International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 8(7), April, 2016

Pages: 08-12

Date of Publication: 12-Apr-2016


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KNOWLEDGE OF QUALIFIED PARAMEDICAL STAFFS IN UNDERSTANDING THE SYMPTOMATOLOGY AND HORMONAL REPLACEMENT THERAPY IN MENOPAUSE

Author: Umakant Valvekar, S. Viswanathan

Category: Healthcare

Abstract:Background: Menopause is a hormonal depletion state which may lead to psychosomatic condition where it needs psychological support by family members. Most menopausal women go untreated. It is better to have physician's advice in some cases for normal life style. The awareness of menopause and hormonal replacement therapy (HRT) was low among paramedical staff. Methodology: A survey was conducted in 34 women paramedical staff members of Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Tamil Nadu, India. The survey was about the knowledge of women paramedical staff in understanding vasomotor, psychosocial, physical, sexual changes and hormonal replacement therapy (HRT) in menopausal women. The study subjects were divided into two groups as menopausal group (group A) and premenopausal group (group B) consists of 17 subjects in each group. Results: In the present study most menopausal group (group A) women answered that they had experienced hot flushes, insomnia, psychological disturbances, bloated feeling as major symptoms. In this survey most of the paramedical women staff members of menopausal group replied that there was a decrease in the sexual interest in them and they felt natural approaches are better than replacement therapy. Whereas majority of women from premenopausal group (group B) opinioned that sexual interest does not decrease even after menopause. However, they expressed similar opinion as that of menopausal women for the natural approach of menopause is better than hormonal replacement therapy. Conclusion: Awareness of the menopause and HRT is low even among the paramedical staffs. This clearly suggests that there is need to change the attitude of a common woman towards menopause. This can be done by conducting awareness programs on menopause and hormonal replacement therapy (HRT) to paramedical staffs and general public.

Keywords: Attitude, Knowledge, HRT, Symptomatology of menopause, Nursing staffs and Medical technicians

Full Text:

INTRODUCTION When a woman stops menstruating, then it is termed as menopause. It is a natural event, not a disease or illness. However, for some women the physical and emotional symptoms can be difficult1 . Menopause involves hormonal changes that may cause physical symptoms. For some women, menopause may bring on feelings of sadness1 . As per a study done by Sengupta2 in 2003, more than 130 million women in India would have reached menopause by 2016. Menopause is an unspoken, unattended reality of woman, which can last 1/3rd phase of her life2 . Various types of menopausal symptoms include vasomotor, psychosocial, physical and sexual1 . 60% of post-menopausal women will experience mild symptoms, 20% severe and another 20% no symptoms3, 4.

With literacy, increasing age expectancy, urbanization, health consciousness, rapid globalization, internet, health education on T.V and improved economic conditions, menopause is emerging important health issue. Changes taking place in post-menopause are also new issues. Symptoms recognized early can help in reducing discomfort and fear3, 4. Mean age for attaining menopause is 44-45 years in developing countries and 48.2 years in developed countries. Under reporting of symptoms in India is due to socio-cultural features.

Menopause and related changes in the hormone also cause symptoms which are affected on the quality of life, such as night sweats, sleep disturbances, hot flushes, vaginal dryness, urinary frequency, poor memory and depression3-5. Hormonal replacement therapy (HRT) is the effective management to menopausal symptoms and may prevent women from increased osteoporosis and also decreases the cardiovascular risk3-5.

MATERIAL AND METHODS The present survey was conducted at Karpaga Vinayaga Institute of Medical Sciences and Research Centre, a tertiary care centre with teaching hospital in Kanchipuram district of Tamil Nadu. Aim of the study was to find out the attitude, symptomatology, knowledge of menopause and HRT in our paramedical staff members i.e. qualified nursing staffs and medical technicians. Total of 34 women working at our hospital in different clinical departments were selected for the study. Study subjects were divided into two groups i.e, group A and group B; Group A being post-menopausal women and the age of all the subjects were more than 45 years.

The other group is, group B being pre-menopausal women and they are all in reproductive age group only. Each group consists of 17 subjects. Details of age, marital status, and duration of menopause experience of both the groups were mentioned in table 1, table 2 and table 3 respectively. By using a pre designed and tested questionnaire we collected the information about their medical history, current or past history of hormonal treatment, alternative treatment, signs and symptoms of osteoporosis and cardio-vascular diseases, dietary and life style changes were noted down carefully.

No woman had any mental problems, or was on neither any anxiolytics, anti-depressants nor any recent mishap/trauma. Comparisons were made between premenopausal and postmenopausal women. Data storage, analysis, statistics summary and chi square tests were carried out using a standard statistical package. Data was expressed in percentage. Pre menopausal women were included for the study because they could help in identifying the gap in the knowledge, understanding and differences in attitude.

