Emirati women’s attitudes towards menopause: Implications for health care policy

Abstract

Objectives

To investigate the attitudes of Emirati women aged 30–64 years towards menopause and determine the relationships between these attitudes and their sociodemographic and reproductive characteristics.

Study design

A community-based cross-sectional study was conducted with 497 Emirati women attending five primary health care centres in Dubai using a multistage stratified and clustered random sampling technique. Emirati women were interviewed face-to-face via a structured questionnaire with two parts: sociodemographic and reproductive characteristics and the attitudes towards menopause scale.

Results

The mean ± S.D. of age was 42.06 years ± 8.716 (median 40 years). Mean age at menopause for the study sample (N = 436) was 49.94 years ± 4.593 (median 50 years). Of the respondents, 36.6% had completed high school, and 41.4% had graduated from university. Approximately, 70.8% of the women were premenopausal, 13.1% were perimenopausal and 16.1% were postmenopausal. Sixty-four percent of the respondents had never used oral contraceptive pills, while 32.9% were past users; 44.6% were employed outside the home. Mean average attitudes score ± S.D. was 2.42 ± 0.26 (minimum score of 1 indicates very negative attitudes, maximum score of 4 indicates very positive attitudes). Statistically significant differences in mean average attitudes score were noted for employment and menopausal status, and mean average attitudes score was positively correlated with age. Premenopausal women held more positive attitudes towards menopause than peri- and postmenopausal women.

Conclusions

Emirati women displayed neutral to positive attitudes towards menopause and premenopausal women exhibited more negative attitudes towards menopause than postmenopausal women.

Keywords

Attitudes Emirati women menopause

Introduction

Menopause is a physiological condition that involves ovarian failure and leads to the end of a woman’s reproductive life. Menopause is defined as the time when a woman’s menstrual period stops for 12 sequential months after the last period, and it takes place between 45 and 55 years of age, with an average onset of 51 years.¹

The global trend towards an aging population and the consequent growth in the population of postmenopausal women has rendered the health of women at menopausal age a current major health issue.²

The UAE, similar to other developing countries, is undergoing substantial demographic and epidemiological changes. According to the UAE census,³ in 2010, the reported life expectancy of different age groups of Emirati women who live in Dubai is 39.4 years at 45–49 years and 34.4 years at 50–54 years; therefore, women are expected to live no less than one-third of their lives beyond menopause, which will have remarkable effects on the health care system and its policies in the future.

Women’s diverse attitudes towards menopause (ATM) determine how they describe menopause and interpret its effects on their lives.⁴ One study showed that ATM, which evolve in a community context and are influenced by social beliefs, affect women’s lifestyles during menopause.⁵ Therefore, it can be said that cultural values, beliefs and attitudes regarding menopause could have a positive or negative effect on the lives of women during the menopausal years. Furthermore, ATM have been mentioned as one of the reasons explaining the variation in women’s experiences of menopausal symptoms.⁶ According to the evidence presented in some studies, women’s ATM affect the severity of menopause symptoms, for example, negative attitudes are associated with greater symptom severity.⁷

In Western society, menopause research has provided an abundance of information about menopausal women; however, menopause research in the Arab world is very scarce.

To our knowledge, only two studies have been published in the UAE that examined women’s knowledge of and ATM and hormone replacement therapy (HRT),^8,9 while another recently published study investigated women’s knowledge and attitudes towards HRT and the prevalence of use of HRT in the UAE.¹⁰

Menopause is universal, but attitudes regarding menopause vary by culture. Combined with the lack of information about women’s attitudes regarding menopause, this highlights the need for studies that collect data focused on ATM and HRT and their related health risks.

The proposed study is the first to investigate Emirati women’s ATM and HRT in the Emirate of Dubai. This study adds further information about Emirati menopausal women to the limited menopause research in the Arab world and specifically in the UAE. There is a substantial need to conduct more research in this area, as it has a remarkable impact not only on menopausal women’s quality of life but also on health care policies regarding their health.

