This study was conducted to investigate the effects of post menopause on physical and psychological health of women. The aim of this study is to analyze the effects of post menopause specifically on married women who faced menopause naturally. A sample of 70 married menopausal women of 47-57 years of age was selected through convenient sampling procedure from two hospitals. Quantitative method was used to conduct the study. The inclusion criteria of post-menopausal women are that only those women are included in this research who already experienced menopause 1-3 years before. Structured Greene Climacteric scale was used as an instrument for collecting information from married menopausal women. Only those women taken in this research who were agree to provide information voluntarily. It is found that mostly women suffered from physical and psychological symptoms of menopause but they are not highly aware about menopause and its effects on their body they did not bother it due to cultural barrier and lack of education. This is the only reason due to this they cannot access health facilities symptoms of post menopausal women vary from women to women due to these there treatments also vary. Proper diet which includes vitamin D and A, calcium, fibers, fruits is helpful to minimize the effects of post menopause. Awareness campaigns must be undertaken to inform women about coping strategies to be used in phase of post menopause healthy diet and exercise can reduce the severity of post menopause symptoms.
Menopause is the end of reproductive life and is defined as permanent cessation of menstruation which occurs at an average age of 51 years. Unlike the age of menarche, the age of menopause is constant for centuries and is not affected by socioeconomic class, race, height, weight. Menopause occurs a year or two years earlier smokers or in patients with severe malnutrition. Menopause is not an abrupt event but a gradual process. Menopause is not a disease that needs to be cured, but a natural life stage transition. It is a universal phenomenon and a natural biological event, As a women get transition from reproductive years through menopause and beyond, she experience many physical as well as psychological changes.(Notelovitz,2003)
Mayo Foundation for Medical and Educational Research (2003) Menopause begins naturally when ovaries make less estrogen and progesterone. During a woman’s reproductive years, these hormones regulate her monthly cycle of ovulation and Menstruation. In late thirties, the amount of progesterone that a woman’s body produces diminishes, and the remaining eggs from the ovaries are less likely to be fertilized. Eventually, her menstrual period will stop and the woman can no longer become pregnant.
Many issues can collide to cause enormous stress on the midlife of women during menopause, such as physical changes, medical illness, and psychological health. Physical effects include feeling tired, muscle and joint pains, breathing difficulty, hot flashes, loss of interest in sex, vaginal dryness, and quick heartbeat. Psychological effects include dizziness, anxiety, panic attacks, depression, irritability, hypertension, moods swings.The 21st century is bringing up a dramatic rise in the number of women entering menopause. It can be observed through increased life expectancy of women. Some decades ago, a few number of women lived beyond middle age, however, now the statistics for menopausal women have changed.Until 1900, the average life of women was 50 years and by 1990s, it rose approximately up to 80 years. Moreover, till the year 2020, the life expectancy of women will increase to 90 years (Doctor’s Guide, 1997).
Interestingly, each woman experiences menopause in a unique way. For some women, menopause means a transitional phase, leading to a new dimension of life which contains confidence and empowerment than younger years, while for some other women, menopause is a reminder that they are aging, which may cause distress. In this stage, a woman may be dealing with changing relationships with children, marital problems or widowhood. On positive side, menopause can also be a transition from child bearing and child rearing to a time of personal growth.Menopause is not a disease; it’s a natural process that every woman will experience if she lives into her fifties. In transition to menopause, women find that it can also be the time for reflection, reassessment, and renewal of purpose and can lead to a more meaningful life (Cling,2012).
According to Santoro (2003), the menopausal transition is complex period in a women’s life, reflecting ovarian aging and hormone changes. These changes in turn, influence the signs and symptoms common to this period. Symptoms during menopausal transition include vasomotor symptoms and vaginal dryness, breast tenderness, poor sleep and premenstrual dysphonic.Menopause is different from infertility. Infertility is a disease which occurs before 40s and 50s. A girl, whose age is inbetween 30 to 40, can face infertility.
Infertility has typically been presumed to be women’s problem. Men also face have infertility but the barren woman is more culturally a salient figure than a sterile or impotent man. It is the woman, who bears or fails to bear children. Infertility came to be seen as a physical problem that requires medical intervention (Marsh, 1997; Rosenberg & Smith Rosenberg, 1976).
If a woman enters the post-menopausal stage, then she becomes infertile, and unable to bear child and raise her family. There are different stages of menopause which are discuss here below.
1.2 Stages of Menopause
Often used ambiguously, this term is either used to refer to 1 or 2 years immediately before the menopause, or to refer to the whole of the reproductive period prior to the menopause.
In this stage, woman’s body is closer to menopause. Females begin experiencing menopausal symptoms, even though they are still ovulating.
1.2.3 Induced Menopause
It is defined as the cessation of menstruation, which follows either surgical removal of both ovaries
1.2.4 Post Menopause
After menopause, the period of time, in which the woman has experienced 12 consecutive months without menstruation s with or without hysterectomy.
1.2.5 Natural Menopause
The term natural menopause is defined as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Natural menopause is recognized to have occurred after twelve consecutive months of amenorrhea, for which there is no obvious pathological or physiological cause.
1.3 Post Menopause
Post menopauseis the stage of life after menopause. It begins with your last period and continues for the rest of your life. One hundred years ago some women associated menopause with the end of life.In surgical Menopause, there are more severe menopausal symptoms than someone going through natural menopause. Symptoms may begin soon after surgery. Hot flashes may be more severe, morefrequent, and longer lasting. Moreover heart disease and osteoporosis develops. Postmenopausal bleeding (PMB) is bleeding occurring after 12 months (or six months according to some) of amenorrhea in a woman of age where the menopause can be expected (on the average 50 years). It can also apply to younger women following premature menopause. It is a common gynecologic problem seen in about 5%-10% of all gynecologic patients and is likely to increase further. About 25 million women pass through Menopause each year. Infertility develops in this stage and no Hormone Replacement Therapy (HRT) and medications can prolong the menstrual cycle at this stage. The age of post menopause is in between 40 to 60 (Chohan, 2009)
Follicle Stimulating Hormone (FSH) is also a way to determine the post menopause stage. FSH is a hormone produced by pituitary gland. The post menopause stage generally starts between 24 to 36 months after a woman’s last period. Outwardly, the most marked difference between menopause and post menopause is reduction in symptoms such as hot flashes, which are less frequent and not powerful. The pituitary gland is found at the base of the brain and produces FSH. When there is a transition of women into post menopause, the FSH if extremely high, indicating that her ovaries are beginning to shut down. Another hormone, estradiol is a form of estrogen, which decreases in post menopause, when ovaries no longer produce eggs. Various hormone therapies and treatments are used in post menopause and menopause. (Chohan,2009). This study conduct in order to find out the severity of physical and psychological symptoms that which symptoms women experience mostly after having menopause in Pakistani culture, their level of awareness and about their beliefs regarding post menopause period and to find out that either they are satisfied after having post menopause or not, either menopause brought positive signs to their personal life or not.
Another reason to conduct this study is to find out that support of spouse and family after having menopause this reason would strengthen this research because previous studies interpret less literature about the effects of menopause on women regarding her family and spouse.Researchers also want to elaborate about the cultural perspectives of menopause in Pakistani society whether women have positive views after having post menopause or not.
1.4 Statement of the problem
This Quantitative research aims to study the effects of post menopause on women health and also to understand about the cultural phenomena of physical and psychological symptoms of post menopause in Pakistan.
1.5 Objective of the study
To Study the effects of psychological and physical symptoms among women in post menopause.
1.6 Research Question
- What are the effects of menopause on physical and psychological health of Women?
- Which symptoms women experienced mostly after having menopause?
1.7 Research Significance
The present study would provide the results about the menopausal symptoms and also elaborates that which symptom of post menopause women experience mostly Although symptoms of women vary from women to women but this study provide the results about which symptoms are faced by mostly women. It will elaborate cultural perspectives of menopause in Pakistani society whether women have positive views after having post menopause or not.
1.8 Research Methodology
This chapter consisted of methodology of the present research it elaborates about the nature of research, population of study, sample size and technique of sampling, which tool is used for data collection, analysis of data and limitations of the study.
1.8.1 Nature of research
This research is a quantitative research in nature based on descriptive research. Quantitative type of descriptive research includes numeric and categorical data. The purpose to use descriptive research in our study is that the scale which is used in this study divided its symptoms into categories.
1.8.2 Population of study
The population of the study consists of married menopausal women of 47-57 years in Lahore district. Inclusion criteria of post menopausal women are that only those women are included in this research that already experienced it 1-3 years later and the reason to use this age limit is that the women who fall in this age group currently face the problems of post menopause and this study did not consider those women who are above this age group because they forgot those problems which they face in previous years.
