|Year : 2018 | Volume
| Issue : 1 | Page : 16-23
Health-related quality of life among menopausal women
Thilagavathy Ganapathy1, Samia Saud Al Furaikh2
1 Department of MCH, King Saud Bin Abdul Aziz University of Health Sciences, Al- Ahsa, CON-A, KSA
2 Department of MCH, King Saud Bin Abdul Aziz University of Health Sciences; Department of Pediatrics, King Abdul Aziz Hospital, Al- Ahsa, CON-A, KSA
|Date of Web Publication||11-Jun-2018|
Dr. Thilagavathy Ganapathy
King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Hospital, Ministry of National Guard Health Affairs, Al Ahsa
Source of Support: None, Conflict of Interest: None
Background: Menopausal symptoms impact physical, psychological, vasomotor, and sexual health-related quality of life (QOL) among women. Objective: This exploratory study aimed to assess the effects of menopausal symptoms on the QOL using Menopause-Specific QOL Questionnaire (MENQOL) among women in India. Materials and Methods: By purposive sampling, n = 140 women aged between 40 and 60 years were recruited, and the prevalence of menopausal symptoms and its relationship with physical, psychological, vasomotor, and sexual health-related QOL was assessed using MENQOL, at Arekare, Mico-Layout, Bangalore South, Karnataka, India. Results: The mean age at menopause was 49.59 + 3.09 years. Nearly 97.14% of women reported having experienced minimum five or more menopausal symptoms. The prevalence of symptoms in physical, vasomotor, psychological, and sexual domains was 74.56%, 60.7%, 44.68%, and 26.4%, respectively. An overall mean MENQOL score of physical (27.1 + 0.72), psychological (2.01 + 0.27), vasomotor (4.08 + 0.79), and sexual (3.89 + 0.59) health-related QOL among menopausal women showed poor QOL. Statistical significant differences were observed between the sociodemographic variables and the health-related QOL scores in all domains at P < 0.05. Conclusion: Menopausal women-centered integrated model of care would empower women to lead improved health-related QOL in the next one-third of postmenopausal life span development.
Keywords: Health-related quality of life, menopausal symptoms, menopause, menopause-specific quality of life questionnaire
|How to cite this article:|
Ganapathy T, Al Furaikh SS. Health-related quality of life among menopausal women. Arch Med Health Sci 2018;6:16-23
| Introduction|| |
In human life span development, menopausal phase signifies the normal aging process that subjects women from the reproductive to the nonreproductive state. The menopausal process may extend for a longer variable period before and after the physiological cessation of menstruation and last many years after that, subjecting women into a complex biophysiological and psychosocial change. In the general population, the proportion of the menopausal women has significantly increased due to increase in life expectancy. The Population Projections Survey in India reveals that the number of women aged 45 years and above is expected to reach 401 million in 2026 from 96 million at present. These huge numbers of women are expected to spend nearly 30 years in a postreproductive period of life.
Menopausal period is positively correlated with noncommunicable diseases such as diabetes, hypertension, osteoporosis, cervical cancer, and breast cancer. Furthermore, the menopausal women experience complex psychosocial problems – depression, mood swings, sleep disorders, loss of social, professional roles, and poor ego integrity. Poor compliance to recommended lifestyle modifications and limited knowledge could impede a better overall health-related quality of life (QOL). The poor QOL among high proportionate of menopausal phase of women would place a significant burden on public health care in developing countries like India. The existing biomedical health-care model in developing nations focuses mainly on curative aspect, giving prime importance to treatment of medical symptoms to minimize the impact of those on the psychosocial transition in the menopausal period. This biomedical perspective model has limited influence on health-related QOL since health is a multidimensional concept that incorporates domains related to physical, emotional, and social functioning. Health-related QOL goes beyond the direct approach of a medical model of health and focuses on the QOL consequences of health status and the holistic well-being. Measures of well-being typically assess the positive aspects of a person's life such as positive emotions and life satisfaction. Menopausal symptoms have negative impact on QOL among women. Epidemiological studies reported higher prevalence (40%–60%) of physical, psychological, vasomotor, and sexual disorders among menopausal women and a positive linear relationship between menopausal changes and QOL., While it is true that various treatment modalities are available for menopausal symptoms, women in general compromise the health-seeking behavior and silently suffer with symptoms which may invariably affect QOL. The multiple paradigmatic pattern of symptoms associated with menopausal stage and the subjective evaluation of the impact of these symptomatologies in the holistic welfare of woman are overlooked by the health personnel. Nonetheless, there is scarcity of research that explores the impact of menopausal symptoms on health-related QOL among women in India. Hence, this study was undertaken to explore the impact of menopausal symptoms on health-related QOL among women in a postreproductive life span developmental period and its association with sociodemographic characteristics. The findings of this study may govern the attitude of health-care personnel to use community-based health-care interventions in improving the menopausal health-related QOL outcomes among women.
