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Comparative study of the quality of life associated with menopause in Tunisia and France

Ferrand, Farida MPH1,2,3; Hajri, Selma MD1,4,5; Benzineb, Sarah MD4,5; Draoui, Dorra Mahfoudh PhD4,6; Hassoun, Danielle MD1,2,3; Delanoë, Daniel MD, PhD1,2,3,7; Zins, Marie MD, PhD8; Ringa, Virginie MD, PhD1,2,3

doi: 10.1097/GME.0b013e318278b0ce
Original Articles

Objective Because the experience of menopause varies by ethnic group, society, and social class, we sought to compare quality of life (QoL) at menopause between Tunisian and French women.

Methods This secondary analysis of existing data collected in two independent, cross-sectional surveys (the French GAZEL cohort and a representative sample of Tunisian women) compared both samples for six dimensions of the Women’s Health Questionnaire while taking into account social and demographic characteristics and menopause status with multivariate logistic models.

Results Comparison of 1,040 Tunisian women aged 45 to 64 years with 774 French women aged 48 to 53 years showed that Tunisian women had a significantly lower QoL than the French women in every dimension (low QoL for Tunisian vs French, odds ratio [95% CI]: somatic symptoms, 2.1 [1.6-2.7]; depressed mood, 3.6 [2.8-4.7]; anxiety, 2.4 [1.8-3.3]; vasomotor symptoms, 1.7 [1.3-2.3]). QoL was also lower for working-class women, but associations were weaker than for country (low QoL for working class vs middle class, odds ratio [95% CI]: somatic symptoms: 1.9 [1.5-2.4]; depressed mood, 1.5 [1.2-1.8]; anxiety, 1.8 [1.5-2.3]; vasomotor symptoms, 1.7 [1.4-2.2]). Associations between country and QoL were stronger in the working class than in the middle class.

Conclusions This epidemiological study comparing France and a North African country sheds light on the major role of country of residence, social class, and their interaction in the experience of menopause. Levels of national wealth, human development, cultural constraints, and social and gender inequality are likely to explain how country and class affect QoL.

From the 1Gender, Sexual, and Reproductive Health Team, Center for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale, U1018, le Kremlin-Bicêtre, France; 2Université Paris-Sud, UMRS 1018, le Kremlin-Bicêtre, France; 3Institut National des Etudes Démographiques, Paris, France; 4National Office for Family and Population, Centre Urbain Nord, Tunis, Tunisia; 5Group Tawhida Ben Cheikh: Research and Action for Women’s Health, La Marsa, Tunisia; 6Département de Sociologie, Faculté des Sciences Sociales et Humaines, Université de Tunis, Tunis, Tunisia; 7Laboratoire de Pédagogie de la Santé UPRES EA 3412, Université Paris, Bobigny, France; and 8Université Versailles Saint-Quentin, UMRS 1018, Villejuif, France.

Received June 18, 2012; revised and accepted October 3, 2012.

Funding/support: The GAZEL Cohort Study was funded by Electricité de France-Gaz de France and Institut National de la Santé et de la Recherche Médicale, and received grants from the Cohortes Santé TGIR Program, Agence Nationale de la Recherche, and Agence française de sécurité sanitaire de l’environnement et du travail. This research received financial support from the National Research Agency of France (ANR-07-SUDS-004 MENOPSUD).

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Virginie Ringa, MD, PhD, Center for Research in Epidemiology and Population Health 1018, Hôpital de Bicêtre, 82 av du Général Leclerc, 94276 le Kremlin Bicêtre Cedex, France. E-mail:

© 2013 by The North American Menopause Society.