The aim of this study is to contribute to the evaluation and understanding of the current attitudes of Emirati women towards menopause in Dubai. The results will help health care providers work effectively with menopausal women by providing a better understanding of the women’s needs and beliefs.

Materials and methods

Study design and sample

A community-based cross-sectional study was conducted with a random sample of 497 Emirati women aged 30 to 64 years recruited from five primary health care (PHC) centres in Dubai. The sample size was determined based on a power of 85% and a significance level of 5%.

Sampling method

Public health care consists of 20 health centres and peripheral clinics representing 20 regions throughout the Emirate of Dubai, and each region is represented by one health centre. A random sample of 497 Emirati women aged 30–64 years were enrolled in the study via a multistage stratified and clustered random sampling technique. The first stage was a clustered random sample in which five health centres were chosen. The second stage was a stratified random sample on age in which three age groups were identified (30–39, 40–49 and 50–64 years). The final stage was a simple random sample from each age group stratum from the five chosen health centres.

Study instruments

A structured questionnaire was administered through face-to-face interviews at the health centres. The questionnaire included sociodemographic variables and reproductive characteristics and the ATM scale developed by Neugarten et al.¹¹

ATM scale

The ATM scale includes 34 items representing specific ATM. The items are constructed in terms of what a woman thinks in general about menopause. The participants were asked to indicate the degree to which they agreed with each item on a four-point Likert scale ranging from strongly agree to strongly disagree. Bowles⁵ reported a Cronbach’s $α$ reliability coefficient of 0.80 for the ATM scale total score.

Validity and reliability of the questionnaire

A professional translator translated the English version of the questionnaire into the Arabic language. A second bilingual speaker checked the Arabic version word by word against the English version and translated it back to English. The content validity of the Arabic version of the questionnaire was assessed by a panel of experts in the field to evaluate the items’ readability, language simplicity and suitability and to assess the relationship of each item to the whole scale. The internal consistency reliability of the Arabic version of the questionnaire was assessed using Cronbach’s $α$ and found to be 0.902 for the ATM scale based on a pilot survey of 25 Emirati women from one health care centre.

Ethical considerations

We sought ethical clearance from Zayed University’s research and ethics committee and Dubai Health Authority’s medical research committee. Additionally, permission from each of the selected PHC centres was obtained. The selected Emirati women were invited to participate in the study on a voluntary basis. An information sheet was provided, and informed consent was obtained prior to participation. The participants were assured of confidentiality, anonymity and security.

Statistical analysis

The collected data were coded, entered and analysed using the statistical package SPSS version 25. Descriptive statistics were computed to describe all the items in the questionnaire. The ATM scale is a four-point Likert scale (1 strongly agree, 2 agree, 3 disagree, 4 strongly disagree). Positive items were reverse coded so that agreement with positive items and disagreement with negative items had the same score. Higher scores indicated more positive attitudes.

The average of each respondent’s responses to all the ATM items was computed and called the ‘average attitudes score’ (AAS). The newly created AAS variable served as the outcome variable in the study for the purpose of data analyses. Sociodemographic and reproductive variables served as the independent variables. One-way analyses of variance (ANOVAs) or independent-sample t-tests were carried out to test the equality of the population means across the categories of each predictor. Pearson’s linear correlation coefficient was computed to assess the linear relationship between the AAS and each of the independent variables. Multiple linear regression analysis was used to predict the value of the AAS using the predictors, i.e. education level, marital status, employment, smoking, age, HRT status, menopausal status and use of oral contraceptive pills (OCPs). Statistical tests with P-values <0.05 were considered statistically significant.

Results

Characteristics of the study sample

The mean ± S.D. for age was 42.06 ± 8.716 years, with a median of 40 years. The mean age at menopause for the study sample (N = 436) was 49.94 years ± 4.593, with a median age of 50 years. The maximum age at menopause was 73 years, while the minimum age was 38 years.

Most of the participants (93.4%) had never used HRT, were nonsmokers (96.4%) and were married (74.3%). Of the respondents, 36.6% had completed high school, while 41.4% had graduated from university. Approximately, 70.8% of the women were premenopausal, 13.1% were perimenopausal and 16.1% were postmenopausal. Of the women, 64% had never used OCPs and 32.9% were past users; 44.6% of the respondents were currently employed outside the home.