1.8.3 Sample size and Sampling technique
The sample of 70 women for the study was selected from two Hospitals of Lahore (Jinnah and ShiekhZaid) through convenient sampling procedure and researchers purposely selected those women who experienced post menopause naturally and have spent 1-3 years after menopause.
1.8.4 Tool of data Collection
An internationally authorized scale was used to collect samples of post-menopausal symptoms. The name of this scale is “Greene Climacteric Scale” and the name of author of this scale isAmanda Rosett (Research Analyst). Researcher approached this scale through mailing and got permission from Amanda Rosett and then he provide the license agreement of this scale to the researchers, after this the researcher has to be able to start it.In this study the age of respondents were 47 to 57 who experienced post menopause maximum three years and minimum one year later. The scale is further divided into three parts:
- Psychological symptoms (1-11 items)
- Physical symptoms (12-18)
- Vasomotor symptoms (19 and 20)
Last symptom is sexual dysfunction. The psychological symptoms of the scale are divided into two parts anxiety (1-6) and depression (7-11).
Somatic symptoms (relating to body not mental illness) and Vasomotor symptoms (relating to the nerves and muscles that caused blood vessels to constrict or dilate).
1.8.5 Operational definition of the variable
Menopause is the end of reproductive life and permanent cessation of menstruation which occurs at an average age of 51 years.
Post menopause: After menopause the period of time in which the women have experience twelve consecutive months without menstruation.
Physical effects include feeling dizzy or faint, tightness in head or body, numbness in body, muscles and joint pain(Osteoporosis), hot flushes etc.
Psychological effects include anxiety, panic attacks, depression, irritability, lack of concentration, crying spells, feeling tense or nervous, heart beating etc.
1.8.6 Period of Data Collection
A formal permission was collected from hospitals; field work lasted from 25th March to May 30th 2013. Structured Interviews were conducted from hospitals Jinnah and SheikhZaid. Secrecy was maintained in every interview of respondents.
1.8.7 Data analysis
The data is entered in SPSS (statistical package for social sciences) data is interpreted in the form of tables.
1.8.8 Field Experience
During research interviews were conducted from doctors. First interview was conducted from Dr. Ikram-ul-Haq (sheikh zaid hospital) he is very capable he guides us efficiently in order to complete our sampling and also helped us in order to complete that research. He shared his practical experience about post menopause patients he said different ladies visited the hospital and said that we are facing osteoporosis, hot flashes, headaches, bleeding, breathing problems heart problems and a lot more. When i asked from them about their menstruation cycle then they said it was stop 5 months later or 9 months later then I told them you are facing menopausal symptoms. They don’t even know about this stage it is due to lack of awareness and lack of sharing, mostly women feel hesitation in order to share their experience with anyone in this way they suffered a lot.
Next interview was conducted with Dr. Zarqa she is gynecologist she shared her field experienced about post menopause she said mostly women were terminate their menstruation cycle when they are in Peri menopausal stage (because of symptoms) which ultimately effects their body badly. She suggested that proper guideline should be given to women about the symptoms of post menopause also describe them possible way to tackle it.
Another Dr. AhsanQazmi from Jinnah hospital help very much in sampling he provide us list of patients who visits gynae ward for their checkup researchers take interview with those women all are very cooperating and ready to answer about all the questions the crux of the whole interviews which were collected during research is that mostly women did not know about the effects of post menopause on their body because of lack of education and lack of medical facilities. Some women said that menopause brought positive change to their life they are free to offer prayers regularly and get rid of monthly bleeding and others said menopause brought negative change because they are facing problems of obesity. Mostly women complained about joint pains this is only because of low level of estrogen. Some said that their eye sight weak after facing this stage.
Apart from all this no doubt many hindrances were faced by the researchers but data was collected effectively.
Although,Menopause is vast dilemma which include hysterectomy (surgical) and natural. But this study is restricted to only naturally post-menopausal women who experienced it 1-3 years before. The convenient sampling technique was used the data was collected only from two hospitals of Lahore so the results cannot be generalized to the whole population due to shortage of time and resources.
Literature Review of Post Menopause
The basic objective of this chapter is to review the existing studies which are related to the present study. These studies provide a base for the present topic. Many researchers have done their work on post menopause as well as menopause. Following are the some researches on it in order to find out the results that Is symptoms of post menopause do effect the women health or not.
2.1 History of Post Menopause
In past times nobody really knew anything about hormones or the role they play in the human body. Early beliefs about women in Western society evolved from misconceptions about a woman’s monthly menstrual cycle and events leading up to the end of her reproductive years. As a woman neared menstrual cessation – the end of her child-bearing years was proof that a woman had outlived her usefulness. By having children she had served her purpose, and now had nothing more to contribute to her husband’s namesake or to society in general. While these views might come off as crass and seem obsolete, many of these ideals still pervade many aspects of our social consciousness today.In 1970s International Menopause Society was established. First International Congress on Menopause was also organized in Paris, France in 1976. Various countries have formed national societies on menopause. Symptomotology of menopause differs in different areas of the world e.g. In West – hot flush, in Japan shoulder pain and in India low vision are the hallmarks of menopause. HRT use rate is high in West while it is low or negligible in developing countries. Age at menopause is also higher in West as compared to the range of 45-47 years in developing countries. This rose to the range of 50-51 years in the present era. Overall, women in western countries view menopause negatively. This is contrasted with a positive outlook towards menopause in developing countries. (All about Menopause: Well-being and Symptoms Relief, 2012) .
Aristotle referred to age at menopause being 40 years. A French physician coined the term menopause in 1821. Medical interest in menopause increased considerably in mid-19th century age of menopause is 51 years old. In 1902, English physiologists Ernest Starling and William Bayliss discovered the first-ever hormone. It was called secreting and it helps maintain water homeostasis throughout the body. This discovery was a significant milestone in gaining a better understanding of menopause as a whole. Then in 1925, modern scientists unveiled human hormonal make-up and were able to differentiate between estrogen and progesterone. Over the next several decades or so, a great deal of scientific research was underway, in hopes of finding a way for estrogen to help women deal with a wide range of physical and emotional symptoms attributed to menopause. Many of these findings helped pave the groundwork for what hormone replacement therapy has evolved into today. Further Singh, Kaur,Walia(2002) presented the ratios of post menopause. He describes that, there is 1.2 billion menopausal women worldwide and 40 million in the U.S. alone. 60% of women will seek treatment for menopausal symptoms at least once in their life. The Earliest known references to menopause have been very scarce. It wasn’t until March of 2005 that the National Institutes of Health (NIH) issued a statement concluding that menopause was not a disease to be treated or eliminated, but a natural phase in the life of women. (Aranda,2012).
2.2 Menopause and post menopause
Menopause is defined as the time in a woman’s life, usually between 45 and 55 years, when the ovaries stop producing eggs and menstrual periods end. Body adjust itself to these changes For several years before menopause, menstrual periods become irregular, and many women develop hot flashes, night sweats, difficulty falling and staying asleep, and vaginal dryness. This stage is called peri-menopause or the menopausal transition. A woman is said to be postmenopausal when she has not had menstrual bleeding for at least 12 months. The word climacteric more accurately describes the ongoing changes and symptoms, as it refers to a transition period that may last 15 to 20 years.(Stoppard,1998)
The average age of menopause is approximately 51 years, but 5 percent of women become postmenopausal before age 45 years and 5 percent become postmenopausal after age 55. There is no specific time to predict exactly when your menopause will occur. There are factors that may influence its timings the age you begin to menstruate may affect the age that you experience the menopause. Factors that do not influence the menopause are whether or not you took the oral contraceptives pill, or your age when you had your first and last child.(Stoppard,1998)
Post menopause is the stage which followed menopause and generally starts between 24 and 36 months after a women’s last period. According to some doctors, a woman is also considered post-menopausal after the removal of ovaries because it effectively ends menstrual bleeding. This period overlaps at the end of the Peri-menopausal stage will extend into the years that follow your last menstrual period. It lasts until the end of your life. (Stoppard,1998)
In the light of above mentioned research work, it appears that the most common symptoms experienced by women during and after menopause are the following:
2.3 Physical and Psychological Symptoms of Post Menopause
Heart disease is the most common physical symptom. Mostly, it is found in post-menopausal women. In post menopause, when ovaries stop production, estrogen’s protective effect is lost. Due to this, the rate of coronary heart disease is higher as compared to those women who have not experienced menopause yet. It can be cope through healthy take fruits, vegetables, pulses low animal fats and rich dairy products can help and lower your cholesterol level and reduce the risk of heart disease. Use of garlic in meal also improves cardiovascular health.
Osteoporosis is the most common disease that weakens bones, increasing the risk of sudden and unexpected fractures. Literally meaning “porous bones”, results in increased loss of bone mass and strength. Generally it is found in post-menopausal women because they lose bone mass more rapidly (0.5 to 3% in a year) due to lack of estrogen and progesterone. Women in her 80’s easily have lost 40% of the bone.
