Women’s health in midlife - a person-centered approach in primary care -effects on mental, somatic, and urogenital symptoms, and quality of life

Abstract: Midlife women, from 45-60, enter new challenges in life with various impacts on health and quality of life. Mental and stress-related illnesses are common causes for attending primary health care (PHC) and long-term sick leave. Today there are few educational opportunities, support or care for life going through the natural ageing and topics related to this transition period, which often coincides with menopause transition (MT). The identification of the prevalence of symptoms, prognostic factors and evaluating interventions for preventing stress-related illnesses, long-term sick leave, improve quality of life, and gaining further knowledge, is motivated. The overall aim of the present thesis was to obtain knowledge about; I) prevalence and severity of somatic, urogenital and psychological symptoms measured with the Menopause Rating Scale (MRS), II) the effect of group education intervention based on topics related to menopause transition in midlife women with focus on somatic, urogenital, psychological and psycho-social health, III) prognostic factors for health-related quality of life and work ability, and IV) the effect of group education or person-centered individual support in PHC on mental health, quality of life and sick leave in women aged 45-60 with stress-related symptoms. Study I The aim was to estimate the prevalence of somatic, urogenital and psychological symptoms in women aged 45–55 attending PHC and evaluate factors associated with severe symptoms. One hundred and thirty-one women were included in this cross-sectional study. Data was obtained from two self-reported questionnaires, the MRS and the Montgomery-Asberg Depression Rating Scale (MADRS). The five most frequently reported MRS symptoms were; physical and mental exhaustion (73 %), depressive mood (66 %), sleep problems (66 %), hot flushes (66 %), and muscle, joint and sexual problems (62 %). Moreover, more severe depression symptoms (MADRS) and increasing age were associated with more severe menopausal symptoms (MRS). A nomogram was constructed for assessing the probability for severity of menopause symptoms using these three factors. Study II This RCT, investigates whether group education about menopause transition to women in PHC can improve women’s menopausal symptoms and mental health. Midlife women (n=131), aged 45-55 years, were randomized to group education (n=64) or no intervention (n=67). The group education included two sessions with topics related to menopause transition. The MRS and MADRS were filled in at baseline and four months later. Main outcomes were change in MRS and MADRS over the four months. The intervention group experienced a slight reduction in symptoms while the control group mostly experienced the opposite. Study III This 6-year longitudinal cohort study investigated prognostic factors for future mental, physical, and urogenital health, as well as work ability in a population of women aged 45–55 years. Sixty-five percent (n = 71/110) of the women included in Study I could be followed up at 6 years. Prognostic factors for later health-related quality of life (SF36), work ability (yes/no) and hypertension (yes/no) were analysed by multivariate regression analyses. Living with a partner was associated with a better chance for good health, and having tertiary education was shown to be associated with poorer mental health after six years. Study IV This RCT, with a two-factor design including 368 women, evaluated the effect of group education as well as person-centred support in a PHC context on mental health issues and quality of life in women aged 45-60 with stress-related symptoms. The women were allocated to four groups: 1, group education (GE) 2, GE and person-centered individual support (PCS) 3, PCS and 4, a control group. GE comprised four one and one half hour, weekly sessions, and PCS included five sessions with topics related to middle age, but adapted to the woman’s individual situation and based on the woman´s narratives, needs, resources and beliefs. The effect of the interventions were followed up at 6 and 12 months after baseline. Conclusion This thesis has described and identified factors associated with the transition period in women between the ages of 45 and 60, identified prognostics factors for later work ability and quality of life, as well as positive effects on health-related quality of life, physical, urogenital, and mental symptoms of a person-centered intervention using the district nurse’s competence and assignment in PHC and an interdisciplinary collaboration with midwife.