Review of Literature on Menopausal symptoms
57% of postmenopausal women perceived menopause as convenient. 69% of them complained of diminishing abilities after menopause. 23% felt that sexual life ends with the onset of menopause. 16% reported that their husbands had become disinterested in them after menopause and 11% were apprehensive about the loss of femininity. A higher proportion of postmenopausal women reported hot flushes, night sweats, urge incontinence and other somatic symptoms as compared to premenopausal women. 54% of postmenopausal and 32% of premenopausal women were currently not sexually active. 59% of postmenopausal and 38% of premenopausal women expressed loss of sexual desire and this difference was statistically significant. There was no significant association between menopause and depression. A poor perceived relationship within the family was shown to have a significant association with depression. There was a significant association between multiple somatic symptoms and menopause. A significantly higher proportion of postmenopausal women suffer from vasomotor symptoms, urge incontinence, loss of sexual desire and multiple somatic symptoms. They do not link these symptoms with menopause. Poor family environmental factors have a stronger association with depression than menopause. In view of these findings, it is important to determine the feasibility and impact of hormone replacement therapy in preventive health care in rural India.
Peeyananjarassri K et.al (2006) conducted a cross-sectional study to evaluate menopausal symptoms and quality of life in middle-aged women. The data collected from 270 women aged between 45-65 years who attended the menopause and gynecological clinic, by using the Menopause quality of life questionnaire as the tool.
The results stated that the mean age at menopause of the postmenopausal women was 48.7 years. The prevalence of the menopausal symptoms like night sweats, hot flashes and vaginal dryness among the women aged 45-65 years were 20.8%, 36.8% and 55.3% respectively. In perimenopause, the three most prevalent symptoms were experiencing poor memory, muscle and joint aches and change in libido. The researcher concluded that perimenopausal and postmenopausal women had a significant decrease in quality of life compared to premenopausal women.
Huerta R et.al (1995) studied the association of symptoms with attitudes toward life-style, sexuality, follicle-stimulating hormone and family functioning levels in perimenopausal women. Data collected on anxiety, depression and nonspecific index of depression in 222 women. Family functioning was assessed with the McMaster model, and women's opinions about sexuality were assessed by a questionnaire. Scores of depression were higher in women with more than 1 year of menopause. Attitudes to sexuality were significantly associated with all four symptoms. For family function, affective involvement, control of behavior, the roles of the members in the family, and communication were associated with some symptoms. Serum FSH was associated with body mass index, abdomen/hip ratio, and depression. Researchers concluded that attitudes toward sexuality regresses the symptoms, the family functioning is also associated with symptoms and FSH levels may be higher in women with depression or anxiety and lower in obese menopausal women.
Howard JR et.al (2004) did a study to investigate the sexual relationships, sexual behavior, sexual distress, sexual dysfunction and sexual satisfaction in 474 urban Australian women. The instruments used were the Relationship Assessment Scale (RAS), Short Personal Experiences Questionnaire (SPEQ), Female Sexual Distress Scale (FSDS).
The results stated that the percentage of women with partners ranged from 46.4% women in the 70 – 79 years age group whereas in the 40 – 49 years age group it was 83.3%. The sexual ability of partners decreased markedly with age, 4.8% of the partners used medicine to enable erections and whereas 2.5% of women reported low satisfaction in sexual relationship. Low sexual distress was reported by 5.7% of women. Younger women and women with partners had higher levels of distress than older women. The researcher concluded that when the women become aged, their sexual activity, libido and distress about sex decreased.
Laurie. K.et.al. (2008) conducted a study to investigate the direct and indirect relationship between psychological distress, psychosocial factors, stress, severity of menopausal symptoms and physical health in women aged 45-55 years. One hundred and sixteen women were selected through community organizations and women’s health centers. They answered a short questionnaire asking about psychological distress, menopause symptoms, stress and physical health. This research concluded that high emotional intelligent women have positive attitude towards menopause and they experience less severe menopause symptoms, psychological distress, stress and better physical health. These results suggested that women, who expect menopause to be a difficult process, are undergoing greater stress than others are.
Callister, L. et.al (2008) conducted a descriptive qualitative study to describe the perceptions about menopausal transition among Jordanian midlife women. Audio taped interviews were conducted with 25 perimenopausal Jordanian women.
The results stated that there are no more reproductive obligations, give relief and rest, provide time for managing perimenopausal symptoms, and provide time for growing into wise woman and accepting aging as a part of life.