| Methods|| |
With the assistance of female medical social worker, a house-to-house survey was carried out to identify postmenopausal women aged between 40 and 60 years at Arekere, Mico-Layout primary health center (PHC) area, Bangalore South, Karnataka, India, from January to December 2016. A total of n = 140 women who had attained physiological menopause were recruited by purposive sampling method. Those women who were on hormonal therapy or any form of complementary or alternative treatment for menopausal symptoms and medical risk factors were excluded from the study. Based on the prevalence of menopausal symptoms as 47.4% from the previous study  among menopausal women in India with an acceptable error of 10% at 95% confidence interval (CI), the sample size was calculated by n = 4pq/D2. Taking into consideration about missing data, withdrawal, and nonrespondents by 40%, a total of n = 140 women in the menopausal period were included in the study. An ethical clearance was obtained from the Bruhat Bengaluru Mahanagara Palike – District Health and Family Welfare Officer (Maternal Child Health and Family Welfare) and Medical Officer In-charge of Arekere, PHC, which cater primary preventive services to the Arekere residents. Participants were informed about the purpose of the study, and oral informed consent was obtained. Participants were assured that they can withdraw themselves from the study at any time, findings would not be linked to individuals, and that all study events and materials would maintain confidentiality. Participants were not considered to be at risk of harm. They were informed that the duration of the interview would be approximately 25–30 min.
Participants' sociodemographic characteristics such as age, education, income, and occupation were collected. Data on menopausal symptoms experienced over the last 1 month were collected by the 2004 Version of Menopause-Specific QOL (MENQOL)-Intervention Questionnaire from Toronto, Canada Women's Health Society. The tool was translated into Kanada and back to English by the language experts and was subjected to content validity. The computed content validity index was 0.89. The tool was pilot tested among 20 participants, and the reliability correlation coefficient yielded 0.9. The tool has 29 items spread over four domains; physical (16 items), vasomotor (3 items), psychosocial (7 items), and sexual (3 items) on a 7-point Likert scale ranging from 0 – not at all bothered to 6 – extremely bothered. For the analysis, score 1 for “No” and 2 for “Yes” given. The mean scores of the symptoms in each domain were computed by dividing the sum of scores by the number of participants.
SPSS Software (Version 20, Chicago, IL, USA) was used to compute data. Sociodemographic characteristics and the prevalence of menopausal symptoms were analyzed and presented as means, standard deviations, and percentages. Student's t-test was used to compare the sociodemographic characteristics and MENQOL in different domains. An alpha of <0.05 was considered statistically significant.
| Results|| |
A total of n = 140 women were interviewed. The mean age of the participants was 52.6 + 4.24 years, ranging from 42 to 57 years. The mean age of women at menopause was 49.59 + 3.09 years. Majority (95%) were literate with higher secondary and university education and 92% were employed. Most of them (94%) had an active lifestyle and a few (6%) were leading a sedentary lifestyle. In relation to socioeconomic class, 88% belonged to Class I (high-income group) and 12% were in Class II–IV (middle- and low-income group). Regarding the duration of menopause, 63% had <5 years of duration and 37% had >5 years of duration. In relation to the pattern of menstruation, 63.8% had profuse bleeding before the cessation of menstruation, for which they had sought gynecological treatment, 28.9% had normal cessation, and 13.3% had an abrupt cessation of menstruation.
