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Differential Impact of Sociodemographic Variables on the Quality of Life of Menopausal Iranian Women


1 Social Determinants of Health Research Center and Department of Public Health, Hamadan University of Medical Sciences, Hamadan, IR Iran
2 Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, IR Iran
3 Department of Public Health, Hamadan University of Medical Sciences, Hamadan, IR Iran
4 Chronic Diseases Care Research Center and Department of Mother and Child Health, Hamadan University of Medical Sciences, Hamadan, IR Iran
5 Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders, University of Basel, Basel, Switzerland
6 Department of Sport, Exercise and Health, Sport Science Division, University of Basel, Basel, Switzerland
*Corresponding author: Serge Brand, Psychiatric Hospital of the University of Basel, Center for Affective-, Stress- and Sleep Disorders, Basel, Switzerland. Tel: +41-613255114, Fax: +41-613255513, E-mail: serge.brand@upkbs.ch.
Avicenna Journal of Neuro Psych Physiology. 3(2): e39026 , DOI: 10.17795/ajnpp-39026
Article Type: Research Article; Received: Mar 31, 2016; Revised: Apr 16, 2016; Accepted: May 14, 2016; epub: May 29, 2016; collection: May 2016

Abstract


Background: Menopause is a natural physiological event in women’s lives that can potentially have negative effects on their quality of life (QoL).

Objectives: The aim of the present study was to explore the extent to which sociodemographic characteristics are related to QoL and to compare the QoL of Iranian women with that of women in other countries.

Methods: This cross-sectional study was conducted using cluster sampling of 250 postmenopausal women in Hamadan in the west part of Iran in 2014. The participants were interviewed and completed questionnaires. These methods provided data on sociodemographic characteristics and menopause-specific QoL factors (vasomotor symptoms, psychosocial symptoms, physical symptoms, and sexual satisfaction). The QoL evidence was also compared with normative data from other countries. Inferential and descriptive statistics via SPSS 20.0 software were used for data analysis.

Results: The mean age of the respondents was 52.27 years (SD = 3.84). The average scores of their vasomotor, psychosocial, physical, and sexual dimensions were 3.86, 2.30, 2.44, and 1.35, respectively. Sociodemographic dimensions, such as smaller age, being married, having a lower education level, and having a higher number of children, were related to sexual symptoms. Vasomotor symptoms were related to lower education and lower income. Psychosocial symptoms and physical symptoms were related to hormone replacement therapy. The QoL results did not differ from the normative data from other countries.

Conclusions: Sociodemographic dimensions were related to QoL, particularly to sexual satisfaction. The QoL results for postmenopausal Iranian women do not differ from results from other countries, suggesting that cultural factors do not influence QoL among postmenopausal Iranian women.

Keywords: Postmenopause; Sociodemographic Status; Quality of Life

1. Background


In a woman’s life, menopause is the ending of menstruation. During menopause, fertility ceases because production of estradiol and progesterone by the ovaries comes to an end (1). Based on this cessation of the endocrine function of the ovaries, a woman is no longer able to conceive or give birth to children (climacteric). The transition from being potentially or actually fertile to being definitively infertile occurs gradually over a period of years, usually starting around 45–55 years of age, and is a natural stage in female development (2). The physiological signs of menopause usually include the beginning of irregular menses and vasomotor instability (hot flushes, night sweats). Psychologically, the change can be marked by sudden mood swings, increased stress, forgetfulness, and sleep disturbances (1, 2). Due to a variety of physiological, psychological, and social causes, menopausal changes may often coincide with critical life events, such as dealing with and caring for elderly parents, the death of parents, children leaving home, or the birth of grandchildren. Moreover, from a psychological point of view, menopause indicates a definite and irreversible psychophysiological period of human female development a clear sign of “getting older” that may be difficult for an individual to accept and with which an individual may have problems coping (3).


During the menopausal period, women often identify lack of energy and vitality as the most frequent and distressing effects together with psychological effects, such as depression, anxiety, irritability, mood swings, memory problems, and lack of concentration (1). Weber et al. (2) suggested that declines in estrogen during menopause may be associated with declines in cognitive functioning, bringing an increased risk of depressive symptoms and depressive disorders. However, most women do not develop depression during their menopausal transition, and assumptions about the occurrence of major depressive disorder in menopausal women might be based largely on “beliefs” and hearsay. Findings are either lacking or mixed (3, 4).


