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Table of Contents
RESEARCH ARTICLE
Year : 2021  |  Volume : 22  |  Issue : 1  |  Page : 53-56

Post-menopausal symptoms: Reports from urban women


Professor & Vice Principal, SGRD College of Nursing, Sri Guru Ram Das University of Health Sciences, Amritsar, Punjab, India

Date of Submission11-Jun-2020
Date of Decision08-Jan-2021
Date of Acceptance05-Feb-2021
Date of Web Publication07-Jul-2021

Correspondence Address:
Dr. Manpreet Kaur
SGRD College of Nursing, SGRDUHS, Vallah, Amritsar, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCN.IJCN_54_20

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  Abstract 


Menopause is a universal occurrence. Menopause refers to that time when woman's periods stop and her ovaries lose their reproductive function. Usually, this occurs between the age group of 45 and 55 years. A descriptive study was undertaken on post-menopausal symptoms among women in the selected urban community, Amritsar. This study included 100 post-menopausal women who were recruited by the convenient sampling technique. Tools for the data collection consisted of socio-demographic profile and the Standardised Women Health Questionnaire related to post-menopausal symptoms. The findings revealed that the mean age of post-menopausal women in the study was 64.13 ± 8.92 years, whereas the mean age at menopause was 47.11 ± 3.66 years. Majority (80%) of post-menopausal women had backache, followed by 76% had loss of appetite, 71% reported restlessness, 68% had difficulty in getting to sleep, and 64% felt miserable and sad. The findings of the study reveal that more than half (52%) of post-menopausal women were not able to cope up with symptoms and 43% agreed to have overall good quality of life. A large proportion of post-menopausal women also reported loss of appetite, loss of interest in things, dizzy spells, headache and poor memory. A larger study is required to generalise the findings.

Keywords: Menopause, post-menopausal symptoms, women


How to cite this article:
Kaur M. Post-menopausal symptoms: Reports from urban women. Indian J Cont Nsg Edn 2021;22:53-6

How to cite this URL:
Kaur M. Post-menopausal symptoms: Reports from urban women. Indian J Cont Nsg Edn [serial online] 2021 [cited 2021 Jul 26];22:53-6. Available from: https://www.ijcne.org/text.asp?2021/22/1/53/320826




  Introduction Top


For women, the middle years constitute the biologic phase in a life cycle during which an inevitable and irreversible decline in ovarian hormones occurs that culminates the cessation of menopause. For many women, this natural process is a time of anxiety and distress due to the various symptoms that can accompany it.[1]

Menopause is a universal occurrence. Menopause refers to that time, in woman's life when her periods stop and her ovaries lose their reproductive function. Usually, this occurs between the age group of 45 and 55 years. In 1990, there were about 467 million postmenopausal women worldwide, and this figure is expected to rise to 1200 million by 2030. Out of these, 76% will be living in the developing countries.[2],[3] Mahajan et al. conducted a study to evaluate the age of menopause and its symptoms among Himachali middle-aged women and found that the mean age of menopause was 44.54 years. The reported symptoms were fatigue (80%), hot flushes (75%), osteoporosis (75%), sleep disturbance (40%–60%), vaginal dryness (22%–30%), night sweats (17%) and weight gain (12%).[4]

It was also observed during routine home visits in the community that menopausal women experience hot flushes, irritability, night sweating, mood swings and joint pain. Some of these symptoms go unnoticed, and at certain times, women are not able to correlate these symptoms with menopause. The investigators, therefore, were interested to quantify the post-menopausal symptoms of women in our field practice area. This study will lead to the generation of empirical data which will be further helpful in taking evidence-based actions on helping post-menopausal women to cope with their health problems.


  Methods Top


The study design was descriptive and was carried out in the Urban filed practice area of a College of Nursing, Amritsar. The target population of the study included post-menopausal women residing in selected area. The study was conducted upon 100 conveniently selected post-menopausal women due to limited time for the data collection. Women with at least 1 year of amenorrhea and those who had attained natural menopause in the last 5 years were included in the study.

A demographic profile form and the Women Health Questionnaire on post-menopausal symptoms (WHQ) (Professor Myra Hunter, King's College London, UK)[5] were used as data collection tools. Socio-demographic profile included questions related to age, educational status, occupational status, family income, recent living pattern, marital status and age at menopause. The WHQ was designed to assess symptom perceptions during the menopause transition and for older post-menopausal women. It consists of 37 questions or statements about the health problem of menopausal women such as depressed mood (7), somatic symptoms (7), memory/concentration (3), vasomotor symptoms (2), anxiety/fear (4), sexual behaviour (3), sleep problem (3), menstrual symptoms (4) and attractiveness (2).

