Prevalence of menopausal symptoms and health-seeking behavior of school teachers with menopausal symptoms in Kumbakonam, South India

INTRODUCTION

Menopause an inevitable phenomenon is an important landmark in the life of women experienced by 1.5 million women every year.¹ The World Health Organization defines menopause as the permanent cessation of menstrual periods that occurs naturally or is induced by surgery, chemotherapy, or radiation.² Middle age is the bridge between young and old age which is more affinity towards physical and mental health regarding issues occupies the whole.³

According to the Indian Menopause Society, there are about 65 million Indian Women over the age of 45 years.^4,5 The transitional period is classified into three phases namely, pre-menopause, peri-menopause, and post-menopause which indicates the entire life after menopause.⁶

Those turmoils coincide with a progressive decline of female hormones, culminating in a total shutdown from the ovaries resulting in various vasomotor, psychological, and urogenital symptoms.^7,8 There are also some serious medical concerns related to menopause firstly loss of bone density, which results in osteoporosis, and heart disease risk may grow due to age-related increases in weight, blood pressure, and cholesterol levels.³ As women approach the period of menopause, an estimated 85% of women reported atleast one menopausal symptom, and only 10% of the women seek health care.^9,10

Since the reproductive and child health scheme was adopted, more studies done for the reproductive age group but little effort has been made to study the needs of women in their late reproductive years. An upward trend in life expectancy has led women to spend half of their lives after menopause.¹¹ Various studies revealed that menopausal symptoms predominantly affect women in the workforce because of the increasing stress in the working environment, as teachers have essential duties concerning qualification and education.¹²

A determination of the most common medical problem in this broad occupational group serves as the basis for measures that help to maintain the health of the teachers and their ability to work in their profession.

Aim and objectives

The present study aimed to estimate the prevalence of menopausal symptoms and to determine the health seeking behavior among school teachers in Kumbakonam, Tamil Nadu.

METHODS

A descriptive cross-sectional study was conducted from June to September among middle-aged school teachers including government, government-aided and self-financing schools in Kumbakonam taluk. The period of study was from July 2022 to December 2022.

Sample size

Sample size was estimated using the formula for sample size for proportions, with the prevalence of menopausal symptoms by 25% obtained from a pilot study of 30 respondents in same area, with 95% confidence Interval and 5% absolute precision was calculated to be approximately was 288.

Inclusion criteria

All school teacher who is in the age group of 40 and 60 years, and at the stage of peri-menopause and post-menopause were included in the study.

Exclusion criteria

Women with induced menopause, hysterectomy, receiving any kind of hormonal replacement therapy in preceding six months were excluded from the study.

Data collection

After obtaining institutional ethical committee approval, permissions from District Educational Officer and Principal of respective school were obtained. Data collection was proceeded using stratified sampling technique. A total of 264 middle aged women under 40-60 years of age were interviewed using semi-structured questionnaire and menopause rating scale (MRS), the overall MRS score was generated by summing up the scores given for eleven symptoms. The subscale score was also generated by summing up the relevant scores for each symptom that were given in four-point Likert scale as none=0, mild=1, moderate=2, severe=3. followed by health seeking behavior questions.

Operational definition

Peri-menopausal

The period immediately prior to menopause characterized by irregular menses without skipping cycles, experienced after the previously regular cycles when the endocrinological, biological and clinical features of approaching menopause.

Post-menopause

The period can be defined as dating from the menopause, although it cannot be determined until after a period of 12 months of spontaneous amenorrhea has been observed.

Health seeking behavior

Sequence of remedial actions that an individual undertakes to rectify perceived ill health, which includes self-care, change in diet, home remedies, rest, treatment compliance, consult with family, friends and neighbors, seeking either traditional or biomedical care.

Description of the tool

The data collection tool consists of three parts.

Part 1

Socio demographic and general health information, knowledge on menopause, present menstrual history.

Part 2

MRS is a self-reported subjective scale that has been used in different international populations and validated in clinical and different epidemiological studies on menopause symptoms. The MRS was organized with multiple items graded from 0-3 (0- not present), (1-mild), (2-moderate), (3-severe, in which case the symptoms were so bothersome which disturb the daily activities of life) with three main groups - somatic symptoms: hot flashes, heart discomfort, sleep disturbances, muscle and joint problem; psychological symptoms: depression, irritability, anxiety, physical and mental exhaustion; and urogenital symptoms: sexual problems, bladder symptoms, dryness of vagina.¹³

Part 3

Health seeking behavior of women. This part of the study was conducted with a structured questionnaire containing straight dichotomous and close-ended questions. This was designed after informal conversations with the menopausal women in the schools about their health seeking behavior.

Data analysis

Data collected were entered in Microsoft excel 2016 for its completeness and correctness. Later subsequently analysed using statistical package for the social sciences (SPSS) 25 software package. Quantitative variables were presented as frequency, percentage, mean, and SD.

RESULTS

Socio-demographic characteristics of the study population

A total of 264 school teachers in the age group of 40-60 years, predominantly belonging to the age group of 51-55 years with 51.2%. The mean age of the women included in the study was 51.67 years ±4.9 SD.

The prevalence of menopausal symptoms is 93.5% with confidence interval (LL – UL).

Being school teachers, the majority 42.8% (113) of women working in the government sector as high school teachers with 64.8% (171). The majority 39% of women earn more than 40,000. The marital status of the women was also studied, 79.5% (210) of them are married and belonged to a nuclear family with 55.3% (146). Almost half 124 (47%) of the women had health insurance.

With regard to menopausal status, Figure 1 depicted that amongst 264 women, the majority 134 (50.8%) were post-menopausal women and 130 (49.2%) were peri-menopausal women.

