INRODUCTION

Menopause is a transition that women undergo in the mid-stages of life which involves the slow process of menstrual cycle cessation, which in turn, triggers various physiological changes in the body such as vascular instability, atrophy of the urogenital tract, bone and skin diseases as well as soft tissue disorders [1, 2]. The menopausal phase also includes other common symptoms like hot flashes, night sweats, a myriad of nonspecific emotional and psychological distresses, decreased sexual functioning and libido [3]. The menopausal common key symptoms can be categorized in four areas depending on nature, i.e. psychosocial, physical, vasomotor, and sexual [4]. In the menopausal phase, women have higher levels of depression and anxiety, hormonal changes are linked with increased mood swings, which have been strongly associated with the deprivation of estrogens in females after menopause [5]. The quality of life (QoL) of women is highly influenced during menopause as it is a major biological change in one’s life, and can produce physical as well as emotional changes in females [6].

Along with physiological changes, women during the post-menopausal phase have a greater risk of developing depression, anxiety, and other cardiovascular diseases therefore adoption of a healthy lifestyle and proper management of co-morbidities among post-menopausal women is of prime importance. The changes associated with menopausal women are highly linked with the development of other non-communicable diseases, e.g. hypertension, diabetes, breast and cervical cancer, and osteoporosis [7]. Several physiological and social evolutions happening during female mid-life may intensify the risk of depressive disorders. These changes increase the incidence of menopausal complaints, which result in higher rates of depression among females. Depressive condition and mood have a negative effect that impairs the quality of life, sleep, sexual function, resilience, and life satisfaction of mid-aged women. Depression is also related to a higher risk of increased body weight, cardio-vascular diseases, poor cognitive function, subclinical inflammation, and osteoporosis [8].

Women in developing countries such as Pakistan lack basic knowledge about the physiology of menopause and its signs and symptoms and they tend to avoid discussion about it or seek medical help. This behavior may result in reduced QoL as well as enhanced chances of developing depression among postmenopausal women in Pakistan. To design effective interventions aimed at improving quality of life, it is necessary to assess the current status as well as factors affecting the quality of life in postmenopausal women. Therefore, this research was done to evaluate the QoL and depression among postmenopausal women in Pakistan.

MATERIALS AND METHODS

In order to assess menopausal quality of life and depression among post-menopausal women in Pakistan, a descriptive cross-sectional study design was applied. Study approval was taken from the Ethical Committee of Hamdard University (BASR-78-5). Approval was also taken from medical superintendents of different hospitals of Islamabad and Rawalpindi. Respondents were briefed regarding the nature and objectives of the study. Verbal and written consent were obtained before data collection from respondents. Respondents were assured of the confidentiality of their responses and their right to withdraw from the study whenever they wanted. The study respondents were postmenopausal women aged between 40-65 years old. Patients were categorized based on age between 40-65 years old, whose last menstrual period occurred within a period of last 1-5 years, and had normal menopause. Raosoft sample size calculator was used for calculation of the sample size at 95% confidence interval and 5% margin of error which came to be 382. Convenient sampling techniques were used and all the respondents available upon data collection were chosen. Two pre-validated structured questionnaires were used for the collection of data in this study i.e. Menopause Specific Quality of Life (MENQOL) and Hospital Anxiety and Depression Scale (HADS) to evaluate menopause specific quality of life and depression respectively among postmenopausal women from twin cities of Pakistan.

Menopause specific Quality of Life developed by Hilditch J R [9] includes 5 domains such as vasomotor (hot flushes, night sweats, and sweating), psychological (anxiousness, poor memory, lowered ability, feeling depressed, impatient, wanting to be alone), physical (flatulence, muscles and joints pain, tiredness, difficulty sleeping, backaches, decreased stamina, lack of energy, dry skin, weight gain, weakness, increased facial hair, change in skin texture, bloating, low backache, frequent and/or involuntary urination) sexual (changes in sexual desire, vaginal dryness and avoiding intimacy) and others (palpitation, headache, dizziness). The Hospital Anxiety and Depression Scale (HADS) measures the extent to which patients experience anxiety or depressive symptoms. It consists of 7 items each for anxiety and depression [10].

Pilot testing was performed on 10% of the sample size to check the reliability of the tool. The value of Cronbach's alpha was 0.70 for MENQOL and 0.69 for HADS.         Data nwas cleaned, coded, and analyzed using SPSS 21. Descriptive statistics comprised of frequencies and percentages were determined. Mann-Whitney and Kruskal Wallis test (p≦0.05) was applied to determine differences among various variables.

RESULTS AND DISCUSSION

Demographic Characteristics of Respondents

Out of 382 respondents, 30.4 % (n=116) were 40-49 years old, 43.2% (n=165) were 50-59 years old and 26.2% (n=100) were 60-65 years old. Of all the respondents, 88.5% (n=388) had menopause between the age of 44-53 years. Most of the females were married (85.6%, n=327) and over three-quarters of respondents (75.4%, n=228) had more than 3 children. A detailed description is given in Table 1.                

Mean Scores of Menopause Specific Quality of Life among Postmenopausal Women

The results obtained from this study highlighted that mean scores for the sexual domain were higher (4.52, ±4.05) indicating the poor menopause-specific quality of life in this domain whereas the lowest scores were seen for the psychosocial domain (3.29, ±3.92). A detailed description is shown in Table 2.

Comparison of Mean Scores of Menopause Specific Quality of Life by Demographic Variables

A significant difference (p<0.05) was observed in specific menopause quality of life among different age groups. Respondents having age greater than 60 years were more bothered concerning vasomotor, psychosocial, physical, and sexual domains of menopause quality of life as compared to other age groups. A significant difference was observed (p<0.05) among different levels of education. Illiterate respondents were comparatively more worrisome in the physical domain whereas the sexual domain was comparatively more disturbed among postgraduate respondents. A significant difference (p<0.05) was seen among respondents having a different number of children. Respondents having no children were comparatively more bothered in the psychosocial and physical domain than other respondents. A significant difference (p<0.05) was seen among respondents having different types of co-morbidities. Respondents having hypertension and diabetes were comparatively more bothered in the psychosocial domain than other respondents whereas respondents having diabetes were more bothered in the sexual domain. No significant difference was observed among respondents having different marital statuses and using different types of therapies. A detailed description is given in Table 3.

^a Mann-Whitney, ^b Kruskal-Wallis