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A study of menopausal symptoms and its impact on lives of Nepalese perimenopausal and postmenopausal women
Abstract
p> Background: Menopausal health has not been given any consideration till the recent years in developing countries. With the improving status of women in the society, more and more women are seeking help for their menopausal problems.
Objectives: The study aimed to find out the prevalence of menopausal symptoms and its impact on life of perimenopausal and postmenopausal women attending gynecology outpatient department at Kathmandu Medical College Teaching Hospital.
Methods: A hospital based cross sectional study was done at Kathmandu medical college teaching hospital among 100 perimenopausal and postmenopausal women attending gynecology outpatient department in the month of August 2016. A pretested questionnaire was administered to the women selected by convenience sampling. Data was analyzed by SPSS version 20 and presented in percentage and frequency table.
Results: The mean age of the women in the study population was 49.98 years(SD±6.18) and mean age at menopause was
48.02 years (SD± 2.12). Ninety four percent of the women had one or more of the menopausal symptoms. The commonest menopausal symptom was mood swings and irritability (80% and 68% respectively) followed by vasomotor symptoms like hot flashes in 42% and night sweats in 24% of the women. These symptoms interfered with the women’s daily work performances in 46% of the cases, affected family life in 28% and affected social life in 32% of the cases.
Conclusion: Majority of the women have menopausal symptoms during perimenopause and postmenopausal period. These symptoms have major impact on women’s personal, social, and family lives.
Journal of Kathmandu Medical College
Vol. 6, No. 1, 2017, page: 4-8</p
... 2 People suffering from various menopausal health problems like heart disease and osteoporosis, also causes physical and psychological health burden. 3 Studies from India on urban versus rural women reports low level of awareness of postmenopausal symptoms. Similarly, 59.2% had low awareness reported from Nepal. 5 Another study from Kathmandu, Nepal, observed that the menopausal symptoms interfered with the women's daily work in 46%, affected family life in 28% and social life in 32%. 3 The study aimed to assess the level of awareness regarding menopausal symptoms and effect on daily life of postmenopausal women so that they could seek prompt treatment and reduce morbidity related to menopausal symptoms. ...
... Similarly, 59.2% had low awareness reported from Nepal. 5 Another study from Kathmandu, Nepal, observed that the menopausal symptoms interfered with the women's daily work in 46%, affected family life in 28% and social life in 32%. 3 The study aimed to assess the level of awareness regarding menopausal symptoms and effect on daily life of postmenopausal women so that they could seek prompt treatment and reduce morbidity related to menopausal symptoms. ...
... Among them effect in work efficiency was46%(46) and effect in social life was 32% (n=32) which was similar to the findings of this study. 3 On the contrary another findings on knowledge, attitudes and perceptions towards menopause among highly educated Asian women showed that only 30% (n=60) had altered work capability and loss of femininity. 14 The result of study showed statistically significant association between educational, marital and occupational status with menopausal symptoms, p value 0.047, 0.000 and 0.009 respectively. ...
Introduction: Menopause is permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity and hormone deficiency which causes various symptoms and negative effects on life. This study aimed to find out the awareness level of menopausal symptoms and effect on daily life of postmenopausal women. Method: A cross sectional study was conducted during April 2018 to February 2019 to find out the awareness level of menopausal symptoms and effect on daily life among postmenopausal women attending female outpatient department of Patan Hospital, Nepal. Non probability purposive sampling technique was used. Data were collected using structured interview schedule. The SPSS version 16 software was used for data analysis. The association between variables was measured by chi-square test Result: Among 160 postmenopausal women, the overall awareness of menopausal symptoms was inadequate in 130 (81.2%), effect on daily activities in 95 (59.3%), on work efficiency in 94(58.8%) and on social activities in 69 (43.2%). Educational, marital and occupational status were significantly associated with awareness level of menopausal symptoms and the symptoms had significant effect on daily life. Conclusion: The study revealed that more than two third of postmenopausal women had inadequate awareness of menopausal symptoms and more than half had effect on daily life. Educational, marital and occupational status were significantly associated with awareness level.
... 6 On the other hand, 59.6% of women reported menopausal symptoms affected their daily work performance to some extent which is comparable to the prior study from Nepal reporting 46% of the women experiencing difficulties in their daily activities due to these symptoms. 23 The transition through menopause is a life event that can profoundly affect overall well-being and quality of life of menopausal women. [3][4][5] Previous studies from Nepal and Sri Lanka have reported that menopausespecific symptoms highly diminish the overall wellbeing and quality of life of postmenopausal women in comparison to premenopausal and perimenopausal women. ...
Introduction: Postmenopausal women experience various menopause-specific somatic, psychological, and urogenital symptoms which tend to affect their overall well-being. However, there is a scant focus on menopausal health problems of postmenopausal women in Nepal. The aim of the study was to find out the prevalence of menopausal symptoms among postmenopausal women of a Municipality.
Methods: A cross-sectional survey was conducted in selected wards of Tokha Municipality of Kathmandu district among postmenopausal women aged 45-60 years from September to October 2019. Ethical approval was taken from the Ethical Review Board, Nepal Health Research Council (reference number 694). Random sampling was used as the sampling technique. Face-to-face interview was used for data collection while a semi-structured interview schedule including the Nepali version of Menopause Rating Scale was used as a tool for measuring menopausal symptoms. EpiData version 3.1 was used for data entry while data analysis was performed using Statistical Packages for the Social Sciences version 20.
