RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKAPROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE

CANDIDATE

AND ADDRESS

MRS. TISHA JOHN VELIYATHU

1ST YEAR M.Sc NURSING

THE OXFORD COLLEGE OF NURSING

1ST PHASE, J.P.NAGAR,

BANGALORE – 560078

2. NAME OF THE

INSTITUTION

THE OXFORD COLLEGE OF NURSING,

1ST PHASE, J.P.NAGAR,

BANGALORE – 560078

3. COURSE OF

STUDY AND

SUBJECT

DEGREE OF MASTER OF SCIENCE IN NURSING.

OBSTETRICAL AND GYNAECOLOGICAL

NURSING.

4. DATE OF

ADMISSION

TO

COURSE

15.05.2008

5. TITLE OF THE

TOPIC

QUALITY OF LIFE AMONG RURAL AND URBAN

MENOPAUSAL WOMEN.

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6. BRIEF RESUME OF THE INTENDED WORK :

INTRODUCTION

Men and women experience various turning points in their life cycle, which may

be developmental or transitional life cycle and one such transitional period is

menopause in women. In a society that glorifies youth and beauty, the transition

through menopause can cause anxiety and apprehension in many women¹. The

word “menopause” was first used in 1872 which means simply the cessation of

periods².

Menopause is an inevitable milestone in the reproductive life of every woman.

Throughout history menopause women faced various challenges, from coping with

hot flushes and night sweats to dealing with the discomfort of vaginal dryness³.

The menopausal symptoms experienced by women may affect all components of

quality of life: socioeconomic, physical health, relationship with friends and family

and satisfaction with self. The concern about quality of life increased dramatically

because of the heightened awareness of the effect of symptoms on all dimensions

of quality of life 4.

The term “quality of life” entered the American vocabulary in the middle of the

20th century. Ever since Aristotle wrote in his Ethics, ‘when it comes to saying in

what happiness consists, opinions differ”, there has never been a universally agreed

definition of quality of life. The concept of quality of life is not a new one. It is

enshrined in the Hippocratic oath taken by the doctors to do no harm to their

patients14.

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Every woman’s experience of the menopausal is unique. She may experience all of

the symptoms or none of them. Today there are over 200 million post menopausal

women worldwide and 50 million in India. The average age at which menopause

occurs is 51 years. The range may be between 44 and 59 years. Mean age at which

Indian women attain menopause is around 47.3 years 3.

6.1 NEED FOR THE STUDY

During menopause, majority of the women experience varying degree of adverse

symptoms such as vasomotor instability, hot flush, headache, dizziness,

diaphoresis, sleeplessness wrinkling and drying of the skin and loss of hair.

Menopause can affect body organs and system in many different ways like

problem with sudden or frequent urination, weakening of bones, osteoporosis,

heart attack and other heart problems etc. sometimes symptoms of menopause are

significant and annoying. These symptoms may affect all components of quality of

life5.

For some African women the time of menopause indicates a higher social status,

and life becomes easier after it. This means that menopause is seen as a positive

life event, whereas in countries such as the USA, Germany and Italy, it is viewed

in a negative way- as a demarcation of ageing. This may influence how a women

feels at the time of the menopause4.

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Chinese women generally perceive the menopause as a natural purpose and so

perhaps have a positive attitude towards and symptoms they may experience15.

A woman seldom discusses about menopausal symptoms with others and silently

suffers and she experiences conflicting feelings, physical vulnerability and feeling

of vulnerability about the future. It is important to realize that women spend one-

third of their lives in postmenopausal status today and hence it is necessary to

ensure that women are physically and mentally healthy during these years1.

Analysis of literature reveals that because of this emotional and physical change

associated with menopause in the women’s life there will be various problems like

depression, anxiety, irritability, low self esteem and lack of confidence may occur.

Long-standing problems may become harder to live with or to deal with when a

woman is also experiencing physical or psychological upset as a result of hormonal

changes. She experience both negative and positive feelings. These all will affect

the quality of her life6.

Achieving optimal health should be the focus of women after menopause. Though

hormone replacement therapy is available to overcome the problems of menopause

everyone is encouraged to address lifestyle first, prior to considering medication.

