Introduction
Menopause is a natural and irreversible stage in every woman’s life, characterized by the permanent cessation of menstruation and the end of reproductive capacity [1]. While physiological, menopause is often accompanied by a range of bio-psycho-social changes that may negatively impact a woman’s quality of life, particularly through alterations in mood, cognition, physical health, and self-perception. Of increasing interest in contemporary health psychology and women’s health is how these changes intersect with body image, a multidimensional construct encompassing individuals’ perceptions, emotions, and behaviors regarding their physical appearance [2, 3].
Modern women are living longer, remaining professionally and socially active well into midlife and beyond. This shift underscores the importance of understanding the psychological experiences of aging, particularly those shaped by cultural ideals that promote youthfulness, thinness, and physical perfection standards often reinforced by social media and popular culture. These external pressures can intensify the already complex psychological effects of menopause, potentially leading to dissatisfaction with physical changes such as weight gain, skin aging, reduced muscle tone, or changes in sexual function. Previous research has shown that peri- and postmenopausal women often report lowered self-esteem, depressive symptoms, and impaired quality of life, conditions frequently linked to declining estrogen levels, sleep disturbances, metabolic changes, and cognitive impairment. These symptoms may be compounded by negative stereotypes of aging and obesity, contributing to a distorted or critical body image. Despite this, the specific relationship between menopause-related symptoms and body image remains understudied, especially in the context of pelvic floor dysfunction and prolapse symptoms, which further affect self-perception and sexual health [4–6].
Body image is a subjective image of what the body looks like and is independent of what that body objectively looks like. It is a very complex construct, resulting from thoughts, feelings and judgement and behavior related to one’s own body. Nowadays, the aim is to achieve the ideal body shape, to stay young and fully fit.
Social media promotes unrealistic standards of beauty that are virtually impossible for the population to achieve. This disturbs normal social functioning, affects the achievement of life goals or lowers self-esteem [7].
According to researchers, there is a relationship between psychological state and body image. It is a stage consisting of several components, which include [8]:
the cognitive component of body image (body perception and beliefs about one’s own appearance, attractiveness, and physical fitness),
the emotional component (degree of satisfaction with one’s own body),
the behavioral component (improvement of body image).
Body image is presented as a multidimensional and interdisciplinary structure. Creating a positive or negative self-concept of one’s body image is an individual matter; and it occurs differently in women and in men. The female gender is more susceptible to factors negatively influencing self-perception. A theory developed in 1990 states that body image should be analyzed on three levels [9]: attractive appearance, physical condition, and health.
A review of the literature indicates that many postmenopausal women view their own bodies very critically and receive critical comments from those around them. Reasons for this dissatisfaction include fat accumulation in the lower body, as well as weight gain associated with low levels of sex hormones. In addition, women manifest dissatisfaction with their facial appearance, such as the firmness and smoothness of their skin, redness, and the appearance of wrinkles, as well as with their skin, hair, or sex life. As a result of perceived post-menopausal effects, including vaginal dryness, decreased libido, and reduced sexual activity occurs, leading to a negative perception of one’s own body [10]. A positive perception of one’s body associated with the absence of problems in the interpretation of one’s own body promotes body acceptance [11].
Woods and Mitchell identified four factors that influence mood changes during the peri-menopausal period [11]. The first is the change in estrogen levels, which causes symptoms such as dysphoria, sleep problems, and hot flashes. Another factor is the effects of bothersome hot flashes and night sweats, which influence the onset of anxiety and depression. The next determinants are stressful life events, which result in the emergence of a depressive mood. In addition, stress significantly influences the experience of more intense depressive symptoms and vasomotor symptoms. The last factor that plays a role in the severity of psychiatric disorders is a woman’s health status, the current one and the one before menopause [12].
Symptoms occurring during the menopause have a very strong impact on women’s mental health. Mental well-being is seen as an emotional and cognitive evaluation of one’s life. The emotional aspect concerns a person’s positive feelings (sense of fulfilment and satisfaction with life) and emotional reactions regarding events that occur. The cognitive aspect, on the other hand, focuses on women’s thinking about the subject of life: how they perceive it, and how they evaluate it [13].