The psychological changes most frequently reported are depression and/or anxiety (3, 5), fatigue, irritability, memory loss, problems with concentration, mood disturbances, sleep disturbances (poor or light sleep), insomnia (6, 7), sleepiness (8), and a decline in quality of life (QoL) (9). Specifically, good QoL among postmenopausal women is defined as a favorable state of vasomotor, psychosocial, and physical wellbeing and sexual satisfaction. However, QoL evidence for non-Western populations is limited, and the associations between QoL and sociodemographic factors have not been well explored. Therefore, the first aim of the present study was to investigate the association between QoL and sociodemographic factors.


QoL following menopause is influenced by many parameters, including vasomotor and urogenital symptoms and psychosocial and physical status (10, 11). Women may experience significant QoL changes during menopause (12), and several studies have indicated that QoL is impaired in menopausal women (13-15).


The available evidence concerning possible cultural influences on the QoL of postmenopausal women is primarily derived from Asian and industrialized Western populations; there is currently very little evidence derived from non-Western countries, such as the Islamic Republic of Iran (henceforth: Iran). Therefore, another aim of the present study was to compare the QoL of postmenopausal Iranian women with evidence from other countries. In this regard, studies have indicated that the prevalence of menopausal symptoms is markedly higher in Asian populations than in non-Asian populations, and the effects of these symptoms may have been underestimated (13, 14). Although women throughout the world experience similar hormonal changes as a result of menopause, their menopausal experiences might be affected by sociodemographic characteristics, individual and cultural factors, and environmental conditions (16). Some studies have shown that particular demographic characteristics, such as age, marital status, education level, economic circumstances, and number of children, are factors that affect postmenopausal life (17, 18). To our knowledge, comparable data concerning postmenopausal women in Iran is lacking so far.

2. Objectives


The purpose of the present study was twofold: to investigate the association between sociodemographic variables and the QoL of postmenopausal Iranian women and to compare these QoL results with those from other countries. Instead of using hypotheses, an exploratory approach was chosen.

3. Methods


3.1. Sample

This cross-sectional analytical study was conducted in Hamadan in the west part of Iran between November 2013 and October 2014. A total of 250 postmenopausal women took part in the study. Sampling was based on the cluster method, in which each cluster included 20 households in different sections of the city. The choice of 20 households for the cluster size was based on the seven-day performance capacity of the data collection group, which consisted of two interviewers. The statistical framework used was based on the household lists held by the health department in Hamadan Province. Women aged between 50 and 60 years with one year or longer of amenorrhea and with an intact uterus were asked to participate in the study.


3.2. Procedure

Participants were informed of the voluntary nature of their participation in the study and of the study’s aims. After obtaining written informed consent, a brief face-to-face interview was conducted to collect sociodemographic information (age, civil status, employment, marital status, education level, income, health insurance coverage, number of children, age at menopause, and history of hormone replacement therapy [HRT]) and to assess physical and mental health concerns. The thorough structured interview to assess QoL was based on the questionnaire described in greater detail below. This study was conducted with approval from Hamadan University of Medical Sciences’s institutional review board and ethical committee and was conducted in accordance with the ethical standards laid down in the Declaration of Helsinki.


3.3. Tools

Sociodemographic variables. Information about the participants’ age (which was dichotomized into 50 - 55-year and 55 - 60-year ranges), age at the beginning of menopause (40 - 50 years or 50 years and older), civil status (married or single), education (highest level: illiterate, primary school, middle school, or high school), income (below $400, $400 - 800, or more than $800 per month), HRT status (yes or no), and number of children (fewer than 4, 5 - 7, or more than 7).


Menopause-Specific QoL Questionnaire. QoL was assessed via a structured interview based on the Menopause-Specific Quality of Life Questionnaire (MENQOL) (10, 17, 18). The MENQOL consists of 29 items that assess menopausal symptoms in four dimensions: vasomotor symptoms, psychosocial symptoms, physical symptoms, and sexual satisfaction. For every symptom experienced, the participants were asked to indicate how bothered they had been by the symptoms on a seven-point scale ranging from 0 (not at all bothered) to 6 (extremely bothered). Next, a mean score for each of the four subscales and the total MENQOL score were calculated. Higher scores reflected more severe symptoms or discomfort (Cronbach’s alpha for the present sample: 0.85).


