INTRODUCTION:

Menopause is like a major transition in women’s like next to pregnancy and child birth. Many women sees this as a positive change in terms of free from monthly periods, painful reproductive process, change of liberating, anxiety of childbearing etc.

On the contrary there are women who experience this as most negative transition which affects their quality of life, daily activities etc.¹

The word menopause has extracted from the Greek word ‘Meno’ means month and ‘Pausis’ means stoppage. Hence the word menopause means the permanent cessation of menstruation.²According to a study estimate around 1.2 billion women worldwide will enter in to the phase of menopause by the year 2030. Along with that 85% of women experience menopause related symptoms. The common presentation of menopause are hot flushes (40 %), night sweats (17 %), insomnia (16 %), vaginal dryness (13 %), mood disorders (12 %), and weight gain (12 %).³the statistics of level of menopausal symptoms shows that majority of women shows mild symptoms which can be managed with alternative therapies like yoga, teaching etc.³⁴

In India from the year 2016-2020 the prevalence of menopausal symptoms varies from 4-87.7%.^4,5And the state Odisha is highly prevalent for the premature menopause below the age of 40year which is 2.4%. This study identified many reasons behind the untimely menopause from which poverty, other sociocultural factors are responsible.⁶A study by Whiteley. J etal concluded that Women experiencing menopausal symptoms reported significantly lower levels of health related quality of life and significantly higher work impairment, and healthcare utilization in comparison to the women without symptoms. Depression,²⁷anxiety, and joint stiffness were symptoms with the strongest associations with health outcomes.⁷ in continuation with this it is seen that about 96% of the menopausal women were having disturbed physical, psychological and social quality of life.⁸An intresting study revealed that the quality of life have association with the family type. That is the women living in nuclear family have good quality of life than women living with joint family.³³Many researcher tried to identify the factors behind which influence the severity of menopausal symptoms but yet these are dynamic which can vary according to geographic areas, culture, ethnicity, lifestyle, behavioural measures etc. one of the finding of a longitudinal population study identified ethnic, geographical and individual factors affecting the severity of symptoms.⁹There is a need for every menopausal women for education and awareness regarding lifestyle modification as it is evident that postmenopausal obesity increases the risk for breast cancer for the women, also to add fracture secondary to osteoporosis.¹⁰

Sound sleep is the necessity of every individual for a disease free life. But because of menopausal hormonal disturbance many women face the problems like sleep disorder. According to a recent study of 2022, the incidence of sleep disorders among perimenopausal women is 16% to 47%. Unfortunately, hormonal replacement therapy is of no help for the same. Hence the author has mentioned the beneficial role of Sleep hygiene practices, self-hypnosis, meditation, and exercise for sleep improvement.¹⁴

Apart from that physical problems like muscle and joint pain, feeling extreme tired along with development of co-morbidities like diabetes, memory loss. This has been studied at Utter Pradesh, India among menopausal women. The study emphasized how the quality of life declines after menopause as a result of estrogen deficiency and aging adding to morbidities. Hence the study recommended various Lifestyle modification and awareness programs, which may be beneficial for the same.¹⁵if the problem continues it even may result in development of depression. As demonstrated in a study, that around 81.1% of women had somatic symptoms, 70.3% had psychological problems, and 45.9% had urogenital symptoms when they were assessed with The menopausal rating scale.¹⁶In continuation during the period of COVID 19, a study on peri and post menopausal women revealed that the “prevalence of depression was 39% and anxiety 29.5% among them. The significant predictors were fear of COVID-19 infection (adjusted odds ratio [aOR] 8.43, confidence interval [CI]: 1.99-35.64; aOR 10.54, CI: 2.76-40.24) and sleeplessness (aOR 13.29, CI: 3.22-54.82)”^17,25

Another study of Gujarat, India on menopausal symptoms resulted that both rural and urban menopausal women shows fatigue (73% and 42%), problem with climbing stair (59% and 62%), difficulty falling asleep (45% each) and hot flushes (41% each). The study also resulted no significant difference in genito-urinary and musculo-skeletal symptom scores among urban and rural menopausal women. And obesity is the import predictor among urban menopausal women for the severity of symptoms than rural one.^18,19

Another aspect of this is the poor quality of life and sexual health among menopausal women. We know sexual health is very much important and essential for any persons wellbeing, self esteem and also to maintain a good quality of life. But with menopause along with quality of life the sexual dysfunction is also causing problem. The study reported 80.9% postmenopausal women have sexual dysfunction. The determinants were advanced age and long duration of menopause.^20,21

Some studies recommended about alternative therapies to aid menopausal symptoms like supplements of herbs and diet, acupuncture and acupressure therapies, Yoga,²⁸ massage, hypnosis and sometimes homeopathy.²²A similar study on effect of physical activity on menopausal symptoms reduction shows that regular physical activity is inversely proportional to severity of postmenopausal symptom.²³A similar work of randomised controlled trial done to see which therapy is more superior in alleviating menopausal symptoms. The author compared both structured teaching program and yoga therapy. The result showed that both the therapies were equally effective when used with right principle and protocol followed.²⁹coming to medical management, the most common recommendation being the hormonal replacement therapy (HRT) in case of severe symptoms. But it is always import to have self knowledge on the usage, benefits, how does it works, and importantly side effects. Some authors of Rajkot did an teaching program to enhance knowledge of women regarding HRT and was found effective.³⁰