ATM

Hypothesis 1: Emirati women display positive ATM.

The mean average attitudes score (MAAS) was 2.42 (S.D. = 0.26). The minimum score is 1, which represents a very negative attitude, while the highest score is 4, which represents a very positive attitude. The MAAS therefore reflected neutral to slightly positive ATM. Table 1 presents the percentage of respondents who agreed or strongly agreed with each item on the ATM scale. The range of the percentage of agreement for all items was 68.4, with an average of 55.8 (minimum 21.6%, maximum 90%).

Table 1.

Percentage of agree and strongly agree responses on the ATM scale (N = 497).

Statement	Agreement (%)
A woman should see a doctor at menopause	87.2
Menopause is one of the biggest changes that happens in a woman’s life	90
A woman is concerned about how her husband will feel about her after menopause	73.2
Menopause is an unpleasant experience	66.1
After the change of life, a woman feels freer to do things for herself	66.2
Women generally feel better after menopause	46.2
Women are generally calmer and happier after the change of life	43.2
A woman has a broader outlook on life after the change	57.6
Menopause is a disturbing thing that women naturally dread	70.6
Women should expect some trouble during menopause	82.5
A woman’s body may change in menopause, but otherwise, she doesn’t change much	67.4
It is no wonder women feel down in the dumps at the time of menopause	67.4
Life is more interesting for a woman after menopause	38.6
Changes inside the body that women cannot control cause all the trouble during menopause	67.7
A woman gains more confidence in herself after the change of life	47.9
Going through menopause really does not change a woman in any important way	52.3
Women worry about losing their minds during menopause	49
Women think of menopause as the beginning of the end	48.2
The only difference between a woman who has been through menopause and one who has not is that one menstruates and the other doesn’t	60.5
In truth, just about every woman is depressed about menopause	69.6
Women often use the change of life as an excuse for getting attention	36.1
After the change of life, women do not consider themselves real women	39.9
It’s not surprising that most women become disagreeable during menopause	45
After the change of life, a woman has a better relationship with her husband	39
Many women think menopause is the best thing that ever happened to them	41.9
After the change of life, a woman becomes more interested in community affairs than before	61.7
Women who have trouble with menopause are usually those who have nothing to do with their time	53.3
Women who have trouble with menopause are those who are expecting it	51.2
Women often become self-centred at the time of menopause	59.4
A woman in menopause is apt to do crazy things she herself does not understand	30.6
Menopause is a mysterious thing that most women don’t understand	46.9
After menopause, a woman is more interested in sex than she was before	21.6
Unmarried women have a harder time than married women do at the time of menopause	45.2
A good thing about menopause is that a woman can quit worrying about becoming pregnant	75.3

On the positive side, the range for percentage of agreement with the positive items was 53.7, with an average of 51.5. Most of the participants (75.3%) agreed with the statement that ‘A good thing about menopause is that a woman can quit worrying about becoming pregnant’. The lowest percentage of agreement for the positive items was observed for the statement that ‘After menopause, a woman is more interested in sex than she was before’ (21.6%).

On the negative side, the range for the percentage of agreement with the negative items was 59.4, with an average of 59.7. A high percentage of the respondents (90%) thought that ‘Menopause is one of the biggest changes that happens in a woman’s life’. The lowest percentage of agreement for the negative items was observed for the statement that ‘A woman in menopause is apt to do crazy things she herself does not understand’ (30%).

With regard to lifestyle expectations during the climacteric period, a large percentage (82.5%) of the respondents agreed that ‘Women should expect some trouble during menopause’. Regarding negative changes in women’s way of life during menopause, 48% of the respondents reported that ‘Women think of menopause as the beginning of the end’, while 39.9% said that ‘Women do not consider themselves real women’.

The participants were nearly equally divided on the following items: ‘Women who have trouble with menopause are those who are expecting it’, ‘Going through menopause really does not change a woman in any important way’ and ‘Women who have trouble with menopause are usually those who have nothing to do with their time’ (51.2%, 52.3% and 53.3%, respectively).