2. Menopause rating scale.
Jara D, et.al (2008) conducted a study to evaluate the accuracy of the Menopause Rating Scale (MRS) in diagnosing SD among climacteric women. In this cross-sectional study, 370 women aged 40-59 years filled out the MRS and the Female Sexual Functioning Index (FSFI) simultaneously. SD among surveyed women was defined as those obtaining a total FSFI score of <or=26.55. A receiver-operator curve (ROC) was used to plot and measure the diagnostic accuracy of one MRS item (item 8, assessing sexual problems) using the FSFI total score as a gold standard.
The results stated that mean age of surveyed women was 49.3+/-5.8 years. A 56.5% of them were married, 44.3% were postmenopausal, 66.8% were sexually active and 57% had SD (FSFI total score <or=26.55). ROC curve determined a score >or=1 in the MRS item 8 as a cut-off value for discriminating women with SD (78% sensitivity and 62% specificity with an area below the curve of 0.70 Swett). The researcher concluded that the MRS was moderately accurate for diagnosing SD among climacteric women. More research is warranted in this regard.
Rahman SA et.al (2009) conducted a study to determine the common menopausal symptoms among Sarawakian women (MRS) by using Menopause Rating Scale questionnaire, 356 Sarawakian women aged between 40-65 years were interviewed to document 11 symptoms commonly related to menopause.
The results stated that the mean age of menopause was 51.3 years). The most prevalent symptoms reported were joint and muscular discomfort (80.1%); physical and mental exhaustion (67.1%); and sleeping problems (52.2%). Followed by symptoms of hot flushes and sweating (41.6%); irritability (37.9%); dryness of vagina (37.9%); anxiety (36.5%); depressive mood (32.6%). Other complaints noted were sexual problem (30.9%); bladder problem (13.8%) and heart discomfort (18.3%). Perimenopausal women (n = 141) experienced higher prevalence of somatic and psychological symptoms compared to premenopausal (n = 82) and postmenopausal (n=133) women. However, urogenital symptoms mostly occur in the postmenopausal group of women. The researcher concluded that the prevalence of menopausal symptoms of hot flushes, sweating was lower among Sarawakian women compared to studies on Caucasian women.
3. Effect of exercise on menopausal symptoms
Christine MacArthur (2007) did a study to examine the association between body mass index, exercise participation and health-related quality of life in menopausal women. Two thousand three hundred and ninety nine (2,399) aged 46–55 years selected in the West Midlands. The tool was a questionnaire containing items relating to lifestyle factors, weight, demographics, height; menopausal bleeding patterns exercise participation, and health-related quality of life.
The results stated that the regularly active women reported better health in quality of life scores than others in all subscales. No difference in vasomotor symptoms was recorded for exercise status. Obese women reported significantly (P<0.01) higher scores in vasomotor symptoms, somatic symptoms and attractiveness concern scores than normal weight women. The data reported a positive association between psychological and somatic dimensions in quality of life and regular exercise participation.
James.w.Carson (2009) conducted a study to assess the effectiveness of yoga intervention on menopausal symptoms in early-stage breast cancer survivors. Thirty-seven disease-free women experiencing hot flashes underwent the 8-week Yoga Program (breathing exercises, meditation and gentle yoga poses). The daily report of hot flashes was gathered at baseline and 3 months after treatment through an interactive telephone system. The results stated that women who underwent the yoga program shown greater improvements in reduction of hot flash, joint paint, fatigue and sleep disturbance in early-stage breast cancer survivors.
Ayşegul Agil et.al, (2009) did a study to determine the effectiveness of different short-term exercise programs on psychological health, menopausal symptoms and quality of life among postmenopausal women. Forty-two women, who were experiencing menopause naturally, were chosen. They were randomly divided into resistance (n=18) and aerobic (n=18) exercise groups. The women exercised 3 days per week for 8 weeks under the supervision of a physiotherapist. Before and after the training, lipid profiles were measured and menopausal symptoms, psychological health, depression, and the quality of life were assessed through questionnaires.
The results stated that the resistance exercise group, excluding the urogenital complaints, there were significant improvements in all subscales of Menopausal Rating Scale (MRS). The researcher concluded that resistance exercise and aerobic exercise were found to have a positive impact on menopausal symptoms, psychological health, depression, and the quality of life.
Deborah CH. Tchou et.al (2006) did a study to investigate the effectiveness of pelvic-floor musculature exercises in the treatment of women with anatomical urinary stress incontinence. Fourteen female subjects, aged between 33 to 67 years, underwent a 4 weeks pelvic-floor musculature exercise program. Urodynamic evaluation performed for the samples, before and after intervention. There is no significant diiference in values of functional urethral length, bladder capacity and static urethral pressure profile pre and post training. All subjects reported post-training improvement in control of urinary incontinence. The researcher concluded that a short-term exercise program strengthen the pelvic-floor musculature and produced positive changes in samples with anatomical urinary stress incontinence.
