Skip to main content Accessibility help
  • Print publication year: 2004
  • Online publication date: August 2009

9 - Spiritual and psychological aspects of menopause

from Part II - Hormonal changes


This chapter reviews the most common psychological features of menopause and recent research regarding anxiety, depression, and social factors. Women's religious and spiritual beliefs play an important role in their views of life and medical illness. Commonly used tools that assist in gathering spiritual and religious information from patients are the FAITH and HOPE questionnaires. The FAITH tool addresses issues of religious faith and may be more useful when the clinician is aware that the patient is religious. Spiritual counseling is full of ethical challenges, including issues of autonomy, authority, confidentiality, and coercion. Cross-cultural studies indicate that women from different cultures cope with menopause differently. Anxiety disorders should be treated with medicines indicated for that purpose, including benzodiazepines, selective serotonin-reuptake inhibitors (SSRIs), and tricyclic agents. Physicians treating patients during menopause should be alert for psychological and spiritual issues, and be familiar with treatment options, including pharmacotherapy, exercise, and counseling.
Northrup, C.Menopause. Prim. Care 1997; 24:921–48
Nijs, P.Counseling of the climacteric woman: diagnostic difficulties and therapeutic possibilities. Eur. J. Obstet. Gynecol. Reprod. Biol. 1998; 81:273–6
Cobb, J. O.Reassuring the woman facing menopause: strategies and resources. Patient Educ. Couns. 1998; 33:281–8
Puchalski, C. M., and Larson, D. B.Developing curricula in spirituality and medicine. Acad. Med. 1998; 73:970–74
King, D. E. Faith, Spirituality, and Medicine: Toward the Making of a Healing Practitioner. New York: Haworth Press; 2000
King, D. E. Spirituality and medicine. In Mengel, M. G., Holleman, W. L. and Fields, S. (eds.). Fundamentals of Clinical Practice: A Textbook on the Patient, Doctor, and Society, 2nd edition. New York: Kluwer, Academic/Plenum; 2002
Koenig, H. G., McCullough, M. and Larson, D. B. Handbook of Religion and Health. New York: Oxford University Press; 2001
Gallup, G. Religion in America 1990. Princeton: The Princeton Religion Research Center; 1990
King, D. E. and Bushwick, B.Beliefs and attitudes of hospital in-patients about faith healing and prayer. J. Fam. Pract. 1994; 39:349–52
Koenig, H. G., George, L. K. and Peterson, B. L.Religiosity and remission from depression in medically ill older patients. Am. J. Psychiatry 1998; 155:536–42
Matthews, D. A., McCullough, M. E., Larson, D. B., et al.Religious commitment and health status. Arch. Fam. Med. 1998; 7:118–24
Koenig, H. G., Cohen, H. J., Blazer, D. G., et al.Religious coping and depression among elderly, hospitalized, medically ill men. Am. J. Psychiatry 1992; 149:1693–700
Anandarajah, G. and Hight, E.Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. Am. Fam. Phys. 2000; 63:81–8
Roberts, J. A., Brown, D., Elkins, T. and Larson, D. B.Factors influencing views of patients with gynecological cancer about end-of-life decisions. Am. J. Obstet. Gynecol. 1997; 176:166–72
Johnson, S. C. and Spilka, B.Coping with breast cancer: the roles of clergy and faith. J. Relig. Health 1991; 30:21–33
Rahman, F. and Marty, M. Health and Medicine in the Islamic Tradition: Change and Identity (Health/Medicine and the Faith Traditions). Chicago: Kazi Publications; 1998
Breuilly, E., O'Brien, J., Marty, M. E. and Palmer, M. Religions of the World: The Illustrated Guide to Origins, Beliefs, Traditions and Festivals. Chicago: Checkmark; 1997
Sloan, R. P., Bagiella, E. and Powell, T.Religion, spirituality, and medicine. Lancet 1999; 353:664–7
Sloan, R. P., Bagiella, E., VandeCreek, L., Hasan, Y. and Puolos, P.Should physicians prescribe religious activities?N. Engl. J. Med. 2000; 342:1913–16
Martin, E. The Woman in the Body: A Cultural Analysis of Reproduction. Boston: Beacon Press; 1987
Jones, J.Embodied meaning: menopause and the change of life. Soc. Work Health Care 1994; 19:43–65
Woods, F. W. and Mitchell, E. S.Anticipating menopause: observations from the Seattle Midlife Women's Health Study. Menopause 1999; 6:167–73