Hypothesis 2: There is no significant difference in Emirati women’s ATM based on their sociodemographic and reproductive variables.

A statistically significant difference was found in the AASs for employment (P = 0.022) and menopausal status (P = 0.019), as indicated in Table 2. Post hoc analysis results showed that the MAASs for premenopausal women were significantly different from those for postmenopausal women (P = 0.019). A weak positive linear relationship was also observed between AAS and age (r = 0.146, P = 0.001).

Table 2.

AAS by independent variable (N = 497).

Variable	Level	Mean	S.D.	P
Education level	Illiterate	2.51	0.27	0.246
	Primary school	2.34	0.33
	Preparatory school	2.37	0.31
	Secondary school	2.43	0.22
	University undergraduate	2.42	0.26
	University graduate	2.45	0.22
Menopausal status	Premenopause	2.40	0.25	0.019
	Perimenopause	2.41	0.27
	Postmenopause	2.49	0.25
Marital status	Single	2.42	0.25	0.945
	Married	2.42	0.25
	Divorced	2.43	0.23
	Widowed	2.42	0.26
Use of oral contraceptive pills (OCPs)	Current user	2.41	0.28	0.771
	Past user	2.41	0.27
	Never used	2.42	0.25
Employment	Yes	2.41	0.22	0.022
Employment	No	2.42	0.28

Table 3 displays the results of the final multiple linear regression model for the AAS (dependent variable), which contains the following predictors: education, marital status, employment, smoking, age, OCP use, HRT use and menopausal status. The independent variables described approximately 6.3% of the variation in attitudes (R² =0.063). The only predictor that had a significant effect on ATM given the other independent variables in the model was smoking (P = 0.005).

Table 3.

Parameter estimates for the general linear model for AAS.

Variable	Level	β	S.E.	d.f.	F	P
Corrected model	–	–	–	17	1.981	0.047
Intercept	–	2.446	0.165	1	439.979	<0.001
Education level	Illiterate	–0.016	0.099	5	1.340	0.056
	Primary school	–0.180	0.088
	Preparatory school	–0.128	0.082
	Secondary school	–0.030	0.071
	University undergraduate	–0.047	0.069
	University graduate	0	0
Marital status	Single	0.043	0.093	3	0.125	0.960
	Married	0.039	0.086
	Divorced	0.051	0.098
	Widowed	0	0
Employment	Yes	0.002	0.030	1	5.313	0.942
Employment	No	0	0
Smoking	Yes	–0.175	0.064	1	2.126	0.005
Smoking	No	0	0
Age	–	0.002	0.002	1	0.856	0.353
Use of oral contraceptive pills (OCPs)	Current user	0.035	0.075	2	0.261	0.657
	Past user	–0.019	0.028
	Never used	0	0
Use of hormone replacement therapy (HRT)	Current user	–0.012	0.080	2	0.165	0.504
	Past user	0.072	0.064
	Never used	0	0
Menopausal status	Premenopause	–0.102	0.048	2	3.982	0.093
	Perimenopause	–0.090	0.053
	Postmenopause	0	0

Hypothesis 3: Premenopausal women demonstrate more positive ATM than post- and perimenopausal women.

Table 4 shows the ANOVA results observed when testing the equality of the means of the ATM items among pre-, peri- and postmenopausal women. The results show statistically significant attitudinal differences among the participants according to menopausal status. Premenopausal women had the highest MAASs compared to peri- and postmenopausal women, which is an indication that these women hold more positive attitudes toward menopause. Postmenopausal women had more negative attitudes towards many of the negative items than pre- and perimenopausal women, for example, ‘A woman should see a doctor at menopause’ (P = 0.001), ‘Menopause is one of the biggest changes that happens in a woman’s life’ (P < 0.001) and ‘A woman is concerned about how her husband will feel about her after menopause’ (P = 0.035).

Table 4.

Attitudes toward menopause: premenopausal vs. perimenopausal and postmenopausal Emirati women (N = 497).

