Social determinants of health and menopausal symptoms: the mediating role of menopausal attitudes

Background

Menopause is a multidimensional period affecting physical, mental, and social well-being. This study aimed to evaluate the direct and indirect (mediating: menopausal attitudes) effects of social determinants of health on menopausal symptoms in women aged 45-64 years.

Methods

This cross-sectional study was conducted with 495 women who applied to a university hospital. The questionnaire used in the study included questions on sociodemographic characteristics, factors related to menopausal symptoms, questions about domestic violence, the Menopausal Rating Scale (MRS), the Menopause Attitude Assessment Scale (MAAS), the Financial Well-being Scale (FWBS), the Turkish Health Literacy Scale–Short Form (THLS-SF), the Perceived Neighborhood Disorder Scale (PNDS), and the Perceived Social Support Questionnaire (F-SozU K-3). General linear model (GLM) mediation analysis was performed to determine the mediating role of menopausal attitudes in the relationship between social determinants of health and menopausal symptoms.

Results

The mean age of the women was 53.3±6.2 years. Women’s scores on the MRS and MAAS ranged from 0 to 44 and 5 to 52, with a mean score of 20.1±6.6 and 30.2±7.5. GLM mediation analysis identified direct effects on menopausal symptoms from educational level, FWBS, and the history of domestic violence (β=-0.087, p = 0.031; β=-0.158, p < 0.001; β = 0.192, p < 0.001, respectively). Indirect effects were observed for educational level and PNDS (β = 0.019, p = 0.031; β = 0.021, p = 0.024).

Conclusions

Menopausal symptoms should be addressed holistically, considering the social determinants of health, and social risk screenings should be made routine in primary care. Multidisciplinary interventions for domestic violence and economic support should be strengthened. Health education programs and social support policies that improve women’s attitudes towards menopause and health literacy should be widespread.

Key messages

• Menopausal symptoms are directly related to social determinants of health, such as educational level, financial well-being, and domestic violence.

• Attitudes toward menopause influence menopausal symptoms, particularly through the mediating effect of determinants such as education level and neighborhood disorder.