Postmenopausal Experiences and Constraints in Seeking Health Care in A Rural Area of West Bengal, India

Introduction: During menopause, women experience various psychological or physical changes which need adequate attention. Moreover, women don’t seek help for these problems due to their hesitancy, lack of awareness, socio-cultural, financial constraints or as they feel this is a natural-phenomenon. The study aims to explore the postmenopausal experiences faced by women during menopause and to elicit the constraints faced by them in seeking health-care services. Methodology: This was a qualitative study with phenomenological approach conducted among post-menopausal women (≥45 years) from Oct 2022-Jan 2023 with the help of In-Depth-Interview guide in four villages of Bhatar Block, Purba-Bardhaman District. Considering the availability of the study participants, they were selected purposively from the list prepared by ASHA of each village and recruitment done till the point of data-saturation. Inductive thematic-analysis was used to identify codes and themes. Results: During menopause, women experienced physical and psychological changes in the body, changes in social life and for these changes they had to adjust to cope-up. They felt various needs like empathy from hus-bands, children, peers. On the other hand, they did not seek help from health-care services due to their knowledge gap, dissatisfaction from previous-visit, cost-issue and unavailability of resources in health-care delivery system. Conclusion: Majority of the post-menopausal women faced various problems associated with menopause, but very few had sought help. So, health care providers have an important role to generate awareness among post-menopausal women regarding physical and mental changes during this phase.

Health seeking behaviour among post menopausal women in rural and urban field practice areas of Gandhi Medical College, Hyderabad: a cross-sectional study

Background: The phase of menopause is a physiological event which occurs as a result of progression of reproductive ageing. Women from developing countries view variations due to menopause as natural process and there is no need for medical care. The objective of the study was to assess the health seeking behaviour among the post menopausal women.Methods: A cross-sectional study was conducted in the rural and urban field practice areas of department of Community Medicine of Gandhi Medical College, Hyderabad. About 300 urban and 300 rural women were interviewed using a semi-structured and pretested questionnaire from August 2015 to September 2017.Results: Among the rural women, 100 (25.4%) women did not seek health care and among those who sought health care, majority (34.3%) preferred government healthcare services followed by 23% who consulted private facility. Of the urban women, 14.7% did not seek health care, 42% of the women approached private practitioner followed by 23% who sought health care in government hospital. Majority of the women (42.2%) did not seek health care as they thought they will be normal with time.Conclusions: More than one third of the women are not aware of menopause and related problems. Among those who did not seek health care, higher proportion felt they will be Ok with time followed by financial constraints, fear/shy, family problems and lack of transport.

Assessment of Quality of Life in Post − Menopausal Women: A Questionnaire Study

Background: Menopausal women may experience vasomotor, urogenital and psychological symptoms as well as sexual dysfunction. These problems are often attributed to hormonal changes during midlife and are projected as health risk. The present study was conducted to assess the quality of life (QOL) and determinants in postmenopausal women. Materials & Methods: The present study was conducted on 140 postmenopausal women age ranged 45- 60 years of age. All women were provided with a pre-designed questionnaire containing 24 questions about quality-of-life in menopause. Scores for vasomotor aspect ranged from 0 to 6, for psychosocial aspect from 0 to 18, for physical aspect from 0 to 42 and for sexual aspects from 0 to 6. Results: 60 women were <50 years and 80 were >50 years. Psychosocial score of 5-15 was observed in 42 women, vasomotor score of 2-5 was seen in, physical score of 24-33 was seen in 12 and sexual score of 2-4 was seen in 32 women. 65 women had more than 5 years of menopause while 75 had less than 5 years. 110 women exercise in the form of brisk walking while 30 do not. In 90 women, relation with husband deteriorated after menopause and 50 women never complained of this. 80 were living with their children while 60 not. 50 women had support from their children while 90 had not. 75 women had good perception of her heath while 65 had average perception. All domain showed significant difference in QOL. Conclusion: Post-menopausal women who fall in a transitional population between the reproductive age group and geriatric population need special attention. Their quality of life is highly determined by physical domain and psychosocial domain