Normative QoL data from other countries. Normative evidence of the QoL of menopausal women in other countries was taken from published studies that used the MENQOL. Specifically, normative data was compared from the following countries: Iran: Fallahzadeh (17), Equador: Chedraui et al. (19), Chile: Blumel et al. (20), Canada: Whelan et al. (21), Pakistan: Nisar et al. (22).


3.4. Statistical Analysis

To calculate the associations between the four dimensions of QoL, a series of Pearson’s correlations was performed. Next, a series of ANOVAs was performed with the sociodemographic dimensions as independent variables and the QoL dimensions as dependent variables. Where appropriate, post hoc analyses were performed with Bonferroni-Holm corrections for p values. To compare the QoL data from this study with the normative evidence from other countries, a series of ANOVAs was performed. The level of significance was set at P < 0.05. All statistical analyses were calculated with SPSS® 20.0 (IBM Corporation, Armonk, NY, USA) for Apple Macintosh®.

4. Results


The mean age of the 250 women included in this study was 52.27 ± 3.84 years. More than half were between 50 and 55 years old. The mean length of time since menopause was 6.93 ± 4.8 years. The proportion of women with no formal education was 50% (n = 125); only 11.6% (n = 29) of the sample was highly educated. The majority (70.8%) of these women were still married and living with their husbands. Most women (94%) were housewives, and only 15 (6%) were employed. At the time of survey, 66 (26.4%) participants reported household incomes of less than $400 per month. Only 40 (16%) participants had undergone HRT within the preceding six months.


The mean total and subscale MENQOL scores and the prevalence of low to severe total scores in relation to menopause symptoms are depicted in Table 1. Overall, the most prevalent symptom was body aches, which was reported by 83.2% of the sample. The least common symptom was an increase in facial hair; this was reported by only 32.8% of the sample. In total, 82% reported “feeling tired or worn out,” while 76.8% and 76.4% reported a decrease in “physical strength” and a “lack of energy,” respectively (the full sample characteristics are reported in Table 1).


Table 1.
Frequency Distribution and Scores of MENQOL Items

Table 2 reports the correlations between the four dimensions of menopause-related QoL factors (vasomotor symptoms, psychosocial symptoms, physical symptoms, and sexual satisfaction).


Higher vasomotor symptoms were associated with higher psychosocial, physical, and overall symptoms but not with lower sexual satisfaction. Higher psychosocial symptoms were associated with higher physical, sexual, and overall symptoms; higher physical symptoms were associated with lower sexual satisfaction and overall score. Lower sexual satisfaction was associated with higher overall symptoms.


Table 2.
Descriptive Statistics and Intercorrelations Between the Study Variables (n = 250)

Table 3 summarizes the descriptive and inferential results from the ANOVAs with sociodemographic dimensions as independent variables and QoL dimensions as dependent variables. Smaller age, being married, having a lower education level, and having a higher number of children were related to sexual symptoms (significant ANOVAs and post hoc analyses with Bonferroni–Holm corrections for P values). No other statistically significant mean differences were observed for this QoL dimension. Vasomotor symptoms decreased with greater education and higher income (significant ANOVAs and post hoc analyses with Bonferroni Holm corrections for P values). There were fewer psychosocial and physical symptoms in participants who had undergone HRT. No other statistically significant mean differences were observed for these dimensions.


Table 3.
Relationship Between Dimension of Quality of Life Scores and Various Demographic Characteristics

The QoL of postmenopausal Iranian women were compared with that of postmenopausal women from Ecuador, Chile, Canada, and Pakistan. Table 4 gives a descriptive and statistical comparison of the QoL dimensions between five different countries. No significant mean differences were observed between these groups of women.


Table 4.
Comparison Quality of life Domains Among Various Menopausal Ethnic Populations Using MENQOL Questionnaire

5. Discussion


Among postmenopausal Iranian women, menopause-related QoL was related to specific sociodemographic and menopause-related dimensions. Furthermore, the menopause-related QoL scores of this Iranian sample did not differ from the QoL scores obtained from comparable populations within other countries.


The results of this study showed that most women had a moderate and relatively positive status in terms of the physical dimension of QoL. These results are consistent with the findings reported by Taebi et al. (18) and Fallahzadeh (17). Other studies have produced similar results (23, 24). Among the symptoms associated with the physical dimension of QoL, joint and muscle pain, fatigue, and back pain had the greatest impact. Fallahzadeh (17) and Shouhani et al. (25) both found that back pain, joint and muscle pain, and fatigue were among the most common complaints and physical ailments reported by postmenopausal women. These results are consistent with the findings of other studies (26-28). Since a considerable proportion of postmenopausal women suffer from moderate to severe physical problems, particular attention should be paid to this issue when providing healthcare services to this population.


