INTRODUCTION:

In most societies, menopause is a normal physiological process which is characterized by the permanent cessation of menses in women as a result of reduced ovarian hormone secretion usually between the age of 45 to 55 years.^1,5 Menopause marks a turning point in a women’s life. This stage also signals the end of women’s ability to have children. This turning point before the menopause referred to peri-menopause period.¹²

Menopause is an adaptation process during which women go through a new biological state. During this period women can experience many symptoms including Somatic symptoms (Hot flushes and sweating, heat discomfort, sleep problem, joint and muscle pain), Psychological symptoms (Depressive mood, irritability, anxiety, mental, and physical exhaustion) and urogential symptoms (Sexual problems, bladder problems, dryness of vagina) which frequently associated with menopause^{2, 3} The duration, severity, and impact of these symptoms vary from person to person, and population to population. Some women have severe symptoms that affect their personal and social functioning, and quality of life² others may have mild symptoms only.⁴

During menopause the quality of life of peri-menopasual women is disturbed due to this transition phase of life. A survey done in 2011 measured the menopausal symptoms and quality of life in primary health care clinics. The results shows that women having sedentary life style or who did not have time for leisure activities showed worst quality of life with severe menopausal symptom.⁶

Menopause can be seen as a natural transition encompassing not only the biological changes but also the social changes associated with the natural aging process^6,7 Fifty-two percent of Indian women felt that menopausal symptoms affected their quality of life and 2.7% felt it was severely affected Oestrogen depletion during menopause is responsible for this such as vasomotor symptoms (e.g. Hot flushes, night sweats), psychological symptoms (mood swings, anxiety, depression), musculoskeletal aches (joint and muscle pain), difficulty sleeping and urogenital symptoms (vaginal dryness, dyspareunia, urinary frequency and urgency).^4,8 menopausal symptoms can be managed with the help of simple home management. Before the management of menopausal symptoms, it is important to assess the prevalence menopausal symptoms and its severity in peri-menopausal women hence, the need was felt to undertake this study.

OBJECTIVE:

To assess the prevalence of menopausal symptoms among peri-menopasual women

MATERIAL AND METHODS:

A quantitative approach and decriptive research design was used in the study. The present study was conducted in two peripheral areas of Chandigarh, India. Which comprises of the population with low socioeconomic status. These areas were selected purposively for the study due to familiarity with the areas. This is practical area choosen for community health nursing by National Institute of Nursing Education, PGIMER, Chandigarh. The residents of these both areas are migrants from other states like Punjab, Haryana, Uttar Pradesh, Bihar, Himachal Pradesh and neighbouring countries like Nepal. They are engaged in petty jobs like labourer, fruit seller, rickshaw puller, shopkeepers, sweepers, household helpers etc. Few are involved in technical work and clerks. In both areas most of women were housewives. Approximately 48000 populations is there in both areas. The population has facilities of senior secondary schools, dispensary pipe water supply, underground drainage system and regular bus service. There is a small local market, a police station and post office in both areas.

Women in age group of <40-55 years living in these areas had their last menstrual period in less than 2 years were identified by house to house survey using survey perfoma. Total 150 women were enrolled in study chosen by purposive sampling technique the interview schedule comprising of socio-demographic profile, reproductive history and menopausal rating scale was used for data collection. Menopausal rating scale is standardized tool. It is freely available on the public domain for the practice. It has 11 menopausal symptoms which were graded in the form of likert scale 0 to 4 i.e No symptom (0), mild (1), moderate (2), severe (3), very severe (4) as severity of menopausal symptom. Data was collected from August–November 2018.

Ethical clearance was taken from Institute ethics committee, PGIMER, Chandigarh. Written informed consent was taken from the participants. Participants were interviewed in their own home setting as per interviewed schedule. They were made comfortable and interview was conducted in separate room. Each interview was of 30-35 minute duration. Data was analysed by SPSS (Statistical Package for Social Sciences) version 23.0 using descriptive statistics.

