Menopause Experiences among Women Veterans with Mental Health Concerns

Principle Investigator: Haley Miles-McLean, PhD
Co-Investigators: Amy Drapalski, PhD; Alicia Lucksted, PhD
Funding: VISN 5 MIRECC Pilot Study

The largest proportion of women Veterans are in mid-life or beyond (Frayne et al., 2018), a period commonly impacted by biopsychosocial stressors (Hunter & Rendall, 2007; Thomas & Thurston, 2016). A particularly important change that typically occurs during this period is the menopause transition (Hunter & Rendall, 2007). While menopause is a natural, biological process, it can be a period of vulnerability particularly for mental health challenges (Hunter & Rendall, 2007). This is of particular concern for Veterans during the menopause transition given that studies suggest approximately half of all women Veterans have a mental health diagnosis (Runnals et al., 2014). Further, emerging research on aging and the menopause transition among women Veterans suggests they may experience more challenges during this period than civilian women (Katon et al., 2016).

We are conducting a project that will collect preliminary data to support planning of a small-scale trial of an intervention to help women Veterans with mental health concerns navigate the menopause transition in ways that do not disrupt mental health. To do this, we will collect data on the intersection of menopause and mental health. First, we will conduct qualitative interviews to learn about menopause transition experiences among women Veterans with mental health diagnoses (Aim 1). Second, we will examine the feasibility and appropriateness (i.e., applicability to women Veterans; item clarity) of measures to evaluate menopause symptoms in a small sample of women Veterans with mental health concerns (Aim 2). In addition, we will pilot procedures for recruitment and screening in order to inform study recruitment procedures for a small-scale menopause intervention trial. The outcomes of this exploratory project will inform future research that will further examine menopause experiences in this population and consider how current psychosocial menopause treatment strategies may need to be modified to better address the needs of Veterans with mental health concerns. As the menopause transition often negatively impacts the functioning of women with mental health concerns (Sajatovic et al., 2006), this pilot aligns with VISN 5 MIRECC’s mission to “support and enhance the longevity, health and wellness, and community functioning of Veterans with serious mental illness.”

The specific aims of this study are: (1) To learn about the experience of the menopause transition among women Veterans with mental health diagnoses, including impact of the menopause transition on psychiatric symptoms, its impact on functioning, and desire for treatment; and (2) to examine the feasibility and appropriateness of recruitment procedures and menopause assessment to inform future research with women Veterans with mental health concerns during the menopause transition.

Participants will include 20 women Veterans aged 45 or older with a diagnosis of a mental health condition and at least one symptom related to menopause in the past two years. Veterans will be recruited from the VA Maryland Health Care System. Eligible Veterans that consent to participate will complete one virtual study visit where they will complete a qualitative interview and quantitative measures with a trained research staff member. Qualitative data collected to evaluate Aim 1 will be examined to identify themes and patterns of the data that inform understanding of participants experiences related to menopause and mental health, impacts of menopause on functioning, and treatment preferences. To evaluate Aim 2, recruitment and screening feasibility indicators will be used, including numbers screened to yield the proposed sample, rates of study recruitment, completion of study visit, and presence of menopause symptoms. Descriptive statistics will be calculated to describe presence of menopause symptoms and relationship to functioning among participants as well as describe the demographic features of the sample. Indicators of appropriateness will be primarily descriptive and include review of participants’ feedback on the menopause specific measures. These qualitative and quantitative analysis methods will help inform future research by expanding the understanding of experiences of menopause among women Veterans with mental health concerns and examining the feasibility and appropriateness of menopause measures and screening methods in this population.

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References

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Hunter, M., & Rendall, M. (2007) Bio-psycho-socio-cultural perspectives on menopause. Best Practice & Research: Clinical Obstetrics & Gynecology, 21(2), 261-74. doi:10.1016/j.bpobgyn.2006.11.001

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Sajatovic, M., Friedman, S.H., Schuermeyer, I. N., Safavi, R., Ignacio, R.V., Hays, R.W., West, J. A., Blow, F. C. (2006). Menopause knowledge and subjective experience among peri- and postmenopausal women with bipolar disorder, schizophrenia and major depression. The Journal of Nervous and Mental Disease, 194(3), 173-178. doi:10.1097/01.nmd.0000202479.00623.86

Thomas, H. N., & Thurston, R. C. A biopsychosocial approach to women's sexual function and dysfunction at midlife: A narrative review. Maturitas, 87, 49-60. doi:10.1016/j.maturitas.2016.02.009