A woman who began menopause after age of 55 has an increased risk of ovarian, breast and uterine cancer. Those women who are post-menopausal and who have been through natural menopause are at a greater risk of developing cancer. Because they are older, this is a greater risk of developing cancer.
It is the sudden sensation of warmth or heat that spreads over the body especially the chest, face and head and creates blushing (redness). When hot flashes occur at night, they are referred to as night sweats. These hot flashes last from a few seconds to several minutes. How often they occur, varies from woman to woman (Kirsten Braun, 2005). The intensity of hot flashes is somehow lower in post-menopausal women as compared to menopausal women. Coping therapies of hot flashes is avoid the synthetic fabrics and avoid clothes with high necks and long sleeves discover the ways of cooling down your body. Take vitamin E but avoid it in case of diabetes and heart problems. Herbalist suggests the white willow, soya beans. Acupuncture can also relieve hot flashes. ESA (electro stimulated acupuncture) SNPA (superficial needles position acupuncture) decreased the number of flashes all this changes persisted three months after treatment. Avoid salty hot spicy dishes intake soya based products such as soya sauce which include estrogen properties.
Loss of libido
Sex therapists say that the low libido becomes a problem that should be addressed because it is a lower level of desire to have sex.
It is basically the loss of usual moisture and soft feel of the lining of the vaginal area, which is associated with itching and irritation. It occurs when estrogen level drops. Due to loss of estrogen, the vagina loses some of its elasticity, becomes dryer and takes longer to become lubricated. This symptom is mostly found in post-menopausal women. Corn silk herb, reduce the intensity of dryness at least 2 liters water a day also good for it.
Though headaches can be caused by a variety of factors, such as muscle tension, drinking too much alcohol; these headaches, sometimes called menstrual migraines occur when estrogen levels plunge during the menstrual cycle.
Pain, soreness or tenderness in one or both breasts often precedes or accompanies menstrual periods but can also occur during pregnancy, breast feeding and menopause. Breast pain causes discomfort in one or both breasts due to fluctuating hormones. Fatty acids significantly reduce breast pain.
9) Panic Disorder
The symptoms of panic attack include pondering heart, sweating and feeling weak, faint or dizzy, and chest pain. Panic attacks occur at any time even during sleep.
It is a feeling of agitation or loss of control that may be associated with panic attacks and physical symptoms such as rapid heartbeat and shortness of breath.
Depression is more than a bad mood or “blues”. It is a serious illness that affects women’s physical as well as mental health. Menopause and depression occur simultaneously in every woman, but menopause directly does not cause depression. Menopausal depression may be alleviated by ginger root.
The body’s metabolic rate changes during and after menopause. Some of the females may gain weight and become obese after menopause.
Dizziness is a transient spinning sensation, a feeling of light headedness or unsteadiness. It is also the inability to maintain balance upon standing or walking.
Difficulty in Concentration
Many menopausal women find that they are facing difficulties in menopause transition, by not getting enough sleep or having sleep disrupted can contribute to memory and concentration problem.
Waking up a lot at night, tossing and turning is known as insomnia. It might be connected with menopause. When you begin going through menopause, you may find that your sleep is less restful. Avoid eating large meal and walk before sleep is very affected for it.
Fatigue is referred to as “episodes of lethargy and tiredness”. Chronic fatigue has a drastic effect on daily life, putting a strain on relationships, productivity and quality of life.
Night sweats is the evening cousin of hot flashes, but typically more intense, also known as nocturnal hyperhydrosis, not a sleep disorder. It is a common perspiration disorder that occurs during sleep. In order to get relieve try to do yoga because night sweats slow down your metabolism use sage tea or buy sage in tablet. AgnusCastus is excellent herb used to reduce the symptoms of night sweats.
A large number of menopausal women experience short term loss. Notably, several medical studies have shown several distinct differences in women who have active ovaries producing estrogen compared to women with low level of estrogen due to menopause.
Urinary Track Infection
In menopause, decrease in estrogen affects the bladder. The residual urine is sitting in the bladder for a long time and is prone to infection. The thin menopausal lining is susceptible to attack by the bacteria.
Some women have problems with bladder control after menopause. Some women find that the urine leaks during exercise, sneezing, coughing and laughing.
Gas indigestion and bloating are also one of the problems faced by women after menopause.
Mood swings and Irritability
Mood swings, crying spells and irritability are mostly seen in post-menopausal women.
Muscle and joint pains
Muscle and joint pain is mostly seen in post-menopausal women, because, osteoporosis has been developed in them. Menopause affects bones due to low level of estrogen. Estrogen is involved in the process of calcium absorption into the bones. Herbs include Alfalfa; white willow rosemary may relieve pain. Use increased amount of calcium in your diet.
Many women say that their sexual desire lessens during the time of menopause. Sexual function can be divided into two components. The first consists of the desire, motivation and pleasure. The second is characterized by response. Both of these functions may be affected after menopause.
Facial and body hair growth
Although estrogen levels drop, the body continues to produce small amounts of male hormones, the testosterone. As a result, women may develop hairs on chin, upper lips, chest and abdomen.
2.4 Causes of post menopause
Post menopause is caused by the same hormonal changes and external factors that cause the other stages of menopause. Also, post menopause can be triggered by other factors
2.4.1 Internal Factors:
Fluctuations in hormones like estrogen and progesterone are at the very foundation of post menopause and may occur naturally.
2.4.2 External Factors:
Brought on by a trigger, such as an illness or surgery.
These hormone changes that cause post menopause are complex and can be more than a bit confusing.
Post-menopausal symptoms are as follows:
Vagina dryness and itching
• Weight gain
• Stress incontinence
• Urinary tract infections
• Occasional hot flashes
Post-menopausal women are at increased risk for health diseases such as osteoporosis, heart diseases, vaginal dryness, urinary bladder problems, weight gain, stress incontinence, insomnia, hot flashes but occasionally, mood swings, lower libido, and fatigue
Treatment for post menopause symptoms can vary, and there are three distinct levels of treatment intensity. These different levels are:
2.5.1 Life style changes
These can include changes such as reducing stress, exercising more frequently, and eating a Post menopause-friendly diet rich in calcium and other essential nutrients.
2.5.2 Alternative treatments
Ranging from acupuncture and hypnosis to the more common herbal remedies, many women find that combining these with lifestyle changes makes a significant positive impact on their lives.
2.5.3 Prescription drugs
Thisis the most common form of treatment in the United States and usually involves some form of hormone replacement therapy (HRT).
Women might need to experiment with their treatments before finding one that works for their symptoms and lifestyle, but many women find that a combination of lifestyle changes and alternative medicines work wonderfully(34 Menopause symptoms, 2013).
2.6 Studies of physical and psychological symptoms of post menopause
Earlier, women were considered not sexual after menopause the 21st century is bringing up a dramatic rise in the number of women entering menopause it can be observed through increased life expectancy rate of women. Some decades ago, a few number of women lived beyond middle age, however, now the statistics for menopausal women have changed. Until 1900, the average life of women was 50 years and by 1990’s rose to approximately 80 years. Moreover, till the year 2020, the life expectancy for women will increase Up to 90 years of age (Doctor’s guide, 1997).
A brief study was conducted by (Mohile,2003) about an overview of menopause its problems and beliefs of women about menopause Mohile describes menopause is a physiological endocrinopathy (Any disease due to disorder in endocrine system, endocrine are hormones and glands that secrete into blood stream through which they travel to distant organ) occurring due to cessation of ovarian function. Post menopause can be natural or surgical. Worldwide the age of natural menopause is between 45 and 55 years, the mean age being 50.
As, life expectancy rate increases large number of women will reach the age of menopauses and many will have more than 20 years of post-menopausal life. Estrogen is female sex related hormones after menopause the level of estrogen in female body is decreased as Mohile said that when ovarian function stops, a variety of physiological changes take place. Many of them are due to estrogen deficiency and some are due to ageing process. No two women react to menopausal changes in the same way. The social, cultural background, emotional and physical health and her beliefs about menopause play an important role on her acceptance of this change in her life. The stoppage of 85 monthly bleeding that interferes with her work may be a welcome event to some, while to others this may mean a loss of femininity. As stated further the estrogen deficiency symptoms may cause some short term as well as long term problems. The short-term problems may be related to Peri and post-menopausal uterine bleeding abnormalities, genital symptoms, vasomotor symptoms, urinary symptoms and psychological symptoms. The long-term problems may be related to genital problems, neurological symptoms, osteoporosis, cardio-vascular effect and skin and hair effects.
