Elsevier

Maturitas

Volume 57, Issue 3, 20 July 2007, Pages 306-314
Maturitas

Assessment of the variation in menopausal symptoms with age, education and working/non-working status in north-Indian sub population using menopause rating scale (MRS)

https://doi.org/10.1016/j.maturitas.2007.02.026Get rights and content

Abstract

Objective

To study the variation of the menopause rating scale (MRS) scores with age, working/non-working and educated/uneducated status in a cohort of north-Indian subpopulation and to look for the possible reasons for the incurred variations. MRS is a well-known and validated instrument for assessing the frequency and intensity of menopausal symptoms.

Method

A menopause clinic was organized in collaboration with a primary care centre (under the guidance of a gynecologist). A random sample of 208 women aged 35–65 years participated in the study. The MRS scale, a self-administered standardized questionnaire was applied with additional patient related information (age at menopause, level of education, working/non-working and exercising or not).

Results

The results were evaluated for psychological (P), somatic (S), and urogenital (U) symptoms. The average age at which menopause set in, in the cohort was found to be 48.7 ± 2.3 years (46.4–51 years). Based on the average age at the menopause, the cohort was divided into peri (35–45), menopausal/early menopause (46–51) and the postmenopausal (52–65) groups. A significantly higher % of perimenopausal women (36%) showed a P score of ≥7; while a higher % of postmenopausal showed S score and U score ≥7 (>40%; p  0.001). Working women seem to suffer more from psychological symptoms whereas non-working women showed a greater incidence of somatic symptoms. Educated women showed a lower incidence of psychological and somatic symptoms.

Conclusions

Present study indicates that age, level of education and working/non-working status (in a group of women with same socio-cultural background) may also contribute to significant variations in menopausal symptoms.

Introduction

The word ‘menopause’ is derived from men and pauses and is a direct description of the physiological event in women where menstruation ceases to occur [1]. The word ‘climacteric’ is a greek derivation of the ‘ladder’ or the steps of a ladder. It has been observed that the middle-aged women have a varied attitude towards climacteric, i.e. either of climbing up (having a positive attitude towards the approaching transitional phase) or down that ladder (a negative influence on quality of life as a result of menopausal symptoms) [2]. Menopause is a transitional period for women [3]. At the menopausal transition, levels of the main “reproductive” estrogen, 17β-estradiol, drops from mean values of the cycling life (100–250 pg/ml) to less than 10 pg/ml, thus losing the ability to saturate receptors and to stimulate target cells. This situation leads to a functional deficiency of estrogenic activity [4]. Symptoms associated with this oestrogen deficiency during or after menopause are hot flushes and night sweats, insomnia and vaginal dryness [5], [6], [7], [8]. Many other symptoms and conditions (irregular menstrual bleeding, osteoporosis, arteriosclerosis, dyslipidaemia, depressed mood, irritability, headache, forgetfulness, dizziness, deterioration in postural balance, palpitation, dry eyes, dry mouth, reduced skin elasticity, restless legs, and muscle and joint pain) have been implicated as associated with menopause [8], [9], [10] but are not necessarily correlated to oestrogen levels [11], [12].

Since the normal life expectancy has increased, women are now spending a longer time in the postmenopausal phase of life [13]. The age of onset of menopause cannot be ascertained due to intraindividual, intracultural and various environmental factors. According to our literature survey, menopause occurs at around the age of 50–51 years in the western world while the median age for menopause was 47 years in Turkish women [14], 47.1 in Pakistani women [15] and 46.7 years in northern India [16].

As mentioned above, menopause is associated with a wide variety of symptoms, and some of these may have a negative impact on the quality of life (Qol) of these women. Our study aimed at determining the variations of the menopausal symptoms with (a) age, (b) educated versus uneducated and (c) working versus non-working women. We wished to examine the association/s of job and education with the quality of life and psychological well being of women in their mid-life. The influence of these factors on women's perceptions and practices is discussed. For assessment of the menopausal symptoms, menopausal rating scale (MRS) [17], [18] was chosen as a standardized instrument out of the other available due to its reliability, the short format encompassing all the associated symptoms and the simple scoring scheme [19]. The scale is designed and standardized to act as a self-administered scale to assess the occurrence and severity of symptoms/complaints of menopausal women. According to MRS the symptoms/complaints can be identified into three dimensions: psychological (P), somatic-vegetative (S), and urogenital (U). It consists of a list of 11 items (symptoms or complaints). Each of the 11 symptoms contained in the scale can get 0 (no complaints) or up to 4 scoring points (severe symptoms) depending on the severity of the complaints perceived by the women completing the scale (an appropriate box is to be ticked) [19]. The scoring scheme is simple, i.e. the score increases point by point with increasing severity of subjectively perceived symptoms in each of the 11 items. The respondent provides her personal perception by checking one of five possible boxes of “severity” for each of the items. The menopause rating scale (MRS) registers every single symptom individually in a numerical and graphic way without any multiplication factor. Thus, an individual profile of each patient can be established [19]. In the present study we studied the intensity of climacteric symptoms in terms of MRS scores in perimenopausal, menopausal and postmenopausal women.

The prevalence of psychological and physiological symptoms among the educated versus uneducated and working versus non-working women in the urban subpopulation of SAS Nagar, Mohali, India is presented here.

Section snippets

Study sample

The study was conducted in collaboration with a gynaecologist running a menopause clinic at SAS Nagar, Mohali, India since the last 4 years at a primary care health centre. The menopause clinic was held twice a week. In this study a sample of 208 menopausal/post menopausal women, undergoing therapy for menopause were included:

  • Inclusion criteria:

    • (1)

      Perimenopausal/menopausal (natural/surgical menopause)/postmenopausal women were included in the study.

    • (2)

      Age: 35–65 years.

    • (3)

      Women suffering from diabetes,

Results and discussion

The average age at menopause amongst the north-Indian women under study was found to be 48.7 ± 2.3 years (46.4–51.0 years). Earlier studies have indicated mean age of menopause in the north-Indian population to be 46.7 years [16]. Based on this we divided our cohort into peri (35–45), early menopause (46–51) and the postmenopausal (52–65) groups. To study the prevalence of menopausal symptoms the MRS scale is sub divided into three domains. Three independent dimensions (psychological domain:

Conclusions

From the above results it can be concluded that the transitional phase symptoms vary with age from peri menopausal to menopausal and finally postmenopausal state. The results indicate that education and economic status of the women play an important role in helping the women to maintain their health during this phase of life. It may however be noted that a number of symptoms thought to be part of menopause are in fact non-specific. It is reported that association between hormonal changes and

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