Attitude Of Women Towards Menopause: A Study Of Teachers In Enugu North Local Government Area Of Enugu State.

Attitude Of Women Towards Menopause: A Study Of Teachers In Enugu North Local Government Area Of Enugu State.

Menopause is the permanent causation of menstrual activity; it occurs normally between the age of 40 and 55 years but may be surgically induced earlier. Certain physiologic changes result from decreasing amounts of estrogen in women during the climacteric (a period of decrease of reproductive capacity in women, culminating, in women in the menopause) Bernhard (2007).  Marking the end of the child bearing period. It may occur suddenly or over a period of years, sometimes as long as 10 years, and is caused by a progressive reduction in estrogen levels, as the number of fundamental follicles in the ovaries declines with age, the ovaries gradually become less responsive to FSH and LH and ovulation and the menstrual cycle become irregular, eventually ceasing Ross and Wilson (2011). Several other phenomena may occur at the same time, such as shrinkage of the breast, short-term unpredictable vasodilatation with flushing, sweating and palpitations, causing discomfort and disturbance of the normal sleep pattern.

v Auxiliary’s and public hair become sparse

v Episodes of uncharacteristic behaviour, e.g, irritability, mood changes.

v Gradual thinning of the skin.

v Loss of bone mass predisposing to osteoporosis.

v Show increase in blood cholesterol levels that increase the risk of cardiovascular disease in postmenopausal women to that in male of same age. Ross and Wilson (2011).

According to (World Health Statically Records, 2008) Middle aged women are being faced with a lot of health challenges which are induced by aging process such as menopause. Majority of these health challenges would not have been serious issues to the women, if they had adequate and correct information about menopause. At menopause the functions of the ovaries gradually cease as menopause does not occur over night. It is a natural phenomenon that occurs in every class of women. The time of onset of menopause is not affected by race, educational, background; marital status, number of pregnancies, height, poverty or wealth. There is no relationship between the time of menarche and the age at menopause. Rather, it’s time of on set is affected by heredity ( genetics) and cigarette smoking.  Smokers experience menopause two years earlier than non smokers (World Health Statically Records, 2008).

In addition according to Women’s Health Factsheet (2006), menopause typically occurs in “midlife”, between late 40s and early 50s. It is a normal life event characterized by hormonal changes. Menopause occurs naturally or physiologically when the menses ceases as part of the woman’s normal ageing process.

A surgical induced menopause occurs when the menses ceases as a result of previous hysterectomy, or therapy or chemotherapy could induce menopause. It could also occur prematurely before the age of 40 years, this premature menopause may be particularly distressing, for young women especially if it impacts on their plans to have children, because this is uncommon, symptoms may initially not be acknowledged as experiencing menopause Walker (2008).

Attitude to menopause varies widely from women to women, culture to culture and society to society, According to Gabriella, and Bernhard (2012). The social constriction of menopause as the entry point to old age represents a challenging and often difficult time. This is because while some women may feel rather young and full of energy, society tends to perceive them as becoming increasingly less attractive and less fully, functioning. In Western societies, the time of menopause is characterized by a series of losses. (Example loss of youth, beauty, fertility, Iibido, health, hormones and calcium) and there are suggestions that it possibly impacts on physical and psychological well-being in mid-life.

All woman undergo the same basic hormonal changes during menopause, however, only very few go through it without noticing any other signs of menopause except cessations of menses, Walker (2008). The type of attitude exhibited towards menopause greatly influences the family life of the menopausal woman.

Some uninformed or poorly informed women in their pre menopausal period try to avert the presence of menopause; because of fear of this condition, knowledge of this natural phenomenon help to reduce the anxiety this natural transition happily, due to the possible changes, Nina (2007) opines that woman need positive education and support during this phase of life. This study intends to find out the attitude of women of menopausal age, towards menopause.

STATEMENT OF PROBLEM

Menopause is a natural transitory phase of life in the middle-aged women. It is present in every class of women, irrespective of their educational background or marital status, yet many women lack this knowledge. The researcher has been on several occasions, where women in their early 40s and middle 50s kept going to hospital for treatment of one illness after another, only to finally come up with the diagnosis of menopause and its associated signs and symptoms. These problems stimulated the researcher’s concern and interest to carry out this study with a view of giving proper information to teachers of menopausal age.

AIM OF THE STUDY

The aim of this study is to determine the knowledge and attitude of women of menopausal age.