The prevalence of menopausal symptoms
A total of 97.14% women experienced at least five or more menopausal symptoms. The most common prevalent menopausal symptoms among women were related to the physical health-related QOL. The highest number of women (74.56%) experienced physical symptoms such as frequent back pain in the lumbar region (96%), decrease in physical strength (92%), generalized weakness, tiredness (89%), weight gain (88%), pain in the neck (88%), generalized musculoskeletal pain (87%), lack of energy (85%), difficulty in sleeping (85%), frequent flatulence problems (78%), poor physical energy (78%), changes in appearance, texture, and tone in the skin (75%), stress incontinence while laughing or coughing (69%), dryness of skin (55%), increased frequency in micturition (42%), feeling bloated (47%), and growth of facial hair (40%). Of the participants reported, there were various problems such as experiencing depressive feeling for unknown reasons (69%), anxiety and nervousness (64%), dissatisfaction with personal life (64%), poor memory (47%), feeling low (69%), and impatience and irritability (17%). A few expressed the desire to be left alone most of the time (8%). Vasomotor symptoms were experienced by 60.7% of menopausal women in the form of hot flushes (67%), sweating (56.4%), and night sweating (57.9%). Sexual problems reported by 26.4% of the women in the form of changes in sexual drive (30.7%), vaginal dryness (30%), and a few (18.6) avoided intimate contact with the partners [Table 1].
Mean Menopause-specific Quality of Life Questionnaire scores in different domains as per sociodemographic characteristics
The mean physical health-related QOL score in 50 years and <50 years of age and >50 years of age was 23.01 + 0.14 vs. 31.01 + 0.14, psychological health-related QOL score 11.12 + 10.04 vs. 13.65 + 0.04; vasomotor health-related QOL score 2.94 + 1.17 vs. 5.18 + 0.71; and sexual health-related QOL score 2.42 + 0.84 vs. 5.29 + 0.17.
The health-related QOL was better in women with higher education. Menopausal women who had higher secondary and university education had lower QOL scores as compared to those with the lower level of education in all the domains. MENQOL score of physical health-related QOL 22.87 + 1.21 vs. 31.34 + 0.44; psychological health-related QOL score 10.17 +1.02 vs. 13.56 + 0.03; vasomotor health-related QOL score 2.61 + 1.03 vs. 5.51 + 0.09; and sexual health-related QOL scores 2.32 + 0.53 vs. 5.31 + 0.47.
The socioeconomic class also revealed a significant difference in health-related QOL scores in all the domains. Women who were from higher-income group had good MENQOL scores in physical (23.04 + 1.07 vs. 31.07 + 0.09); psychological (10.44 + 0.09 vs. 13.36 + 0.41); vasomotor (3.10 + 0.81 vs. 5.09 + 0.76); and sexual health-related QOL scores (2.41 + 0.84 vs. 5.44 + 3.93) as compared to those from lower-income group.
Lifestyle also showed a significant difference in menopausal QOL in all the four domains. Menopausal women who were physically active had a lower-quality score among physical, psychological, vasomotor, and sexual as compared to those who led a sedentary lifestyle. The MENQOL score in physical health-related QOL was 23.08 + 1.01 vs. 31.21 + 0.46; psychological health-related QOL was 10.18 + 0.14 vs. 13.61 + 0.21; vasomotor health-related QOL was 3.05 + 1.01 vs. 5.10 + 0.69; and sexual health-related QOL was 2.76 + 0.94 vs. 5.09 + 0.67 [Table 2].
|Table 2: Domains mean scores of menopausal women according to sociodemographic characteristics|
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The overall mean MENQOL score in physical (27.1 + 0.72), psychological (2.01 + 0.27), vasomotor (4.08 + 0.79), and sexual (3.89 + 0.59) health-related QOL among menopausal women showed poor QOL [Table 3].
|Table 3: Mean menopausal health-related quality of life scores in domains|
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| Discussion|| |
A primary health-care model should comprehensively cater to the health needs of people, exceptionally the women in the menopausal phase of life, at risk for chronic physical, psychological, and social morbidity. It is estimated that Indian women are expected to spend nearly 23.5 years in the postmenopausal period with a mean menopausal age of 47.5 years and life expectancy of 71 years (Indian Menopause Society, 2007). Recognizing health problems at the earliest would enhance the health-related QOL among women in the next one-third of their postmenopausal life span period.