Choosing healthy life style habits will result in dramatic improvement in health

and longevity. Menopause presents a unique opportunity to reassess these life style

choices including healthy diet, exercise, weight management, stress reduction,

natural therapies and hormone replacement therapy2.

Hence the researcher is interested to study the effect of menopause on quality of

life of women and to impart education to achieve optimal health during

menopause.

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6.2 REVIEW OF LITERATURE

Review of literature for the present study has been organized under the following

headings:

6.2.1 Studies related to menopausal experience of women.

6.2.2 Studies related to quality of life of menopausal women.

6.2.1Studies related to menopausal experience of women.

Majority of the menopausal women experience physical or emotional symptoms

relate to menopause and this will significantly affect their daily personal,

professional and social lives. This is revealed by a study conducted among 961

members of the National Association of Female Executives aged 35 years and

older completed an Internet survey about the impact of menopausal symptoms and

general knowledge and understanding of hormone therapy. The majority of

menopausal women surveyed experience physical or emotional symptoms. For

many women, symptoms related to menopause significantly affect their daily

personal, professional, and social lives. Educating patients about scientific

findings, current treatment options, and the associated risks and benefits is critical

to providing effective, individualized care to improve quality of life7.

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Most of the menopausal women may experience various types of menopausal

symptoms. These symptoms may vary from individual to individual. A study was

conducted to investigate the menopausal experience of Greek women to examine

the relationship between common symptoms and various socio demographic

factors. A total of 217 women participated in the survey. It was found that the

most commonly reported symptoms related was fatigue (66%) and a decrease in

physical strength and stamina (<60%), and nearly as many (59%) complained of

lower backache. Fifty percent of women also complained of psychological

symptoms. Hot flushes were reported by 43%12.

The menopause epidemiology study builds upon existing literature by providing

data on daily frequency and severity of vasomotor symptoms. A study was

conducted to describe characteristics of vasomotor symptoms among women 40-

65 years old in US. A questionnaire focusing on menopausal symptoms was

administered online. The study revealed that the prevalence of vasomotor

symptoms was 79% in peri and 65% in postmenopausal women. . There are many

postmenopausal women with frequent and severe vasomotor symptoms who may

benefit from treatment11.

During the menopausal period there is a high degree of anxiety symptoms which

is especially connected to fluctuations in the serum level of gonadal hormones.

This is revealed by a study conducted in Norway among a population of 19,677

women aged 35- 60 years. It is found that there is a significantly higher score on

depression and anxiety in the period and postmenopausal period compared to the

pre menopausal period. Comparing the postmenopausal period with the peri

menopausal period, the score for depressive symptoms will somewhat higher while

the score for anxious symptoms will be somewhat lower13.

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6.2.3 Studies related to quality of life of menopausal women.

Health-related quality of life is a subjective parameter which refers to the effects of

an individual's physical state on all aspects of psychosocial functioning. Aging is a

natural unavoidable process that is expressed through physical, psychological,

emotional and social changes and menopause in women. This is supported by a

study conducted among 481 women aged 40-59 years attending the Southern

Metropolitan Health Service in Santiago de Chile were studied using the Specific

Quality of Life Questionnaire for Menopause from Toronto University. Analysis

showed that menopausal women have worse quality of life scores than women

conserving cycles in the four areas of the questionnaire: They show a 10.6-fold

higher risk for suffering vasomotor disorders affecting quality of life, a 3.5-fold

higher risk for psychosocial impairment, a 5.7-fold higher risk for physical

disorders, and a 3.2-fold higher risk for sexual disorders. So it is concluded that

menopause will cause a decrease in the quality of life and will have a negative

impact on the quality of life which is independent of age and other socio

demographic variables9.

Quality of life in menopause is influenced by many parameters, including

vasomotor symptoms, psychological status and culture. A study was conducted to

examine the association of hormone therapy (HT) with quality of life and

psychological symptoms in Greek postmenopausal women. The study assessed 216

postmenopausal women (mean age 54.5 years) attending a university menopause

clinic in Greece. Fifty-three were users of HT and 163 were not. Analysis revealed

that hormone therapy users had better total quality of life scores than non-users (p

< 0.05). Hormone therapy use is independently related to an improvement in the

total score and in most domains of quality of life, and has a significant positive

effect on many aspects of psychological well-being in Greek postmenopausal

women8.

