
==== Front
J Family Med Prim Care
J Family Med Prim Care
JFMPC
J Family Med Prim Care
Journal of Family Medicine and Primary Care
2249-4863
2278-7135
Wolters Kluwer - Medknow India

JFMPC-13-2873
10.4103/jfmpc.jfmpc_1677_23
Original Article
Epidemiological study of health profile and quality of life of postmenopausal women in the urban field practice area of a teaching medical institute in a metropolitan city
Singh Khushboo 1
Rawat Shalini 2
Dhutraj Pooja 3
Gokhe Seema S Bansode 4
1 WHO NTEP, Consultant, Jodhpur, Rajasthan, India
2 Department of Community Medicine, Government Doon Medical College, Dehradun, Uttarakhand, India
3 Drug Safety Physician,Tata Consultancy Services, Mumbai, Maharashtra, India
4 Department of Community Medicine, LTMMC and GH Sion, Mumbai, Maharashtra, India
Address for correspondence: Dr. Shalini Rawat, Flat No 214, Sahastradhara Heights, Sahastradhara Road, Dehradun, Uttrakhand, India. E-mail: shalinimbbs89@gmail.com
8 2024
26 7 2024
13 8 28732879
11 10 2023
02 12 2023
04 12 2023
Copyright: © 2024 Journal of Family Medicine and Primary Care
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
ABSTRACT

Background:

Menopause is one of the most significant phases in the life of a woman which brings about various physiological changes called postmenopausal syndrome. A health programme catering to the needs of postmenopausal women is lacking in our health system.

Methodology:

A cross-sectional study was conducted in an urban health and training centre. Sample size of 171 was taken by simple random sampling. Women of age more than or equal to 45 and having 12 months of amenorrhea were enrolled in the study after obtaining their consent.

Results:

The mean age of menopause was found to be 45.31 years. In the vasomotor domain, the most common postmenopausal symptom was hot flushes (47.95%) followed by sweating (25.73%) while in the psychological domain it was seen that the most common symptom was feeling depressed down or blue (37.43%) followed by being dissatisfied with personal life, feeling anxious or nervous (36.26%) and being impatient with other people and feelings of wanting to be alone (34.50%). In physical domain, the most common symptom was ache in muscles and joints (92.98%) followed by low backache (86.55%), feeling tired or worn out (84.80%), decrease in physical strength (83.63%) and aches in the back of neck or head (81.87%). The other domain was the sexual domain in which the most common symptom was a change in sexual desire (93.57%) followed by avoiding intimacy (92.98%).

Conclusion:

It was found that the domain, most severely affecting quality of life was sexual followed by physical and psychological domain. Awareness should be created regarding the psychosocial, physical, nutritional and sexual needs of postmenopausal women.

Postmenopausal women
QOL
women
==== Body
pmcIntroduction

World Health Organization (WHO) has defined postmenopausal 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.[1]

According to Indian Menopause Society, there are currently 65 million Indian women over the age of 45 years affected with menopause-related health problems.[2] The health and well-being of women is always a matter of major public health concern. There are many national health programmes catering to the needs of women in their reproductive age, a health programme concerning specifically to the needs and concerns of postmenopausal women is lacking in our health system.[3]

The symptoms of menopause are reflected not only in the female genital tract but also in the skeletal, cardiovascular and psychological systems. Thus, menopause is characterized by major physical, psychological, sexual and social changes that may adversely affect quality of life (QoL).[4]

Late consequences of menopause are musculoskeletal problems, osteoporosis, urogenital changes and related sexual dysfunctions, and cardiovascular diseases. One Indian study showed that 81% of women in perimenopausal and postmenopausal phases have low bone mass density.[5] These changes affect the QoL of postmenopausal women.

QoL has been defined by the 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”.[6] So studying QoL in postmenopausal women and finding out ways to improve it becomes important both on the individual level and on the social level in helping women bloom in their later stages of life. The present study was done to assess the health profile and determine the proportion of various postmenopausal symptoms in postmenopausal women and their effect on their QoL.