Unlike Mohile, (Krishna&Shah,2004) stated that estrogen deficiency affects the physical and mental health of the woman at menopause. From the earliest vasomotor symptoms to the psychological effects, the drying of the vagina and the skin and to the subsequent sexual and urinary problems, estrogen deprivation follows a pattern of well-defined chronological symptoms. Prompt hormone replacement therapy of early climacteric symptoms will lead to better patient compliance for the long-term therapy necessary for the prevention of complications later in life.
Later on another study was conducted by (Bansal&Thaker,2005) to determine age and perception of menopause as well as prevalence of various menopausal symptoms amongst underprivileged women of Ahmadabad (india). A questionnaire was used as a tool for data collection from 100 menopausal underprivileged women. Their results shows that mostly symptoms that women suffered after menopause are joint pain, poor memory and fatigue, irritability, urinary symptoms, hot flushes, dysparunia, leucorrhoea and anxiety and some had post-menopausal bleeding. mostly women had not taken any treatment and none knew about pap‘s test and self-breast examination. The researcher concluded that uneducated and under privileged women are unaware of their right to health care and protection, as some did not realize the need to consult doctor for their menopausal symptoms.Mostly women especially in under developing countries do not consult doctors if they face menopausal symptoms due to this they face adverse menopausal problems which affects their health.
Sen in (2005) conducted a study in Kolkata, where a group of urban educated upper middle class women aged 40 years and above were given a questionnaire. The aim of the study was to look into the specific health needs of socially settled urban women at a crucial period of their lives, which is often ignored and overlooked otherwise. The results showed that the most prevalent symptom was joint pain, mostly of knee joint. Few other symptoms in order of decreasing frequency were memory impairment, anxiety and weight gain. Hot flush was complained by only one fourth of the women studied. The researcher concluded that the findings were at variance with western literature, where vasomotor symptoms are sited as most prevalent in this age group and so intended to develop a wide database in near future.
In post menopause women Dyspareunia is most common, pain during sexual intercourse, is among the problems most frequently reported by postmenopausal women. Past literature has almost unanimously attributed dyspareunic pain occurring during or after the menopausal transition to declining estrogen levels and vaginal atrophy.(Alina Kao,2008).
The present review also examines the traditional and widely held conceptualization of postmenopausal dyspareunia as a direct symptom of hormonal decline. Some empirical evidences suggest that dyspareunia is common in postmenopausal women. Decreasing levels of endogenous estrogen contribute to the development of dyspareunia in postmenopausal women suffering from vaginal atrophy. Hormonal supplementation is beneficial in alleviating their pain. However, a substantial proportion of treated women do not report relief.
Menopause has severe physical and psychological symptoms on women health. Various studies was conducted to know the severity of menopausal problems such as a study On “Post-menopausal Women about Their Psycho- physical Changes this study focused on the physical and psychological changes in post- menopausal women, the effect of these changes on their family and the coping strategies used by women after menopause Random sampling technique was used to select the sample. The study revealed that most of the women experienced menarche at the age of 12–14 years and had a menopause naturally. Most of the women experienced hot flashes before onset of menopause. Majority of women also experienced night sweats, fatigue and decrease in sex drive. For most of the women sex formed an important part of their life and majority of them were satisfied with their appearance. A large percentage of post-menopausal Women received emotional support from their family members. Most of the women experienced leucorrhea and vaginal dryness as well. Majority of women believed that there was not any effect of menopause on their families and the approach of family members was positive towards them even after menopause. Also, for most of the women their husbands had a positive attitude towards them. Majority of women were considered whenever decisions were made in their Families. (Mushtaq, 2011)
(Chaudary,2005) conducted a study in Ahmadabad on postmenopausal women for evaluation of osteoporosis. Average age of menopause was 46.7 years and subjects were +4 years (those who passed menopause 4 years back). Results showed severe osteoporosis were found in women from age 60 and above, most of them with moderate osteoporosis and majority required surgical treatment. Another researcher studies the osteopenia and osteoporosis. Most of the women considered menopause as a normal stage. Also majority of women revealed that menopause accelerates aging process. Further, most of the women had not undergone Follicle Stimulating Hormone test (FSH, a hormone produced by pituitary gland). Majority of women had not taken anti-depressants or any stress reduction technique. Also, most of the women did not experience any change in dietary habits. Osteoporosis is a disease that weakens bones, increasing the risk of sudden and unexpected fractures. It results in increased loss of bone mass and strength. There is a direct relation between the lack of estrogen after menopause and development of osteoporosis. In this HT (hormone therapy) is believed to be useful in preventing or alleviating the increased rate of bone loss that leads to osteoporosis. But at the same time some studies shows that HT may increase breast cancer, blood clots and high blood pressure.
According to (Jog,2005) decreased Bone Mineral Density (BMD) of women in post-menopausal age is a matter of concern. Early detection of osteopenia (bone mass+1,-2.5) and osteoporosis (bone mass 2.5 SD equal to and more than). Measurement of BMD was done in postmenopausal women (min. 2 years). Appropriate advice regarding diet, exercises will be recommended. Follow up BMD was done every year for 3 years. It was found that osteopenia responds better and early. Osteoporosis shows slow improvement. Regular exercise gives early results. Adult women have less bone mass than adult men and after menopause they initially lose it more rapidly than men of comparable age do. Consequently, they are more prone to development of serious osteoporosis. The reason of the bone loss after menopause is primarily estrogen deficiency Indian and Pakistani women has lower BMD than American, placing them at greater osteoporotic risk. It has also been reported that the group of postmenopausal women has significantly lower bone mass than pre and Peri menopausal women.The result of these studies shows that post-menopausal women are at higher risk of osteoporosis and loss of BMD. Osteoporosis shows slow improvement as compared to Osteopenia.
Insomnia is another vital symptom of post menopause. Insomnia is basically the sleep disturbance. (Krystal,1998) suggested that insomnia may be directly linked to the changes that occur during post- menopausal periods. The insomnia appeared to be due to night sweats caused by hormonal changes which occur and which lead to an increase in arousals. Insomnia in postmenopausal woman could be due to unresolved grief related to going through menopause or could reflect an independent sleep disorder, such as periodic movements of sleep, depression, anxiety etc.
Another Spanish researchers (Cuadrosa et al,2012) theobjective of his study is to assess perceived stress, insomnia and related factors in mid-aged Spanish women.They concluded that in this mid-aged Spanish sample perceived stress and insomnia were significantly correlated and related to various female and partner issues.
Some researchers set out to study women’s psychological development during menopause and to examine the relationship between women’s appraisal of menopause and symptoms reporting), they examined 130 healthy women annually for five consecutive years using semi structured interviews and menopause system rating scale. Thesis results showed that initially, the majority of women (57%) had neutral beliefs about menopause 31 were pessimistic, and 12% were optimistic natural expectations were associated with fewer symptoms, whereas pessimistic appraisal was significantly related to having more symptoms. During the course of menopause and amazing things happened. The majority of neutral and pessimistic women reappraised menopause during study period, and at the last follow up 67% appraised menopausal positivity. Majority of women felt that menopause had been a positive experience despite their more negative initial expectations. (Busch et al 2003)
With 1 million new cases in the world each year, breast cancer is the most common malignancy in women and comprises 18% of all female cancers. Breast cancer incidence rates are increasing in most regions of the world, especially in the developing nations. Breast cancer is the most common female cancer in Pakistan with an age-adjusted incidence rate of 50.1 per 100,000 per year .Globally there is a wide variation in age standardized breast cancer incidence across different populations ranging from 19.3 per 100,000 in Eastern Africa to 89.9 per 100,000 women in Western Europe. This variation is mainly due to differences in reproductive and menstrual characteristics.
Breastfeeding was not associated with both pre- and post-menopausal breast cancer. In summing up, Majority of risk factors for pre-menopausal breast cancer are also associated with post-menopausal breast cancer except less parity, which increased the risk for post-menopausal breast cancer only.
As women reaches their early 40’s this discomfort may develop into a more severe pain called mastalgia. The breast become more hard tender and extremely painful. An attack of mastalgia can last up to 10 days. Mastalgia,occurs often cyclical fluctuating with menstrual cycle and becoming worse immediately before menstruation. Non-cyclical Mastalgia can occur at any time of month most commonly in women over 40 years of age. (Stoppard, 1998).
Depression and menopause has some relationship. Menopause can cause depression to find out the relationship of depression with menopause here are some studies which shows the relation of depression with menopause. A study was conducted in china Beijing by (Li et al,2008) the purpose of this study is to investigate the prevalence of depression and anxiety symptoms and their influence factors in women during menopausal transition and post menopause. After their research they find out that Depression and anxiety were common symptoms in Chinese women during menopausal transition and post menopause.
After that researchers find out that is hormone therapy is better to cope with depression .There has been a report that estrogen hormone therapy shows significant improvement of the postmenopausal women’s depression (Oh, 2000).
