Effect of Menopause on Quality of Life: Path Analysis from Ponorogo East Jawa
Abstract
Background: Menopause is a biological process in women which is characterized by the cessation of menstruation and a decrease in hormone levels that cause symptoms that can affect quality of life. This study aims to determine the impact of menopause and other factors that influence the quality of life in women.
Subjects and Method: This study was observational analytic with a case control approach. The study was conducted in six health centers in Ponorogo Regency, East Java in March to April 2019. The total sample of 225 women aged 40 to 64 years was divided between 2 grou included menopausal as case group and non-menopausal as control groups based on purposive sampling. The dependent variable was quality of life. The independent variables were menopause, hot flush, anxiety, insomnia, vaginal dryness, and family intimacy. Quality of life is measured by the SF-36 (Short Form Health Survey). Anxiety was measured by Depression Anxiety Stress Scales. Insomnia was measured by the Pittsburgh Sleep Quality Index. The collection of other variables was conducted using questionnaires and analyzed using path analysis.
Results: The decrease in quality of life was directly and negatively affected by menopause (b = -0.72; 95% CI = -1.39 to -0.05; p = 0.034), hot flush (b = -0.72; 95% CI = -1.34 to -0.07; p = 0.028), insomnia (b = -0.79; 95% CI = -1.43 to -0.16; p = 0.014), anxiety (b = -1.75; 95% CI = -3.09 to -0.47; p = 0.011), and drought vagina (b = -1.01; 95% CI = -1.65 to -0.37; p = 0.002). Women with high family intimacy can improve quality of life and are positive (b = 1.32; 95% CI = 0.69 to 1.95; p <0.001).
Conclusions: The decreased quality of life in women is directly affected by menopause, hot flush, insomnia, anxiety, and vaginal dryness. High family intimacy improves quality of life. Family flush, anxiety, and family intimacy have indirect effects on quality of life.
Keywords: quality of life, menopause, path analysis
Correspondence: Shally Ayu Chintya, Public Health Master’s Program, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Jawa Tengah. Email: shallyayuchintya@yahoo.co.id. Mobile: 087702640660
Indonesian Journal of Medicine (2019), 4(2): 155-164
https://doi.org/10.26911/theijmed.2019.04.02.09
References
Arakane M, Castillo C, Rosero MF, Penafiel R, Perez Lopez FR, Chedraui P (2011). Factors relating to insomnia during the menopausal transition as evaluated by the insomnia severity index. Maturitas, 69(2): 157–161. doi: 10.1016/j.maturitas.2011.02.015.
Ayers B, Hunter MS (2013). Health related quality of life of women with menopausal hot flushes and night sweats. Climacteric, 16(2): 235–239. doi:10.3109/13697137.2012.688078.
Bremer E, Jallo N, Rodgers B, Kinser P, Dautovich N (2019). Anxiety in menopause: A distinctly different syn-drome?. The Journal for Nurse Prac-titioners, 15(5): 374–378. doi: 10.1016/j.nurpra.2019.01.018.
Bruyneel M (2015). Sleep disturbances in menopausal women: Aetiology and practical aspects.Maturitas, 81(3): 406–409. doi: 10.1016/j.maturitas.-2015.04.017.
Bryant C, Judd FK, Hickey M (2012). Anxiety during the menopausal transition: a systematic review. Journal of Affective Disorders, 139(2): 141–148. doi: 10.1016/j.jad.2011.06.055.
Caruso D, Masci I, Cipollone G, Palagini L (2019). Insomnia and depressive symptoms during the menopausal transition: the theoretical and therapeutic implications of a self reinforcing feedback loop. Maturitas, 123: 78-81.doi: 10.1016/j.maturitas.2019.02.007.
Ceylan B, Ozerdogan N (2015). Factors affecting age of onset of menopause and determination of quality of life in menopause. Journal Turkish Society Obstetrics Gynecology, 12(1): 43–49. doi: 10.4274/tjod.79836.
Chedraui P, Perez-Lopez FR, Aguirre W, Calle A, Hidalgo L, Leon P, Miranda O, Martinez N, Mendoza M et al (2010). Beliefs regarding menopausal hot flushes among climacteric wo-men as assessed with the hot flush beliefs scale. Maturitas, 66(3): 298–304.doi: 10.1016/j.maturitas.2010.03.019.