Utian, W. H. and Boggs, P. P.The North American Menopause Society 1998 Menopause Survey, part 1: postmenopausal women's perceptions about menopause and midlife. Menopause 1999; 6:122–8
Uphold, C. R. and Susman, E. J.Self-reported climacteric symptoms as a function of the relationships between marital adjustment and childrearing stage. Nurs. Res. 1981; 30:84–8
Dosey, M. F. and Dosey, M. A.The climacteric woman. Patient Couns. Health Educ. 1980; 2:14–21
Costello, E. J.Married with children: predictors of mental and physical health in middle-aged women. Psychiatry 1991; 54:292–305
Weissman, M. M., Bland, R. C. and Canino, G. J.Cross-national epidemiology of major depression and bipolar disorder. J. Am. Med. Assoc. 1996; 276:293–9
Kessler, R. C., McGonagle, K. A., Zhao, S., et al.Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch. Gen. Psychiatry 1994; 51:8–19
McCormick, L. H.Depression in mothers of children with attention deficit hyperactivity disorder. Fam. Med. 1995; 27:176–9
Yonkers, K. A. and Austin, L. S.Mood disorders: women and affective disorders. Prim. Psychiatry 1996; 3:27–8
Leibenluft, E.Women with bipolar illness: clinical and research issues. Am. J. Psychiatry 1996; 153:163–73
Hallstrom, T. and Samuelson, S.Mental health in the climacteric: the longitudinal study of women in Gothenburg. Acta Obstet. Gynecol. Scand. Suppl. 1985; 130:13–18
Holte, A. and Mikkelsen, A.Psychosocial determinants of climacteric complaints. Maturitas 1991; 13:205–15
Cawood, E. H. H. and Bancroft, J.Steroid hormones, the menopause, sexuality and well being of women. Psychol. Med. 1996; 26:925–36
DeAngelis, T.Menopause symptoms vary among ethnic groups. Am. Psychiatr. Assoc. Monit. 1997; 17:16
Garnett, T., Studd, J. W. W., Henderson, A., et al.Hormone implants and tachyphylaxis. Br. J. Obstet. Gynaecol, 1990; 97:917–21
Hay, A. G., Bancroft, J. and Johnstone, E. C.Affective symptoms in women attending a menopause clinic. Br. J. Psychiatry 1994; 164:513–16
Sarrel, P. M. and Whitehead, M. I.Sex and menopause: defining the issues. Maturitas 1985; 7:217–24
Osborn, M., Hawton, K. and Gath, D.Sexual function among middle aged women in the community. Br. Med. J. 1985; 296:959–62
Hawton, K., Gath, D. and Day, A.Sexual function in a community sample of middle-aged women with partners: effects of age, marital, socio-economic, psychiatric, gynaecological and menopausal factors. Arch. Sex. Behav. 1994; 23:375–95
Hunter, M. S.Emotional well being, sexual behavior and hormone replacement therapy. Maturitas 1990; 12:299–314
Fishbein, E. G.Women at midlife: the transition to menopause. Nurs. Clin. North. Am. 1992; 27:951–7
Carolan, M.Beyond deficiency: broadening the view of menopause. J. Appl. Gerontol. 1994; 13:193–205
Berkun, C.On behalf of women over 40: understanding the importance of menopause. Soc. Work 1986; 31:378–84
Lock, M.Ambiguities of aging: Japanese experience and perceptions of the menopause. Cult. Med. Psychiatry 1980; 10:23–46
Beyenne, Y.Cultural significance and physiological manifestations of menopause, a biocultural analysis. Cult. Med. Soc. 1986; 10:47–71
Voda, A. M.Climacteric hot flush. Maturitas 1981; 3:73–90xs
Gannon, L., Hansel, S. and Goodwin, J.Correlates of menopausal hot flushes. J. Behav. Med. 1987; 10:277–85
Vliet, E.Menopause and perimenopause: the role of ovarian hormones in common neuroendocrine syndromes in primary care. Prim. Care 2002; 29:43–67
Bhatia, S.Depression in women: diagnostic and treatment considerations. Am. Fam. Physician 1999; 60:225–40
Miszko, T. A. and Cress, M. E.A lifetime of fitness: exercise in the perimenopausal and postmenopausal woman. Clin. Sports Med. 2000; 19:215–32
Lane, N. A., Bloch, D. A., Hubert, H. B., et al.Running, osteoarthritis, and bone density: initial 2 year longitudinal study. Am. J. Med. 1990; 88:452
Manber, R.Alternative treatments for depression: empirical support and relevance to women. J. Clin. Psychiatry 2002; 63:628–40
Dunn, A. L., Marcus, B. H. and Kampert, J. B.Comparison of the lifestyle and structured intervention to increase physical activity and cardiorespiratory fitness: a randomized trial. J. Am. Med. Assoc. 1999; 281:327
Manson, J. E., Hu, F. B., Rich-Edwards, J. W., et al.A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N. Engl. J. Med. 1999; 341:651