In the present study, the mean age of menopausal women was 49.59 + 3.09 years, which is in good agreement with the findings of earlier studies of Cyriac et al. in Kerala (49 + 3.6 years), Sagdeo and Arora  in Nagpur (49.67 ± 6.53 years), Ruchika et al. in Agra (48.26 years), Borker et al. in Kerala (48.26 years), Kaulagekar  in Pune (48.3 ± 1.9 years), Sharma and Mahajan  in Jammu (47.35 years), and Singh and Pradhan  in Delhi (46.24 ± 3.38 years). However, the higher mean age at menopausal period was reported from developed  countries (51.6–52.8 years). These differences could be ascribed to variations in genetic, environmental, and lifestyle factors.
Socioeconomic status is one of the detrimental factors that could invariably influence the women to attain menopause earlier than the expected age. The present study indicated that women from class I (higher-income group) attained menopause at 49.37 + 2.21 years as compared to women from Class II, III, and IV (lower-income group) socioeconomic status (42.34 + 2.03). A cross-sectional study by Poomalar and Arounassalame  on the occurrence of menopausal symptoms in Southern India reported that women who belonged to the lower-income group reached menopause at 43.3 years as compared to women in middle class, with a mean age of 47.5 years. Kapur et al., who investigated the onset of climacteric symptoms among women from Haridwar District of Uttarakhand, Northern India, reported that poorer socioeconomic background women reached menopause at 42.13 years earlier than those women from middle and upper socioeconomic status (45.47 years). These findings suggest that income is an important factor that has a linear relationship with the quality health outcomes.
This study highlighted that overall menopausal health-related QOL was comparatively better among women who were educated than those with no such formal education in physical, psychological, vasomotor, and sexual domains. Abedzadeh Kalarhoudi et al. corroborate the findings revealing that women with university education had improved QOL scores in physical and psychological domains as compared to illiterates (1.99 ± 1.20, P < 0.001; and 1.66 ± 0.88, P = 0.01; respectively). This could be explained by the fact that educated people tend to have improved health-related QOL by their healthy behavior, uptake of preventive measures, and positive lifestyles.
Active lifestyle has beneficial effects on satisfaction with life, physical, and emotional well-being and positively associated with minimal sleep disorders, mood swings, and better cognitive functions. Women who are physically inactive report poor psychosocial health. Our study showed that women, who were physically active and lead a healthy lifestyle, had better QOL scores in physical, psychological, vasomotor, and sexual domains as compared to women who had a sedentary lifestyle and physically inactive. Being physically active improves the holistic QOL. A cross-sectional survey by Kakkar et al. conducted in Mohali, India, is in line with our study findings, indicating that nonworking and sedentary lifestyle women significantly suffer with higher frequencies of psychosomatic and urogenital disorders (P ≤ 0.017) than those working and active lifestyle behavior women. A population-based study in Finland  reported consistent results that physically inactive women had an increased probability of anxiety/depressed mood (proportional odds ratio [POR] 1.44; 95% CI 1.26–1.65), of decreased well-being (POR 1.96; 95% CI 1.71–2.25), of somatic symptoms (POR 1.61; 95% CI 1.40–1.85), of memory/concentration problems (POR 1.48; 95% CI 1.29–1.70), and of vasomotor symptoms (POR 1.19; 95% CI 1.03–1.36) as compared to physically active women. Physically active women had higher chances of achieving good QOL and fewer menopausal health problems (eb = 1.49, 95% CI 1.23, P < 0.001–1.80, eb = 1.46, 95% CI 1.24–1.73, P < 0.001, respectively). A recent cross-sectional study conducted in Iran  among n = 600 menopausal women showed a significant correlation between physical activity and physical health, social functioning, anxiety, and depression (P< 0.05).