The tool also included two questions related to ability to cope with menstrual symptoms and overall quality of life (QOL). Provisional multitrait analysis suggests that the internal reliability of the subscales is reasonable. Cronbach alpha levels were as follows: Depressed mood (0.7), anxiety (0.77), somatic symptoms (0.76), vasomotor symptoms (0.84), sleep problems (0.73), for menstrual problems and sexual problems the coefficients were lower, being 0.64 and 0.59, respectively.[5] The items were ranked based on the frequency of their prevalence in each category. The data were collected by interviewing the women in their households assuring their confidentiality and anonymity. Data were coded and presented in tables and graphs by using ranks and frequency distribution.


  Results Top


The mean age of postmenopausal women was 64.13 ± 8.92 years, 53% had studied up to matriculation and only 18% were engaged in salaried occupation. The mean age at menopause was 47.11 ± 3.66 years.

[Table 1] reveals that regarding symptoms related to depressed mood, three fourth (76%) of post-menopausal women had loss of appetite followed by 67% women felt that they did not had sense of well-being, 64% felt miserable and sad. Nearly 60% felt that they are not enjoying the things earlier they used to followed by 58% lost interest in things, whereas 54% had become more irritable than usual and 44% thought that life is not worth living. Regarding somatic symptoms, majority (80%) of the post-menopausal women reported backache or pain in limbs, 70% felt more tired than usual, had headache (63%) and 62% had urinary urgency as predominant symptoms observed in post-menopausal women followed by some other symptoms such as felt sick or nauseous 54%, had dizzy spells 50% and 45% women often noticed pins and needles in hands and feet.
Table 1: Ranking of post-menopausal symptoms related to categories

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Ranking of post-menopausal symptoms related to memory/concentration reveals that most of the women had poor memory (65%), 53% reported difficult in concentration followed by 34%, became clumsier than usual. Regarding vasomotor symptoms, occurrence of hot flushes (48%) was high in post-menopausal women which was followed by night sweats (42%).

About anxiety/fear, 67% women felt tensed, 53% felt sensation of butterflies or palpitation in stomach followed by 49% women complained that they became more frightened or had panic feeling without any reason and 44% felt anxious when they go out of house. Related to sexual life, more than half (64%) women were not satisfied with their current sexual relationship. Some women complained about loss of interest in sexual activity, whereas 56% women said that they had uncomfortable intercourse due to vaginal dryness.

Ranking of post-menopausal symptoms related to sleep depict that majority (82%) of the women wake early and slept badly for rest of night, 71% women had restlessness and 68% had difficulty in getting off to sleep. In context of menstrual symptoms, the prevalence of bloating in stomach (53%), abdominal cramp (45%) and 22% breast tenderness was found in women after menopause while very few (3%) of the post-menopausal women had heavy periods. While ranking of post-menopausal symptoms related to attractiveness reveals that 56% of women felt neither lively nor excitable after attaining menopause while 48% of women reveal that they were not physically attractive.

[Figure 1] reveals that majority (52%) of post-menopausal women were not able to cope up with symptoms.
Figure 1: Percentage distribution regarding the ability to cope up with post-menopausal symptoms

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[Figure 2] reveals that nearly half (57%) of the post-menopausal women reported to having bad QOL and 43% reported to have good quality of life.
Figure 2: Percentage distribution of quality of life of post-menopausal women

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  Discussion Top


Menopause has emerged as a prominent issue in the woman's health. The present study was an attempt to study the post-menopausal symptoms experienced by urban woman in a selected locality. The mean age at menopause in this group was reported as 47 years which is similar to a Turkish study in which the mean age of menopause was found to be 46.5 years.[6] Mean age of menopause was lower (44.5 years) in a study on women in Northern India[4] and was similar (48.7) in a study from South India.[7] It can be concluded that the general age of menopause for Indian women was between 44 and 49 years. A wide range in age of menopause (40–49 years) is also discussed in another study.[7] However, the age at which menopause occurs is thought to be genetically determined and not related to race, place, socioeconomic status or age at menarche.[8]

On analysis, it was found that majority (80%) of post-menopausal women had backache, followed by 76% had loss of appetite, 71% reported restlessness, 68% had difficulty in getting sleep, 64% felt miserable and sad and 48% reported hot flushes. Although hot flush is a common symptom (>75%) in women and is the reason that they seek help,[8] in this study, it was found to be reported by comparatively less proportion (48%) of women. Similar proportion or less of Indian women reported hot flush in some studies, whereas another study reported the proportion as 75%.[4],[7] Hot flush as a symptom may probably be acknowledged as abnormal/different in colder areas as compared to hotter areas where feeling hot and sweating may be more common. Majority (40%) of women from the USA[9] and about half the proportion (50.7%) of women from Turkey also complained of hot flush as a distressing symptom of menopause compared to other symptoms.[6]

