https://doi.org/10.33698/NRF0240-Kamlesh Kumara Mishra, Swati,Sarvjeet Kaur
Abstract: Background: The menopause is unspoken aspect of a women’s life and the majority of health issues begins with menopause in a women’s life. Average age of menopause is 47.5 years in Indian women with an average life expectancy of 71 years. The health issues related to menopause are increasing among women of menopausal age as the life expectancy is increasing along with better advanced medical care. Objectives: 1) To assess the knowledge of menopausal women regarding menopausal symptoms. 2) To assess management strategies adopted by menopausal women. Material and methods: A cross sectional study was conducted among 50 women of Alambagh area of Lucknow aged between 40-55 years and had attained menopause. The samples were selected by two stage sampling technique and data was collected by using structured questionnaire and 16 point scale to assess the self reported management of the respondents. Result: The ndings of study revealed the mean age of menopause to be ± 44.8 years. Majority (68%) had poor knowledge regarding menopausal symptoms. It was also found out that major source of information regarding menopausal symptoms were family members and the most common menopausal symptoms were joint pain (56%), hot ashes (48%), insomnia (44%) and low mood (40%). It was also seen that 98% of the respondents who had menopausal symptoms had adopted some management for the symptoms and the most frequently used management was pharmacological management(56%) and others management strategies (48%) like massaging, hot fermentation, cold sponging, applying balm etc. Signicantly lesser symptoms were reported by women who had attained early menarche, late menopause and consuming vegetarian diet. Conclusion: This study brought out that 68% of women in menopausal age group had knowledge decit. The study also brought out that 68 % women regarded cause of menopausal symptoms to be supernatural like God created and illnesses like less Hb and long-term effect of child birth. The alarming nding was that maximum respondents had adopted pharmacological management with 56% of respondents resorting to over the counter drugs for different symptoms. Recommendations: The community health nurse working in community centers in various capacities can play important role in imparting knowledge regarding menopause to women of community
Keywords: Menopause, menopausal symptoms, knowledge, management strategies
Correspondence at-
Lt Col Sarvjeet Kaur,
Professor, College of Nursing Command Hospital Lucknow
Introduction
Almost from the beginning of scientic era, early philosophers and scientists tried to explain why a woman eventually became amenorrhoeic and sterile whereas fertility apparently continued unabated in the older male. Indeed, the rst known references to menopause date back to biblical and pre- biblical writings. Menopause as a life event was recognized far back in history. Aristotle (384-322 B.C.) noted menstruation to cease at the age of 40 years and references to the cessation of the age of fertility are found in the literature over the next 2000 years.1
The term ‘menopause’ is constituted by two Greek words men-month and has already crossed the 1 billion mark with 71 million people over 60 years of age and the number of menopausal women about 43 million. Projected gures in 2026 have estimated the population in India will be 1.4 billion, people over 60 years 173 million, and the menopausal population 103 million. With the transition of life to ageing, menopause brings many changes in a woman’s body.6 As the estrogen level decreases in the body, it starts its mechanism to cope up with these changes. The hormone changes in the woman’s body causes many symptoms and these symptoms are hot ashes, night sweats, mood swings, joint pain, headache, excessive crying, insomnia, dyspareunia, frequent micturition, vaginal dryness etc.7 There are about 37.5 million women reaching or currently at menopause worldwide. The average age of menopause is 51 years; however there is a wide age distribution that ranges from 40 years to 58 pauses-stop. It was rst utilized to describe years. 8 Every women experiences the cessation of menstruation, although. Climacteric also appears to be of Greek derivation representing the word for ‘ladder’ or ‘steps of a ladder’ (Utian, 1977).2,3
Menopause is dened as the time when there have been no menstrual periods for 12 consecutive months and no other biological or physiological cause can be identied. It is the end of fertility, the end of the childbearing years. (A woman may still, however, be able to become pregnant unless 12 consecutive months have passed without a period.)4,5
India has a large population, which menopause differently and their way of dealing with menopause and menopausal symptoms is different. It is important to know the kind of menopausal problems experienced by women and management strategies so that community health nurses and other health care professional in the community can help them accordingly.