However, contradictory findings were reported by Kaulagekar  that the prevalence of menopausal symptoms was comparatively minimal in homemakers as compared to employed women (76% vs. 85%). Our study showed that working women enjoy better QOL than the homemakers which could be attributed to greater social networking, economic independence, higher self-esteem, and ego integrity that women working outside the home enjoy with. Our findings revealed that the health-related QOL was generally low among menopausal women. Regarding the physical symptoms, most of the women (74.56%) reported a higher prevalence of back pain in the lumbar region, decreased physical energy, generalized weakness, musculoskeletal pains, and shoulder and joints pain and a significant weight gain with minimal dietary intake, difficulty in sleeping, and stress urinary incontinence. Karmakar et al., who conducted a study on QOL among menopausal women in West Bengal, reported consistent findings that 93% of the women experienced physical symptoms of poor physical stamina (88%), musculoskeletal pain (84%), flatulence or pain due to gas (81%), pain in the neck and headache (76%), low back pain (69%), frequency in urination (63%), and dryness of skin, changes in the appearance, and skin tone (40%). A cross-sectional  survey in Kerala showed that nearly 92.7% of the women in the menopausal stage experienced musculoskeletal pain, 88% headache, 62.1% numbness in hands and feet, and 61.1% breathing difficulties. A cross-sectional study by Ruchika et al. among women in Agra supported these findings saying that 70% of the women suffered with muscular and joint pain and 46.7% with low backache as the most frequent physical problems in their menopausal life. A cross-sectional study by Joshi et al. in Gujarat, India, corroborates the same findings, indicating that fluctuations in weight (83.7%), cracks in the nails (97.9%), visual problems (86.9%), constipation (86.1%), and pain in hands and legs (26.4%) were the most predominant menopausal symptoms. Ahlawat et al.'s study  in Delhi among 580 postmenopausal women agrees with these results, indicating that 89.5% of the women were experiencing physical ailments such as joint/muscle pain, fatigue (66.4%), hot flashes (44.3%), weight gain (36.4%) as chief physical symptoms.
This present study indicated that higher-income group and educated women reported comparatively fewer frequencies of physical complaints than those women in low-income and illiterates (P< 0.05). Kakkar et al. agree with our findings by saying that somatic complaints were more among unemployed women (P ≤ 0.017) and sedentary women than those with active lifestyle and leading a professional life. Kaulagekar  contradicted these findings, reporting that the working women had experienced a higher proportion of physical symptoms (76% vs. 85%) than the women who were homemakers due to work and family imbalance. This could be due to the impact of education and income on maximal utilization of preventive health measures and lifestyle behavior.
Hot flashes, generalized sweating, and night sweats are the most common prevalent vasomotor symptoms in menopausal age. The physiological mechanisms contributing to these symptoms in the postmenopausal period are incompletely understood but believed to be the consequences of estrogen. These vasomotor symptoms such as hot flushes and sweating may result in emotional outburst, poor concentration at work, and sleep disorders. Study of Women's Health Across the Nation reports that nearly 65%–80% of the women experience vasomotor symptoms and it may last for 1–10 years or longer than that in postmenopausal life. Besides physical problems, vasomotor symptoms (60.7%) was the most frequently reported complaint of menopausal women in our study. A vast majority of the women reported hot flushes, night sweats, and generalized sweating. A study by Dasgupta et al. among tribal and caste women in West Bengal, India, reported that 40.4 versus 38.4 of the tribal and caste women experienced hot flushes and night sweats (54.7 vs. 53.9). Chowta et al., Kaulagekar, and Poomalar and Arounassalame  validate our findings by saying that 89%, 80%, and 70%, respectively, experienced more frequent attacks of vasomotor symptoms of hot flushes and night sweats in the menopausal period. A cross-sectional hospital-based study among Pakistan women by Nisar and Sohoo  revealed that 68.8% of the participants reported vasomotor symptoms of hot flashes and 2% sweating at night. Joshi et al. reported that 78% of the women experienced hot flashes. Similarly, Ruchika et al. reported that nearly 45% of women suffered with hot flushes and night sweating. Karmakar et al. too reported similar results that 60% of the women suffer with vasomotor symptoms and 47% with sweating at night.
Whether menopause results in poor psychological health continues to be debated and women may experience mood disorder, anxious feelings, nervousness, irritability, and emotional outburst. Nearly 45% of the participants reported psychological problems of difficulty in sleeping, palpitations, nervousness, tension, anxiety, panic attack, poor concentration, lack of energy, loss of interest, depression, crying, an outburst of anger, and irritability in our study. A study in Daerah village of West Bengal, India, among menopausal women corroborates the findings, showing that 94% of the participants reported anxiety and nervousness and feeling tired, decrease physical stamina (93%). A study by Satpathy  at Western Odisha, India, reported that 75% of the menopausal women were suffering from various psychological problems such as forgetfulness (59%), irritability (42%), anxiety (42%), worry about body image (75%), confusion (46%), loss of control over emotions (27%), feeling that something is crawling on skin (24%), and poor concentration (17%).
