|Year : 2021 | Volume
| Issue : 3 | Page : 109-115
Prevalence and factors associated with morbidity among postmenopausal women in a rural area in Kozhikode District
PR Shamin1, S Suthanthira Kannan2
1 Junior Administrative Medical Officer, Taluk Hospital, Perambra, Kozhikode, Kerala, India
2 Department of Community Medicine, ESIC Medical College, Hyderabad, Telangana, India
|Date of Submission||12-Feb-2021|
|Date of Decision||18-Apr-2021|
|Date of Acceptance||01-May-2021|
|Date of Web Publication||25-Sep-2021|
Dr. S Suthanthira Kannan
Department of Community Medicine, ESIC Medical College, Sanath Nagar, Hyderabad, Telangana
Source of Support: None, Conflict of Interest: None
Introduction: The focus of women's health researchers and health policy planners has also shifted toward postmenopausal women since recent trends suggest an increase in their number and life expectancy. In general, women have more complex and stressful aging process as men do, as a consequence of hormonal changes that occur during menopausal transition.
Objectives: The objective of this study is to estimate the prevalence of postmenopausal symptoms among women in a rural area of Kozhikode and study factors associated with it.
Material and Methodology: A cross-sectional study was conducted among postmenopausal women aged 40–55 years in Nanminda panchayat, a rural area in Kozhikode district. This 1-year study was conducted from June 2015 to June 2016, had 245 participants with informed consent. There are 17 wards (17 clusters) in Nanminda panchayat area from which 6 wards were selected. The prevalence of postmenopausal symptoms and associated factors such as sociodemographic profile, morbidity details, diet supplements, anthropometric, clinical, and reproductive components was assessed using the pretested semistructured questionnaire.
Results: A total of 245 postmenopausal women were studied. The prevalence of postmenopausal symptoms was found to be 64%. The mean age of the study population was 50.87 years. Age, education, marital status, menopausal age, and duration of menopause were found to be significantly associated with the presence of postmenopausal symptoms. Intake of Calcium supplements was found to be having protective effect against menopausal symptoms. Binary logistic regression revealed that age, educational status, marital status, and dietary intake of calcium supplements are significantly associated with postmenopausal symptoms.
Conclusion: Women with early age of menopause and less duration since menopause had more risk of having postmenopausal symptoms. The prevalence of symptoms was found to be less if calcium supplements were taken.
Keywords: Calcium, menopause, postmenopausal symptoms, prevalence, rural
|How to cite this article:|
Shamin P R, Kannan S S. Prevalence and factors associated with morbidity among postmenopausal women in a rural area in Kozhikode District. MRIMS J Health Sci 2021;9:109-15
|How to cite this URL:|
Shamin P R, Kannan S S. Prevalence and factors associated with morbidity among postmenopausal women in a rural area in Kozhikode District. MRIMS J Health Sci [serial online] 2021 [cited 2021 Oct 25];9:109-15. Available from: http://www.mrimsjournal.com/text.asp?2021/9/3/109/326729
| Introduction|| |
Menopause is the permanent cessation of menstruation when menstrual cycle stops for longer than 12 months, and there is a drop in the levels of estrogen and progesterone, the two important hormones in the female body. There exists a growing interest in matters concerned with the menopause as it is considered to be etiologically related to some of women's major age-related health problems such as osteoporosis, cardiovascular disease, cancer, and depression.
According to Indian menopause society research, there are about 65 million Indian women over the age of 45 years and estimated that in the year 2026, the population in India will be 1.4 billion, people over 60 years will be 173 million and the menopausal population will be 103 million.
There are very few studies having data regarding the prevalence and associated factors of postmenopausal symptoms in Kozhikode district. It is necessary to study the same so that the magnitude of the problem among these women is known so that early interventions can be attended. Hence, this study was conducted to generate the data about the prevalence of postmenopausal symptoms and factors associated with it among women aged 40–55 years in a rural area of Kozhikode district.
| Material and Methodology|| |
This study is cross-sectional study conducted in Nanminda Panchayat of Kozhikode district in Kerala. The study was conducted from June 2015 to June 2016 over a period of 1 year. Data collection was done over 6 months from September 2015 to February 2016. Women of age group 40–55 years who have attained menopause residing in the study area were included in the study. Women with unnatural menopause hysterectomy, radiotherapy, women with serious illness like cancer, severe psychiatric illness, bedridden, and women not willing for the study were excluded from the study.
