Knowledge, Attitude and Experience of Menopause

1 Pakistan Journalof Medical Research, 2013 (April- June)42 Pak J Med ResVol. 52, No. 2, 2013 knowledge , Attitude and Experience of MenopauseShazia KhokharDepartment of Gynecology and Obstertrics, Shaheed Mohtarmma Benazir BhuttoMedical College Lyari, :To determine the knowledge , Attitude and experiences of post-menopausal women towards type, settings and duration:This cross sectional study was conducted at Gynaecology ward of Lyari GeneralHospital Karachi from May 1, 2011 to September 30, and Methods:Using convenient samplingpostmenopausal women were selected from the were women with Menopause of age 45 years. A questionnaire was designed which contained demographiccharacteristics of the respondents along with questions on menstrual status, knowledge and attitudes toward Menopause andthe information and use of hormone replacement therapy.

2 Interviews were carried out by a third year resident in :Atotal of 170 women were interviewed. The mean age of the respondents was years. Almost 80%women had prior knowledge of Menopause (p< ) while, only 46% were aware about its effect on health (p< ). Menopause was considered a normal event by 72% women. Only 13% women knew about hormone replacement therapy(p< ). Following Menopause 74% were bothered by its symptoms (p< ) and only 36% were happy (p< ).Only 29% had consulted a physician for relief of their symptoms (p< ) and only 1was on hormone replacementtherapy (p< ).Conclusion:Highproportions of women were aware about Menopause but few knew its health implications. Most of themwere bothered by menopausal symptoms, but very few consulted words:Post menopausal, Menopause awareness, Attitude , menopausal is an inevitable milestone in thereproductive life of every woman.

3 A woman issaid to have reached Menopause when she had 1 yearwithout menstruating. The climacteric, or climacterium, isused to refer to the wide variety of physiological changesoccurringintheyear findthistransition barelynoticeable while, others find it life altering2,3. In literature,it hasbeenoften stated as a difficult period with manysymptoms4. Besides being a major cause of morbidity suchas heart disease and osteoporosis, Menopause and itsassociated hormonal changes also cause symptoms thataffect the quality of life, such as hot flushes, night sweats,sleepdisturbances, urinary frequency, vaginal dryness,poor memory, anxiety and depression5thus causing animportant impact in the daily, social and sexual life ofthese women6. Some population based surveys, havereported a high prevalence of menopausal symptomsranging between 40% and 70%7,8, while those from Asiaare between 10% and 50%9.

4 Turkey showed a prevalenceof 35%-90%10, ArticleShazia KhokharPakistan Journalof Medical Research, 2013 (April- June)43 Numerous factors including menopausal status,social background, and education, physical and emotionalhealth may influence women s knowledge and beliefsabout menopause12. Women in Western countries tend tobe better informed about implication of menopause13. Asurvey conducted at Mexico City14reported that had knowledge about climacteric symptoms and90% knew aboutosteoporosis and 37% had someknowledge about cardiovascular risk after Menopause . Ina study from Latin America- Ecuador women aged 40 ormore, frequently perceived the Menopause as a positiveevent rather than a negative. Almost 80% agreed that themenopause lead to definitive cessation of female three main sources of receiving information onmenopause were: friends, television and physicians andonly 50% received information through educationalsessions15.

5 In another study done on menopausal womenaged 50- <60 years living in Alexandria, almost 40% ofthe women in the study had prior knowledge aboutmenopausal symptoms and 91% had never heard abouthormone replacement therapy. When asked aboutpractices that might help them to overcome menopausalsymptoms 61% said taking vitamins and 55%saidexposure to sunlight. Almost 90% had not consulted replacement therapy is an effectivetreatment for menopausal symptoms and can protectwomenfromdevelopingosteoporosis,a lthougheffectiveness is associated with continued use17. Researchsuggests that it decreases the risk of hip fracture inpostmenopausal women by 30%andspinal fracture by50%18. Italso decrease the risk of cardiovascular diseasethe main cause of death in western societies19. There isalso an association between hormone replacementtherapy and the prevention of Alzheimer s disease andenhanced cognitive performance20.