A Study of Anti-hypertensive Drug Prescription Patterns in Hypertensive Post-menopausal women

Background: Drug prescription in menopause is complex as estrogen deficiency, hypertension (HT) and other risk factors, rapidly increase the risk of cardiovascular diseases (CVD) in post-menopausal women (PMW). Objectives: To evaluate the prescription trends of anti-hypertensive drugs in PMW. Methods: This was an observational, cross sectional study conducted over a period of 1 year, on hypertensive PMW. The prescriptions were evaluated for antihypertensive drug use patterns and also as per WHO core drug indicators. Results: 21.82% of prescriptions had monotherapy, amongst which angiotensin receptor blockers (ARB) (10%) and individually, telmisartan (5.45%) were most commonly prescribed. Majority of prescriptions had two drug therapy (44.09%), among which ARB + beta-blockers (BB) (20.91%) and individually, Telmisartan + Metoprolol (13.64%) were most frequently prescribed. ARB + Diuretic (DI) (9.55%) was the most common fixed drug combination (FDC) prescribed. ARB + BB + DI (10.45%), ARB + 2DI + BB (4.09%) and ARB + 2DI + BB + Calcium channel blocker (1.82%) were most commonly prescribed three, four and ≥five drug combinations, respectively. Hypolipidemic drugs (60.45%) were maximally co-prescribed. Percentage of drugs prescribed by generic name was 4.63% and from essential drug list was 32.62%. Conclusions: A high trend of polypharmacy was observed in hypertensive PMW. HT, being a multifactorial disease, deserves a multidisciplinary and a comprehensive approach in the care of this population subgroup. Knowledge of prescription pattern and thus the rational utilisation of drugs will help achieve better control rates of HT and hence curb down the burden of CVDs in PMW.

A study of clinical profile of cardiovascular manifestations in postmenopausal women

Background: In today’s era lifestyle related diseases like diabetes mellitus, have emerged as a major public health problem. Diabetes mellitus, a common metabolic disorder, which accounts for a high incidence of morbidity leads to various events including micro and macro vascular complications. This study aims to assess the baseline levels of (KAP) knowledge, attitude and practices of general population of Vadodara. Materials and methods: The present cross sectional study was carried out on general population of Vadodara with the help of a suitably designed and validated KAP questionnaire. The questionnaire was pretested and verified for errors. The data was analyzed statistically. Results: Altogether, 60.12 % of respondents scored 100% in the questions related with knowledge. However 23.54% scored 100% in the attitude questions and12.80% scored 100% in practice questions. Conclusions: We can conclude that the responders had good knowledge but poor attitude and practice towards diabetes. We can overcome this by increasing quality of health education and improving applicability of scope of health education at all level. The effect of the hormonal changes associated with menopause may play an important role in most cardiovascular disorders in post-menopausal women. So the present study was undertaken to identify various cardiovascular profile changes in postmenopausal women and women were recruited for the study. We check for various parameters like hypertension, diabetes, Ischemic heart disease, Cerebrovascular Stroke, metabolic syndrome, anaemia, fundus examination. Results: Prevalence of Hypertension, dyslipidaemia, metabolic Bhavik Prajapati, Shirish Raval, Jigar Patel, Ishwar Parmar, Janak Chokshi, Nilay Thakore. A study of clinical profile of cardiovascular manifestations in postmenopausal women. IAIM, 2018; 5(4): 100-106. Page 101 syndrome, CV stroke, ischemic heart disease is higher in postmenopausal women. Five deaths due to cardiovascular disease were observed. This study showed high prevalence of most of the conventional cardiovascular risk factors, especially diabetes, hypertension, dyslipidemia, obesity, and other risk factors in postmenopausal women. Therefore it is important to consider each and every postmenopausal woman to undergo screening for cardiovascular profile and very important to identify and treat these cardiovascular risk factors properly to prevent mortality and morbidity.