RESULTS:

Table 1 depicts the socio-demographic profile of the peri-menopausal enlisted in this study. One third (39.3%) of the women were in the age group of 46-50 years. Hindu women constituted 86.6%. Only 26.6% women were educated above 8^th standard. Mostly women were housewife (91.3%). More than half of women belong to middle class (58%), most of them (73.3%) were married. More than half (57%) of the women were living in joint family.

Table No 1: Socio-demographic profile of peri-menopausal women N=150

Variables	F (%)
Age (yr)
<40	05(3.3)
41-45	28(18.6)
46-50	59(39.3)
51-55	58(38.6)
Caste
Hindu	130(86.6)
Sikh	15(10)
Other	5(3.3)
(christian/muslim)
Education
Illiterate	24(16)
Primary school	40(26.6)
Middle school	33(22)
High school	37(24.6)
10+2 and above	17(11.3)
Occupation
Housewife	137(91.3)
working	12(8)
Socio-economic status (B.G Prasad 2018)
Lower class	20 (13.3)
Lower middle class	40 (26.6)
Middle class	43 (28.6)
Upper middle class	32 (24)
Upper class	18 (11.3)
Marital status
Married	110 (73.3)
Widow	40 (26.6)
Type of family
Nuclear family	64 (42.6)
Joint family	86 (57.3)

Most of the women (77.3%) had menarche at 15 years of age all the women had children. Only one third of women (32.6%) were sexually active others had either loss of interest in sexual activity (36.6%) or they were experiencing pain during intercourse (12%).

Table 2 depicts the personal history of peri-menopausal women. More than half (56.6%) women were overweight and 11.3% had comorbidity (hypertension, diabetic and hypothyroidism) and all of them were on medication. One third of women (32%) were taking supplements also (calcium and multivitamin). One of them was addicted to huka

Table 2: Personal history of the peri-menopasual women in control and experimental group N=150

Variables	F (%)
BMI
Under weight (<18)	09(6)
Normal weight (18.5-24.9)	56(37.3)
Overweight (25.0-29.9)	62(41.3)
Obese (≥30.0)	23(15.3)
Disease condition
Hypertension	25(16.6)
Diabetic	14(9.3)
Hypothyroidism	03(2.0)
Diabetes and hypertension	17(11.3)
Diabetes and hypothyroidism	05(3.3)
Medication
Amilodipine	25(16.6)
Metformin	14(9.3)
Sodiumthyroxine	05(3.3)
Amilodipine and metformin	03(2.0)
Metformin and sodiumthyroxine	10(6.6)
Rabeprazole	05(3.3)
Specify any other medicine
Calcium	12(8.0)
Calcium and multivitamin	36(24.0)
Addiction
huka	01(0.6)

Table 3 depicts the Prevalence of menopausal symptom in peri-menopausal women. Most of them experienced Somatic menopausal symptoms such as hotflushes (85.3%), insomnia (44%), joint and muscle pain (77.3%), palpitation (38%), backache (7.3%), headache (8%), Urogential symptoms were experienced by approximately half of women such as vaginal dryness (38%), bladder problem (28.6%). Some of them experienced psychological symptoms such as moodswing (10%), sleep disturbances (29.3%), irritability (58.6%) anxiety (55.3%) mental and physical exhaustion (66%) and sadness (48.6%)

