Introduction

Currently the elderly population represents one of the population segments with the greatest growth in the world. According to the National Institute of Statistics,¹ in 2050, for the first time in history, the number of older persons in the world will exceed the number of young people. Worldwide, one of the challenges of an aging population is the feminization of aging.² Women perceive menopause as the beginning of aging.^3,4 Menopause is defined as the permanent cessation of menstruation; whether of a natural or surgical nature, the latter produced by the removal of the ovaries before the natural cessation of hormone function. Menopause is the milestone that clearly connects physiological and biological changes with cultural and social issues. Worldwide, the age of menopause is around fifty (50 and 52 years old) in Europe,⁵ Australia⁶ the USA⁷ and in Chile.⁸ Understanding the meaning of menopause and aging is relevant to promote healthy aging, not only from a physical perspective, but also from social and psychological aspects. There is a lack of research on the experience of Chilean menopause women and aging. The aim of this article is to develop the meaning of a group of post-menopausal women and their relationship with aging.

Methods

Research design. This study is a secondary analysis from a qualitative descriptive study⁹ based on content analysis according to Krippendorff.¹⁰ The original study explored the meaning of menopause, and one description was related to aging.

Participants and setting. All participants were drawn from a convenience sample of 15 Chilean Women recruited between June and July 2014 from an outpatient clinic in Santiago, Chile. Eligible participants were women who have lived the menopause period during the last twenty-four months or more, not including those who have had surgery menopause and/or early menopause.

Data collection. Women were informed about the study by a research assistant in the waiting room at the clinic during their routine medical appointments. Snowball sampling was employed to reach the number of participants who provided data that were saturated. Women interested in participating were referred to the principal investigator to check eligibility criteria and to obtain informed consent to participate. Then the women completed an audio taped face-to-face in depth interview in Spanish administered by 3 female nurse-midwife trained interviewers (the research team) in a private room at the clinic. Audio tapes were transcribed verbatim. The interviews were back translated to verify the accuracy of the quotations. The original interview was conducted in an open and exploratory way, using 5 open-ended questions: “What is the meaning of menopause to you? and this was followed by the next four questions: “In what ways did you face this stage? , “What were the needs of support/help during this period?”, “What were the positive aspects of this period?”, and “What were the negatives aspects during this period?”. This paper is focused on menopause and its connection with aging. In addition, women were asked basic demographic questions including age, number of children, partner, and age of menopause.

Data analysis. Tapes were transcribed verbatim and analysed by 4 qualitative researchers. Individual investigators performed preliminary secondary analyses of the data until categories were saturated and themes were generated as appropriate for qualitative inquiry.¹¹ Trustworthiness of the data was ensured through member checks, with the researchers discussing findings with 13/15 study participants, to verify that the themes identified reflected their experiences. Themes were identified and amplified using rich narrative data obtained during the interviews through discussion by the research team on a continuing basis.¹²

Ethical approval. All study procedures were approved by the Institutional Review Boards at the Pontificia Universidad Católica de Chile in Santiago, Chile and at the Southeast Metropolitan Public Health Service.

Results

The demographic characteristics of the women were between 55 and 71 years old. There were nine married women and two single, two divorced and two widows. For women with partners, the average time of living together was over thirty-four years. Five women did not have a partner and two of them did not have any children. The age of menopause ranged between 47 and 58 years and the time lived without menstruation ranged between 2 and 29 years. Two themes pertaining to the menopause is the beginning of aging were identified: Cessation of women´s reproductive stage and a life transition to aging. The menopause as the beginning of aging dimension refers to all the accounts where women identify the process of menopause as a particular manner and timing of aging focusing on the end of the reproductive life. Women feel that menopause is a milestone that must be faced and the last stage of the life. While their responses varied, all the study participants viewed menopause as a cessation of their reproductive life and a life transition to aging.

Cessation of women´s reproductive stage. Menopause connects women with leaving their fertility and therefore they need to deal with the inability to have children, which in some cases causes feelings of nostalgia for not being able to have children any more. In other words, the meaning of menopause for women is mainly related to the end of the reproductive life focusing on tasks related to reproduction and the childrearing stage:... To me it [menopause] means that the adult part is over, a thing ... so I describe it ... childhood, youth, adult part comes later, when you are a mom, you have children, the children are grown, and then comes the menopause as, it's like seniors ... you know? ... [Interview 4]; I cannot have more children ... I'm happy with my only daughter I had, but I feel sad about the productive stage, what do you call that? The reproductive stage of women [Interview 8].

A life transition to aging. The results show that women identify menopause as an age at a particular time; women felt that menopause is a milestone that places and must face the final stage of the life, the aging part of life. Reinforcing the concept of aging, there are accounts that emphasize the perception of women that identify the milestone of menopause as the beginning of the aging stage in a woman’s life: For me to get older, they are women that want to believe that they are young... There are women who want to live in an eternal youth. It is not possible because we have to live this process we have to get older. The aging process entails many things, and one of those things is the menopause [Interview 2]; ... now comes the aging, one goes down, then it has affected me but ... I've been preparing myself for this period but now that I turned 60 it has affected me a lot…[Interview 5].

Discussion

Menopause is a normal stage in the life cycle of women, marked by the cessation of ovarian function, however beyond this biological fact, it is important to understand women´s meaning of this period and its connection with aging. Women perceived their menopause as the beginning of aging focusing on the end of fertility and the social connotation that this new role implies. In Latin cultures the woman’s role is closely linked with the concept of motherhood and it is also associated with the parenting role. No longer having the biological status of getting pregnant may influence women as a female gender role to play in Latino society. This difference may be due to what role the female gender plays in different cultures. For example, the end of fertility is perceived as an aspect of maturity in which women recognize the independence of their children as a result of the cessation of the task of nurturing and, therefore an aspect that influences their perception of freedom¹³ and to refocus attention on themselves.¹⁴ Relating to the life transition of aging, this research developed a link between menopause and conceptualization, by women, on the onset of aging. These results are consistent with other studies, where women from different cultures and countries identify with the biological milestone of menopause as a sign of aging^15-22 recognizing aging with positive and negative values.²³

Interestingly, the significance of passing to another stage in other cultures has been a synonym for advancement, as role changes, you have more time²⁴ and gain respect in society²⁵ older woman are given a position of having greater wisdom, knowledge and ability to hold their own opinions regarding younger women.²⁶ Post-menopausal women are more competent¹³ and live a privileged status in some societies;²⁷ they are able to educate younger women¹⁹ and have more self-confidence.²⁰ The transition to another stage, and thus the start of old age, becomes a prize,²⁵ whereas in this study these points are not reflected. The effect of menopause in women’s lives may thus be more symbolic than biological, expressed as a form of anticipation of old age.²⁸ Feeling old 10 years before the customary beginning of old age is an important starting point to be incorporated in women’s health education. This situation brings up the questions for nursing related to anticipating women’s care in this period of life targeting women’s needs about menopause not only in the biological aspects of this period but also incorporating psychological and social aspects of this period of women`s life. Indeed, changes in women´s quality of life are related to their perception of aging;²⁹ therefore, it is important to address well what women’s feelings of getting older at 50 years old are. In conclusion, there is a need to recognize the special health needs of women beyond the reproductive age, through strengthening and reorienting the public health services at all levels starting from primary healthcare with adequate referral linkages to other levels. Discussions between healthcare providers and menopausal women should include the provision of information that will be helpful for women making this life transition, focusing on menopause as a wellness experience.