Five workshops were held between June and November 2015 at community locations in Maskwacis: Samson Cree Management building, Maskwacis Friendship Center, Ermineskin Income Support Center, Pigeon Lake Satellite Health Center, and Louis Bull Satellite Health Center, providing the opportunity for women from all four Nations to participate. A total of 37 women participated in workshops, (6–11 participants per session) lasting between 70 and 90 min. Since the workshops were held at specific community locations, most women participating in a given workshop knew each other. Questionnaire data were available from 34 participants.
Workshop discussions
1.
Menopause symptom experience
Participants talked very openly about their own experience of menopause: their experiences of menopause onset and symptoms varied widely.
The majority of women talked about experiencing menopause symptoms: most could relate to hot flashes and night sweats. Hot flashes were sometimes extreme; one woman described her feeling as “burning inside and out”, while another woman described it as getting hot from the inside “like firecracker”. Sometimes the main symptom was their face flushing very red. Night sweats could also be extreme, causing women to be drenched in sweat. One woman described an occasion when a new nightdress leaked dye into clean sheets—truly “leaving your mark”. Many women complained about hot feet that required cooling off. One said that she could “start a fire” with her feet when walking. Others complained they feel the cold much more now compared to when they were younger indicating the limited window of comfortable temperature commonly experienced during menopause.
Participants described unpredictability in menstrual blood flow which caused embarrassment and anxiety. Blood flow changes could include both decreases, as well as significant increases in flow. In extreme cases, blood could flow “like a waterfall... need to change [menstrual] pads every 30 min”. For some women the variation in flow caused them to worry that it may indicate a more serious cause (e.g. cancer). Heavy bleeding was sometimes experienced in connection with severe pain that required medical interventions including hysterectomy. The impact of hysterectomy (with or without ovaries being removed) and “tied tubes” was of concern; women discussed how these procedures affected menopause symptoms and how they may influence their future health.
Vaginal dryness was experienced by a number of women and could affect their sex drive. Lack of desire for sex was worrying, particularly for women who had previously enjoyed a healthy and fulfilling sex life. They wondered whether and when their previous desires would return, and were concerned because their partner and relationship suffered.
Many participants experienced physical symptoms related to weakness, stiff and achy joints, and sleep deprivation. Insomnia was often associated with night sweats leading to sleep disruptions. Uncontrollable weight gain was also experienced by some women much to their dismay. Other symptoms included changes to skin and hair texture and hair growth where it was not seen before, such as on face, chin or lengthening of eyebrows. These symptoms were not always recognized as being associated with menopause.
Psychological symptoms such as mood swings, anger, depression, and anxiety were also common, unpredictable and worrisome. “Sometimes you cry all the time or get mad about trivial things”. These psychological symptoms and mood swings were a concern, specifically because of their impact on family life and relationships, and were often connected to other life events such as children leaving home and the start of a new phase in family life. One woman described her newly experienced contentment with being alone; another woman mentioned her withdrawal from gathering with people and socializing; one woman mentioned occasional suicidal thoughts.
Some women complained about memory loss and forgetfulness. This prompted a discussion about menopause-specific versus age-related symptoms.
During one workshop, benefits of menopause were discussed. One woman described how activities were less restricted post-menopause. A major constraint before menopause was not being able to take part in ceremonies (sweats, dancing, etc.) while having one's moon time (menstruation) and for four days afterwards.
2.
Menopause knowledge prior to own experience
Most participants felt they had not acquired sufficient information about menopause and symptoms before their own experience, because menopause was “not talked about” by their mothers, aunts, grandmothers or by their doctors.
Several women reported that their mothers, when asked directly about menopause symptoms, declared that menopause was not a problem, “it was really nothing”, or endured their symptoms stoically. The women discussed whether their mothers were in denial of menopause symptoms, viewed them as the consequences of a natural, invariable stage of their life, or whether they really had forgotten about their symptoms. One woman suggested that in the past, menopause symptoms may not have been as obvious because people were too busy to deal with symptoms, and sweating was usual when women were occupied doing physical work.
Observing other women experiencing menopause has helped some women prepare for their own menopause. Participants remembered occasions when as young girls they were seeing their mothers, a class teacher, an older female friend or relative experiencing mood swings or hot flashes and being drenched in sweat, “like someone turning on a tap”, without knowing what was happening at the time. One woman said she felt grateful to have observed others experience these symptoms. A few women mentioned their older sister or a friend as the source of first menopause knowledge.
In one workshop women discussed whether menopause disregard prevents worry about symptoms and symptom awareness. While this hypothesis was considered by some, the majority agreed with another woman’s statement: “it is the other way around: if we know what to expect, then we would worry less”.
3.
