#Menopause on Instagram: A Mixed-methods Study

Morgan E. Arseneau, BS; Uba Backonja, PhD, MS, RN; Michelle L. Litchman, PhD, FNP-BC; Rojin Karimanfard, BS; Xiaoming Sheng, PhD; Lisa Taylor-Swanson, BS (Hons), PhD, MAcOM

Disclosures

Menopause. 2021;28(4):391-399. 

In This Article

Abstract and Introduction

Abstract

Objective: The aims of this study were to: (1) characterize the menopause transition (MT) on social media and (2) determine if concordance or discordance exists when comparing MT-focused social media posts and biomedical research literature.

Methods: We analyzed 440 sequential Instagram posts with the hashtag #menopause over 2 weeks from January to February 2019. Posts were composed of 299 unique accounts, resulting in an average of 1.7 posts per account (standard deviation SD 1; range 1–9; median 1 and interquartile range [IQR] 1–2). Each account had an average of 2,616 followers (SD 11,271; range 3–129,000; median 421.5 and IQR 177–1,101). Content and thematic analyses were completed for posts, images, and videos to identify codes related to the MT. The top 15 codes were then searched along with the key term "menopause" in PubMed to ascertain the level of concordance between Instagram content and peer-reviewed literature on the MT.

Results: We identified 69 codes in our corpus of Instagram content, resulting in 9 categories: physical health, mental health, complementary and integrative health, advertising, social, advice, self-care, nature, and self-expression (kappa 0.95–1.00). The most prevalent codes were related to weight loss/fitness (20.5%) and hormones (18.4%). The majority of frequent codes identified in Instagram posts were infrequently listed in biomedical literature related to menopause. However, there were two codes, Weight loss/Fitness and Hot flashes, that were frequently discussed in Instagram posts and the biomedical literature.

Conclusions: The examination of #menopause on Instagram provides novel insights for researchers and clinicians. Our findings provide a better understanding of the experiences and support needs of individuals experiencing menopause. Furthermore, codes related to menopause have low prominence in the biomedical literature, suggesting key topics that could be explored in the future.

Video Summary: http://links.lww.com/MENO/A695.

Introduction

The menopausal transition (MT) is a biopsychosocial transition that may include biological changes in menstruation and hormone production, psychological symptoms such as anxiety or depression, and/or psycho-social changes in roles and identity.[1] Menopause was approached here as a cis-gendered women's health issue (whether surgically-induced or naturally occurring menopause) and therefore does not account for other menstruators (eg, nonbinary individuals, transgender men). The MT is a complex time of life with a wide range of heterogeneity in social and symptomatic experience. Much of the health sciences-generated literature has published on symptoms and syndromes. Yet, some women do not experience troublesome symptoms, and some women report the MT in positive terms when asked about their experiences.

For example, The Hilo Women's Health Study surveyed 185 multiethnic women aged 45–55. While premenopausal women expressed anxiety about the MT, peri- and postmenopausal women expressed confidence and freedom and their attitudes were not biomedically oriented.[2] Another qualitative study conducted in the United Kingdom reported that some women described the MT as a normal process that was distinct from social and role changes.[3] While women's narratives have been captured in qualitative inquiry, as far as our team was able to determine, women's narratives about the MT—positive, negative, or both—as posted on social media have not yet been studied. Further still, little is known about what midlife women communicate about via social media and whether that is similar or different from clinical narratives (eg, research reports) regarding the MT.

Studying MT postings on social media is relevant because a majority of midlife women are accessing and posting to social media sites. The Pew Research Center reported that, on average, 68% of US women used social media and that 77% of adults ages 30–49 (men and women) used social media in 2015.[4] Some of the most popular social media sites include Twitter and Facebook, which respectively generate 500 million tweets per day and 2.7 billion "likes" per day.[5] However, Instagram has emerged as the leading photo-sharing platform and is the second most popular post-sharing platform for adults age 30–64 behind Facebook with 47% of 30–49 year-olds and 23% of 50–64 year-olds having used the platform in 2019.[6] Instagram is particularly popular amongst women with 43% of all adult US women having used the website compared to 31% of all US men.[6] It should be bore in mind, though, that not just women experience menopause and that much of the data on usage only uses binary male/female definitions of gender. Instagram is a mobile social network that allows users to edit and share photos and videos. Postings are "tagged" with hashtag terms. There were approximately 100 million active Instagram accounts in the United States and 1 billion worldwide in 2018.[7] Analysis of social media data may provide novel insights into the MT to supplement traditional self-report data collection approaches.

Given the lack of information about social media's role in the discussion of menopause, the present study was undertaken to understand better how midlife women perceive their MT, how menopause is characterized by other people, and to understand if symptoms are or are not the common topic of social media posts. This study focuses on perceptions of the MT and health information exposure/seeking[8,9] as shared by individuals on social media. We were not attempting to capture the general population's perceptions of the MT. To that end, we obtained data to answer the following research questions: (1) What are the characteristics of posts and posting accounts on social media regarding the MT? and (2) What level of concordance or discordance exists when comparing MT-focused social media posts and research literature?

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