Table 4: Menopausal rating scale and symptom N=150

	Degree of severity (No. %)
Variable	No	Mild	Moderate	Severe	Very severe
Somatic symptoms
Hot flushes	21 (14)	17 (11)	18 (12)	18 (12)	76 (50.6)
Palpitation	93 (62)	21 (14)	25 (16.6)	05 (3.3)	06 (4.0)
Insomnia	84 (56)	15 (10)	25 (16.6)	15 (10)	11 (7.3)
Joint and muscle pain	34 (22.6)	08 (5.3)	33 (22)	28 (18.6)	47 (31.3)
Psychological symptoms
Sadness	71(47.3)	27(18)	38(25.3)	08(5.3)	04(2.6)
Irritability	67(44)	17(11.3)	35(23.4)	23(15)	08(5.3)
Anxiety	64(42.6)	25(16.6)	41(27.3)	12(8.0)	07(4.6)
Physical and mental weakness	51(34)	19(12.6)	49(32.6)	24(16)	07(4.6)
Urogential symptoms
Sexual problem	147(98)	-	-	01(0.6)	02(1.3)
Bladder problem	116(72.3)	19(12.6)	05(3.3)	06(4.0)	04(2.6)
Vaginal dryness	93(62)	36(24)	15(10)	03(2.0)	03(2.0)

DISCUSSION:

Menopause is a natural process, which occurs in women’s life. During this process, estrogen level decrease and cause various menopausal symptoms. Most of the women suffer from the menopausal symptom and their daily activities are disturbed . Health care of women during this transitional stage requires special attention .There is need to identify the symptoms and so that it can be managed accordingly.

In the present study low income society women were taken as participant because they had less knowledge regarding the menopause symptoms and its management. Peri-menopausal women were interview as per interview schedule. The interviewed schedule comprising of socio-demographic profile, reproductive history and menopausal rating scale. Menopausal rating scale was used to assess presence and severity of menopausal symptoms in peri-menopausal women as it is a standard international scale that is widely used in different studies.

Literature reveals that all the peri-menopausal women suffer from one or another menopausal symptoms. A study conducted in rural north India, on 558 women aged 35-55 years reported that more than half (53%) of them reported seven or more symptoms at menopause. diminished vision was reported as the most common symptom at menopause. Most of them (85%) admitted that menopause adversely affected women’s physical health. however, most of them (95%) considered menopause socially good for women and they welcomed it¹⁰. Another cross-sectional study was conducted in a rural area of New Delhi among 252 postmenopausal women reported that common complaints of postmenopausal women were sleep disturbances (62.7%), muscle or joint pain (59.1%), hot flushes (46.4%) and night sweats (45.6%). Total 32.1% postmenopausal women suffered from depression and 21.0% postmenopausal women suffered from anxiety⁹.

Similar type of finding were reported in present study i.e All the women reported one or another menopausal symptoms prominent among them were severe/very severe hot flushes (62.6%) and experienced severe/very severe joint and muscle pain (50%). Some women experienced severe/very severe physical and mental weakness (20.6%), anxiety (12.6%) and irritability (20.6%). Similar study was conducted on 683 women ages 45 to 60 years living in the district of Colombo, Sri Lanka, jan-feb 2007. Reported that 90% of the participants had one or more menopausal symptoms. The most prevalent menopausal symptoms were joint and muscular discomfort (74.7%), physical and mental exhaustion (53.9%), and hot flushes (39.1%)¹¹.

Another type of cross-sectional study was conducted in a rural area among 252 postmenopausal women from October 2011 to March 2013. A pretested, self-designed, semi structured, interview based, oral questionnaire was used. The Statistical Package for Social Sciences software Version 21.0 (SPSS) was used for analyses. The mean age at attaining menopause was 46.24 (Standard Deviation = 3.38) years. Only 4 (1.6%) postmenopausal women had premature menopause. A total of 225 (89.3%) postmenopausal women experienced at least one or more menopausal symptom (s). The most common complaints of postmenopausal women were sleep disturbances (62.7%), muscle or joint pain (59.1%), hot flushes (46.4%) and night sweats (45.6%). A total of 32.1% (n=81) postmenopausal women suffered from depression and 21.0% (n=53) postmenopausal women suffered from anxiety.¹⁰

The current study, concluded that prevalence of menopausal symptoms is definitely high among peri-menopausal women and the hot flushes and joint and muscle pain are most prevalence. Community health nurses and other health professional working in community can play important role in identifying and managing menopausal symptoms. Further research can be done on home based management of menopausal symptoms. Women can be motivated to adopt life style modification to prevent their symptoms.

