The severity of menopause and associated factors among middle aged women residing in Arba Minch, DHSS, Ethiopia, 2022

Abstract

Background

Menopausal symptoms are physiological symptoms that can be caused by a decrease in sex hormone levels particularly estrogen in the blood. It is among the major public health problems of middle-aged women. Particularly severe forms of menopausal symptoms are bothersome for middle-aged women. However little is known about the severity status and associated factors of menopausal symptoms among middle-aged women in the study area.

Objective

The main aim of the study was to assess the severity of menopausal symptoms and associated factors among middle-aged women residing in Arba Minch DHSS.

Methods and materials:

Community-based crossectional study was employed. A single population proportion formula was used to determine the sample size. A total of 423 study participants were recruited to conduct the study. A simple random sampling technique was used to employ study participants. Proportional sample size allocation formula was used to allocate study participants in each Kebele of Arba Minch DHSS (demographic and health surveillance site). A menopausal rating scale was used to assess the severity status of Menopausal status. The collected data were analyzed by using SPSS version 20. A descriptive analysis was made to describe the Sociodemographic characteristics of the study participants. Moreover, bivariate and multivariate logistic regressions were calculated to identify the factors associated with the severity of menopausal symptoms among middle-aged women. On bivariate logistic regression variables with p value < 0.25 were eligible for multivariate logistic regression. Variables with a p-value of less than 0.05 are considered statistically significant.

Result

The present study revealed that the prevalence of menopausal symptoms was 88.1%. According to the Menopausal rating scale, 91.2% of the study participants were Asymptomatic, 6.6% of them were mild in severity, 1.2% of them were moderate and the remaining one individual was a severe menopausal symptom. The most severe menopausal symptom was the sexual problem. The factors that have a significant association with the severity of menopausal symptoms were Age with AOR [0.22(0.59–0.87)] and history of chronic disease with AOR [2.334(1.4–24.1)].

Conclusion and recommendation: Generally the prevalence of menopausal symptoms among middle-aged women was high. Asymptomatic and mild forms are the dominant severity forms of menopausal symptoms. Age and history of chronic diseases have a significant association with the severity of menopause. The government, researchers, and stakeholders are recommended to be concerned about this neglected issue.

Introduction

Menopausal symptoms are physiological symptoms that can be caused by a decrease in sex hormone levels particularly estrogen in the blood(1). With the prolongation of human life expectancy, females spend more than one‑third of their lifetime in pre-menopause, menopausal transition (MT) and the subsequent post-menopause (PM)(2, 3). Severity of menopausal symptoms can be assessed by several tools including Menopausal Rating Scale(4). There is a continuous loss of ovarian follicles throughout the reproductive lifespan and gradual reduction of hormones by the ovaries, which leads to changes in the length of the menstrual cycle, ultimately to its cessation and the manifestations of different menopausal symptoms(5, 6). Middle-aged women are highly affected by the gradual decrement of sex hormones. Those women are in the period of menopausal transition and they are vulnerable for different degrees of menopausal symptoms including hot flush, depression, anxiety and stress, sexual problems including dyspareunia(7). The nature, severity and frequency of symptoms vary not only among the individuals of different countries, but also in the same population with different cultures and ethnicities(8).

In some women, these symptoms are so severe that they affect their social and individual lives(9). Identifying the factors associated with menopausal symptoms, especially those which are modifiable may be important to reduce the risk of future chronic illness among postmenopausal women(10, 11). Information about severity and experience of menopausal symptoms among different racial and ethnic groups is important for healthcare personnel to provide appropriate and specific interventions(4, 10).

Materials And Methods

Study Setting

A community based crossectional study was conducted in Arba Minch DHSS, Ethiopia.

Operational Definitions

The Menopause Rating Scale (MRS) comprises 11 items with symptom intensities ranging

from 0 = 0 (no symptom/s) to 1.0 (very severe symptoms).

0 = No, symptom does not occur

1 = Yes, minor or mild symptoms, rarely occurs (monthly):- Duration: last less than 3 minutes.

2 = Moderate symptom, occurs occasionally (weekly):- Duration: may last up to 5 minutes.

3 = Severe symptom, occurs frequently (daily):- Duration: last up to 10 minutes.

4 = Very severe symptom, occurs more frequently: Duration last more than 10 minutes.