A study in Kerala  reported that huge proportionate of menopausal women (90.7%) suffer from various emotional problems in varying degree and intensity. The precise mechanism related to psychological problems in menopause is not yet known although the fluctuations in estrogen level and its effects on neurotransmitters serotonin and norepinephrine may be the contributing factors for menopausal mood swings, poor emotional well-being, and depression. In addition, societal expectations and role changes due to the advancing age may contribute to the heightened rate of depression in women. Sexual dysfunction after menopause is a complex problem with many etiologies. The dramatic cessation of estrogen may lead to vaginal dryness, vaginal lubrication, and dyspareunia, which in turn decrease sexual drive The prevalence rate of sexual problems among the postmenopausal women ranges from 68% to 86.5%.
This study found that nearly 88% of the women experienced vaginal dryness and changes in sexual desire and intimate relationship with partners. A cross-sectional study by Santpure et al. in Maharashtra among postmenopausal women corroborates that sexual activity decreased from 54.4% to 5.6% in menopause and women avoid sexual activity related to decreased sexual energy (10.7%), vaginal dryness (55.36%), and painful intercourse (10.7%). A study in West Bengal  among tribe and caste women showed that genital complaints such as vaginal dryness (45.9 vs. 7.1%), burning sensation (9.3 vs. 5.0%), vaginal discharge (32.6 vs. 13.5%), vaginal itching (14.0 vs. 12.1%), and bad smell (11.6 vs. 2.1%), and urinary problems – burning micturition (25.6 vs. 17.7%), inability to retain urine (47.1 vs. 64.5%), frequent urination (29.1 vs. 38.3%), and urine leakage (23.8 vs. 51.1%) – were the most frequently reported menopausal symptoms. Another study  reported that 75.5% of menopausal women experience sexual problems, 90.7% bladder problems, and 51.5% dryness of the vagina. A study among Pune, Maharashtra urban women, revealed consistent results that 22% suffer from frequent urination, 17% vaginal dryness, and 16.3% reduced sexual desire. A study  in Nagpur reported that 40.8% of postmenopausal women experienced vaginal dryness and 3.6% sexual problems such as dyspareunia and loss of sexual intimacy.
In the present study, the menopausal women showed a considerably poor QOL in the physical, psychological, vasomotor, and sexual domains. These findings were homogenous with a study in Pakistan  that reported 99% of the menopausal women suffer from physical problems, 96% with psychological disorders, 71% with vasomotor symptoms, and 66% with sexual dysfunctions. Consistent findings were reported by Karmakar et al. that mid-life women suffer with the occurrence of vasomotor symptoms – hot flushes (60%) and sweating (47%), and of psychosocial symptoms – feeling of anxiety and nervousness (94%) and depression (88%). The prevalence (93%) of physical symptoms was related to poor stamina (88%), aches in muscles or joints, difficulty in sleep (84%), flatulence or gas pains (81%), pain in the neck or head (76%), low backache (69%), frequent urination (63%), dryness of the skin and changes in appearance, texture, and tone (40%), and with hair growth in the face (5%).
Similar results were reported by Nayak et al. that menopausal women suffer with higher frequencies of somatic symptoms of tiredness (67.5%), decreased physical energy (64.1%), muscles and joint pain (55.0%), neck pain or headache (54.5%), gas pain (50.7%), low backache (51.7%), lack of energy (47.8%), difficulty in sleeping (44%), feeling bloated (38.8%), involuntary urination while laughing, coughing (38.8%), poor memory (73.7%), negative ideas (47.4%), and nervousness (40.2%). Symptoms related to experiences of vasomotor and sexual aspects were relatively less with 32.1% reporting hot flushes, 24.9% night sweats, 23% vaginal dryness, and 26.8% changes in sexual desire. A study in the Kingdom of Saudi Arabia  among 90 women reported hot flushes (29.0%), poor memory (48.3%), dissatisfaction with personal life (44.8%), low backache (41.9%), changes in their sexual desire (36.8%), night sweats (54.2%,), sweating (56.3%), anxiety (51.7%), flatulence (68.4%), sleeping disorder (67.5%), increased facial hair (67.7%), and avoiding intimacy (60.5%).
