INTRODUCTION:

Menopause means permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity.¹ The average age is being 50 years.

The classic symptoms of menopause are hot flushes (50%) and night sweating and the diagnosis is from the classic symptom of hotflush (50%) and confirmed by elevated FSH level to > 100ml U/ml and serum estradiol<20pg/ml.¹Psychological symptoms that are frequently associated with menopause include fatigue, irritability, and anxiety. Some symptoms associated with changing hormone levels are directly linked with estrogen depletion. Hot flushes, night sweats, and vaginal atrophy resulting in vaginal dryness are correlated with changing levels of sex hormones. The frequency of symptoms can vary based on epidemiological characteristics of the population and the assessment tools used.²

Menopause is a physiological process in women's life. The transition through menopause is a life event that can profoundly affect quality of life³. More than 80% of women state that physical and physiological symptoms commonly accompany menopause and affect women's health and well- being.⁴ As per the World Health Organization (WHO) report, menopause is defined as 12 months of amenorrhea in women. More than 25 million women reached menopause in worldwide in the 1990 and it would be increase in double by the year 2020 and above years.¹

Menopausal symptoms have a significant impact on quality of life among postmenopausal women.The physical psychosocial, vasomotor sexual disorders among postmenopausal women had a positive linear relationship between menopausal changes and quality of life.

India has a large population, which has already crossed the 1 billion mark with 71 million people over 60 years of age and the number of menopausal women about 43 million. Projected figures in 2026 have estimated the population in India will be 1.4 billion, people over 60 years 173 million, and the menopausal population 103 million. According to Indian menopause society, by 2016 the estimated people over 60 years is 173 million, and the menopausal population is 103 million. Average age of menopause in Indian women is 47.5 years with life expectancy of 71 years.⁶ With the increase life expectancy women spend one third of their life during menopause.

Maintaining optimal Quality Of Life (QOL)is a priority for women as they negotiate per menopause in partnership with the health professionals who provide their care.² The time has come to improve women’s lives everywhere and remember that menopause does not discriminate nations around the world should continue to educate women about menopause and the benefits of preventive health care, knowledge, attitudes, and behaviours regarding menopausal Issues among Women.⁷

STATEMENT OF THE PROBLEM:

A study to assess the quality of life among post menopausal women in selected wards of Jubilee Mission Medical College And Research Institute, Thrissur.

OBJECTIVES OF THE STUDY:

1. To assess the quality of life among postmenopausal women.

2. To associate quality of life among postmenopausal women with selected sociodemographic and clinical data variables

HYPOTHESIS:

H1: There is significant association between quality of life of post menopausal women with selected socio-demographic and clinical data variables

ASSUMPTION:

Post menopausal women experiences variations in quality of life changes than compared to their previous life activities.

MATERIALS AND METHODS:

Research approach:

A quantitative research approach was used

Research design:

Descriptive design was used

Variables

Research variable:

Quality of life of postmenopausal Women

Socio demographic variables:

It includes age, religion, type of family, educational status, marital status, occupation, income and area of living.

Clinical data variables:

It includes number of children, history of any surgery, age of menopause and type of diet.

Setting of the study:

The setting of the study was Jubilee Mission Medical College & Research Institute is a multi specialty, tertiary care hospital which consists of 1500 beds. Data collection was conducted in the selected wards.

Population:-

The women in the age group between 50-65 years

Sample and sampling technique Sample:

Postmenopausal women in the age group between 50-65 years and who met inclusion criteria.

Sample size:

30 postmenopausal women was used for this study.

Sampling technique:

Non probability convenience sampling technique was used to recruit the samples.

Criteria for sample collection:

Inclusion criteria

Women who were:

· Attained menopause (women not having menstruation in the last12 months)

· Between the age group of 50-65years.

· Able to read and understand malayalam.

· Willing to participate.

Exclusion criteria:

Women who were:

· Used hormonal replacement therapy

· Undergone hysterectomy

· Having co morbidities and on treatment.

Description of data collection Tools and techniques:

The tool consists of two sections. Section A and Section B.

Section A:

Socio demographic and clinical data variables questionnaire-It includes age, religion, types of family, educational status, marital status, occupation, income, area of living, age of menopause, type of diet, year of menopause, number of children and previous knowledge about menopausal symptoms.

