Magnitude and factors influencing post menopausal symptoms – A Cross sectional study in Mysuru

Introduction

According to WHO Scientific committee, 1980 menopause is defined as the permanent cessation of menstruation resulting from loss of ovarian follicular activity.Menopause is diagnosed after 12 months of amenorrhea. Menopause is a critical period in a woman’s life that not only marks the end of reproductive ability but is also associated with multiple physical, vasomotor, psychological, and sexual complaints. The year immediately preceding and the decade afterward, however, are of much clinical significance.¹ The average age of menopause in India is 47.5 years, with an average life expectancy of 70 years. Therefore, Indian women are likely to spend almost 23.5 years in menopause (Indian Menopause Society, 2007). The mean age of attaining menopause was 48.26 years. Prevalence of symptoms among ladies was emotional problems (crying spells, depression, and irritability), headache, lethargy, dysuria, forgetfulness, musculoskeletal problems (joint pain, muscle pain), sexual problems (decreased libido, dyspareunia), genital problems (itching, vaginal dryness) and changes in voice. Only 22.4% of women knew the correct cause of menopause.² However, relatively little is known about the prevalence of symptoms in women in post-menopausal period. The National Health Programs in India have focused mainly on the health of women in reproductive age groups and neglected their health after attaining menopause. Developing preventive strategies for such women who are undergoing social and physiologic transition requires understanding of multiple factors that influence reporting of symptoms in women from different socioeconomic and racial/ ethnic backgrounds.

Materials and methods

This cross-sectional community-based study was conducted in the field practice area of the Department of Community Medicine, JSS Medical College, Mysore, from December 2018 to February 2019.Institutional Ethics Committee approval was obtained. Sample size was calculated based on the reported prevalence of postmenopausal symptoms to be 92%¹ with 10% relative allowable error at 5% confidence level to be 118.Details of Women in the menopausal age group were collected from the available data base and was utilised for selection of study subjects.Women in the age group of 45 to 75 years attending Health Center of JSS Medical College were selected through purposive sampling. The houses of these women were visited and details regarding their socio-demographic characteristics, various postmenopausal symptoms and factors associated with them were collected in a pretested structured pro forma by interview technique. Postmenopausal Rating Scale³ was used to assess the postmenopausal symptoms.

Statistical analysis

The data collected were entered in MS Excel 2007 and analyses using SPSS version 24. Descriptive statistical measures like percentage mean and SD were applied. Inferential statistical test such as Chi-square test for association was applied. The association was interpreted statistically significant at P < 0.05

Results

Among 118 post-menopausal women included in the present study, 49 (41.5%) were in the age group of 51 – 60 years, 57 (48.3%) were illiterates, 89 (75.4%) were not working currently, 56 (47.5%) were from nuclear family, 72 (61%) were Hindus and 88 (74.6%) were married and currently staying with their spouse. (Table 1). Mean age of participants is 56.97 ± 8.39 years, mean age at menopause was 44.45 ± 3.37years Mean duration of menopause was 12.64 ± 8.87years. Among 118 women included in the study, 82 (69.5%) of women had one or more post menopausal symptoms. Joint and muscular pain was found to be commonest post menopausal symptom 94.9%, followed by irritability 92.4%, anxiety 89.8%, depressive mood 88.1%, physical and mental exhaustion 82.2%. Sexual problems 4.2% and dryness of vagina 28.0% were among the least common symptoms. (Figure 1).

Post menopausal symptoms were higher in illiterate women, 46 (80.7%), those who were not currently working 65 (73.0%), women belonging to Muslim religion 35 (76.1%), widows 22 (84.6%), belonging to joint families 20 (74.1%), staying alone 9 (90.0%) and those who consult doctor 53 (85.5%). The association of post menopausal symptoms with literacy, staying alone and consult doctor were found to be statistically significant. (Table 2).

Among subjects with post menopausal symptoms was mean age was 58.87 ± 8.90 years, age at menarche was 13.74 ± 1.91 years, age at menopause was 44.14 ± 3.5 years and mean duration of menopause was 13.95 ± 3.22. Mean age and duration of menopause were significantly higher among subjects with post menopausal symptoms compared to their counterparts. (Table 3)

Discussion

Demographic transition with improved socioeconomic standards and improved access to health care has resulted in longevity among people. Menopause is considered as an unattended reality of life, which is certain for every women but the consequences of menopause are often unspoken and diverse across different women. The reasons for which a particular women develops more serious symptoms and some remain uneventful are not explored to a significant extent. In this background the present study was undertaken to assess the profile of symptoms and the factors associated with post menopausal symptoms among study subjects.

Mean age of menopause in the present study was 44.45 ± 3.37 year, this was in line with observations by Khan and Hallad in their studyreported that the mean age at menopause to be a 44.9 years.⁴ On the other hand this was lessercompared to the study conducted by Kulkarni et al. where it was found to be46.7 ± 5.2 years. In a study conducted by Borkeret al. in Kerala, reported the age at menopauseto be 48.26 years.1and Peeyananjarassri et al, in their study found that the average age atmenopause to be 48.7 years (range: 40–57 years).⁵ Wider variation in the age at menopause maybe due to factors such as geographic location, socioeconomic status, climatic conditions, and genetic factors.In the present study, 69.5% of the women had one or morepostmenopausal symptoms. This burden is quite lower than the observations made by Kulkarni P et al where 95% of women had one or the other post menopausal symptoms.² Borker et al. in Kerala found 90.7% of the womento have one or more postmenopausal symptoms.¹ Singh and Pradhan in their study in New Delhi reported that 89.3%of the postmenopausal women experienced at least one or more menopausal symptom(s)⁶

The results showed that the most common symptoms associated with menopause to be joint and muscular pain was found to be commonest post menopausal symptom 94.9%, followed by irritability 92.4%, anxiety 89.8%, depressive mood 88.1%, physical and mental exhaustion 82.2%. Sexual problems 4.2% and dryness of vagina 28.0% were among the least common symptoms. These were similar to the observations by Kulkarni et al where joint and muscular discomfort (92%), physical and mental exhaustion (84%), depression (76%), irritability (73%), and vasomotor symptoms such as hot flushes and night sweats (65%), and heart discomfort (52%) were observed. These observations arealso similar to the study done at Udupi by Bairyet al., among 352 postmenopausal women attending the out-patient clinics in a tertiary care hospital in South India, wherethere was a high prevalence of aching in muscles andjoints (67.7%), feeling tired (64.8%), poor memory (60.5%),lower backache (58.8%), feeling bloated (55.1%), and difficulty in sleeping (51.7%) among the menopausal respondents.⁷ In another study conducted by Lu et al.,the most frequent symptom reported was “feeling tired or worn out (86%),” followed by “aching in muscles and joints (85%).” The prevalence of the classical menopausal symptoms – hot flushes, night sweats, and vaginal dryness – in the women aged 45–65 years was 36.8%, 20.8%, and 55.3%, respectively.8 Borker et al. in their study reported the most common symptoms to be emotional problems 90.7%, headache 72.9%, lethargy 65.4%, and dysuria 58.9%.[10] Singh and Pradhan in their study reported the most common complaints of postmenopausal women to be sleep disturbances (62.7%),muscle or joint pain (59.1%), hot flushes (46.4%), and night sweats (45.6%). Variation in these figures may be due to the type of scale used for assessing the symptoms, ability of subjects to comprehend to the symptom profiles in these scales, and most importantly, the recall capacity of the subjects.⁷

Conclusion

There is a high burden of postmenopausal symptoms which have shown an increasing trend with advancement of age. This calls for establishment of specific health interventions for postmenopausal women in the health-care settings.