Methodology

The study was a cross-sectional observational done in an urban slum area of a metropolitan city. It was conducted at the urban health and training centre under the Department of Community Medicine. Institutional ethics committee approval was obtained before initiating the study. The study duration was 1 year 6 months and postmenopausal women of the urban field practice area enrolled for the study. The sample size was calculated to be 171. Mothers consenting and willing to participate in the study were enrolled.

Prevalence: P = 80%,[7] q = 1 − p = 100 − 80, i.e. 20, Z = 1.96, L is allowable error = 6%.

Using the formula:

N = Z2 × P (1 – P)/L2

N = (1.96)2 × 80 × 20/6 × 6

N = 170.73, approximately 171.

Thus, the sample size is 171 postmenopausal women in the urban field practice area. For sampling, an average daily patient load of the urban field practice area OPD was found and then postmenopausal women of age more than 45 years were selected by the simple random sampling method by using Random number tables. Women of age more than or equal to 45 and having 12 months of amenorrhea were enrolled in the study after obtaining their consent.

Study tools used in the study were the following:

1) Predesigned pretested semistructured interview schedule questionnaire consisting of questions related to sociodemographic profile.

2) Menopause-specific quality of life questionnaire (MENQOL)[8]

It is a self-report measure assessing the presence and severity of menopausal symptoms and the degree to which they adversely affect women’s lives designed by (Hilditch JR, Lewis J).[8]

It consists of 29 items divided into four domains: vasomotor (three items), psychosocial (seven items), physical (16 items) and sexual (three items).

The vasomotor domain assesses hot flushes, night sweats, and sweating. The psychosocial domain evaluates the psychological well-being of the individual by including items regarding anxiousness, memory, and feeling “blue”. The physical domain assesses items such as flatulence, bloating, pain, tiredness, sleeping, energy and weight gain. The sexual domain includes items related to changes in sexual desire, vaginal dryness and intimacy.

3) Sphygmomanometer for measuring systolic and diastolic blood pressure.

4) Weighing machine to measure weight.

5) Measuring tape for measuring height.

Menopause specific quality of life scale (MENQOL) analysis plan:

The systematic scoring for each of the four MENQOL domains is identical. The seven-point Likert scale used during the administration of the MENQOL is converted for scoring and data analysis. For each of the 29 items, this seven-point Likert scale is converted to an eight point scale, ranging from 1 to 8. A “one” is equivalent to a woman responding “no”, indicating she has not experienced this symptom in the past month. A “two” indicates that the woman experienced the symptom, but it was not at all bothersome. Scores “three” through “eight” indicate increasing levels of bother experienced from the symptom, and correspond to the “1” though “6”. The score by domain is the mean of the converted item scores forming that domain and ranges from 1- 8.

All items followed the same format. Each woman was asked whether she experienced the symptoms, if answer was no she was asked next item and if answer was yes she was asked to indicate how bothered she had been by the symptoms on a 7 point scale ranging from 0=not at all bothered to 6 extremely bothered. For analysis score becomes 1 for “No”, 2 for “Yes” through to 8 for “Yes (Extremely bothered)”. Grading the severity of the symptoms as; mild, moderate or severe calculated as score from 2-4 (mild), scores from 5-6 (moderate) and from 7-8 (severe).

Results

In our study, the maximum number of postmenopausal women included in the study belonged to the age group of 45–55 years (50.88%) followed by 56–65 years of age group (39.77%) and the least were present beyond the age group of 76 years. The mean age was found to be 55.94 years with a standard deviation of 7.46.

It was observed that more than half of the study subjects were Hindus (56.14%) followed by Muslims (39.77%). It was seen that 91 (53.22%) of them were illiterate and 39 (22.81%) had studied till middle school and 69 (40.35%) of them belonged to upper lower class (IV) followed by 21 (12.28%) who belonged to lower class (V).

It is seen that 122 (71.35%) of the study subjects were unemployed while 49 (28.65%) were engaged in some or the other work.