In light of the ambiguous relationship between peri-menopausal symptoms and body image, this study aimed to explore the association between body image and the menopausal symptoms among postmenopausal women. Additionally, the study sought to examine whether sociodemographic variables (including age, education level, occupational status, place of residence, and marital status) and menopause-related factors (such as age at menopause onset, type of menopause, and use of hormone replacement therapy) influence self-perceived body image and the severity of depressive symptoms in this population.
The scientific contribution of this study lies in its integrated approach, combining biological, psychological, and social perspectives to deepen our understanding of how menopause impacts body image. By including prolapse symptoms often neglected in broader discussions of menopause and self-perception this study introduces a novel variable into the body image literature and offers practical implications for holistic clinical care, mental health support, and targeted interventions aimed at improving midlife women’s body satisfaction and emotional well-being.
Material and methods
Organization and course of the study
This cross-sectional study was conducted among 271 postmenopausal women residing in the West Pomeranian Voivodeship in Poland.
The study was carried out at University Clinical Hospital No. 1 in Szczecin, Poland, across all departments where women meeting the inclusion criteria were hospitalized, including gynecology, internal medicine, and general medicine wards. Recruitment was based on information posters in public areas and advertisements in local newspapers, as well as direct recruitment in hospital settings. Women were approached during hospitalization and invited to participate if eligible.
A total of 300 women who met the inclusion criteria were invited to participate in the study. After exclusion of incomplete questionnaires, 271 properly completed survey forms were included in the final analysis, yielding a completion rate of 90%.
The inclusion criteria for participation were as follows:
women aged over 40 years,
established menopause (natural or surgical),
no clinically confirmed mental illness,
a standard Polish diet without supplementation,
European biogeographic ancestry and residence in the West Pomeranian Voivodeship,
provided informed consent to participate.
Exclusion criteria included:
The study was conducted in accordance with the principles of the Declaration of Helsinki and received ethical approval from the Bioethics Committee of the Pomeranian Medical University in Szczecin. Additionally, formal authorization was granted by the hospital administration of USK No. 1 in Szczecin, allowing the study to be conducted in all hospital departments where eligible patients were hospitalized.
All participants were thoroughly informed, about the purpose, scope, and voluntary nature of the study. Prior to enrollment, each participant received a comprehensive information sheet outlining the study objectives, the confidentiality and anonymity of the data collected, the right to withdraw at any time without providing justification, and the intended use of the data for research purposes only. In hospital settings, trained study personnel personally distributed the information and survey materials to eligible women, provided verbal explanations, and remained available to address any questions or concerns. In community-based recruitment, including local advertisements and public posters, the study details were clearly presented, accompanied by contact information for participants to seek clarification if needed. Informed consent was implied through the voluntary and anonymous completion and return of the questionnaire, a procedure explicitly approved by the Bioethics Committee. Participants were informed that submission of the completed survey constituted their agreement to participate in the study.
The required sample size was determined using statistical data for the population of women aged 40–65 living in the West Pomeranian Voivodeship as of 2022 [14]. The sample size was calculated with a 95% confidence level, a maximum margin of error of 7%, and an estimated proportion of 0.5, ensuring adequate power to detect meaningful associations.
Research instruments
The present study used a diagnostic survey method and standardized research tools: the Menopause Rating Scale (MRC), the Body Image Questionnaire by A. Głębocka, and Patient Health Questionnaire-9 (PHQ-9) [15–18].
Menopause Rating Scale (MRS) – is a comprehensive tool for assessing menopausal symptoms in women. It includes 11 symptoms, rated on a scale of 0–4 (where 0 is “none”, 1 is “mild”, 2 is “moderate”, 3 is “severe”, 4 is “very severe”). The 11 symptoms measured by the MRS are: hot flashes, sweating, cardiac problems, sleep problems, depressive mood, irritability, anxiety, physical and mental exhaustion, sexual problems, bladder problems, vaginal dryness, joint and muscle discomfort [15].