Hot flush which is a result of vasomotor instability due to deficient oestrogen is also a common cause of sleep disturbance which was reported by many women (64%) in this study. Sleep problem, especially getting to sleep was a major concern in women in the present study as compared to other studies which reported the proportion as 51.7%

The symptom which was of concern for many (80%) in this study was backache. Aches and pains were associated with menopause and were also found to be the most common problem reported by majority (67.7%), especially the back pain (58.8%) for women in the South Indian study.[7] Hormonal changes-dependent osteoporosis is a common cause attributed to the aches and pains.[7] Another common symptom that was reported in the present study was depressed mood (64%) which was present along with loss of appetite and restlessness. Most women from Asia had more physical and psychological symptoms generally.[10] However, these symptoms are often neither expressed nor identified as symptomatology that needs assessment and support.

Vaginal dryness, a common presentation in many women (61%) in another study on urogenital symptoms in menopausal Indian women was also replicated in this study. Women in this study also reported uncomfortable sexual intercourse because of vaginal dryness.[11] Vaginal dryness and sexuality problems may not be reported voluntarily by many women especially in India, and this study highlights that more than half the proportion of women in this study experienced this problem.

With majority experiencing more than two or three distressing symptom, it is not surprising that more than half the proportion (57%) expressed that the quality of their life was not good and expressed their inability to cope with symptoms.


  Conclusion Top


This study added a broader understanding of what were some of the common postmenopausal symptoms that the women are struggling with in India. The most frequently reported postmenopausal symptoms included backache, sleep disturbances, hot flushes, night sweats and loss of appetite. More than half of postmenopausal women were not able to cope up with symptoms and reported to have bad QOL. Although menopause is increasingly seen as an important period with its own challenges in a woman's life, the symptoms may go unheard and struggles are underestimated, especially in India where other infections, diseases and disorders take priority over these symptoms and symptoms. There is a high relevance for a role of specialist nurse to address menopausal issue in women through nurse run clinics. Further, studies are needed to explore the QOL and coping in depth among post-menopausal women.

Acknowledgements

The authors would like to thank Amanatpreet Kaur, ArshdeepKaur, AmritdeepKaur, Bharti, Ankurpreet Kaur, Bhawna.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Aaron R, Muliyil J, Abraham S. Medico-social dimensions of menopause: A cross-sectional study from rural south India. Natl Med J India 2002;15:14-7.  Back to cited text no. 1
    
2.
Baig LA, Karim SA. Age at menopause, and knowledge of and attitudes to menopause, of women in Karachi, Pakistan. J Br Menopause Soc 2006;12:71-4.  Back to cited text no. 2
    
3.
World Health Organization (WHO). Report of WHO Scientific Group on Menopause is 1990; 2020. Available from: https://apps.who.int/iris/handle/10665/41841. [Last accessed on 2021 Apr 20].  Back to cited text no. 3
    
4.
Mahajan N, Aggarwal M, Bagga A. Health issues of menopausal women in North India. J Midlife Health 2012;3:84-7.  Back to cited text no. 4
    
5.
Hunter M. The Women's Health Questionnaire: A measure of mid-aged women's perceptions of their emotional and physical health. Psychol Health 1992;7:45-54.  Back to cited text no. 5
    
6.
Budakoğlu II, Ozcan C, Eroğlu D, Yanik F. Quality of life and postmenopausal symptoms among women in a rural district of the capital city of Turkey. Gynecol Endocrinol 2007;23:404-9.  Back to cited text no. 6
    
7.
Bairy L, Adiga S, Bhat P, Bhat R. Prevalence of menopausal symptoms and quality of life after menopause in women from South India. Aust N Z J Obstet Gynaecol 2009;49:106-9.  Back to cited text no. 7
    
8.
Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J Psychiatry 2015;57 Suppl 2:S222-32.  Back to cited text no. 8
    
9.
Sussman M, Trocio J, Best C, Mirkin S, Bushmakin AG, Yood R, et al. Prevalence of menopausal symptoms among mid-life women: Findings from electronic medical records. BMC Womens Health 2015;15:58.  Back to cited text no. 9
    
10.
Anderson D, Yoshizawa T, Gollschewski S, Atogami F, Courtney M. Menopause in Australia and Japan: Effects of country of residence on menopausal status and menopausal symptoms. Climacteric 2004;7:165-74.  Back to cited text no. 10
    
11.
Gupta N, Aggarwal M, Sinha R, Varun N. Study on prevalence and severity of urogenital complaints in postmenopausal women at a tertiary care hospital. J Midlife Health 2018;9:130-4.  Back to cited text no. 11
    


    Figures

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    Tables

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