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Research Article

Menopausal

Public Health Review - International Journal of Public Health Research

2019 Volume 6 Number 3 May-June
Publisherwww.medresearch.in

Quality of life among post - menopausal women in rural Puducherry

Surendar R.1, Durgapriya G.2, Arthi M.3*, Srikanth S.4
DOI: https://doi.org/10.17511/ijphr.2019.i3.03

1 Surendar R., Assistant Professor, Department of Community Medicine, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India.

2 Durgapriya G., III MBBS, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India.

3* Arthi M., Assistant Professor, Department of Community Medicine, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India.

4 Srikanth S., Professor, Department of Community Medicine, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India.

Background: Postmenopausal women are the most vulnerable group affected due to physiological changes. The quality of life during the menopause is assessed by the frequency and severity of menopausal symptoms. Objectives: To assess the menopause symptoms and quality of life among post-menopause women in rural Puducherry and study the socio-demographic factors associated with menopausal symptoms and quality of life. Methods: A cross sectional study was conducted in rural field practicing area of a medical college. 133 postmenopausal women were selected from 3 villages by Simple random sampling. Socio-demographic details and menopausal symptoms using modified MENQOL questionnaire was elicited. Body mapping was done by the participants. Results: The mean age was 51±2 years. About 32% of them were suffering from any one of the chronic diseases like Diabetes, Hypertension. Joint pain (79.2%) was found to have higher prevalence and reduced sexual desire (2.3%) as lower prevalence. Overall, sixty four study population had no menopausal symptoms followed by 35 with mild, 20 had moderate menopausal symptoms. Significant association was seen between age of menopause and the severity of the menopausal symptoms in vasomotor and psychosocial domains. Positive correlations were seen among the domains. Majority (65%) of the women perceived pain any of the parts in body mapping which affects their day to day life. Conclusion: The Quality of life (QOL) of the post-menopausal women was poor based on the presence of symptoms in many domains.

Keywords: Menopause, Quality Of Life, Body mapping

Corresponding Author How to Cite this Article To Browse
Arthi M., Assistant Professor, Department of Community Medicine, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India.
Email: 		Surendar R, Durgapriya G, Arthi M, Srikanth S. Quality of life among post - menopausal women in rural Puducherry. Public Health Rev Int J Public Health Res. 2019;6(3):112-118.
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https://publichealth.medresearch.in/index.php/ijphr/article/view/108

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2019-06-04 2019-06-14 2019-06-20 2019-06-24
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© 2019 by Surendar R., Durgapriya G., Arthi M., Srikanth S. and Published by Siddharth Health Research and Social Welfare Society. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Quality of life among post - menopausal

Introduction

According to the World Health Organisation (WHO), it was estimated that in 2030, 1.2 million women will be premenopausal or postmenopausal which will increase by 4.7 million per year [1]. One of the goals of health service for all the people in 21st century is to improve quality of life.

By WHO definition, quality-of- life is the individual’s perception of their status in life according to the culture and value systems the person lives in, considering his goals, expectations, standards and concerns [2].

Menopause is the physiological event in women’s life. It means permanent cessation of menstruation at the end of reproductive life, due to loss of ovarian follicular activity. It is the end point when final menstruation occurs [3].

It is a stage when the menstrual cycles stops for longer than 12 months and there is a drop in the level of oestrogen and progesterone, the two most important hormones in female body. During menopausal transition, there is a lot of fluctuation in hormone levels making the postmenopausal women susceptible to various mental and physical disorders [4, 5].

It is linked with a variety of symptoms which vary in intensity from mild to severe, they include vasomotor symptoms such as hot flushes, night sweats, anxiety, depressive mood, irritability, genital symptoms like dysuria, dyspareunia, recurrent urinary tract infection, vaginal dryness, joint pain and loss of sexual desire.

The nature of symptoms during the menopausal period also varies among the individual. These symptoms have marked impact on menopausal women’s quality of life [6, 7]. There are several scales for rating the quality of life of menopausal women like Menopausal specific Quality of Life scale [MENQOL], Cervantes Scale [CS], Midlife Women’s Symptoms Index [MSI], The Utain Quality of Life [UQOL], Menopause Rating Scale [MRS] [8-12].

Menopausal specific Quality of Life [MENQOL] is used to rule out common post-menopausal symptoms. It has 4 domains - vasomotor, psychosocial, physical and sexual health. Various studies from several countries have indicated that menopause is negatively related to Quality Of Life (QOL) by menopause symptoms based on their severity.

A very little information exists about this in developing countries like India. Thus the present study was undertaken to assess the quality of life among post-menopausal women.

Aims and Objectives

  1. To assess the menopause symptoms and quality of life among menopause women in rural Puducherry.
  2. To study the socio-demographic factors associated with menopausal symptoms and quality of life.