Cluster sampling was employed. Sample size was calculated using the formula 4 pq/d2 with allowable error of 20% (d), taking P as 60% obtained from a study conducted by Borker et al. in 2013. After applying the design effect of 1.5, the sample size was calculated to 225. Sample size was approximated to 250 considering 10% nonresponse rate.
Of the 75 panchayats in Kozhikode district, Nanminda panchayat was selected by simple random method. Of the 17 wards in Nanminda panchayat each ward was taken as a cluster. From the pilot study, the number of responses (participants) in a cluster was found to be 40. To obtain sample size of 250 (250/40 = 6), 6 clusters were required. Clusters were selected using simple random sampling (lottery method). Out of 6 selected wards, the data of women in the study age group of 40–55 years were obtained from the electoral roll.
After getting permission from DMO, the Medical Officer of the PHC was contacted. Forty study participants satisfying the eligibility criteria were selected from each ward. Their houses were identified and camps conducted in each ward including 10 participants at a time. Written informed consent was obtained from the study participants. Data collection was done using a semi-structured questionnaire based on Greenes, Neugarten, and Kranines checklist of menopausal symptoms by interview method. The participants were interviewed after ensuring adequate privacy in a convenient place. The data regarding sociodemographic, personal and medical history, postmenopausal symptoms, and related factors were obtained. Clinical and anthropometric examination was then done. Height was measured using a Stadiometer (Portable Height – length measuring board) participant was asked to stand on the board facing the investigator keeping their feet together, heels against the back board and knees straight. The participant was told to look straight ahead and not look up, making the eyes at the same level as ears. The measuring plate was moved down and placed on the top of the head. Height was read in centimeters to the nearest 0.1 cm. Weight was measured using an Omron Digital Weighing Scale – Product code HN-283 with high precision of 0.1 kg. Blood pressure (BP) was measured by sphygmomanometer. Blood glucose meter measured blood glucose levels electronically. Comorbidities were assessed by known history of any other illness, by BP and random blood sugar measurement. Body mass index was also assessed. Women who could not be contacted on the first day were visited a second time. If in spite of two visits, they could not be contacted and they were not included in the study.
All the data collected were coded and entered in Microsoft Excel sheet which was re-checked and analyzed using the SPSS Version 20 developed by IBM, United States of America. Descriptive statistics were analyzed such as frequency, mean, standard deviation (SD), and median. The prevalence of postmenopausal symptoms was estimated using Openepi software. Statistical comparison was done using appropriate statistical method and level of significance was P value of 0.05. Statistical testing for the association of factors with various symptoms was done using the Pearson Chi-square test.
Study protocol was submitted to the Institutional Research Committee as well as Institutional Ethics Committee of Govt. Medical College, Kozhikode and clearance was obtained for conducting the study. Permission obtained from District Medical Officer, Kozhikode. Informed written consent was obtained from all the study participants.
| Results|| |
Out of 250 participants included in the study, 245 participants gave consent to participate in the study.
Sociodemographic details as described in [Table 1]. The mean age of the study population is 50.87 (SD = 3.212) years, and the age of the study group ranged from 44 to 55 years. One-hundred and thirty-six (55.4%) of the study population was 54 years, whereas 106 (44.6%) were in the age group of 44 years. Majority of the women in the study were Hindus 152 (62%), followed by Muslims 93 (38%). According to the Modified Kuppuswamy Scale classification, 219 (89%) of the study group belonged to the upper lower class (Class IV). Majority had primary and secondary school education 215 (88%), while the rest 30 (12%) had middle/primary school education. Two hundred and nine (85.3%) of the study participants were currently married and living with their spouse, whereas 36 (15%) of the participants were widows.