Objectives:
- To a s s e s s t h e k n o w l e d g e o f menopausal women regarding menopausal
- To assess management strategies adopted by menopausal
Methodology:
The research design used in this research study was cross sectional descriptive design. Two stage sampling technique was used in the study. In the rst stage, Stratied sampling was done and two strata were selected and in second stage proportionate sample was selected from two strata i.e. 76% of subjects were drawn from one & 24% from other stratum. Total 50 women who have attained menopause and of age 40-55 years were selected. Where 76% (38) subjects were taken from one stratum of community & 24% (12) from another stratum of community. Interview Schedule developed and validated by expert in the eld of nursing gynaecology. The interview schedule included section A :socio demographic prole, section B: questions related to gynaecological history which includes age of menarche, parity, age of menopause and duration of irregular bleeding. Section C: questions related to knowledge of women regarding menopausal symptoms which include knowledge questions like denition of menopause, causes, common age of menopause, common health issues related to menopause and common symptoms that occurred in a woman during menopause. Section D was a validated scale to assess the occurrence of menopausal symptoms & self-reported management strategies of women. In that each respondent who had menopausal symptoms were asked about the management strategies for each menopausal symptom. Reliability of tool was established by test retest method by administering to 10 women.
Ethical clearance of research proposal was put to obtained from ethical committee of the Hospital. Permission for data collection was obtained from MOI/C Urban Health Centre in May 2018. Data was collected by face to face interview at their home setting. Data was analysed by using descriptive and analytical statistics.
Results
Total fty (50) women who had attained menopause and were of age group 40-55years were included in the study. The demographic data revealed that out of 50 respondents, 9 (18%) were in the age group of 41-45 years, 13 (26%) were in the age group of 46-50 years and 28 (56%) were in 51-55 years of age group. Majority of respondents were married (72 %) and 14 (28%) were widowed. There were 25 (50%) participants from nuclear families & 25 (50%) from joint families. It was also seen that 28(56%) were vegetarians and 22 (44%) were non-vegetarians. Nearly half of respondents (44%) were educated till intermediate, 17 (34%) were graduate and 11(22%) were illiterate.
Data on menstrual history of women revealed that out of 50 women, 7(14%) had attained menarche at the age of 10-12 years, 29(58%) at 13-15years, 7(14%) at 16-17 years and 8(16%) were not knowing their age of menarche. Table 2 also shows the parity of women. Out of 50 women 30(60%) had more than 3 children and 18(36%) had one to two children and only 2(4%) were nulli para. It also shows age of menopause where maximum respondents 38(76%) had attained menopause at 41-45 years and 12 (24%) at 46-50 years. Mean menopausal age was 44.8 years.
Knowledge of women regarding menopause, its related problems and symptoms-
Table 1 depicts the knowledge of women regarding menopause. Most of women (80%) knew that menstruation is stoppage of menstruation (amenorrhea) for twelve consecutive months without any other pathology. Almost all (94%) knew about the age of menstruation and 32% knew that the cause of menopausal symptoms is hormonal. They were aware of health problems associated with menopause such as bone problems (54%), Increased body weight (54%) and urine problems (36%).
Table 1: Knowledge of women regarding menopause, its related problems and symptoms
n=50
| S.No. | Questions | No of subjects answered correct
f (%) |
| 1. | Menopause is stoppage of menstruation (amenorrhea) for twelve
consecutive months without any other pathology. |
40(80) |
| 2. | The age of menopause is 40-50 years | 47(94) |
| 3. | The cause of menopausal symptoms is hormonal | 16(32) |
| 4.
