By Helene Ekström, Johanna Esseveld and Birgitta Hovelius Abstract The meanings given to menopause by women themselves are often left aside. In this grounded theory study, based on interviews and on open-ended questions in questionnaires answered by middle-aged women, the authors found that not being able to know what would happen and what influence menopause would have were sources of uncertainty for the women. The process, Keeping My Ways of Being, emerged in the analysis as the pattern of behavior through which the women endeavored to resolve their uncertainty. The intensity of the process and the use of its three different stages, those of Preserving present ways of being, Limiting changes and Reappraising, were considered to be dependent upon the central Personal Calculation Process, in which the women used their individual explanatory beliefs and evaluations of need. The theory, used as a model of thinking in consultations with middle-aged women, might show a high degree of workability in explaining what is going on. Key words: Grounded theory, menopause, hormone therapy, ways of being, personal calculation Background Midlife is not a clearly demarcated period and it was the last segment of the life-span to be discovered (Lock, 1998). It tends to be characterized more by key events than by a particular age period, although this depends on what cohort, culture or context is of primary concern (Lachman & James, 1997). In Sweden, the terms “climacteric” or “transition-age” are commonly used for the years before and after the final menstrual period. In common parlance the terms are used for a wide range of symptoms and circumstances during these years, and thus similar to the content often given to the term “menopause” (Ballard, Kuh, & Wadsworth, 2001). Menopause is a physiological event occurring universally in women who reach midlife. In the medical literature, midlife or middle-age is often redefined for women in terms of menopause (Esseveld & Eldén, 2002). This redefinition implies an emphasis on the loss of fertility and on estrogen deficiency, followed by a focus on problems, symptoms and risks of various diseases (Esseveld & Eldén, 2002; Lock, 2002; Murtagh & Hepworth, 2003). Menopause has been promoted as a critical point of choice in women’s lives. The choices they then make influence their lives and health into old age (Murtagh & Hepworth, 2003). This approach to menopause and the promotion of hormone therapy (HT) have been the subject of intense debate among social scientists, feminists and medical professionals (Guillemin, 1999; Hemminki, 2004; Lock, 1998; Murtagh & Hepworth, 2003). Medical practice in the form of HT has been widely advocated as a remedy for relieving such symptoms as hot flushes, cold sweats and vaginal dryness as well as for the prevention of public health problems such as heart disease and osteoporosis (Hemminki, 2004; Murtagh & Hepworth, 2003). However, in the late 1990s and in the early years of the 21 st century, results from randomized controlled studies such as the Heart and Estrogen/Progestin Replacement Study (HERS) and Women’s Health Initiative (WHI), has turned medical counseling on HT upside down. Today, HT is recommended for the treatment of menopausal symptoms only (EMEA, 2003). In Sweden, general practitioners as well as gynecologists prescribe HT. In general, no referrals are needed and women’s choice of physician does not carry with it a major difference in costs for them. In contrast to the bio-medical conception of menopause, social scientists and feminists but also some medical professionals have emphasized its social construction and have promoted an...