Dinas Kesehatan Kabupaten Ponorogo (2018). Profil Kesehatan Kabupaten Ponorogo tahun 2017. Ponorogo.
Dinas Kesehatan Provinsi Jawa Timur (2018). Profil Kesehatan Provinsi Jawa Timur tahun 2017. Surabaya.
Erbil N (2018). Attitudes towards menopause and depression, body image of women during menopause. Alexandria Journal of Medicine, 54(3): 241–246. doi: 10.1016/j.ajme.2017.05.012.
Ermawati DH, Budihastuti UR, Murti B (2018). Menopause and biopsychosocial factors associated with quality of life in women in Surakarta, Central Java. Journal of Maternal and Child Health, 3(2): 119–127. https://doi.org/10.26911/thejmch.2018.03.02.04.
Hess R, Thurston RC, Hays RD, Chang CC, Dillon SN, Ness RB, Bryce CL, Ka-poor WN, Matthews KA (2012). The impact of menopausal on healthrelated quality of life: results from the STRIDE longitudinal study. Quality of Life Research, 21(3): 535–544.doi: 10.1007/s1113601199597.
Jehan S, Masters Isarilov A, Salifu I, Zizi F, Jean Louis G, Pandi Perumal SR, Gupta R, Brzezinski A, McFarlane SI (2015). Sleep disorders in postmenopausal women. Journal Sleep Dis-order Therapy, 4(5): 1-18. doi: 10.4172/2167-0277.1000212.
Jenabi E, Shobeiri F, Hazavehei SMM, Roshanaei G (2015). Assessment of questionnaire measuring quality of life in menopausal women: a systematic review. Oman Medical Journal, 30(3): 151–156. doi: 10.5001/omj.2015.34.
Kalarhoudi MA, Taebi M, Sadat Z, Saberi F (2011). Assessment of quality of life in menopausal periods: a population study in Kashan, Iran. Iranian Red Crescent Medical Journal, 13(11): 811–817. PMCID: PMC3371893.
Karmakar N, Majumdar S, Dasgupta A, Das S (2017). Quality of life among menopausal women: A community based study in a rural area of West Bengal. Journal of Mid-life Health, 8(1): 21–27. doi: 10.4103/jmh.JMH-_78_16
Kementrian Kesehatan Republik Indonesia (2018). Profil Kesehatan Indonesia tahun 2017. Jakarta.
Kravitz HM, Kazlauskaite R (2018). Sleep, health, and metabolism in midlife women and menopause: food for Thought. Obstetrics Gynecology Cli-nics of North America, 45(4): 679–694. doi: 10.1016/j.ogc.2018.07.008.
Maringga EG, Adriani RB, Mudigdo A (2015). Effect of contraceptive use, parity, and social economic factors on age at menopause at Bendo Community. Journal of Maternal and Child Health, 2(2): 113–123. https://doi.org/10.26911/thejmch.2017.02.02.03.
Marlatt Kl, Beyl RA, Redman LM (2018). A qualitative assessment of health behaviors and experiences during menopause: A cross sectional, observational study. Maturitas, 116: 36–42. doi: 10.1016/j.maturitas.2018.07.014.
Mulhall S, Andel R, Anstey KJ (2018). Variation in symptoms of depression and anxiety in midlife women by menopausal status. Maturitas, 108: 7–12. doi: 10.1016/j.maturitas.2017.11.005.
Panichkul S, Wongwananuruk T, Boonyanurak P, Wiriyasirivaj B, Waniches-takul P, Pongsatha S, Peeyananjarassri K et al, (2017). Menopause-related symptoms and quality of life in peri and postmenopausal women in Thailand: a multicenter study. Asian Biomedicine, 11(3): 207–216. doi: 10.5372/1905-7415.1103.551.
Parsa P, Ahmadinia Tabesh R, Soltani F, Karami M, Khorami N (2017). Inves tigation of quality of life in menopausal women in Iran. Maturitas, 100: 166. doi: 10.1016/j.maturitas.2017.03.164.