Section B:

A standardized menopause specific quality of life questionnaire (MENQOL) was used to assess the quality of life in postmenopausal women. The MENQOL is self administered tool and which consist of 29 items. The questions were used to assess the respondents quality of life. 0 score was awarded for if women responded as “no” and score one was provided for if women responded as “yes”. If symptoms present, the score increases from 1 to 6 on the basis of how much they are bothered about their symptoms. The severity of menopause symptoms scoring system as the following, Score range from 0-2 considered mild, 3-4 considered moderate, 5-6 considered severe symptoms. The maximum score was 174 and minimum score was 29. The scoring interpretation was, less than 58 score were as considered good quality of life, The score between 58-116 were considered as average quality of life, greater than score 116 were considered as poor quality of life. The questions were organized under four domains. Vasomotor, Psychosocial, Physical and Sexual symptoms.

Data collection process:

Permission was obtained from the hospital authorities. After explaining the purpose of the study informed consent was obtained. Samples were selected by using convenience sampling technique followed by self administered questionnaire was provided to the samples individually. Each samples were taken about 5-10 minutes to fill up the questionnaire. Data were analyzed using descriptive and inferential statistics.

RESULTS:

Table 1: Frequency and percentage of distribution of Postmenopausal women according to socio-demographic variables such as age, religion, type of family, education. n = 30

Socio-demographic data variables	Frequency (f)	Percentage (%)
1. Age in years 1) 46-50	3	10
2) 51-55	10	33.33
3) 56-60	17	56.66
2. Religion 1) Hindu	15	50
2) Muslim	2	6.66
3) Christian	13	43.33
4) Others	0	0
3. Type of Family 1) Nuclear Family	21	70
2) Joint Family	09	30
4. Education 1) Illiterate	2	6.66
2) Non formally literate	0	0
3) Primary education	18	60
4) Secondary education	3	10
5) Higher secondary education	2	6.66
6) Collegiate	5	16.66
1. Marital Status 1) Married	27	90
2) Widow	2	6.66
3) Unmarried	0	0
4) Divorce	1	3.33
2. Occupation 1) House Wife	21	70
2) Working	09	30
3. Income in Rupees 1) Below 5000	18	60
2) 5000-10000	07	23.33
3) Above 10000	05	16.66
4. Area of living 1) Rural	29	96.66
2) Urban	01	3.33

Table 1 shows that more than half 17 (56.66%) of post menopausal women were between the age group of 56-60 years old and half of the 15 (50%) were Hindus. While 21(70%) were belonged to nuclear family. 18(60%) had primary education. Majority 27 (90%) were married. 21 (70%) were house wives and 18 (60%) of them had income less than Rs:5000. Almost 29 (96.66%) were living in rural areas.

Table 2: Frequency and percentage of distribution of samples according to clinical data variables n = 30

Clinical data variable	Frequency (f)	Percentage (%)
1. Number of children
1) 1 - 3	29	96.3
2) 4-7	1	3.33
3) 8 - 10	0	0
2. Age of menopause
1) 45 – 50 years	24	80
2) 51- 55 years	6	20
3) 56 – 60 years	0	0
3. Type of diet
1) Vegetarian	2	6.66
2) Non vegetarian	2	6.66
3) Mixed	26	86.66
4. Do you have any previous knowledge about menopausal symptoms
1) Yes	29	96.66
2) No	01	3.33
5. If yes what is your source of information
1) Friends	6	20
2) School	3	10
3) Family	8	26.6
4) Media	11	36.6
5) Others	2	6.6

Table 2 shows that almost 29(96.33%) samples had 1.3 1-3 children and 24(80%) had attained menopause in the age group between 45 – 50 years. Among 30 samples 20 (86.66%) of them were mixed type of diet. 29(96.66%) had previous knowledge about menopausal symptoms and 11(36.6%) had source of information was from the media.

Table 3:- Frequency and percentage of distribution of quality of life among postmenopausal women according to their severity of symptoms. n=30

