Waheed et al.

, Gynecol Obstet (Sunnyvale) 2016, 6:4

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Gynecology & Obstetrics
Gyn

ISSN: 2161-0932 ics

Research Article Open Access

Quality of Life after Menopause in Pakistani Women

Khadija waheed*, Amna Khanum, Sara Ejaz, Ambreen Butt, Fawad Ahmad Randhawa
Department of Gynaecology and Obstetrics, King Edward Medical University, Lahore, Pakistan

Abstract
Background: With the increase in life expectancy of women all over the world, women are expected to spend
almost 1/3rd of their life in menopause phase, usually starting in 4th to 5th decade of life.
Objective: This study was planned to look for quality of life of women during menopause in Pakistan.
Material and methods: This cross-sectional study was conducted at Gynaecology and Obstetrics department
of Lady Atchison Hospital, Lahore over a period of 3 months from June, 2015 to August, 2015. Menopause-Specific
Quality of Life Questionnaire (MENQOL) was distributed among 120 patients with the age range of 51-80 years
presenting in Outdoor department of the institution. All the demographic details and MenQol results were analyzed.
Also Odds ratio (OR) was calculated for these symptoms according to age groups of the patients.
Results: The mean age of the patients was 60 5.8 years. The mean age of patients at time of menarche was
calculated as 13.4 1.80 years and the mean age at menopause was 49.10 3.98 years. We found that the most
common symptom of the patients in our study was low backache and the least reported symptom was drying skin.
The OR was also calculated for various symptoms according to age of the patients but it was found significant only
(OR:10.9; (4.467 26.58) for vasomotor symptoms in our study.
Conclusion: Menopausal symptoms may vary in different parts of the world. Therefore exact determination of
these symptoms in our society is essential as it can help us to identify preventable factors and educate our women
about their quality of life.

Keywords: Menopause; MenQol; Women; Vasomotor misconceptions about these symptoms. Therefore, we conducted this
study to find the Qol in Pakistani women.
Introduction
Material and Methods
Menopause is a normal physiological process in every woman's
life [1,2]. It is usually defined as 12 months of amenorrhea after the After approval from hospital ethical review board, this study was
final menstrual period. This process is the result of complete or partial planned. It was a cross-sectional study, conducted at Gynecology and
absence of estrogen release from ovaries as well as depletion of ovarian Obstetrics department, Lady Atchison hospital, Lahore over a period
follicles. Menopausal period is further divided into early menopause of 3 months from June, 2015 to August, 2015. All the female patients
and late menopause. Early menopause is the period of first five years with the age range of 51-80 years, having developed menopause were
after final menstrual cycle; while the period after five years is termed as included in the study. Those patients taking hormonal treatment
late menopausal period [3]. during post-menstrual period and those with mental and physical
problems or systemic diseases were excluded from the study as they
Quality of life (Qol) has been defined by World Health Organization can interfere our results and patients can misinterpret the menopausal
(WHO) as "an individual's perception of his/her position in life in the symptoms. Written informed consent for inclusion in the study was
context of the culture and value systems in which he/she lives, and in obtained from all patients. Menopause was defined as 12 months of
relation to his/her goals, expectations, standards and concerns"[4]. amenorrhea after the final menstrual period. All the patients were
Therefore it is a subjective assessment of every person about his/her supposed to fill a questionnaire proforma designed for the study. All
well-being [5]. Various studies have documented the fact that after the demographic details of the patients including age, age at menarche
menopause, the Qol of most of the women falls drastically [6]. However and menopause, educational status and marital status were noted.
at the same time some studies have shown the minimal change in Qol The quality of life of the patients was assessed by Menopause-Specific
after menopause [7,8]. Quality of Life Questionnaire (MENQOL). The MENQOL is a self-
The Qol among menopausal women is being increasingly discussed administered proforma and consists of a total of 29 items in a Likert-
in the literature. Specifically, vasomotor and psychological symptoms scale format. Each item assesses the impact of one of four domains of
are the most common and the most bothersome in most of the women.
Vasomotor symptoms may be present among as much as 95% of post-
menopausal patients which shows the gravity of the situation. However, *Corresponding author: Khadija Waheed, Department of Gynaecology
and Obstetrics, King Edward Medical University, Lahore, Pakistan, Tel:
there is minimal literature available on Qol in Pakistani women after 00923334274228; E-mail: [email protected]
menopause. Nisar et al. had conducted a study and they found that
menopause related symptoms had negative effect on the quality of life ReceivedFebruary 19, 2016; AcceptedApril 03, 2016; Published April 09, 2016