Results: Amongst the postmenopausal women, all 203 (100%) had menopausal symptoms with majority reporting milder symptoms as found in 143 (70.4%). The mean Menopause Rating Scale (MRS) score was obtained as 13.21±5.1. The most prevalent moderate and mild symptoms were vaginal dryness 94 (46.3%), and depressive mood 71 (35%) respectively while physical and mental exhaustion 175 (86.2%) was the most common in all forms. Over half 102 (50.2%) of the respondents were unaware of menopausal symptoms and almost three-fifth 121 (59.6%) reported menopause related symptoms affected their daily work activities.
Conclusions: The majority of postmenopausal women in this study had milder menopausal symptoms, which parallels findings from other national studies.
... years. 13 Ghimire and colleagues found median age of menopause at 47 years. 14 Our findings were thus in consistence with published literatures. ...
... years. 13 Ghimire and colleagues found median age of menopause at 47 years. 14 Our findings were thus in consistence with published literatures. ...
Background and Aims: Postmenopausal diabetic female are at increased risk of cardiovascular disease. The objective of this study was to study their lipid profile and prevalence of dyslipidemia and assess relation of control of lipid components with various risk factors. Methods: A cross sectional prospective study conducted at Shahid Gangalal National Heart Centre from 15th July 2020 to 14th October 2020 including 109 postmenopausal diabetic female. Detailed history along with clinical examination were conducted. Fasting lipid profile and other relevant investigations were obtained. Results: Mean age of participants was 63.48±9.26 years. Mean age of menopause was 48.59±1.88 years. A total of 37 (33.9%) were hypertensive, 17 (15.6%) were smoker, 67 (61.5%) were physically inactive. A total of 91 (83.5%) were non-vegetarian. Thirty eight (34.9%) had their blood sugar controlled with hemoglobin A1c of <7%. The mean total cholesterol and high density lipoprotein were 5.21±0.97 mmol/l and 1.02±0.13 mmol/l. Similarly mean triglyceride and low density lipoprotein were 2.24±0.75 mmol/l and 3.04±0.12 mmol/l. Dyslipidemia was present in 82.6%. Significant correlation of control of blood sugar with total cholesterol control status (R=0.28, P=0.01), low density lipoprotein control status (R=0.38, P=0.01), high density lipoprotein control status (R=0.36, P=0.04) and triglyceride control status (R=0.30, P=0.04) were seen. Conclusion: Dyslipidemia was common in post menopausal diabetic female. Blood sugar control status showed significant correlation with lipid profile parameters. A good sugar control and evaluation for lipid abnormalities is recommended in postmenopausal diabetic female.
... Menopause is characterized by the vasomotor, urogenital, psychological and physical symptoms that appear gradually due to depletion and fluctuation in ovarian estrogen hormone. [1][2][3][4][5][6][7][8][9] National demographic data 10 shows 24.3% of women above 40 years of age and menopausal women at Paropakar Maternity and Women's Hospital (PMWH) are around 5% (unpublished data from out-patient record) but adequate work hasn't been carried out yet. ...
Background: Menopausal Rating Scale is one of the globally used tools to assess quality of life in menopause and peri-menopause. The aim of this study is to validate the standard menopausal rating scale in Nepalese menopausal women and to test menopausal symptoms during clinical consultation at hospital.
Methods: Cross sectional validation study at Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu. Five-step language translation of menopausal rating scale from English to Nepali, questionnaire clarity assessment with gynecologists and Likert scale questionnaire based interview to the clients. Reliability and validity tests applied. Each component of rating scale analyzed.
Results: Nepali version of menopausal rating scale developed. Acceptable level (Cronbach’s Alpha = 0.77) of tools reliability obtained. Barlett’s test of sphericity was highly significant and Pearson correlation between variables was significant. Average age of menarche was 15 years, and mean and modal value of menopause was 48 and 50 years respectively. First menopausal symptom was vasomotor flush in 62%, one-forth didn’t experience flush, half experienced mild to moderate flush and rest one-fourth had severe to very severe form; 50% had significant sleep, bladder and sexual dysfunction. Three-fourth had vaginal dryness and musculoskeletal problem. One-half had some degree of mental dysfunction.
Conclusions: Nepali version of menopausal rating scale developed. Baseline menopausal parameters obtained.
Keywords: Applicability; menopause; rating scale; validation.
... Menopause is characterized by the vasomotor, urogenital, psychological and physical symptoms that appear gradually due to depletion and fluctuation in ovarian estrogen hormone. [1][2][3][4][5][6][7][8][9] National demographic data 10 shows 24.3% of women above 40 years of age and menopausal women at Paropakar Maternity and Women's Hospital (PMWH) are around 5% (unpublished data from out-patient record) but adequate work hasn't been carried out yet. ...
Background:
Menopausal Rating Scale is one of the globally used tools to assess quality of life in menopause and peri-menopause. The aim of this study is to validate the standard menopausal rating scale in Nepalese menopausal women and to test menopausal symptoms during clinical consultation at hospital.
Methods:
Cross sectional validation study at Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu. Five-step language translation of menopausal rating scale from English to Nepali, questionnaire clarity assessment with gynecologists and Likert scale questionnaire based interview to the clients. Reliability and validity tests applied. Each component of rating scale analyzed.
Results:
Nepali version of menopausal rating scale developed. Acceptable level (Cronbach's Alpha = 0.77) of tools reliability obtained. Barlett's test of sphericity was highly significant and Pearson correlation between variables was significant. Average age of menarche was 15 years, and mean and modal value of menopause was 48 and 50 years respectively. First menopausal symptom was vasomotor flush in 62%, one-forth didn't experience flush, half experienced mild to moderate flush and rest one-fourth had severe to very severe form; 50% had significant sleep, bladder and sexual dysfunction. Three-fourth had vaginal dryness and musculoskeletal problem. One-half had some degree of mental dysfunction.
Conclusions:
Nepali version of menopausal rating scale developed. Baseline menopausal parameters obtained.