In our study, 98 (57.31%) of the females belonged to the preobese category i.e., in the range of 25–29.9 kg/m2 followed by 33 (19.3%) in the range of 23–24.9 and 25 (14.62%) in the range of 18.5–22.9, i.e. normal weight category. About 14 (8.19%) of the females had their BMI ≥30, i.e., were in the obese class I category. It was also seen that 77 (45.03%) had normal sleep habits while in 56 (32.75%) sleep was found to be decreased and in 25 (14.62%) it was intermittently disturbed.

In total, 110 (64.33%) females had a normal frequency of micturition while 26 (15.20%) had an increased frequency of micturition and 24 (14.04%) suffered from urinary incontinence. The mean age of menarche was found to be 13.23 years with a standard deviation of 4.41.

Seventy-seven (45.03%) of them reported having premenopausal symptoms (PMS) symptoms like bloating, breast engorgement, irritability, etc., some or the other time in their life. More than half, i.e. 91 (53.21%) had more than three children followed by 41 (23.98%) who had three children. Seven (4.09%) of the women reported having no children at all.

It was seen that of the 171 women taken up for the study 127 (74.27%) had used some or the other family planning methods during their life while 44 (25.73%) denied using any method at all.

The mean age of menopause was found to be 45.31 years with a standard deviation of 10.63. It is observed that 54 (31.58%) of females attained menopause between the ages of 46–50 years followed by 44 (25.73%) who attained between 41 and 45 years of age. Twenty-eight (16.37%) attained menopause between 36 and 40 years of age and 25 (14.62%) between 51 and 55. Eleven (6.44%) of the study subjects were totally unaware of their menopausal age.

One hundred twenty-two (71.35%) of the females attained menopause naturally, while 49 (28.65%) had surgical menopause, i.e. attained menopause because of some surgical procedure.

Ninety-six (56.14%) of the women had been in menopause for 1–10 years followed by 54 (31.58%) between 11 and 20 years. Only one (0.58%) of them had a duration of 41–50 years. Fifty-two (30.41%) agreed to be suffering from hypertension, 22 (12.87%) from diabetes and 34 (19.88%) from both diabetes and hypertension. In 11 (6.43%) of study subjects, diabetes, hypertension and heart disease coexisted together. Five (2.92%) of them reported having some thyroid abnormality.

Proportion of postmenopausal symptoms

On distribution of study subjects according to postmenopausal symptoms in vasomotor domain It was observed that the most common postmenopausal symptom in this domain was hot flushes (47.95%) followed by sweating (25.73%) while in the psychological domain it was observed that the most common symptom was feeling depressed down or blue (37.43%) followed by being dissatisfied with personal life, feeling anxious or nervous (36.26%) and being impatient with other people and feelings of wanting to be alone (34.50%).

In the physical domain, the most common symptom was ache in muscles and joints (92.98%) followed by low backache (86.55%), feeling tired or worn out (84.80%), decrease in physical strength (83.63%) and aches in the back of neck or head (81.87%). The other domain was the sexual domain in which the most common symptom was avoiding intimacy (92.98%).

Quality of life

Distribution of study subjects according to severity of postmenopausal symptoms using MENQOL scale it was seen that out of the total study subjects 17(9.94%) of them had severe symptoms of hot flushes while 53(30.99%) had mild symptoms followed by 41(23.98%) having mild symptoms of sweating. severity of postmenopausal symptoms in psychological domain. It was observed in psychological domain that out of the total study subjects 5(2.92%) had severe symptoms of feelings of wanting to be alone followed by 4(2.34%) of being impatient with other people and 3(1.75%) of feeling depressed down or blue while 52(30.41%) had mild symptoms of feeling anxious or nervous followed by 48(28.07%) of feeling depressed down or blue and being impatient with other people. In physical domain, out of the total study subjects 2(1.17%) had severe symptoms of flatulence or gas pains and aching in muscles and joints while 137(80.12%) had mild symptom of feeling tired or worn out followed by 134(78.36%) of decrease in physical strength while in sexual domain ,out of the total study subjects 112(66.51%) had severe symptoms of avoiding intimacy followed by 49(28.66%) of change in sexual desire while 20(11.70%) had mild symptoms of change in sexual desire .