The Body Image Questionnaire by A. Głębocka [16, 17] is a questionnaire that examines body image in cognitive, emotional, and behavioral aspects. It contains 40 statements on a 5-point scale, where the respondent indicates the answer: “definitely not”, “probably not”, “hard to say”, “probably yes”, or “definitely yes”. There are four scales in the questionnaire: “cognitions-emotions” – examines respondents’ opinions about their appearance and emotional attitudes towards their own bodies (items: 2, 3, 4, 6, 10, 17, 18, 19, 25, 27, 29, 31, 32, 34, 36, 37). A higher score on the cognition-emotion scale indicates more negative beliefs about one’s own body;
“behavior” – the behavior scale assesses behaviors related to physical activity (items: 7, 8, 11, 20, 35). A higher score on this scale indicates a higher level of engagement in physical activity;
“the pretty-ugly stereotype” – measures the degree of internalization of cultural and social ideals of beauty (items: 1, 5, 9, 12, 15, 21, 22, 24, 26, 33, 38, 39, 40). The higher the score on the pretty-ugly stereotype scale, the greater is the internalization of the subject’s contemporary beauty standards;
“ambient criticism” – measures perceived environmental criticism of appearance (items: 13, 14, 16, 23, 28, 30). The higher the ambient criticism score is, the higher is the level of perceived ambient criticism of appearance;
the tool’s accuracy and reliability index is satisfactory. Scale of Satisfaction with Particular Parts and Parameters of the Body – this is a scale, authored by A. Głębocka, which determines the level of satisfaction with particular parts of the body. The respondent indicates a value from 1 to 9, where 1 means “no satisfaction at all”, 5 – “no opinion on the subject”, and 9 – “complete satisfaction”.
The author’s survey questionnaire consisted of closed questions, which concerned sociodemographic data such as age, place of residence, marital status, education and occupational status. Other questions concerned the age of the last menstrual period, the timing of the first prolapse symptoms, its causes, the use of hormone replacement therapy, the number of deliveries, the presence of comorbidities, changes in body image, nicotine addiction, and physical activity.
Statistical analysis
The analysis of quantitative variables was performed by calculating descriptive statistics such as mean, standard deviations, median, quartiles, and minimum and maximum. The analysis of qualitative variables was performed by calculating the absolute frequencies and percentages of occurrence of all the values these variables could take. Comparison of the results of the standardized questionnaires in the two groups was performed using the Mann-Whitney test. Comparison of the results of standardized questionnaires in three or more groups was performed using the Kruskal-Wallis test and, if statistically significant differences between groups were detected, the Dunn post-hoc test. Correlations between the results of the standardised questionnaires and quantitative variables were analyzed using the Spearman correlation coefficient. The analysis assumed a significance level of 0.05, so all p-values below 0.05 were interpreted as indicating significant relationships.
The data collected during the research process were collected in a Microsoft Office Excel spreadsheet. Statistical analysis was performed in R, version 4.3.2 (RStudio, Boston, MA, USA) [19].
Results
Characteristics of respondents
A total of 271 postmenopausal women participated in the study. The mean age of the respondents was 55.05 years (SD = 6.28 years). The largest group consisted of those living in a city of more than 100,000 inhabitants (144 persons; 53.14%), in a formal relationship (57.20%), characterized by secondary education (44.28%), and economically active (88.19%) (Table 1).
Table 1
General characteristics of the population studied
The study observed that the mean age of onset of the last menstrual period was 49.24 years (SD = 3.87). The largest group consisted of respondents whose last menstrual period occurred at the age of 46 - 50 years (45.76%), and the first symptoms of menopause appeared at the age of 45–50 years (46.86%). In addition, the majority of women experienced menopause due to natural causes (87.08%), while 84.13% of respondents were not taking hormone replacement therapy. The most common diagnosed chronic disease among respondents was hypertension (49.82%), followed by thyroid disease (35.79%) and degenerative spine disease (32.47%).
The vast majority of respondents (72.32%) noticed changes in the body during the menopause. Respondents were convinced of the negative impact of the menopause on their health (57.02%) and their perception of their own body (60.52%). The most common changes in appearance during the menopausal period were weight gain (66.05%), loss of skin firmness (62.73%), and dry skin and mucous membranes (53.14%).