Prevalencia de síntomas menopáusicos y su relación con factores sociodemográficos entre mujeres mayores de 45 años en Mosul, Irak Abstract Context: Menopause in an unavoidable event in wom-ingly). On the other hand, 94.7% of postmenopausal en lives. Women during menopause experienced several women were complaining from physical and mental ex-symptoms of variable severity which affect their quality haustion. Likewise, vaginal dryness was significantly more of life. Aim of the study: The aim of this study is to study frequent among postmenopausal women. According to the distribution of menopausal symptoms among middle MRS somatic and psychological symptoms were more age women in Mosul City and their associated factors. severe among perimenopausal women while urogenital Subjects and Methods: The aim of the present study was symptoms were more severe among postmenopausal achieved by using cross sectional descriptive study design. women. Menopausal symptoms were significantly more The frequency of menopausal symptoms was assessed severe among illiterate women, working, widowed, paros, from 342 women attending two primary health centres in non-practicing exercise and previously smoker women. Mosul City, in Northern Iraq. Direct interview were used for Conclusion and recommendations: Menopausal symp-data collection by using predesigned questionnaire form toms were severe among perimenopausal and postmeno-and Menopausal Ratting Scale (MRS) during a period of pausal women in Mosul City which was adversely affected 2 months. Results: Mean age of participants was 53.95 ± their quality of life. Counseling health and social welfare 6.46. The most prevalent somatic menopausal symptoms services for postmenopausal women were required to be among middle aged women in Mosul City were Joint and established. In addition, women empowerment, and en-muscular disorder (93.0%) which was more among peri-couragement to adopt a healthy life style were essential. menopausal fallowed by postmenopausal women. Also, Keywords: menopausal, perimenopausal, postmenopau-hot flushes was more common among perimenopousal sal women, somatic symptoms, psychological, urogenital fallowed by postmenopausal (88.9%, 77.3% correspond-symptoms and menopausal rating scale. Contexto: La menopausia en un acontecimiento inelud-ible en la vida de la mujer. Las mujeres durante la meno-pausia experimentaron varios síntomas de gravedad variable que afectan su calidad de vida. Objetivo del estudio: El objetivo de este estudio es estudiar la distribución de los síntomas de la menopausia entre las mujeres de me-diana edad en la ciudad de Mosul y sus factores asocia-dos. Sujetos y métodos: El objetivo del presente estudio se logró mediante el uso de un diseño de estudio descriptivo transversal. La frecuencia de los síntomas de la menopau-sia se evaluó en 342 mujeres que asistían a dos centros de salud primarios en la ciudad de Mosul, en el norte de Irak. La entrevista directa se utilizó para la recopilación de datos mediante el uso de un formulario de cuestionario prediseñado y la Escala de Ratting Menopáusico (MRS) durante un período de 2 meses. Resultados: La edad me-1 Resumen 2 dia de los participantes fue 53,95 ± 6,46. Los síntomas de la menopausia somática más prevalentes entre las mu-jeres de mediana edad en la ciudad de Mosul fueron los trastornos musculares y de las articulaciones (93,0%), que fueron más frecuentes entre las mujeres posmenopáusicas en período perimenopáusico. Además, los sofocos fueron más comunes entre perimenopáusicas en barbecho y pos-menopáusicas (88,9%, 77,3% correspondientemente). Por otro lado, el 94,7% de las mujeres posmenopáusicas se quejaban de agotamiento físico y mental. Asimismo, la sequedad vaginal fue significativamente más frecuente entre las mujeres posmenopáusicas. Según MRS, los sín-tomas somáticos y psicológicos eran más graves entre las mujeres perimenopáusicas, mientras que los sínto-mas urogenitales eran más graves entre las mujeres pos-menopáusicas. Los síntomas de la menopausia fueron sig-nificativamente más severos entre las mujeres analfabetas, trabajadoras, viudas, paros, no practicantes de ejercicio y mujeres previamente fumadoras. Conclusión y recomen-daciones: Los síntomas de la menopausia fueron graves entre las mujeres perimenopáusicas y posmenopáusicas en la ciudad de Mosul, lo que afectó negativamente su calidad de vida. Era necesario establecer servicios de ase-soramiento en materia de salud y bienestar social para mujeres posmenopáusicas. Además, el empoderamiento de la mujer y el estímulo para adoptar un estilo de vida saludable eran fundamentales. Palabras Clave: mujeres menopáusicas, perimenopáu-sicas, posmenopáusicas, síntomas somáticos, síntomas psicológicos, urogenitales y escala de calificación de la menopausia. enopause is a normal physiological process; according to World Health Organization (WHO) definition 'is the permanent cessation of menstruation as a result of the loss of ovarian activity' 1. Accordingly, women became menopause when her menstrual cycle was permanently stopped for 12 successive months or more due to cessation of ovarian hormone production 2. Menopausal women complained from numerous symptoms during this period due to hormonal level fluctuations, some of these symptoms were severe enough to affect the quality of life and the wellbeing of middle aged women 3,4. These symptoms may be in the form of hot flushes, sleep and mood disturbance, lack of sexual desire, dryness of vagina and locomotors complaints 4. Multiple geographic, socioeconomic , cultural, environmental factors and the biological variations linked to the changed ovarian hormonal status or deficiency affect the occurrence and severity of meno-pausal symptoms 5,6. In fact menopausal symptoms were a common problem as an unavoidable part of every wom-an's life; about three quarters of women suffer from some problems during menopause 7. It was found that majority of women spend about one third of their life complaining from menopausal symptoms by various degree 8,9. Women are suffering without proper counseling and management due to lack of health programs that deal with such health problem 10. Yet, various degrees of suffering and distress can be alleviated by suitable recognition, counselling and treatment 9. The aim of the present study is to identify the prevalence of menopausal symptoms that experience by middle aged women in Mosul City with their associated socio-demographic factors. t the beginning of the study scientific and ethical approval from College of Medicine/ University of Mosul, and Directorate of Nineveh Health was obtained. The aim of the current study was accomplished by implementing a cross-sectional descriptive study design. The target study population was any women aged 45 and above. While, any women on hormonal replacement therapy or undergo medical or surgical