RESULTS Details of age and marital status of the subjects in group A and group B was given in table 1 and table 2 respectively. Out of 17 women selected for the study in group A, four women (23.52%) were had the duration of the menopause less than one year, four (23.52%) women had 1 to 2 years of menopausal duration, another four women (23.52%) had 2 to 5 years menopausal duration, and other 5 (29.4%) women had more than five years of menopausal duration (table 3).

In the present study most menopausal group (group A) women answered that they had experienced hot flushes (47.04%), insomnia (58.8%), psychological disturbances (58.8%), bloated feeling (58.8%) as major symptoms (table 4). While assessing the attitudes of the paramedical women staff members of menopausal group (group A), 58.80% of them were answered that there was a decrease in the sexual interest in them. This may be because of dryness of vagina. Further 87.20% of the women felt natural approaches were better than hormonal replacement therapy. Majority of women from premenopausal group (group B) opinioned that sexual interest does not decrease even after menopause (table 4). However, they expressed similar opinion as that of menopausal women for the natural approach of menopause is better than hormonal replacement therapy. In group A, 58.80% women experienced that sexual desire was decreased after menopause, 23.52% had sexual discomfort.

About 47 % of women from group B did not answer about the attitudes towards sexual life after menopause as they had yet to attend menopause. More than 50% of women in both the groups were having the impression of psychological changes were physiological or due to ageing but not hormonal. Most interesting thing was that women of both the groups (group A = 47% and group B = 35.28%) think that those who suffer from the changes are those who expect it. About 47% of women of both the groups think that the risk of estrogen treatment outweighs the benefit. Further, women of both groups (group A = 87.2%; group B = 82.32%) think that natural approach is always better than hormonal replacement therapy in menopause; they say natural is natural (table 5). In answering about their male partner has reduced sexual desire after menopause, 17.64 % in group A and 11.76% in group B think so.

This clearly suggests that their male partner having normal sexual feeling even after their menopause. In the present study post-menopausal women had insomnia in 58.8%, pain in upper abdomen in 29.4% and psychological disturbances 58.8% (table 5 and table 6). The association between reported symptoms and attitude towards menopause and HRT was found to be statistically significant (p <0.05). Premenopausal group women hesitated to answer questions related to sexual interest, discomfort and their husband’s attitude towards libido, women as less feminine, or they themselves feel less feminine or attractive after attaining menopause, reasons being shy, no knowledge or have yet to attain menopause.

DISCUSSION Menopause is the stage where frequent social and hormonal characteristic changes occur in a woman6 . As life expectation  increasing, most of the women are attending menopause. HRT can have significant profit in postmenopausal women. As of now, hormonal replacement therapy utilization in menopause women was very low. Menopause awareness is the key analyst of hormonal replacement therapy use4, 7. Women approach regarding menopause are powerfully predisposed by social, cultural and economical situations in that’s they live and also reproduce the dissimilarity in modes of management for or perceptions of its symptoms7 .

Symptoms of the menopause are experimented in all over countries of the world but incidence varies from place to place. In the present study 47.04% of women from menopausal group experienced hot flushes, 17.6% women had urinary complications, 5.88% women had increased white discharge, 35.29% women experiencing vaginal dryness and 29.4% experienced altered libido. The similar results were reported by Porter3 , et al. 1996, Ferguson8 , et al. 1989, Mahajan9 , et al. 2012, Bairy and Shalini10 et al. 2009. Further Mahajan study revealed hot flushes and night sweats are miss-interpretated in India9 . Ferguson8 et al. in 1989, in their survey reported 51% hot-flushes, 28% experienced vaginal dryness, 14% insomnia, 9% depression, 7% just didn’t feel well.

In a survey done by Porter3 in 1996, reported that 57% postmenopausal women experienced various symptoms as, hotflushes (22%), psychological (25%). Bairy 10 et al., in Udipi from South India recorded in their study that aches in muscles and joints 67.7%, tiredness 64.8%, poor memory 60.5%, low back-ache 58.80%, feeling bloated 55.1% and disturbed sleep (insomnia) 51.1%. In a study done by Sengupta2 in 2003, it was reported that most menopausal women go untreated or use unproven alternative therapies as there is unavailability or ever-increasing cost of the medicines and also lack of social support. In the present study, about 47.04% women in menopausal group (group A), had felt that women with more negative attitudes towards the menopause suffer more and 35.28% women from group B (Premenopausal women) had expressed same kind of opinion. This is in line with the other studies done by Bairy et al10 2009, Saka et al11., 2012, Puri et al.,12 2007.

