Effect of Menopausal Changes on Women ’ s Quality of Life in Tanta / Egypt

Natural menopause is a universal experience for women during midlife regardless of race, education, religion or wealth. Menopause is the permanent cessation of menstruation because of loss of ovarian functions, whether naturally or after surgery. Menopause, an event often accompanied by symptoms that can have a significant impact on a woman's quality of life. Therefore, the aim of this study is to identify the effect of menopausal changes on women’s quality of life among a sample of menopausal women in Tanta/ Egypt. A random sample of 150 generally healthy women, who experience natural menopause and free from major medical conditions were included in this study from Tanta university hospital and El-Menshawy hospital in Tanta city. The tool used is Utian Quality of Life Scale (UQOL). This tool is a five point likert-like scale to gain information from women about menopause-related quality of life. The result of this study showed that the majority of menopausal women suffer from vasomotor symptoms, which affect their quality of life. No one of menopausal women received medical help for menopausal symptoms or used hormone replacement therapy (HRT). Menopausal women consider these symptoms as natural and transient, and they wait for the symptoms to pass. The study recommended that menopausal women mainly need counseling about menopause and its symptoms as well as elements of a healthy lifestyle. INTRODUCTION: Menopause is a unique experience for every woman, it is a natural process that occurs in women’s lives as part of normal aging; it is a universal experience for women during midlife regardless of race, education, religion or wealth(1). Menopause is a permanent cessation of menstruation resulting from loss of ovarian functions, whether naturally or after surgery (2). In the early 1900's, most women did not live beyond the age of 50; therefore menopausal health was not a great concern (3). Today, women live at least one third of their lives past menopause. By the 836 Bull High Inst Public Health Vol.38 No.4 [2008] year 2020, the United States will achieve a demographic milestone; for the first time there will be as many post menopausal women as there are women of childbearing years (5). In Egypt 2008 18.9% of the total Egyptian female population were aged 45 years and more with life expectancy of 74.52 years (6, 7). Egyptian studies revealed that women’s health needs are often neglected, poorly understood, usually misinterpreted, and seldom discussed. Menopausal symptoms were widely experienced by women and the majority of them used traditional practices like take a bath at bedtime, dress in light, go bed in regular times, and use of herb to overcome this symptoms rather than seeking medical help (8, 9, 10). The frequency and intensity of symptom varies among women. Furthermore, menopause does place women at greater risk for the development of many conditions of aging such as postmenopausal cardiovascular disease and osteoporosis. Therefore, they would have to cope with the post menopausal syndrome and face the consequences (11). Women can expect to spend a significant portion of their lives after menopause. This period should be a highly productive time for women, and maintaining functional ability and a good (QOL) is of extreme importance. Neglected menopausal changes can have a significant negative impact on overall quality of life (QOL) for a large number of women (12). Quality of life is a multidimensional concept incorporating the individual’s perception of several aspects of life (. Quality of life (QOL) can be defined as one’s own subjective view of their physical health, psychosomatic status, and personal life. Healthy women perception of QOL can be significantly affected during menopause . Reproductive health needs of the older woman should be an area of concern. Menopause should be better understood Hanan Gaber Gabry 837 and more openly discussed than ever before. Nurses can play a significant role in encouraging, supporting, and teaching menopausal women. The information obtained from this study will contribute to the growing body of knowledge on determining the effectiveness of menopausal changes on menopausal women quality of life. Aim The aim of this study is to identify the effect of menopausal changes on women quality of life among a sample of menopausal women in Tanta/ Egypt. Material and Methods A non-experimental descriptive design was used to examine the association among the variable of interest. A random sample of 150 generally healthy women, who experience natural menopause and free from major medical condition included in this study. The study sample selected from the outpatient gynecological clinic of Tanta Maternity University Hospital and ElMenshawy hospital in Tanta city. There ages ranged from 45to 60 years. All women who have the needed criteria were invited to participate in the study in randomly selected three days of the week


INTRODUCTION:
Menopause is a unique experience for every woman, it is a natural process that occurs in women's lives as part of normal aging; it is a universal experience for women during midlife regardless of race, education, religion or wealth (1) .Menopause is a permanent cessation of menstruation resulting from loss of ovarian functions, whether naturally or after surgery (2) .
In the early 1900's, most women did not live beyond the age of 50; therefore menopausal health was not a great concern (3) .Today, women live at least one third of their lives past menopause.By the  Bull High Inst Public Health Vol.38 No.4 [2008]   year 2020, the United States will achieve a demographic milestone; for the first time there will be as many post menopausal women as there are women of childbearing years (5) .In Egypt 2008 18.9% of the total Egyptian female population were aged 45 years and more with life expectancy of 74.52 years (6,7) .
Egyptian studies revealed that women's health needs are often neglected, poorly understood, usually misinterpreted, and seldom discussed.Menopausal symptoms were widely experienced by women and the majority of them used traditional practices like take a bath at bedtime, dress in light, go bed in regular times, and use of herb to overcome this symptoms rather than seeking medical help (8,9,10) .The frequency and intensity of symptom varies among women.
Furthermore, menopause does place women at greater risk for the development of many conditions of aging such as postmenopausal cardiovascular disease and osteoporosis.Therefore, they would have to cope with the post menopausal syndrome and face the consequences (11) .
Women can expect to spend a significant portion of their lives after menopause.This period should be a highly productive time for women, and maintaining functional ability and a good (QOL) is of extreme importance.Neglected menopausal changes can have a significant negative impact on overall quality of life (QOL) for a large number of women (12) .
Quality of life is a multidimensional concept incorporating the individual's perception of several aspects of life (.Quality of life (QOL) can be defined as one's own subjective view of their physical health, psychosomatic status, and personal life.
Healthy women perception of QOL can be significantly affected during menopause (13) .
Reproductive health needs of the older woman should be an area of concern.
Menopause should be better understood and more openly discussed than ever before.Nurses can play a significant role in encouraging, supporting, and teaching menopausal women.The information obtained from this study will contribute to the growing body of knowledge on determining the effectiveness of menopausal changes on menopausal women quality of life.

