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Health Care Seeking Practice for Menopausal Problems Among Women in Syangja District, Nepal

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Health Care Seeking Practice for Menopausal Problems Among Women in Syangja District, Nepal International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Health Care Seeking Practice for Menopausal Problems among Women in Syangja District, Nepal Shanta Gyawali1, Shankar Nand Subedi2, Nawazia Yasmin3, Susmita Pandey4 1Lecturer, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal. 2Assistant Professor, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal. 3Associate Professor, State University of Bangladesh, Dhaka, Bangladesh. 4Lecturer, Nepal Army Institute of Health Sciences, Kathmandu, Nepal. Corresponding Author: Shanta Gyawali Received: 15/06/2016 Revised: 30/06/2016 Accepted: 04/07/2016 ABSTRACT Introduction: Menopause is a normal physiological change experienced by middle age women. It has become a major public health concern around the world. Methods: A cross-sectional study was conducted to find out the health care seeking practice among 140 women having natural menopause from Putali bazar Municipality of Syangja district, Nepal. Data was collected through face to face interview by using interview schedule. Results: This study revealed that 97.1% had at least one of the menopausal problems, namely somatic (84.3%), psychological (76.4%) and urogenital (44.4%). Among the somatic problems, joint and muscular discomfort (84.7%), hot flushes (44.3%), sleep problems (42.9%) and heart discomfort (35.7%) were reported. Among psychological problems, anxiety (67.9%), irritability (40.7%), depressive mood (30.7%), physical and mental exhaustion (29.3%) and among urogenital problems, bladder problem (32.9%), sexual problems (11.4%), dryness of vagina (9.3%) were also reported by the respondents. Regarding treatment seeking behavior, about 65.5% were found to be consulting for urogenital problems and 38.3% for psychological problems and 32.2% for somatic problems. Among the respondents who seek health care services, majority of the respondents consult directly to the pharmacy rather than hospital for psychological and urogenital problems but 81.1% respondents found to be consulted in hospital for somatic problems. Conclusion: The findings revealed that majority of the respondents were ignorant regarding health seeking behavior of menopause related problems, so there is strong need of programmatic effort to educate the women to make them aware of menopausal problems through appropriate awareness programs. Key words: Menopause, Menopausal Problems, Health care seeking. INTRODUCTION marks the end of women’s reproductive Menopause is the permanent function but also introduces them to a new cessation of menstruation resulting from phase of life. Many women experience the loss of follicular activity of the ovaries. symptoms around the time of menopause, It is a stage when the menstrual cycle stops most of which are self - limiting and not for longer than 12 months and there is a life - threatening, but are nonetheless drop in the levels of estrogen and unpleasant and sometimes disabling. [1] progesterone, the two most important Worldwide, the estimates for the median hormones in the female body. The onset of age at menopause range from 45 to 55 this physiological development not only years, with women from Western countries International Journal of Health Sciences & Research (www.ijhsr.org) 247 Vol.6; Issue: 8; August 2016 Shanta Gyawali et al. Health Care Seeking Practice for Menopausal Problems among Women in Syangja District, Nepal having a higher menopausal age compared In Western countries, menopausal to women from other parts of the world. [2] symptoms such as hot flushes, sweating Age of menopause in Nepal is 47 to 48 and vaginal dryness are considered as the years like in many developing countries. [3] main climacteric complaints. In other The common climacteric cultures, these symptoms dramatically symptoms experienced by menopausal vary from those observed in Western women can be group into: vasomotor, women, while North American and physical, psychological or sexual European samples were reported higher complaints. It was also noted in some rates of symptoms than that of Asian postmenopausal women with long term women. It has been suggested that Asian estrogen deficiency, changes to the women suffer more from the atypical cardiovascular or bone which leads to symptoms and fewer, and with lesser osteoporosis has been established. During severity, the typical psychological and menopause, women often experience some vasomotor symptoms in comparison to symptoms which may affect their daily those reported in Caucasian women in the activities and unfortunately majority of west. [9] Although menopause related these women are not aware of the changes symptoms have been extensively studied brought about by menopause. [4] in the western countries, but very limited Postmenopausal woman can be considered studies are available in Asia where as a risk population. More than 80% of dearth of studies were found especially in women experience physical or Nepal. psychological