Table 1 shows the mean scores of postmenopausal symptoms. The highest mean score of postmenopausal symptom in vasomotor domain was that of hot flushes (3.95 ± 1.96), in psychological domain was of feeling depressed or blue (4.12 ± 1.66) followed by feelings of wanting to be alone (4.10 ± 1.63), in physical domain was of feeling bloated (4.08 ± 1.60) followed by flatulence or gas pains(3.89 ± 1.78) and of sexual domain was avoiding intimacy (6.96 ± 1.88) followed by changes in sexual desire (5.86 ± 1.65).

Table 1 Score of menopause specific quality of life (MENQOL) items

Postmenopausal symptom	Scores
Mean±S.D	
VASOMOTOR		
 Hot flushes	3.95±1.96	
 Night sweats	2.63±0.83	
 Sweating	2.41±0.77	
PSYCHOLOGICAL		
 Being dissatisfied with personal life	3.82±1.5	
 Feeling anxious or nervous	3.68±1.40	
 Experiencing poor memory	2.47±0.57	
 Accomplishing less than I used to	2.98±0.99	
 Feeling depressed down or blue	4.12±1.66	
 Being impatient with other people	3.82±1.59	
 Feelings of wanting to be alone	4.10±1.63	
PHYSICAL		
 Flatulence or gas pains	3.89±1.78	
 Aching in muscles and joints	3.78±1.45	
 Feeling tired or worn out	2.78±1.03	
 Difficulty sleeping	2.90±1.03	
 Aches in back of neck or head	3.34±1.25	
 Decrease in physical strength	2.76±1.04	
 Decrease in stamina	2.55±0.91	
 Feeling a lack of energy	2.58±0.96	
 Drying skin	2.13±0.38	
 Weight gain	3.40±0.99	
 Increased facial hair	2.00±0.25	
 Changes in appearance, texture or tone of your skin	3.84±0.99	
 Feeling bloated	4.08±1.60	
 Low backache	3.63±1.25	
 Frequent urination	2.83±0.77	
 Involuntary urination when laughing or coughing	2.83±0.67	
SEXUAL		
 Change in your sexual desire	5.86±1.65	
 Vaginal dryness during intercourse	4.67±1.55	
 Avoiding intimacy	6.96±1.88	

Therefore, it can be said that the most affected domain was sexual domain with avoiding intimacy as the most severe symptom.

Table 2 shows overall score of quality of life domain wise. It was seen that the most affected domain is sexual followed by physical and psychological domain.

Table 2 Domain score of menopause specific quality of life (MENQOL)

Domain of postmenopausal symptom	Domain score	
Vasomotor domain	1.72±0.93	
Psychological domain	1.84±1.22	
Physical domain	2.14±0.61	
Sexual domain	4.51±1.22	

As seen in Table 3 a significant association was seen between the age group of study subjects and Post menopausal symptoms of vasomotor and psychological domain. It was also observed that maximum proportion of psychological symptoms were present in subjects who were separated from their husbands followed by those who were divorced and the maximum proportion of psychological symptoms were present for the duration of postmenopausal years between 30 to 40 years followed by that between 20 to 30 years. This association was found to be significant (P<0.05).

Table 3 Association between sociodemographic factors and Vasomotor and Psychological domains

	Sexual domain symptoms	Chi-square	
	
Present	Absent	
Age group (in years)				
 45–55	100 (38.31%)	161 (61.69%)		
 56–65	144 (70.59%)	60 (29.41%)	105.1 (df=3)	
 66–75	29 (69.05%)	13 (30.95%)	0.0000001	
 >76	73 (97.33%)	2 (2.67%)		
Educational status				
 Illiterate	187 (68.50%)	86 (31.50%)	46.03 (df=1)	
 Literate	159 (95.78%)	7 (4.22%)	0.0000001	

In Table 4 it is seen that maximum post menopausal symptoms of physical domain were present in >76 years age grp and maximum proportion of physical symptoms were present for the duration of postmenopausal years between 40 to 50 and 30 to 40 years followed by that between 20 to 30 years.