Quality of Life of Postmenopausal Women in Urban and Rural Communities

OBJECTIVES: Menopause is a transitional time in a woman's life leading to both physical and emotional challenges which affects the quality of life (QOL). Average age of menopause is around 48 years but it strikes Indian women at the age of 40 to 45 years. So, menopausal health demands higher priority in Indian as well as global scenario. The present study was conducted to compare the QOL of postmenopausal women residing in urban and rural communities. METHODS: The study adopted quantitative research approach with comparative survey design. The samples were 100 postmenopausal women from rural urban communities selected using non probability purposive sampling technique. Data was collected by interview using demographic performa and menopause specific QOL. RESULTS: The mean QOL score (X2 = 27.24) of rural women was higher than the mean QOL score (X1 = 26.34) of urban women. The calculated independent ‘t’ value (t = 0.86; P < 0.05) is lesser than the table value (t 98 = 1.980). There was association between QOL of urban postmenopausal women and monthly income of the family (χ2 = 4.023) was statistically significant at 0.05 levels. CONCLUSIONS: There was no significant difference in the QOL of postmenopausal women in rural and urban areas. Indian women are ignorant about the changes taking place in their reproductive system. Religion and culture of our society also inhibits to express these changes. Health care professionals have a great role in addressing these issues to prepare women to face the challenges of reproductive health.

Bone Mineral Density and Prevalence of Osteoporosis in Postmenopausal Korean Women with Low-Energy Distal Radius Fractures

The aim of this study was to evaluate the bone mineral density and the prevalence of osteoporosis in postmenopausal Korean women with low-energy distal radius fractures and compared with those of aged-matched normal Korean women. Two hundred and six patients with distal radius fractures between March 2006 and March 2010 were included in this study. Patients were divided into three groups by age; group 1 (50-59 years), group 2 (60-69 years), and group 3 (70-79 years). Controls were age-matched normal Korean women. The bone mineral density values at all measured sites, except for the spine, were significantly lower in group 1 than those of control. While the bone mineral density values in group 2 and 3 were lower than those of controls, these differences were not statistically significant. All groups had significantly higher prevalence of osteoporosis at the Ward's triangle; however, at the spine, femoral neck and trochanteric area it was not significantly different from those of age-matched controls. Although the prevalence of osteoporosis of the postmenopausal women with low-energy distal radius fractures may not be higher than that of the control, osteoporosis should be evaluated especially in younger postmenopausal patients to prevent other osteoporotic hip and/or spine fractures.

Cardiovascular Risk Profile of Post-Menopausal Women in a Semi-Urban Community in Nigeria.

Aims: Menopause is associated with a myriad of chronic health risks. This study assessed the Cardiovascular Disease (CVD) risk profile of post-menopausal women from a semi-urban community in Nigeria. Study Design: Cross-sectional study Place and Duration of Study: Ife Central Local Government, Ile - Ife, Nigeria Methodology: One hundred and twenty menopausal women aged 55 years and older participated in this study. The respondents were recruited using a multistage sampling technique. The Framingham Heart Study Questionnaire was used to assess CVD risk level. Risk scores were classified as low (0-19), medium (20-29) and high risk (40+). Socio-Economic Status (SES) was assessed using a validated questionnaire while cardiovascular and anthropometric parameters were measured following standard procedures. Data were analyzed using descriptive and inferential statistics. Alpha level was set at 0.05. Results: The mean age, weight and Body Mass Index (BMI) of respondents were 64.9±8.4 years, 73.4±15.2kg and 27.3±5.4kg/m² respectively. A majority, 84(70.0%) of the respondents had high blood pressure, 77(64.2%) had over five years duration of onset of menopause while 13(10.8%) had high cardiovascular risk. Half of the respondents, 64(53.3%) were in the low SES class. High CVD risk was higher among individuals with over five years of menopause. Pearson Product Moment Correlation revealed significant relationship between CVD risk and each of age (r = 0.507; P = 0.01), body weight (r = 0.257; P = 0.01), onset time of menopause (0.359; P = 0.01), blood pressure status (r = 0.665; P = 0.01), occupation (r = 0.330; P = 0.01) and SES (r = 0.406; P = 0.01) among post-menopausal women. Conclusion: Prevalence of CVD risk was high among Nigerian post-menopausal women in a semi-urban community. Age, body weight, years of onset menopause, blood pressure, occupation and socio-economic status level had significant relationship with high cardiovascular disease risk.

