|Year : 2016 | Volume
| Issue : 3 | Page : 263-269
Prevalence and predictors of menopausal symptoms among postmenopausal Ibo and Hausa women in Nigeria
N Ameh1, NH Madugu1, D Onwusulu2, G Eleje3, A Oyefabi4
1 Department of Obstetrics and Gynecology, Ahmadu Bello University, Zaria, Nigeria
2 Department of Obstetrics and Gynecology, Federal Medical Centre, Asaba, Nigeria
3 Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
4 Department of Community Medicine, Kaduna State University, Kaduna, Nigeria
|Date of Web Publication||8-Feb-2017|
P. O. Box 187, Garki 900001, Abuja
Source of Support: None, Conflict of Interest: None
Background: Menopause is an important part of the life of a woman. The perception and reaction to these symptoms vary from woman to woman and among different tribes and races. Nigerian women are becoming more aware of menopause and its associated problems through the media and other sources. This has important implications including health and financial burden of treatment and loss of work hours.
Objective: To determine the pattern of menopausal symptoms and factors affecting them among Ibo women in southeast and Hausa women in northeast geopolitical zones of Nigeria.
Methods: A descriptive cross-sectional study involving 261 randomly selected postmenopausal women from the southeast and northeast geopolitical zones of Nigeria.
Results: The mean age of the respondent was 52.68 ± 5.76. Major complaints were joint and body pains (74%), reduction in scalp hair volume (57%), internal heat (51.7%), and vulvar pruritus (47.1%). Most of them had multiple symptoms with moderate severity (58.6%). Vulva vagina dryness was observed in age group of 50–54 years while underweight women presented more with forgetfulness. Women with tertiary education were more likely to experience severe symptoms and to seek medical help, and Ibo women were more likely to have their daily functions affected by menopause (P < 0.05). Only 7.9% of the respondents had knowledge of treatment for menopausal symptoms.
Conclusion: There is an increased awareness of menopause among women in this population. Menopausal women mainly experienced body and joint pains and reduction in scalp hair volume, contrary to commonly held view that dark-skinned women mainly experience vasomotor symptoms. Menopausal clinics will address these problems.
Keywords: Factors; postmenopause; symptoms.
|How to cite this article:|
Ameh N, Madugu N H, Onwusulu D, Eleje G, Oyefabi A. Prevalence and predictors of menopausal symptoms among postmenopausal Ibo and Hausa women in Nigeria. Trop J Obstet Gynaecol 2016;33:263-9
|How to cite this URL:|
Ameh N, Madugu N H, Onwusulu D, Eleje G, Oyefabi A. Prevalence and predictors of menopausal symptoms among postmenopausal Ibo and Hausa women in Nigeria. Trop J Obstet Gynaecol [serial online] 2016 [cited 2019 Jun 19];33:263-9. Available from: http://www.tjogonline.com/text.asp?2016/33/3/263/199819
| Introduction|| |
Menopause is a naturally or medically induced process that occurs in nearly all women to herald the end of their reproductive ability. It marks the conclusion of reproductive capacity of women and results from the permanent cessation of ovarian function. Unlike medically induced menopause, natural menopause is a gradual process that occurs for most women between the ages of 47 and 55 years. It is confirmed by the absence of menstrual periods for 12 consecutive months, excluding other obvious pathologic or physiologic causes.
The perimenopause, a time of changing ovarian function, precedes the final menses by 2–8 years (median of 3.8 years). The clinical manifestations of this transition to menopause are not well understood. However, some symptoms such as hot flashes (flushes) begin in the perimenopause and increase as women progress through the menopause and postmenopause. Nonspecific psychological and somatic symptoms, including irritability, tiredness, insomnia, palpitations, memory or concentration difficulties, and depression or mood swings, have been commonly reported. Notwithstanding, every woman's experience of menopause is unique; she may experience all the symptoms or none of them.
However, the prevalence of symptoms differs widely and their relationship with the menopause transition may vary.,,, Thus, the specific symptoms associated with menopause vary among cultures, race/ethnicity, socioeconomic groups, and persons. For example, in a population-based study, psychosomatic symptoms were reported more frequently in light-skinned women whereas vasomotor symptoms were more frequently reported in African-American women. Very few studies have compared the symptoms of menopause between different ethnic groups in Nigeria.,,, No wonder, the features of menopause have always been assumed to occur only to a minor degree of significance in Nigerian women. Even in settings where research on the menopause has been ongoing, women have identified lack of reliable, accessible, and current information on menopause and related topics as a hitch. To optimize health care for middle-aged women in Nigeria, there is need for an up-to-date understanding of the process by which women describe, explain, and experience menopause, as well as the factors that may shape or affect their experiences. Studies on menopausal symptoms among women living their home states are limited at the moment. The aim of this study is to determine the pattern, prevalence, and predictors of menopausal symptoms among postmenopausal Hausa and Ibo women in Nigeria.
| Methods|| |
This study was carried out at Nnewi in Southeast Nigeria and Bauchi in Northeast Nigeria.