induction of menopause were excluded from the study population. The data was collected from women how visiting two primary health care centres in Mosul City during study period. Convenient random sample of 342 women were approached over a period of two months from 3 Sept 2020 to-3 November 2020. Data was collected by direct face to face interview by using a predesigned questionnaire form after explanation of the study objectives and obtaining verbal consent. The form consists of two parts; the first part was concerned with the socio-demographic features, physical exercise practicing , body mass index estimation and menstrual history of the participants. The second part was confined to identify the frequency and severity of menopausal symptoms by using menopausal rating scale (MRS) 11,12. MRS was a standardized form designed to estimate the severity of menopausal symptoms and categorized them into: so-matic symptoms include (hot flushes, heart discomfort, sleep disturbance, joint and muscular disorder) psychological symptoms (depressive mood, irritability, anxiety, physical and mental exhaustion) and urogenital symptoms (sexual problems, bladder problems, vaginal dryness). Menopausal symptoms in this scale was assessed by scoring each symptom according to the severity from score 0 (none) to score 4 (very sever). The total MRS scores were calculated by summation of scores in three components of somatic, psychological and urogenital symptoms. According to MRS if the total mean scores (0-4) reflect little or no symptoms, (4-8) mild, and (9-16) moderate while above 16 is sever.
The issue of postreproductive health care in women demands recognition and priority in India as the number of women in this age group is increasing due to higher life expectancy as a result of better healthcare facilities. Menopause marks the transition to postreproductive life in women. The physical, physiological and psychological symptoms accompany menopause which affect the women’s health and well-being. Perimenopausal and postmenopausal women have to bear the results of these developments in their bodies. Women experience these symptoms around and after menopause which remain uncared for due to lack of awareness. The biological age of women is usually different from their chronological age and may depend on several factors like diet, environment, lifestyle changes, menopause, etc. The women, who experience menopause early in their lives, tend to age faster than women of similar age who have late menopause. Thus, menopause hastens the process of ageing in women. In India, there is not much awareness about the problems and needs of women in their postreproductive stage of life, especially menopause. Like menstruation, women do not feel free to discuss the problems they face during menopause and thus majority of the women bear the consequences of the developments of midlife in silence. There is a strong need to address the problems faced by women in their postreproductive life and to spread the awareness about this crucial phase as it is a transition from reproductive to non-reproductive phase of life which is accompanied by several health issues.
Background:
Women face numerous health problems in their post-reproductive and menopausal years, including issues such as pelvic pain, incontinence and obstetric fistula. In Nepal, the importance of these health issues is increasing with the aging of the population, yet women are often unable to access adequate health care due to entrenched gender structures and misconceptions regarding menopause. This study aimed to describe the prevalence of menopause, the associated health problems and their severity amongst women aged 40-60 years in Kapilvastu.
Methods:
A descriptive study was conducted in Kapilvastu district. Multi stage cluster sampling technique was adopted: Illakas of Kapilvastu were identified, then one Village Development Committee (VDC) from each Illaka of the district, and two wards from each of these VDCs, were selected randomly.
Results:
The median age of onset of menopause was 47 years (25 th and 75 percentiles = 43 and 50 years), and >90% of women had entered menopause by 54. All symptoms in the Menopause Rating Scale were experienced to some extent by at least 30% of women, even amongst the premenopausal group. The most common problems experienced by menopausal women were: sexual problems (81.7%, 95%CI: 78.0-85.4), physical and mental exhaustion (81.5%, 95%CI: 77.8-85.2) and joint and muscular discomfort (78.5%, 95%CI: 74.6-82.4). The symptoms most frequently deemed "severe" or "very severe" were: sexual problems (40.5%), joint and muscular discomfort (27.4%), and sleep problems (21.0%). th
Conclusions:
Middle-aged women in Kapilvastu experienced menopausal symptoms to a substantial degree. The prevalence and severity of these symptoms increased with the menopausal transition, and with increasing age. Menopause itself did not appear to be the primary risk factor for typical "menopausal" symptoms.
Introduction: Many women over the age of forty years experience symptoms associated with the transition of menopause. At the same time, these women face increased risk of morbidity due to cardiovascular disease, diabetes, cancer and other chronic diseases. In combination, these changes can lead to psychological problems that affect their quality of life. The study was conducted to find out physical, psychological and menopausal problems among women above 40 years of age. Methods: This was community based cross-sectional study, conducted in two purposively selected VDCs of Rupandehi District. A total number of 300 women above forty years were interviewed by using semi structured interviewed schedule. Data were analyzed by using SPSS software version 12 Results: The mean age of menopause was 46.81 years. General health problems as reported by respondents were gastritis (38.3%), headache (33.3%), eye problems (32%), sleep disturbance (30.7%) and musculoskeletal problems (27.3%) followed by hypertension (19%), diabetes (17.7%). Menopausal problems as reported by respondents were dizzy spell (44.78%), hot flushes (23.88%), painful period (19.40%) were more common in the age group 40-44 and palpitation (53.64%), history of fracture (44.90%), cold hand and feet (10.20%) were more common in the age group 50-54. Psychological problems were found most common in the age group 60 and above. Conclusion: Large efforts are required to educate and make these women and community aware of health problems of this segment of population. Family members need to be more responsive to their needs during this period in their lives. Proactive measures need to be taken to avoid health related problems like health diet, regular exercise, yoga, meditation and regular checkups to avoid problems and for early diagnosis and management of the problems as and when they arise.