A Study of Endometrial Pathology by Transvaginal Color Doppler Ultrasonography and its Correlation with Histopathology in Post-menopausal Women.

Objective: Endometrial carcinoma is the most common gynaecological malignancy. Approximately 80% of endomentrial carcinoma occur in post-menopausal women. Present study aimed to evaluate the role of transvaginal ultrasonography and colour flow imaging in diagnosing endometrial pathologies especially endometrial carcinoma and later its confirmation by histopathology. Methods: 38 women presenting with history of at least 6 months amenorrhoea followed by bleeding per vaginum were included in the study. Transvaginal colour Doppler (TVS) followed by fractional curettage was done in all cases and cervical biopsy was done in selected cases. Uterine size, endometrial thickness and blood flow indices (RI, PI) were measured. Analysis of data was done using ‘z’ test and ‘t’ test. Results: Out of 38 women maximum number of cases (39.47%) were between 50 – 55 years. Using 4 mm of endometrial thickness as cut off value for discriminating normal and abnormal endometrium, sensitivity, specificity, PPV and NPV were 94.12%, 50%, 95.12% and 50% respectively (p < 0.05). No case of endometrial carcinoma was detected when the endometrium was <4 mm, making the sensitivity as 100%, NPV 100%, specificity 13.33% and PPV 23.53%. Using RI = 0.81 as cut off value for discriminating benign and malignant endometrium, sensitivity was 62.5%, specificity 53.33%, PPV – 26.3% and NPV as 84.2%. Conclusion: Transvaginal sonographic (TVS) evaluation of endometrial thickness (ET) is a reliable method of screening women with post-menopausal bleeding. Conservative approach may be offered to women showing ET of less than 4 mm and high impedance to flow in uterine and endometrial vessels.

Prevalence and Associated Risk Factors of Osteoporosis in Post-Menopausal Women in North India

Introduction: Osteoporosis is a global health problem contributing to increased functional limitations (mortality, morbidity, disability) and economic costs. The study aimed at assessing the prevalence and risk factors of osteoporosis in a sample of post-menopausal women from the states of Punjab, Haryana and Chandigarh in North India. Methods: A total of 250 post-menopausal women, ranging in age from 45 to 80 years, were selected by purposive sampling from three states in North India. Information was collected on height, weight, waist and hip circumferences, grip strength, dietary intake, physical activity, and exposure to sunlight. Bone mineral density (BMD) was evaluated by using Dual Energy X-ray Absorptiometry (DXA) at lumbar spine (L1-L4). Results: The prevalence of osteoporosis at lumbar spine (L1-L4) was found in 26.4% of the post-menopausal women. Osteoporotic women were significantly shorter (155.17 vs. 157.57,p

Efficacy and Tolerability of GenTeal® Gel in Post-menopausal Women with Moderate to Severe Dry Eye: Results of a Post Marketing Observational Study.