symptoms in the year Menopausal problem is a major approaching menopause with various health problem in Nepal and is least distress and distribution in their lives, addressed by the general public due to leading to decrease in quality of life. [5] cultural taboo and ignorance. Most women Modern medicine has significantly in Nepal are unaware about the condition. increased the life expectancy of women [7] Despite the fact that the availability of throughout the world. The world public health services has increased population of women aged over 60 years throughout the country, health services are was below 250 million in 1960 and it is still beyond the reach of most rural women estimated that in 2030, 1.2 billion women in Nepal. It is reported that only 45 percent will be peri or postmenopausal and this of households have access to basic health will increase by 4.7 million a year. [6] care. Gender discrimination, position of Nepal’s Life expectancy has increased as women in the family and lack of self- well. The average life span for females is worthiness among women are important 67 years. With the increase in life span, factors influencing their health care old age related problems are increasing as seeking behavior. Family members and well. [7] With the increasing life women themselves place a very low value expectancy a women spends almost a third on women's lives, thus women's health is of her life in menopause. Menopause can often ignored. [10] be said to be a universal reproductive Women do not tend to seek any phenomenon. The reproductive landmark treatment for menopausal symptoms in is not always the same for all women in all Nepal due to cultural and social barriers as cultures. The prevalence of menopausal well as lack of knowledge and awareness symptoms varies widely not only among on its consequences. The start of individuals of the same population but also menopause can be traumatic for many between different ethnic populations. Even women especially if they are unfamiliar there is a great diversity in nature of with menopause symptoms. It is extremely symptom and frequencies across countries, important for every woman to be aware even in the same cultures. [8] about menopause and the symptoms it International Journal of Health Sciences & Research (www.ijhsr.org) 248 Vol.6; Issue: 8; August 2016 Shanta Gyawali et al. Health Care Seeking Practice for Menopausal Problems among Women in Syangja District, Nepal carries so that they could be able to make respondents (62.9%) were illiterate and decision about their own health. If they are 37.1% were literate. More than half of the informed well and counseled properly, its women (51.4%) were housewives, one- risk factors and effects can be managed to fourth of the respondents (25.0%) were some extent. So this study aims to identify involved in business, 22.1% were farmer the health care seeking practice for but72.9% of them were dependent on other menopausal problems among the women and only 27.1% were self-sustained (Table having natural menopause. So that, 1). appropriate health education and health Table 1: Socio-demographic characteristics of the care program can be planned for the respondents (n=140) menopausal women. Variables Frequency Percent (%) Age in group (years) ≤45 7 5.0 MATERIALS AND METHODS 46-55 51 36.4 >55 82 58.6 This was a community based cross- Mean age 59.11±9.27 years, Minimum 44 years, Maximum sectional study. To find out the health care 82 years seeking practice among the women with Marital status Married 103 73.6 problems related to menopause, total of Unmarried 2 1.4 140 respondents were recruited from Widowed 35 25.0 Number of children Putalibazar municipality, Syangja district, No 4 2.8 Nepal on April 2012. Municipality was 1-2 33 23.6 ≥3 103 73.6 stratified into 13 wards and two wards Mean=3.59±1.8, Minimum 0, Maximum 11 were randomly selected among them. Type of Family Fifty- fifty percent households were Nuclear 18 12.9 Joint 122 87.1 selected from each ward up to reaching the Religion required sample size. Data were collected Hindu 131 93.6 Buddhist 4 2.8 from all eligible respondents from those Islam 5 3.6 households who had natural menopause Education level and whose menstrual cycle has stopped Illiterate 88 62.9 Literate 52 37.1 since last 12 months. Information was Occupation collected by using face to face interview Housewife 72 51.4 Service holder 2 1.5 using a semi-structured questionnaire. Business 35 25.0 Descriptive statistics are presented in Farming 31 22.1 Economical dependency terms of frequency and percentages. The Self-sustained 38 27.1 data was analyzed by using Statistical Dependent on others 102 72.9 Packages for Social Sciences (SPSS) version 16.0. The study found that half of the respondent had got menopause at the age RESULTS of 45 years or below, 46.4% had In this study, out of 140 menopause at the age of 46-55 years and respondents, 58.6% of the respondents had only 3.6% had their menopause after the age more than 55years followed by 36.4% age of 55 years (mean menopausal age in the age group 46 to 55years and 5.0% 46.3±4.78 years, minimum 38 years and had age 45 years or below.
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