Exploring gaps in menopausal and self-care knowledge among rural women of Ambedkar Nagar

Introduction

The menopausal transition marks a significant stage in a woman's life, characterized by a series of hormonal and physiological changes that signal the end of her reproductive years. This phase, which can last anywhere from one to ten years, involves gradual adjustments as the body reduces its reproductive capacity. During this time, women may experience irregular menstrual cycles, hormonal fluctuations and various physical and emotional symptoms. The onset and progression of menopause vary among individuals, influenced by factors such as genetics, lifestyle and overall health. [1] . Menopause, derived from the Latin words meno (month) and pausia (halt), marks the end of a woman's natural fertility. The years surrounding menopause, often referred to as the climacteric, represent a significant transition in a woman's life. During this time, menstrual periods cease permanently and women are no longer able to conceive naturally. [2] . Menopause is a universal phenomenon however, there is considerable variation among women in terms of the age at which it occurs and the way menopausal signs and symptoms are experienced. Globally, it is estimated that there are over 200 million post-menopausal women, with 40 million of them living in India. The average age at which Indian women experience menopause is 47.5 years [3] . Population projections show that in 1990, there were approximately 467 million women aged 50 and older worldwide. This number is expected to increase to 1.2 billion by 2030. By that year, the proportion of postmenopausal women living in industrialized regions will decrease to 24 percent, while 76 percent will reside in developing regions. In 1990, around 25 million women globally reached menopause and this number is expected to double by the late 2020s. The process of menopause occurs in several phases: pre-menopausal, peri-menopausal (which includes early and late stages) and post-menopausal. A woman is considered to be in the prewww.extensionjournal.com menopausal stage if she experiences amenorrhea for 12 consecutive months. [4] A woman is classified as being in the early peri-menopausal stage if menstruation has occurred within the past 2 to 3 months, with cycle lengths becoming irregular and lasting seven or more days. In the late peri-menopausal stage, menstruation has occurred in the past 12 months but not within the last 2 to 3 months. A woman is considered postmenopausal if menstruation has ceased for at least 12 consecutive months without surgical intervention. While menopause is a universal phenomenon, the timing of its onset, the duration of the menopausal transition and the timing of the final menstrual period vary significantly among individuals. [5] . Menopause is typically a natural process, but it can occur earlier in individuals who smoke tobacco. Other factors that may induce early menopause include surgery that removes both ovaries or certain types of chemotherapy. Physiologically, menopause results from a decline in the ovarian production of the hormones estrogen and progesterone. Research has shown that the age at which menopause occurs can be influenced by a combination of biological factors such as genetics, nutrition and reproductive history, socio-cultural factors including education, occupation, smoking habits and urban or rural residence and lifestyle factors such as tobacco use and dietary habits [6] . Women undergoing postmenopausal changes have the potential to enhance their lives by approaching this stage with a positive mind-set, seeing it as a chance for personal growth and emotional maturity. As they face the challenges associated with menopause, difficulties in adjusting to these changes can significantly affect their overall well-being. Consequently, maintaining healthy lifestyle habits and fostering psychological resilience become essential. A deeper understanding of the physical, emotional and social changes that accompany menopause allows women to approach these transitions with greater confidence and preparedness, enabling them to navigate this life stage more effectively [7] .

Need for study

Menopause is a unique experience for each woman. Some may notice only minor changes in their bodies, while others may struggle to manage more intense symptoms. The most common symptom of menopause is hot flushes, which can lead to confusion and anxiety, as women may fear that something abnormal is happening to them. While attention is often focused on the health needs of women during their reproductive years, it is equally important to address the health concerns of menopausal women. Throughout their reproductive years and beyond, women face various health challenges, partly due to limited medical care during labor and delivery, along with high parity (Elias and Sherris, 2003). As women approach the end of their childbearing years and transition into menopause, they become at greater risk for symptoms related to hormonal changes, heart disease, stroke, gynecological cancers, osteoporosis and other genitourinary conditions (Elias and Sherris, 2003). [8] . A study conducted by Kaur et.al,(2012) aimed to evaluate the knowledge, attitudes, problems faced and remedial measures adopted by menopausal women, as well as to examine the relationship between these factors. A purposive sample of 200 menopausal women was selected for data collection using a structured interview schedule to assess knowledge, an attitude scale to measure attitudes and a checklist to identify problems faced and remedial measures adopted. The results indicated that 65 women had average knowledge, while 72 had a moderately favourable attitude. Most participants experienced a variety of problems and implemented various remedial measures to relieve menopausal symptoms. The study concluded that there is a need to improve women's knowledge about effective measures to manage menopausal challenges.

Materials and Methods

A non-experimental, quantitative research approach with a descriptive design was employed to assess the knowledge and health-related issues of menopausal women in the rural community of Ambedkar Nagar district. The study targeted 200 women who had attained natural menopause, selected through purposive random sampling. Women who had undergone surgical menopause were excluded from the study. Data collection was conducted via structured interviews using two validated tools:

Educational qualification:

The data indicated that a majority of respondents (37.5%) were illiterate, 21 percent of the respondents had completed primary education. Approximately 13.5 percent of the respondents had completed their education up to the middle school level, while 12 percent had passed high school and 11 percent had attained education up to the intermediate level. It is very fortunate to know that 1.5 percent of the respondents were having educational qualification above than graduation.

Occupational status: Majority of the respondents (32%) were unemployed whereas among the employed respondents, 21 percent were involved in agriculture related work, while 16 percent identified as entrepreneurs.

Gardening and craft-related occupations were reported equally by 8.5 percent of the respondents each. Another 8.5 percent of women worked in shops and markets. A small proportion of women were employed as clerks or in elementary roles 1.5 percent and only 2 percent were employed in the medical profession.

