|Year : 2017 | Volume
| Issue : 2 | Page : 185-188
Study of menopausal symptoms in the nursing staff and female attendants in a rural medical college
Abhilash Sood, Mitasha Singh, Sunil Kumar Raina, AK Bhardwaj, Vishav Chander, Akshay Manhas
Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh, India
|Date of Web Publication||14-Nov-2017|
Sunil Kumar Raina
Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh
Introduction: Menopause is defined as complete cessation of menstruation for 12 months or more. It is characterized by various symptoms such as hot flushes, irritability, sweating, anxiety, and depressive mood. Menopausal symptoms can be assessed by several tools and can be influenced by various sociodemographic factors. The study was planned with the aim to assess the commonly reported menopausal symptoms among women using the Menopause Rating Scale (MRS). Methodology: A cross-sectional study was undertaken at Dr. Rajendra Prasad Government Medical College (DRPGMC) Kangra at Tanda. The study was conducted in the month of November 2013, over a period of 3 weeks. The study population was nursing staff of DRPGMC Tanda and female attendants of patients in the age group 40–60 years. Convenience sampling was used, and the study sample was 200. The psychosomatic, somatic, and urogenital complaints were assessed in this group using the MRS. Results: Two hundred questionnaires were distributed among the nurses and female attendants of whom 180 women responded, a response rate of 90%. 103 of these women had attained menopause. The mean age of study participants was 49.4 ± 4.8 years. The average age of menarche was 14.8 years and mean age of menopause was 45.2 ± 4.7 years. Average MRS score was 11.67 with a maximum score of 31 and minimum score 2. The highest dimensional mean score was 5.48 for the psychosomatic symptoms. Conclusions: Common menopausal symptoms in this study are physical and mental exhaustion, irritability and joint and muscular discomfort.
Keywords: Menarche, menopausal rating scale, menopausal symptoms
|How to cite this article:|
Sood A, Singh M, Raina SK, Bhardwaj A K, Chander V, Manhas A. Study of menopausal symptoms in the nursing staff and female attendants in a rural medical college. Trop J Med Res 2017;20:185-8
|How to cite this URL:|
Sood A, Singh M, Raina SK, Bhardwaj A K, Chander V, Manhas A. Study of menopausal symptoms in the nursing staff and female attendants in a rural medical college. Trop J Med Res [serial online] 2017 [cited 2019 Apr 18];20:185-8. Available from: http://www.tjmrjournal.org/text.asp?2017/20/2/185/218212
| Introduction|| |
The World Health Organization defines menopause as “the permanent cessation of menstruation as a result of the loss of ovarian activity.” Menopause is a natural process which occurs as a part of woman's normal aging process. It results in atresia of almost all oocytes in ovaries, causing an increase in follicle-stimulating hormone and luteinizing hormone levels and a decrease in estrogen levels. This decrease in estrogen levels leads to perimenopausal symptoms of hot flushes, insomnia, mood changes, generalized physical, and mental exhaustion as well as postmenopausal symptoms such as vaginal atrophy, bladder problems, and osteoporosis. With increasing life expectancy and age at menopause remaining relatively unchanged, women are spending more of their life in the postmenopause period.
The Menopause Rating Scale (MRS) is a health-related quality of life scale (HRQoL) and was developed in response to the lack of standardized scales to measure the severity of aging symptoms and their impact on the HRQoL in the early 1990s. A scale was intended that can easily be completed by women, not by their physician. The scale was designed and standardized as a self-administered scale to (a) to assess symptoms/complaints of aging women under different conditions, (b) to evaluate the severity of symptoms over time, and (c) to measure changes pre- and post-menopausal replacement therapy. Our study was also conducted among the women of peri- and post-menopausal age group to assess the menopausal symptoms using this scale. The aim of our study was to assess the commonly reported menopausal symptoms among women using the MRS.
| Methodology|| |
The study was conducted in a case study mode using convenience sampling among female attendants, aged >40 years, of patients attending a tertiary care center in a rural area of Himachal Pradesh, India. The study design was cross-sectional conducted over a period of 3 weeks at the end of November 2013 among 200 nursing staff and female attendants of patients of age 40–60 years. The study procedure consisted of collecting data by way of the interview using a local version of MRS. The MRS questionnaire consists of 11 questions based on symptoms of menopause. Each question is graded on the scale of 0 (no symptoms) to 4 (very severe symptoms). A minimum score of 0 and maximum score of 44 can be achieved. The questions are divided into 3 domains: Psychosomatic: Depressive mood, irritability, anxiety, and physical and mental exhaustion (0–16 score); somatovegetative: Hot flushes, heart discomfort/palpitations, sleeping problems and muscle and joint problems (0–16); and urogenital: sexual problems, bladder problems, and dryness of vagina (0–12).
Procedures for tool development
The most common language that the study population could understand was Hindi. The instrumentation appropriate for the local population was developed with the help of three experts (public health specialists). This was a systematic, iterative process. The team of experts, all bilingual, i.e., Hindi as well as English speaking, selected the items in the MRS instrument and translated them from English to Hindi, with a different group back translating the responses to English. The selected instrument was first pretested among educated, bilingual Himachali population and then pilot-tested on a random sample of 50 purely Hindi population. The Hindi version of MRS was administered by an M.B.B.S doctor to all 200 female attendants.