Analysis of postmenopausal women’s body image assessment and severity of menopausal symptoms
Based on the interpretation of the MRS, the mean score on the Menopause Symptom Scale (total) was found to be 17.86 points, giving 1.62 points per question, so the respondents had moderate menopause-related symptoms. On the other hand, the mean score on the psychological symptoms scale was 6.24 points, i.e. 1.56 points per question, so respondents had moderate psychological symptoms. The mean score on the somatic-vegetative symptom scale was 6.75 points, i.e. 1.69 points per question, so the female respondents had moderate somatic-vegetative symptoms. The mean score on the genitourinary symptoms scale was 4.86 points, averaging 1.62 points per question, so the female respondents had moderate genitourinary symptoms (Table 2).
Table 2
Menopause symptom severity scale according to the Menopause Rating Scale and body image rating scale according to the Body Image Questionnaire (BQI)
An analysis of body image assessment according to the Body Image Questionnaire showed that the mean score on the “Cognition-Emotions” subscale was 43.15 points, averaging 2.7 points per question, so the respondents were neutral about their appearance. The mean score on the “Behavior” subscale was 14.39 points, i.e. 2.88 points per question, so the respondents did not show significant engagement in physical activity. The mean score on the “Criticism of the environment” subscale was 12.59 points, averaging 2.10 points per question, so the respondents felt accepted by their environment. The mean score on the “Pretty-ugly stereotype” subscale was 44.97 points, averaging 3.46 points per question, so the respondents had a neutral attitude towards the fact that a slim body appearance is desirable and preferred in society (Table 2).
Analysis of the relationship between postmenopausal women’s self-assessed body image according to the Body Image Questionnaire and selected sociodemographic and medical variables
The study analyzed the relationship between postmenopausal women’s self-assessed body image and selected sociodemographic variables (age, place of residence, marital status, education, occupational status).
Data analysis showed statistically significant correlations between selected subscales of postmenopausal women’s self-assessment of body image according to Body Image Questionnaire and place of residence (p < 0.05). It was found that the score on the “Behavior” subscale was significantly higher in female residents of rural areas than in the other subjects (p = 0.018). It was found that the score on the “Criticism of environment” subscale was significantly higher in female residents of rural areas than in female residents of cities with a population of 10,000–100,000 and in female residents of cities with a population of over 100,000. Moreover, the score was significantly higher in female residents of cities with a population of up to 10,000 than in female residents of cities with a population of over 100,000 (p < 0.001). However, there was no statistically significant relationship between the place of residence and the other subscales (“Cognition-emotions” and “Pretty-ugly stereotype”) of the Alicja Głębocka Body Image Questionnaire (p > 0.05; Table 3).
Table 3
Sociodemographic variables. and postmenopausal women’s self-assessed body image according to Body Image Questionnaire (BQI) and severity of menopausal symptoms according to Menopause Rating Scale
Analysis of the data showed statistically significant relationships between postmenopausal women’s self-assessment of their body image according to the Body Image Questionnaire and education. It was found that the score on the “Cognition-Emotions” subscale was significantly higher in women with primary or vocational education than in women with higher education and women with secondary education (p = 0.01). Furthermore, it was noted that the score on the “Behavior” subscale was significantly higher in women with primary or vocational education than in women with university education and women with secondary education (p < 0.001). Also, the score on the “Criticism of environment” subscale was significantly higher in women with primary or vocational education than in women with secondary education and in women with tertiary education (p < 0.001). However, there was no statistically significant relationship between education and the “Pretty-ugly stereotype” subscale according to the Alicja Głębocka Body Image Questionnaire (p > 0.05; Table 3).
Analysis of the data showed no statistically significant relationship between the other sociodemographic variables (age, marital status, occupational status) and postmenopausal women’s self-assessed body image according to Body Image Questionnaire (p > 0.05).
The study analyzed the relationship between postmenopausal women’s self-assessed body image and selected medical variables (time of onset of first menopausal symptoms, hormone replacement therapy [HRT] used).
Data analysis showed statistically significant correlations between postmenopausal women’s self-reported body image according to the Body Image Questionnaire and the time of onset of the first menopausal symptoms (p < 0.05). It was found that the score on the “Criticism of the environment” subscale was significantly higher in women who noticed their first menopausal symptoms after the age of 50 than in women who noticed their first menopausal symptoms at the age of 45–50 and before the age of 45 (p = 0.034). In addition, it was observed that the score on the “Pretty and ugly stereotype” subscale was significantly higher in women who noticed the first symptoms of menopause at age 45–50 and before age 45 than in women who did not notice the first symptoms of menopause (p = 0.021). In contrast, there was no statistically significant relationship between the time of onset of first menopausal symptoms and the other subscales (“Cognition-Emotions” and “Behavior”) of the Alicja Głębocka Body Image Questionnaire (p > 0.05; Table 4).