This is a descriptive cross-sectional study using structured questionnaire and a multistage sampling technique. Structured questionnaires were used to obtain demographic information and information regarding menopausal symptoms among postmenopausal women. The questionnaires were interviewer-administered by one of the authors (GE) and trained demographic data collectors.
The study population was selected by stratifying the Nigeria nation into the six geopolitical zones: Northwest, north-central, northeast, south-south, southeast, and southwest. The northeast and southeast were then selected by a simple random sampling technique (SRS). Two states were selected also by SRS from the selected geopolitical zones, one state per region. Three local government areas (LGAs) were selected at random from each state. In the selected LGA, a community was randomly selected from the list of the communities in the LGA, and a systematic sampling technique was used to select postmenopausal women in every fifth house for the interview. In the event of a fifth house not having a postmenopausal woman, the next house was visited until the calculated sample size of 365 was reached. The number of questionnaires was rounded up to 366 for equal distribution among the two states. Two hundred and sixty-one postmenopausal adequately completed and returned their questionnaires (percentage response rate of 71.3%).
The sample size was obtained using the formula Z 2 pq/d 2 (where Z = standard normal deviation at 95% confidence interval = 1.96;p = prevalence of menopausal symptoms of 39% from another study; q = 1 − p = 0.61; d = precision limit = 0.05). This was divided equally between the two states. Sampling interval was obtained by assigning a value of 200 to N and 40 to n. Therefore, the sampling interval was N/n = 200/40 = 5.
Menopausal symptoms were graded based on the number of symptoms as follows:
Few: 1–2 symptoms; moderate: 3–5 symptoms; multiple: ≥6 symptoms.
Two hundred and sixty-one postmenopausal women from the two geopolitical areas.
Inclusion criteria: Any woman who is 35 years or more with 1 year or more of a natural absence of the menstrual periods and a willingness to participate.
Exclusion criteria: Any form of artificially induced menopause (secondary amenorrhea) such as hysterectomy or bilateral oophorectomy, any illness that can cause amenorrhea, age <35 years, and/or unwillingness to participate.
Data were analyzed using SPSS version 20 (IBM (R) Corp., 2011). Level of significant was set at 95% confidence interval (P < 0.05).
| Results|| |
There were 132 (50.6%) Hausa and 129 (49.4%) Ibo women aged 35–65 years (mean of 52.68 ± 5.76). There were 132 (50.6%) Hausa and 129 (49.4%) Ibo women, of which 190 (73%) were married. Two hundred and twenty-three women (85.3%) had their first child before the age of 25 years and 38 (14.7%) at age ≥25 years. Eighty-six (33%) women had their last child before the age of 35 years and 175 (67%) at age ≥35 years. Majority of the women (218, 83.5%) had a parity of <5 and 43 (16.5%) ≥5 [Table 1].
Thirty-five (13.4%) had tertiary education, 59 (22.6%) secondary, 88 (33.7%) primary, and 79 (30.3%) no formal education. One hundred and eighty-five (70.9%) women had medical conditions, mainly hypertension and diabetes mellitus. Twenty-two (17%) of the Hausa women and no Ibo women smoked cigarettes. Contraceptive use prevalence rate was 67 (25.7%).
The age at menarche was 13–16 years and mean age at menopause was 46.41 ± 0.29 years. Menstrual period stopped gradually in 179 (69.15%) women and suddenly in 80 (30.9%) (Two women did not respond to this question).
The prevalence of various menopausal symptoms is summarized in [Table 2]. Seventy-three (28%) women had six or more symptoms. Comparing the two tribes, Ibo women were more likely to have internal heat, forgetfulness, short temper, and depression, and Hausa women were more likely to have itching of the vulva (P < 0.05).
Overall, most of the women had moderate symptoms (153, 58.6%). The symptoms tended to be multiple among Ibo women (P = 0.0001) [Table 3] and [Table 4] and women in monogamous marriages (P = 0.0001).
|Table 3: Multiplicity of menopausal symptoms among 261 postmenopausal women|
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Effect of menopausal symptoms
The effect of menopausal symptoms on day-to-day activities could be ascertained in 255 women, of which 81 (31.8%) had their activities adversely affected [Table 5]. The symptoms also negatively affected sexual relationships with husbands among 76 (44.4%) of 171 women who were married.
|Table 5: Role of various factors in relation to effect of menopausal symptoms on functions and activities|
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The symptoms affected day-to-day activities in 45.1% of women with tertiary education, 21.5% with secondary education, 36.5% with primary education, and 29.8% with no formal education (P = 0.0048). Activities were affected in 38.2% of Ibo women and 25.8% of Hausa women (P = 0.033).