Marital status:

The marital status of the respondents revealed that majority of the respondent's 65.5 percent were married. Approximately one fourth of the respondents (27.5%) was widowed, 7.5 percent were divorced and 1.5 percent were unmarried. Table 2 revealed the information about the menopausal selfcare awareness of the respondents. There was a concerning lack of comprehensive awareness among the majority of women. Majority of the respondents (50.5%) lacks the general awareness regarding the menopausal self-care whereas 49.5 percent of the respondents were aware about it. It is disheartening to note that although every woman faces menopause at some point in her life, but yet a significant proportion of the women (62.5%) were unaware of the physical changes associated with it. A significant proportion of the female respondents (77%) were unaware about the hormonal changes that occur during menopause www.extensionjournal.com whereas only 23 percent were aware about it. Hormones play a critical role in regulating our emotions, it is not surprising that a majority of the respondents were unaware about the hormonal changes during menopause, they were also unaware about the emotional changes during menopause. Only 35 percent of woman were aware about the emotional changes associated with the menopause whereas 65 percent were unaware. It is very alarming to note that majority of the respondents (62.5%) were not aware about the symptoms and health risks during menopause. It highlights a crucial need for targeted health education and community-based awareness programs for woman. It is very alarming to note that near about threefourth of the respondents (73%) were unaware about the management and treatment during menopause. This lack of awareness can lead to various complications during menopause as they may be ill-equipped to address or manage the physical and psychological consequences associated with this phase of life. The majority of respondents from Iltifatganj were wellinformed about the symptoms and health risks related to menopause. Moreover, Danpur showed the lowest www.extensionjournal.com awareness in the area of management and treatment during menopause. When it came to lifestyle modifications and preventive measures, women from Iltifatganj exhibited significantly higher levels of awareness. Overall, menopausal awareness were found highest among women in Iltifatganj. This can be largely attributed to its urban development, enhanced infrastructure, and improved educational opportunities following its elevation to Nagar Panchayat status. These factors have played a crucial role in raising awareness and understanding of menopause among the women in this village. The results of the one-way ANOVA revealed statistically significant differences in awareness regarding menopausal self-care among rural women. Specifically, a significant difference was found in general awareness (F= 19.734, p<0.001), indicating that levels of general knowledge about menopause varied notably among the groups studied. Additionally, a significant difference was observed in the domain of management and treatment (F= 3.553, p = 0.008), suggesting that women's understanding of how to manage and treat menopausal symptoms differed across groups. In contrast, no significant differences were found in the awareness regarding physical (F = 2.173, p=0.073), emotional (F = 0.964, p = 0.428) and hormonal changes (F = 2.036, p = 0.091), as well as in the domain of symptoms and health risks (F = 0.966, p = 0.427). These findings indicate that awareness in these areas was relatively low among the respondents, independent of group differences. Overall, the data suggested that while general awareness and knowledge of treatment options vary significantly, other aspects of menopausal awareness remain more uniform across the study population. In support of these findings, Sihag et al. (2024) reported a statistically significant difference in menopause-related knowledge when respondents were categorized according to their educational attainment (F = 13.08, p < 0.05). This result highlights the critical role of education in shaping women's awareness and understanding of menopausal health, particularly within rural populations. The correlation analysis revealed a statistically significant positive relationship between the education level of the respondents and their knowledge across all domains of menopausal self-care. Pearson correlation coefficients indicated moderate to strong positive correlations, all significant at the 0.01 level (2-tailed). Specifically, education was positively correlated with general awareness (r=.516, p<0.001), awareness of physical changes (r=.595, p<0.001), emotional changes (r=.586, p<0.001), hormonal changes (r =.619, p<0.001), symptoms and health risks (r=.607, p<.001), management and treatment (r=.607, p<0.001) and lifestyle prevention (r =.600, p<0.001). These findings suggest that higher levels of education were associated with a greater understanding and awareness of menopausal self-care among rural women. This is consistent with existing literature which indicates that education plays a critical role in enhancing health literacy and healthseeking behavior among women, particularly in the context of reproductive and post-reproductive health (Baber et al., 2016; Avis et al., 2009). Similarly, by Khatoon & Jahan (2018) and Borker et al. (2013) similarly reported that women with higher educational attainment were more knowledgeable about menopausal symptoms, coping strategies and available treatment options. Moreover, according to the World Health Organization (2010), health education contributes significantly to empowering women to manage menopause-related challenges more effectively.

Conclusion

This study highlights the urgent need to strengthen awareness initiatives related to peri-menopause and menopause. Efforts should focus on educating women about expected symptoms, potential complications, risk factors and associated health concerns to empower informed health decisions during this transitional phase. There is a critical necessity to promote the adoption of healthy lifestyle modifications -including balanced diet, regular physical activity, dietary supplements and a positive mental outlook -as the first line of management. Such proactive measures can significantly reduce the distressing symptoms associated with the menopausal transitionand enhance the overall quality of life for women. The findings shows that rural women with higher education levels have better awareness and understanding of menopausal self-care. This is consistent with data from the National Family Health Survey-5 (NFHS-5), which reports that premature menopause is more common among less educated women (6.8% for ages 30-39) compared to only 0.9 percent among more educated women. In light of these findings, it is imperative to implement targeted educational programs, especially in rural and underserved areas. Bridging the knowledge gap through community-based interventions and public health initiatives will empower women to manage menopause more effectively, ultimately improving health outcomes and enhancing their quality of life during this critical stage.

Limitations

As the study is conducted on the population of the Ambedkar Nagar district of Uttar Pradesh with a small sample size, therefore the results and observations will reflect only those in this geographic area and not the whole country.

Acknowledgement

AcknowledgementsAuthors would like to thank all the participants who spent their valuable time and volunteered their efforts to be a part of this study.

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