A community-based study on menopausal symptoms and quality of life in postmenopausal women in a rural area of West Bengal

INTRODUCTION

World Health Organization has defined post-menopausal women as those women who have stopped menstrual bleeding one year ago or stopped having periods as a result of medical or surgical intervention (hysterectomy/oophorectomy) or both. It is a stage when the menstrual cycle stops for longer than 12 months, and there is a drop in the levels of oestrogen and progesterone, the two most important hormones in the female body (World Health Organization,1996). The onset of physiological development not only marks the end of women's reproductive function but also introduces them to a new phase of life.¹ This phase of life is shrouded with lots of myths and taboos.² Early recognition of symptoms can help in reduction of discomfort and fears among women. With increasing life expectancy, women spend 1/3^rdof life in this phase.³ The elderly population is increasing every year, and it is projected that it would increase to 12% of the total population by the year 2025. In the Western world, the most typical age range for menopause is between ages of 40 and 61.⁴ Average age of menopause is around 48 years, but it strikes Indian women as young as 30-35 years.⁵ Some of the important and common symptoms women can experience during menopausal transition are changes in periods, hot flushes and night sweats, problems with vagina and bladder, changes in sexual desire, sleep problems, mood swings, etc.

There are also some serious medical concerns related to menopause e.g. osteoporosis and heart disease risk that may grow due to age-related increase in weight, blood pressure, and cholesterol levels. Some women have severe symptoms that profoundly affect their personal and social functioning, and quality of life (QOL).⁶ QOL is defined by WHO as the “individual's perceptions of their position in life in the context of the cultural and value systems in which they live and in relation to their goals, expectations, standards, and concerns.”.⁷

This cultural aspect of menopausal symptoms has been described in number of studies among Asian women, including Japanese and Chinese women.^8,9 Studies on issues relating to menopause, especially among rural women, are lacking in India. With this background, the current study has been carried out in a rural area of West Bengal.

METHODS

This was a cross-sectional community based, observational, descriptive study conducted from 1^st July 2024 to 31^st August 2024 in Jagadishpur block, Howrah, West Bengal which is the rural field practice area of Calcutta National Medical College, Kolkata. Ethical clearance was obtained from the Institutional Ethics Committee of Calcutta National Medical College, Kolkata.

The study population included all the postmenopausal women in the said study area who were permanent residents of the area and who gave informed verbal consent. Women receiving any kind of hormone therapy; those with presence of medical conditions e.g. diabetes, hypertension, cardiac disease and thyroid disorders; locked houses or the women who did not give the consent were excluded from the study. The duration of study period was 8 weeks. Considering 2 days a week, data collection was done on 16 days. Assuming the total time required to explain the purpose of the study and other ethical issues, interviewing and attending to any query, it took around 30-40 minutes for each participant to complete the schedule. Keeping this in mind, convenient sample size of 120 was taken. Convenient sampling technique was used.

A predesigned and pre-tested structured schedule was used to collect data regarding sociodemographic characteristics of the postmenopausal women and QOL due to menopausal symptoms based on four domains (vasomotor, psychosocial, physical, and sexual) using the 29-item MENQOL questionnaire by interview method. The responses to the questions were adapted to a 2-point scale consisting of Yes and No options from a 6-point severity scoring pattern in the original version considering the difficulty to answer on a 6-point scale due to low level of education of the respondents.

The MENQOL (Menopause Specific Quality of Life Questionnaire) was introduced in 1996 as a tool to assess health-related QOL in the menopausal period. Vasomotor (items 1-3), Psychosocial (items 4-10), Physical (items 11-26), and Sexual (items 27-29). Items pertaining to a specific symptom are rated as present or not present, and if present, how bothersome on a zero (not bothersome) to six (extremely bothersome) point scale.Means are computed for each subscale by dividing the sum of the domain's items by the number of items within that domain. Data was collected by interview method and presented by tabulation, mean, standard deviation, proportion, percentage, etc. Suitable statistical tests of significance were used as applicable. All statistical analysis was performed using Statistical Packages of Social Sciences (SPSS), version 21.0 (IBM SPSS Inc. Somer, New York).

The independent variables in this study were: Sociodemographic and economic characteristics of the postmenopausal women: age in years, religion- (hindu/muslim), caste- (general/OBC/SC), type of family- (nuclear/joint), marital status- (married/widow), education (illiterate/primary/secondary/higher secondary), occupation- (working/homemaker), type of living house- (kutcha/pukka/mixed), PCI- (lower/upper lower/lower middle/upper middle). The dependant variables were 4 domains of menopausal symptoms as in 29-item MENQOL questionnaire (the Menopause Specific Quality of Life Questionnaire).