There are few menopausal study data available in South East Asia especially in Bangladesh. This study was conducted in a well populated town named Kushtia, which is located in the western part of Bangladesh.
This study was aimed to document the menopausal-related symptoms among middle age women of Kushtia region of Bangladesh.
By using modified MRS (Menopause Rating Scale) questionnaire, 509 women aged 40-70 years were interviewed to document symptoms commonly associated with menopause.
The mean age of menopause was 51.14 years. The most prevalent symptoms reported include, feeling tired (92.90%); headache (88.80%); joint and muscular discomfort (76.20%); physical and mental exhaustion (60.90%) and sleeplessness (54.40%) which are followed by depressive mood (37.30%); irritability (36%); dryness of vagina (36%); hot flushes and sweating (35.80%); anxiety (34.20%). However, noted less frequent symptoms were sexual problem (31.20%); cardiac discomfort (19.10%) and bladder problem (12.80%).
The prevalence of menopausal symptoms found in this study correspond to other studies on Asian women however the prevalence of classical menopausal symptoms of hot flushes and sweating were lower compared to studies on Caucasian women.
Majority of Nepalese women live in remote rural areas, where health services are not easily accessible. We determined the validity of Menopause Rating Scale (MRS) as a screening tool for identification of women with severe menopausal symptoms and cut-off MRS score for referral.
A cross-sectional survey was carried out between February and August, 2008. Trained health workers administered MRS and a questionnaire to 729 women (40 to 65 years) attending health screening camps in Kaski district of Western Development Region of Nepal. Information about demographics, menopausal status, and use of hormone replacement therapy (HRT), chronic disease, self-perceived general health and reproductive history was also collected. Menopausal status was classified according to the Staging of Reproductive Ageing Workshop (STRAW). We calculated rates of menopausal symptoms, sensitivity, and specificity and likelihood ratios of MRS scores for referral to a gynaecologist. We also carried out multivariate analyses to identify the predictors for referral to a gynaecologist for severe symptoms.
A total 729 women were interviewed. Mean age at menopause was 49.9 years (SD 5.6). Most frequently reported symptoms were, sleeping problems (574, 78.7%), physical and mental exhaustion (73.5%), hot flushes (508, 69.7%), joint and muscular discomfort (500, 68.6%) and dryness of vagina (449, 61.6%). Postmenopausal women (247, 33.9%) and perimenopausal (215, 29.5%) women together experienced significantly higher prevalence of all symptoms than the premenopausal (267, 36.6%) women. MRS score of ≥16 had highest ratio for (sensitivity + specificity)/2. Women who reported urogenital symptoms [OR 5.29, 95% CI 2.59, 10.78], and self perceived general health as poor [OR 1.29, 95% CI 1.11, 1.53] were more likely to be referred to a gynaecologist for severe menopausal symptoms. While women reporting somatic [OR 0.72, 95% CI 0.63, 0.82] and psychological [OR 0.86, 95% CI 0.74, 0.99] symptoms were less likely to be referred.
MRS may be used as a screening tool at a cut-off score of ≥16 with least misclassification rate. However, its utility may be limited by woman's general health status and occurrence of urogenital symptoms.
It is a well accepted status that socio-cultural characteristics may affect the onset of menopause and its characteristics. The aims of this study were to describe the prevalence rates of menopausal symptoms and these symptoms related factors, and to assess the women's attitudes towards some climacteric issues.
This survey was conducted between Jan., 1st 2008 and March, 31st 2008 to research the menopause status of the female population in a city of western Turkey. The study group consisted of 1551 women selected with a multistage area sampling method: a random sample of individuals aged 40-65 years. The questionnaire included questions pertaining to women's sociodemographic characteristics, women's menopausal status, some statements about the climacteric, use of hormones at menopause or before menopause, and some climacteric myths. The data was analyzed by Chi-square (x2) analysis and percent (%) ratios with a significant value of P < 0.05.
The mean age of the women was 49.1 years. Over 90% of the women were of the negative opinion that the climacteric is "the end of youth", "the end of fecundity", and "the end of unclean days". Most women said that cessation of menstrual periods was the most positive thing because they do not have to wait for monthly bleedings, use sanitary equipment, or take birth control methods. There were significant connections between age groups and nearly all the items, with the exception of the items "the end of life" and "the end of fecundity". Among the women, hot flushes were the most common complaint occurring in 96.5% of women: being severe in 32.9%, moderate in 43.1% and mild in 20.4%. This was followed by low backache or muscle pain 95.0% (25.9% severe, 46.0% moderate and mild 23.1%), headache 91.7% (21.9% severe, 34.9% moderate and 34.9% mild) and feeling tired 91.0% (15.3% severe, 38.6% moderate and 37.1% mild).
Most of the women in this study had mixed ideas of opinions concerning the climacteric, and the majority was also suffering from climacteric complaints. This data could assist healthcare providers in the provision of culturally competent health care to midlife Turkish women.
A cross-sectional study was conducted among women of different ethnic groups aged 40 to 60 years and health workers in different parts of Nepal using focus group discussions (FGDs), key informant interviews (KIIs) and clinical examinations to determine the symptoms and complains related to menopause.
The mean age at menarche was 15 years and the mean age of menopause was 47. The highest menarche and menopause (50 years) was found to be among the Gurung women. Mean age of menopause was found to be higher among currently older women (52 years among 60+ women vs 41 years among <45 years women) and unmarried women. Tharu perimenopausal women and Sarki, Gurung and Tharu postmenopausal women were found to have relatively more regular menstrual cycles. However, Tharu perimenopausal women were found to have excess bleedings during the menstrual cycle.
