1.0
Aims
The main purpose of this study is to conduct a
comparative study between HRT and Psychotherapy and to understand the changes
that women experience during climacteric period based on these two therapeutic
methods. In this period also, there are changes in the mental health of these
women resulting to depression and emergence of other stressors for women. As
such, the research will aim at distinguishing the mood-related issues that
confront these women while approaching perimenopause and post-menopause whereby
the majority of these women experience hormonal and psychological changes.
2.0
Sample Size
The study will sample a target of 100 women whom
50 are undergoing HRT and the other half psychotherapy. Purposive sampling will
be used since there are explicit criteria. As such, the respondents should be
women, aged 35-45 and undergoing either therapy method. This study will
disregard family income, social status, religion and race. These specific
demographic requirements have been put in the study so as to make the results
more specific.
3.0
Critical Evaluation of Pertinent
Concepts
As Bertero (2003) puts it, women have differing
views regarding menopause as evident on the various expectations, challenges,
apprehensions and knowledge about the menopausal period and climacteric periods.
He discovered that women to some extent are aware of the physical and
psychological changes that follow the menopause but are lacking on knowledge
about these changes or self-care activities that could prevent problems or
mitigate symptoms. He concluded that interaction is very important in awareness
building in addition to feelings of freedom to know and to relate own’s
experiences. The idea is central to women’s decision-making in choosing what
therapy best suits their condition.
Jones (1999) made mentioned that making an
informed decision about whether to participate in a therapy to offset short-
and/or long-range effects of decreased estrogen due to menopause is particularly
important because of the health-related risks and benefits associated with such
therapy< major contributors to the decision are the kinds and sources of
information used in arriving at a decision, the decision-making process
followed, and whether the decision was informed. There are two basic choices for
women as hormonal and non-hormonal therapies.
Kenemans (1999) clarifies that there
are typical climacteric symptoms and atypical symptoms including tiredness,
irritability and mood swings and these are being remedied by topical and
systemic oral and transdermal HRTs that are generally effective as symptomatic
treatment. On the other hand, Castelo-Branco et al (2006) found out that
HRT has inherent limitations that failed to promote, maintain and enhance the
well-being of women. The researchers discovered that vasomotor symptoms prevail
during climacteric period with HRT as the main therapy. These include were hot
flushes, sweats, irregular menstruation, and cessation of menstruation,
irritability and mood changes as well as vaginal dryness, insomnia and
depression/anxiety.
One of the non-hormonal therapies is
the psychotherapy whereby the Study by Alder et al (2006) proved that
there is a positive effectiveness of cognitive-behavioral interventions for the
treatment of climacteric syndrome. However, a separate study points out that
there are differences in the diminution as in the absence of symptoms were
observed as much after the psychotherapeutic process. They concluded that
psychoanalytic psychotherapy is functional for specific patients.
4.0
Preliminary Review of Literature
Mood problems are known to be among the three
most common problems associated with menopause as symptoms of tension and
depression increase among women in the premenstruum. These symptoms are
considered problematic as the main reason that they seek medical interventions.
Mood changes and its adverse consequences are among the frequent symptoms.
According to Lorraine Dennerstein, such menstrual transition is largely
characterised by underlying endocrine changes that results in specific mood
complaints. The indicators of which are hormonal changes related to aging,
psychosocial factors, health and lifestyle factors and risk factors for minor
and major depression (2004).
David Kahn et al (2001) share the same
view with Dennerstein reiterating that during perimenopause women become more
vulnerable to depression wherein menstrual period lighten and become less
frequent. Therefore, insomnia, hot flushes and mood problems are common. Several
theories suggest that there are biological effects of hormonal fluctuations on
moods especially because ovaries tend to produce less estrogen. Estrogen
interacts with the brain to influence moods. Major depression as a mood disorder
was tended to affect any person’s ability to experience normal mood states. Some
of these are fatigue or lack of energy, restlessness, feelings of guilt or
worthlessness, difficulty in concentrating, trouble sleeping and recurrent
thoughts of death and suicide.
