Social determinants of health and menopausal symptoms: path analysis using the WHO framework

Introduction: Menopausal symptoms frequently occur in middle-aged women and severely reduce their quality of life worldwide. Considering the potential influences of social determinants of health on menopausal symptoms, this study investigated the relationship between social determinants of health, as outlined by the World Health Organization framework, and menopausal symptoms among Iranian women.

Method: This cross-sectional study was conducted on 465 women aged 45 to 55 attending health centers in Kashan, Iran, between March and September 2024. Participants were selected via convenience sampling from a pool of women attending routine check-ups. Data were collected using six validated questionnaires: (1) a demographic and obstetric information survey (age, parity, etc.) (2), a socioeconomic status assessment (income, education) (3), the Multidimensional Scale of Perceived Social Support (MSPSS) (4), the WHO Intimate Partner Violence Questionnaire (WHO-IPV) (5), Sharkey Physical Activity Questionnaire, and (6) the Menopause Rating Scale (MRS) for symptom severity. Data were analyzed using SPSS 27 for descriptive statistics and LISREL 8.8 for path analysis, which modeled direct and indirect effects.

Results: Path analysis identified several social determinants directly influencing menopausal symptom severity. Domestic violence (B = 0.073, p < 0.05) and parity (B = 0.84, p < 0.01) were positively associated with symptom severity, indicating that higher exposure to violence or more childbirths worsened symptoms. In contrast, perceived social support (B=-0.15, p < 0.05) and physical activity (B=-0.25, p < 0.01) showed negative associations, suggesting protective effects. Indirect effects emerged from socioeconomic status (B=-0.29, p < 0.05), age (B = 0.11, p < 0.05), and spouse’s education (B=-0.25, p < 0.05), mediated through variables like support and activity levels. BMI uniquely influenced symptoms via direct and indirect paths (B = 0.38, p < 0.01), with higher BMI linked to greater severity. The model demonstrated excellent fit: RMSEA = 0.027 (< 0.06), GFI = 0.99 (> 0.90), CFI = 0.97 (> 0.90), and χ²/df = 2.24 (< 3), confirming its robustness.

Conclusion: Social determinants of health significantly influence menopausal symptom severity. Domestic violence and higher parity worsened symptoms, while social support and physical activity had protective effects. Socioeconomic status, spouse’s education, and BMI also contributed through direct and indirect pathways. These findings could help healthcare providers identify menopausal and perimenopausal women at risk for severe symptoms and provide women with strategies to reduce symptoms, such as weight loss and physical activity.