Most of the women had heard about menopause but did not have detailed knowledge on it. Loss of sexual interest (95.3%), decreased visual activity (58%), joint pain (31.3%) and body pain (31.3%) were the most commonly reported menopausal symptoms. Mean body mass index (BMI) was highest among the Gurung women (both perimenopausal and postmenopausal). Pap smear was normal in all 138 women but around 50% had some cervical and vaginal-related problems. One-third of Tharu postmenopausal women had atropic labia and onethird of Tamang women had leukoderma.
Since, very little knowledge is known about the postmenopausal symptoms and problems in Nepal, this study can serve as the basis for further researches in this area with an increased sample size.
How to cite this article
Rajbhandari S, Amatya A, Giri K. Relation of Ethnicity and Menopausal Symptoms in Nepal. J South Asian Feder Menopause Soc 2013;1(2):50-55.
Age at menopause and symptoms vary among populations and societies. Scarce data is available about menopausal age, symptoms and socio-demographic and reproductive factors from rural women of Sindh, Pakistan. The present study was conducted to find out the self reported age at natural menopause, prevalence of menopausal symptoms, and to identify sociodemographic and reproductive factors that may influence the onset of menopause.
A survey was carried out on women aged 40-70. A multistage random sampling technique was used to retrieve 1,355 women with natural menopause from 10 union councils of district Matiari. These women were further categorised into 3 groups, I, II, and III having menopause for 1-5, 6-10, > 10 years respectively. Pearson's chi-square test was used to analyse the percentage of symptoms distribution. ANOVA was used to analyse the relationship between demographic, reproductive factors and the age at natural menopause.
Age at menopause in our subjects was 46.2 +/- 6.4 years. The prevalence of menopausal symptoms ranges from 26 % to 83%. Frequency of somatic, psychological and urogenital symptoms was high in group II. No significant association was found between parity, socioeconomic status and age at natural menopause.
The results have shown the early age at menopause. The prevalence of menopausal symptoms is high. Results regarding correlation of age at menopause with socio-demographic and reproductive characteristics were different from literature.
This is a prospective study conducted in the department of OBGYN, Nepal medical college teaching hospital (NMCTH), Kathmandu Nepal. The main objective of this study being to find out the major health problem in mid-life of female, to see the age of menopause and to see prevalence of menopausal symptoms and common menopausal symptom among Nepalese women. Total 500 women were included in the study with effect from 1st of January 1012 till 500 respondents were interviewed, it took almost 10 months and ended on November 1012 for the study. Age wise all women from 45 years to 60 years are included, surgical menopause, diagnosed Hypertensive, diabetes and thyroid disorder were excluded from the study. Informed consent was taken and standard questionnaire were administered to women after history and clinical examination. Data were collected and analysed. The mean age of menopause found to be 49.9% with urinary tract infection being the major clinical diagnosis and physical menopausal symptoms being the commonest. About 20% of respondent had MRS (menopausal rating scale) score more than 16.
To provide current insights into the opinions, attitudes, and knowledge of menopausal women in Asia regarding menopause and hormone replacement therapy (HRT).
Cross-sectional.
Between January 2006 and February 2006, 1000 postmenopausal women from China, Malaysia, Taiwan, Thailand and Hong Kong were interviewed to determine postmenopausal symptoms, HRT use and knowledge, breast discomfort and knowledge of breast cancer risks, and sexual function.
Almost all women reported experiencing postmenopausal symptoms. Sleeplessness (42%) was reported as the main reason for seeking treatment. On average, 54% of women were aware of HRT, despite the fact that most (38%) were unable to mention any associated benefits. Most women had used natural or herbal treatments (37%) for the alleviation of menopausal symptoms. Only 19% had received HRT. 27% of respondents reported having breast discomfort, while 70% reported performing self-breast examinations. 53% of women had never received a mammogram, despite breast cancer concern (50%). 24% of women described HRT as being a risk factor for breast cancer. Most women and their partners reported no reductions in sexual function (66 and 51%, respectively), while 90% of respondents did not seek treatment for reduced sexual function. In the event of sexual dysfunction, 33% of women replied that they would be willing to seek treatment.
Many Asian women experience postmenopausal symptoms that are often left untreated (due to the acceptance of menopause as a natural process) or treated with herbal/natural remedies. There was a general lack of knowledge among these women regarding treatment options, HRT, and possible risks associated with HRT. A more concerted effort should be made to better disseminate information regarding the pathogenesis and risk factors associated with breast cancer, menopause, and menopausal symptoms to Asian women.
Differences in age at natural menopause by occupation, education, and place of residence were examined using a cross-sectional population sample of Finnish women aged 45–64 years ( n = 1,713, response rate 86%). The sample was selected at random from the Finnish Population Register in 1989 (final n = 1,505, 75%). Kaplan-Meier estimates showed the median age at natural menopause to be 51 years for all women (95% confidence interval (CI) 50.6–51.4). The median menopausal age of smokers and nulliparous women was 50 years; that of nonsmokers and women whose first full-term pregnancy occurred before the age of 25 years was 52 years. Differences between occupational and educational groups were statistically significant (Mantel-Cox test for occupation, p < 0.02; for education, p < 0.03). In the Cox proportional hazards model, the odds ratio of the occurrence of natural menopause among upper white-collar women was 0.74 (95% CI 0.57–0.96) and among the most educated women (education > 11 years) it was 0.75 (95% CI 0.59–0.96), adjusted to reflect smoking, use of hormones, body mass index, and age at first full-term pregnancy. Sociodemographic variables appear to be associated with age at natural menopause in a representative sample of Finnish women. Am J Epidemiol 1994;139.64–76.