Menstrual and obstetric details of patients as in [Table 2]. Majority of the study group attained menarche at the age of 14 years (51%). The mean age of menarche was 14 years. The mean age at marriage of the study population was 20 years (SD = 2.9). The minimum age at marriage was 15 years and the maximum age was 30 years. Majority of the study participants had their first childbirth between the age of 20–24 years. Mean age at child delivery was 21 years (SD = 6). Sixteen of the participants in the present study were nulliparous. Number of pregnancy in 102 (42%) of the study participants were two. There were 16 women who never became pregnant. Majority of the study participants 111 (45%) had two children while 16 women were nulliparous. Only 22 of them had four or more children. The mean number of children in this study was two. The mean age of menopause was found to be 46.7 (SD = 1.9) years in the study population. Most of the study participants attained menopause after the age of 47 years. Menopausal age ranged from 42 years to 50 years. Only ten of them attained menopause before 44 years. The mean duration since menopause in the present study was 4.3 years (SD = 2.5). The duration ranged from 1 to 10 years.
Prevalence of postmenopausal symptoms
The prevalence of postmenopausal symptoms in the present study was 156, i. e., (64% with a 95% confidence interval [CI] of 57.4–69.7) estimated using Wald's statistics.
Majority of the study participants, 79% had two or three symptoms in the present study, as shown in [Figure 1]. Majority had vasomotor symptoms such as hot flushes, palpitations, and night sweats. Psychosomatic symptoms included headache, sleep disturbance, and dizziness. Among the 31% who had sexual symptoms, majority complained of loss of sexual desire. Thirteen percent had urinary complaints mainly polyuria and recurrent urinary tract infections. Main psychological symptoms were irritability, poor concentration, and anxiety. Other symptoms constituting 35% included bleeding disturbances, fatigue, skin changes such as melasma and joint problems, as mentioned in [Figure 2].
The association between sociodemographic factors and postmenopausal symptoms are given in [Table 3]. The women in the younger age group had symptoms and majority in the next age group were also symptomatic. The prevalence of postmenopausal symptoms was significantly more in Muslim women as compared to Hindus in the present study. The prevalence of postmenopausal symptoms was less in lower socioeconomic group than the middle group in the present study. However, it was not statistically significant. Although the prevalence of postmenopausal symptoms was found to be 76% in women from joint family as compared to 62% in nuclear family, it was not statistically significant in the present study. In the present study, the educational status of the women was significantly related to the postmenopausal symptoms. Women with higher secondary education were less symptomatic (36%) when compared to those with less education. In the present study, currently married women living with their spouses were having more symptoms in comparison with widows and it was found to be statistically significant. Sexual symptoms were exclusively reported by currently married women.
|Table 3: Association between the prevalence of postmenopausal symptoms and sociodemographic factors|
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Menstrual and obstetric factors as described in [Table 4]. The present study shows a higher prevalence of postmenopausal symptoms among women who attained menarche earlier, i.e. 75% of those with menarche at the age of 13 years had symptoms while only 56% of those at 15 years had symptoms. The prevalence of postmenopausal symptoms was 64% in those who got married before the age of 20 years. Of the 16 women who married after 24 years all were having symptoms. In our study, majority of nulliparous women (63%) did not have any postmenopausal symptoms while 67% of women with more than two pregnancies had symptoms. However, this difference was not statistically significant. The study revealed a significant increase in postmenopausal symptoms in women who attained early menopause. In the present study, there was a significantly higher prevalence of postmenopausal symptoms if the duration of menopausal stage was less. As the duration increases, the symptoms tend to be less. The prevalence of symptoms was less in women consuming Calcium supplements, and it was statistically significant.
|Table 4: Association between menstrual & obstetric factors and prevalence of postmenopausal symptoms|
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Comorbidities and postmenopausal symptoms as tabulated in [Table 5] and [Table 6] In this study, no significant association was found between chronic diseases and postmenopausal symptoms. Among those with known history of comorbidities, hypertension alone was present in 18 women and both hypertension and diabetes mellitus were present in 6. The prevalence of postmenopausal symptoms was significantly more in women with comorbidities. In the present study, 62% who were overweight and all of the obese participants had postmenopausal symptoms, but the difference was not significant as compared to women with normal body mass index. In our study, 71% of women with systolic BP more than 140 and 70% with diastolic BP more than 90 had postmenopausal symptoms. In the present study, there was no difference in the prevalence of symptoms in relation to random blood sugar values.