In the present study, women had a largely positive status in terms of the sexual dimension of their QoL. These results are consistent with the findings of the study by Taebi et al. (18); however, the levels we found are higher than those reported in studies from other countries (17, 24, 29). Though it cannot be verified on basis of the present data, our assumption is that these differences are due to cultural factors. In some societies, for example, it is difficult to speak about sexual issues, and for some people, sexual change with aging is regarded as natural. Among the symptoms associated with the sexual dimension, changes in sexual desire had the greatest impact on QoL. These results are consistent with the findings of similar studies (17, 25, 30).


There was a significant relationship between the sexual dimension of women’s QoL and their age, level of education, and marital status. Women’s QoL decreased with age as the incidence and severity of symptoms and problems with the sexual dimension increased. Because married women may have more sexual intercourse and consequently may think about sexual issues more often, they may be more likely to report symptoms associated with the sexual dimension than single women. In this regard, Fallahzadeh (17), Sheikhan et al. (29), and Ehsanpour et al. (31) all reported a significant relationship between the sexual dimension of postmenopausal women’s QoL and age and education. Research shows that educated women who are in better economic circumstances enjoy a higher QoL during menopause (14, 15, 32). Overall, the results of this study are consistent with the findings of the majority of similar studies.


A majority of our participants had poor QoL with respect to the vasomotor dimension. This is consistent with the majority of studies, which have reported the vasomotor dimension of postmenopausal women’s QoL to be poor or moderate (Taebi et al. (18); Fallahzadeh, (17); Li et al. (24); Blumel et al. (33)). The minor differences are probably due to differences in the measures used in these other studies. Among the symptoms associated with the vasomotor dimension, hot flush had the greatest impact on women’s QoL. Shouhani et al. (25) and Fallahzadeh (17) both reported hot flush as the most common complaint associated with the vasomotor dimension. These results are also consistent with the findings of some other studies (34, 35). In the present study, there was a significant negative relationship between level of education and the vasomotor dimension of QoL, which is an association that has been reported in other studies (17). One reason for this association may be that with greater knowledge and familiarity with social opportunities, more educated women are able to achieve greater control over vasomotor symptoms. This study also showed that there was a significant relationship between the vasomotor dimension of QoL and women’s economic status, which is consistent with the findings of similar studies (11, 36). This is likely because economic status can improve access to healthcare services and thus enhance QoL (15).


With regard to the psychosocial dimension of QoL after menopause, our participants had moderate and relatively positive profiles. The results of this study are consistent with the findings of the majority of similar studies (17, 18, 24). The most negative scores on the psychological dimension were for feelings of anxiety, nervousness, and depression. Our findings in this area are also consistent with the results of similar studies (17, 25, 37-39).


Finally, the comparison of the present findings with evidence reported from other countries revealed that scores of Iranian women closely matched those of women from other countries, suggesting that despite different sociocultural backgrounds, changes in QoL are experienced in virtually the same way by postmenopausal women.


Several of this study’s limitations prevent the overgeneralization of its findings. First, the data was derived from self-reports, which can be biased. Second, the study design was cross-sectional, so no conclusive answer can be given concerning directions of influence. Finally, the pattern of results might have been emerged due to further latent variables that might have influenced two or more variables in the same direction. Future studies should be based on longitudinal designs and should include objective assessments of psychophysiological parameters; such studies could provide further insight into the complex interplay between physiological and psychological mechanisms among postmenopausal women.


Menopause-related QoL among postmenopausal Iranian women varies as a function of sociodemographic factors, but no differences were found between this Iranian sample and comparable samples from other countries.

Acknowledgments

We would like to thank the Deputy of Research and Technology for the financial support of this study.

Footnotes

Authors’ Contribution: Study design: Majid Barati, Mohammad Ahmadpanah, Samaneh Shirahmadi, Saeed Bashirian, Parisa Parsa, Edith Holsboer-Trachsler and Serge Brand; data gathering: Majid Barati, Mohammad Ahmadpanah, Samaneh Shirahmadi, Saeed Bashirian and Parisa Parsa; data entering: Majid Barati, Mohammad Ahmadpanah, Samaneh Shirahmadi, Saeed Bashirian and Parisa Parsa; statistical analysis: Mohammad Ahmadpanah, Edith Holsboer-Trachsler and Serge Brand; manuscript drafts: Majid Barati, Mohammad Ahmadpanah, Samaneh Shirahmadi, Saeed Bashirian, Parisa Parsa, Edith Holsboer-Trachsler, Serge Brand and Mohammad Haghighi; modification drafts and final version: Mohammad Ahmadpanah, Edith Holsboer-Trachsler and Serge Brand.
Financial Disclosure: The authors report no conflict of interest in the undertaking of this research.
Funding/Support: This study was supported by Hamadan University of Medical Sciences (No. 900125113).