To use the Menopause-Specific Quality of Life Questionnaire (MENQOL) to assess the impact of menopausal symptoms on health-related quality of life in a large US population-based study.
Participants were recruited from the US population through random-digit-dialing and probability sampling. Analyses included 2703 postmenopausal women 40-65 years old in our Menopause Epidemiology Study. Respondents answered a 30-min questionnaire, including the MENQOL.
Scores for each domain were: vasomotor: 3.2+/-2.2; psycho-social: 3.3+/-1.8; physical: 3.5+/-1.5; sexual: 2.9+/-2.1. There were significant differences in the MENQOL scores by age, smoking, exercise, education, employment status and BMI. Women aged 60-65 years (p<0.0001), with a bachelor's degree or higher level of education (p<0.0001), who exercised at least 3 days a week (p<0.0001), who had never smoked (p<0.0001), with a body mass index < or =25kg/m(2) (p<0.0001), and who had significantly lower scores indicating better quality of life. Hot flashes affected work (46.0%), social activities (44.4%), leisure activities (47.6%), sleep (82.0%), mood (68.6%), concentration (69.0%), sexual activity (40.9%), total energy level (63.3%) and overall quality of life (69.3%).
Symptoms experienced during menopause and socio-demographic characteristics affect the quality of life in postmenopausal women. Hot flashes impact the daily activities of most postmenopausal women, especially those with more frequent/severe symptoms. Treatments that safely and effectively treat these symptoms could improve quality of life among postmenopausal women.
To determine the knowledge and attitude of women towards menopause and to investigate the symptoms experienced by postmenopausal women.
It was a cross sectional survey based on sample of convenience.
Study was conducted at out patient department of Isra university hospital from 1st January 2005 to 31st December 2006.
Total 863 women of age 42 to 80 years were interviewed in office of out patient department. A semi structured questionnaire was used to collect data. Data analysis done by computer software statistical program for social sciences (SPSS) version 11.0.
Mean age of respondents was 55.05, Menopause was natural in 727 (84.24%) women and 136 (15.75%) had surgical menopause. 680 (78.79%) women had little knowledge about menopause, while 137 (15.8%) women knew about effects and symptom of menopause. 680 (78.79%) women considered menopause as a natural process, while 183 (21.2%) perceived it as a disease, 720 (83.42%) women were happy about cessation of menses and they did not want to have menses again, while 143 (16.57%) women wanted to have menses again. These women were of age 45 to 58 years and 85 (59.4%) were uneducated. Frequently reported symptoms were Backache in 653 (75.66%), body aches, 576 (66.74%) and Insomnia in 544 (63.44%) women. Vasomotor symptoms (Hot Flushes and Night Sweats) were reported by 513 (59.4%) and 390 (45.19%) respectively. Short loss of memory was reported by 536 (62.10%) women. 318 (36.84%) women were bothered by menopausal symptoms but only 275 (31.86%) has consulted doctor. 649 (75.20%) women were not taking any medicine for symptoms, 08 (0.926%) were taking Herbs, 10 (1.15%) were on HRT and 196 (22.71%) women were taking analgesics and Ca supplements off and on. Hypertension and Diabetes Mellitus was present in 180 (20.85%), 215 (24.9%) women respectively.
Majority of our women were unaware of menopausal symptoms and its health effects. Most of them considered it as a natural process of aging, though bothered by symptoms but did not go for consultation due to lack of awareness and poverty.
In this study, 6877 women were analysed whose ages ranged between 38 and 58 (born between 1909 and 1929) and who had had no artificial menopause. This is 88.04% of the total female population in this actual period of life, living in Martin District in 1967. The mean age at the menopause was found, by status quo method, to be 51.21 years (standard deviation 4.4), and by the method of weighted arithmetical means, 48.81 years, (standard deviation 3.9). The mean age at the onset of the climacteric, calculated by the same methods, was 47.55 years, or 46.74 years, respectively. The mean age at menarche was 14.6 years. The average birth-rate was 2.8. The mean period of fertility for the series as a whole was 36.6 years. Women with menstrual disturbances had their menopause about 1 year earlier. We have noted a similar tendency in nulliparas and primiparas. We could find no great difference in the age at menopause between those who had had an early or a late menarche. Menstrual disturbances also influenced the onset of the climacteric. It was at least one year earlier than with regular menstruation. Age at menarche and parity had no effect on the age at the onset of climacteric. Women working in agriculture and housewives had their menopause a little later than mean age of the series, whereas manual workers and those in other occupational categories had their menopause and onset of the climacteric about 1 year earlier. Furthermore, single women had their menopause about one year earlier than the married ones. Widows had their menopause twice so often as the married women and they got it very soon after the husbands's death.
This paper presents analyses from a comprehensive prospective cohort study of mid-aged women [the Massachusetts Women's Health Study (MWHS)], with numbers sufficient to provide stable estimates of parameters in the normal menopause transition. Three questions are addressed: what are the natural menopause transitions and when do they occur; what factors affect the transitions; and what signs and/or symptoms accompany the transitions? The data were obtained primarily from 5 years of follow-up of 2,570 women in Massachusetts who were aged 44–55 years as of January 1, 1982. Prospective study of the cohort consisted of six telephone contacts (T1–T6) at 9 month intervals with excellent retention. A subset of the full cohort was defined that consisted of women who were premenopausal (rather than perimenopausal) at baseline (To) (n = 1,178). Confirming prior reports, the age at natural menopause occurred at 51.3 years with a highly significant median difference (1.8 years) between current smokers and non-smokers. The new analyses reported here on median age at inception of perimenopause (47.5 years) and factors affecting it are consistent with findings for age at last menstrual period. Smokers tend to have not only an earlier but also shorter perimenopause. The length of the perimenopausal transition, estimated at about 3.5 years, has not been previously reported. The relationship between menopause transitions and symptom reporting appears to be transitory, with reporting rates showing an increase in the perimenopause and a compensatory decrease in postmenopause. The implications of combined hormone replacement therapy for future research on menopause in industrial societies is discussed in relation to these findings.