After that many researchers suggest that main reason for depression in middle age women is due to lower secretion of estrogen after the menopause. (Wood & Mitchell, 1995; Sung, 2000)
Thus to reduce depression state, it is necessary to control climacteric symptoms first than any other thing else. Gannon (1988) and Kim (2000) have reported that climacteric symptoms and depression may be reduced through exercise. In addition, there is statistically significant negative correlation between depression and good relationship with spouse. (Kim& Chang,2000).
Nevertheless, from the report concerning the hormone therapy to post-menopausal women by Oh in 2000, found that there were no significant relationship between depression and lack of female hormone, and researcher mentioned that use of female hormone may be effective to post-menopausal women’s depression, but there are cases of ineffectiveness. Also, there has been a research concluding that hormone therapy increase risk of breast cancer (North American Menopause Society, 2000). Hence, use of hormone therapy to treat depression may have to be considered through further research.
Among other changes that come in pre and post menopause women risk of heart disease also increase during this time. Although women short term risk of coronary heart diseases is generally lower than men (unless she has diabetes) However, In case of Menopause her risk of coronary heart disease is equal to her male counterpart. Many scientist and doctors believes that increase rate of coronary heart disease in women is due to decreased in the level of estrogen hormones which is produced during a women fertile year. In post menopause when ovaries stop production, estrogen’s protective effect is lost. The rate of coronary heart disease in those women who have experienced menopause is greater as compared to those women who have not experienced it.
2.7 Pakistani studies regarding physical and psychological Effects of menopause
Unfortunately there is dearth of research on this issue in Pakistan. However few researchers have touched this area but they have medical background. Pakistan is the 6 most populous countries in the world with population growth rate 2.2%. Menopause is significantly public issue in Pakistan as by 2020, population will reach 226 million and 7.1%. 16 million people will be aged more than 60 years. (Population reference bureau, 2010).
Menopause is a universal biological phenomenon experienced by all human females who liveinto old age. It is often researched with the justification that menopause is a threat to health. Menopause as a part of cycle of reproductive aging is universal but how women experience menopause is differs by ethnicity, culture and socio economic status. Menopause is an event that tends to be highly variable in timing and pattern. It occurs relatively early in women from developing countries and later in developed countries. (Thomas,2005).
Later on research conducted to evaluate the difference between pre- and post-menopausal breast cancer regarding menstrual and reproductive risk factors. The case-control study was conducted in Mayo Hospital, Lahore, between October 2008 and April 2009. The results show that among the breast cancer patients, 42.7% were pre-menopausal and 57.3% were post-menopausal. Age at menarche had no association with breast cancer for both pre- and post-menopausal women.Breastfeeding was not associated with both pre- and post-menopausal breast cancer. In summing up, Majority of risk factors for pre-menopausal breast cancer are also associated with post-menopausal breast cancer except less parity, which increased the risk for post-menopausal breast cancer only.Numerous factors including menopausal status, social background, Education, physical and emotional health may influence women’s knowledge and beliefs about menopause. (Butt, ShumailaArif, Shehbaz&sayed Furqan,2012).
Another researcher (Qazi,2006) studied menopausal symptoms, age , pattern and associated problems among Urban population of Hyderabad Pakistan. The major findings of his research showed following menopausal symptoms i.e headaches, tiredness, limb pain, sleep disturbances, lack of concentration, hot flashes and night sweats. Moreover, the participant’s average age for menopause was 47.16 years and period of menopausal symptoms range from 2 to 36 months.Menopause seems to be associated with fewer and less severe symptoms in Asia than West.
Another research was conducted by (Baig&karim,2006) to identify the average age of menopause and explored attitude and knowledge of Pakistani women towards menopause in different social strata. They concluded that in majority of the cases source of information about menopause were relatives. Their findings affirm the previous studies.
Later (Nusratet al,2008)determine the knowledge and attitude of women towards menopause and to investigate the symptoms experienced by postmenopausal women. Their results showed, Menopause was natural in 84.24% women and15.75% had surgical menopause. 78.79% women had little knowledge about menopause, while 15.8% women knew about effects and symptom of menopause. 78.79% women considered menopause as a natural process, while 21.2 % perceived it as a disease, 83.42% women were happy about cessation of menses and they did not want to have menses again, while 16.57% women wanted to have menses again. These women were of age 45 to 58 years and 59.4% were uneducated. Bodyaches,66.74% and Insomnia in 63.44% women. Vasomotor symptoms (Hot Flushes and Night Sweats) were reported by 59.4% and 45.19% respectively. Short loss of memory was reported by 62.10% women. 36.84% women were bothered by menopausal symptoms but only 31.86% has consulted doctor. 75.20% women were not taking any medicine for symptoms and 0.926% were taking Herbs, 10 (1.15%) were on HRT and 22.71% women were taking analgesics and Ca supplements off and on. Hypertension and Diabetes Mellitus was present in 20.85% and 24.9% women respectively.
They concluded thatMajority of our women were unaware of Menopausal symptoms and its health effects. Most of them considered it as a natural process of aging, though bothered by symptoms but did not go for consultation due to lack of awareness and poverty.
Another study on menopausal symptoms was conducted by (Nisar&Sohoo,2009) the objective of their study is to assess the menopause related symptoms and to determine the impact of these symptoms on the quality of life on menopausal women. Their results showed that Menopause related symptoms had negative effect on the quality of life of postmenopausal women.
Pakistani researchers worked on Assessment of bone mineral density and other risk factors of osteoporosis in Post-menopausal age group of Pakistani population and to compare them with premenopausal group. The risk factors of osteoporosis were studied both in premenopausal and postmenopausal groups. These risk factors can be exogenous or endogenous. Endogenous risk factors are aging altered menstrual status, low bone mass, positive family history and estrogen deficiency. Exogenous factors include lack of adequate nutrition (milk, calcium, vitamin D etc.) and lack of physical exercise. These risk factors were evaluated by taking history, recording height and weight, doing blood parameters and checking bone mineral density. Estrogen level was carried out by the Eliza technique. Bone mass density was carried out by the bone heel densitometer. The data was analyzed statistically and the values of two groups were compared. The risk factors in postmenopausal group were low BMD, low estrogen levels, poor Intake of milk and calcium and lack of physical exercise (hafeezn.d).
One theory suggests that the protection of post-menopausal years is related to iron lost through menstrual blood. Iron contributes to the oxidation of cells. When women menstruates they lose iron but after menopause iron can be build up In body, excess iron can be found in blood and also store in organs such as heart and liver. It’s important that once women reach menopause they no longer take multivitamins or supplements with iron in them. Once women reached the age of 50, the age of natural menopause, her risk of heart disease increases. (Stone,2013).
Post-menopausal hormone therapy may increase a women’s risk of cancer women who have reach natural menopause are at greater risk for developing cancer. A Women who began Menopause after age 55 years has an increased risk of ovarian, breast and uterine cancer. Ovarian cancer is the malignant tumor that develops in women’s ovaries. It is the fourth leading cause of cancer death among women most common in post-menopausal women. (menopause and cancer risk and treatments, 2013).
2.8 Coping Therapies
Various therapies suggested by Gynecologists to cope up with symptoms of post menopause In order to minimize its effects.
2.8.1 HORMONE REPLACEMENT THERAPY (HRT)
HRT is a system of medical treatment for surgically menopausal, menopausal, and post-menopausal women and transgender men. The main types of hormones involved are estrogen, progesterone or progestin, and less commonly, testosterone. Estrogen and progesterone are hormones that are produced by women’s ovaries, when ovaries no longer produce hormones.HRT can be given to supplement the body with adequate level of these two hormones. These hormones together, thicken the lining of the uterus, preparing it for possible implantation of a fertilized egg. Estrogen keeps the vagina healthy. Lowered or fluctuating estrogen level can cause menopause symptoms. It is often referred to as treatment rather than therapy. In the past, HRT was thought to have a beneficial effect on coronary heart disease, up until 1998. In 1998, however, the heart and estrogen/progestin replacement study (HERS) found that hormone therapy resulted in an increase in events related to coronary heart disease and had no benefits on cardiovascular health.4 years later, Women Health Initiative (WHI) estrogen-progestin theory was ended prematurely, because the risks were found to outweigh the benefits of hormone therapy. In fact, estrogen-progestin caused an increased risk of events related to coronary heart disease, strokes and breast cancer.Further in 2002, WHI found that hormone replacement therapy could raise the risk of heart disease, strike and breast cancer and due to this study, millions of women put their pills on the shelf. After detailed examination, some experts are reaching on the more pronounced view of the risks and benefits of HRT. It may be a good option for healthy women in their 50s- the women who are post-menopausal aged 50 to 59 took hormone therapy had less heart disease.(Anonymous, 2011)
2.8.2 MENOPAUSAL HORMONE THERAPY (MHT)
Another name of HRT is menopausal hormone therapy. MHT can be very good at helping with moderate to severe symptoms of the menopausal transition and preventing bone loss. But MHT also has some risks if it is used for a long time.
