Background: During menopause transitions, fluctuate hormone levels make menopausal women susceptible to mental and physical disorders that affect their quality of life. Research on menopause-related problems, especially among rural women, are also lacking. With that sense, research is aimed at investigating some signs of dysfunction and quality of life in menopausal women.
Methods: A cross-sectional study was performed on 296 menopausal women aged 45-60 in 2 communes Tan Phong, Tan Hoa, Vu Thu district, Thai Binh province. Data was collected with 2 study tools: The Menopause Rating Scale (MRS) scale and the World health organization quality of life questionnaire (WHOQOL-BREF).
Results: 68.2% of women participating in the study has mild-moderate, severe-very severe symptoms 7.4% and 24.3% of women has no menopausal symptoms. The average score of the QOL is 66.0±8.4. The highest quality score in the field of environment is 21.5±3.7, the lowest is in the field of social relations with 8.7±2.1.
Conclusion: Menopause causes physical, mental and urogenital problems. Almost all domains evaluated were impaired in menopausal women and affect their quality of life. Education, creating awareness and providing suitable intervention to improve the QOL of menopausal women are important at both the individual and community level.
Keywords: Quality of life, Menopausal women
Menopause is a condition in which a woman ceases menstruation due to exhaustion of her ovaries, which are no longer receptive to gonadotropic hormone stimulation, and as a result, she no longer secretes enough sex hormones. A woman can no longer become pregnant after menopause. Menopause is the end of menstruation and the secondary amenorrhea, which is caused by a natural and irreversible reduction in ovarian function. Menopause occurs at an average age of 45-50.1
Menopause is a natural part of the aging process that can occur smoothly or with a slew of symptoms including changes in menstrual cycle, cardiovascular, sexual, and urinary issues, as well as mental health. In the long run, symptoms can be worse resulting in osteoporosis, cardiovascular disease, Alzheimer's disease, and other diseases, which impair postmenopausal women's quality of life (CLCS), work efficiency, and family happiness. As a result of improved living conditions and health care, people's average life expectancy has increased in recent years. As women's lifespans lengthen, they spend roughly a third of their lives with hormone deficiency; consequently, analyzing quality of life during menopause is of pivotal importance.2 In addition, women are more involved in social activities and hold a prominent place in modern society; life quality is one of the indicators of health-care outcomes. Understanding some of the symptoms of dysfunction and quality of life in menopausal women is therefore an important aspect of women's health treatment at this period. With this in mind, the goal of this study was to look into certain signs of dysfunction in postmenopausal women as well as their quality of life.
Subject
Menopausal women who live and work in Tan Phong and Tan Hoa communes in Vu Thu district of Thai Binh province.
Researching location and time
The research was carried out in the communes of Tan Phong and Tan Hoa, Vu Thu district, Thai Binh province, from August 2020 to February 2021.
Research design
Cross-sectional study
Sample size
296
Measuring and evaluating methodology
We used a three-part questionair system.
+ Part 1: General imforamtions about the subjects.
+ Part 2: The Menopause Rating Scale (MRS), which consists of 11 questions separated into three categories, was used to assess the severity of menopausal symptoms. Physical symptoms (four questions); psychiatric symptoms (four questions); and urogenital symptoms (3 questions). Each question has five degrees of answers, ranging from none (=0) to very severe (=4). The lowest total score is 0 points, and the maximum total score is 44 points.3 MRS≤ 11: no symptoms; 12≤ MRS≤35: mild to moderate; MRS≥36: symptoms ranging from severe to very severe.
+ Part 3: The WHO Quality of Life Scale (WHOQOL-BREF) is a questionnaire with 26 items grouped into four categories: physical, mental, social interactions, and environment. Each aspect that influences quality of life will be given a five-level response, ranging from very terrible (=1) to very good (=5).
The average score of four areas of physical, mental, social relations, and environment is used to determine the quality-of-life score; the results are then converted to a scale of 100 according to the convention table; the higher the score, the higher the quality of life, and vice versa. The 33.3rd and 66.7th percentiles of the quality-of-life score range are used to classify low, moderate, and high quality of life.
WHOQOL-BREF<33.3: low quality of life
33.3≤WHOQOL-BREF≤66.7: moderate quality of life
WHOQOL-BREF>66.7: high quality of life
In this study, we classified the quality of life into two levels: good and not good
Data analysis
The data was input and processed using SPSS 20.0 software after it was checked, and statistical methods were utilized for analysis.
Table 1 Menopause symptoms had the highest average score of 7.3±3.6 points in the physical category, followed by 7.2±3.6 points in the mental category, and 4.6±2.7 points in the urogenital symptoms category. Sleeping problems had the highest average score of 2.4±1.2 points in the physical symptoms category, with 96.0% of women experiencing them. Then there were hot flushes, which scored 2.0±1.0 points and were reported by 96.3 percent of women. With 90.5% of women experiencing this indication, tiredness had the highest average score of 2.1±1.1 points in the psychiatric category. Regarding category of urogenital-genital symptoms: vaginal dryness had the highest average score of 1.6±1.1 points with 91.2% of women having it, and the number of women with reduced sex drive (libio) and bladder problems were 82.1% and 76.7%, respectively.
Table 2 While 202 of the women (68.2%) in the study had mild to moderate symptoms, only 7.4% had severe to very severe symptoms, and 24.3 percent had no menopausal discomfort.