a). |
The health problems associated with menopause
Bone problem |
27(54) |
| b) | Increased body weight | 27(54) |
| c) | Urine problems | 18(36) |
| 5 | The common symptoms associated with menopause |
22(44) 20(40) 18(36) 28(56) 6(12) 9(18) 13(26) 6(12) 13(26) 10(20) 5(10) 21(42) |
| a). | Hot ushes | |
| b) | Low mood | |
| c) | Insomnia | |
| d) | Joint pain | |
| e) | Night sweats | |
| f) | Headache | |
| g) | Frequent urination | |
| h) | Painful urination | |
| i) | Vaginal dryness/itching/burning | |
| j) | Painful sex | |
| k) | Chest pain | |
| l) | Palpitation |
They had knowledge about common symptoms such as Hot ushes(44%), Low mood (40%), Insomnia(36%), Joint pain (6%), night sweats(12%), Headache (18%), Frequent urination (26%), Painful urination (12%), Vaginal dryness/itching/burning (26%), Painful sex(20%), Chest pain (10%), Palpitation (42%)
Source of information regarding
menopausal symptoms
The source of information regarding menopause of 29 (58%) women was family whereas 14 (28%) got knowledge from books & media and 7(14%) reported health care workers as source of information
Prevalence of symptoms among women-
The study revealed that out of 50 women, 48(84%) have reported menopausal symptoms and only 8 (16%) did not have any symptoms related to menopause. Fig 4 depicts the type of symptoms reported i.e. most prevalent symptoms among respondents were Joint pain (56%), hot ush (48%) , Insomnia (44%) , Palpitation (42%) , Low mood ( 40%). The other prevalent symptoms were headache (28%) frequent urination (20%) , vaginal dryness (26%), painful sex (20%) , night sweats (12%) , painful urination (12%) and chest pain (10%).
Association of menopausal symptoms with sociodemographic variables
Table 4 depicts the relation between menopausal symptoms and select sociodemographic variables. It shows that vegetarian diet has relation with
Table 4: Relationship between menopausal symptoms with selected sociodemographic variables
n=50
| Demography | Respondents with complaints of >4 Symptoms
(multiple symptoms) |
Respondents with complaints of < 4 Symptoms
(few symptoms) |
χ2 (df) p-value |
| Age 41-45
46-50 51-55 |
4 (44 )
4 (31) 8 (29) |
5(56)
9( 69) 20(71) |
1.23 (2)0.11
NS |
| Marital Status Married
Widow |
12 ( 33)
5 ( 36) |
24( 67)
9( 64) |
3.26 (1)
0.09 NS |
| Family Type
Nuclear Joint |
7 (28)
9 (36) |
18(72)
16(64) |
1.11(1)0.13
NS |
| Diet
Veg N/Veg |
7( 25)
9 (41) |
21(75)
13(59) |
6.56 (1)
<0.02 |
| Occupation
housewife Working |
9 ( 36)
8 (32) |
16( 64)
17(68 ) |
3.11(1)
0.08 NS |
| Education Illiterate 5-12
Graduate & above |
2 (18)
8 (36) 6 (35) |
9(82 )
14( 64) 11(65) |
7.56 (2)
<0.002 |
Data in parenthesis denotes percentage menopausal symptoms 75% respondents had less than 4 symptoms where only 59% non vegetarian had less than four menopausal symptoms and i t was statistically signicant (χ2 = 6.56 & p<0.02). It also depicts that more the education more the symptoms 35% graduates had more than four symptoms where illiterate only 18% had more than four symptoms. This was also statistically signicant (p<0.02). No difference was observed in other variables such as Age, marital status, type of family and occupation with menopausal symptoms.
Association of menopausal symptoms with menstrual history
Table 5 shows relation between menstrual data and menopausal symptoms. It depicts that the number of symptoms signicantly increased with the increase in age of menarche (p<0.001 as per chi square test).
Table5: Association of menopausal symptoms with menstrual history
| Variable | Respondents with >4 symptoms
f(%) |
Respondents with <4 symptoms
f(%) |
p-value(df)
χ2 |
| Age of menarche
10-12 yrs 13-15 yrs 16-17 yrs Don’t Know |
2 (29)
11 (38) 3 (43) 1 (13) |
5 (71)
18 (62) 4 (57) 7 (87) |
0.001* (3)
12.56 |
| Age of periods stopped 41-45 yrs
46-50 yrs |
13 (34)
3 (25) |
25 (66)
9 (75) |
0.03* (1)
9.15 |
Data in parenthesis denotes percentage It also shows that signicantly higher percentage of women with earlier the age of menopause(41-45years) had more than four symptoms as compared to women with late age of menopause (46-50 years) (p<0.03 as per chi sqare test)
The above table 7 explains the different management strategies adopted by women who had menopausal symptoms. Women managed their problems by some or other physical measures such as Yoga (24%), Exercise (26%), diet( 16%), wearing loose clothes(28%), frequent bathing (30%) and drinking lot of water( 40 %). The psychological management practiced by women were sharing with family (18%), prayers (42%), went to calm place (36%) and kept busy(18%). Most of the women practiced pharmacological management either allopathic (56%) or ayurvedic (20%).