In this study, women aged <50 years, with higher education, income, attained menopause <5 years of duration, and who were physically active had lower scores in physical, psychological, vasomotor, and sexual domains as compared to women >50 years of age, with no formal education, lower income, duration of menopause >5 years, and with sedentary lifestyle behaviour. Concurrent findings were reported by a cross-sectional study among menopausal women in Hong Kong  that QOL was better among women with higher educational level (P = 0.005) and physically activities (P ≤ 0.001). A study by Yanikkerem et al. reported that menopausal women with no formal education had poor QOL scores in physical, psychosocial, and vasomotor symptoms (4.1 ± 2.0, 3.1 ± 1.6, and 3.2 ± 1.4, respectively) as compared to those educated with good QOL. Sedentary workers such as homemakers had higher QOL scores in physical health (3.2 ± 1.40) and vasomotor symptoms (4.0 ± 1.9) than women performing physical activity. A Taiwan cross-sectional study  among 1250 women between 43 and 77 years of age revealed that the menopausal age and educational level have direct impact on QOL in physical and emotional aspects of life. A study  among n = 100 menopausal women revealed a significant correlation of psychological symptoms and physical symptoms with age above 50 years (4.06, 1.67–9.83) and educational level (0.38, 0.16–0.91).
The findings may not be generalizable to other setting as the participants were from diverse socioeconomic backgrounds of a cosmopolitan Bangalore city.
| Conclusion|| |
The current study revealed that age, education, socioeconomic status, and active lifestyle factors were significantly related to an increase in frequency, intensity of menopausal symptoms, and poor physical, psychological, vasomotor, and sexual health-related QOL among women in the postreproductive period. From the patient's perspective, primary care health personnel should engage menopausal women to discuss sensitive issues and reassure them that they are being cared for in a holistic manner. An integrative approach of care addressing mind, body, and spirit would ensure that women engage in lifestyle modifications and health-promoting behaviors to improve their QOL in the next one-third of lifespan development.
We are grateful to all the participants and medical social workers of the study setting for their support and cooperation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Doubova SV, Espinosa-Alarcón P, Flores-Hernández S, Infante C, Pérez-Cuevas R. Integrative health care model for climacteric stage women: Design of the intervention. BMC Womens Health 2011;11:6.
Pallikadavath S, Ogollah R, Singh A, Dean T, Dewey A, Stones W, et al.
Natural menopause among women below 50 years in India: A population-based study. Indian J Med Res 2016;144:366-77.
] [Full text]
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.
The world health organization quality of life assessment (WHOQOL): Position paper from the world health organization. Soc Sci Med 1995;41:1403-9.
Borker SA, Venugopalan PP, Bhat SN. Study of menopausal symptoms, and perceptions about menopause among women at a rural community in Kerala. J Midlife Health 2013;4:182-7.
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.
Singh A, Pradhan SK. Menopausal symptoms of postmenopausal women in a rural community of Delhi, India: A cross-sectional study. J Midlife Health 2014;5:62-7.
Cyriac SL, Viswanath L, Philip AT. Menopausal problems among postmenopausal women. JSAFMS 2015;4:88-92.
Sagdeo MM, Arora D. Menopausal symptoms: A comparative study in rural and urban women. JK Sci J Med Educ Res 2011;13:23-6.
Ruchika G, Rajani R, Manisha P, Lalitha GM, Renu R. Menopausal symptoms among postmenopausal women of North India: A cross-sectional study. JSAFMS 2015;3:3-5.
Kaulagekar A. Age of menopause and menopausal symptoms among urban women in Pune, Maharashtra. J Obstet Gynaecol India 2011;61:323-26.
Sharma S, Mahajan N. Menopausal symptoms and its effect on quality of life in urban versus rural women: A cross-sectional study. J Midlife Health 2015;6:16-20.
Palacios S, Henderson VW, Siseles N, Tan D, Villaseca P. Age of menopause and impact of climacteric symptoms by geographical region. Climacteric 2010;13:419-28.
Poomalar GK, Arounassalame B. The quality of life during and after menopause among rural women. J Clin Diagn Res 2013;7:135-9.
Kapur P, Sinha B, Pereira BM. Measuring climacteric symptoms and age at natural menopause in an Indian population using the Greene climacteric scale. Menopause 2009;16:378-84.