- MHT can help with menopause by:
- Reducing hot flashes, night sweats, irritability, and sleep disturbance related problems
- Treating vaginal symptoms
- Slowing bone loss&Treating mood swings and mild depressive symptoms
- For some women, MHT may increase their chances of:
- Blood clots
- Heart attack
- Breast cancer
Doctors recommend MHT as a short time period treatment. Women who have gone through menopause should not take MHT to prevent heart disease. It should not be used to prevent memory loss. Some side effects of MHT are:
- Vaginal bleeding
- Breast tenderness and swelling
- Mood swings
- Nausea (women’s health.gov, 2010)
2.9 Summary of studies
Researchers reviewed a lot of studies but we extract data from some of them. Some studies are based on vasomotor or physical symptoms of post menopause and some are based on somatic or psychological symptoms of post menopause. The review of literature helped the researcher to understand the subject more clearly and scientifically. It also throws light on various researches conducted in the area, their methodology and findings. The studies reviewed pointed out an interesting feature of menopause which could be quoted as follows: M — Menses Case ,E — Estrogen Falls, N — Neurology Disables, O — Ovaries Fail, P — Palpitations Disturb, A — Amenorrhea Ensures, U – Uro-urgency Manifests, S – Sleep Lacks, E -Eyesight deteriorates.
Some researchers also described the coping therapies of post menopause and relief tricks from the severe symptoms of post menopause. One of the most common and serious symptom of menopause is depression. It entails more than the occasional bout of sadness and if not treated, can lead to the more severe mental disorders and lessened quality of life. Researchers also added in our review of literature some longitudinal and cross sectional studies.
From above studies researchers found that osteoporosis, cardiovascular diseases & Depression are the more serious having long lasting effects, Which harmfully affect the menopausal women and other diseases like hot flashes,memory loss, dryness of vagina, insomnia, breast cancer etc. These are very common in post-menopausal women. Menopause is a time of major hormonal, physical and psychological change for women although studies are suggested that menopausal symptoms vary from women to women. Insomnia is a very well-known disease in post-menopausal women. It means difficulty in sleeping which is a biggest problem of post-menopausal women. Studies suggested that insomnia may be directly linked to the changes taking place after menopause. Insomnia appears due to night sweats.
The various studies done within or outside the country showed how important it is to take care during this stage of females life because the female body undergoing various physiological as well as physical changes during this stage. Various studies cited in the previous literature review showed that there is still vast gap in the information regarding this aspect of female life, which they might not be knowing are caused due to menopause. We have found some gaps from above mentioned studies that there is less literature on the after effects of post-menopausal women related to her spouse and family. And very few studies based upon attitude of those females who are very close to menopause stage and studies on their behaviors after facing menopausal symptoms.
2.10 THEORETICAL FRAMEWORK
Theoretical framework is a conceptual model of how one theory makes logical sense of the relationships among several factors that have been identified as important to the problem under study. From theoretical framework we can identified our testable hypothesis.
2.10.1 Cognitive Behavioral Theory
There are different theories which explain the issue of post menopause but for this present study cognitive behavioral theory is being used to explain the effects of post menopause on physical and psychological health of women.This approach has been presented to highlight the potential role of psychological factors in the experience of vasomotor symptoms (Hunter, 2003). The cognitive behavioral approach rests on the assumptions that emotional arousal depends on interpretation of events, (Beck, 1976), therefore suggesting that cognitions mediate between environmental events, subjective reactions and behavioral responses.
Lenthal, Narenz&Sheel (1984) presented a model which is self-regulatory. This model proposes that human beings have their unique manifestations of health problems and their cognitive appraisals primarily determine their behavioral and emotional responses.
When this approach was applied to women going through menopause, it came to attention that women have an unambiguous cognitive appraisal even in their early days of menopause. (Hunter SO’Dea, 2001).
This is the reason that there is a marked variation in the appraisal of menopausal experience some women experience it as a positive event whereas some other (evaluate it is a negative one). Consistent with these lines, a recent study proposed a strong relationship between menopausal anxiety and symptoms. The results showed that highly anxious women tend to report increased frequency of menopausal hot flashes with increased levels of distress. (Freeman, Samuel, Lin, Garcia, Kapoor, &Fredousi, 2005).
Moreover, women seeking treatment for hot flashes tend to show lower internal locus of control and decreased self-esteem. (Hunter &LiaO.1995).
The above mentioned studies support the evidence that the way of appraising menopausal experience crowns the women to become alert to their bodily states that introduces high level of distress. Specifically having increased awareness of their physiological state they are at increased list of experiencing the complications arising due to menopausal symptoms.
Analysis of data and its interpretation
This chapter consisted of quantitative data analysis and its interpretation data was collected from those menopausal women who were willing to provide information. For this Researchers want to analyze the effects of post-menopause on physical and psychological health of women. They assessed menopausal symptoms by the internationally authorized scale named as Greene Climacteric Scale (GSC), this scale assesses the degree to which women experienced by psychological symptoms which include 1-11 items, physical or somatic includes 12-18 items, vasomotor includes 2 items (19, 20) and sexual include 1 item (21).Psychological symptoms are further subdivided to give measurements of anxiety (1-6) and depression (7-11).
In this scale, the rating of symptoms is from “0-3”. Ranging from 0 (not at all), 1(little) 2 (quite a bit),3(extremely). Total number of respondent include in this research is 70, specifically of naturally post-menopausal women, 30 samples collected from Jinnah Hospital and 40 from Sheikh Zaid Hospital. It was personal willingness of the respondents to give information and express their personal views regarding menopausal.This Scale can also be used to identify menopausal women who are severely and possibly clinically anxious and depressed. The recommended cut-off points are:
Clinically Anxious = Anxiety Score of 10 or more
Clinically Depressed = Depression Score of 10 or more
These scores are based on a comparative study of the Scale with the Hospital Anxiety and Depression Scale, a scale designed to diagnose psychiatric disorders among general hospital patients.
4.1. Age of respondents
The ages of respondents were below from 57 and upper from 47, who faced menopause 1-3 years before. Samples were collected from two hospitals, Jinnah and Sheikh Zaid. Below is the table showing the frequencies of ages of the respondents.
Table 4.1 Age of the respondents and their respective frequencies
*Total no. of respondents 70
*Percentages have been collected from actual no. of respondents, which is 70
4.2. Psychological Symptoms
Following tables interpret the psychological symptoms of the respondents, which includes 11 symptoms, such as heart beating, tension or nervousness, difficulty in sleeping, excitability, attacks of panic, difficulty in concentration, lack of energy, loss of interest in most things, depression or unhappiness, crying spells, and irritability. These psychological symptoms are further sub divided into two categories: anxiety, which includes 1-6 items, and depression, which includes 7-11 items. The table of anxiety and depression are as follows.
Table 4.2.1 Symptoms of Anxiety
Heart beating quickly/
Not at all 23 33
A little 9 13
Quite a bit 30 43
Extremely 8 11
Total 70 100
Feeling tensed or nervous
Not at all 13 19
A little 12 17
Quite a bit 16 23
Extremely 29 41
Total 70 100
Difficulty in sleeping
Not at all 22 31
A little 11 16
Quite a bit 14 20
Extremely 23 33
Total 70 100
Not at all 13 19
A little 12 17
Quite a bit 21 30
Extremely 24 34
Total 70 100
Attacks of panic
Not at all 27 39
A little 22 31
Quite a bit 13 19
Extremely 8 11
Total 70 100
Difficulty in concentration
Not at all 18 26
A little 20 29
Quite a bit 17 24
Extremely 15 21
Total 70 100
The results of table 4.2.1 shows that from the symptoms of anxiety table the most prominent and high symptom is feeling tense or nervous which is forty one percent, apart from this difficulty in sleeping and excitability, difficulty in concentration is nearest to this symptoms which is thirty three, thirty four and twenty one percent. And the lowest symptom of anxiety scale is heart beating and panic attacks which are eleven percent.Furthermore, thirty nine respondents with fifty six percent shows symptoms of heart beating quietly and little when they experienced the stage of post menopause and eight respondents with eleven percent shows that they experienced extreme symptoms of heart beating in this stage. From scale symptom of tension and nervousness asked from respondents twenty eight with forty percent respondents replied that they were tensed and nervous how to overcome this symptom of menopause and twenty nine with forty one percent women experienced this symptoms extremely. Twenty five with thirty six percent women also experienced difficulty in sleeping quietly and little and twenty three with thirty three percent women experienced it extremely. From scale items the symptom of excitability experienced by women thirty three with forty seven percent quietly and a little and twenty four with thirty four percent women experienced it extremely. Various respondents said that they were more excitable in order to accomplish their task which is quite different from their normal routine. Attacks of panic experienced thirty five with fifty percent of respondents quietly and little and eight respondents with eleven percent experienced panic attacks extremely. Thirty seven with fifty three percent respondents experienced difficulty in concentrating, loss their concentration while doing any task and fifteen with twenty one percent experienced it extremely.This table interpret that various women experienced anxiety problems when they face post menopause stage.