Poomalar GK, Arounassalame B (2013). The quality of life during and after menopause among rural women. Journal of Clinical and Diagnostic Research, 7(1): 135–139. doi: 10.7860/JCDR/2012/4910.2688.
Ray S, Dasgupta A. (2012). An assessment of QOL and its determining factors of post menopausal women in a rural area of West Bengal, India: a mul-tivariate analysis. International Journal of Medicine and Public Health, 2(4): 12-19. doi: 10.5530/ijmedph.2.4.3.
Sari NIY, Adriani RB, Mudigdo A (2017). Effect of menopause duration and biopsychosocial factors on quality of life of women in Kediri District , East Java. Journal of Maternal and Child Health, 2(2): 125–136. https://doi.org/10.26911/thejmch.2017.02.02.04
Sharma S, Mahajan N (2015). Menopausal symptoms and its effect on quality of life in urban versus rural women: a cross sectional study.Journal of Mid life Health, 6(1): 16-20. doi: 10.4103/0976-7800.153606.
Shepherd banigan M, Goldstein KM, Coeytaux RR, McDuffie JR, Goode AP, Kosinski AS, Noord MG et al, (2017). Improving vasomotor symptoms; psychological symptoms; and health related quality of life in peri or post menopausal women through yoga: an umbrella systematic review and meta analysis. Complementary The rapies in Medicine, 34: 156–164. doi: 10.1016/j.ctim.2017.08.011.
Shobeiri F, Jenabi E, Hazavehei SMM, Roshanaei G (2016). Quality of life in postmenopausal women in Iran: a population-based study. Journal of Menopausal Medicine, 22(1): 31–38.http://dx.doi.org/10.6118/jmm.2016.22.1.31
Smith RL, Flaws JA, Mahoney MM (2018). Factors associated with poor sleep during menopause: results from the midlife women's health study.Sleep Medicine, 45: 98–105. doi: 10.1016/j.sleep.2018.01.012.
Sun N, Xing J, Li L, Han XY, Man J, Wang HY, Dong mei (2018). Impact of menopause on quality of life in community based women in China: 1 year follow up. Archives of Psychiatric Nursing, 32(2): 224–228. doi: 10.1016/j.apnu.2017.11.005.
Vale F, Rezende C, Raciclan A, Bretas T, Geber S (2019). Efficacy and safety of a non hormonal intravaginal moisturizer for the treatment of vaginal dryness in postmenopausal women with sexual dysfunction. European Jour-nal of Obstetrics and Gynecology, 234: 92–95. doi: 10.1016/j.ejogrb.2018.12.040.
Valiensi SM, Belardo MA, Pilnik S, Izbizky G, Starvaggi AP, CasteloBC (2019). Sleep quality and related factors in postmenopausal women.Maturitas, 123: 73-77.doi: 10.1016/j.maturitas.2019.02.008.
Waetjen LE, Crawford SL, Chang P, Reed BD, Hess R, Avis NE, Harlow SD et al, (2018). Factors associated with developing vaginal dryness symptoms in women transitioning through menopause: a longitudinal study. The Journal of The North American Menopause Society, 25(10), pp. 1094–1104. doi: 10.1097/GME.0000000000001130.
Whiteley J, DiBonaventura MC, Wagner J, Alvir J, Shah S (2013). The impact of menopausal symptoms on quality of life, productivity, and economic 0ut-comes. Journal of Women's Health, 22(11): 983-990. doi: 10.1089/jwh.2012.3719.
Yazdi Z, Sadeghniiat Haghighi K, Ziaee A, Elmizadeh K, Ziaeeha M (2013). Influence of sleep disturbances on quality of life of Iranian menopausal women. Psychiatry Journal, 1-5 http://dx.doi.org/10.1155/2013/907068.
Zambotti MD, Trinder J, Colrain LM, Baker FC (2017). Menstrual cyclerelated variation in autonomic nervous system functioning in women in the early menopausal transition with and without insomnia disorder. Psycho-neuro endocrinology, 75: 44 51. doi: 10.1016/-j.psyneuen.-2016.10.009.