Table 7 : Type of management strategies used by women
n= 50
| Management strategies | f(%) |
| Physical management
1. Yoga 2. Exercise 3. Diet 4. Wearing loose clothes 5. Frequent bathing 6. Drink lots of water |
12 ( 24) 13 (26) 8 (16) 14 (28) 15 (30) 20 (40) |
| Psychological management
1. Sharing with family 2. Prayers 3. Went to calm place 4. Kept busy |
9 (18) 21 (42) 18 (36) 9 (18) |
| Pharmacological management
1. Took Hormone replacement therapy 2. Allopathic Medicine 3. Ayurveda |
– 28 (56) 10 (20) |
Data in parenthesis denotes percentage
Discussion
Menopausal health demands priority in Indian scenario, reason being rise in population of post-menopausal women. India has a large population, which has already crossed the 1 billion mark with 71 million people over 60 years of age and the number of menopausal women about 43 million. Projected gures in 2026 have estimated the population in India will be 1.4 billion, people over 60 years 173 million, and the menopausal population 103 million. Average age of menopause is 47.5 years in Indian women with an average life expectancy of 71 years. So the need to work on menopausal health is much more.
This study brought out knowledge of women regarding menopause and menopausal symptoms and relationship of m e n o p a u s a l s y m p t o m s w i t h sociodemographic variables. Mean age of menopause in the study population was 44.8 years which is similar to mean age 46.24 years reported by a study conducted by Singh A et.al in New Delhi (2014) and 44.82 years reported by Satpathi M (2016).10,11
It was found out that 32 % of respondents attributed menopausal symptoms to be because of hormonal changes In the study 84% had menopausal symptoms .This resembles to study done in Tamil Nadu by Ganitha G et al where 87% respondent suffered with symptoms related to menopause.12
The study also revealed that most prevalent symptoms were joint pain, insomnia and hot ash. The ndings were supported by Lt Col Geetha et.al (2013). The study also showed that dietary pattern had effect on menopausal symptoms. The respondents consuming vegetarian diet had fewer symptoms as compared to those consuming non-vegetarian diet. 25% respondents with vegetarian diet had more than four menopausal symptoms where as 41% non-vegetarian had more than four menopausal symptoms. Similar ndings were reported in present study i.e. signicantly fewer symptoms were reported by vegetarian (75%) as compare to non-vegetarian (59%).13
Further, as education status increased the number of menopausal complaints increased. The respondents having educational status as graduation and above had reported more complaints related to menopause as compare to illiterates. The reason for this could be that illiterate women may have had very poor knowledge regarding menopause symptoms and may have failed to identify and associate symptoms with menopause. On further evaluation it was seen that the women who attained early menopause (41-45 years) had reported more symptoms as compared to those who attained late menopause (46-50 years). This study also brought out that the women who had late menarche had reported more menopausal symptoms as compare to the women who had early menarche had reported lesser symptoms.
The study also brought out that there is need that health care workers should focus their attention in this eld as only 14% women had obtained information from health workers regarding menopause, its symptoms and management. It was also found that very little information on this common problem was taken from books and media i.e. 28% ; where the major(58%) source of information were female members of the respondents families. These results were similar to the ndings of study done at Nigeria by Ibraheem et.al
In India, many health programs have been l aunched for the women in reproductive age groups, but the post reproductive age of women remains neglected as there are no health programs that caters the post reproductive health needs of the women. The current study concluded that the prevalence of menopausal symptoms is high (84%) a m o n g w o m e n . T h e r e a r e m a n y misunderstandings about menopausal cause and symptoms among women. The community health nurse working in community in various capacities can play important role in imparting knowledge regarding menopause to women. The roles of community health nurse in educating the menopausal women can be related prevention, early diagnosis & health education for promotion of health- healthy life style and healthy practices related to menopause to the women and for encouraging healthy management strategies for menopausal symptoms. It is necessary to assess health needs of postmenopausal women and this can be incorporated in the National Heath Program. Further research studies can be conducted to assess the severity of s y m p t o m s a n d e f f e c t i v e n e s s o f management strategies. IEC should focus on developing more educational material like videos, pamphlets etc. for display in various health centers both in rural and urban community. Community health nurses along with other members of health team should participate in making educational media more effective to combat the huge knowledge decit regarding menopause.
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