Purpose: To assess the effectiveness and tolerability of GenTeal® gel in post-menopausal patients with moderate to severe dry eye. Methods: This was an open label, multicenter, non-comparative, non-interventional, observational study in post-menopausal women patients of age 39-82 years with moderate to severe dry eye. The patients were treated with GenTeal® gel for 20 weeks and assessed for effectiveness at baseline, 10-12 weeks and at 20 weeks. The primary effectiveness outcomes were changes in ocular symptoms (foreign body sensation, itching, burning, watering, photophobia, feeling of dryness in the eye), tear break up time (TBUT), Schirmer, fluorescein corneal staining score and global assessment for efficacy on dry eye condition. The secondary objective of the study was to evaluate ocular tolerance and systemic safety of the product. Results: A total of 169 out of 170 enrolled patients completed the study. At 20 weeks of treatment, the median composite ocular symptoms scores was reduced by 78% from baseline (median; 2.0 vs 9.0 of baseline, p<0.0001). All ocular symptoms except photophobia were significantly reduced (p<0.05) at 20 weeks of treatment. At 20 weeks, TBUT and schirmer scores were significantly increased by 39.9% and 48.6% respectively (p < 0.0001); while fluorescein staining cumulative score was significantly decreased (100.0%, p < 0.0001) from their baseline. The overall efficacy and ocular tolerability of GenTeal® gel, was ‘good’ to ‘excellent’ for >98.0% of the subjects. Adverse events of mild dyspepsia and frequent micturition of moderate intensity were reported by a subject. Conclusions: The findings of the present study indicate that GenTeal® gel treatment is an effective and tolerable treatment for dry eye in post-menopausal women patients in Indian clinical practice.

Comparação da qualidade de vida relacionada à saúde entre mulheres na pós-menopausa praticantes de atividade física com e sem osteoporose / Comparison of the health-related quality of life between physically active postmenopausal women with or without osteoporosis

OBJETIVO: comparar a qualidade de vida relacionada à saúde de mulheres na pós-menopausa praticantes de atividade física com e sem o diagnóstico de osteoporose. MÉTODOS: trata-se de estudo descritivo transversal, realizado por meio de entrevistas, em que o pesquisador aplicou uma ficha de avaliação e o questionário SF-36. Todas as voluntárias mulheres participaram do estudo por meio de um contato prévio por telefone. As características e objetivos da entrevista foram explicadas, além de confirmar o estágio pós-menopausa da voluntária. Formaram-se dois grupos, com 21 voluntárias cada um: grupo 1, constituído por mulheres sem osteoporose (64,38 ± 4,24 anos), e grupo 2, constituído por mulheres com osteoporose (67,81± 4,19 anos). Cada voluntária, inicialmente, submetia-se a uma ficha de avaliação para obtenção dos dados pessoais, história clínica, comorbidades e cuidados com a saúde. Em seguida, aplicava-se o questionário SF-36. Para avaliação das diferenças entre os grupos, aplicou-se o teste não-paramétrico de Wilcoxon. RESULTADOS: houve diferença significativa (p < 0,05) entre os grupos em relação aos componentes Aspectos Físicos e Estado Geral da Saúde do SF-36, com desempenho melhor para o grupo 1. CONCLUSÃO: mulheres na pós-menopausa com diagnóstico de osteoporose, mas que não tiveram fraturas, podem ter qualidade de vida semelhante à de mulheres na pós-menopausa sem osteoporose.

OBJECTIVE: to investigate the quality of life among physically active post-menopausal women with and without a diagnosis of osteoporosis. METHODS: a cross-sectional descriptive study was carried out through interview. All the participating women volunteered to take part of this study through previous contact by telephone. The characteristics and objectives of the inter view were explained in addition to confirmation of their postmenopausal status. There were two groups of 21 volunteers each: group 1 were non-osteoporotic women (64.38 ± 4.24 years-old) and group 2 were osteoporotic women (67.81 ± 4.19 years-old). Each volunteer was asked to fulfill a preliminary form in order to register personal information, clinical history, co-morbidities and health care. Following, the SF-36 questionnaire was applied. The Wilcoxon rank-sum test was used to assess differences between the two groups. RESULTS: there was a significant difference (p < 0.05) between both groups only with regard to the "Role Physical" and "General Health " components of the SF-36 form showing a better performance to group 1. CONCLUSION: post-menopausal women with a diagnosis of osteoporosis that did not sustain a fracture may present a similar quality of life, as compared to non-osteoporotic post-menopausal women.