MEDICAL LITERATURE ON MENOPAUSE AND. MID-LIFE WOMEN
In this section we present the publication patterns and topical focus of the medical and psychological literature on menopause and identify some pervasive methodological and conceptual problems. More extended discussion of particular details of this analysis is presented in Rostosky and Travis (1996). What the following figures reveal is that compared with the vast array of other topics and other journal articles, little has been published on women at mid-life, women’s roles as a function of age and experience, or even women and menopause. What has been published is overwhelmingly colored by a medical, biological lens. A potential problem with such a biological emphasis is that women themselves may come to view their own lives and experiences as fundamentally characterized by illness that requires medical intervention in the form of pharmaceutical and surgical procedures.
A search of the Medline database was conducted for the years 1984— 1994 to identify all articles on menopause. Medline cites about 300,000 articles each year from more than 3,200 journals. It encompasses all major medical journals, including those of interest to the general field, such as Lancet and the New England Journal of Medicine and journals specific to obstetrics and gynecology. Additionally, there is coverage of the major psychiatric journals such as the American Journal of Psychiatry and the Archives of General Psychiatry. Medline also includes some social, psychological, and interdisciplinary journals such as The Journal of Clinical Psychology and Women and Health.
The number of articles on menopause from all sources cited in Medline totaled 9,018, ranging from a low of 448 in 1994 to a high of 690 in 1992. Most of these articles focused on medical treatment rather than theory, and the most frequent topic was reproductive hormones and their replacement. Examples included articles such as, “Effect of oestrogen and testosterone implants on psychological disorder in the climacteric” (Montgomery et al., 1987) and “A prospective one-year study of estrogen and progestin in post menopausal women: Effects on clinical symptoms and lipoprotein lipids” (Sherwin & Gelfand, 1989). Articles that had a focus on social aspects of menopause made up only about 6% of all menopause articles. There were an additional 5,606 articles published that were on aging or mid-life women, but were not specifically about menopause. Nevertheless, these articles focused almost exclusively on disease conditions (e. g., cardiovascular disease).
We conducted a search of PsychLit using the same strategy. PsychLit cites approximately 40,000 articles per year from more than 1,300 journals. As did the Medline search, the search included articles on menopause in general, and then identified a subset of these that had a specifically psychosocial focus. Finally, the search was expanded to locate the articles that did not mention menopause but that did focus on women and middle age or aging.
Over the study years, 227 articles from PsychLit were on menopause, or about 16 articles each year. This body of work contained many studies that reflected the message of decline and deficiency (Facchinetti, Demyt – tenaere, Fioroni, Neri, & Genazzani, 1992; Gannon, 1988; Greendale &. Judd, 1993). Most of these were medical in focus and only about 25% dealt with specifically psychosocial factors. Very few articles addressed any midlife developmental issues.
Articles published in a selected subset of journals were reviewed to better characterize the publication trends for medical, psychiatric, and psychological journals. The medical journals, such as New England Journal of Medicine, were selected because we assumed they would be widely read and reported. During the study years of 1984-1994 these influential medical journals published 508 articles on menopause or women’s middle age or women’s aging; of these only 18 articles addressed psychosocial considerations. Psychiatric journals, such as Archives of General Psychiatry, and psychology journals, such as Journal of Health and Social Behavior, contained a total of 16 articles for the same decade. Most of these articles focused on depressive symptomatology. The three psychology-based studies addressed issues of roles for women at mid-life (Erdwins & Mellinger, 1984; Harris, Ellicott, & Holmes, 1986) and job stress (Abush &. Burkhead, 1984).
Examination of a set of psychology journals focused specifically on women revealed only a nominally better record, with 31 articles focusing on middle age. Approximately one fourth of all these articles appeared in Psychology of Women Quarterly. Three of the articles focused on attitudes or perceptions of menopause (Cowan, Warren, & Young, 1985; Gannon & Ekstrom, 1993; Koff, Rierdan, & Stubbs, 1990). Two focused on depression and menopausal symptoms (Hagstad, 1988; Lennon, 1987). Three of four conceptual and theoretical papers discussed menopause and sexuality (Cole &. Rothblum, 1990; Lieblum, 1990; Morokoff, 1988), and one reviewed the literature on exercise and menopausal symptomatology (Gannon, 1988).
Of the 22 psychological articles on mid-life that did not focus on menopause, 15 were empirical studies using self-report data on topics such as employment and career issues (Ackerman, 1990; Adelmann, Antonucci, Crohan, & Coleman, 1989, 1990; Waldron & Herold, 1986), physical activity (Dan, Wilbur, Hendricks, O’Connor, & Holm, 1990), cross-cultural comparisons (Friedman & Pines, 1992; Sanchez-Ayendez, 1988; Todd, Friedman, &. Kariuki, 1990), generativity (Ryff & Migdal, 1984; Stewart &. Gold-Steinberg, 1990; Vaillant & Vaillant, 1990), and sex roles (Frank, Towell, &. Huyck, 1985; Tinsley, Sullivan-Guest, & McGuire, 1984). Conceptual or theoretical papers on mid-life that appeared in these women’s psychology journals addressed topics such as aging and minority women (Padgett, 1988), mid-life childbearing (Mansfield, 1988), and psychological theory and aging (Gergen, 1990; Porcino, 1985).
In summary, there is a paucity of information on mid-life sexuality available. Although we were encouraged by some notable exceptions, mainly found in nursing journals and feminist-oriented journals, most of the available information remains negative and disease-focused. As we mentioned earlier, a potential danger of this pattern is that women may incorporate these negative images into their own identities. Furthermore, this one-sided view of menopause may become extended to views of women in general. Presently, these remain empirical questions in need of exploration. If these negative images do affect personal views, it is particularly disturbing that the scientific basis for a substantial portion of the published literature is irretrievably flawed, both methodologically and conceptually. The fact that it is nevertheless published as sanctioned (i. e., peer-reviewed) knowledge to be taken seriously and applied broadly demonstrates the operation of a social construction by which jury-rigged methods are used in the service of biased cultural beliefs. In the following section we briefly delineate some of these methodological and conceptual flaws that pervade the literature on menopause and subsequently are packaged as a basis for understanding women’s lives.