Introduction
Menopause is the period in women’s life when menstruation ceases, it’s a universal phenomenon, which is experienced by middle age women which affect their quality of life. Perimenopause refers to the time during which body makes the natural transition to menopause, marking the end of reproductive years. It roughly starts in the late 30sor as late as your mid-50s. Due to hormonal imbalance women may experience psychological as well as physiological changes that affect their overall health status.1 There is lack of knowledge and awareness regarding Perimenopause and menopause and its problems among women. It is essential to increase women’s knowledge about perimenopause and menopause which may help them to cope with it in a better manner and there by lead to a good quality of life. Proper knowledge and awareness regarding menopause and perimenopause, is very necessary, especially for women.
Menopausal symptoms such as hot flush, night sweats, sudden perspiration, exhaustion, dizziness vaginal dryness, mood swings leads to several physiological changes in women. Hot flush is the most important symptom of menopause and most women complain of it. About 50% to 80% of women report hot flushes in the ages before and after menopause. Although menopause is not an illness, mortality and morbidity rates are enhanced in menopausal women. The effects of this physiological phenomenon include vaginal changes, bones’ thinning, behavioral changes, urinary changes, increase of body fat content around the waist (weight increase), and low desire for sexual activity.2
Most of the women reach menopause age without having adequate knowledge about the events of this period and the ways to deal with it. In the societies where women have high knowledge about menopause, the consequences dealing with perimenopause and menopause are still less obvious.3
Women’s awareness regarding perimenopause and menopause is based on different factors like age, the number of births, social, economic, cultural, educational status, and geographical factors. Most of the women attain menopausal periods without having the adequate knowledge about its consequences. So females having adequate knowledge and information of symptoms and complications of menopause are able to cope with it in a better manner and take appropriate treatment. As menopause is a natural phenomenon, every woman will face menopause but awareness regarding its problems faced during menopause needs to be addressed and taken care of. If a woman may not be aware of what’s happening to her during this period, it leads to a stressful postmenopausal period. The more negative the attitudes, the higher the severity of the symptoms.4
Materials and Methods
A self-made questionnaire was designed by the authors and face validated. After ethical approval from the Institutional Review Board, 100 females between the ages of 40 -45 years were invited to participate in the study through Google forms and personal interviews. It was crosses sectional study in which informed consent was taken and were asked to answer the questionnaire. The females having regular or irregular menstrual cycles and belonging to non medical fields were included in the study.
Results
Women living in urban areas of age 40-45 years were included in this study.
(Mean age-42.5; Standard deviation – 1.88)
Discussion
The current study was conducted to find the knowledge, attitude, perception in the women (aged 40-45 years old) regarding the term perimenopause and menopause, its sign and symptoms, problems faced in different domains (physical, psychological, hormonal, emotional), risk factors faced in menopause, its complication, awareness of physiotherapeutic exercises to be done, the different treatment strategies and awareness about Hormonal replacement therapy.
As depicted in Figure 1, 94% women have heard about the term Perimenopause and menopause, the reason attributed to this study be the higher educational status of the women included in the study which were similar to the study done by Kishor V. et al in Bhavnagar and Surat city of Gujarat, as education level increases, awareness about menopause and perimenopause related problems are increased.5
In this study as depicted in Figure 2, the highest source of information identified was from Family doctors, followed by friends/relatives and the rest have known about it through studies and self-awareness. In the study done by Tsehay DS, they found that in most women the source of information was obtained from their friends, followed by medical professionals.6
On studying the awareness regarding the knowledge of perimenopause and menopause, Figure 3 shows that 96% of the women had knowledge about the related terms and 4% were unaware about it. This is due to the fact that the level of education was more as the women were from urban areas. It was similar to the study done by Nusrat N, et al. In which 78.79% women were aware about menopause, among them 73.52% were illiterate and 180 (26.47%) were educated. 137 (15.8%) women had knowledge about the effects and symptom of menopause.7
Figure 4 shows that, 85% of the women were aware about the causes of ceasing/stopping of a women’s menstrual cycle being a natural phenomenon, this could be attributed to educational level, as its being higher in urban population. And 42% of women think that it happens due to advancing age.5
As shown in Figure 5, 95% women were aware that perimenopause/ menopause affect’s women’s body and 5% were not aware about it, this states the fact that women now days are more conscious about their health and fitness and changes that happen in their bodies.
In this study, the awareness regarding physical symptoms, emotional symptoms, hormonal deficiency related symptoms and bone and muscle related symptoms faced in perimenopause and menopause was done by comparing the Figure 6, Figure 7, Figure 8, Figure 9 which states that 92% women are mostly aware about the bone and muscle related symptoms, followed by emotional/ psychological symptoms 88%, hormonal deficiency related symptoms 78%, lastly only 46% women were aware about the physical symptoms. Eventually, ovaries stop producing estrogen and other hormones. Since the human body is dependent on these hormones for years, when hormone levels decrease, changes are noticeable and may result in emotional reactions and bodily changes. These include physical symptoms, such as hot flashes, decreased energy levels, and sleep disruption, as well as mood-related symptoms, such as anxiety and depression, mood swings. Over time, these symptoms gradually disappear as age advances.7
74% women were aware of the various risk factors associated with perimenopause and menopause as depicted in Figure 10, and 26% were completely unaware about it. Of which 57% of the women were aware about osteoarthritis.
Figure 11 in this study gives knowledge about the awareness of complications faced in menopause/ perimenopause, 61% women are totally unaware about the complications and only 49% were aware about it. 27% of women were mostly aware about vaginal discharge. After menopause, estrogen levels decrease markedly. As a result, the amount of normal discharge usually decreases. However, because the lining of the vagina thins and becomes drier (called atrophic virginities’), due to which the vagina is more likely to become irritated, often resulting in an abnormal discharge from the vagina.8
Awareness of exercises which help to cope up with the changes in perimenopause and menopause phase were studied, as shown in Figure 12, 51% of the women were aware about the physiotherapeutic exercises and 49% weren’t aware about them. Women do enjoy a good quality of life after menopause even without hormones. Osteoporosis, the greatest ailment in older women, can be kept under control with exercise. Even a moderate exercise schedule routine can not only keep the weight in check, but it also lowers the risk of stress, anxiety, and depression, all of which tend to show up liberally during and beyond menopause. Exercise works by improving muscle mass, strength, balance, and coordination. Therefore, unlike treatment with medicine, exercises work simultaneously on various aspects of one's health.9 The role of exercise in hot flashes, however, is inconclusive. Awareness can be made by conducting camps, through social media which will indeed help women to change their way of lifestyle and thus lead them to adapt a healthy way of living.
Figure 13 in this study shows the awareness in women of various treatment strategies which they will adopt in future to cope up with menopausal and perimenopause changes, 52% of the women opted for medicine and only 45% have chosen exercises of which 2% women opted for both the treatment options. This states the fact that women are unaware about the importance of exercise to cope up with menopausal and perimenopausal symptoms.9 That’s why women opt for the easy relieving method of treatment which is medicines, but they are unaware about the fact that exercise will give a long term relief then medicines.
As shown in Figure 14, only 4% of the women viewed awareness of Hormonal Replacement Therapy as positively and 59% of the population was unaware of it, because the attitude of women towards menopause are strongly influenced by social, cultural and economic settings in which they live and may also reflect the differences in modes of treatment or perceptions of its symptoms.10