The following factors had no significant impact on severity of symptoms and effect of symptoms; age at menarche, age at first and last childbirth, use of contraceptives, number of children, and marital status.
Treatment of menopausal symptoms
Overall, 121 (46.5%) of 260 women would like to seek medical treatment for their symptoms, but only 31.5% actually sought treatment from hospital and other sources [Table 6]. 7.4% had knowledge of some form of treatment for menopausal symptoms, and 81 (40.7%) would like to use estrogen to ameliorate some symptoms [Table 7], especially internal heat; the remaining felt menopause was a natural process. However, none has ever used estrogen for their symptoms. Most Hausa women (62.1%) and 30.5% of Ibo women would like to seek treatment for their symptoms (P = 0.0001). 74.3% of women with tertiary education would like to seek treatment, secondary education 48.1%, primary education 42%, and no formal education 34% (P = 0.0002).
|Table 6: Willingness to seek treatment for menopausal symptoms among Hausa and Ibo women|
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|Table 7: Attitude to treatment of menopausal symptoms among Hausa and Ibo women|
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| Discussion|| |
Menopause may be a trying period for some women but not so for others depending on the severity of and their perception of postmenopausal symptoms. In this study, the mean age at menopause was 46.41 ± 0.29 years. The age at menopause from this study is like findings from other studies which reported 46.24 years., While 2.3% of women experienced menopause before 40 years, an Indian study reported a lower figure of 1%.
The demographics from the present report are similar to those of the 2008 Nigeria Demographic and Health Survey (NDHS). The contraceptive prevalence use of 25.5% is higher than reported in the NDHS. The type of contraceptive used by the two tribes as well as the difference in smoking prevalence did not affect menopausal symptoms. This may suggest that depletion of the ovarian reserve may not be affected by smoking and contraceptive type among the study population.
The menstrual pattern begins to change in the premenopausal period before it ceases completely for 1 year. Two major patterns of the period are noticed; in one pattern, the period stops for variable duration of months and starts again before it finally stops for a continuous 1 year; the other pattern is characterized by sudden stoppage which persists for 1 year and beyond. In this study, the pattern of the menstrual periods before the onset of menopause did not affect menopausal symptoms or its severity. The age at menarche is like other studies but did not affect the age at menopause.,
The prevalence of menopausal symptoms revealed Ibo women to have more symptoms than Hausa women. In one report from Lagos, Nigeria, women from three ethnic groups of Nigeria who all resided within Lagos were found to have similar menopausal symptoms. The difference between the findings of this study and the Lagos one may be because in the present study the women are resident in their respective states of origin. This may suggest that environment may play a role in prevalence of menopausal symptoms.,, Previous reports have indicated that African women complained more of vasomotor symptoms. The respondents in the present study complained more of body and joint pains. However, further studies are required to be sure that these musculoskeletal symptoms are not the result of age rather than menopause.
Effect and severity of menopausal symptoms
Menopausal symptoms affected the daily activities of 31.8% of the women and negatively affected sexual activity with husbands in 41%. This is similar to reports from Nigeria and other countries.,
Ibo women were more likely to have multiple symptoms as compared to the Hausa women. This may be due to differences in cultural beliefs and practices between the two groups. Some studies have suggested that previous knowledge of menopause and good family support were associated with less menopausal symptoms.,
Treatment of menopausal symptoms
Many women in the present study would like to seek treatment for their menopausal symptoms, but few sought treatment from hospitals. Reports from other countries show that menopausal women sought treatment from patent medicine stores, spiritual houses, and native doctors., Yet, other reports indicate that menopausal women were too poor to seek treatment for their symptoms. Aside from hospital treatment, other methods of treating menopausal symptoms as perceived by the women in this study include exercise, yoga, and dietary modifications. Another report found multivitamins to be helpful in managing menopausal symptoms. Some of the women believed that menopausal symptoms should not be treated because it is a natural process. This belief may be culturally related.
Hausa women and women with tertiary education were more likely to seek treatment. Hausa women were more likely to be in polygamous marriages and so need to maintain their sexual role to avoid losing attention from their husbands, and this may well have influenced their likelihood to seek treatment. The women with tertiary education were more likely to have multiple symptoms and this may have influenced their likelihood to seek treatment. Another study reported that obese women were found to have more symptoms than normal and underweight women.
| Conclusion and Recommendations|| |
The present study has revealed that postmenopausal women in these settings complained more of body and joint pain. More enlightenment may well help the women to cope with the symptoms. There is a need to have special clinics to attend to the needs of perimenopausal and menopausal women.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]