4.6 Diagnostic use of Greene Climacteric Scale
This scale can also be used to identify the menopausal women who are severely and possibly clinically anxious and depressed. The recommended cut-off points are:
Clinically anxious = Anxiety score of 10 or more.
Clinically depressed = depression score of 10 or more.
Following are the scoring of anxiety depression and sexual dysfunction according to this scale.
Table 4.6.1 scoring of anxiety
0-9 32 46
10-18 38 54
Total 70 100
This above mention table 4.6.1 interprets that thirty two with forty six percent women were not severely or clinically anxious and thirty eight with fifty four percent women were clinically anxious they need proper treatment for this but there is slightly or minor difference between this two above mention categories which shows that few people need proper treatment for symptoms of anxiety.
Table 4.2.2 Symptoms of depression
Feeling tiresome or lacking energy
Not at all 5 7
A little 8 11
Quite a bit 16 23
Extremely 41 59
Total 70 100
Loss of interest in most things
Not at all 18 26
A little 19 27
Quite a bit 19 27
Extremely 14 20
Total 70 100
Depression or unhappiness
Not at all 13 18
A little 20 29
Quite a bit 16 23
Extremely 21 30
Total 70 100
Not at all 25 36
A little 8 11
Quite a bit 20 29
Extremely 17 24
Total 70 100
Not at all 18 25
A little 20 29
Quite a bit 25 36
Extremely 7 10
Total 70 100
Table 4.2.2 interprets that from the symptoms of depression scale the most prominent and high symptoms is feeling tired or lacking energy which is fifty nine percent, apart from this the nearest symptoms of this table is loss of interest in most things,depression or unhappiness and crying spells which is twenty, thirty and twenty four percent. And lowest symptom of depression scale is irritability which is ten percent. Furthermore, twenty four with thirty four percent respondents experienced the symptoms of lacking energy in their body quietly and little forty one with fifty nine percent women experienced this symptom extremely. When the symptom of loss of interest was asked from respondents thirty eight with fifty four percent replied that they experienced it quietly and little, fourteen with twenty percent experienced it extremely. Depression is faced by thirty six with fifty two percent women quietly and little, twenty one with thirty percent women experienced it extremely when they experienced the stage of post menopause. Many women replied that they were touchier about everything in their life after having post menopause and they rate symptom of crying spells twenty eight with forty percent quietly and little experienced it. Seventeen with twenty four percent experienced it extremely. Along with this forty five with sixty five percent experienced the symptoms of Irritability quietly and little. And only seven with ten percent women experienced it extremely.
Table 4.6.2 scoring of depression
0-9 44 63
10-15 26 37
Total 70 100
This table 4.6.2 shows that forty four with sixty three percent women were not clinically depressed and twenty six with thirty seven percent women were clinically depressed and need treatment for the symptoms of depression.
4.3 Physical Symptoms
Following table interpret the physical symptoms of post menopause which include 7 items such as dizziness or fainting, pressure or tightness in head or body, numbness in different parts of body, headaches , muscle and joint pains (osteoporosis), loss of feeling in hand or feet and breathing difficulties the results of these symptoms are as follows.
Table 4.3 Physical symptoms
Feeling dizzy or faint
Not at all 24 34
A little 19 27
Quite a bit 18 26
Extremely 9 13
Total 70 100
Pressure or tightness in headOr body
Not at all 8 11
A little 20 29
Quite a bit 10 14
Extremely 32 46
Total 70 100
Parts of body feel numb
Not at all 13 19
A little 13 19
Quite a bit 25 35
Extremely 19 27
Total 70 100
Not at all 15 21
A little 18 26
Quite a bit 24 34
Extremely 13 19
Total 70 100
Muscle and joint pains
Not at all 14 20
A little 16 23
Quite a bit 14 20
Extremely 26 37
Total 70 100
Loss of feeling in hands or feet
Not at all 18 26
A little 20 28
Quite a bit 21 30
Extremely 11 16
Total 70 100
Not at all 44 63
A little 8 11
Quite a bit 9 13
Extremely 9 13
Total 70 100
Table 4.3 interpret the physical symptoms of post menopause it shows that the most prominent and high symptom of this table is pressure or tightness in head or body apart from this the lowest symptom is feeling dizzy or faint and breathing difficulties which is thirteen percent. Furthermore, forty six percent thirty seven with fifty three percent women experienced the symptoms of dizziness and fainting quietly and little, only nine with thirteen percent women experienced it extremely. Various women feel the symptoms of tightness in head or body and about thirty with forty three percent women experienced it little and quietly and a prominent number thirty two women with forty six percent experienced it extremely. Many women complain that after having menopause their parts of body feeling numb and almost about thirty eight with fifty four percent women experienced it little and quietly. And nineteen with twenty seven percent women experienced it extremely. In headaches problems forty two with sixty percent women experienced it little and quietly. And thirteen with nineteen percent experienced it extremely. Joint pains problems also faced by prominent number of women such as thirty with forty three percent women experienced it little and quietly , and twenty six with thirty seven percent women experienced it extremely. Loss of feeling in hands and feet experienced by respondents as forty one with fifty eight percent experienced it quietly and little, whereas eleven with sixteen percent women experienced it extremely. Breathing difficulties faced by women as seventeen with twenty four percent women experienced it quietly and little only nine with thirteen percent experienced it extremely.
4.4 Vasomotor Symptoms
Following table interpret the symptoms of vasomotor of post menopause such as hot flashes and sweating at night the results are as follows.
Table 4.4 Vasomotor symptoms
Symptom of Hot flashes
Not at all 13 19
A little 15 21
Quite a bit 21 30
Extremely 21 30
Total 70 100
Symptom of sweating at night
Not at all 29 41
A little 10 15
Quite a bit 15 21
Extremely 16 23
Total 70 100
Table 4.4 interpret the scale item in which prominent number of women experienced symptom of hot flashes thirty six with fifty one percent little and quietly. Twenty one with thirty percent women experienced it extremely.
Sweating Problems faced by twenty five with thirty six percent women,quietly and little. And sixteen with twenty three percent women experienced it extremely.
4.5 Sexual Dysfunction
This table interprets the sexual dysfunction face by women the results are as follows.
Table 4.5 Sexual dysfunction
Symptom of loss of interest in sex
Not at all 13 19
A little 13 19
Quite a bit 13 19
Extremely 31 43
Total 70 100
This table shows sexual problems which women face after having post menopause such as loss of interest in sex twenty six with thirty eight percent women experienced it little and quietly. And prominent number of women thirty one with forty three percent of women experienced sexual problems extremely after having post menopause.
Table 4.6.3 Scoring of sexual Dysfunction
0-2 26 37
3.0 44 63
Total 70 100
This table 4.6.3 interprets that twenty six with thirty seven percent women were not sexually dysfunction and a prominent number forty four with sixty three percent women were sexually dysfunction. This shows that the women in Pakistani culture were also experienced this symptoms in post menopause stage as well as women of western societies.
Summary of the procedures, key major findings, Discussion, Conclusion and Recommendation
This research was conducted to understand the effects of post menopause on physical and psychological health of women. Menopause is definedas end of reproductive life and permanent cessation of menstruation which occurs at an average age of 51 years. Menopause is not an abrupt event but a gradual process. Menopause is not a disease that needs to be cured, but a natural life stage transition. It is a universal phenomenon and a natural biological event, As a women get transition from reproductive years through menopause and beyond, she experience many physical as well as psychological changes (Notelovitz,2003). In this study the researcher also found that the average age of menopause is 50-51 years and women are also facing physical and psychological problems such as nervousness, lacking energy and hot flashes etc.
In this study it was also found that majority of women have not any awareness about consulting a doctor during this crucial period of women’s life. As it was mentioned by(Bansal& Thakar2005) that uneducated and underprivileged women are unaware of their right to health care and protection as some did not realize the need to consult with doctor for their menopausal related problems.
In the study of (Mohile,2003) which is about the problems of menopausal symptoms. found in his study the long term problems of menopause which were genital problems, neurological problems, cardiovascular diseases etc but researcher disagree with Mohile on some points like researcher had not seen the symptoms of heart beating at extreme level in this study as it was mentioned by Mohile in his research.