Specific Objectives:

1.      To determine their attitudes towards the occurrence of menopause.

2.      To determine their source of information

3.      To determine the women’s knowledge about menopause.

4.      To find out factors that influences their attitudes.

 

SIGNIFICANCE OF THE STUDY

Findings from this study will help to widen the under standing of women towards menopause. It will help them to understand that menopause is not a cause rather it is something that happens in the brain, it happens naturally when one is aging. It will also help to determine the attitude of women towards menopause and finally to equip them to cope better with this condition. They need psychological care when they come to the hospital with complaint of menopause they can be reassured and they can manage the stage of life with HRT (Hormone replacement therapy).

SCOPE OF THE STUDY

This study is generally designed to determine the attitude of teachers of menopausal age towards menopause. It is limited to teachers of menopausal age, a survey study of teachers in Enugu North Local Government Area of Enugu State.

 

OPERATIONAL DEFINITION OF TERMS

1.  Attitude: It refers to manner, disposition, feeling, position, to a person or thing tendency or orientation of mind.

2.  Menopause: Is the permanent cessation of ovarian function which occurs during a woman’s late 40 or early 50 years with cultural variation.

3.  Progesterone: Is hormone secreted by the corpus luteum of the ovary, the placenta, and also (in small amounts) by the adrenal cortex and testes. It is responsible for preparing the inner linning (endometrium) of the uterus for pregnancy.

4.  Estrogen:  Is a steroid hormones produced chiefly by the ovaries and responsible for promoting estrus and the development and maintenance of female secondary sex characteristics. It is also any of the several male or female sex hormones produced primarily by ovarian follicles, capable of inducing estrus, producing secondary female sex characteristics and preparing the uterus for the reception of a fertilized egg, synthesized and used in oral contraceptives and in various therapies.

 

CHAPTER TWO

LITERATURE REVIEW

This chapter will be discussed under the following headings:

v Concept of Menopause

v Signs and symptoms of menopause

v Knowledge of menopause

v Attitudes of women towards menopause

v Factors influencing women’s attitude to menopause

v Summary of related literature review.

 

CONCEPT OF MENOPAUSE

Menopause is defined as the permanent ceasation of menstruation, which generally occurs between the ages of 45 and 55 years, (Meldrum, Alexendra and Kimora 2007).

The term menopause refers to the time of transition for a woman from a working reproductive system to a reproductive system that is no longer functioning that is, until her last menstrual cycle. This signals the shut down of the ovaries in their process of maturing eggs and releasing sex hormones of oestrogen and progesterone Nina (2007). In the same line, menopause is defined as the period when there is no menstrual period for 12 consecutive months and no other biological or physiological cause can be identified. It is end of fertility, or end of the child bearing years. A woman may still however, be able to become pregnant unless 12 consecutive months have passed without a period, international menopause society (2009).

Menopause typically occurs in “mid-life” between the late 40s and early 50s. It is a normal event in life, characterized by hormonal changes in this way. It is similar to life’s other significant hormone-related events e.g, menarche. Woman who smoke tend to experience menopause around two years earlier than non-smokers, with an average life expectancy of 82 for Australian women, menopause signals the start of a life stage that may sparn 30 or more years. Rather than the beginning of old age, as it is sometimes presented, menopause is the beginning of a new phase of life in a woman that will bring different expectations, opportunities and experiences. Women’s health factsheet (2006)

Samira, (2006) asserted that it is generally accepted that the average age at which menopause occurs is about 51 years in industrialized countries. However, a recent study of 14,620 women from USA showed a median age at natural menopause of 51.4 years. He further stated that one international study of 18, 997 women from 11 countries found the median age at natural menopause to be 50 years, with a range of 49-62 years. There are types of menopause namely:

i.        Premature Menopause: This occurs before 35-40 years of age and could be caused by diseases affecting the ovaries, deficiencies of fertility hormones (like follide stimulating hormones and leutinizing) drugs (eg birth control pills) cancer of the womb, surgery (oophorectomy: removal of the ovaries) and hysterectomy (removal of the uterus or both), diseases of the thyroid, diabetes mellitus, and radiotherapy. It occurs in 1% of women before age 40 and 0.1% by 30 years. In some cases cause is unknown (Kalantaridou, Davis and Nelson 2010).

ii.       Artificial Menopause: This type of menopause can be induced by either surgery or chemotherapy; it is referred to as surgical/medical or artificial menopause. (Women’s factsheet 2006).

iii.      Natural Menopause: This type is associated with advancing age and the menopausal syndromes last for many years (Meldrum, Alexendra and Kimora, 2007).

