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Women's midlife health across cultures: DAMES comparative analysis

Parsons, Michelle A. SM1; Obermeyer, Carla Makhlouf DSc2

doi: 10.1097/gme.0b013e3180415e54
Articles from the Workshop on "Cross-cultural Comparisons of Midlife and Aging"

Objective: The Decisions At Menopause Study (DAMES) investigates the experience of menopause in four countries. This article explores self-reported health.

Design: Women aged 45 to 55 years were interviewed in Lebanon (n = 298), Morocco (n = 299), Spain (n = 300), and the United States (n = 293). The survey instrument included closed- and open-ended questions. Statistical analyses were used to assess the determinants of reporting poor health, and textual analyses were used to highlight themes related to perceptions of health.

Results: In Lebanon and Morocco, 22% and 28%, respectively, of the women sampled indicated that their health was not good. In Spain and the United States, 15% and 11% of the women sampled reported their health as fair or poor. We explored significant predictors of poorer reported health across sites. Responses to the open-ended questions "How is your health?" and "How do you compare your health to other women your own age?" revealed common concerns of aches and pains, tiredness, work/responsibilities, and family across all four sites. Unique themes included the war in Lebanon, poverty in Morocco, and social activity in Spain. Menopausal symptoms may in many cases be overshadowed by other health concerns of middle-aged women. Nonspecific symptoms such as tiredness and aches and pains serve to link bodily health with social circumstances. Family and work responsibilities are common concerns of middle-aged women.

Conclusions: Research on midlife health and menopause needs to be systematic enough to enable cross-cultural comparisons. At the same time, it must be flexible enough to identify population-specific symptoms, social context, and lifestyle concerns.

This article explores self-reported health of middle-aged women in Lebanon, Morocco, Spain, and the United States using the Decisions At Menopause Comparative Study (DAMES) data. Quantitative and qualitative data illustrate that menopausal symptoms may in many cases be overshadowed by other concerns, such as family and work responsibilities.

From the 1Department of Anthropology, Emory University, Atlanta, GA; and 2Department of Population and International Health, Harvard School of Public Health, Boston, MA.

Received November 6, 2006; revised and accepted January 30, 2007.

Financial support: This work was supported by the National Institutes of Health/National Institute on Aging grant 5R01 AG17578-03.

Financial disclosure: None reported.

Address correspondence to: Michelle A. Parsons, SM, Department of Anthropology, Emory University, 1557 Dickey Drive, Atlanta, GA 30322. E-mail:

©2007The North American Menopause Society