There are two common treatments for
mood problems during menopausal stage: hormonal replacement therapy and
psychotherapy. The former refers to the system of medical treatment for women in
perimenopausal and postmenopausal periods as it can prevent (further) discomfort
and health problems due to the decreased circulation of estrogen and
progesterone hormone. In boosting the hormone levels of the patients, estrogens,
progesterone or progestin and sometimes testosterone are utilised. There are
different types of hormonal therapies such as conjugated equine estrogen and
bioidentical HRT. While the former has two types: the interpersonal therapy that
deals with understanding of changing human relationship as a contributing factor
on mood problems and the cognitive behavioral therapy which focuses on
identifying and changing of the pessimistic thoughts and the subsequent relief
relating to mood swings. Basically, psychotherapy is relational in nature and
aims to approach problems with living as it integrates sense of well-being and
reduction of subjective discomforting experiences.
Nonetheless, both therapies shared a
weight of criticisms notably in terms of the methods’ efficacy. For HRT, it was
contradicted mainly because of its side effects that include liver diseases,
coronary artery disease and venous thombosis. These are even exacerbated when
the patient has migraine headaches, history of breast cancer and fibroids and
prior urinary diseases. On the other hand, for psychotherapy, these are the
skepticism on its curative effects particularly because it takes time to observe
changes manifesting the inadequacy of coping dilemmas. As such, the process was
perceived to be inappropriate and unneeded. The rationale behind the research is
to determine the extent to which each method is to be considered effective and
therefore disclose its weaknesses.
5.0
Justification of Methods
Literature review and some surveys will be the
only methods to be used in this research for the purpose of presenting the data
descriptively. Both methods may help present the current scenario regarding the
degree of effectiveness of HRT and psychotherapy that decrease the mood changes
in women during their menopause. Surveys provide the researcher information
about the views of women about the matter and explore on how these therapies are
affecting their being and why they chose to seek such method. Surveys are also
conducted to gather data from the field in order to generalize results from a
sample to a larger population (Commonwealth of Learning, 2000).
Accordingly, it is necessary to provide basic
knowledge and descriptions and therefore necessary for the researcher to collate
date through reviewing the current literatures. Through literature reviews,
information can be useful in the analysis of data because they can help the
researcher explain different issues in the study. Obenzinger (2005) of Stanford
University explained that one of the advantages of using literature review as
one form of data collection is that it sets the basis for the discussion or
analysis or contemplation of implications or anticipation of further research.
Literature review can also be useful in understanding the structure of the
problem, as well distinguishing what has been done from what needs to be done.
Its purpose is to help the research define and clarify important issues.
6.0
Significance of the Study
The results that will be gathered from this
study will be beneficial to the women who are currently experiencing mood
problems that affecting their familial and social functioning. This study will
be significant to the families, medical practitioners specializing in the
subject area, therapists, authoritative bodies and the academia in such a way
that it can contribute to the delineating the successful therapies on menopausal
problems and restructure those that are not effective. By assessing the
effectiveness of HRT and psychotherapy, the researcher can formulate plausible
recommendations directed towards the importance and limitation of both and in
having an informed choice. This study will also be significant not only to the
women who are under climacteric periods but also for the rest of the world
through its emphasis on the issue.
7.0
Brief Synopsis
Menopause is defined as the final menstruation,
directly preceding the permanent cessation of ovarian follicular function. The
transition from the reproductive to the non-reproductive phase of life can take
many years, frequently characterised by perimenopausal cycle disorders,
vasomotor symptoms (hot flushes and night sweats) and urogenital complaints
(vaginal dryness, micturition complaints) (Kenemans, 1999). According to Alder
(2006) during peri- and postmenopause there is a high prevalence of
psychological symptoms such as emotional instability, depressive moods, anxiety,
sleep disorders, and sexual dysfunction. Aetiologically relevant factors for
discomfort are decline of sex hormones and psychosocial factors such as
lifestyle, attitude towards menopause, pre-menopausal mental health and
sociocultural factors. This comparative research will utilise HRT and
psychotherapy as the major remedies that menopausal women are converging into.