Table 4
Medical variables and self-rated body image of postmenopausal women according to Body Image Questionnaire
Data analysis showed statistically significant correlations between postmenopausal women’s self-assessment of their body image according to the Body Image Questionnaire and the use of hormone replacement therapy (p < 0.05). It was found that the score on the “Cognition-emotions” subscale was significantly higher in women not using HRT than in other women (p = 0.024). Furthermore, it was observed that the score on the “Criticism of the environment” subscale was significantly higher in women not using HRT than in women using HRT (p = 0.049). However, there was no statistically significant relationship between HRT use and the other subscales (“Behavior” and “Pretty-ugly stereotype”) of the Alicja Głębocka Body Image Questionnaire (p > 0.05; Table 5). In addition, analysis of the data showed no statistically significant relationship between the reason for menopause and the self-assessment of postmenopausal women’s body image according to the Body Image Questionnaire (p > 0.05; Table 4).
Analysis of the relationship between postmenopausal women’s self-assessed body image according to the Menopause Rating Scale and selected sociodemographic and medical variables
The study analyzed the relationship between the severity of menopausal symptoms according to the MRS and selected sociodemographic variables (age, place of residence, marital status, education, occupational status).
Analysis of the data showed statistically significant correlations between the severity of menopausal symptoms according to the MRS and place of residence (p < 0.05). It was found that the severity of genitourinary symptoms was significantly higher in female residents of cities with up to 10,000 inhabitants and in rural residents than in women living in cities with more than 100,000 inhabitants (p = 0.09; Table 3). There was no statistically significant relationship between the place of residence and the severity of menopausal symptoms according to the MRS in the subscales menopausal symptoms, psychological symptoms, somato-vegetative symptoms (p > 0.05).
Analysis of the data showed statistically significant relationships between the severity of menopausal symptoms according to the MRS and education (p < 0.05). It was found that the severity of menopausal symptoms (combined) was significantly higher in women with primary or vocational education than in women with tertiary education and in women with secondary education (p = 0.001). Furthermore, it was observed that the severity of psychological symptoms was significantly higher in women with primary or vocational education than in women with tertiary education and in women with secondary education (p = 0.001; Table 3).
There was no statistically significant relationship between age and the severity of menopausal symptoms according to the MRS (p > 0.05).
Also, the severity of somato-vegetative symptoms was significantly higher in women with primary or vocational education than in women with tertiary education and in women with secondary education (p = 0.004). It was observed that the severity of genitourinary symptoms was significantly higher in women with primary or vocational education than in women with secondary education and in women with tertiary education (p = 0.001). Furthermore, there were no significant static differences between marital status or occupational status and the severity of menopausal symptoms (all p > 0.05; Table 3).
The study analyzed the relationship between the severity of menopausal symptoms according to the MRS and selected medical variables (time of onset of first menopausal symptoms, HRT used).
Analysis of the data showed statistically significant relationships between the severity of menopausal symptoms according to the MRS and the age at which women observed their first menopausal symptoms. It was found that the severity of menopausal symptoms (combined) was significantly higher in women who first noticed symptoms at the age of 45–50 than in women who first noticed symptoms after the age of 50 and in women who did not notice menopausal symptoms. Also, it was observed that the severity of menopausal symptoms (combined) was also significantly higher in women who first noticed symptoms before the age of 45 and in women who first noticed symptoms after the age of 50 than in women who did not notice menopausal symptoms (p < 0.001; Table 3).
Furthermore, it was shown that the severity of psychological symptoms was significantly higher in women who first noticed symptoms at the age of 45–50 years than in women who first noticed symptoms after the age of 50 years and in women who did not notice menopausal symptoms. It is also significantly higher in women who first noticed symptoms before the age of 45 than in women who did not notice menopausal symptoms (p = 0.002; Table 3).