Table 4 Association between sociodemographic factors and postmenopausal symptoms of physical domain

	Physical Domain Symptoms	Chi-square	
	
Present	Absent	
Age group (in years)				
 45–55	777 (62.46%)	467 (37.54%)		
 56–65	542 (49.82%)	546 (50.18%)	59.21 (df=3)	
 66–75	91 (40.63%)	133 (59.38%)	0.0000001	
 >76	20 (62.50%)	12 (37.50%)		
Educational status				
 Illiterate	807 (55.43%)	649 (44.57%)	12.45 (df=1)	
 Literate	623 (48.67%)	657 (51.33%)	0.000417	
Duration of postmenopausal years (in years)				
 1–10	842 (54.82%)	694 (45.18%)		
 10–20	380 (48.47%)	404 (51.53%)		
 20–30	106 (55.21%)	86 (44.79%)	88.32	
 30–40	20 (62.50%)	12 (37.50%)	0.0000001	
 40–50	10 (62.50%)	6 (37.50%)		

Table 5 shows that maximum proportion of sexual symptoms were present in the age group >76 years followed by 56-65 years of age group. It was also seen that sexual symptoms were present in subjects who were separated from their husbands followed by those who were married but this association was not found to be significant.

Table 5 Association between age of study subjects and postmenopausal symptoms of vasomotor domain

	Vasomotor Domain Symptoms	Chi-square	
	
Present	Absent	
Age group (in years)				
 45–55	137 (52.49%)	124 (47.51%)		
 56–65	18 (8.82%)	186 (91.18%)		
 66–75	6 (14.29%)	36 (85.71%)	118.4 (df=3)	
 >76	6 (100.00%)	0 (0.00%)	0.001	
 Total	167	346		
	
	Psychological Domain Symptoms	Total	
	
Present	Absent	
	
Age group (in years)				
 45–55	197 (32.35%)	412 (67.65%)	22.56 (df=3)	
 56–65	147 (30.88%)	329 (69.12%)	0.00004976	
 66–75	18 (18.37%)	80 (81.63%)		
 >76	11 (78.57%)	3 (21.43%)		
Marital status				
 Married	163 (28.75%)	404 (71.25%)	34.98 (df=3)	
 Widow	110 (26.19%)	310 (73.81%)	0.000000123	
 Divorced	32 (41.56%)	45 (58.44%)		
 Separated	68 (51.13%)	65 (48.87%)		
Duration of postmenopausal years (in years)				
 1–10	180 (28.17%)	459 (71.83%)		
 10–20	109 (31.78%)	234 (68.22%)		
 20–30	34 (40.48%)	50 (59.52%)	24.05 (df=4)	
 30–40	11 (78.57%)	3 (21.43%)	0.0000779	
 40–50	0 (0.00%)	7 (100.00%)		

Discussion

This cross-sectional observational study was done to assess the health profile and QOL of postmenopausal women in the urban field practice area. The total sample size taken was 171. In the current study, it was seen that the mean age at menopause was 45.31 years with a standard deviation of 10.63. Fifty-four (31.58%) of females attained menopause between the ages of 46–50 years followed by 44 (25.73%) who attained between 41 and 45 years of age in a similar study done by Donald S Christian et al.[9] found that the mean age of menopause was 47.74 (44.84- 50.64) years. These findings are quite similar to the present study. In all the four domains, it was found that the most common postmenopausal symptoms changed in your sexual desire (93.57%) followed by avoiding intimacy (92.98%) and aching in muscles and joints (92.98%), low backache (86.55%), feeling tired or worn out (84.80%), decrease in physical strength (83.63%), aches in the back of neck or head (81.87%), hot flushes (47.95%), feeling depressed down or blue (37.43%) being dissatisfied with personal life, feeling anxious or nervous (36.26%) being impatient with other people and feelings of wanting to be alone (34.50%). The most affected domain is sexual followed by physical and psychological domain. The most severe symptoms in this study affecting the QOL were avoiding intimacy in the sexual domain followed by hot flushes in the vasomotor domain, feelings of wanting to be alone in the psychological domain and flatulence or gas pains and aching in muscles and joints in the physical domain. Manjusha Deotale[10] did a study on 185 postmenopausal women and found that 46 (24.86%) women experienced hot flushes. Vulvo vaginal symptoms were present in (31.89%) of women. Urological symptoms were present in 82 (23.43%) of postmenopausal women. Out of 185 postmenopausal women, 44 (12.57%) complained of psychological symptoms. Psychosexual symptoms were present in 25.56% of women. The proportion of postmenopausal symptoms in this study were quite less as compared to that of the present study.