 

SIGNS AND SYMPTOMS OF MENOPAUSE

Numerous physical and psychological symptoms have been attributed to the hormonal changes of menopause. The pattern and frequency of these symptoms differ in different societies. The international data, according to Samira (2006) showed that the symptoms associated with menopause are: Irritability 92%, lethargy -88%, Depression 78%, Hot flashes and night sweats-75%, Headaches 71%, forgetfulness- 64%, weight gain-61%, Insomnia-51% joint and muscle pains-48%, Palpitations-44%, crying spells-42%, constipation-37%, Dysuria-20%, Decreased Libido-20%.

The degree to which the woman’s body responds to these hormonal changes varies:

i.        25% of women do not have any problems with menopause and they manage the transition without assistance.

ii.       50% of women experience some menopausal symptoms varying from mild to moderate.

iii.      25%of women have more severe problems women health factsheet (2006).

 

Gabriella and Eberhand W. (2012) stated that menopause is a retrospectively observable event, a demarcation line, an invisible milestone that allows for too narrow an interpretation. Initial signs of aging such as a missed bleed are sometimes greeted with shock, disbelief, alarm and unhappiness. It is usually not the end of menstruation and fertility that is mourned but the fact that physical signs of aging increasingly make their appearance in the form of gray hair, wrinkles, weight gain and less elastic skin.

According to Samira, (2006) clinically, menopause is important because the decline in oestrogen often causes symptoms that adversely affect quality of life. In her study of age, pattern and symptoms of menopause among rural women of lahore, she stated that the most common symptoms are as shown in the table below.

Table 1: Symptoms Associated with Menopause

Symptoms Numbers Percentages %
Lethargy 85 66.4
Urinary symptoms 73 56.2
Agitation 66 50.8
Depression 50 38.5
Insomnia 50 38.5
Hot Flushes 47 36.2
Dyspareunia 22 16.9

 

The most common complaints for which the woman sought treatment were not flushes-15.14% followed by depression-10%, Insomnia-9.2% and urinary complaints-4.6%.

Thompson and Philip (2006) stated that hot flushes will lesson in frequency and intensity with advancing age unlike other sequels of menopause that progress with time. Hot flushes are consequences of the withdrawal of oestrogen and are therefore associated with menopause whether it is natural, artificial or premature. Some of the common physical symptoms that women experience include hot flushes and night sweats, menstrual irregularities, sleep disturbances, vagina dryness/thinning, urinary problems. Such symptom like depression, forgetfulness, anxiety, irritability or other mood changes and weight gain are commonly attributed to menopause. It is further stated that the incidence of depression does not increase during menopause. Weight gain is associated with natural decrease in metabolic rate that occurs with age and a more sedentary lifestyle. Menopause also appears to be associated with a distribution of weight form the hip and thigh area to the abdominal area. Post-menopausal women have increased risk of a number of health conditions especially osteoporosis and cardiovascular disease because of the inherent hormonal changes women’s health factsheet (2006).

According to Williams and Wilkins (2011) urogenital atrophy is a common observation in post menopausal women which increases with age, but the prevalence of symptomatic atrophy is unclear. In a population-based study of Australian women observed over seven years, vaginal dryness was a complaint in 3 percent of premenopausal women, 4 percent of women in early menopause, but up to 47 percent of women three years or more into their menopause. Vaginal atrophy results in loss of normal architecture within the vaginal epithelium, reducing its secretions and elasticity and making it more prone to trauma dryness, spontaneous bleeding and infection.

According to Aila, (2010) the Asian-American women had significantly fewer symptoms than the white women, and the African-American women had the highest prevalence of vasomotor symptoms. Mayan women reported that the only recognized symptom of menopause was menstrual irregularity followed by the final ceasation of menses. Non reported hot flushes or cold sweats. Further more, he stated that menopausal Nigerian women of Yoruba tribe recorded 30% that presented with hot flushes, joint pain was the most frequent reported symptoms. Also, in Beirut, Lebanon, 45% reported hot flushes similar to figures in United States, Canada and Sweden. Incidence of depression was lower than 30%, which is United States figure. The frequency of hot flushes was, higher in smokers and employed women reported fewer symptoms. He further stated that 39% had sought help for their symptoms and 15% reported using hormone replacement therapy (HRT).

KNOWLEDGE OF MENOPAUSE

According to Aila, (2010) it is important to consider where women obtain their information about menopause. Several United States studies showed that in general, African-American women in particular less educated African-American women have less knowledge of menopause. They are also less likely to discuss menopause with a physician, and have less awareness of and less knowledge of hormone replacement therapy (HRT). He further stated that the pre-menopausal Mayan woman did not seem to have cultural knowledge or expectations relating to the onset of menopause other than the cessation of menstruation. In his study of menopausal Nigerian women of Yoruba descent he stated that the Yoruba women may not have been aware of hot flushes as white women and so, they may have wrongly attributed their sensations to environmental temperature or to fever. In the same view, he recorded that educated women in industrialized counties with well-developed medical care are privileged group with access to the most recent information on hormone replacement therapy where as other groups have less access and less knowledge.