Methodology

Type of study: A community based cross – sectional study

Study setting: Rural field practicing area of a medical college

Study subjects: Postmenopausal women (45 years of age and above)

Duration of study: 6 months, between June and December 2018

Sampling methods: 3 out of 7 villages were randomly selected and the participants were interviewed.

Sample size calculation: Sample size was calculated to be 133 using the formula n = 4pq/l2

Where p = 36.7 % [13], 10% acceptable error, 95% confidence interval.

Inclusion criteria

  1. Women above 45 years of age
  2. Women whose menopause was natural
  3. Women who were residing in the selected rural area more than one year

Exclusion criteria

  1. Women with induced menopause/ undergone hysterectomy/receiving hormonal therapy
  2. Women who were not residing for more than 1 year
  3. Women who were not in their house for successive three visits

Ethical clearance was obtained. Informed written consent was obtained from participants were interviewed using a predesigned, pretested question-naire which contains three parts:

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Part I: Socio demographic profile- Information about socio-demographic details like age, educational level, monthly income and occupational status were recorded.

Part II: Questionnaire on menopausal symptoms- Menopause specific Quality of life Questionnaire [MENQOL] consists of 29 individual items were modified into 25 items and grouped under four domains (Vasomotor, Psychosocial, Physical and Sexual).

Severitywas assessed by 5 point Likert scale which was used in WHOQOL questionnaire.0- no symptoms, 1- Mild, 2- Moderate, 3- severe, 4- Very severe. The reliability of tool was tested by Alpha Cronbach test. Its result was 0.742indicating an accepted reliability of the tool.

Part III: Body Mapping- Body mapping is a powerful tool for provoking perceived health status and for promoting self-assessment in the identification of health issueswhich is easily understandable. It is assessable even for illiterates.

The rationale behind using this tool is to engage the participants to critically appreciate their current symptoms. An outline figure of woman was given to the participant and asked to mark the areas where she experience symptoms after attaining menopause for the past one week. A multiple response symptoms were obtained.

Statistical analysis- The collected data was statistically analysed using SPSS version 23.0. Rate, ratio and proportions were calculated. Chi – square test was applied to find out association between two variables.

Results

Totally 133 willing women who gave consent were interviewed. The mean age was 51± 2 years ranges from45- 68 years. About 45% of study participants were above the age group of 55 years. (Figure 1). About half of the study population (50%) were illiterate and only 5% were educated up to graduate level (Figure 2).

45% were housewives and 81% of them belonged to lower socioeconomic status. About 75.2% were married, 52% had more than three children. About 36.84% attained menopause from 46-50 years of age. Only 2% reported menstrual irregularities. About 32% of them were suffering from any one of the chronic diseases like Diabetes, Hypertension.

public_108_01.jpg

Fig-1: Age wise distribution of participants

public_108_02.jpg

Fig-2: Educational status of participants

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Fig-3: Self-reported body mapping

Prevalence of symptoms among the study participants shows under the vasomotor domain, about 27.1% of the study population reported to have sweating and waking up at night.

Under the psychosocial domain, 34.6% of the study population reported to have forgetfulness. Under the physical domain, joint pain was the commonest with about 79%.

Under the sexual health domain, only 3% of the study participants had reported to have symptoms (dyspareunia and avoiding intimacy) (Table 1). The menopausal women were asked to map their perceived present symptoms in the body image.

The predominant complaints wereBack pain (49.6%) followed by Joint pain (26.1%) and Knee

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pain (16.5%) (Figure 3).

Table-1: Prevalence of menopausal symptoms of participants.

Symptoms Domains Present n (%) Absent n (%)
Hot flush
Vasomotor 		22 (16.5) 111 (83.5)
Night sweats 24 (17.1) 109 (82.9)
Sweating 36 (27.1) 97 (72.9)
Depression

Psychosocial 		34 (25.6) 99 (74.4)
Feeling anxious or nervous 17 (12.8) 116 (87.2)
Experiencing poor memory 46 (34.6) 87 (65.4)
Lack of concentration 36 (27.1) 97 (72.9)
Sleeplessness 41 (30.9) 92 (69.1)
Irritability 22 (24.1) 101 (75.9)
Headache




Physical 		08 (06) 125 (94)
Fatigability 57 (42.9) 76 (57.1)
Urine frequency 29 (21.8) 104 (78.2)
Urinary urgency 17 (12.8) 116 (87.2)
Stress incontinence 10 (07.6) 123 (92.4)
Dysuria 07 (05.3) 126 (94.7)
Burning micturition 23 (17.3) 110 (82.7)
Body ache 102 (76.7) 31 (23.3)
Joint pain 106 (79.2) 27 (20.8)
Back ache 104 (78.1) 29 (21.9)
Dry skin 11 (08.3) 122 (91.7)
Feeling bloated 20 (15) 113 (85)
Flatulence or Gas pain 21 (15.8) 112 (84.2)
Vaginal dryness
Sexual 		04 (03) 129 (97)
Avoiding intimacy 04 (03) 129 (97)
Reduced sexual desire 03 (02.3) 130 (97.7)

Table-2: Association of menopausal age with severity of symptoms.