RESULTS

Present study observed, majority of the postmenopausal women (36.7%) were in the age group of 46-50 years. The mean age was 49.38±4.22 years with a minimum age of 43 years and maximum age of 58 years. 87.5% of the study population were Hindu and 50% of them were illiterate. 91.7% were homemakers and were currently married. 56.7% of them belonged to nuclear families. 43.3% of them belonged to lower socioeconomic status.

The occurrence of vasomotor symptoms in the study population was average with 67.5% of them reporting hot flushes, 43.3% reporting sweating and 37.5% complaining of night sweats. Most prevalent psychosocial symptoms reported were feeling of anxiety and nervousness (36.7%) and feeling depressed (35.8%). Among other psychological symptoms such as “accomplishing less than I used to do” was 32.5%, experiencing poor memory was 30.8%, dissatisfaction with personal life was 30.0%.Physical symptoms were quite varying in occurrence with feeling tired and difficulty in sleeping- 39.2% followed by aches in back of neck or head-38.3%, flatulence-37.5%, decrease in stamina 35.8%.

Only 6.7% occurrence of facial hair. 30.0%-low backache, 28.3%-frequent urination, 24.2%- drying skin and changes in appearance, texture, tone of skin,16.7%. Involuntary urination when laughing or coughing. Among sexual changes reported by participants were 27.5% reporting of avoiding intimacy, 26.7%- changes in sexual desire and 19.2% of them complaining of vaginal dryness during intercourse. The association between socio-demographic characteristics and MENQOL Questionnaire domain using Pearson’s chi square test.

There is statistically significant association between, vasomotor symptoms of the study participants and their age, education, type of house; psychological symptoms and age of the participants; physical symptoms and education of the participants. No significant association was found between sexual symptoms and socio-demographic characteristics of the study subjects.

Binary logistic regression analysis between Socio-demographic characteristics and MENQOL Questionnaire domain. There is statistically significant association between: vasomotor symptoms of the study participants and their age, education, type of house, psychological symptoms and age of the participants, physical symptoms and education of the participants. No significant association was found between sexual symptoms and socio-demographic characteristics of the study subjects.

Multinomial logistic regression analysis between socio-demographic characteristics and MENQOL Questionnaire domain. There is statistically significant association between: vasomotor symptoms of the study participants and their age, education; psychological symptoms and age of the participants. No significant association was found between sexual symptoms and socio-demographic characteristics of the study subjects.

DISCUSSION

The present study found the mean age of menopause to be 49.38±4.22 years and median age as 49 years. A similar study by Karmakar et al in a rural area of West Bengal found the mean age of menopause as 45.93±8.37 years whereas a study by Nisar and Shoo in Sindh Pakistan found the mean age of menopause as 52.17±6.019 years.^10,11

The most prevalent menopausal symptoms reported were feeling of anxiety & nervousness (36.7%), feeling tired and difficulty in sleeping (39.2%), decrease in stamina (35.8%), depression (35.8%). The occurrence of vasomotor symptoms were-hot flushes (67.5%), sweating (43.3%) and night sweats (37.5%).

Sagdeo and Arora in a comparative study in rural and urban women showed that most common problem was joint and muscular symptoms (60.4%) followed by hot flushes and night sweats (36.7%).¹² The least found symptoms were facial hair (6.7%), vaginal dryness during intercourse (19.2%). Poomala and Arounassalame in Puducherry and Sarkar et al in Jamnagar showed that the least found symptoms were increase in facial hair (15%) and feeling of dryness during intimacy (10.8%).^13,14 In this study, small sample was taken due to limited time, manpower and resources. The symptoms were self-reported by the study participants, so there is chance of over/under reporting.

CONCLUSION

The results of the study support the popular belief that menopause causes both physical and psychiatric problems. Almost all areas or domains evaluated were impaired in menopausal women. A large number of women all over the world suffer from menopausal symptoms and the problem cannot thus be ignored.

Further study of other variables is required which may affect the health status of the post-menopausal women. Education, creating awareness and providing suitable interventions to improve the quality of life in the postmenopausal women are important social and medical issues which need to be addressed.

ACKNOWLEDGEMENTS

We would like to thank the Principal, Calcutta National Medical College, Kolkata for giving us permission to conduct the research work in Jagadishpur block, Howrah, West Bengal which was the rural field practice area of Calcutta National Medical College, Kolkata. We are grateful for the said participants residing in the area for co-operating with us during data collection.

Funding: No funding sources

Conflict of interest: None declared

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

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