Statement	Pre (n = 352)Mean (S.D.)	Peri (n = 65) Mean (S.D.)	Post (n = 80) Mean (S.D.)	P
A woman should see a doctor at menopause	3.31 (0.668)	3.13 (0.745)	3.00 (0.763)	0.001
Menopause is one of the biggest changes that happens in a woman’s life	3.31 (0.601)	3.17 (0.747)	2.98 (0.711)	<0.001
A woman is concerned about how her husband will feel about her after menopause	3.01 (0.745)	2.82 (0.800)	2.81 (0.752)	0.035
Menopause is an unpleasant experience	2.86 (0.768)	2.83 (0.794)	2.73 (0.729)	0.352
After the change of life, a woman feels freer to do things for herself	2.73 (0.705)	2.68 (0.742)	2.83 (0.652)	0.426
Women generally feel better after menopause	2.47 (0.706)	2.43 (0.712)	2.56 (0.675)	0.505
Women are generally calmer and happier after the change of life	2.44 (0.735)	2.38 (0.662)	2.53 (0.657)	0.422
A woman has a broader outlook on life after the change	2.63 (0.695)	2.54 (0.721)	2.70 (0.664)	0.402
Menopause is a disturbing thing that women naturally dread	2.85 (0.739)	2.81 (0.692)	2.80 (0.723)	0.795
Women should expect some trouble during menopause	2.95 (0.590)	2.83 (0.583)	2.87 (0.628)	0.247
A woman’s body may change in menopause, but otherwise, she doesn’t change much	2.77 (0.658)	2.78 (0.728)	2.70 (0.753)	0.675
It is no wonder women feel down in the dumps at the time of menopause	2.80 (0.694)	2.75 (0.718)	2.69 (0.704)	0.428
Life is more interesting for a woman after menopause	2.36 (0.684)	2.46 (0.714)	2.44 (0.749)	0.468
Changes inside the body that women cannot control cause all the trouble during menopause	2.77 (0.698)	2.82 (0.736)	2.71 (0.660)	0.642
A woman gains more confidence in herself after the change of life	2.48 (0.704)	2.48 (0.715)	2.56 (0.709)	0.610
Going through menopause really does not change a woman in any important way	2.53 (0.712)	2.56 (0.719)	2.52 (0.731)	0.943
Women worry about losing their minds during menopause	2.56 (0.689)	2.45 (0.717)	2.47 (0.788)	0.355
Women think of menopause as the beginning of the end	2.52 (0.772)	2.61 (0.732)	2.45 (0.804)	0.484
The only difference between a woman who has been through menopause and one who has not is that one menstruates and the other doesn’t	2.62 (0.720)	2.65 (0.704)	2.66 (0.799)	0.901
In truth, just about every woman is depressed about menopause	2.79 (0.694)	2.79 (0.699)	2.81 (0.658)	0.953
Women often use the change of life as an excuse for getting attention	2.37 (0.656)	2.40 (0.685)	2.29 (0.663)	0.587
After the change of life, women do not consider themselves real women	2.44 (0.726)	2.38 (0.705)	2.34 (0.745)	0.505
It’s not surprising that most women become disagreeable during the menopause	2.51 (0.720)	2.43 (0.712)	2.30 (0.736)	0.062
After the change of life, a woman has a better relationship with her husband	2.34 (0.722)	2.40 (0.689)	2.45 (0.732)	0.435
Many women think menopause is the best thing that ever happened to them	2.36 (0.683)	2.41(0.638)	2.61 (0.758)	0.019
After the change of life, a woman becomes more interested in community affairs than before	2.60 (0.650)	2.65 (0.600)	2.79 (0.650)	0.069
Women who have trouble with menopause are usually those who have nothing to do with their time	2.55 (0.676)	2.59 (0.706)	2.56 (0.729)	0.912
Women who have trouble with menopause are those who are expecting it	2.55 (0.665)	2.52 (0.715)	2.39 (0.706)	0.196
Women often become self-centred at the time of menopause	2.64 (0.636)	2.56 (0.738)	2.61 (0.738)	0.674
A woman in menopause is apt to do crazy things she herself does not understand	2.23 (0.791)	2.30 (0.738)	2.09 (0.754)	0.242
Menopause is a mysterious thing that most women don’t understand	2.57 (0.771)	2.52 (0.780)	2.34 (0.795)	0.058
After menopause, a woman is more interested in sex than she was before	2.14 (0.741)	2.19 (0.715)	1.92 (0.546)	0.033
Unmarried women have a harder time than married women do at the time of menopause	2.50 (0.816)	2.41 (0.796)	2.47 (0.830)	0.752
A good thing about menopause is that a woman can quit worrying about becoming pregnant	2.91 (0.688)	2.87 (0.813)	2.86 (0.742)	0.806