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Some women may perceive menopause as a natural process and so will have a

positive attitude towards any symptom they may experience. So their quality of life

may not be reduced after menopause. This is revealed by a study conducted among

1,119 pre and postmenopausal women with an intact uterus in Pomerania. It was a

cross-sectional, population-based survey. Analyses suggest that menopausal status

was not associated with quality of life10.

STATEMENT OF THE PROBLEM

A comparative study to asses the quality of life among menopausal women in

selected rural and urban area in Bangalore.

6.3 OBJECTIVES

6.3.1. To compare the quality of life among rural and urban menopausal women.

6.3.2. To find the association between selected demographic variables and the

quality of life of menopausal women.

6.3.3. To develop an health education pamphlet regarding achieving optimum

health after menopause.

6.4 RESEARCH HYPOTHESIS

H1 → There will be a significant difference between the quality of life of rural

and urban menopausal women.

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H2 → There will be significant association between the selected demographic

variables such as age, education, religion, income, occupation and the quality of

life of urban and rural menopausal women.

VARIABLES UNDER STUDY

1. Quality of life of rural and urban women after menopause

2. Selected demographic variables such as age, education, religion, income,

occupation.

6.5 OPERATIONAL DEFINITIONS

Quality of life: In this study the quality of life refers to the participants physical

and emotional status, stress factors, life enjoyment activities and their overall

impression about the quality of life after menopause.

Menopausal women: In this study it refers to women who had physiological

cessation of menstruation living in Nelamangala (rural area) and Gavipuram

Guttahalli (urban area) of Bangalore.

Rural area: In this study it refers to Nelamangala, rural area located in Bangalore

with a population of 80,000 and having a primary health centre.

Urban area: In this study it refers to Gavipuram Guttahalli, urban area located 5

km away from college in Bangalore south, with a population of 58,212 and having

a primary health centre.

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Selected demographic variables: In this study it refers to education, religion,

income and occupation of rural and urban menopausal women.

Health education pamphlet regarding achieving optimal health after menopause

consists of:

General concepts of menopause

Lifestyle changes for better quality of life such as:

> healthy diet

> exercise

> weight management

> stress reduction

> natural therapy

> hormone replacement therapy

> regular clinical checkup.

6.6 ASSUMPTION:

Healthy life style habits after menopause results in significant improvement

in the quality of life.

6.7 DELIMITATION:

The study is limited to menopausal women residing in Gavipuram Guttahalli

(urban area) and Nelamangalal (rural area) of Bangalore, Karnataka.

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7.0 MATERIALS AND METHODS

7.1 SOURCES OF DATA:

Data will be collected from menopausal women in Gavipuram Guttahalli (urban

area) and Nelamangala (rural area) of Bangalore, South Karnataka.

7.2 METHODS OF COLLECTION OF DATA:

7.2.1 RESEARCH APPROACH

Survey Approach

7.2.2 RESEARCH DESIGN

Descriptive and Comparative design

7.2.3 RESEARCH SETTING

Study will be conducted in Gavipuram Guttahalli (urban area) and Nelamangala

(rural area) of Bangalore, Karnataka.

7.2.4 POPULATION

Population of the study comprises of menopausal women of rural and urban areas.

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7.2.5 SAMPLE SIZE

The total sample of the study consists of 50 menopausal women from Gavipuram

Guttahalli (urban area) and 50 menopausal women from Nelamangala (rural area)

of Bangalore, Karnataka.

7.2.6 SAMPLING TECHNIQUE

Purposive sampling technique.

7.2.7 SAMPLING CRITERIA.

INCLUSION CRITERIA

1. Menopausal women residing at Gavipuram Guttahalli (urban area) and at

Nelamangala (rural area), Bangalore.

2. Women who are not able to read English or Kannada.

EXCLUSION CRITERIA.

1. Women who are on hormone replacement therapy.

2. women who are not available during data collection period.