REFERENCES:

1. Williams R, Levineb B, Kalilani L, Lewisc J, Clarkd R. Menopause-specific questionnaire assessment in US population-based study shows negative impact on health-related quality of life. Maturitas. 2009;(62):153-9. www.ejmanager.com/mnstemps/ 89/ 89-1402209809.pdf

2. Grant MD, Marbella A, Wang AT, Pines E, Hoag J, Bonnell C, et al. Introduction [Internet]. Agency for Healthcare Research and Quality (US); 2015 [cited 2019Jan 21]. Available from: https:// www.ncbi.nlm.nih.gov/books/NBK285446/

3. Menopause-Wikipedia [Internet]. [cited 2019 Mar 18]. Available from: https://en.wikipedia.org/wiki/Menopause.

4. Menopause: Symptoms and Types [Internet]. WebMD. [cited 2019 Mar 12]. Available from: https://www.webmd.com/menopause/ guide/menopause-symptoms-types

5. Jafary F, Farahbakhsh K, Shafiabadi A, Delavar A. Quality of life and menopause: Developing a theoretical model based on meaning in life, self-efficacy beliefs, and body image. Aging Mental Health. 2011 Jul 1;15(5) [cited 2019 Apr 7:630–7. Available from: https://www.ncbi.nlm.nih.gov/m/pubmed/21815855/?i=3&from=/25743735/related

6. Stages of Menopause | Menopause [Internet]. [cited 2019 Mar 21]. Available from: http://menopause.northwestern.edu/content/ stages-menopause

7. Culture and symptom reporting at menopause|Human Reproduction Update|Oxford Academic [Internet]. [cited 2019 Mar 19 ]. Available from: https://academic.oup.com/humupd/ article/11/5/495/605995

8. Dalal PK, Agarwal M. Postmenopausal syndrome. Indian Journal of Psychiatry. 2015 Jul 1; 57(6): 222 Available from: www.indianjpsychiatry.org/article.asp?issn=0019-5545;year=2015;...57;...

9. Singh A, Pradhan SK. Menopausal symptoms of postmenopausal women in a rural community of Delhi, India: A cross-sectional study. J Midlife Health. 2014;5(2):62–7[cited 2019 Mar 20];15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4071646/

10. Singh A, Arora AK. Profile of menopausal women in rural north India. Climacteric. 2005 Jun; 8 (2): 177–84. [cited 2019 Mar 1]; 15. Available from: https://www.ncbi.nlm.nih.gov/pubmed/ 16096174

11. De Silva Weliange S, Fernando D, Gunatilake J. Pattern of Physical Activity Among Sri Lankan Adults in the District of Colombo: A Cross-sectional Study. Asia Pac J Public Health. 2016 Nov;28(8):725–36. [cited 2019 Apr 2];15. Available from: https:// www.ncbi.nlm.nih.gov/pubmed/27469309

12. Introduction to Menopause - Health Encyclopedia - University of Rochester Medical Center [Internet]. [cited 2019 Jan 21]. Available from: https://www.urmc.rochester.edu/encyclopedia/ content.aspx?contenttypeid=85&contentid=P01535

Received on 05.07.2020 Modified on 03.09.2020

Int. J. Nur. Edu. and Research. 2021; 9(1):69-73.

DOI: 10.5958/2454-2660.2021.00017.X

Menopause symptoms	No. (%)
Somatic symptoms
Hotflushes	128 (85.3)
Insomnia	66 (44)
Joint and muscle pain	116 (77.3)
palpitation	57 (38)
Backache	11 (7.3)
Headache	12 (8)
Urogential symptoms
Vaginal dryness	57 (38)
Bladder problem	43 (28.6)
Psychological symptoms
Moodswing	15 (10)
Sleep disturbances	44 (29.3)
sadness	73 (48.6)
Irritability	88 (58.6)
Anxiety	83 (55.3)
Mental and physical exhaustion	99 (66)