6 It is reported thatwomen sattitudestowardsmenopauseandtheirknowle dge of the benefits and risks of hormonereplacement therapy have a direct effect on their use ofhormone replacement therapy21. In a survey on womenaged 20- 69 years living in Scotland, almost 39% postmenopausal women had used hormone replacementtherapy while, its use was higherin America (43%15to71%22).This study was conducted to evaluate woman sknowledge and Attitude towards Menopause and hormonereplacement therapy and their Experience of climactericsymptoms in our and MethodsThis cross sectionalstudywas conducted atGynaecology ward of Lyari General Hospital, Karachifrom May 1, 2011 to September 30, 2011. A total of 170postmenopausal women were included using convenientsampling from criteria were women withmenopause (either naturalor surgical) of age greater thanor equal to 45 years, capable of active taking written consent all women were interviewedfor knowledge , Attitude and experiences of questionnaire was designed which containeddemographic characteristics of the respondents, menstrualstatus, knowledge and use hormone replacement (GynecologistandEpidemiologist).

7 Interviews were carried out by third year residents in theoutpatient departmentData was analyzed using SPSS18. Frequenciesand percentages were calculated for age groups,educational level, socio economic status, symptoms ofmenopause and knowledge , Attitude and practices relatedto the Menopause and hormone replacement SD was computed for age. Chi-square test forproportion was used to compare the results at 5% level total of 170 menopausal women aged 45years were included having a mean age of yearsrangingbetween 45 89 years. Majority were between 45-60 years 117( ). Out of 170 women, 137( )had normal Menopause while, 33( ) had surgicalmenopause. One hundred and forty six ( ) womenhad no formal education and ( ) belonged to poorfamilies (Table- 1).Table 1:Socio-demographic characteristics of of Women%Age (Years)Mean SD = > of of EducationNo Economic Author:Shazia KhokharDepartment of Gynecology and ObstertricsShaheed Mohtarmma Benazir Bhutto Medical College Attitude and Experience of MenopausePakistan Journalof Medical Research, 2013 (April- June)44 The most frequent menopausal symptom wasinsomnia reported by 136(80%) followed by moodchanges in 128( ) and backache in 106( ).

8 Other symptoms are shownin (Table-2).Table 2:Symptoms perceived by participants to be relatedto of Women% of and perception of Menopause andhormone replacement therapy is shown in Table-3. Onehundred and thirty-six (80%) women had prior knowledgeof Menopause (p< ) while, only 78( ) womenwere aware about its effects on health(p< ). Menopause was considered a normal event by 122( )while, 48( ) believed it as a disease (p< ). Only22( ) women had heard about hormone replacementtherapy (p< ).Table 3:Distribution of women according to knowledge andperception related to ofWomen%p-valuesKnowledge aboutmenopause Yes No136348020< aboutpossible health effectsof Menopause Yes Perceived < about HRT Yes NoKnowledge about nonhormonal therapy Yes < < 65( ) women were happy and56( ) unhappy with the cessation of their menses(p< ).

9 Bothersome menopausal symptoms were facedby 127( ) women (p< ) yet only 49( ) hadconsulted a physician (p< ) and only 1( ) womanwas on hormone replacement therapy (p< )andnonewere taking non hormonal treatment for hot flashes orother is diagnosed when a woman does nothave menstrual period for 12 consecutive months withoutany other biological or physiological mean age of our patients was similartoanother study from Nigeria24and Pakistan25while, anEgyptian study showed a higher age of 50 symptoms are influenced by socialandcultural beliefs and almost 80% Western women sufferfrom physical and psychological symptom at (75%), body aches (66%), insomnia (63%)andvasomotor symptoms (hot flushes & night sweats) werecommon symptoms reportedbya study symptoms were reported in another study fromHyderabad Sindh28. From Punjab common symptoms werelethargy (65%), urinary symptom (56%) and Commonest symptoms reported in a study fromKarachi, Sindh werebody ache 86%, hot flushes 86% andirritability 65%30.

10 In Japanese population commonestsymptoms were shoulder stiffness (50%), headache (30%)and hot flushes (28%)31while, Thai women had moresymptoms of dizziness,tirednessand aches and present study 80% women were aware aboutmenopause but only 46% had knowledge about itsimplications on health. A smaller study of 70 women fromPakistan Institute of Medical Sciences,Islamabad and alarger study from Hyderabad also reported similarresults25,33. Overall awareness about its implications onhealth were known in few cases in both the studies. Astudy from Karachi reported that 97% women had heardabout Menopause and 29% were aware of its symptoms,4% knew its long term implications and only 2% wereaware of hormone replacement therapy34. Thesefindingsare in contrast tothose reportedfrom Western countrieswhere womenappear to be better informed aboutmenopause14,35.