Aim
The aim of this study is to identify the effect of menopausal changes on women quality of life among a sample of menopausal women in Tanta/ Egypt.Bull High Inst Public Health Vol.38 No.4 [2008]   structure that demonstrates four separate, intercorrelated domains: occupational QOL seven items such as "I feel challenged by my work"; health QOL seven items such as "My diet is not nutritionally sound";

A
emotional QOL six items such as "My mood is generally depressed"); and sexual QOL three items such as "I am content with my romantic life" (14) .Reported alpha reliabilities coefficient for UQOL scales is r= 0.75 (15) .For this study sample, alpha reliability coefficients were estimated to be r = 0.74.Regarding women education the table revealed that there were significant differences between educated and non educated women in their occupation and total quality of life (P = .000& .014) .

UQOL
Educated women had a higher mean than non educated women (23.22: 18.97   &70.75: 66.27).The table also showed that there were significant differences between working and house wife menopausal women in their occupation and health quality of life (p = .000&.017).Working women had a higher mean than house wife (22.89: 18.98), while the house wife had a higher mean than working women in their health quality of life (20.73:19.23).

Discussion
Menopause is part of a gradual and natural process in which the ovaries produce less of estrogen and progesterone hormones, and menstrual periods gradually disappear.
The average age women complete menopause is around 50 (16,17) .Menopause is called "change of life".This stage of life can be viewed negatively by those suffering with severe symptoms and for those who regard loss of fertility as the loss of youth, while others view this stage as a new chapter of life when one is more wise and free to enjoy Life (18) .
Menopause presents unique preventive health problem and quality-of-life challenges for women.Quality of life is a multidimensional concept incorporating the individual's perception of several aspects of life.It is not equal to the terms health status, mental statuses, and well-being (19,20,21) .The number of women in the menopausal age group is increasing and represents a significant portion of the population.Care of the menopausal women can be challenging for the caregiver (22) .
Each woman experiences menopause differently.Changing hormone levels can cause a variety of both physiological and psychological symptoms Although many women suffer from menopausal changes, for most women these changes are mild and infrequent (23) .
The menopausal literature documents that 10 to 15% of women are experiencing symptoms severe enough to cause them to consult a physician and receive medical help including hormone replacement therapy (HRT) (24,25) .
The result of this study revealed that all women choose not to receive medical help, use hormonal replacement therapy, or even estrogen containing cream at all, and they used only some simple measures to overcome some of this symptoms (table 4).
This result is quite expected in the Egyptian culture that regardless of their  Bull High Inst Public Health Vol.38 No.4 [2008]   menopause; and the minority of the study sample gets their information from the physicians.There is a strong need for more information and more education on this subject (27) .
This finding is in accordance with the finding with several authors, who stated that women in general do not prepare for menopausal years so many arrive at this stage with little or no information and women are more likely to turn to their friends or to the popular media include television, books, and magazines than to their physicians for their menopausal questions and answers (28,29,30) .
Demographic characteristics of women may shape their quality of life.One important characteristic is the level of education attained by women.The present work indicated that education was a significant factor related QOL.The result indicated the higher the education level is the higher quality of life score.Income and occupation is another feature that can be related to higher quality of life score.
Women with enough family income and working had higher quality of life score.
When women were asked about menopause symptoms, the result revealed that different menopausal symptoms were widely present (table 3).Most studies indicated that vasomotor symptoms were the most common symptom experienced during menopause (31,32,33) (37)(38)(39)(40)(41)(42) .In another study, it argued that sleep quality is an important determinant of health status and quality of life for women during and beyond menopause (43) .
Menopause is accompanied also by many psychological changes that affect QOL.The psychological factors that most often associated with reduced QOL in post menopausal women include mood change, loss of libido, anxiety, poor memory, difficult in concentration, and pessimistic.
Further analysis of the results reveals that the more the number of symptoms the women had the more the negative impact on their perceived quality of life (QOL).
This funding are in line with Daly; Gray et.al.(1993), who stated that quality of life may be severely compromised in women with menopausal symptoms (38) .
Menopause does not mean that non-experimental descriptive design was used to examine the association among the variable of interest.A random sample of 150 generally healthy women, who experience natural menopause and free from major medical condition included in this study.The study sample selected from the outpatient gynecological clinic of Tanta Maternity University Hospital and El-Menshawy hospital in Tanta city.There ages ranged from 45to 60 years.All women who have the needed criteria were invited to participate in the study in randomly selected three days of the week for five months.Tools Two tools were used to collect the necessary information for this study.The first one was structured interview sheet which includes sociodemographic and personal data sheet, women physiological and psychological symptoms, and their source of information.The second tool was Utian Quality of Life Scale (UQOL) used to quantify the perception of quality of life in postmenopausal women.The UQOL is the first pure QOL measure of this new generation of instruments that can be applied to a menopausal population.The UQOL scale consists of twenty three questions to be answered on a five point Likert-like scale with a stable factor women have to suffer hot flashes, night sweats, sleeplessness, irritability, dryness, confusion and memory loss.Menopausal symptoms that interfere with daily living should not be considered un-avoidable consequences of the aging process.ThereBull High Inst Public Health Vol.38 No.4