SI		Symptoms	No		Mild		Moderate		Severe
			f	%	f	%	f	%	f	%
		Vasomotor
1		Hot flushes	7	23.33	4	13.33	10	33.33	9	30
2		Sweating	7	23.33	4	13.33	9	30	10	33.33
3		Being dissatisfied with my personal life.	11	36.66	8	26.6	11	36.66	0	0
Psychosocial
4		Night sweats	8	26.6	3	10	10	33.33	9	30
5		Feeling anxious	10	33.33	2	6.66	12	40	6	20
6		Or nervous Experiencing	10	33.33	8	26.6	7	23.33	5	16.66
7		poor memory Accomplishing	23	76.66	6	20	0	0	1	3.33
8		less than 1used to Feeling depressed down or blue	14	46.66	9	30	5	16.66	2	6.66
9		Feeling or Wanting to be alone	18	60	6	20	4	13.33	2	6.66
10		Being Impatient with other people	16	53.33	3	10	7	23.33	4	13.33
Physical
11	Flatulence or gas pains		20	66.66	3	10	1	33.33	6	30
12	Aching in muscle and joints		7	23.33	4	13.33	9	30	10	33.33
13	Feeling tired or worn out		2	6.66	6	20	14	46.66	8	26.6
14	Difficulty sleeping		8	26.66	4	13.33	10	33.33	8	26.6
15	Aches in back of neck or head		14	46.66	1	3.33	11	36.66	4	13.33
16	Decrease in physical strength		6	20	7	23.33	12	40	5	16.66
17	Decrease in stamina		7	23.33	6	20	11	36.66	6	20
18	Feeling in lack of energy		8	26.66	5	16.66	12	40	5	16.66
19	Dry skin		6	20	9	30	12	40	3	10
20	Weight gain		18	60	4	13.33	6	20	2	6.66
21	Increased facial hair		20	66.66	7	23.33	2	6.66	1	3.33
22	Changes in appearance and texture or tones of your skin		24	80	4	13.33	1	3.33	1	3.33
23	Feeling bloated		20	66.66	2	3.33	5	16.66	3	10
24	Low back ache		10	33.33	5	16.66	8	26.66	7	23.33
25	Frequent urination		12	40	4	13.33	13	43.33	1	3.33
26	Involuntary urination when laughing or coughing		18	60	3	10	5	16.66	4	13.33
Sexual
27		Changes in your sexual desire	12	40	12	40	6	20	0	0
28		Vaginal dryness over intercourse	22	73.33	7	23.33	0	0	1	3.33
29		Avoiding intimacy	13	43.33	7	23.33	9	30	1	3.33

Table 4 Distribution of quality of life among postmenopausal women according to their severity of symptoms. n=30

Domains of Quality of life of postmenopausal women	Good quality of life		Average quality of life		Poor quality of life
Domains of Quality of life of postmenopausal women	Frequency (f)	(%)	Frequency (f)	(%)	Frequency (f)	(%)
Vasomotor	13	43.33	10	33.33	7	23.33
Psychosocial	16	53.33	13	43.33	1	3.33
Physical	17	56.66	13	43.33	0	0
Sexual	26	86.66	3	10	1	3.33

Table 5: Association of Quality of life of postmenopausal women with sociodemographic and clinical data variables. n=30

Sociodemographic And clinical data variables.	Good F %		Poor F %		X2	df	P value
1.Age in years
<55	7	53.8	5	46.2	.074	1	0.785
>55	10	58.8	7	41.2	.074	1	0.785
2.Type of family
Nuclear family	15	71.4	6	28.6	6.212	1		0.0*
Joint family	2	22.2	7	77.8	6.212	1		0.0*
3.Education
Primary Education	9	45.0	11	55.0	3.326	1		0.068
Secondary Education	8	80.0	2	20.0	3.326	1		0.068
4.Income
<5000	11	61.1	7	38.9	.362	1		0.547
>5000	6	50.0	6	50.0	.362	1		0.547
5.Age of menopause
<50	14	58.3	10	41.7	.136	1		0.713
>50	3	50.0	3	50.0	.136	1		0.713
6.Occupation
House wife	11	52.4	10	47.6	.524	1		0.469
Working	6	66.7	3	3.33	.524	1		0.469

Significant (p <0.05)

Table 5 shows that there was a significant association (p<0.05) between selected sociodemographic and clinical data variables such as type of family with quality of life among postmenopausal women. It indicates that women who lived in nuclear family had increased quality of life than women lived in joint family. There is no significant association between other sociodemographic and clinical data variable with quality of life among postmenopausal women.

DISCUSSION:

The first objective was to assess the quality of life among post menopausal women: The study reveals that 17(56.66%) women had good quality of life and 12(40 %) samples had average quality of life and only 1(3.33%) samples had poor quality of life.In component wise analysis In vasomotor symptoms 11(36.66%) postmenopausal women were being dissatisfied with their personal life, In psychosocial symptoms 12(40%) of them had night sweats, In sexual symptoms 12(40%) of them have changes in their sexual desire.