of postmenopausal women in Pakistan [9]. In general Qol of women in Citation: Waheed K, Khanum A, Butt A, Ejaz S, Randhawa FA (2016) Quality of
third world countries is considered as lower than rest of the world but Life after Menopause in Pakistani Women. Gynecol Obstet (Sunnyvale) 6: 367.
doi:10.4172/2161-0932.1000367
literature is scarce over the topic. As due to longer expected lives, now
women are spending about 20-30 years of their lives in this period. So Copyright: 2016 Waheed K, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
there is a need to address Qol, particularly in our population where unrestricted use, distribution, and reproduction in any medium, provided the
women are less aware regarding menopausal symptoms and they have original author and source are credited.

Gynecol Obstet (Sunnyvale)

ISSN: 2161-0932 Gynecology, an open access journal Volume 6 Issue 4 1000367
Citation: Waheed K, Khanum A, Butt A, Ejaz S, Randhawa FA (2016) Quality of Life after Menopause in Pakistani Women. Gynecol Obstet (Sunnyvale)
6: 367. doi:10.4172/2161-0932.1000367

Page 2 of 3

menopausal symptoms, as experienced over the last month: vasomotor Number of Mean
Sr. No Variable
(items 1-3), psychosocial (items 4-10), physical (items 11-26), and patients Score
sexual (items 27-29). Items pertaining to a specific symptom are rated Vasomotor
as present or not present, and if present, how bothersome on a zero Hot flushes 66 3.37
(not bothersome) to six (extremely bothersome) scale [10]. All the data Night sweats 62 3.31
were noted on the proforma. A sample size of 115 female patients was Sweating 69 3.52
calculated using 95% confidence level and 4% margin of error taking Psychosocial
the expected vasomotor symptoms in 95% of post-menopausal women Dissatisfaction with personal life 72 3.62
[11]. All the data were analyzed using SPSS version 20. For quantitative Feeling anxious or nervous 80 3.03
variables like age of patients and score of quality of life tool mean S.D Experiencing poor memory 64 2.51
were calculated. For qualitative variables frequency and percentages Accomplishing less than I used to do 48 2.37
were calculated. The MenQol score for each question was stratified Feeling depressed, down or blue 65 2.09
according to the age groups of the patients and Odds ratio (OR) was Impatience with other people 88 2.41
calculated. Willing to be alone 41 2.31
Physical
Results Flatulence (wind) or gas pains 48 2.79
Aching in muscles and joints 86 2.82
A total of 115 patients were included in the study. The mean age
Feeling tired or worn out 94 3.54
of the patients was 60 5.8 years. All the demographic details of the
Difficulty I sleeping 59 3.54
patients included in the study are summarized in Table 1. The mean
Aches in back of neck or head 85 3.55
age of patients at time of menarche was 13.4 1.80 years. The mean age
Decrease in physical strength 88 3.54
at menopause was found to be 49.10 3.98 years. The mean gravidity
Decrease in stamina 94 3.54
of patients in the study was 4.81 2.03 and parity was 3.88 1.66. Feeling lack of energy 93 3.53
The mean duration after marriage was calculated as 38.2 30.62 years. Drying skin 33 2.21
The MenQol score of the patients is summarized in Table 2. We found Facial hair 38 2.66
that the most common symptom of the patients in our study was low Weight gain 91 3.54
backache in 98 of 115 patients (85.2%) and vaginal dryness in 97 of Changes in appearance, texture or
94 3.63
115 patients (84.3%). The least reported symptom by the patients tone of skin