8.0
Proposal Brief
This study will use the descriptive approach so
as to utilise survey in the study. Since the researcher will also gather
information about the present existing condition, it is also pertinent that the
researcher will describe the nature of a situation purporting the formulation of
rational and sound conclusions and recommendations for the study. In addition,
the research will employ a qualitative research method wherein the researcher
will seek to find and build theories that would explain the relationship of one
variable with another variable through qualitative elements in research.
Examples of qualitative elements that do not have standard measures are
behavior, attitudes, opinions, and beliefs.
As the study involves an interpretative,
naturalistic approach to the subject matter, this means that qualitative
researchers study things in their natural settings, attempting to make sense of,
or interpret phenomena in terms of the meanings that people bring to them. The
primary source of data will come from the researcher-made questionnaire and
interview questions. The primary data frequently gives the detailed definitions
of terms and statistical units used in the study. These are usually broken down
into finer classifications. The secondary sources of data will come from
published articles, social science journals, theses and related studies on
menopause, mood changes, HRT and psychotherapy. Acquiring secondary data are
more convenient to use because they are already condensed and organized.
Moreover, analysis and interpretation are done more easily.
9.0
References
Aldana, E., Eugenia-Gomez, M., Morales, F. A.
and Gaviño, F. (2007). Psychological symptoms in a group of climacteric women,
before and after a psychotherapeutic process. Ginecologia Obstetricia Mexico,
75(5), 268-276.
Alder J.,
Eymann Besken K.,
Armbruster U.,
Decio R.,
Gairing A,
Kang A. and
Bitzer J.
(2006). Cognitive-behavioural group intervention for climacteric syndrome.
Psychotherapy Psychosomatic, 75(5), 298-303.
Bertero, C. (2003). What do women think about
menopause? A qualitative study of women’s expectations, apprehensions and
knowledge about the climacteric period. International Nurse Review, 50(2),
109-118.
Castelo-Branco, C., Peralta, S., Ferrer, J.,
Palacios, S., Cornago, S. and Quereda, F. (2006). The dilemma of menopause and
hormone replacement–a challenge for women and health-care providers: knowledge
of menopause and hormone therapy in Spanish menopausal women. Climacteric,
9(5), 380-387.
Commonwealth of Learning. (2000). Manual for
Educational Media Researchers: Knowing your Audience. Vancouver, Canada:
Commonwealth Educational Media Centre for Asia (CEMCA).
Dennerstein, L. (2004). Mood and Menopause.
Medscape Today. 2nd World Congress on Women’s Mental Health.
Jones, J. B. (1999). Hormone replacement
therapy: women’s decision-making process. Social Work Health Care, 28(3),
95-111.
Kahn, D. A., Moline, M. L., Ross, R. W.,
Altshuler, L. L. and Cohen, L. S. (2001). Depression During the Transition to
Menopause: A Guide for Patients and Families. A Postgraduate Medicine Special
Report.
Kenemans, P. (1999). Menopause, HRT and
menopausal symptoms. Journal of Epidemiol Biostat, 4(3), 141-146.
Obenzinger, H. (2005). “What Can A Literature
Do For Me?” How To Research, Write, And Survive A Literature Review. Stanford
University (online). Available at: http://www.stanford.edu/dept/undergrad/urp/PDFLibrary/writing/LiteratureReviewHandout.pdf
[Accessed: 03/06/07].
Smyrk, J. (2006). Project threats and opportunities—a conjecture. PHILICA.COM
Observation number 29.
Credit:ivythesis.typepad.com
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