The cause and effects of the female menopause

“One of the greatest investments which we can make is to invest in health; for there is no other investment like it….Health is life insurance, success and happiness”

-Mahatma Gandhi

The wise woman tradition seeks to heal the whole individual. The primary techniques involve nourishing the woman through storytelling, simple ceremony and dietary herbs. The “mysteries” of a woman’s body – puberty, menstruation, pregnancy, lactation and menopause – are seen as times of power and growth. Menopause is an opportunity for conscious change, not a disease to be treated.

The change of life. The end of fertility. The beginning of freedom. Whatever people call it, menopause is a unique and personal experience for every woman. The joy of menopause is the world’s best-kept secret ….in order to claim that joy a woman must be willing to pass beyond the monsters that guard its gate. As you stand at the brink of it, it can appear that only darkness, danger and delay lie beyond. But as thousands of women from all cultures throughout history have widespread to each other. It is the most exciting passage a woman ever makes. As a third of a woman’s life will be in her postmenopausal period, it is essential that she understands and manages this period, makes some adjustments and enjoys optimum health.

Puberty and menopause are mysteries that every woman experiences. Puberty seems to be about beginnings and menopause about endings but both encompass death and birth, loss and emergence. Puberty is the end of the child and the beginning of the fertile women, whereas menopause is the end of the mother and the beginning of the wise elder (Crone). Puberty and menopause are both necessary for maturation and both are times of physical, emotional and spiritual upheaval.

There is another viewpoint, one that does not see supplemental hormones as a useful or healthy. One that does not see women as victims of menopause, It is called the wise woman tradition. From this view, menopause is seen as normal, healthy and scared not just for women but also for society as a whole. The focus is on nourishing the whole woman, supporting her ability to produce the hormones she needs rather than offering so- called replacements. Menopausal women are encouraged to honor and respect their changing bodies and to use menopause as a time for intense introspection and personal growth. Postmenopausal women are understood to be critical to the health of the culture. Menopause is seen not as a disease but as a survival advantage.

Menopause is derived from Latin words “meno” means months and “pausia” means halt respectively. Menopause really marks the end of a woman’s period of natural fertility. Menopause is often defined as the permanent cessation of menstruation resulting from loss of ovarian follicular activity and the absence of menses after the climacteric changes of amenorrhea as evidence.

This menopause affects the health of the women not only physically, also psychologically, socially. They are likely to suffer more from the stigmatization and attitudes of ageing after the reproductive phase. In addition, when they enter into this menopause phase they experience low social status and decreasing sexual desire due to the advancing age. They lack in terms of income, status, power relative to men. Moreover, women’s physical and mental condition during this stage of life will have a significant influence on her later years of life (David & Norman, 2000).

As women age, there health will be influenced by many factors such as career, changes in the home life, dietary pattern, physical activity, economic status, her society and the environment. The normal process of aging and these changes together with hormonal changes in the reproductive system affect the welfare of women.

In 1990, 476 million of postmenopausal women were reported throughout the world, in which 40% live in the industrialized world. It is predicted that total number of postmenopausal women in 2030 will approximately 1200 million in the world and the proportion of those living in the developing world will increase to 76%. In East Asian region the available data from 1989 to 1992 postulated the percentages of population above 45 years of age is ranged from 15.3 to 24%. (WHO, 2002)

Women in India go through menopause just as women do elsewhere in the world. India has traditionally ignored women’s health issues including menopause but now exciting changes are taking place. Indian women face many social and cultural challenges in their life. The symptoms of menopause may vary from woman to woman. As per the Indian menopause society (2008) the average age of attaining menopause for Indian women is 47.5 years. Indian women who is living in rural area 72 % are having general body aches and pains which is mainly impairing their quality of life.

Various studies have proved that the last three decades of female life are dominated by two categories of health disorders greatly impairing the quality of their life. These two categories are gynecological disorders and postmenopausal problems. Women needs all types of health support after reproductive phase mainly for menopause, but regrettably these services are not available to most of them, in rural settings (Bhattacharya, 2006)

It is evident that most of the health services are focusing towards women of childbearing age and she receives less attention even from the public health care services once she travels out of the childbearing age. Menopause is a vital point in one’s life where the woman faces number of health problems. As ageing and menopause together over burden the women’s health, it is necessary to open up our eyes towards this population. Previously most women did not live long enough for the symptoms to become fatal. All of this adds up to a unique and growing challenge for the public health care services, since most of the women at this age group don’t have spouse to care for them are living alone with the health problems that have not been adequately addressed.