It was noted that the severity of somato-vegetative symptoms was significantly higher in women who first noticed symptoms at 45–50 years of age than in women who first noticed symptoms after 50 years of age as well as in women who did not notice menopausal symptoms. Higher values also occurred in women who first noticed symptoms before the age of 45 than in women who did not notice menopausal symptoms (p < 0.001; Table 3).
Also, the severity of genitourinary symptoms was significantly higher in women who first noticed symptoms before 45 years of age, in women who first noticed symptoms at 45–50 years of age and in women who first noticed symptoms after 50 years of age than in women who did not notice menopausal symptoms (p < 0.001; Table 4).
Analysis of the data showed statistically significant relationships between the severity of menopausal symptoms and the cause of menopause onset. It was found that the severity of genitourinary symptoms was significantly higher in women with surgical menopause than in women with natural menopause (p = 0.042). There was no statistically significant relationship between the cause of menopause and the severity of menopausal symptoms according to the MRS subscales of menopausal symptoms (total), psychological symptoms, and somato-vegetative symptoms (p > 0.05; Table 4).
Furthermore, there was no statistically significant relationship between the use of hormone replacement therapy and the severity of menopausal symptoms according to the MRS (Table 4).
Analysis of the relationship between postmenopausal women’s self-assessed body image according to the Menopause Rating Scale and selected sociodemographic and medical variables
The study analyzed the relationship between the severity of menopausal symptoms according to the MRS and body image assessment according to the Body Image Questionnaire. Data analysis showed statistically significant relationships between menopausal symptoms according to the MRS and body image assessment according to the Body Image Questionnaire (p < 0.05).
On the basis of the collected results, statistically significant positive correlations were found between the severity of menopausal symptoms (psychological, somatic-vegetative, genitourinary symptoms) and all aspects of perception of body image according to the Body Image Questionnaire. This means that the more severe the symptoms of menopause are, the worse is the perception of one’s body, and also the higher the level of physical activity is, the greater is the internalization of the subject’s contemporary standards of beauty and the higher is the level of perceived environmental criticism of appearance (Table 5).
Discussion
Identification of factors influencing body image of postmenopausal women
Our study revealed statistically significant associations between the severity of prolapse symptoms, including psychological, somato-vegetative, and genitourinary manifestations, and women’s perceived body image. Specifically, greater symptom severity correlated with more negative self-perception and heightened sensitivity to environmental criticism regarding appearance.
A review of the literature highlights that both subjective and objective factors influence body image [20]. For instance, Stadnicka et al. [21] found that menopausal women’s body self-image is largely shaped by their subjective experience of prolapse symptoms. They reported significant correlations between somatic symptom severity and Body Image Questionnaire subscales such as “Cognition-Emotions,” “Pretty-Ugly Stereotype,” and “Behaviour.” Additionally, psychological menopausal symptoms increased sensitivity to external criticism, while urogynaecological symptoms related significantly to the “Pretty-Ugly” stereotype, and somatic symptoms influenced behavioral responses.
A study by Satwik et al. [22] showed that the prevalence of poor body image in middle-aged women was 17.4%. In addition, negative self-perception was strongly correlated with low self-esteem and depression. Also, lower education level, higher body mass index, negative perceptions of menopause, poor social support structure, and history of mental illness increased the risk of poor body image in middle-aged women.
Similarly, Nazarpour et al. [13] observed a negative correlation between prolapse symptom severity and body image across all symptom dimensions. Their regression analysis confirmed menopausal symptom intensity as a significant predictor of body image in postmenopausal women. Włodarczyk and Dolińska-Zygmunt [23] further demonstrated that severe vasomotor and psychosomatic symptoms are associated with lower self-confidence and negative body perception.
Multiple studies confirm that physical and psychological changes during the perimenopausal period, such as weight gain, insomnia, hot flashes, skin and hair alterations, sexual dysfunction, and osteoporosis, negatively affect body image [24, 25]. Ginsberg et al. [26] found a significant negative correlation between body mass index (BMI) and positive body image.
A review of the literature indicates that negative attitudes towards the changes taking place during the peri-menopausal period also influence dissatisfaction with one’s body, inducing fear of ageing and the associated changes in appearance. In addition, prolapse symptoms are associated with negative attitudes towards attractiveness, low self-esteem or body image [27]. Both Pazmany et al. [28] and Hunter et al. [29] reported that women experiencing heightened genitourinary symptoms express greater dissatisfaction with their body image. Stress urinary incontinence specifically has been linked to adverse effects on body image [29] and mental health [30].