Krishnamoorthy et al.[11] in their study in 220 postmenopausal women found that the majority (78%) of the postmenopausal women experienced some psychological fatigue of which almost half (44%) experienced moderate–severe symptoms. About 62% of postmenopausal women experience one or more somato-vegetative symptoms of which about 29% perceive moderate–severe symptoms. In the urogenital domain, 33% of women appear to perceive health issues. Overall, more than one-third (37.2%) had poor QOL (with moderate to severe level of symptoms).

The vasomotor and sexual domains were less frequently complained when compared to physical and psychological domains. Among the four domains, the physical domain had the maximum mean score, while in the present study, sexual domain was found to be the most affected domain.

Poomalar G K and Bupathy Arounassalame[12] in their study in 500 women found that vasomotor symptoms were found in 80% of the study group, psychosocial symptoms were found in 93.2%, physical symptoms were found in 99% and sexual symptoms were found in 82%. The most prevalent symptoms were low back ache in 79% women and aching in the muscles and joints in 77.2% women. The least frequent symptoms were an increase in facial hair in 75 (15%) women and a feeling of dryness during intimate encounters in 54 (10.8%) of the women. Low back ache was the most common symptom which was seen. These findings were quite similar to the present study.

In the present study, there was a significant association between the age group of the study subjects and postmenopausal status, also a significant association was found between marital status of study subjects and vasomotor and psychological symptoms, educational status of study subjects and psychological, physical and sexual symptoms, employment status of study subjects and vasomotor symptoms and duration of postmenopausal years and vasomotor, psychological and physical symptoms.

Sumathi Senthilvel et al.[13] found a highly significant association with educational status, socioeconomic status and marital status similar to the present study. In contrast to the present study, age groups and occupational status did not show statistical significance in this study.

Poomalar G K and Bupathy Arounassalame[12] found that there was no significant difference between the age and the prevalence of postmenopausal symptoms which was in contrast with the findings of the present study.

To conclude we can say that most common symptom in vasomotor, psychological, physical and sexual domain was hot flushes, feeling depressed down or blue, aches in muscles and joints and changes in sexual desire respectively while the most severe symptom was hot flushes, being dissatisfied with personal life, flatulence or gas pains and avoiding intimacy respectively.

Conclusion

As life expectancy is increasing women spend a major portion of their life in the postmenopausal period and as we have seen they get affected by a variety of postmenopausal symptoms, therefore, in the current scenario postmenopausal health should be given due importance the way reproductive health is given so that they can recognise these symptoms and take timely medical intervention if needed to improve their QOL. Awareness should be created regarding psychosocial, physical, nutritional and sexual needs of postmenopausal women using mass media. Health education sessions regarding healthy and nutritious diet, adequate physical activity and exercise, and supplements like calcium, vitamin D should be held at adequate intervals for them.

Special clinics should be set up pertaining to the medical needs of postmenopausal women where more stress should be given on promotive and preventive measures and where counselling and treatment shall be available under one common roof. At community levels, social groups like mahila mandal should be formed so that social interactions can take place where all the women can discuss their problems and learn from each other’s experiences and find solutions to their problems, this will also help them in dealing with feelings of loneliness and depression. Integration of services for postmenopausal women should be strengthened with the existing national health programmes like RMNCH+A.

Code of ethics

The study was approved by the IEC. Code of ethics was followed at all stages of the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
==== Refs
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