Angeles-Llerenas et.al (2010) conducted a population-based case-control study to evaluate the effectiveness of physical activity on the risk of breast cancer by menopausal status in Mexican women. One thousand and seventy four matched controls and 1,000 incident cases participated in the study in five-year duration. Information was provided to women on physical activity, health and diet by an in-person interview. Anthropometric measurements and blood samples assessed, in all women. The results stated that moderate-intensity physical activity (3 hour / week) decreased the risk of breast cancer in both pre- and postmenopausal women. There was a statistically significant modification effect by menopausal status.
Larson B, Collins A (1997) conducted a study to assess the relationship between hormonal levels, climacteric status, vaginal dryness, vasomotor symptoms, and urinary incontinence during menopausal transition and to assess the effectiveness of hormone replacement therapy on these menopausal symptoms. One hundred and forty seven women were followed for 4 years during transition to menopause. A gynecological examination, general health screening and blood sampling was carried out annually. The researcher concluded that premenopausal women were not relieved from urogenital and vasomotor symptoms even after taking hormone replacement therapy.
Steriani Elavsky and Edward McAuley (2007) conducted a study to assess the effectiveness of exercise trial on outcomes of mental health in 164 low-active middle-aged women (Mean age=49.9; SD=3.6). At the beginning, participants completed fitness assessment and body composition and a battery of psychological measures and at the end of a 4-month exercise trial with walking, yoga and control.
The researcher concluded that physical activity (walking and yoga) were effective in enhancing positive effect on mood and Quality of Life in menopausal women. Increasing cardio respiratory health maintenance might reduce menopausal symptoms.
Booth-LaForce C, et.al (2007) did a prospective within-group study to assess the effectiveness of Hatha yoga treatment on menopausal symptoms. Participants were 12 peri and post-menopausal women experiencing at least four menopausal hot flashes per day, at least 4 days per week. Assessments were administered before and after completion of a 10-week yoga program. Pre and post-treatment measures included: Severity of questionnaire-rated menopausal symptoms (Wiklund Symptom Check List), frequency, duration, and severity of hot flashes (24 hour ambulatory skin-conductance monitoring; hot-flash diary), interference of hot flashes with daily life (Hot Flash Related Daily Interference Scale), and subjective sleep quality (Pittsburgh Sleep Quality Index). Yoga classes included breathing techniques, postures, and relaxation poses designed specifically for menopausal symptoms. Participants were asked to practice at home 15 minutes each day in addition to weekly classes.
Chattha, Agarathna, Admalatha and Nagendra (2008) conducted a randomised control study to assess the efficacy of an Integrated Approach of Yoga Therapy (IAYT) on cognitive abilities among menopausal women. A setting of the study is fourteen yoga centers in Bangalore. One hundred and twenty(120) perimenopausal women were divided into the yoga and the control groups, randomly. Under supervision, the yoga group practised breathing exercise, cyclic meditation and sun salutation whereas the control group practised simple physical exercises (5 days per week for 8 weeks). Assessments were made by vasomotor symptom checklist, Six-letter cancellation test (SLCT) for attention and concentration and Intelligence memory scale (IMS) with ten subtests.
The results stated that significant reduction in hot flushes, sleep disturbance and night sweats in yoga group. The yoga group performed significantly better compared to the control group. The researcher concluded that IAYT can reduce the hot flushes and night sweats and can enhance cognitive functions such as concentration, remote memory, delayed and immediate recall, attention, verbal retention and recognition tests.
Young whee Lee et.al (2008) conducted a cross sectional descriptive study to compare the severity of menopausal symptoms and depression between the subjects who performed the exercise regularly and the subjects who did not exercise regularly. Data were collected by administering questionnaires related to general information, menopausal symptoms and the Beck Depression Index.
The results stated that there was a significant positive correlation between the depression and severity of menopausal symptoms. The researcher concluded that the depression and menopausal symptoms were less among the women who exercised regularly when compared to those who did not exercise.
The review of literature enlightened the investigator to develop an insight into the exercise and its effects. This review helped the investigator to gain a deeper knowledge of the research problem and guided in designing the study. All the researches related to support mentioned above have been explored to reveal that the exercise have some effect on menopausal symptoms. It is clear that exercises play a major role in reducing the severity of menopausal symptoms.
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