Our own data indicate that place of residence, education, and HRT usage significantly influence body image perception, especially regarding environmental criticism.
Other studies have identified important sociodemographic correlates of body image, including education, parity, marital status, employment, and housing stability [37–39]. Cultural and sociodemographic contexts strongly shape women’s subjective menopausal experiences. Garrusi et al. [39] found a negative correlation between education and body dissatisfaction in adults, while Chang et al. [37] reported a positive association between education and body image in women with breast cancer.
Baratlou et al. [38] demonstrated that higher education supports better coping with menopausal symptoms. Educated and employed women with stable housing conditions appear to manage menopausal symptoms more effectively and report a more positive body image. Both employment and homeownership are positively associated with body image, underscoring the role of women’s empowerment in shaping self-perception during the menopausal transition.
An intriguing finding is the negative correlation between parity and body image of the lower limbs, possibly reflecting the impact of multiple vaginal deliveries. Married women exhibited lower body image scores than single, widowed, or separated women, aligning with prior reports of greater body dissatisfaction among married women [9, 37].
Vincent et al. [31] synthesized existing research and confirmed a robust association between body image and the intensity, frequency, or number of menopausal symptoms. Baker et al. [32] similarly reported significant correlations between body image and both somatic and psychosomatic menopausal symptoms. Mangweth-Matzek et al. [33] corroborated these findings, reporting that total MRS scores correlated with weight and shape concerns as well as satisfaction. Olchowska-Kotala [34] observed a negative correlation between the number of menopausal symptoms and self-rated body image.
Rubinstein et al. [35] emphasized that postmenopausal appearance changes not only affect body image but can also worsen the quality of life – a finding echoed by Chang et al. [36], who linked negative body image appraisal and menopausal symptom severity to reduced quality of life in middle-aged women.
Żmuda et al. [40] found that menopausal phase influences symptom evaluation and attitudes: premenopausal women reported the lowest symptom severity but the most negative attitudes, while HRT users displayed milder symptoms, more positive attitudes, and higher life satisfaction. Negative correlations emerged between symptom severity and attitudes/satisfaction, whereas attitudes positively correlated with life satisfaction.
Becker et al. [41] identified significant associations between menopausal somatic and psychosomatic symptoms and body image concerns, indicating that severe menopausal symptoms heighten anxiety about appearance.
In summary, this study underscores that education, economic status, employment, and marital status significantly affect body image in menopausal women. Women’s empowerment emerges as a critical factor enhancing self-esteem and body perception during this transitional life phase. These findings emphasize the need for personalized menopausal care addressing medical, psychological, and social dimensions to support women’s holistic well-being.
Identification of factors influencing the severity of depression among postmenopausal women
Our own research showed statistically significant relationships between the severity of psychological, somato-vegetative, and genitourinary symptoms in postmenopause and the occurrence of depressive symptoms. The greater the severity of depressive symptoms, the more severe are the menopausal symptoms. In addition, a significant association was observed between the severity of depressive symptoms and the education and economic activity of postmenopausal women. Lower education and inactivity also increased depressive symptoms among the women studied.
A review of the literature indicates that a number of factors contribute to increased depression among postmenopausal women. One of these is the emergence of vasomotor symptoms such as hot flashes, night sweats, vaginal dryness, and dyspareunia which negatively affect sleep [42]. Other factors should also not be ignored, such as socio-economic data (marital status, educational level, ethnicity [43, 44], psychological factors [45–47], personality traits, and genetic conditions [42].
A study by An et al. [48], on the other hand, showed that in middle-aged women depressive symptoms and suicidal tendencies were significantly associated with the stages of menopause and started to increase from the early transition stage. Many studies confirm a significant increase in the frequency and risk of depressive symptoms in the peri- and postmenopausal period [48–51]. Also the study by Timur and Sahin [52] found that, compared to premenopausal women, peri-menopausal and postmenopausal women were twice as likely to experience depressive symptoms.
