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A Postmodern Feminist Discourse on Distress During the Menopause Transition

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A Postmodern Feminist Discourse on Distress During the Menopause Transition A Postmodern Feminist Discourse on Distress during the Menopause Transition by Marcianna Nosek DISSERTATION Submitted in partial satisfaction of the requirements for the degree of 'DOCTOR OF PHILOSOPHY in Nursing in the GRADUATE DIVISION of the UNIVERSITY OF CALIFORNIA, SAN FRANCISCO ii Copyright 2007 Marcianna Nosek iii Dedication I dedicate this to three particular women of my family—my mother, who, although born in the United States, never had the opportunity to continue school beyond the eight grade; my sister, Teresa who, although confined to a wheelchair for most of her adult life, lived with courage, character, and humor, and died before even having the opportunity to experience menopause; and my 24 year old daughter, Crystal, who lived twenty years of her life through the unceasing endeavors of her mother’s educational pursuits. Without the inspiration of these women, I would not have arrived here. iv Acknowledgements I wholly acknowledge the generosity of the Betty Irene Moore Foundation for the substantial grant that made this dissertation accomplishable in three years. I further acknowledge the National Institutes of Health T-32 from the National Institute of Nursing Research, Grant # R007088: "Nurse Research Training in Symptom Management." My advisor, Dr. Holly P. Kennedy has taught me a new meaning for midwifery. She has spent hundreds of hours coaching me through the birth of this from conception to expulsion. I will forever be grateful. My committee member, Dr. Maria Gudmundsdottir has lived the role of the doula, sustaining her position at my side as she endured the special challenges of transition and crowning. I extend my thanks to my two other committee members, Dr. Kathryn A. Lee and Dr. Margaret Wallhagen. I have much gratitude for their expertise and patience as they belabored my 300 page first draft. I must acknowledge my sister Hedy, who has lived through every second of this dissertation process with me as she perpetually remained available by phone to cry, laugh, complain, and exclaim with. Also, I am forever indebted to my friend and classmate, Elizabeth who saved me during my injury bringing me respite and smiles (and coffee). I especially thank my friends who are still my friends after all these years of being neglected. Special thanks to my supportive classmates, Lori, Val, Mica, Daniel, Sasha, and Alicia. I am honored to have crossed their paths. And last but certainly not least, I thank the participants of this study who shared their pain, sorrow, joys, and journeys with me. May they continue to be acknowledged for the amazing women they are. And may all women transitioning through menopause find the support and validation they need and deserve. v Abstract A POSTMODERN DISCOURSE ON DISTRESS DURING THE MENOPAUSE TRANSITION Marcianna Nosek CNM MPH MS University of California, San Francisco 2007 Some women experience symptoms during the menopause transition that cause distress. Due to the heterogeneity of experiences, distress has been difficult to measure. Researchers have examined risk factors such as personality traits, stress, coping, lifecourse, and hormonal sensitivities to explain distress during menopause. The purpose of this narrative analysis study was to explore the experiences of distress for women during the menopause transition, and to examine the experiences of aging. A postmodern feminist framework allowed for individual experiences of distress to unfold within the stories and to view how women adopt positions in prevailing discourses. Narrative analysis methodology facilitated the understanding of individually defined distress and how it reflected shared meanings embedded in Western society. Fifteen women were interviewed in person using open interview techniques and were digitally voice recorded. Interviews were transcribed verbatim to examine use of language such as utterances, tone of voice, and pauses. Data were re-transcribed after the identification of narratives and poetic structures. Themes were analyzed within and across interviews. Coding was conducted to aid in the noting of themes. vi The women described hot flashes, night sweats, menstrual changes, decreased libido, vaginal dryness, sleep disruption, and others within the context of their lives. The women demonstrated ways of adopting social discourses on menopause and aging that aided or dampened positions of power. Themes identified were of silence, shame, and stigma related to aging and menopause. Some women experienced social withdrawal and alienation. Narratives of chaos, restitution, and quest were analyzed. Loss of control was experienced to be most distressful for some of the women. It is a historical time with many babyboomers reaching the age of menopause and studies cautioning against the liberal use of hormone therapy. Nurses need to understand the contextual meaning embedded in the women’s experiences. Alternative models to provide care and reduce alienation, such as group care, is worthy of research. Women need to be advised in how the adoption of social discourse may influence experiences of distress. Further exploration of the meaning of control in women’s lives needs to be conducted. vii TABLE OF CONTENTS CHAPTER ONE: THE STUDY PROBLEM............................................................... 1 Distress during the Menopause Transition: A Complex Phenomenon...................... 1 Problem Statement and Purpose of Study.................................................................. 4 Significance................................................................................................................ 4 CHAPTER TWO: LITERATURE REVIEW AND CONCEPTUAL FRAMEWORK 8 Overview of Relevant Research................................................................................. 8 Summary of Epidemiological Studies .................................................................... 9 Hormone Therapy ................................................................................................ 11 The Women’s Health Initiative ........................................................................ 12 Decision Making and Hormone Therapy......................................................... 13 Summary of Hormone Therapy........................................................................ 16 Quantitative Studies Related to Distress during Menopause .............................. 16 Summary .......................................................................................................... 25 Qualitative Studies on Menopause and Aging..................................................... 26 Summary .......................................................................................................... 30 Gaps in the Literature.......................................................................................... 30 Conceptual Framework: Postmodern Feminism...................................................... 33 Philosophical Views of Self.................................................................................. 34 Sociocultural Perspectives on Women and Aging ............................................... 36 Assumptions of Aging....................................................................................... 36 Ageism.............................................................................................................. 39 Women and Aging............................................................................................ 40 Aging and Distress during Menopause............................................................ 42 Feminisms ............................................................................................................ 43 Modern Feminism ............................................................................................ 43 Postmodernism and Postmodern Feminism..................................................... 44 A Postmodern Feminist Framework for the Study of Distress During the Menopause Transition....................................................................... 46 Assumptions............................................................................................................. 49 Research Questions.................................................................................................. 50 Definitions of Concepts ........................................................................................... 50 Symptom........................................................................................................... 50 Distress ............................................................................................................ 52 MenopauseTransition ...................................................................................... 52 CHAPTER THREE: NARRATIVE ANALYSIS AS A METHOD FOR THE STUDY OF DISTRESS DURING THE MENOPAUSE TRANSITION ................................. 54 Research Design: Narrative Analysis ..................................................................... 54 Self Reflexive Account.......................................................................................... 54 What is a Narrative?............................................................................................ 55 Reissman on Representation............................................................................ 57 Labov’s Elements of a Narrative ..................................................................... 59 Gee’s Poetic Structures...................................................................................
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