The above findings of the present study were supported by a descriptive analytical cross-sectional study conducted among 270 postmenopausal women aged 45- 60 years covered by Hamadan health centers in 2018. Sample was selected using stratified random sampling technique. Menopausal Quality of Life Questionnaire (MENQOL) was used for the data collection method. There mean MENQOL Score in menopausal was 2.45±1.04. Also, vasomotor symptoms had the highest score, and sexual symptoms had the lowest score rather than other dimensions. According to the association between Quality of Life and demographic variables, there was a significant association between the total quality of life score and job, economy status, smoking, exercise, supplemental Omega-3 sintake, and postmenopausal stage (p<0.01). While the MENQOL scores for menopausal females who exercised more often (mean=1.56±0.7) had lower than those who exercised less than 3 times per week (mean=3.27±0.9; p<0.001). Though women who had postmenopausal stage less than 5 years stage (mean=2.28±0.87) had signifcantly lower MENQOL scores from those who had postmenopausal stage 5 or more years (mean=2.63±1.16; p<0.001). The present study reveal that , vasomotor symptoms were the most dominant symptom. Therefore, it is necessary to improve physical activity levels, focusing on job status, recommend taking an omega 3 s supplement, and planning education and promotion intervention for cessation or prevention of smoking among postmenopausal women to increase the MENQOL is essential.

The second objectives was to associate quality of life among postmenopausal women with selected socio demographic and clinical data variables: There was a significant (p<0.05) association between type of family with quality of life among postmenopausal women. This indicates that women lived in nuclear family had increased quality of life. Therefore The researcher hypothesis H1: There is significant association between quality of life of post menopausal women with selected socio- demographic and clinical data variables) was accepted.

CONCLUSION:

In rural areas of Kerala, researcher founded that the type of family had a higher influence in maintaining good quality of life among postmenopausal women. Majority of the postmenopausal women had good quality of life, even though vasomotor, psychosocial, physical and sexual symptoms were existing. The nuclear family had an significant association with the quality of life. Hence educating the family members helps to promote the quality of life of postmenopausal women in an adequate way.

NURSING IMPLICATION:

Nursing Education:

1. Nurse educator educate regarding the problems of perimenopausal women among working women.

Nursing Practice:

1. To conduct awareness programmes for the public to understand the problems of menopausal symptoms among post menopausal women.

2. To provide adequate knowledge about quality of life after menopause and the postmenopausal symptoms for women in perimenopausal age group.

Nursing Administration:

1. Nurse administrator planned for menopausal clinic to conduct awareness class for women in perimenopausal between 45-55years.

Nursing Research:

1. Research findings help to improve adequate knowledge regarding the quality of life among the post menopausal women.

2. The investigators can use the methodology, tools and findings of the study as a reference material to conduct intervention based studies.

RECOMMENDATION:

On the basis of the study that has been conducted certain suggestions are given for future recommendation.

1. A similar study can be replicated with larger sample sizes.

2. Intervention based study for relief of menopausal related health issues can be done.

REFERENCE:

1. D C Dutta’s textbook of gynecology,Hiralal Konar jaypee publication 6th edition,2013 New delhi, page no: 75-83

2. Hoda A E Muhamed, Sahar M Lamadah, Luma Gh.Al.Zamil. Quality of life among menopausal women. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. Year=2014, September3, volume=3,issue=3,pageno:552- 561.http://dx.doi.org/10.5455/23201770.ijrcog20140906.

3. Dr Deepshikha Karma, Dr Shipra Saini, Dr Shavinder Singh.A crosssectional study was conducted to evaluate the menopausal related symptoms and their impact on the women’s quality of among postmenopause women in rural area of punjab. JMSC. Volume 6, Issue1, January 2018 https://dx.doi.org/10.18535/jmscr/v6i1. 168

4. Sumathi Senthivel, Senthivel Vasudevan, PS Anju, Anjana Sukumaran, Jayanthi, Sureshbabu, Assessment of symptoms and quality of life among postmenopausal women in a tertiary care hospital in Kochi, South India: https:// www. jmidlifehealth.org/ article.asp ?issn=0976- 7800;year=2018; volume=9;issue=4; spage=185;epage=190

5. Nabarun Karmakar, Somak Majumdar, Aparajita Dasgupta, Sulagna Das. A study to assess Quality of life among menopausal women: A community based study in a rural area of West Bengal. Journal of Mid wife life health official publication of indian menopause society. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367220/

6. Nabarun Karmakar, Somak Majumdar, Aparajita Dasgupta, Sulagna Das. A study to assess Quality of life among menopausal women: A community based study in a rural area of West Bengal. Journal of Mid wife life health official publication of indian menopause society https: //www .ncbi. nlm. nih.gov/ pmc/articles /PMC5367220/

7. Ms.Jiny james, A study to evaluate the effectiveness of sturctured teaching programme on knowledge regarding menopausal problems and its remedial measures among middle aged women in selected rural area of Bengalore, Karnadaka. JINY JAMES.pdf

Received on 25.07.2022 Modified on 22.09.2022

Int. J. of Advances in Nur. Management. 2023; 11(1):41-46.

DOI: 10.52711/2454-2652.2023.00009

Assess the quality of life among postmenopausal women