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