Very severe menopausal symptoms: when they scored > 40 on menopausal rating scale

Severe menopausal symptoms: when they scored between35 and 40 on menopausal rating scale

Moderate menopausal symptoms when they scored between 24–35 on MRS.

Mild menopausal symptoms: when they scored between 12–23 on MRS.

Asymptomatic: when they scored less than or equal to 11 on MRS(4).

Result

Sociodemographic characteristic of study participants

In the present study a total of 423study participants were participated with a response rate of 100%.The mean age of the study participant was 53.80 with a standard division of 5.786. Among this 59.8% (285) of the study participant were protestant in religion. Of all 85.3% of the study participants were married. From all 74.5% (315) of them were Illiterate in educational status and 80.4% (340) of the study participant were Housewife in occupation. The mean monthly income of the study participant was 1520 with a standard deviation of 1482.05 as shown in Table S1.

Anthropometric and clinical characteristics of the study participant

The mean BMI of the study participant was 22.7 with a standard deviation of 2.9 and 80.1 %( 339) of the study participant had healthy body mass index. Among all the study participants 19.6% (83) of them have history of chronic diseases as shown in Table S2.

Reproductive health status of the study participant

From a total of 423 study participants 77.8% (329) of them had regular menstrual flow. Of all 62.9 % (266) of them married at age 18 and above. Among all 3.3% (14) of them had history of hysterectomy/ovariectomy and 15.6 % (66) of them had contraceptive history as shown in Table S3.

Substance use 

Among all the study participants 92.4% (391) of them were non-smokers. On the other hand 26.5 % (112) of the study participants consume different types of alcohol. The common type of alcohol that could be used in the study area was as shown in Table S4.  

Severity of menopause 

From all of the study participant’s percent of them have menopausal symptoms. The most prevalent menopausal symptom among middle age groups in the study area was Hot flush. Among those middle aged women with menopausal symptoms 91.7 %( 388) of them were considered as Asymptomatic, 6.6 %( 28) were mild,  1.4 %( 6) of study participants classified as moderate  and only one individual reported severe menopausal symptom as determined by the menopausal rating scale. In the present study there are no very severe menopausal symptoms as shown in Table S5.

Severity of individual menopausal symptoms 

Among the common individual menopausal symptoms that were reported by study participants, the most severe menopausal symptom of the study participant was sexual problem with 4.5% (19) very severe symptoms and 4.7% (20) severe symptoms as shown in the table S6.

Factors affecting severity of menopause of middle aged women

In the present study among the Sociodemographic variables occupational status, age and educational level were associated with severity of menopause among middle aged women on binary logistic regression. Similarly on multivariate logistic regression the Sociodemographic variables that have significantly association with the severity of menopausal symptom was age with AOR [0.22(0.059-0.78)] and P-value of 0.027). Being older age is more prone than the lower age groups to be affected by severe menopausal symptoms as shown in table S7.

. Reproductive health related factors

Regarding the reproductive health related factors, even if the menstrual status, contraceptive history and history of hysterectomy were associated with the severity of menopausal symptoms on binary logistic regression, there is no variable that have significant association with the severity of menopause on multivariate logistic regression as shown in table S8.

Substance use, anthropometric and medical related factors

On Bivariate regression of the substance use, anthropometric and medical related factors history of cigarette smoking, BMI and presence of chronic diseases are significantly associated with the severity of menopausal symptoms. On the other hand there is no substance use related and anthropometry related variables that are significantly associated with severity of menopausal symptoms on multivariate logistic regression. Regarding medical related factors perceived history of chronic disease was significantly associated with the severity of menopause on multivariate logistic regression with AOR [2.334(1.4-24.1)] as shown in Table S 9. 

Discussion

The most severe menopausal symptom that is reported by middle aged women residing in Arba Minch DHSS was sexual problem with a frequency of 4.7% (20) and 4.5% with severe and very severe menopausal symptoms respectively. The finding of the present study was in line with a study done in Korea by Yim et.al who showed that severe to very severe sexual problem was reported in 27.1% of study participants(11). The reason behind the severity of sexual problem in middle aged women is due to the gradual depletion of the hormone estrogen. This is a very important hormone that is crucial for vaginal lubrication and prevents pain during sexual intercourse(2).

The present study also revealed the severity status of menopausal symptoms among middle aged women residing in Arba Minch DHSS by using WHO validated menopausal rating scale. Among the total study participants 91.7% (388) of cases were asymptomatic regarding the severity status of the menopausal symptom on MRS. From all 6.6% (28) of cases were mild.