References


  • 1. Twiss JJ, Wegner J, Hunter M, Kelsay M, Rathe-Hart M, Salado W. Perimenopausal symptoms, quality of life, and health behaviors in users and nonusers of hormone therapy. J Am Acad Nurse Pract. 2007;19(11):602-13. [DOI] [PubMed]
  • 2. Weber MT, Maki PM, McDermott MP. Cognition and mood in perimenopause: a systematic review and meta-analysis. J Steroid Biochem Mol Biol. 2014;142:90-8. [DOI] [PubMed]
  • 3. Bromberger JT, Kravitz HM. Mood and menopause: findings from the Study of Women's Health Across the Nation (SWAN) over 10 years. Obstet Gynecol Clin North Am. 2011;38(3):609-25. [DOI] [PubMed]
  • 4. Jahangard L, Haghighi M, Bajoghli H, Holsboer-Trachsler E, Brand S. Among a sample of Iranian premenopausal and menopausal women differences in mood, sleep and health quality are small. Int J Psychiatry Clin Pract. 2014;18(2):139-44. [DOI] [PubMed]
  • 5. Llaneza P, Garcia-Portilla MP, Llaneza-Suarez D, Armott B, Perez-Lopez FR. Depressive disorders and the menopause transition. Maturitas. 2012;71(2):120-30. [DOI] [PubMed]
  • 6. Arakane M, Castillo C, Rosero MF, Penafiel R, Perez-Lopez FR, Chedraui P. Factors relating to insomnia during the menopausal transition as evaluated by the Insomnia Severity Index. Maturitas. 2011;69(2):157-61. [DOI] [PubMed]
  • 7. Monterrosa-Castro A, Marrugo-Florez M, Romero-Perez I, Chedraui P, Fernandez-Alonso AM, Perez-Lopez FR. Prevalence of insomnia and related factors in a large mid-aged female Colombian sample. Maturitas. 2013;74(4):346-51. [DOI] [PubMed]
  • 8. Chedraui P, Perez-Lopez FR, Mendoza M, Leimberg ML, Martinez MA, Vallarino V, et al. Factors related to increased daytime sleepiness during the menopausal transition as evaluated by the Epworth sleepiness scale. Maturitas. 2010;65(1):75-80. [DOI] [PubMed]
  • 9. Karacam Z, Seker SE. Factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women. Maturitas. 2007;58(1):75-82. [DOI] [PubMed]
  • 10. Hilditch JR, Lewis J, Peter A, van Maris B, Ross A, Franssen E, et al. A menopause-specific quality of life questionnaire: development and psychometric properties. Maturitas. 2008;61(1-2):107-21. [PubMed]
  • 11. Schwarz S, Volzke H, Alte D, Schwahn C, Grabe HJ, Hoffmann W, et al. Menopause and determinants of quality of life in women at midlife and beyond: the study of health in pomerania (SHIP). Menopause. 2007;14(1):123-34. [DOI] [PubMed]
  • 12. Fuh JL, Wang SJ, Lee SJ, Lu SR, Juang KD. Quality of life and menopausal transition for middle-aged women on Kinmen island. Qual Life Res. 2003;12(1):53-61. [PubMed]
  • 13. Chen Y, Lin SQ, Wei Y, Gao HL, Wang SH, Wu ZL. Impact of menopause on quality of life in community-based women in China. Menopause. 2008;15(1):144-9. [DOI] [PubMed]
  • 14. Chiu YW, Moore RW, Hsu CE, Huang CT, Liu HW, Chuang HY. Factors influencing women's quality of life in the later half of life. Climacteric. 2008;11(3):201-11. [DOI] [PubMed]
  • 15. Williams RE, Levine KB, Kalilani L, Lewis J, Clark RV. Menopause-specific questionnaire assessment in US population-based study shows negative impact on health-related quality of life. Maturitas. 2009;62(2):153-9. [DOI] [PubMed]
  • 16. Monterrosa A, Blumel JE, Chedraui P. Increased menopausal symptoms among Afro-Colombian women as assessed with the Menopause Rating Scale. Maturitas. 2008;59(2):182-90. [DOI] [PubMed]
  • 17. Fallahzadeh H. Quality of life after the menopause in Iran: a population study. Qual Life Res. 2010;19(6):813-9. [DOI] [PubMed]
  • 18. Abedzadeh Kalarhoudi M, Taebi M, Sadat Z, Saberi F. Assessment of quality of life in menopausal periods: a population study in kashan, iran. Iran Red Crescent Med J. 2011;13(11):811-7. [PubMed]
  • 19. Chedraui P, Hidalgo L, Chavez D, Morocho N, Alvarado M, Huc A. Quality of life among postmenopausal Ecuadorian women participating in a metabolic syndrome screening program. Maturitas. 2007;56(1):45-53. [DOI] [PubMed]