Society has only been facing the issues of life beyond the menopause for a comparatively short time. Research is now focusing on factors that completely influence the physical and psychological aspects of menopause and ageing. Women today are expected to live 1/3 of their lives after their reproductive years, or one-half of their adult life. In that case, preventive health care and healthy life style habits and practices can only be the great support to improve the quality of life in their later years (Young kin & Davis, 2004).

SIGNIFICANCE AND NEED FOR THE STUDY

Menopause signals the end of an era for many women. It concludes their ability to reproduce, and some women find advancing age, altered roles, and these physiologic changes to be overwhelming events that may precipitate depression and anxiety (Kessenich, 2007).

With the increasing of life span women in western cultures, most women can expect to live one third of their lives after the reproductive years. As women age, many experience transitions that presents challenges, such as changing health, work, marital status, that require adaptation. Nowhere is this truer than with the changes associated with menopause. In the United States most women undergo menopause during the late forties and early fifties; the median age is approximately 51 years (Andersons 2007).

In India the average life span of women was 31 Years according to the census conducted 4 Years after independence, in 1951, which had considerably increased to 61 years by the year 1991. This means that women will live approximately a quarter to 1/3 of her life in postmenopausal phase. By the year 2025, it is estimated that approximately 165 million women will be in the age group of above 60 years. (Indian menopause society, 2006). With the increased life expectancy, today’s women however must adjust to the challenges in rest of her life.

The popular belief that an early menarche predispose to a late menopause is not substantiated. Unlike menarche the average age of menopause remained about the same since the middle ages. It encompasses the period of changing ovarian activity before menopause and the few years of amenorrhea.

One of the major physiological events in a women’s life is menopause. Cessation of menses, which usually occurs between the age of 45 and 55 years, is universal, obvious, and unpreventable. The hormonal changes of the climacteric, primarily the decline in ovarian estrogen production, manifest in the menopause. When women approach menopause their menstrual cycle begin to change and becomes irregular which is a sign of unpredictable ovulation that cause irregular release of the hormones estrogen and progesterone leading to symptoms associated with menopause ( Krantz, 2007).

Although all women have similar hormonal changes with menopause, the experience of each woman is influenced by age, cultural background, health type of menopause, child bearing desires and relationship. Women may view menopause as a major change in their life, either positive, such as freedom from troublesome, dysmenorrhea or the need for contraception or negative, such as feeling “old” and loss of child bearing ability.

A report by a non Governmental organization in Gujarat was revealed that most of the women were having less understanding about menopause and also they did not pay much attention to it.”For many women, menopause represents freedom from social and religious constraints and from sexual harassment” (as cited in Bhavadam, 1999).

Cultural messages also influence individual women’s perception of menopause. Many women have accepted, whereas other see menopause as the first step to old age and associate with it to the loss of attractiveness, physical ability and energy. In addition to the physical changes some social and psychological changes also occurs which may affect the wellbeing of the menopausal women. In cultures where postmenopausal women gain status, such as India, the Far East, and the south pacific Islands, depression among postmenopausal women is not observed (Shifren & Schiff, 2007)

A study conducted by Sivakami & Shyamala (2005) based on the National Family Health survey – 2 data has shown that the age of menopause is different across different states of India. Around 11% of women are found to be in menopause who belongs to the age group of < 40 years, unlike developed countries where women pierce in to menopause during their fifth decade of life. In Indian women are experiencing menopause from their early forties itself, thereby they are exposed to more period of postmenopausal time and its associated problems. Hence it is much needed to concentrate on the health of the menopausal women to improve their quality of life.

As the average life expectancy for women increases, the number of women reaching and living in menopause has escalated. Most of the women may expect to spend more than 1/3 of their life will be in postmenopausal period. It is usually marked by the changes occurring after menopause (Curran & Bachmann, 2006).

