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Menopausal symptoms among British Pakistani women: a critique of the standard checklist approach

Blell, Mwenza T. PhD

doi: 10.1097/GME.0000000000000256
Original Articles

Objective: This study aims to identify problems with the standard menopause symptom checklist method previously used to study variations in menopause symptoms and to explore data collected using an alternative approach.

Methods: As part of a biosocial study of menopause, 257 British Pakistani women aged 39 to 61 years and living in West Yorkshire, UK, were interviewed. Participants reported and rated any menopause-associated changes (positive or negative) they had experienced. Participants also reported whether they associated with menopause each of the 34 symptoms on a standard checklist. Responses were analyzed using factor analysis, and factor scores from five factors were used to assess predictors of the attribution of symptoms to menopause.

Results: Women reported a wide range of symptoms, most of which are not on symptom checklists. Attribution of symptoms to menopause was associated with menopause status, age, and migration status. Women’s beliefs about which experiences were attributable to menopause did not correspond to those of the checklist developers. Women interpreted some items on the standard checklist in ways other than originally intended based on local ideas; however, because of the use of a more open approach, this produced useful data.

Conclusions: Symptom checklists have serious limitations as a tool for understanding symptom experience, and prior justifications for their use leave much to be desired. The use of a more open approach generates useful data; moreover, research participants’ understanding of changes attributable to menopause may accurately reflect biological changes and may have a relationship with population-specific disease risk.

From the Department of Archaeology and Anthropology, University of Bristol, Bristol, UK.

Received November 14, 2013; revised and accepted March 18, 2014.

Funding/support: This research was supported by a Parkes Foundation PhD Fellowship, a UK Overseas Research Student Award, and a Durham University Doctoral Fellowship.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Mwenza T. Blell, PhD, Department of Archaeology and Anthropology, University of Bristol, 43 Woodland Road, Bristol BS8 1UU, UK. E-mail:

© 2015 by The North American Menopause Society.