Effect of Postmenopausal Symptoms on Health-related Quality of Life among Women Residing in Rural Areas of Central Gujarat and Saurashtra: A Cross-sectional Study
Correspondence Address :
Bhoomi Manishkumar Bavda,
Student, M.Sc. Nursing (OBG), Manikaka Topawala Institute of Nursing,
Anand, Gujarat, India.
Introduction: Menopause means permanent cessation of menstruation at the end of reproductive life. With the increase in life expectancy, women spend one-third of their life in menopausal period. Menopausal women face problems like hot flushes, feeling accomplished, poor memory, tiredness, joint pain, weak physical strength, lack of energy, avoiding intimacy, and vaginal dryness. Due to these the physical, psychosocial, and sexual health-related aspects get deteriorated.
Aim: To assess the effect of postmenopausal symptoms on health-related quality of life among women.
Materials and Methods: A cross-sectional research design was used, and 168 postmenopausal women, were selected following home visits at selected rural areas of Central Gujarat and Saurashtra, India. Women in the age group of 40-60 years, who had completed seven years of natural menopausal period were eligible for the study. The Menopause Specific Quality of Life Questionnaire was used and statistical analysis was done using Statistical Package for Social Sciences (SPSS) Version 20.0.
Results: Mean age of the postmenopausal women was 76.93 years. The majority 85 (50.6%) had completed their primary education. The most commonly found postmenopausal symptoms were feeling tired 153 (91.07%), loss of physical strength 153 (91.07%), and lack of energy 153 (91.07%). The mean score for vasomotor domain was 5.34±1.91, sexual domain 4.31±1.69, psychosocial domain 4.07±1.44, and physical domain was 3.85±1.10. The majority of the postmenopausal symptoms were related to the vasomotor domain.
Conclusion: The present study findings concluded that all domains’ symptoms negatively impacted a women’s quality of life.The majorly affected domain was vasomotor, while least affected was physical domain.
Menopause specific quality of life questionnaire, Menopausal symptoms, Postmenopausal women
The mid-forties, practically all women, regardless of their cultural background or health status, begin to encounter physical, psychological, and emotional problems. Those upheavals correspond with a gradual drop in female hormones, oestrogen and progesterone, culminating in the ovaries’ complete closure, a condition known as menopause (1).
Menopausal women will number 1.2 billion by 2030, up from 467 million in 1990. Between 1990 and 2030, the number of postmenopausal women in the developing countries will quadruple. Postmenopausal women’s proportion of the overall population will similarly rise, from 9% in 1990 to 14% in 2030, but this figure will eventually rise considerably higher, as developed-world proportions of over 20% in 2030 are reached globally. Nearly 2.5 million women would enter menopause every year in the 1990s, with that number expected to rise to 47 million by the 2020s (2).
Each year, roughly 1.3 million women in the United States reach menopause. Menopause usually begins between the ages of 51 and 52 years. However, between the ages of 40 and 45, roughly 5% of women experience early menopause. Furthermore, 1% of women reach menopause early, before the age of 40, due to persistent ovarian failure, which may be linked to sex genetic abnormalities (3).
According to a research, age-adjusted mortality falls by 2%, whereas the risk of uterine/ovarian cancer rises by 5% with each year of menopause (4). As a result, investigating the numerous factors that influence menopausal age in Indian women is of utmost clinical advantage.
Women have a hard time adequately characterising physical, psychosocial, or sexual abnormalities during this time. They typically feature hot flushes, anxiety, anger/irritability, insomnia, and general exhaustion. These symptoms steadily deteriorate women’s health and, as a result, their quality of life (QOL) on a daily basis (1),(3). Vasomotor symptoms affect roughly 75% of women.
Many policies and programmes are available in India for newborns, children, women, geriatrics, adolescents, and pregnant women, but there isn’t a single policy or programme for middle-aged or elderly women going through menopause through which they can receive services. Studies, that focus at the impact of postmenopausal symptoms on health-related quality of life, on the needs of menopausal women are limited in rural areas of Gujarat. As a result, the present researchers decided to undertake a study to determine the intensity of menopausal symptoms as well as their impact on overall health. Furthermore, the study findings will help policy makers recognise the need of including postmenopausal women in various health plans to improve health status.The primary aim was to see how the menopausal symptoms influenced health-related quality of life.