Menopause symptom management
While going through their own menopause transition, some participants were prepared to deal with symptoms. One woman found that exercise (specifically walking) was very helpful to control mood swings and calm her thoughts during menopause. Strategies for hot flashes included going outside in winter, leaning against cold concrete walls, or walking on cold surfaces to cool feet. Some women stated that they take changes of clothes with them in case they sweat profusely; others were prepared with extra towels for night sweats. An older woman advised younger women: “Don’t think about it, and it won’t bother you. You can cope well... Open your windows.” For unpredictable menstruation some peri-menopausal women carried extra menstrual products.
Several women knew of others who used traditional herbs and other natural remedies for treatment of menopause symptoms. There were discussions about herbal and root teas used by Elders in the past for a variety of conditions. One woman said that her mother is a healer who knows about treatments for many illnesses. Another woman regretted not learning from her, now deceased, mother-in-law, who was very knowledgeable about plants and traditional Indigenous medicines. Other traditional practices to reduce the impact of menopause were taking good care of feet and not going out with wet hair during menopause. Some women had seen others eating dirt, ash or earth during menopause, perhaps in response to a deficiency that the body was trying to correct.
4.
Impact of menopause on family members
A major concern for workshop participants was the effect of severe symptoms on their family relationships, particularly their partner-relationships. It was acknowledged by all that menopause can be a strain on the relationship with a partner. The husband/partner may not understand symptoms such as significant mood swings and decreased libido, leading to matrimonial disharmony. One woman jokingly referenced the impact on male partners: “that’s why it’s called MENopause!” Decline in sex drive was of significant concern for women—they felt this was of major importance to their partners, but could not force themselves to be interested in sex, despite knowing this could adversely impact their relationships and potentially cause partners to think their wives no longer care for them or might be unfaithful. One woman complained that she was sick of always apologizing to her husband for her mood swings.
Participants noted that other family members could also be affected by menopause symptoms. Several women felt they were not understood by their family members, especially because of their unpredictable mood swings, depression and anger. These symptoms could cause strife within the family, particularly if the family members did not understand the cause, or if they were undergoing their own hormonal changes (e.g. puberty). Participants felt that they can only now relate to earlier uncomfortable observations of mother’s, aunt’s or grandmother’s menopausal symptoms. One woman said she has told her children, “Don’t get scared of me, I get scared of myself!”.
Participants felt that, if male partners and family members learned about the effects of menopause, they would be more understanding about changes to women's behavior as they go through the transition. They believed there was a need to educate spouses, children, and family members about menopause symptoms. “This is important. I want my family, my daughters and granddaughters to know what [physical changes are] coming” to prepare family members to deal with apparently inexplicable changes that can occur.
Knowledge translation
1.
Formation of Sohki Tehew group and implementation of menopause awareness strategies
A key qualitative finding was a need for increased knowledge about menopause within the community. Knowledge Translation (KT) was planned by a self-selected group of the two Elders from the Advisory Committee and six women community members with the support of Maskwacis Health Services Director of Community Nursing (BG) and a researcher (SR). This group met four times over the noon hour in Ermineskin Cree Nation to plan the KT strategy; lunch and gift cards were provided. Each meeting had a different purpose:
Meeting 1: To discuss future menopause initiatives—the group decided to first develop menopause pamphlets describing symptoms and coping strategies to improve understanding between family members about what women experience during menopause.
Meeting 2: To develop separate pamphlets for men and women—a preliminary men's pamphlet was distributed at a men's health conference 13 days later.
Meeting 3: To finalize the wording for the two pamphlets—and agree on a Cree language name for the group, the "Sohki Tehew (Strong Heart) Group".
Meeting 4: To plan a walk and barbecue event for World Menopause Day (October 18). Unfortunately, this event was cancelled shortly before the scheduled date because the venue was needed urgently for another purpose. (The event was eventually held a year later.)
2.
Development of two pamphlets
Two culturally-sensitive pamphlets were developed by the Sohki Tehew Group for use within the community, based on the findings of the qualitative study.
The wording and layout for both pamphlets are very similar, but targeted at different audiences: one for husband/partner, the other for women and other family members (Additional files
2,
3: Appendix 1 - Menopause information for men and Appendix 2 - Menopause information for women and families). Several sections are designed to help understand about the "Change of Life" i.e. menopause:
1.
What are the symptoms of the Change?
2.
What actions may help someone during the Change, for example engaging in exercise, talking to an Elder, or taking traditional medicines?
3.
What you can do to help someone through the Change?, for example offering support and love?
4.
What happens after the Change, when the hormone fluctuations have calmed down?
With these few simple pieces of advice, the goal was to increase understanding and reduce anxiety and stress about the physical and mental changes associated with menopause.
Following the development of the pamphlets, hundreds of copies have been distributed through Maskwacis Health Services and in the Health Clinics. In addition, the Sohki Tehew Group has taken pamphlets to many community events in the four Nations and Pigeon Lake, including Sohki Tehew Workshops, Powwows, Health Fairs, Indigenous Addictions Week, and Maskwacis Community College and school library events.