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7.2.8 DATA COLLECTION METHOD

Data collection tool consists of:

Part 1 – Selected demographic variables such as age, education, religion, income,

occupation.

Part 2 – Quality of life scale regarding menopausal symptoms.

7.2.9 DATA ANALYSIS METHOD

Data analysis will be through descriptive and inferential statistics.

Descriptive Statistics

Mean, Frequency Percentage and Standard Deviation.

Inferential Statistics

1. Student ‘t’ test to find out the significance of difference between the mean

quality of life score of rural and urban post menopausal women.

2. Chi-square(x2) test to determine the association between the selected

demographic variables and the quality of life of rural and urban post

menopausal women.

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7.3 DOES THE STUDY REQUIRE ANY OTHER INTERVENTION TO BE

CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS ?

Yes, the study requires data collection by using quality of life scale from the rural

and urban postmenopausal women between the age group of 50 – 60 years.

7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION.

Ethical clearance will be obtained from,

The research committee of the Oxford College of Nursing, Bangalore.

The authorities of selected PHC’s

The informed consent from the candidates willing to participate in the study.

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8. LIST OF REFERENCES:

1. Cope E physical changes associated with postmenopausal years in the

management of menopause. Stuart Campbell (Ed), New York, MTP,1976.

2. World Health Report symptoms of menopause and their treatment Geneva;

WHO technical report of scientific group. 1990.

3. Vasishita kala et.al “Factors influencing the age at menopause”, Journal of

Obstetrics and Gynaecology of India 1994.

4. William Hurd W Novak’s gynaecology 12th edition, Pennsylvania: Awa Very

Co., 1999.

5. Dennerstein L et.a1. Menopausal symptoms, Journal of Obstetrics and

Gynaecology; 2000.

6. Jane Harmon. Menopausal symptoms and treatment, Journal of Obstetrics

and Gynaecology, 2003.

7. J. A. Simon, Reape K.Z. Understanding the menopausal experience of

professional women. Menopause, 2008.

8. Schneider.H.P. The quality of life in the post- menopausal women, Best

Practice Clinical Obstetrics and Gyaenacology, 2002.

9. Blumel J.E. et.al. Quality of life after menopause: a population study,

Menopause 2008

10. S. Schwarz Menopause and determinants of quality of life in women at

midlife and beyond: the study of health in Pomerenia, 2007.

11. William R.E. et.al. Frequency and severity of vasomotor symptoms among

peri and post menopausal women in United States, climacteric, 2008.

12. J. Liu, Eden J. A. the menopausal experience of Greek women living in

Sydney, menopause 2008.

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13. Porter Maureen, penny et. Al. “Women’s experience of menopause” British

Journal of Obstetrics and Gynaecology, 1996, 103.

14. A. Rhodes Verna, W. Mc Daniel Roxanne, The symptoms experience and its

impact on quality of life 2005.

15. Chen. Y. et.al. Impact of menopause on quality of life in community- based

women in China, menopause, 2008.

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9. SIGNATURE OF THE CANDIDATE :

10. REMARKS OF THE GUIDE : It is relevant to assess the quality

of life among the urban and rural

women to promote optimal health

during menopause.

11. NAME AND DESIGNATION OF :

11.1 GUIDE : Prof. G. Thilagavathy M.Sc.(N)

HOD

Department of OBG Nursing

The Oxford College of Nursing

1st Phase, J. P. Nagar, Bangalore – 78.

11.2 SIGNATURE OF THE GUIDE :

11.3 HEAD OF THE DEPARTMENT : Prof. G. Thilagavathy M. Sc (N)

HOD

Department of OBG Nursing

The Oxford College of Nursing

1st Phase, J. P. Nagar,

Bangalore – 78

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11.4 SIGNATURE OF THE HOD :

12.1 REMARKS OF THE PRINCIPAL : It is relevant to assess the quality

of life among the urban and rural

women to promote optimal health

during menopause.

12.2 NAME OF THE PRINCIPAL : Dr. G. Kasthuri

Principal

The Oxford College of Nursing

1st Phase, J. P. Nagar, Bangalore – 78.

12.3 SIGNATURE OF THE PRINCIPAL :

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