In contrast, premenopausal Emirati women displayed more positive attitudes towards the positive items than peri- and postmenopausal Emirati women, for example, ‘Many women think menopause is the best thing that ever happened to them’ (P = 0.019) and ‘After menopause, a woman is more interested in sex than she was before’ (P = 0.033).

Discussion

Age at menopause

In this study, the mean age at menopause among menopausal Emirati women attending PHC centres was 49.94 years ± 4.59, with a median age of 50.00 years. It appears that the median age of menopausal Emirati women is lower than the median age in developed regions and countries such as Western Europe,^12–15 Australia¹⁶ and the USA¹⁷ but similar to those in other non-Arab and Arab developing countries, such as most Asian countries,^18,19 Turkey,²⁰ Iran,²¹ Mexico,²² African countries,^23,24 Saudi Arabia,²⁵ Egypt,²⁶ Iraq²⁷ and Bahrain.²⁸

HRT users

In this study, 93.4% of the women had never used HRT, 20 women (4%) reported that they had used HRT in the past and 13 women (2.6%) were currently using it. There is no obvious explanation for this distribution; it could be that women refuse to take HRT or that physicians do not encourage them to do so or do not prescribe HRT to them. There are no studies or data to support this notion; thus, more research is necessary in this direction. A similar pattern was observed in Arab countries.^8,9,25,28 It is clear that the percentage of women using HRT is significantly higher in Western countries where most studies are population based. A Swedish study reported that 21% of women use HRT, while in Norway, this percentage reached 28%.²⁹

ATM

In our study, the MAAS ±S.D. was 2.42 ± 0.26, which indicates that the general ATM were neutral to positive. A systematic review⁸ reported that many studies have found that overall ATM are more positive than negative. In the Al Ain study,⁹ the attitude score showed that 60% of women (not all of whom were Emirati) had a positive attitude towards menopause. This finding contrasts with the more negative attitudes reported two decades ago in a study from Abu Dhabi.⁸

Comparison to studies by Jassim and Huffman et al.

Table 5 presents the percentage of agreement observed for each item on the ATM scale in the studies by Huffman et al.³⁰ and Jassim and Al-Shboul²⁸ and in our study. In each of the three studies, nearly all women agreed with the first two statements, ‘A woman should see a doctor at menopause’ (95.96% in Huffman et al.,³⁰ 80% in Jassim and Al-Shboul²⁸ and 87.2% in our study) and ‘Menopause is one of the biggest changes that happens in a women’s life’ (90% of Emirati women, 82.3% of Bahraini women and 80.63% of Iranian women). Thus, it appears that despite the different cultures, women in the three countries accept menopause as a natural change that happens in their lives.

Table 5.

Comparison between the present study and Huffman’s and Jassim’s studies in terms of percentage of agreement with the items on the ATM scale.

