Post on 09-Dec-2014
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Quality of Life during Menopause
Dr. Amit SenguptaMBBS, MD, Ph.D.
MUMBAI-INDIA
How do we define quality of life?
* Quality of life Index (QLI)
A product of the interplay among social, health, economic and environmental condition which affect human and social development
*std. definition
What is the purpose of QoLI ?
To provide a tool for the community development which can be used to monitor key events that encompasses the social, health, environmental, economic dimension of the quality of life
Can menopause be a key event?
Yes, any defined state in health or disease that potentially affects the human physiology or psychology during the entire life span can be a key event.
1. Physiological events e.g., adolescence, menarche, pregnancy, menopause, senility/aging etc,
2. Pathological events e.g., Diabetes, cancer, hypertension etc
Significance of menopause
Menopause basically signifies overall status of middle aged women passing through a particular biological event
We need menopause- QoLI as a tool to understand, assess, improve their status before, during and after the event
Menopause- present status
Menopause (? Aging in India) was believed to be the beginning of the end,
Now it is the beginning of a new phase (Middle age) of successful aging in urban India
Reproductive period15 – 35 YEARS
Pre- Peri - Post menopause( 45 yrs to 55 years )
CLIMACTERIC( 35 TO 65 YRS )
Aging-senility> 65 YEARS
CHANGING DEMOGRAPHY
LIFE EXPECTANCY ( 35 YRS, 1947 ) MIDDLE AGE MISSING
( 67 YRS, 2001 )
FEMALE LIVES LONGER THAN MALES
WHO- South East Asia
DEMOGRAHIC PATTERN
PROPORTION OF MIDDLE-ELDERLY-DEPENDENTS ( ELDERLY 14% 2025; 7%1995; )
1:4 IN DEVLOPING > BY 2020, 150 MILLION ( 10% OF POPULATION )
1:2 IN DEVELOPED;
AGE 0-14—NEGATIVE GROWTH RATE; 60 + GROWTH RATE 3/YR
Menopause in India
Global - Women constitutes 70% of world’s poorest and 90% of the landless
In India, 60% of women beyond 50 are widow 80% or more stay in extended family More than 80% suffers AFFECTIVE/NEUROTIC
syndrome ( hysterectomy, infertile) More than 60% are anemic between 15- 60yrs More than 50% suffers osteoporosis Indians are prone to DM and CAD.
HDI and GDI in Developing world
HDI- Human development index ( LONGIVITY;KNOWLEDGE AND DECENT STD
LIVING; life exp; adjusted income, education level ) GDI - Gender related development index (Captures inequalities, HDI:GDI > India—0.5;
Developed countries-0.9) ( Vast disparity between different population
groups )
INDIA - BOMBAY RAILWAY STATION
Population migration & distribution
Short term AS MID LEVEL SWELLS ( BOON FOR ECONOMY) Long term MORE ELDERLY — MORE WIDOW WITHOUT SUPPORT
SUGGESTED INTERVENTION
Social Mechanism to care for the ELDERLY PROMOTE EXTENDED FAMILY
URBANIZATION
( 25% 1990 ) ( 34% 2010 )
RAPID ECONOMIC GROWTH
Morbidity expressed during Perimenopause
N 83 %
1 Menstrual irregularity 32 38.5
2 Psychosomatic 17 20.5
5 Musculoskeletal pain/cramps 10 12
Morbidity expressed during Menopause
MAJOR 3 BROAD GROUPS N=173 %
CVS/Palpitations 46 26.6
Musculoskeletal symptoms 46 26.6
Vasomotor/Flushing 28 16.2
Factors affecting menopause
Universal issues ( PQLI-quantifiable) Demographic change Economic & Social security (HDI), Nutrition, safe environment (HDI) Education access, life skill development,
awareness (HDI), Life expectancy (HDI), Disease burden (MRS!!!)
Women right issues - gender equality (GDI)
Factors affecting menopause
Cultural issues (subjective) Attitude/Belief Symptoms expression/retrieval Mind - body – soul – spirit interactions Issues related to marriage/ reproductive
status / conception / widows / divorce Traditional/religious/spiritual belief
Management modalities
PEOPLE BUY BENEFITS AND NOT PRODUCT
BENEFIT MAY BE IN THE FORM OF HRT, COUNCELLING, ALTERNATIVE MEDICINE
AWARENESS INFLUNECES DELIVERY OF THE BENEFITS
Intervention principles
Body – medical check up, exercises, diet, HRT / drugs etc
Mind - counseling, meditations, psychotherapy
Social – extended family norm Spiritual – service of mankind, reading
religious text, prayers, all path leads to one GOD
Intervention Approach (Improve QLI)
EDUCATION – improves body-mind
interaction ( Knowledge / Awareness) ECONOMY– improves Nutrition & self
confidence AVAILABILITY of service – improves Health
seeking behavior & expression AUDIT – Promotes EBM vis-a-vis cultural
practices