  • 20. Blumel JE, Castelo-Branco C, Binfa L, Gramegna G, Tacla X, Aracena B, et al. Quality of life after the menopause: a population study. Maturitas. 2000;34(1):17-23. [PubMed]
  • 21. Whelan TJ, Goss PE, Ingle JN, Pater JL, Tu D, Pritchard K, et al. Assessment of quality of life in MA.17: a randomized, placebo-controlled trial of letrozole after 5 years of tamoxifen in postmenopausal women. J Clin Oncol. 2005;23(28):6931-40. [DOI] [PubMed]
  • 22. Nisar N, Sohoo NA. Frequency of menopausal symptoms and their impact on the quality of life of women: a hospital based survey. J Pak Med Assoc. 2009;59(11):752-6. [PubMed]
  • 23. Forouhari S, Rad MS, Moattari M, Mohit M, Ghaem H. The effect of education on quality of life in menopausal women referring to Shiraz Motahhari clinic in 2004. . J Birjand Univ Med Sci. 2009;16(1):39-44.
  • 24. Li S, Holm K, Gulanick M, Lanuza D. Perimenopause and the quality of life. Clin Nurs Res. 2000;9(1):6-23. discussion 24-6 [PubMed]
  • 25. Shouhani M, Rasouli F, Haji AP, Mahmoudi M. The survey of physical and mental problems of menopause women referred to liam health care centers. 2007.
  • 26. Bairy L, Adiga S, 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(1):106-9. [DOI] [PubMed]
  • 27. Kaur S, Walia I, Singh A. How menopause affects the lives of women in suburban Chandigarh, India. Climacteric. 2004;7(2):175-80. [PubMed]
  • 28. Haines CJ, Xing SM, Park KH, Holinka CF, Ausmanas MK. Prevalence of menopausal symptoms in different ethnic groups of Asian women and responsiveness to therapy with three doses of conjugated estrogens/medroxyprogesterone acetate: the Pan-Asia Menopause (PAM) study. Maturitas. 2005;52(3-4):264-76. [DOI] [PubMed]
  • 29. Sheikhan Z, Pazandeh F, Khoshabi K, Ziaei T, Majd HA, Nasiri M. Sexual satisfaction in postmenopausal women. J Shahid Beheshti School Nurs Midwi. 2009;19(65)
  • 30. Dennerstein L, Randolph J, Taffe J, Dudley E, Burger H. Hormones, mood, sexuality, and the menopausal transition. Fertil Steril. 2002;77 Suppl 4:S42-8. [PubMed]
  • 31. Ehsanpour S, Eivazi M, Davazdah-Emami S. Quality of life after the menopause and its relation with marital status. Iran J Nurs Midwi Res. 2008;12(4)
  • 32. Golyan TS, Ghobadzadeh M, Arastou M. Promoting health status of menopausal women by educating self care strategies. Hayat. 2007;13(3):67-75.
  • 33. Blumel JE, Chedraui P, Baron G, Belzares E, Bencosme A, Calle A, et al. A large multinational study of vasomotor symptom prevalence, duration, and impact on quality of life in middle-aged women. Menopause. 2011;18(7):778-85. [DOI] [PubMed]
  • 34. Borimnejad L, Mohadeth AF, Jozee KF, Haghani H. Comparison of quality of life after hysterectomy in pre and post menopause period in iranian women. 2011.
  • 35. Gupta P, Sturdee DW, Palin SL, Majumder K, Fear R, Marshall T, et al. Menopausal symptoms in women treated for breast cancer: the prevalence and severity of symptoms and their perceived effects on quality of life. Climacteric. 2006;9(1):49-58. [DOI] [PubMed]
  • 36. Satoh T, Ohashi K. Quality-of-life assessment in community-dwelling, middle-aged, healthy women in Japan. Climacteric. 2005;8(2):146-53. [DOI] [PubMed]
  • 37. Asbury EA, Chandrruangphen P, Collins P. The importance of continued exercise participation in quality of life and psychological well-being in previously inactive postmenopausal women: a pilot study. Menopause. 2006;13(4):561-7. [DOI] [PubMed]
  • 38. Ishizuka B, Kudo Y, Tango T. Cross-sectional community survey of menopause symptoms among Japanese women. Maturitas. 2008;61(3):260-7. [DOI] [PubMed]
  • 39. Bauld R, Brown RF. Stress, psychological distress, psychosocial factors, menopause symptoms and physical health in women. Maturitas. 2009;62(2):160-5. [DOI] [PubMed]