Traditionally believed that knowledge on a certain topic help to reduce anxiety and improves the way to adopt healthy practice. Usually many of the women do not have adequate knowledge how to cope with menopause. A study shows that majority (94%) of women have very less knowledge about menopauses symptoms when they approached menopause. And only little (5%) have goof knowledge.³¹ Hence a study on effect of teaching program to enhance the knowledge and practice regarding menopausal symptoms shown that the participating women take menopause in a new light, like sense of freedom and a great time to change. This concept and thought process helps the women to cope in a more effective way about the menopausal symptoms.^24,26,32

As though the factors influencing may vary as per the ethnicity and geographic location hence the researcher wants to explore the factors in rural areas of Odisha so that this will help to generalize the finding over a large scale of population. This is the main aim for choosing this topic for investigation.

METHODS AND MATERIALS:

Study design:

The current study has adopted descriptive research design. The study was conducted at three areasof Bhubaneswar. Those are Sampur, Bharatpur and Rental Colony in Bhubaneswar, Khordha, Odisha. The population of Bhratpur, Rental colony and Sampur are 16839, 1050 and 2004 respectively population

Study period and study population:

The study was conducted for 3 months 1st October to 31st December, 2019. The population were all the women in the age group of 45-55 years of Bhubaneswar.

Ethical Consideration:

As this is an observational study, hence non of the human subjects were harms and every right of the the participants were taken care of. The study participants were included after the informed concent only. They were also informed about the freeness to leave the study at any point of time.

Sampling method and sample size:

Totalenumerative sampling technique was used. A total of 200 post menopausal women in age group of 45-55 years were selected from villages of Sampur, Bharatpur and Rental Colony in Bhubaneswar, Khordha, Odisha

Eligibility criteria:

Inclusion Criteria:

The study included all the Postmenopausal woman in the age group of 45-55 years who were residing in Rental Colony, Shampur and Bharatpur Village, Bubaneswar, Khordha district, Odisha and has expressed their willingness to take part in study.

Exclusion Criteria:

Includes Women who were extremely unwell, were on antidepressant therapy and had received hormone replacement treatment within the last six months.

Data tool:

The data collection toll comprise of 3 parts. The first part comprise of sociodemographic proforma which is a structured interview schedule. It has total 9 questions such as age, marital status, economical status, residence, type of family, number of pregnancy, taking any hormonal pills, history of any substance abuse, has any bad obstetrical history. The second part contains a structured checklist for the prevalence of menopause. And the last part contains a standardized scale on Severity of post menopausal symptoms. It has 14 items. All the tools were based on interview to collect the data. The reliability of the tool was found out to be 0.80 and 0.79 by Cronbach's alpha method.

Data collection procedure:

Information was gathered from the Anganwadi worker and ASHA of rental colony, shampur and Bharatpur village of Khordha prior to the data collection regarding the number of menopausal woman present. Those menopausal women meeting the inclusion criteria were selected for the interview. After obtaining informed consent, the researchers used a face-to-face interview technique to collect the data.

Data entry and data analysis:

The investigator entered the collected data and analysed in in SPSS version 2.0. The mean and standard deviation were used to express all continuous variables. Whereas all categorical data were reported as frequency and percentages. The relationship between menopausal symptoms and socio-demographic factors was determined using the chi-square test.

Action Plan for Data Collection:

RESULT:

SECTION I: Frequency and percentage distribution of demographic characteristics shows that most of the women were in the age group of 46-50years, married, low economic status, residing in rural nuclear family, having <2 children and have no history of taking hormonal pills, substance use and bad obstetrical history (Table 2).

Table-2: Sociodemographic DATA N=200

Variables	Frequency	Percentage
Age in YR
40-45	51	25.5
46-50	61	30.5
51-55	45	22.5
>55	43	21.5
Marital Status
Single	10	5
Married	117	58.5
Divorced	12	6
Widow	61	30.5
Economical Status
>50,000 per annum	35	17.5
<50,000 per annum	165	82.5
Residence
urban	86	43
rural	114	57
Family Type
Nuclear	122	61
Joint	78	39
No. of Preagnancy
<2	105	52.5
>2	82	41
none	13	6.5
Taking Any Hormonal Pills
yes	51	25.5
no	149	74.5
Substance Abuse
Yes	83	41.5
no	117	58.5
Bad Obstetrical History
Yes	38	19
No	162	81

SECTION II shows that the about 61% women suffered with moderate symptoms, where as we can not ignore the fact that still 17% were facing severe menopausal symptoms. (Fig-1)

Fig.1: Levels of Severity of Postmenopausal Symptoms

Section III: data on severity of menopausal symptom shows that almost all the symptoms of menopause were mild – moderate among the women except the problem of hair loss which is severely detected. (Table-3)

