Iran	The effects of menopausal health training for spouses on women’s quality of life during menopause transitional period	Clinical trial	The husband’s training improves the quality of life in women during the menopausal transition.
Aparicio^Citation22	2017	Spain	Association of objectively measured physical activity and physical fitness with menopause symptoms. The Flamenco Project	Cross-sectional	There is a weak association between physical activity and menopausal symptoms.
Asghari^Citation46	2017	Iran	Effect of aerobic exercise and nutrition education on quality of life and early menopause symptoms: A randomized controlled trial	Randomized controlled trial	Nutrition education and exercise can improve quality of life in menopause period.
Shin^Citation41	2017	Korea	Relationship between age at last delivery and age at menopause: The Korea National Health and Nutrition Examination Survey	Cross-sectional	Research indicates that an increased number of pregnancies are related to older age at menopause.

Table 3 Studies on the Relationship Between Menopausal Age and Lifestyle/Norms

The First Author(Year)	Country	Study Design	Sample Size	Median Age of Menopause	Results
Gold^Citation30 (2001)	United States	Cross-sectional	14,620	51.4	Smoking, lower educational level, being single, unemployment, and history of heart disease were all independently associated with earlier age at menopause, while parity, prior use of oral contraceptives, and Japanese race/ethnicity were associated with later age at menopause.
Dratva^Citation42 (2007)	Switzerland	Cohort study	3119	52	Physical activity, smoking, and high BMI were independently associated with earlier age at menopause.
Ansari^Citation35 (2009)	Iran	Cross-sectional	500	48	Lower educational level, being single, unemployment, low social status, and early marriage were all associated with earlier age at menopause.
Dratva^Citation27 (2009)	Nine European countries	Cohort study	5288	54	Current smoking was the most determinant of age at menopause. Besides, obesity and low physical activity were dramatically associated with earlier age at menopause.
Delavar^Citation21 (2011)	Iran	Cross-sectional	1620	46.6	No significant difference was observed for age in menopause, marital status, and body mass index. The nulliparous women had a significantly earlier age of menopause compared with women with at least one child.
Abdollahi^Citation29 (2013)	Iran	Cross-sectional	804	48	The menopausal age in women with first pregnancy before 30 years, without pregnancy, and without delivery was lower than others.
Shobeiri^Citation36 (2013)	Iran	Cross-sectional	400	50	Low physical activity, Low-income level, smoking in the family, and low level of education were associated with later age at menopause.
Schoenaker^Citation31 (2014)	Australia	Systematic review	–	48.8	Smoking and low education were associated with earlier age at menopause. Being overweight and moderate/high physical activity were associated with later age at menopause.
Ahuja^Citation26 (2016)	India	Cross-sectional	2.184	46.2	Lower educational level and being single were all independently associated with earlier age at menopause, while the increase in weight and BMI was associated with a later age at menopause.

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