	% of agreement
Statement	Huffman	Jassim	Our study
A woman should see a doctor at menopause	95.96	80.0	87.2
Menopause is one of the biggest changes that happens in a woman’s life	80.63	82.3	90
A woman is concerned about how her husband will feel about her after menopause	70.78	66.9	73.2
Menopause is an unpleasant experience	69.96	64.2	66.1
After the change of life, a woman feels freer to do things for herself	67.44	44.6	66.2
Women generally feel better after menopause	64.90	37.7	46.2
Women are generally calmer and happier after the change of life	64.15	34.6	43.2
A woman has a broader outlook on life after the change	61.10	43.5	57.6
Menopause is a disturbing thing that women naturally dread	60.00	71.5	70.6
Women should expect some trouble during menopause	58.48	83.1	82.5
A woman’s body may change in menopause, but otherwise, she doesn’t change much	58.45	29.6	67.4
It is no wonder women feel down in the dumps at the time of menopause	57.34	72.3	67.4
Life is more interesting for a woman after menopause	55.56	42.3	38.6
Changes inside the body that women cannot control cause all the trouble during menopause	54.80	69.6	67.7
A woman gains more confidence in herself after the change of life	51.85	43.1	47.9
Going through menopause really does not change a woman in any important way	50.23	52.3	52.3
Women worry about losing their minds during menopause	48.64	30.0	49
Women think of menopause as the beginning of the end	46.19	43.5	48.2
The only difference between a woman who has been through menopause and one who has not is that one menstruates and the other doesn’t	45.41	50.8	60.5
In truth, just about every woman is depressed about menopause	36.81	43.1	69.6
Women often use the change of life as an excuse for getting attention	27.15	36.5	36.1
After the change of life, women do not consider themselves real women	25.24	42.3	39.9

More than 66% of the Emirati and Iranian women agreed with the statement that ‘After the change of life, a woman feels freer to do things for herself’, while only 44.6% of the Bahraini women agreed.

It appears that more than 64% of Iranian women feel better and are generally calmer and happier after the change of life, while less than 46% of Emirati women and less than 37% of Bahraini women feel the same.

While approximately 49% of Emirati and Iranian women agreed with the statement that ‘Women worry about losing their minds during menopause’, only 30% of the Bahraini participants did.

By contrast, approximately 40% of the Emirati and Bahraini women agreed with ‘After the change of life, women do not consider themselves real women’, while less than 26% of the Iranian women did.

Factors related to ATM

Employed women had more positive ATM than unemployed women. Additionally, there was a positive relationship between ATM and age, which is consistent with the findings of other studies.^5,11

Only 6.3% of the variation in the AAS was explained by the predictors included in the multiple regression model, which is perhaps because ATM are more related to personal characteristics than to menopause itself.

When smoking was included as the only predictor in the simple linear regression, it explained only 1% of the variation in attitudes, and when menopausal status was included as the only predictor, it explained only 1.6% of the variation.

Conclusions

The Emirati women in this study displayed neutral to positive ATM, and premenopausal women demonstrated more positive ATM than post- and perimenopausal women.

Employment and menopausal status were the only two factors that had significant effects on the attitudes of Emirati women towards menopause. Further research should be conducted to explain additional factors that may influence the attitudes of Emirati women towards menopause beyond those included in this study.

This study contributes to the evaluation and understanding of the current attitudes of Emirati women towards menopause, which can help health care providers work effectively with menopausal women by providing them with a better understanding of the needs and beliefs of Emirati women.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Research Office, Zayed University [RIF Grant number R17065].

References

World Health Organization. Research on the menopause in the 1990s. Technical Report Series (No. 866), World Health Organization, Geneva, Switzerland, 1999.

Pachana

Helmes

Gudgeon

An Australian facts on ageing quiz. Aust

J Ageing 2013; 32: 117–121.

Dubai Statistics Bureau (DSB). Life expectancy reports for Dubai, www.dsc.gov.ae/en-us (accessed 20 November 2017).

Akkuzu

Örsal

Kecialan

Women’s attitudes towards menopause and influencing factors. Türk

Klin Tıp Bilim Derg 2009; 29: 666–674.

Bowles

Measure of attitude toward menopause using the semantic differential model.

Nurs Res 1986; 35: 81–85.

Santoro

Green

Menopausal symptoms and ethnicity: lessons from the study of women’s health across the nation. Sex Reprod

Menopause 2009; 7: 6–8.

Ayers

Forshaw

Hunter

MS.

The impact of attitudes towards the menopause on women’s symptom experience: a systematic review.

Maturitas 2010; 65: 28–36.