Data were compiled and entered into Microsoft Excel Sheet during the second weekend analyzed in the 3rd week of the study. The results are presented in tabulated forms using proportions.
| Results|| |
A total of 200 questionnaires were distributed, and 180 responded, thus a response rate of 90%. Of the total study participants, 55 were nursing staff and female attendants were 125. All the women in age group 56–60 had attained menopause [Table 1]. In the age group 46–55 years, 62.09% (77) women had attained menopause. Among the total participants, 57.22% (103/180) had attained menopause. The mean age of study participants was 49.4 ± 4.8 years. Maximum symptoms reported by the study participants were related to muscle and joints (76.11%) and physical and mental exhaustion (76.11%) [Table 2]. Irritability was experienced by 75% and anxiety by 73.33% followed by sleep problems which was seen in 72.22% of study participants, hot flushes and sweating in 70.56% and depressive mood in 62.22% study participants. Among the 11 symptoms, severe scoring of Grade 3 was more common in anxiety and exhaustion [Table 2]. The majority of the participants graded all the symptoms in mild or Grade 1 except for irritability which was graded as moderate or Grade 2 by most of the participants.
Mean MRS score of 180 study participants was 11.67, and among postmenopausal women, the mean score was 13.2, with a minimum score of 2 and maximum of 31 [Table 3]. Psychosomatic and somato-vegetative symptoms score was higher in postmenopausal as compared to the urogenital domain.
|Table 3: Mean score of study participants on Menopause Rating Scale subscale|
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| Discussion|| |
The present study was conducted to assess the commonly reported menopausal symptoms among women using the MRS. Mean age of menopause among the study participants was 45.2 ± 4.7 years ranging from 46 to 60 years, which is somewhat earlier in Indian women as compared to Western countries which slightly higher, 51.14 ± 2.11 years worldwide.
Some studies show the common symptoms of menopause are hot flushes and/or night sweats, trouble in sleeping, vaginal dryness, mood swings, trouble focusing, impaired memory, nervousness, bone and joint complaints and experience of age-related decline of physical and mental capacity. In this study, the common symptoms were joint and muscular discomfort, exhaustion, irritability followed by anxiety and sleep disturbances. In a study by Mazhar and Rasheed, MRS ranged from 9 to 21 with a mean of 12. While in our study the mean score is 11.67 among all the participants and 13.2 in postmenopausal females ranging from 2 to 31. Our results are in accordance with the study by Mazhar and Rasheed.
Prado et al. found that 80% of women had moderate to severe climacteric symptoms while 90% of the sample had one or more menopausal symptoms as assessed by Waidyasekera et al. In our study, all the study participants (100%) had one or more menopausal symptoms. Mazhar and Rasheed reported the commonly occurring symptoms were hot flushes (90%) and sleep disturbances (89%) followed by palpitations (42%). Sexual problems (18%) and bladder symptoms (12%) were reported least frequently. Joint and muscular discomfort (76.11%) and exhaustion (76.11%) accounted to a maximum of problems in our study, followed by irritability and anxiety. Sexual (39.44%) and bladder problems (27.78%) were less frequent. Chedraui et al. showed that the 5 most frequent symptoms of the 11 composing the MRS (n = 300) were: Muscle and joint problems (77%), depressive mood (74.6%), sexual problems (69.6%), hot flushes (65.5%), and sleeping disorders (45.6%).
Waidyasekera et al. concluded in their study that hot flushes, sleep problems, and joint/muscular discomfort showed an increase in prevalence from the premenopausal category to the postmenopausal category. Our study also showed irritability, exhaustion, hot flushes, and cardiac problems as an increasing trend from premenopausal to postmenopausal women.
| Conclusions|| |
The common menopausal symptoms observed in our study were physical and mental exhaustion, irritability and joint and muscular discomfort. Psychosomatic symptoms were more prevalent than other domains in both peri- and post-menopausal age group. Majority of the participants were working females either as nurses or in other services. Vegetative domain showed a higher mean score in postmenopausal women as compared to perimenopausal. The MRS can be used as an easily administered tool for evaluation of menopausal symptoms and referral of women with severe symptoms. Menopausal symptoms experienced by women can be severe enough to affect their normal lifestyle. Hence, by treating menopausal symptoms in early-phase may improve the quality of life of these women.
The present study was conducted as a cross-sectional study over a period of 3 weeks using convenient sampling. Results of the study may not be a true representation of the menopausal symptoms of the population in general.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Research on the menopause in the 1990s. Report of a WHO Scientific Group. World Health Organ Tech Rep Ser 1996;866:1-107.
Mustaq S. Post-menopausal women: A study of their psycho-physical changes with an impact on family. Anthropologist 2011;13:131-5.
Puri S, Bhatia V, Mangat C. Perceptions of menopause and postmenopausal bleeding in women of Chandigarh, India. Internet J Fam Pract 2008;6:1-6.
Heinemann K, Ruebig A, Potthoff P, Schneider HP, Strelow F, Heinemann LA, et al.
The Menopause Rating Scale (MRS) scale: A methodological review. Health Qual Life Outcomes 2004;2:45.
Heinemann LA, Potthoff P, Schneider HP. International versions of the Menopause Rating Scale (MRS). Health Qual Life Outcomes 2003;1:28.
Mazhar SB, Rasheed S. Menopause Rating Scale (MRS): A simple tool for assessment of climacteric symptoms in Pakistani women. Ann Pak Inst Med Sci 2009;5:158-61.
Prado MD, Fuenzalida A, Jara D, Figueroa R, Flores D, Blumel JE. Assessment of quality of life using the Menopause Rating Scale in women aged 40 to 59 years. Rev Med Chil 2008;136:1511-7.
Waidyasekera H, Wijewardena K, Lindmark G, Naessen T. Menopausal symptoms and quality of life during the menopausal transition in Sri Lankan women. Menopause 2009;16:164-70.
Chedraui P, Aguirre W, Hidalgo L, Fayad L. Assessing menopausal symptoms among healthy middle aged women with the Menopause Rating Scale. Maturitas 2007;57:271-8.
[Table 1], [Table 2], [Table 3]