Profile and severity of menopausal symptoms among peri-menopausal women

The most prevalent symptom among the peri-menopausal women was irritability with (89) 68.5%, (86) 66.1%, and (86) 66.2% of the women suffering from physical and mental exhaustion followed by joint and muscular pain. In accordance with the data obtained, 22 (16.9%) of the women categorized their irritability symptoms as severe in nature and 18 (13.8%) classified physical and mental exhaustion as severe in nature. Bladder symptoms recorded the least prevalence with only 24 participants (18.5%) presenting with such complaints.

*Living alone

Profile and severity of menopausal symptoms among post-menopausal women

The predominance of joint and muscular pain affects 99 (73.9%) of post-menopausal women, followed by sleep problems, and physical and mental exhaustion with 94 (70.2%) and 85 (63.4%) respectively in descending order of prevalence of symptoms. Sexual problems recorded the least prevalence with only 31 participants 23.1% presenting with such complaints (Table 3).

According to the MRS, Table 4 showed the overall score of the peri-menopausal and postmenopausal women (MRS). Out of 264 teachers, 75 (28.4%) classified their symptoms as mild, 80 (30.3%) as moderate, and 46 (17.4%) as severe in nature.

Health seeking behavior of the participants

Health-seeking practices were quite unsatisfactory in the teachers, 84(31.8%) of the respondents sought health care services for their menopausal symptoms (Figure 2).

Women turned to a wide range of sources, primarily their friends and families, for assistance with menopausal symptoms at (72) 17.3%, and general practitioners (50) at 18.9%. 14% (37) of those interviewed resorted to specialized doctors for assistance, followed by the media (9.1%), traditional leaders (5.7%), and pharmacists (1.5%).

Only (64) 25.4% of the women went to the specific treatment; 20.5% (54) of women went to seek care from a female doctor, and 28.9% (76) sought lifestyle modifications such as meditation and yoga (Table 5).

Figure 3 depicted the knowledge of women on services available at the hospital for menopausal symptoms, 71 (26.9%) of the study subjects does not know about the services available.

*Multiple responses

In Table 7, Chi-square depicted that age, type of organization, and health insurance had a significant association with the health-seeking behavior of the participants (p<0.05).

DISCUSSION

A multi-centric school-based cross-sectional study was conducted to determine the prevalence of menopausal symptoms and health-seeking behavior of school teachers having menopausal symptoms in the age group 40-60 years in Kumbakonam The mean age of the women included in the study was 51.67 years ±4.9 SD.

The study revealed that 68.5% (89) of peri-menopausal women experienced irritability as the most prevalent symptom followed by (86) 66.1%, and (86) 66.2% of the women suffering from physical and mental exhaustion and joint and muscular pain respectively. Supported by similar studies carried out by Ganitha et al and Myint et al in Tamil Nadu and Tampin showing similar results that irritability, and joint and muscular pain as the prevalent symptoms of peri-menopausal women.^14,15

In the present study, bladder problems were least prevalent (17.7%) followed by dryness of the vagina 23.8% among peri-menopausal women. The results will be comparable with Du et al, where bladder problems and sexual dysfunction were the least experiencing symptoms with 2.01% and 2.68% respectively.¹⁰

Among the post-menopausal women, 73.9% (99) of joint and muscular pain were the most prevalent symptoms followed by sleep problems 94 (70.2%) and 85 (63.4%) respectively which is in accordance with Agarwal et al and Joseph et al, Shah et al joint and muscular pain, and physical and mental exhaustion was highly prevalent.^16,17 This is contradicted with Du et al during the postmenopausal stage, hot flushes/sweating (42.2%), fatigue (34.4%), and joint ache (33.8%) were the most common symptoms. The study conducted on post-menopausal women by Alhawat et al and Bairy et al, Ruchika et al supported these findings saying that 70% of the women suffered from muscular and joint pain.^18,20

There are several ways of arresting menopausal symptoms as reported physical activity, healthy diet and alternative therapies. In our present study 84 (31.8%) of the women who had menopausal symptoms sought health care services. Similar studies show that 58.6% respondents were seeking medical advice for menopausal symptoms in Malaysia.²¹ If they sought medical services, 20.5% (54) went to see a female doctor which is supported by Du et al.¹⁰

The majority of the menopausal women believed that there is no need of treatment for these symptoms and think that is normal with age with 10.2% and 35.3% respectively.

Postmenopausal symptoms are normal with age (68.0%) and they don’t need to take treatment for these symptoms. The second most common reason was that they can’t afford the expenses of medicines (19.5%) and some don’t feel like taking medicines (12.5%) Ahlawat et al.¹⁸

The socio-demographic factors such as age, type of organization and health insurance found to be significantly associated with health seeking behavior which is supported by Du et al where the age is found to be associated with health-seeking behavior.

Limitations of the present study include, as this is a school-based study, it does not represent the component of society.

CONCLUSION

Among middle-aged school teachers, menopausal symptoms were highly prevalent. However only a short percentage of teachers sought health care services because of menopausal symptoms. Most of them proceeded the female doctor and followed lifestyle modifications such as medication, physical activity and healthy diet. The majority of teachers were unaware of self-examination of breasts and a PAP smear examination.

Recommendations

Therefore, it is urged that female experts and volunteers from various government health providers spread awareness of the importance of breast self-examination among middle-aged women and their families. Menopause knowledge, attitudes, and awareness of symptoms all need to be enhanced by health education for menopausal management is to be properly balanced between work, family, and health. Through appropriate counselling, it is necessary to eradicate the negative perception of menopause.

ACKNOWLEDGEMENTS

The authors would like to thank all the teachers of the Kumbakonam taluka for their time and cooperation without which this study would have been impossible. The authors acknowledge the support from District Education Office Department, Kumbakonam.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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