Table 3 Postmenopausal women reported an average total point of life satisfaction of 29.5±4.9. The highest level of satisfaction was 43.5% for help received from friends, followed by 38.8% for personal relationships. Only 14.9% of menopausal women were happy with their sleep and their satisfaction with their sex life was the lowest at 14.5%.
Table 4 In the two researched communes, the proportion of postmenopausal women with an excellent quality of life was 42.6% (126 individuals).
Table 5 The average quality of life score was 66.0±8.4 points, ranging from 52 to 95. The environmental category had the greatest quality of life score of 21.5±3.7 points, followed by the physical and psychological categories with 19.7±2.2 and 16.2±1.8 points, respectively. The lowest figure, 8.7±2.1, was in the field of social interactions.
The decline of gonadal hormones during menopause causes a variety of physical, psychophysiological, urogenital changes that can have a substantial impact on a woman's health and quality of life.The study found that 68.2% of women experienced mild-moderate symptoms, 7.4% had severe-very severe symptoms, and 24.3% had no symptoms of menopause. Specifically, physical changes such as hot flushes and sleep problems accounted for a relatively high % age of symptoms. With 65.6% and 51% of mild and moderate symptoms, respectively; 30.7% and 45.0% of severe and very severe symptoms.
When it came to psychiatric issues, exhaustion symptoms were the most common. Mild to moderate symptoms accounted for 58.1%, while severe to very severe symptoms accounted for 32.4%. Urogenital abnormalities included vaginal dryness, libido changes, and bladder issues, with mild and moderate symptoms accounting for 58.4; 52.0 and 56.4%, respectively, and severe and very severe urogenital changes accounting for 32.8; 30.1 and 20.3%.
This finding is similar to that of Le Thanh Binh, et al. (2014), who found that 90.6% of postmenopausal women suffer from musculoskeletal discomfort, 73.2% from hot flushes, over 81.1% from headache and memory loss, and 92.1% from vaginal dryness; or in a study in Hue by Nguyen Dinh Phuong Thao, et al. (2017) found that 84.7% of menopausal women displayed signs of forgetfulness, while 69.4% felt fatigued and frustrated for no reason. These findings were also reported by author Karmakar N, et al. (2017), who discovered a moderate prevalence of vasomotor symptoms, with 60% of individuals experiencing hot flashes and 47% sweating. Anxiety and stress (94%), as well as general depression (88%), were the most commonly reported psychosocial symptoms. Physical symptoms manifest themselves in a variety of ways, with 93% of women experiencing fatigue or weakness, decreased fitness, and a loss of energy. Sexual alterations were seen with 49% of study participants avoiding intimacy with their partners and 26% women reporting vaginal dryness. These findings are similar to that of Augoulea A, et al. (2019), who found a shift in psychiatric and vasomotor symptoms throughout the menopause transition, with vasomotor symptoms accounting for 50.3% to 82.1% with varying frequency, duration, and intensity. Factors in the frequency of certain symptoms could be due to racial, cultural, genetic, and dietary differences. At the same time, that disparity is most likely due to differences in the authors' evaluation criteria; also, the assessment of this symptom is heavily dependent on the subjectivity and perception of the research subjects.3-5
The average point of life satisfaction was 29.5±4.9 points, in which higher satisfaction proportion was with help from friends and personal relationships (43.5% and 38.8%, respectively); 18.5% of menopausal women were satisfied with their sleep, and lowest satisfaction was with their sex life (14.5%). As a matter of fact, the study subjects' perceptions of quality of life and personal health were low. This could be due to the fact that physical health of postmenopausal women in the research area had not been properly cared for, and the rate of chronic diseases in this demographic was still high (68.9%), which lower the overall quality of life score. Additionally, because the area is a rural suburb, the interaction between villages is extremely close, resulting in the highest level of personal relationship satisfaction. Furthermore, according to various studies, over 80% of menopausal women had varying degrees of symptoms when blood estrogen levels fluctuated during the stages of menopause. Women of this age also experienced menopausal symptoms such as hot flashes and sweats, sleep difficulties, changes in sex drive, and vaginal dryness, among other things, which influenced their satisfaction score on the aforementioned factors.6,7
The district's quality of life for postmenopausal women was rated "not good" by 170 people, or 57.4%. The %age of women who said their quality of life was "good" was 42.6% (126 cases). The study's average quality of life score for postmenopausal women was 66.0±8.4 points, with the greatest score being 95 and the lowest being 52. The greatest quality of life score was 21.5±3.7 points in the environmental category, followed by 19.7±2.2 points in the physical category, and 8.7±2.1 points in the social interactions area. This differed from the findings of Tran Thi Thanh Nhan et al., who conducted a study in Hue and found that poor quality of life accounts for 88.5% of the research population, while good quality of life accounts for only 11.5%, with the highest quality of life scores in the social category and the lowest in the physical issue.8 Because Vu Thu is a purely agricultural district located far from the city center and lacking sort of industrial parks and factories, the environment was cleaner; however, social activities were less popular, and the number of postmenopausal women participating in social activities was still limited, so the reported quality of life score in the social field was low.
Menopause is associated with physical, mental, and urogenital issues. Almost every category assessed in postmenopausal women was impaired, which lowered their quality of life. To improve the quality of life of menopausal women. At both the individual and community levels, it is critical to educate, raise awareness, and provide appropriate interventions to improve the quality of life of menopausal women.
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The authors have no disclosures or conflicts of interest.
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