Table-3: Data on severity of menopausal symptom N=200

Symptoms	Score	Frequency	Percentage
Hot flushes, sweating	None	30	15
	Mild	73	36.5
	Moderate	68	34
	Severe	25	12.5
	Very severe	4	2
Heart discomfort	None	49	24.5
	Mild	91	45.5
	Moderate	42	21
	Severe	14	7
	Very severe	4	2
Sleep problems	None	26	13
	Mild	76	38
	Moderate	64	32
	Severe	25	12.5
	Very severe	9	4.5
Depressed Mood	None	11	5.5
	Mild	90	45
	Moderate	59	29.5
	Severe	26	13
	Very severe	14	7
Irritability	None	12	6
	Mild	98	49
	Moderate	52	26
	Severe	24	12
	Very severe	14	7
Anxiety	None	38	19
	Mild	108	54
	Moderate	33	16.5
	Severe	15	7.5
	Very severe	6	3
Physical and mental exhaustion	None	34	17
	Mild	64	32
	Moderate	55	27.5
	Severe	31	15.5
	Very severe	16	8
Sexual Problems	None	84	42
	Mild	63	31.5
	Moderate	40	20
	Severe	12	6
	Very severe	1	0.5
Bladder problems	None	99	49.5
	Mild	52	26
	Moderate	44	22
	Severe	4	2
	Very severe	1	0.5
Change In Weight Body	None	26	13
	Mild	100	50
	Moderate	63	31.5
	Severe	10	5
	Very severe	1	0.5
Changes in breast	None	21	10.5
	Mild	97	48.5
	Moderate	41	20.5
	Severe	32	16
	Very severe	9	4.5
Hair loss	None	0	0
	Mild	15	7.5
	Moderate	49	24.5
	Severe	95	47.5
	Very severe	41	20.5
Dryness of vagina	None	66	33
	Mild	111	55.5
	Moderate	22	11
	Severe	1	0.5
	Very severe	0	0
Joint and muscular Discomfort	None	12	6
	Mild	28	14
	Moderate	50	25
	Severe	60	30
	Very severe	50	25

SECTION IV is the data on chi square test which shows that there is a significant association between the severity of postmenopausal symptoms with age and number of pregnancy at p<0.05. Hence it can be concluded that advance age and multiparous women are increased risk for development of severe postmenopausal symptoms. (Table- 4)

Table-4: Data on chi square test

Sl.no	DF	CHI Square	P Value
AGE	6	36.40151	0.0001
Mariatal Status	6	7.422582	0.2835
Economical Status	2	0.044397	0.9780
Residence	2	3.99648	0.1356
Family	2	0.446754	0.7998
No.of Preagnancy	4	34.36082	0.0001
Hormonals Pills	2	0.131134	0.9365
Substance ABUSE	2	5.895403	0.0525
Bad Obestetrical History	2	0.206854	0.9017

DISCUSSION:

Some of the current study findings are supported by different other similar studies conducted by authors like Ganapathy T etal, 2018 which reported that 97.14% women experienced at-least five or more symptoms and the most common problem identifies the author is the physical problem related to decreased quality of life.¹¹Similarly Senthivel S etal, 2018 found that the prevalence levels of the classical menopausal symptoms such as hot-flushes, night sweats and vaginal dryness in women aged 50-60 years were 75.3%, 58% and 30.7% respectively. The association between Quality of Life scores with educational status and socio- economic status were statistically highly significant with P<0.01 and with marital status statistically significant with P<0.05, which means that the quality of life of women suffering with menopausal symptoms does vary according to high educational state and economic status. ¹² Another descriptive cross-sectional study also shares the similar fact as that of the current study state by Rathnayake N etal, 2019 where the author have used the same menopausal rating scale as that of the current study, the prevalence of menopausal symptoms being 96.4%and they experience moderate symptoms.¹³

CONCLUSION:

Hence from the above discussion it can be concluded that the postmenopausal symptoms are quite common among women in the age group of 45-55years, though the severity dwell between mild to moderate. But keeping in my the prevalence of >97%, it can b certain that they need priority medical attention as these symptoms has direct negative effect on their quality of life, sleeping pattern, social relationship etc. It is everyone’s responsibility to respect every women and to support then during menopause as this period is one of the major transition in the life of a women. The current situation demands an awareness among the family members like spouse, children to support women at this stage of change, to understand them, to respect their bodily and emotional change and to behave patient-fully with them and to be with them through this phase until end. It is recommended for the future researchers to have more innovative ideas about development of intervention which can combat this symptoms and make the women little comfortable while going through this change.

CONFLICT OF INTEREST:

None

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Received on 11.07.2023 Modified on 13.08.2023

Asian J. Nursing Education and Research. 2023; 13(4):259-264.

DOI: 10.52711/2349-2996.2023.00054

2Associate Professor, SUM Nursing College, Siksha O’ Anushandhan University, Bhubaneswar, Odisha.

²Associate Professor, SUM Nursing College, Siksha O’ Anushandhan University, Bhubaneswar, Odisha.