The frequency of moderate severity status of menopausal symptom was reported to be 1.4% (6). The prevalence of severe menopausal symptom among middle aged women was 0.24% (1). The finding of the present study regarding the severity of menopausal symptoms was lower than a study done by Rasha in Egypt, revealed that the prevalence of severe menopausal symptom was 17.1%(12). The lower prevalence of severe menopausal symptoms in the present study may be due to un-ability to recognize and remember severe menopausal symptoms, the difference in the Sociodemographic and socioeconomic characteristics of the study participant, it may be due to difference in the tool used to evaluate severity status of study participants and also it could be due to the difference in the sample size recruited in the study. The prevalence of severe menopausal symptoms was seen only in one individual and there is no very severe menopausal symptom according to the menopausal rating scale. The finding of the present study is supported by a study done in Iran by Marzieh et.al who reported that severe menopausal symptoms are only reported in three individuals (8).

Factors affecting severity of menopause

In the present study it was shown that age has statisticaly significantly associated with the severity of menopausal symptoms. Higher age individuals are more prone to develop severe forms of menopausal symptoms AOR of [0.22(0.059–0.78)] and P-value of 0.027. The finding of the present study was supported by a study done in Iran(10). The main reason for this is that as age increases the estrogen hormone depletes in a significant amount(13, 14). Due to this severe forms of menopausal symptoms may occur. The finding of the present study is also supported by a study done in Korea by Gyeyoon Y et. al(11).

The finding of this study also revealed that presence of history chronic disease was significantly associated with the severity of menopausal symptoms with AOR [2.334(4.4–24.1)] and p-value of < 0.001. Those middle aged women who have history of chronic disease were 2.3 times more prone to develop severe forms of menopausal symptoms. The finding of this study was in line with a study done in Taiwan(15). The reason is that menopause women with menopausal symptoms may develop chronic diseases and also menopausal women with chronic diseases may result in severe symptoms. Low levels of estrogen can raise risk of heart disease and cardiovascular disease risk factors. Some diseases like autoimmune disorder can damage the ovaries and can exacerbate the low levels of estrogen in menopausal women.

In the present study menstrual history, marital status, monthly income, Body mass index and religion have no significant association with the severity of menopause. The finding of the present study was against with a research done in Egypt(16). The reason may be due to similarities in life styles of the study participant.

Conclusion And Recommendation

The present study revealed that menopausal symptoms are common among middle aged women. Regarding the severity of menopause asymptomatic and mild forms of menopausal symptoms are common among study participants. Age and history of chronic diseases were significantly associated with the severity of menopausal symptoms. Future researchers are recommended to do large scale and longitudinal study on the severity of menopausal symptoms.

Limitation of the study

Failure to do biochemical tests which are very important tests that are crucial to determine the cause of menopausal symptoms. Being crossectional study design may not show the typical cause and effect relationship.

Abbreviations

DHSS-Demographic and Health surveillance site, BMI-Body Mass Index, MRS-Menopausal Rating Scale

Declarations

Acknowledgement

First of all we would like to say thanks to Arba Minch University DHSS office for the financial support to do this research. We would also like to say thank you to Arba Minch Zonal office for giving us the baseline information that we need. We would like to express our gratitude towards study participants for participating in the study.

Funding

The present study was funded by Arba Minch University. The organization had no role in the proposal writing, analysis, and interpretation of data and in writing the manuscript.

Availability of data and materials

The dataset used during the present study are available from the corresponding author on reasonable request.

Authors’ contributions

All authors (BM, KK, and DM) contributed to the design of the study and the interpretation of data. BM performed the data analysis and drafted the manuscript. All other authors DM and KK revised the manuscript. All authors read and approved the final manuscript. BM is the guarantor of the paper.

Ethics approval and consent to participate

The data collection process was started after obtaining ethical clearance from the ethical review board of Arba Minch University and it is available on reasonable request. Participation in the study was on a voluntary basis. The purpose and nature of the study was described to the study participants and participation in the study had no physical risks. Women participated in the study after written informed consent was obtained from them in their own language to ensure comprehension. For illiterate individuals written informed consent was signed from their legal representative for participation. All methods were carried out in accordance with relevant guidelines and regulations

Consent for publication

This information is not applicable.

Competing interests

The authors declare that they have no competing interests.

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