Table 1.

Frequency Distribution and Scores of MENQOL Items

Symptom No. (%) Mean ± SD
Vasomotor dimension
Hot flushes or flashes 189 (75.6) 3.94 ± 2.74
Night sweats 182 (72.8) 3.71 ± 2.84
Sweating 190 (76) 3.92 ± 2.75
Total vasomotor dimension 3.86 ± 2.47
Psychosocial dimension
Being dissatisfied with personal life 149 (59.6) 2.34 ± 2.37
Feeling anxious or nervous 189 (75.6) 3.50 ± 2.56
Experiencing poor memory 152 (60.8) 2.37 ± 2.35
Accomplishing poor memory 159 (63.6) 2.35 ± 2.26
Feeling depressed, down, or blue 160 (64) 2.42 ± 2.40
Being impatient with other people 120 (48) 1.65 ± 2.21
Feeling of wanting to be alone 104 (41.6) 1.50 ± 2.23
Total psychosocial dimension 2.30 ± 1.38
Physical dimension
Flatulence (wind) or gas pains 162 (64.8) 2.74 ± 2.55
Aching in muscles and joints 208 (83.2) 4.09 ± 2.45
Feeling tired or worn out 205 (82) 3.78 ± 2.40
Difficulty sleeping 147 (58.8) 2.62 ± 2.64
Aches in back of neck or head 170 (60.8) 2.88 ± 2.50
Decrease in physical strength 192 (76.8) 3.14 ± 2.28
Decrease in stamina 181 (72.4) 2.91 ± 2.38
Feeling a lack of energy 191 (76.4) 2.89 ± 2.21
Drying skin 113 (45.2) 1.78 ± 2.39
Weight gain 118 (47.2) 1.81 ± 2.34
Increased facial hair 82 (32.8) 1.22 ± 2.06
Changes in appearance, texture, or tone of skin 106 (42.4) 1.63 ± 2.29
Feeling bloated 93 (37.2) 1.30 ± 2.17
Low backache 157 (62.8) 2.76 ± 2.64
Frequent urination 127 (50.8) 2.09 ± 2.49
Involuntary urination when laughing or coughing 99 (39.6) 1.46 ± 2.16
Total physical dimension 2.44 ± 1.26
Sexual dimension
Chance in sexual desire 126 (50.4) 1.66 ± 2.04
Vaginal dryness during intercourse 107 (42.8) 1.28 ± 1.87
Avoidance of intimacy 98 (32.2) 1.10 ± 1.74
Total sexual dimension 1.35 ± 1.57
Postmenopausal quality of life 2.53 ± 1.11

Table 2.

Descriptive Statistics and Intercorrelations Between the Study Variables (n = 250)

Variables 2 3 4 5 Mean SD
1. Vasomotor 0.168a 0.231a 0.045 0.447a 3.86 2.47
2. Psychosocial - 0.561a 0.259a 0.754a 2.30 1.38
3. Physical - 0.278a 0.919a 2.44 1.26
4. Sexual - 0.423a 1.35 1.57
5. Total - 2.53 1.11
a P < 0.001.

Table 3.