was drying skin, reported by 33 patients (28.6%) and facial hair by 38 Feeling bloated 43 2.58
patients (33%). Also stratification of each symptom group according to Low backache 98 2.56
age groups was done. Odds ratio (OR) was calculated for each group Frequent urination 75 3.4
and is summarized in Table 3. OR was found significant for vasomotor Involuntary urination when laughing
63 3.77
or coughing
symptoms in different age groups (OR:10.9; 95% CI (4.467 - 26.58)).
Sexual
Discussion Change in sexual desire 57 3.63
Vaginal dryness during intercourse 96 3.45
As the life expectancy has increased all over the world, therefore Avoiding intimacy 61 3.60
it is presumed that women are now expected to spend almost 1/3rd
Table 2: Detail MenQol score of the patients.
of their life in menopausal phase [12]. Therefore Qol of women after
menopause, particularly in our setup, is needed to be assessed. Among
post-menopausal women, most commonly encountered symptoms are Age<55 Years Age>55 Years
Odds Ratio (OR)
that of vasomotor including hot flushes and night sweats which women
Present Absent Present Absent
face in early menopause phase.. According to a study, 88% of women in
Vasomotor 58 11 15 31 10.9 (4.467 26.58)
United States suffer from hot flushes in menopausal age [13]. Mahajan
Psychosocial 57 12 40 6 0.712 (0.246 2.05)
et al., found that 44% of the women are affected in negative manner
Physical 54 14 42 4 0.367 (0.112 1.198)
during menopause stage. Therefore this study was conducted to look
Sexual 46 23 35 11 0.628 (0.27 1.459)
into prevalence of symptoms in post-menopausal women in our setup
[14] so that awareness regarding its symptoms and their management Table 3: Prevalence of postmenopausal symptoms in relation to age.
should be discussed with women in premenopausal period. This
education regarding her health will give benefit later in life. In our study, we found that low backache and other physical
symptoms were most prevalent in our patients. In a similar study by
Number of Patients Percentage Nusrat et al., most common symptoms among menopausal women were
Age of Patients (In Years) found to be backache and bodyaches in Pakistani women [15], these
51-60 69 60% symptoms are more severe in women who dont do exercise. Similarly
61-70 37 32.2% in another study by Nisar et al., most common symptom was bodyaches
71-80 9 7.8%
in 81.7% of patients [9]. In an Indian study, most commonly found
Marital Status
Married 111 96.5% symptom was fatigue in 61% of patients [14]. This is in contrast to most
Unmarried 4 3.5% of the western studies, in which vasomotor symptoms particularly hot
Educational Level flushes is found as more common [13,16]. This may be due to cultural
Uneducated 37 32.2%
differences among different regions. In a study conducted by Zeleke
Primary Level 32 27.8%
Matriculation Level 21 18.3% et al. factors which were significantly associated with post-menopausal
Higher Education 25 21.7% symptoms included age, bilateral oophorectomy, obesity and being a
Table 1: Socio-demographic details of the patients included in the study. caregiver for another person [17].

Gynecol Obstet (Sunnyvale)

ISSN: 2161-0932 Gynecology, an open access journal Volume 6 Issue 4 1000367
Citation: Waheed K, Khanum A, Butt A, Ejaz S, Randhawa FA (2016) Quality of Life after Menopause in Pakistani Women. Gynecol Obstet (Sunnyvale)
6: 367. doi:10.4172/2161-0932.1000367

Page 3 of 3

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Crescent Med J 13: 811-817. OMICS International: Publication Benefits & Features
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