To examine sociodemographic, menstrual, reproductive, and other factors which may influence the age at natural menopause, the authors analyzed data from a large series of women participating in a nationwide breast cancer screening program conducted between 1973 and 1980. Standard life table techniques permitted assessment of factors suspected of varying the time to menstrual cessation among 983 premenopausal women, 1091 surgically menopausal women, and 1423 naturally menopausal women. The median age at natural menopause was 51.1 years. Multivariate analysis indicated that parity, irregularity of menstrual cycles before age 25 or first livebirth, and high socioeconomic status were significantly related to menopausal age. These data provide evidence for the hypothesis that certain environmental and hormonal factors which affect ovulation during reproductive years may ultimately postpone the menopause.
Menopause marks a time of dramatic hormonal and often social change for women. Both risk factors and health needs are likely to change as women pass through menopause. This paper examines the demographic characteristics of the world population of menopausal and post-menopausal women, and also examines the implication of menopause for mortality risks. The numbers of women involved are large. Using age 50 as a proxy for menopause, about 25 million women pass through menopause each year, and we estimate that in 1990 there were 467 million post-menopausal women in the world, with an average age of about 60 years. By 2030, the world population of menopausal and postmenopausal women is projected to increase to 1.2 billion, with 47 million new entrants each year. The mortality implications of menopause are also substantial. Ratios of female to male mortality risks from all causes and from all major cause groups except neoplasms decline to low levels around menopause or shortly thereafter, and then rise again to near unity. This pattern is taken as evidence that the female reproductive period is broadly protective of health, but that this protection disappears after menopause. The main protective effect is through reduced risk of cardiovascular disease mortality, partially offset by increased risks of cancer mortality, particularly of the breast and endometrium.
To determine the median age of natural menopause in United Arab Emirates women, the factors affecting that age and the prevalence of climacteric symptoms amongst those women.
A population-based survey was conducted on a community sample of United Arab Emirates women who had had natural menopause defined as cessation of menstruation for at least 6 months at the end of reproductive years. A total of 742 women aged 40 years and above were recruited from both urban and rural areas of the country using the multi-stage stratified cluster sampling technique. Data were collected using a structured questionnaire and face to face interviews and included a number of familial, reproductive and life-style variables.
The median age of the menopause in the United Arab Emirates is 48 years (mean = 47.3 +/- 3.29, range 40-59). This is significantly lower than the median age reported from the West (50.3 years). The subject median age of the menopause was significantly related to that of the mother (P < 0.001), older sister (P < 0.001), parity (P < 0.0001) and the previous use of oral contraceptive pills for more than 1 year (P < 0.001). Hot flushes were the commonest feature of the menopause occurring in 45% of women.
The age of natural menopause in United Arab Emirates women, as in other developing countries, is less than in Western women and may be influenced by genetic factors, parity and previous use of oral contraceptives. Climacteric symptomatology, however, is similar in the different patient groups.
The aim of this study was to investigate factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women.
This is a cross-sectional study and included 886 women. Data were collected with a questionnaire including questions about demographics and independent variables tested, the Menopause Symptom Checklist and The MOS 36-Item Short Form Health Survey.
The mean age of the women included in the study was 48.62 years (standard deviation (S.D.)=5.75, range: 40-60 years). Of all women, 32.1% were premenopausal, 23.9% perimenopausal and 44.2% postmenopausal. Stepwise multiple regression analyses, performed to determine factors associated with menopausal symptom score, revealed 12 statistically significant variables which increased the strength of the model. These variables were as follows in the order of their contribution to the strength of the model: health problems, recent life stresses, being a primary school graduate, absence of relaxation methods, number of pregnancy, financial problems, tea consumption, inadequate and unbalanced nutrition, coffee consumption, age, being a secondary school graduate and dissatisfaction in marriage. Besides, there was a significant and moderately negative relation between total menopausal symptom scores and quality of life scores.
A large number of factors were associated with experiencing menopausal symptoms and menopausal symptoms had negative effects on the quality of life among Turkish women. Stress management and health promoting practices should be incorporated into menopausal care programs to improve health and quality of life of middle-aged women.
A population-based study was used to describe healthcare seeking behavior for menopausal symptoms and treatment among women 40-65 years old in the United States.
Participants were recruited into the Menopause Epidemiology Study from the KnowledgePanel(SM), which is selected by random digit dialing and probability sampling from the US population. From this source, 6201 women 40-65 years old were contacted and 4402 women participated. From the 3135 peri- and postmenopausal women, detailed information was obtained on menopausal symptoms, healthcare seeking, medication usage, and symptom relief from the medication.
Many women (60%) reported seeking health care for their menopausal symptoms. More than half of these women sought health care in the past 12 months. Vasomotor symptoms were the most frequently reported menopause symptoms across all races/ethnicities, and the most common symptoms discussed with a health care professional. One-third of the women (34%) used only hormone therapies, 12% used complementary and/or alternative medicines, and 16% used both for treatment of menopausal symptoms.
This study has shown that a large number of women consult healthcare providers for menopausal symptoms, indicating these symptoms are bothersome. Yet, in the United States, there is considerable variation in the symptomatology, healthcare seeking, and use of therapies for menopausal symptoms across cultures. To alleviate these symptoms women have tried alternative treatments as well as hormone therapies, yet many women did not get complete relief of specific symptoms.
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