Abedzadeh Kalarhoudi M, Taebi M, Sadat Z, Saberi F. Assessment of quality of life in menopausal periods: A population study in Kashan, Iran. Iran Red Crescent Med J 2011;13:811-7.
Villaverde-Gutiérrez C, Araújo E, Cruz F, Roa JM, Barbosa W, Ruíz-Villaverde G, et al.
Quality of life of rural menopausal women in response to a customized exercise programme. J Adv Nurs 2006;54:11-9.
Kakkar V, Kaur D, Chopra K, Kaur A, Kaur IP. Assessment of the variation in menopausal symptoms with age, education and working/non-working status in North-Indian sub population using menopause rating scale (MRS). Maturitas 2007;57:306-14.
Mansikkamäki K, Raitanen J, Nygård CH, Tomás E, Rutanen R, Luoto R, et al.
Long-term effect of physical activity on health-related quality of life among menopausal women: A 4-year follow-up study to a randomised controlled trial. BMJ Open 2015;5:e008232.
Sharifi N, Jalili L, Khazaeian S, Nia AN. The relationship between physical activity and general health among menopausal women in Ahvaz, Iran. Electron Physician 2017;9:3639-45.
Karmakar N, Majumdar S, Dasgupta A, Das S. Quality of life among menopausal women: A community-based study in a rural area of West Bengal. J Midlife Health 2017;8:21-7.
Joshi, Nair S. Epidemiological study to assess the menopausal problems during menopausal transition in middle age women of Vadodara, Gujarat, India. Indian J Obstet Gynecol Res 2015;2:163-8.
Ahlawat P, Singh MM, Garg S, Ramalingam. Prevalence of postmenopausal symptoms, health seeking behavior and associated factors among postmenopausal women in an urban resettlement colony of Delhi. Int J Health Sci Res 2016;6:51-6.
Deecher DC, Dorries K. Understanding the pathophysiology of vasomotor symptoms (hot flushes and night sweats) that occur in perimenopause, menopause, and postmenopause life stages. Arch Womens Ment Health 2007;10:247-57.
Thurston RC, Joffe H. Vasomotor symptoms and menopause: Findings from the study of women's health across the nation. Obstet Gynecol Clin North Am 2011;38:489-501.
Dasgupta D, Karar P, Ray S, Ganguly N. Menopausal symptoms and its correlates: A Study on tribe and caste population of East India. Curr Gerontol Geriatr Res 2015;2015:984767.
Chowta NK, Sebastian J, Chowta MN. Comparative study of menopausal symptoms in post-menopausal and perimenopausal women. J Clin Diagn Res 2008;2:959-62.
Nisar N, Sohoo NA. Frequency of menopausal symptoms and their impact on the quality of life of women: A hospital based survey. J Pak Med Assoc 2009;59:752-6.
Satpathy M. A cross-sectional study on the health status of menopausal women in Jharsuguda District, Odisha. Int J Sci Res 2016;5:899-901.
Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J Psychiatry 2015;57:S222-32.
Ambler DR, Bieber EJ, Diamond MP. Sexual function in elderly women: A review of current literature. Rev Obstet Gynecol 2012;5:16-27.
Santpure AS, Nagapurkar SN, Giri P
A, Bhanap PL. Female sexual dysfunction amongst rural postmenopausal woman. Int J Reprod Contracept Obstet Gynecol 2016;5:4385-9.
Nayak G, Kamath A, Kumar P, Rao A. A study of quality of life among perimenopausal women in selected coastal areas of Karnataka, India. J Midlife Health 2012;3:71-5.
Mohamed HA, Lamadah SM, Al. Zamil L Gh. Quality of life among menopausal women. Int J Reprod Contracept Obstet Gynecol 2014;3:552-61.
Li S, Ho SC, Sham A. Relationship between menopause status, attitude toward menopause, and quality of life in Chinese midlife women in Hong Kong. Menopause 2016;23:67-73.
Yanikkerem E, Koltan SO, Tamay AG, Dikayak Ş. Relationship between women's attitude towards menopause and quality of life. Climacteric 2012;15:552-62.
Chiu YW, Moore RW, Hsu CE, Huang CT, Liu HW, Chuang HY, et al.
Factors influencing women's quality of life in the later half of life. Climacteric 2008;11:201-11.
[Table 1], [Table 2], [Table 3]