Discourses on menopause - Part I: Menopause described in texts addressed to Danish women 1996-2004

To understand Danish women's very different ways of interpreting menopausal experiences and the way they construct meaning relating to menopause, it is necessary to include the context in which meaning is constructed as well as the background of cultural attitudes to menopause existing in the Danish society. Using documentary material, the aim of this article was to describe different discourses on menopause in Denmark that present themselves to menopausal women, and to discuss how these discourses may affect women's identity and constitute their scope of action. One hundred and thirty-two pieces of text under the heading or subject of `menopause' or `becoming a middle-aged woman', published from 1996 to 2004, were included. All material was addressed to Danish women, and consisted of booklets and informational material, articles from newspapers and magazines and popular science books. Seven different discourses on menopause were identified: the biomedical discourse; the `eternal youth' discourse; the health-promotion discourse; the consumer discourse; the alternative discourse; the feminist/ critical discourse; and the existential discourse. The biomedical discourse on menopause was found to be dominant, but was expanded or challenged by other discourses by offering different scopes of action and/or resting on different fundamental values. The discourses constructed and positioned individual women differently; thus, the women's position varied noticeably from one discourse to another. Depending on the discourse drawn upon, the woman's position could be that of a passive patient or that of an empowered woman, capable of making her own choices in relation to her health

Discourses on menopause — Part II: How do women talk about menopause?

The aim of this article is to describe which of the different available discourses women relate to as revealed in the way they talk about menopause. We use a discourse analytic approach, which implies that meaning is ascribed to things according to how we talk about them. Twenty-four menopausal women from Denmark were interviewed. They were selected to cover a broad spectrum of Danish women with different menopausal experiences and social background factors. Seven previously identified discourses could be found in the interviews, though to varying degrees from woman to woman. Nearly all women used terms from the biomedical sphere like `a period of decline and decay', even if they did not necessarily agree with this view. Also the existential discourse permeated most of the interviews, especially when the conversation turned to the ageing process, femininity and self-development. The way the menopause was talked about almost became kaleidoscopic when images speedily changed from the decrepit osteoporotic woman or a woman with lack of vitality and sex-appeal to a healthy and strong woman with control over her body and self. Since many women contact doctors in relation to menopause, and since the way doctors talk about menopause is influential, doctors should carefully consider which words and images they use in the counselling. The medical way of perceiving menopause is just one of many, and doctors must be aware that there are other different and partially contradicting discourses at play in society and in the women's universes

How younger adults with psychosocial problems experienced person-centered health consultations

Much attention is focused on the social determinants of health. Family medicine is challenged with a growing number of vulnerable persons with psychosocial or lifestyle related problems. The objective of this work was to explore how vulnerable younger adults experience person-centered preventive health consultations with their general practitioner. The design and setting for this work were a secondary qualitative analysis of a randomized controlled trial (RCT) in Danish general practices. Younger adults (20-45) were consecutively invited to answer a screening questionnaire about psychosocial and lifestyle-related problems when visiting general practice (28 general practitioners (GPs)) for ordinary consultations. The 30% most vulnerable persons were invited to participate in a randomized controlled study. Intervention participants (n = 209) received a structured 1- hour ‘health consultation’ with their general practitioner focusing on resources and self-chosen goals and a 20-min follow-up after 3 months; control participants (n = 255) received usual care. At 1 year, 180 participants answered a follow-up postal questionnaire, of whom 135 answered the open-ended question: “Do you think the health consultation was worthwhile?”. This question was analyzed using qualitative content analysis. Six themes were prevalent: ‘Meeting the doctor in a different way’, ‘Supporting dialogue’, ‘Food for thought’, ‘Feeling better’, ‘Opportunity for change’, and the health consultations were ‘Not worthwhile’. Offering vulnerable younger adults a structured, person-centered preventive health consultation strengthened the doctor-patient relationship, allowed patients to reflect on their life situation, enhanced their perceived ability to cope with their problems and their belief in and ability to initiate wanted changes, thereby enhancing self-efficac