Eman

Abdulmajeed

Ibtisam

Assessment of women knowledge and attitude toward menopause and hormone replacement therapy (HRT) in Abu Dhabi, UAE.

Suez Canal Univ Med J 1999; 2: 217–222.

Hamid

Al-Ghufli

Raeesi

et al . Women’s knowledge, attitude and practice towards menopause and hormone replacement therapy: a facility based study in Al-Ain, United Arab Emirates. J Ayub Med Coll Abbottabad 2014; 26: 448–454.

10.

Ibrahim

Hussein

RN.

Knowledge, attitude, and prevalence of use of hormone replacement therapy among women in United Arab Emirates, Asian. J Pharm Clin Res 2016; 9: 154–158.

11.

Neugarten

Wood

Kraines

et al . Women’s attitudes toward the menopause. Vita Hum 1963; 6: 140–151.

12.

Bengtsson

Lindquist

Redvall

Menstrual status and menopausal age of middle-aged Swedish women. A population study of women in Goteborg 1968–69 and 1974–75.

Acta Obstet Gynecol Scand 1981; 60: 269–275.

13.

Khaw

KT.

Epidemiology of the menopause.

Br Med Bull 1992; 48: 249–261.

14.

Luoto

Kaprio

Uutela

Age at natural menopause and sociodemographic status in Finland.

Am J Epidemiol 1994; 139: 64–76.

15.

Parazzini

Negri

La Vecchia

Reproductive and general lifestyle determinants of age at menopause.

Maturitas 1992; 15: 141–149.

16.

Adena

Gallagher

HG.

Cigarette smoking and the age at menopause.

Ann Hum Biol 1982; 9: 121–130.

17.

Whelan

Sandler

McConnaughey

et al . Menstrual and reproductive characteristics and age at natural menopause. Am J Epidemiol 1990; 131: 625–632.

18.

Sharma

Saxena

MS.

Climacteric symptoms: a study in the Indian context.

Maturitas 1981; 3: 11–20.

19.

Ramoso-Jalbuena

Climacteric Filipino women: a preliminary survey in the Philippines.

Maturitas 1994; 19: 183–190.

20.

Beser

Aydemir

Bozkaya

Body mass index and age at natural menopause.

Gynecol Obstet Invest 1994; 37: 40–42.

21.

Ghaderi

Ghazanfarpour

Kaviani

Evaluation of menopausal women's attitudes towards menopause in Shiraz. Pak

J Med Sci 2010; 26: 698–703.

22.

Garrido-Latorre

Lazcano-Ponce

Lopez-Carrillo

et al . Age of natural menopause among women in Mexico City. Int J Gynaecol Obstet 1996; 53: 159–166.

23.

Okonofua

Lawal

Bamgbose

JK.

Features of menopause and menopausal age in Nigerian women.

Int J Gynaecol Obstet 1990; 31: 341–345.

24.

Kwawukume

Ghosh

Wilson

JB.

Menopausal age of Ghanaian women.

Int J Gynaecol Obstet 1993; 40: 151–155.

25.

Bakarman

Abu Ahmed

HA.

Awareness of hormonal replacement therapy among females attending primary health care centers in Western Saudi Arabia, Saudi. Med J 2003; 24: 488–492.

26.

Loutfy

Abdel Aziz

Dabbous

et al . Women’s perception and experience of menopause: a community-based study in Alexandria, Egypt. East Mediterr Health J 2006; 2: S93–S106.

27.

Mustafa

Sabir

JM.

Perception and experience regarding menopause among menopaused women attending teaching hospitals in Erbil City.

Glob J Health Sci 2012; 4: 170–178.

28.

Jassim

Al-Shboul

Attitudes of Bahraini women towards the menopause: implications for health care policy.

Maturitas 2008; 59: 358–372.

29.

Stadberg

Mattsson

Milsom

Womens attitudes and knowledge about the climacteric period and its treatment. A Swedish population-based study.

Maturitas 1997; 27: 109–116.

30.

Huffman

Myers

Tingle

et al . Menopause symptoms and attitudes of African American women: closing the knowledge gap and expanding opportunities for counseling. J Couns Dev 2005; 83: 48–56.