In contrast, the Study of Women’s Health Across the Nation (SWAN) found that the risk of a major depressive episode in women was approximately two to four times higher during or immediately after menopause, with postmenopausal women having the highest risk [53]. For other studies looking at the menopausal stage, it has been observed that the likelihood of depressive symptoms tends to peak in late menopause or immediately before menopause and then slowly decline, regardless of age [54].
It is noteworthy that depression is a multifactorial condition, so many variables can influence its onset, whether genetic, psychosocial, demographic or cultural [55].
Peri-menopausal and post-menopausal women are more prone to weight gain and therefore obesity. This is mainly due to hormonal changes or the ageing process. The changes in body image that occur may influence changes in mood and, consequently, contribute to the choice of maladaptive coping strategies, such as overeating under stress. Thus, obesity may exacerbate depressive symptoms [56], as well as increasing the severity of menopausal symptoms, which in turn affect psychological well-being [57]. In addition, some researchers report that low self-esteem may be a significant predictor of depressive symptoms [58, 59].
Limitations and strengths of the study
Studies on the impact of menopausal symptoms on self-perceived body image among postmenopausal women are very rare, so the above study may provide a basis for future research. This study was probably the first to demonstrate the association of all dimensions of menopausal symptoms with all dimensions of body image in postmenopausal Polish women. This study may form the basis for analytical design and intervention studies to improve the health of postmenopausal women.
The study also has some limitations; firstly, the study is cross-sectional, so a cause-and-effect relationship cannot be assessed. A limitation of the study is that the respondents come only from the West Pomeranian Voivodeship. The study did not analyse other variables that could significantly influence the perception of body image among postmenopausal women, such as BMI or waist-to-hip ratio (WHR). The study could have benefited from an analysis of the actual body proportions of women and their subjective perception of their bodies.
In addition, the survey used questionnaires that assessed the subjective feelings of respondents. This survey technique ensures anonymity, but also carries the risk of false answers, as respondents may subconsciously manipulate their answers.
Further studies are also needed that analyse changes in self-perception with respect to the stages of menopause according to STRAW (Stages of Reproductive Aging Workshop), or sex hormone levels measured over time, and not just as a single measurement. This would enable a better understanding of the potential impact of all variables on women’s self-perception of their bodies after menopause.
Conclusions
Increased severity of psychological, somatic-vegetative, and genitourinary menopausal symptoms is associated with a more negative body image and greater perceived external criticism. Addressing these symptoms may improve body image, with sociodemographic and medical factors warranting consideration in health interventions.
Participants generally reported moderate menopausal symptoms. Lower education correlated with greater overall and psychological symptom severity, while women from rural areas and small towns exhibited more severe genitourinary symptoms.
Poorer body image and higher perceived appearance criticism were associated with rural residency and lower education; age, marital, and occupational status showed no significant effect.
Symptom severity varied by menopause type and onset age; surgical menopause was associated with worse genitourinary symptoms, and onset between 45–50 years with greater overall symptom severity.
Depressive symptoms were predominantly absent or mild; however, increased depression severity strongly correlated with heightened menopausal symptom severity.
The study found a significant association between depressive symptom severity and both education level and occupational status; lower education and unemployment were associated with increased depressive symptoms in postmenopausal women.
Implication
The findings of this study underscore the multifaceted impact of menopausal symptoms on body image and psychological well-being, emphasizing the necessity for an integrated biopsychosocial approach in the care of postmenopausal women. Clinical management should extend beyond addressing physical symptoms to include routine assessment and intervention for mental health issues, particularly depressive symptoms, which are closely linked to the severity of menopausal complaints.
The observed associations between sociodemographic factors such as lower educational attainment, rural residency, and occupational inactivity and both increased symptom severity and poorer body image highlight the importance of personalized, context-sensitive health promotion strategies. Targeted outreach and support for these high-risk subpopulations are essential to reduce health disparities and optimize outcomes.
Furthermore, the study advocates for the incorporation of psychosocial counseling and education about menopause-related changes in routine clinical practice. Empowering women with knowledge and coping mechanisms may mitigate negative body image perceptions and improve mental health.
Given the universal nature of menopause and the growing global population of aging women, these results have broad applicability. They provide an evidence base for developing culturally competent, multidisciplinary interventions tailored to diverse healthcare systems worldwide, ultimately aiming to enhance the quality of life and well-being of postmenopausal women on an international scale.