Age in years No n= 64 Mild n=35 Moderate n=20 Severe n=14 Fisher’s exact test p value
Vasomotor
<41 years 5 2 1 0

17.792

0.03
41-50 years 14 8 6 3
51-55 years 38 15 8 3
>55 years 7 10 5 8
Psychosocial
<41 years 6 2 0 0

25.914

0.002
41-50 years 17 9 5 0
51-55 years 13 16 9 2
>55 years 28 6 12 12
Physical
<41 years 9 3 0 0 5.70 0.769
41-50 years 10 6 4 2    
51-55 years 21 12 7 5
>55 years 24 14 9 7
Sexual
<41 years 3 2 3 0
14.72
0.09
41-50 years 12 6 8 5
51-55 years 24 12 1 5
>55 years 25 18 9 4

Table-3: Correlation analysis of four domains of menopausal symptoms

Domains R Sig.
Vasomotor vs Psychosocial 0.355** < 0.01
Vasomotor vs Physical 0.454** < 0.01
Physical vs Psychosocial 0.651** < 0.01
Sexual vs Psychosocial 0.191* 0.028

** Correlation is significant at the 0.01 level (2-tailed). * Correlation is significant at the 0.05 level (2-tailed).

Overall, out of 133 participants, about sixty four had no menopausal symptoms followed by 35 with mild, 20 had moderate menopausal symptoms and none of the participants had very severe menopausal symptoms.

Association of age of menopause with the severity of menopausal symptoms in four domains shows significant association in all domains except Physical (Table 2).

Also, there was a positive correlation among the three domains of menopausal symptoms (vasomotor vs Psychosocial, Vasomotor vs Physical, Psychosocial and Physical) (p-value < 0.01). Sexual symptoms were positively correlated with Psychosocial (p value < 0.05). (Table 3)

Discussion

In the current study, mean age of the study population was found to be 51±2 years with half of them were illiterate which was lower than the study by Borker et al and Sarkar et al. in Jamnagar, Bansal et al. in Punjab where the mean age was 57 years with 67% illiterate [13-15].

In the current study, most prevalent symptoms reported were joint pain followed by backache. This is similar to the study done by Poomala and Arounasalane in Puducherry (low back ache - 79% and muscle joint pain - 77.2%).

Sagdeo in a comparative study showed that most common symptoms were joint and muscular symptoms followed by hot flushes and night sweats

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which is similar to the present study [16]. Only 3% of the study participants had dyspareunia and avoiding intimacy which was similar to the study done by Poomala GK et al and Nisar et al [17, 18].

In a study done by Vijayalakshmi et al among peri- and post-menopausal women in rural areas of Amritsar using menopausal rating scale reported that most prevalent symptoms were feeling tired (92.90%), headache (88.8%), joint and muscular discomfort (76.20%), physical and mental exhaustion (60.1%), sleeplessness (54.40%) [19].

From the present study, there is a need to create awareness among the postmenopausal women about the physiology of menopause by which they can improve their quality of life. Early the awareness will reduce the severity of the symptoms.

The present study shows that postmenopausal women in rural area of Puducherry suffer from various symptoms, physical as well as vasomotor related to menopausal changes with varied frequencies, depending upon their demographic features.

These women should be addressed separately. Due to the increasing burden of life style diseases, there is a need to educate them to improve quality of life by style modifications.

Conclusion

In the current study higher prevalence of menopausal symptom was observed. Joint pain and back ache were the most common complaints plotted on body mapping by the subjects. There was significant association between symptoms and menopausal age. Positive correlations were seen among the menopausal symptom domains. Education, creating awareness and providing suitable intervention to improve the QOL are important to address the social and medical issues.

What this study adds to existing knowledge

The study had highlighted the prevalence of major symptoms among post-menopausal women. The study highlights the importance by marking themselves on body mapping.

Author’s contribution

First author (SR): Concepts, Design, Literature search, Data analysis, Statistical analysis,

Manuscript preparation, Manuscript editing. Second author (DG): Data collection, entry and coding Corresponding author (AM): Concepts, Design, Data acquisition, Data analysis, Manuscript preparation, Manuscript editing. All authors discussed the results and contributed to the final manuscript.

Acknowledgements

Authors express their sincere and heart full gratitude to the opportunity and support provided by the Dean of Sri Venkateshwaraa Medical College Hospital and research centre, Puducherry.

Authors are extremely thankful for the support provided by our faculties and staffs of rural field practising area of Department of Community Medicine.

Authors would like to extend thanks to all the participants for their cooperation, without whom this study would not have been possible.

Limitations

There may be chances of recall bias. Due to lack of time in-depth discussions and Focus Group Discussion (FGD) cannot be done.

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