Abstract

What does it mean for a woman to experience perimenopause? Some women pass through perimenopause with relative ease while others report hot flashes and multiple disruptive symptoms. The physiological, psychological, and social variables that influence women during the change of life have not been fully examined. Using a phenomenological method of inquiry, this study explored the reflective, lived experiences of 3 perimenopausal women. Interpretation of the data revealed five explanatory themes: (1) Unpredictable Symptoms; (2) Lack of Information; (3) Influence of Others; (4) Fear of Growing Old; and (5) Making the Transition. The results of this study may be obtained from the author: dbfnp@yahoo.com.

Introduction

Aim of the Study

Perimenopause is often portrayed as the onset of old age, a time for mid-life crisis, and the loss of attractiveness, vigor, and worth. These years are associated with transitions that include psychological and physical changes and loss. They can be confusing, value laden, and disruptive. It is no surprise that perimenopause is stressful for so many women. Using a phenomenological method of inquiry, the aim of this study was to reach a greater understanding of what it means to experience perimenopause.

Phenomenon of Interest

The phenomenon investigated was an exploration of what women experience during perimenopause.

The investigation defined perimenopause as "the period extending from the first signs of menopause, usually hot flashes, to beyond the complete cessation of menses (1 year beyond)" (Smeltzer & Bare, 1992, p. 1244). This transition can last from less than one year to ten years or longer.

During perimenopause, estrogen levels decline leading to changes in physical appearance such as diminished skin turgor and muscle mass, altered vision, and graying hair. Many women gain weight. Most experience hot flashes.

Women also notice less visible-changes, such as mood swings and depression. Some complain of vaginal dryness and atrophy, as well as distressing urinary symptoms. The risk for osteoporosis, breast cancer, and cardiac events increases.

Perceived Justification

Because perimenopause was once (and remains, to some extent) a taboo topic, millions of mid-life women may not be adequately informed to cope with associated changes. Most medical and nursing research reports focus on treating physiological changes with medications. Very little is reported about research on what American women actually experience during perimenopause.

Assumptions

As with puberty, perimenopause is experienced differently by each individual. Some women have few symptoms, while others complain of mood swings or excessive vaginal bleeding. Girls learn about puberty in school. Middle-aged women do not have a similar place to learn about and discuss perimenopause.

I believe women lack sufficient, reliable information about the physical and psychological changes of perimenopause to allow them to cope better and to make informed choices about their health. By learning women's perimenopause experiences, nurses can develop more meaningful interventions.

Type of Qualitative Study

Using the phenomenological method of inquiry, this investigation explored the reflective, lived, perimenopausal experiences of 3 women.

Relevance to Nursing

Nurses care for perimenopausal women in every health care setting. In order to practice holistic human care, nurses need to understand the doubts, fears, hopes, and needs of perimenopausal women. Until we know more about the lived experiences of perimenopausal women, nurses will provide care based on conjecture and the medical model.

Rationale, Historical and Literary Contexts

The term climacteric is a Greek expression meaning "critical point in human life." It is sometimes used instead of perimenopause when describing the period of biologic, psychological, social, and spiritual changes during woman's transitional years when hormone levels decline, marking the end of the reproductive stage of life (Choi, 1995; LeBouef & Carter, 1996).

Historically, perimenopause has been a critical time for women. The 18th century French called the climacteric "l'enfer des femmes" or women's hell, but the English viewed the climacteric as a God ordained, natural event, and women did not complain (LeBouef & Carter, 1996).

Nineteenth century Victorians repressed discussion of reproduction and sexual matters. Widows who were unable to bear children were stigmatized. Menopause signified old age and uselessness (Quinn, 1991, Sheehy, 1995).

In the early 1900s, most women spent their lives pregnant, breastfeeding, and performing physical chores. Many died before the age of forty. Without today's medical and dental care, and cosmetics, survivors would seem much older than contemporary women of the same age. While some women may have welcomed menopause as a relief from pregnancy, it also signaled that the end of life was near.

Although menopause was considered normal in the 1940s, today's women expect medical treatment for psychological and social problems, as well as physical symptoms (Watson, 1985). This medicalization of menopause leads women to think of estrogen deficiency as a pathologic condition that requires medical management (Choi, 1995, Watson, 1985).

Today, "many women live as long after menopause as they did before menopause" (Herrick, Douglas, and Carlson (1995, p. 154). Each woman's experience is different, depending on multiple factors including genetics and her physical health. Many women still resist acknowledging menopause, viewing it as the first marker of aging and unspeakable losses (Choi, 1995).

Herrick et al., (1995) stated that "historically, medical literature and psychiatric literature have discussed menopausal women as asexual, depressed, irritable, paranoid, and confused" (p. 156). They said the literature also reported symptoms of headaches, backaches, and hot flashes; sleeplessness from night sweats; somatic complaints, brittle bones; and cardiovascular risk.

Moore & Noonan (1996) described five categories of perimenopausal symptoms: vasomotor changes, urogenital changes, emotional changes, sleep disturbances, and muscle and joint pains and paresthesias. Relief of these symptoms, plus prevention of osteoporosis, cardiovascular disease, and other conditions may justify prescribing hormone therapy.

Many feminists and women's health advocates challenge the medicalization of menopause, asserting that menopause is a relatively uneventful, natural transition. This may create conflict for women who seek medical attention for problematic symptoms. Viewing the menopause experience as a continuum with diverse and complex scenarios may be the most helpful and realistic way to enable women to cope (Choi, 1995).

Various non-medical therapies are available to perimenopausal women. "These include nutrition and nutritional supplementation, exercise, relaxation, herbs, homeopathy, acupuncture, and other self-help measures like increased body and mind (or body-mind) awareness or support groups" (Lichtman, 1996, p. 205). Over 30 different books on perimenopause and menopause, published by the lay press, were noted recently in a local book store. These "self-help" books were written primarily by physicians, nutritionists, or health journalists and were mostly based on the medical model. However, several books suggested experiencing menopause the "natural" way, without medications. Popular magazines publish similar articles about menopausal issues.

Despite the interest in menopause, few related research studies have been published by nurses. One grounded theory study was published on the process of perimenopause (Quinn, 1991). Still, most nursing literature describes the physiologic effects of decreased estrogen levels or explains drugs that are available. These are necessary and important. But if nurses are to provide holistic care, more qualitative information is needed about the experience of perimenopause.

Theoretical Context

My nursing philosophy is based on The Science of Human Care, developed by Jean Watson (1985). It is a holistic-dynamic approach to helping others to gratify their human needs. The nurse integrates ten carative factors, or nursing interventions, to align the patient's subjective reality (phenomenal field) with his external reality to help the person attain unity of the mind-body-spirit. To use these strategies, the nurse strives to incorporate the carative factors into her own life as well as her nursing practice (Chinn & Kramer, 1995).

Caring nurses can help individuals recognize and work toward accepting losses related to passing from one life stage to another. Watson (1985) asserted: "If primary nursing intervention occurs around those three human conditions (stress-change, developmental conflicts, and loss), nursing health care will he relevant to the daily circumstances of living, not simply to illness symptoms or problems" (p. 218).