Many women pass through the menopause without untoward symptoms. These women remain active and in good health with little interruption of their daily routines. The ability cope with any stress involves three factors: the person’s perception of the event, support systems, and coping mechanisms. Nurses can play a major role in assisting menopausal women by educating and counseling them about the multitude of options available for disease prevention, treatment for menopausal symptoms, and health promotion during the time of menopausal change in their life, and nurses can help to make this opportunity as a reality (Kessenich, 2007).

Dr.Meeta Singh on world menopause day held in New Delhi said that even though awareness about menopause is growing, most Indian women have a history of self-denial and neglect. A prepared module an information brochure about the menopause was given to the women in India and feedback was taken from the women about their perception about menopause and it was found that most of the women were not very well knowledgeable about menopause and legends such as menopause being a ‘disease’ rather than a natural phenomenon were gladly believed. It was found that even educated women believed that ill health was a part of menopause (as cited in Lal, 2006).

Health care professional should bear in mind that, the postmenopausal women might be reluctant to raise questions about some problems spontaneously. However, menopause is period of time where the women need to focus on herself and her needs. The first step is to make her understand about the physical and emotional changes that may be ahead for her (Borrego & Forteza, 2005). So it is important to address the health issues faced by menopausal women also should be encouraged to seek healthy life styles and medical help to take charge of their health.

International menopause society (IMS), in collaboration with the World Health Organization (WHO) has designated October 18 as world menopause day. In observation of the day, the IMS and council of affiliated menopause societies launched policies that support researchers and research in the area of menopausal health. The public health care system does not acknowledge the special health needs of older women. There has been extensive research on menopause in the West but in India, only a few institutes have recognized the potential of research on the subject (as cited in Bhavadam, 1999).

Research to assess the quality of life during postmenopausal period may help in improving and maintaining the good health of the women. As the menopause occurs at a deliberate time when a woman’s social support can be withdrawing, research is considered necessary to find out is preventive health care can have a major impact on a woman’s quality of life.

Women residing in rural area are either unwilling to seek medical help, unable to get services from the private sector or they just ignore their postmenopausal problem. Therefore, the investigator had an intention to assess their quality of life among the women who are from the rural area to improve their quality of life by administering a self instructional module on coping strategies.

STATEMENT OF THE PROBLEM

A descriptive study to assess the quality of life of postmenopausal women and in a view to develop self-instructional module on coping strategies in selected rural area at Madurai district – 2010.

OBJECTIVES

The objectives of the study are

1. To assess the quality of life of postmenopausal women

2. To find out the association between the quality of life with selected demographic variables of postmenopausal women such as age, family income, type of family and occupation.

3. To develop a self-instructional module on coping strategies

HYPOTHESIS

H1- There will be a significant association between the quality of life and selected demographic variables of postmenopausal women such as age, family income, type of family and occupation.

OPERATIONAL DEFINITIONS

Quality of life

In this study, quality of life refers to the perceived level of satisfaction felt by the postmenopausal women about their life in terms of physical, psychological, environmental and social domain assessed by using WHOQOL-BREF standardized scale.

Postmenopausal women

In this study postmenopausal woman, refers to who has attained menopause and the last menstrual period is not less than 1 year and not more than 5 years and who belong to the age group of 45 to 55 years.

Self-instructional module on coping strategies

In this study it refers to well planned written information for the postmenopausal women, which they can read by themselves and understand the definition of menopause, health problems, and strategies in reduction of menopausal problems.

ASSUMPTIONS

Qualities of life during menopausal period vary from individual to individual.

Satisfaction in all four domains contributes on good quality of life.

Change in quality of life is more common among postmenopausal women.

A community health nurse being a unique number of the health care team can identify the menopausal problems and can further give them the guidelines to cope with the problems.

DELIMITATIONS

Study was limited to the women who were unable to verbalize all their problems.

Study was limited to the women who are willing to give the written information

Study was limited to the women who were more than 55 years of age.

PROJECTED OUTCOMES

The result of the study would help the investigator to assess the quality of life of postmenopausal women in rural area and increases understanding about the quality of life among postmenopausal women. The study findings will be helpful for the investigator to prepare a self-instructional module on coping strategies to be adopted by the postmenopausal women. It would be helpful for the nurses to identify the kind of support, guidance and counseling, education needed for the clients attaining menopause.