This cross-sectional study was conducted on postmenopausal women at Manikaka Topawala Institute of Nursing, Charusat-Changa. The study was conducted from March 2020 to July 2021. Total 168 women were recruited from five regions of Central Gujarat (Change, Tarapur) and Saurashtra (Mathak, Devadiya, Charadva) rural areas. IEC approval was obtained from Manikaka Topawala Institute of Nursing, Charusat, Changa (letter number CHA/IEC/ADM/21/02/105). Formal administrative permission was obtained from the concerned authorities of Primary Health Centre, and Community Health Centre.
Sample size calculation: The sample size was estimated based on a pilot study conducted among 30 postmenopausal women. Formula used for sample size calculation:
SD2=standard deviation square
L2=allowable error square
Inclusion criteria: Women who had attained natural menopause with a postmenopausal period of a minimum of seven years were included.
Exclusion criteria: Women who were receiving hormonal therapy, women who underwent hysterectomy, presence of medical conditions like diabetes mellitus, hypertension, cardiac disease, venous embolism, thyroid diseases, women involved in the medical and paramedical profession, and have undergone any reproductive tract obliteration-related surgeries were excluded.
The women were selected using non probability consecutive sampling techniques. For data collection, a structured tool was used which was divided into three sections:
Section A (Socio-demographic variables): This included age, educational level, employment status, household income, diet, religion, types of family, marital status, number of children, duration since menopause attained in years.
Section B (Obstetric variables): Included obstetrical history, mode of last delivery, history of abortion, menstrual history included.
Section C (Menopausal related quality of life 1-month tool): The tool (MANQOL) has four domains, viz., vasomotor domain, psychological domain, physical domain, and sexual domain (5).
The investigator obtained list of postmenopausal women from Female Health Worker (FHW) and Accredited Social Health Activist (ASHA) of selected rural areas. Further, each participant who met the inclusion and exclusion criteria was contacted in person by the researcher through home visits. The purpose of the study was described to them as well a participant information sheet was given. On agreement of the participant’s informed written consent data collection was done, with the help and presence of FHW or ASHA workers. Proper guidelines of COVID-19 preventive measures as prescribed and reviewed by the government were followed.
Statistical analysis was done using SPSS software version 20.0. Frequency and percentage were used for demographic and obstetrical variables and also for prevalence for specific postmenopausal symptoms. Mean and standard deviation were calculated for each postmenopausal symptom and for each domain.
The demographic data and the number of women experiencing symptoms are shown in (Table/Fig 1), (Table/Fig 2). The top five symptoms were sweating (5.49±2.06), hot flushes and flashes (5.42±2.17), night sweats (5.11±1.96), avoiding intimacy (4.88±2.05), feeling anxious or nervous (4.40±2.04), respectively in (Table/Fig 3).
The (Table/Fig 4) depicts the mean scores of postmenopausal symptoms where most commonly affected domain was vasomotor domain (5.34±1.91) and least affected was physical (3.85±1.10).
The aim of the present study was to see how the postmenopausal symptoms affected women’s health-related quality of life. The study found that postmenopausal symptoms have a detrimental impact on women’s health-related quality of life in rural parts of Gujarat’s Central and Saurashtra regions. The Menopausal Related Quality of Life tool was used. According to the findings, the study population experienced symptoms majorly in the vasomotor and sexual domains.
The (Table/Fig 5) (6),(7),(8),(9),(10),(11),(12),(13),(14),(15),(16) shows that majority of the researches had used MANQOL tool to assess postmenopausal symptoms. The average sample size was above 100 and a larger group of postmenopausal women were 45-50 years old. Those women who were illiterate suffered physical symptoms. Few studies reported that rural women suffered more vasomotor and sexual domain symptoms compared to urban area. The studies report that majority of these women feel tired, have ache in muscles and back, suffer from decreased physical strength, have poor memory, have vaginal dryness and avoid intimacy.
The present research study is limited to a particular sample population, and the outcomes may not be generalised.
The study concluded that the postmenopausal women had a reduced quality of life. The main reason for deteriorated quality of life is due to lack of awareness and inappropriate follow-up. A comparative study need to be conducted among perimenopausal women and postmenopausal women, or compare rural vs urban women.
There is a need to develop an educational and training module for postmenopausal women in order to improve their quality of life or design a structured counselling session to provide coping mechanism. The present research finding could be used for effective policy making and development of programs regarding welfare of postmenopausal women.
Date of Submission: Jan 05, 2022
Date of Peer Review: Feb 01, 2022
Date of Acceptance: Jun 20, 2022
Date of Publishing: Nov 01, 2022
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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