Many studies showed that menopause can cause depression which ultimately transfer intoheadache due to low level of estrogen such as (Wood & Mitchell, 1995;Sung,2000) suggested that main reason for depression in middle age women is due to lower secretion of estrogen after the menopause But in this research symptoms of depression found at moderate level rather than extreme level this is the difference in this present research because in western countries women feel that their life will end if they enter into menopause stage they relate it with aging but in Pakistan situation is quite different, women feel comfortable after post menopause because according to them they feel free due to stoppage of menstruation cycle and they can easily offer prayer that’s why symptoms of depression seen moderate in women..
Another researcher (Qazi, 2006) studied menopausal symptoms age patterns and associatedwith fewer and less severe symptoms in Asia than west but the findings of this research shows that women experienced the symptoms of post menopause severely but they do not consider it or bother it. So researcher conclude that symptoms of menopause is severe in Asia as well in west but women did not have that much awareness about it, they are facing menopausal symptoms.
Thestudy was conducted by (Nusrat et al, 2006). They concluded that majority of our women were unaware of menopause symptoms and its health effects. Most of them considered it natural process of aging though bothered by symptoms but do not go for consultation due to lack of awareness and poverty. The findings of research is similar with the present study so this study also shows majority of women are facing the menopausal symptoms but they do not consider it or conscious about to go to doctor and seek health facilities.
From the studies previously conducted as well as result of this research shows that many women experienced menopausal symptoms such as anxiety, depression, vasomotor and sexual. Among sexual dysfunction mostly women experienced sexual problems due to loss of libido this may because dyspareunia occurs pain during sexual intercourse(Kao, 2008). In this study women also experienced sexual problems at extreme level, mostly women said after facing menopause they do not have interest in sex, they are free to offer their prayers. No fear of child bearing and child rearing but in western countries women take it serious when they are not sexually active for them loss of sexual drive is a big problem for themselves and their spouses.
Another important point of this present research is that in this research only those post menopausal women were taken who have experienced it from 1-3 recent years of women’s stoppage of menstruation cycle because in this case women were easily elaborate that what kind of symptoms she experienced at that time, This point strength this study.
During this research,It has been found that majority of the menopausal women had little or no knowledge about the symptoms of menopause. It is mainly because of the fact that women are illiterate and culture barriers prevent women from discussing such issues of their life openly. During research, researchers’ have found that women did not consult any doctor during or after menopause, mainly because they felt embarrassed to discuss such issues with the doctor. Another reason for not consulting the doctor was poverty.Moreover, women in their midlife severely face the symptoms of post menopause due to insufficient dietary habits as well as lack of health facilities.
Findings of this research shows that menopausal symptoms possess in Pakistani culture but in our society women did not give reaction against to it. They are facing symptoms severely but due to lack of awareness or hesitation and they did not take it as issue.The difference in western studies and in this research is that in Pakistan women didn’t bother their health they are stick to their household activities they have not enough information about the menopausal symptoms. During research, researcher collect the opinion of respondents about post menopause mostly women show positive attitude about it. According to them they feel free after facing the period of menopause because they can offer their prayers easily. Moreover, they can build healthy personal relationship with their spouses without any fear of babies. 0nly 20 percent women showed negative attitude about menopause according to them rotten blood should pass on from the body because it is harmful for their body and develop the disease of obesity many women complain about the problem of their eye sight.
Whereas in the west, women-related issues and discussion upon them is not considered to be a taboo, and due to the fact that most of the countries are highly developed, women are educated and are concerned about their health. Women consult their doctors and discuss the issues keenly as they are more concerned about their health. Internet is the most important tool in providing information about almost anything. People of the developed countries have easy access to internet and other sources of information.In developed countries, when women experienced that stage she feels that she is getting old her body is like a barren land which is not able to produce a child. They feel sexual dysfunction and not enjoyed sex with their spouses.
The researcher concluded that uneducated and under privileged women are unaware of their right to health care and protection, as some did not realize the need to consult doctor for their menopausal symptoms. It is the responsibility of the health department to aware women by conducting seminars and lectures in different communities.
In this study researcher wanted to check the effects of physical and psychological symptoms on women health. For this purpose sample of 70 postmenopausal women were collected. The samples were collected from two hospitals Jinnah hospital and Sheikh Zaid hospital. The age of respondent was 47 to 57. The instrument used in this research was Greene climacteric scale which was intentionally authorized scale. This scale assesses the degree to which women is bothered by psychological and physical symptoms. The psychological symptoms of scales are further divided into three categories, somatic symptoms, vasomotor and last symptom is sexual dysfunction.
The results showed that menopausal symptoms effects women physical and psychological health severely. The findings of research was that mostly women which were affected from psychological symptoms such as tiredness or lacking energy, depression, tension and irritability etc and women which were affected from physical symptoms such as numbness in body, hot flashes, headaches and tightness in head or body. Apart from this mostly women feel sexual dysfunction after having menopause.
Findings of Research
The major findings of this research are as follows:
- Lack of awareness is the main reason due to which mostly women suffering from post menopausal symptoms severely.
- Among anxiety problems, the most extreme symptoms faced by menopausal women is feeling tension or nervousness which is forty one percent and the lowest symptoms which are faced by women are heart beating and panic attacks which is eleven percent.
- Among depression, feeling tired or lacking energy is the highest symptoms which are fifty nine percent and lowest is irritability which is ten percent.
- Among physical symptoms, highest symptom is pressure or tightness in body which is forty six percent and lowest is breathing difficulties and dizziness which are thirteen percent.
- Among vasomotor hot flashes are mostly experienced by women which are thirty percent and lowest is sweating at night which is twenty percent.
- Among sexual dysfunction loss of interest in sex is mostly experienced by menopausal womenwhich is forty three percent.
- In summing up the most experienced symptoms faced by Pakistani women is tension or nervousness, tired or lacking energy, pressure or tightness in body and hot flashes.
- It was found by researcher at the stage of data collection that various factors such as social background, education, physical and emotional health may influence women’s knowledge and beliefs after menopause.
It was concluded that mostlywomen experience post- menopausal symptoms. They experienced sexuality as well.The symptoms experienced are similar as in other parts of the world, although occurring with varying frequencies. Different women experience different symptoms of menopause some experience hot flashes at extreme level and some feel lacking in energy it depends and vary from women to women.They did not consultanyone to seek relief from post-menopausaldiscomforts. Majority of the women did notmake use of any coping strategy to avoid postmenopausaldiscomforts .Women in whole, which experiencing an early natural post menopausehad a raised risk of tension or nervousness, lacking in energy, tightness in head or body, hot flashes and sexual dysfunction. In this study life stress and poor socioeconomicstatus were associated with more symptoms, the formerlinked especially with psychological symptoms and thelatter with somatic symptoms. It is important to emphasize on educating the women about health risk, and adopting healthy life style behavior which can influence their risk for developing diseases associated to menopause in the near future.
Women in Pakistan did not bother menopause even due to lack of awareness they are facing menopausal symptoms but they did not know that such symptoms are only because of menopause.In Pakistani culture it is assumed that there is no effect of menopause on the life of women but this study shows that women suffered from different symptoms and experienced some of them at extreme level but women don’t have enough knowledge that how much their life change after menopause and how symptoms effect their body. In Pakistani culture women did not bother it and ignores the effects of this stage but actually they are suffering from various symptoms of post menopause.
In order to minimize the effects of menopausal symptoms following are some suggestions to cope the severity of menopausal symptoms.
- Post- menopausal woman should consult gynecologists to know whether they need to be treated with Hormone ReplacementTherapy (HRT) or not.
- Woman should undergo screening forosteoporosis regularly.
- Woman above 40 years should adopt a lifestyle that incorporates stress management.
- A balanced dietary pattern should befollowed by woman.
- Awareness campaigns must be undertakento inform woman about the various copingStrategies to be used in the phase of post menopause.
- Regular, weight-bearing physical exercise at least 30 minutes three or more times weekly canimprove mood reduce hot flashes and help preventosteoporosis heart disease and diabetes.
- Patients should strive to maintain an ideal body weight.
- Consume a diet high in fiber, fruits whole grains and low in fat. Avoiding red meat and dairy products as well as saturated oils is also important. A high-saturated fat diet can increase risk of heart disease and obesity in women of all ages, but particularly menopausal women.
- Healthy essential oils from fish, raw seeds, and nuts can be extremely beneficial for menopausal women. Essential fatty acids help to relieve tissue dryness and protect the heart as well.
- Take calcium along with vitamin D, vitamin K can be useful in preventing osteoporosis.
- Advice patients to dress in layers so they can remove as necessary as hot flashes come on.
- Glass of cold water or juice at the onset of a flash may also be helpful. Recommend that patients to keep a thermos of ice water or an ice pack by their bed. The use of cotton sheets will help the skin be cool at night.
- To help prevent urinary tract infections, advice the patient to urinate before and after intercourse, empty her bladder regularly, drink plenty of fluids, and keep her genital area clean.
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