Relationship Between Dimension of Quality of Life Scores and Various Demographic Characteristics

Variables N (%) Dimension of postmenopausal quality of life
Vasomotor, Mean (SD) Psychosocial, Mean (SD) Physical, Mean (SD) Sexual, Mean (SD)
Age
50 - 55 130 (52) 3.66 (2.49) 2.29 (1.38) 2.39 (1.28) 1.61 (1.58)
55 - 60 120 (48) 4.07 (2.43) 2.32 (1.39) 2.50 (1.23) 1.06 (1.52)
P value 0.184 0.903 0.496 0.006
Civil status
Married 177 (70.8) 3.86 (2.43) 2.24 (1.45) 2.42 (1.32) 1.84 (1.58)
Single 73 (29.2) 3.86 (2.58) 2.46 (1.18) 2.51 (1.09) 0.15 (0.61)
P value 0.995 0.257 0.648 0.001
Education
Illiterate 125 (50) 4.41 (2.42) 2.25 (1.33) 2.41 (1.17) 0.91 (1.23)
Primary school 64 (25) 3.41 (2.31) 2.28 (1.48) 2.37 (1.27) 1.44 (1.54)
Middle school 32 (12) 3.14 (2.57) 2.49 (1.35) 2.64 (1.51) 2.16 (1.91)
High school 29 (11) 3.29 (2.51) 2.36 (1.43) 2.54 (1.33) 2.17 (1.89)
P value 0.005 0.855 0.732 0.001
Income
< $400 66 (26.4) 4.75 (2.31) 2.41 (1.51) 2.42 (1.21) 1.24 (1.50)
$400 - $800 148 (59.2) 3.43 (2.48) 2.21 (1.34) 2.48 (1.29) 1.35 (1.59)
≥ $800 36 (14.4) 3.98 (2.29) 2.51 (1.27) 2.30 (1.21) 1.51 (1.65)
P value 0.001 0.405 0.718 0.709
Age at menopause (yr)
< 40 17 (6.8) 3.41 (2.54) 2.37 (1.54) 2.51 (1.39) 1.01 (1.34)
40 - 50 179 (71.6) 3.82 (2.49) 2.41 (1.35) 2.45 (1.27) 1.53 (1.68)
≥ 50 54 (21.6) 4.11 (2.40) 1.93 (1.37) 2.41 (1.18) 0.85 (1.08)
P value 0.566 0.081 0.958 0.015
Hormone therapy
Yes 40 (16) 4.13 (2.61) 2.62 (1.45) 2.83 (1.49) 1.54 (1.56)
No 210 (84) 3.80 (2.44) 2.32 (1.35) 2.57 (1.21) 1.31 (1.58)
P value 0.449 0.059 0.063 0.404
Number of children
< 4 134 (53.6) 3.53 (2.48) 2.29 (1.44) 2.36 (1.29) 1.67 (1.81)
5 - 7 98 (39.2) 4.26 (2.35) 2.39 (1.32) 2.54 (1.25) 1.21 (1.15)
≥ 7 18 (7.2) 4.07 (2.77) 1.94 (1.26) 2.51 (0.99) 1.01 (1.12)
P value 0.077 0.451 0.549 0.061

Table 4.

Comparison Quality of life Domains Among Various Menopausal Ethnic Populations Using MENQOL Questionnaire

Country Population Hormonal Status Score for Each MENQOL Domain
Vasomotor, Mean ± SD Psychosocial, Mean ± SD Physical, Mean ± SD Sexual Mean, ± SD
Iran a Postmenopausal 3.86 ± 2.47 2.30 ± 1.38 2.44 ± 1.26 1.35 ± 1.57
Iran, Fallahzadeh, 2010 ( 17 ) Postmenopausal 3.66 ± 1.71 2.90 ± 1.48 2.48 ± 1.04 2.88 ± 2.31
Ecuador, Chedraui et al., 2007 ( 19 ) Postmenopausal 3.50 ± 2.40 3.71 ± 1.51 3.81 ± 1.22 4.92 ± 2.32
Chile, Blumel et al., 2000 ( 20 ) Postmenopausal 3.25 ± 1.85 3.51 ± 1.51 3.63 ± 1.18 3.65 ± 2.37
Canada, Whelan et al., 2005 ( 21 ) Postmenopausal 2.93 ± 1.91 2.15 ± 1.14 2.59 ± 1.15 2.19 ± 1.71
Pakistan, Nisar et al., 2009 ( 22 ) Postmenopausal 3.14 ± 0.89 2.75 ± 1.12 2.57 ± 1.08 3.13 ± 1.22
P value b - 0.993 0.779 0.678 0.403
a Data obtained from the present study.
b P values are compared with various studies.