From the research study done by Singh and Arora5 in 2005, on profile of menopausal women in rural North India, found that women view menopause positively but HRT use was low. In another study done by Saka et al11 2012, from Nigeria revealed that poor menopausal knowledge among common women. In this study more than half of the respondents reported negative attitude towards menopause. Most researches4,7,8,9,12,13 have sounded alarm about lack of information for women about the changes they can expect and absence of positive images of aging related to menopause and HRT. Mehershi et al14., 2010 in their study, stated that 85% of gynecologists from Jaipur, Rajasthan give HRT to their parents. Hence, HRT can have a great deal to offer or improve quality of life a woman who has reached natural menopause, have family history of osteoporosis, or undergone hysterectomy or who are currently ignorant of HRT8,10,13.

Changes of menarche are valued and welcomed, as against for menopause is surrounded by secrecy and shame and often signal of end of valued state of reproductively and femininity14. In our study though being paramedical by profession their awareness of menopause and HRT is low, which reflexes general Indian population will still be poorer in awareness. Doctors and health workers must make patients aware of menopause and HRT and also of benefits and side-effects. Decision whether to take or not to take HRT is choice given to them. As most menopausal women go untreated or use unproven alternative therapies as there is unavailability or ever increasing cost of the medicines and also lack of social support systems.

CONCLUSION This study concludes that most of the paramedical women staffs lacked knowledge regarding menopause and hormonal replacement therapy. Mostly ideas of the women participated in this study concerning menopause knowledge were such as; “it is natural thing and needs no medical assistance”. This type of attitude gives negative impression to take hormonal therapy in menopause. Hence education and awareness in women about menopause and hormonal therapy (HRT) can improve the general health of a woman.

ACKNOWLEDGEMENTS We would like to thank all the paramedical staff who had participated in the study. Funding: We did not receive any external funding for this study. Conflicts of Interest: There is no conflict of interest Ethical approval: Not required

References:

1. Al-Azzawi F, Palacios S. Hormonal changes during menopause. Maturitas. 2009; 63(2):135-137.

2. Sengupta A. The emergence of the menopause in India. Climacteric.2003; 6:92 -95.

3. Porter M, Penney GC, Russell D, Russell E, Templeton A. A population based survey of women’s experience of the menopause. Br J. Obst. Gynaecol 1996; 103(10); 1025 – 1028.

4. Shaheen S, Mahmood A, Kadri F. Menopause and HRT; Clinical pattern and awareness. Professional Med J. 2015; 22(7)904-909.

5. Singh A, Arora AK. Profile of menopausal in rural North India. Climacteric. 2005; 8(2):177-184.

6. Pam HA, Wu MH, Hsu CC, Yao BL, Huang KE. The perception of menopause among women in Taiwan. Maturitas 2002; 41:269 – 274.

7. Jin Yong Lee, Chang Suk Suh. The attitudes of postmenopausal women towards hormone replacement therapy (HRT) and effects of HRT on lipid profiles. Proceedings of the first consensus meeting on menopause in East Asian region, 1997; May 26 – 30.

8. Ferguson KJ, Hoegh C, Johnson S. Estrogen replacement therapy: a survey of women’s knowledge and attitudes. Arch Intern Med. 1989; 149:133 – 136.

9. Mahajan N, Aggarwal M, Bagge A. Health issues of menopausal women in North India. J. Midlife Health, 2012; 3:84-87.

10. Bairy L, Shalini A, Bhat P, Bhat R. Prevalence of menopausal symptoms and quality of life after menopause in women from South India. Aust N Z J Obstet Gynaecol. 2009; 49:106–109.

11. Saka MJ, Saidu R, Jimoh A, Akande T. Behavioral pattern of Menopausal Nigeria women. Ann. Trop Med. and Public Health. 2012; 5(2): 74-79.

12. Puri S, Bhatia V, Mangat C. Perceptions of Menopause and Postmenopausal Bleeding In Women of Chandigarh, India. The Internet Journal of Family Practice. 2007; 6(2):1- 6.

13. Nedrow A, Miller J, Walker M, Nygren P, Huffman LH, Nelson HD. Complementary and alternative therapies for the management of menopause related symptoms: A systematic evidence review. JAMA. Arch Intern Med. 2006; 166(14):1453-1465.

14. Meherishi S, Khandelwal S, Swarankar ML, Kaur P. Attitudes and practices of gynecologists in Jaipur towards management of menopause. J. Midlife health, 2010; 1(2):74-78.

Announcements

Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

COPE guidelines for Reviewers

SCOPUS indexing: 2014, 2019 to 2021


Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

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A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
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A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
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A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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