In addition, according to Weinstain (2007), understanding menopause and the range of treatment option can help women to make the best health decision. Furthermore, Aila (2005) stated that women need education and balanced information to make personal decisions regarding whether to use HRT. An important goal for healthcare providers should be to educate women, such education should lead to greater qualify among women in different cultures and social level and also help women to control their own health.

ATTITUDE OF WOMEN TOWARDS MENOPAUSE

Gabreilla and Eberhard (2012) stated that for over three-quarters of Australian and Filipino women studied, menopause was not connected with adverse physical and psychological difficulties, they primarily described their menopause in terms of a “non-event” with associated problems non-existence or barely noticeable. Their positive attitudes were noted to be better sex, improved moods, more energy and time, greater freedom and happiness, relief from pregnancy and menstruation and feeling of being loved. While their negative attitudes were stated thus; loss of Libido, palpitations, weight gain, headaches, right sweats, vaginal dryness, hot flushes, depression, fear of ageing, no longer being loved and respected and irritability. Gabriella and Eberhard (2012) stated that not all women have immediately grown to love their changed and mature appearance and many seem to have “lost” part of their physical identity. However, it became clearly evident during the multi-stage interviewing process that in the space of time women gradually came to accept menopause in a more positive light. The peri-menopause was characterized by more frequent negative perceptions than the post menopause when most women have had time to make sense of their experience. In addition, they stated that menopause is more than a more biological issue, it is shaped by socio-cultural beliefs and values and spans over a considerable period of time.

Gaberiella and Eberhard (2012) further asserted that how a woman feels during the course is not only one day but over a period of weeks, months or years may vary tremendously. Depending on individual circumstances, feeling towards menopause underwent conspicuous changes e.g night sweats were a source of bother and irritability one day and absent on other days thereby causing feeling to swing back and forth like a pendulum on a clock.

(Women’s health factsheet, 2006) stated that a woman’s experiences of menopause is influenced not only by her own personal emotions and attitudes but also by wider factors such as the role and status of women in society. In some non-western cultures, menopausal women generally do not report hot flushes. It has been suggested that these differences could be related to dietary patterns. Other explanations are that, in these cultures, older women contributions receive more recognition and ageing is regarded more positively. Conversely, women in these cultures may not be able to discuss topics such as menopause as openly as in Western countries. They further stated that women may also find menopause as a time to reflect on the past. They may look at their past and present relationships, choices about children and work satisfaction. Some may experience regrets about certain decisions or unfulfilled dreams, though, these may prove difficult for some women. Further more, while some women report feeling greatly relieved to ceased menstruation, others report a sense of loss. For women who saw menstruation as a symbol of feminity and womanliness, its end may lead them to question their female identify. Other women may find it difficult to accept the loss of reproduction. Even for women who have made a well considered decision not to have children (or more children), the loss of the capacity and option may trigger feelings of sadness. Other life circumstances often occurring at midlife such as the children leaving home (or remaining at home), caring for elderly relatives and ill health can affect a woman’s attitude towards menopause.

Gabriella and Eberhard (2012), further asserted that roughly one quarter of Australian women found it difficult to come to terms with the ageing process and they have such negative feelings like irritability, depression, fear of ageing, loneliness, moodswings, unhappiness and loss of self-esteem, respect and admiration. Among Filipino women, a more positive outlook prevailed with almost all of them remarking that they felt only minor if any psychological irritations. Harper, (2002) in Gabriela and Eberhard (2012) stated that Australian culture venerates youths and disregards old age and this affects their attitudes towards menopause. Among pre-menopausal through post-menopausal women, attitudes of African- American women were more positive  and Chinese women who received their- schooling outside United States were the least positive (Aila, 2010).

Mayan women did not consider menopause as a major crisis. In general they reported looking forward to menopause and likened it to being young and free. They reported better sexual relationships with their husbands because of no risk of pregnancy. They considered menopause to be a life stage free from taboos and restrictions (Aila, 2010).

FACTORS INFLUENCING WOMEN’S ATTITUDE TO MENOPAUSE

Nina, (2007) further stated that stigmas or attitudes of women towards menopause begin early in life unless an open and proactive view is stressed by society or families. Culture and societal influence might play a role in determining how individuals think about menopause. Following a multi-cultural study, Bromberger  (2003) in Nina, (2007) suggested that due to psycho-social factors, whites have higher odds for distress than African American and Hispanic women

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