|Table 5: Association between chronic diseases and postmenopausal symptoms|
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Multivariate analysis by binary logistic regression
The risk factors which had statistical significance by univariate analysis (P < 0.05) were further analyzed by binary logistic regression, as shown in [Table 7]. Method of regression used was the ENTER method. Nagelkerker square (R2) which shows the model summary was 0.511 which is a moderate value.
Binary logistic regression revealed that younger age, poor educational status, currently married, and dietary intake of calcium supplements are independently associated with postmenopausal symptoms.
| Discussion|| |
The cohort of postmenopausal women is increasing in India. The abrupt endocrine changes during menopausal transition have important impacts on the physiology of female body which exacerbate risks for many diseases and disabilities during postmenopausal life. The prevalence of postmenopausal symptoms in the present study was 156, i.e. (64% with a 95% CI of 57.4–69.7) estimated using Wald's statistics. This is lower than that reported in most studies from India. Subrahmanyam and Padmaja et al. reported a prevalence of 80% and Singh and Pradhan in 2014 in rural Delhi report that a higher number of 225 (89.3%) had at least one symptom. According to a study by Dutta et al. in 2012, the overall prevalence of any one symptom during the postmenopausal period among the study participants was 88.1% (95% CI: 85.8–90.3).
Among the sociodemographic factors, those who attained menopause at younger age, belong to Muslim religion, educational status, those who are currently married are found to be significantly associated with postmenopausal symptoms. Dasgupta and Ray found similar results as those who attained menopause earlier. Women with higher secondary education were less symptomatic (36%) when compared to those with less education. This difference may be due to increased awareness and difference in perception among women with higher education. However, Madhukumar et al. report that literate women had more symptoms as compared to illiterate. Sharma et al. and Madhukumar et al. had also reported that married women experienced more sexual symptoms than unmarried.
The menstrual and obstetric factors that are found to be significantly associated with postmenopausal symptoms are early onset of menopause, less duration of menopause, and intake of calcium supplements. In a study by Dutta et al. in Tamil Nadu in 2012, Dasgupta and Ray and Sharma et al. majority of women who attained menopause before the mean age had postmenopausal symptoms compared to others. In a study by Sharma et al., Mahajan et al., and Kulkarni et al., there was a significantly higher prevalence of postmenopausal symptoms if the duration of menopausal stage was less. Daily calcium intake of 1000 mg is recommended for postmenopausal women. In a study by Raj et al., the prevalence of symptoms was less in women consuming Calcium supplements and it was statistically significant. The IMS has commendably stayed well-clear of recommending Vitamin D and calcium supplements for extra-skeletal benefits in the absence of convincing data.
No significant associations had been found between postmenopausal symptoms and presence of chronic diseases. Only significant association is found between the presence of hypertension and postmenopausal symptoms. A cross-sectional analysis was done by Zanchetti et al. in 2005 in more than 18,000 Italian women, aged 46–59 years, that found a significant, but clinically small, increase in both systolic and diastolic BP of 3.4/3.1 mm Hg among postmenopausal women, which was independent of age and BMI and was only evident at younger menopausal age.
| Conclusion|| |
The prevalence of postmenopausal symptoms was low in the study population as compared to similar studies conducted in Kerala. Women with early age of menopause and less duration since menopause had more risk of having postmenopausal symptoms. Women with comorbidities also had a higher prevalence of symptoms. The prevalence of symptoms was found to be less if calcium supplements were taken.
- As the diagnosis of menopause is often retrospective and study design being cross-sectional, have to rely on accurate knowledge and unbiased reporting of age. The recall bias is a major limitation
- The accuracy of information depends upon the period of time since menopause, alertness, motivation, and educational level of the women studied.
Feel it is my proud privilege to extend my sincere thanks to all health nurse and staffs of primary health center in Nanminda panchayat who helped me in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]