Women's Decision Making during the Menopausal Transition

Women’s Decision-making During the Menopausal Transition

“Navigating the Waves of Menopausal Changes”

Background: Prior qualitative studies about women’s decision-making during menopause described a multi-stage process. Because of the release of the Women’s Health Initiative findings (WHI) it is unknown how this new information has impacted women’s decision-making. Nurses need to understand women’s concerns and needs in order to provide appropriate counseling to this group of women.

Purpose: To describe women’s experiences when making decisions about the use of hormonal or nonprescription remedies during or after the menopausal transition. The specific aims were to identify the influences on women’s decisions, explore their perceptions about the effect of the release of the findings on their decisions, identify their perceptions of their counseling needs.

Method: A qualitative descriptive approach was used. Semi-structured, tape recorded interviews were conducted with seven women who were currently making a decision about menopausal management, and who consulted a nurse practitioner. The majority of the interviews were conducted on the telephone, as close to the time of the decision as possible. To describe their decisions over time, they were interviewed at two subsequent points after the initial interview over the course of a year. Transcripts were analyzed using the content analysis with grounded theory techniques of constant comparison, simultaneous data collection and analysis. Member checks were conducted at the completion of the study through a focus group and individual interviews.

Findings: Women navigated the changes of menopause through the process of taking care of symptoms. Their priorities were feeling well and returning to function. This non-linear process consisted of several stages in which women became aware of symptoms, sought information, assured safety, weighed benefits and risks, judged efficacy of their choice, and returned to prior stages in the process as needed. When women were unable to manage symptoms themselves or needed help with decision making they consulted a nurse practitioner. Decision-making was influenced by women’s needs, perception of risks, and beliefs about menopause and its management. While decision-making was an easy for some, others experienced conflict and uncertainty. Those who chose hormone therapy needed to reconcile the risks prior to their decision. Women were unsure about the meaning of WHI findings and felt anxiety and fear about using hormone therapy since the release of findings. Nurse practitioners provided women with adequate time to discuss concerns at their visits and provided the information and support necessary for women to feel empowered and satisfied with their decision process.

Implications for Nursing Practice: Nurses should take the lead in meeting women’s needs by creating innovative programs and services to meet their needs for information, education and support. Decision support can be provided through individual counseling, group programs, internet sites, and articles in consumer literature. Women need to be aware of the availability and benefits of nurse practitioner care during the menopausal transition.