Nutritional status and perimenopausal symptom recognition in women during perimenopause: An assessment study

Introduction

Perimenopause, or the menopausal transition, is a significant phase in a woman's life characterized by hormonal fluctuations and physiological changes. This transition, lasting approximately four to nine years, precedes menopause, the complete cessation of menstruation typically occurring around 45.5 years of age, though individual variations exist (Kalita et al., 2024; Srivastava & S, 2024) [1,2] . Fluctuations in estradiol and progesterone levels during this period contribute to a wide range of symptoms, affecting physical, psychological, and sexual health. Women frequently experience irregular menstrual cycles, hot flashes, night sweats, sleep disturbances, cognitive difficulties, and musculoskeletal discomfort (Bagga et al., 2024; Joffe et al., 2020) [3,4] . Additionally, issues such as vaginal dryness, dyspareunia, and reduced libido significantly impact emotional well-being and relationship satisfaction (Manisha, 2024; Ibeachu & Uahomo, 2024; Andrews et al., 2024) [5,6,7] . Beyond physical symptoms, perimenopause is often associated with heightened psychological distress, including anxiety and depression, necessitating routine mental health screening (Dar et al., 2020) [8] . Studies indicate that strained familial relationships further exacerbate emotional distress, highlighting the importance of strong support systems (Johnson et al., 2018) [9] . Broader socio-demographic factors, such as education level and access to healthcare, also influence perimenopausal well-being. Culturally sensitive and equitable healthcare models are essential for ensuring effective management strategies tailored to diverse populations (Evans et al., 2024; Manisha, 2024) [10,5] . With the global population of perimenopausal women projected to reach 1.2 billion by 2030, the demand for effective healthcare interventions is increasing, particularly in developing nations (Siusiuka et al., 2024) [11,15] . Studies from China and India report a high prevalence of moderate to severe perimenopausal symptoms, including hot flashes, fatigue, and mood swings (You et al., 2024; Umamaheshwari & Anitha, 2024) [12,13] An integrated approach combining medical interventions, lifestyle modifications and counselling is essential for symptom management and overall well-being (Kuruvilla & Sagare, 2024) [14] . Engaging in regular physical activity, maintaining a healthy weight and managing stress have been shown to alleviate symptoms and promote long-term health benefits (Siusiuka et al., 2024) [11,15] . Furthermore, participation in religious and social networks enhances emotional resilience and mental well-being (Yingngam, 2024; Kalita et al., 2024) [16,1] . Hormonal changes during perimenopause also increase the risk of cardiovascular disease and osteoporosis (Vohra & Kaur, 2024) [17] . However, research suggests that midlife mood disturbances are often linked to daily stress, poor health, and a history of depression rather than hormonal fluctuations alone (Vohra & Kaur, 2024) [17] . These findings underscore the need for comprehensive healthcare approaches that address both physiological and psychological aspects of perimenopause. Lifestyle-based strategies, including a balanced diet, regular exercise and cognitive behavioural therapy, have demonstrated effectiveness in managing perimenopausal symptoms (Bagga et al., 2024) [3] . Alternative therapies, such as Ayurvedic treatments, have also shown promise in mitigating symptoms with minimal side effects (Manisha, 2024) [5] . A multidisciplinary approach integrating medical, psychological and lifestyle interventions is crucial for holistic care. Educational initiatives, social support and individualized healthcare empower women to navigate this transition more effectively (Manisha, 2024; Ibeachu & Uahomo, 2024) [5,6] . Addressing sexual health concerns through therapeutic interventions further enhances intimacy and overall quality of life (Bagga et al., 2024) [3] . By adopting a holistic and inclusive approach, healthcare providers can improve the overall health and well-being of perimenopausal women, ensuring they receive the necessary support to manage this life stage effectively.

Methodology

Sample selection -Purposive sampling technique was employed to select 90 perimenopausal women in the age group of 35-50 years from different areas of Ambala (Haryana).

Inclusion Criteria

 Women aged between 35 to 50 years, residents of Ambala, Haryana  Self-reportedly undergoing perimenopause  Having elevated lipid profiles and hypertensive status Exclusion criteria  Women outside the specified age range, not undergoing perimenopause and pregnant or breastfeeding  Individuals with a history of cardiovascular disease/ renal failure/ diabetic/ neuromuscular diseases or using medications affecting neuromuscular function.  Use of hormone replacement therapy or other medications potentially altering body composition.  Women who are either unwilling to participate in the study or have not provided their consent.

Informed Consent

Written informed consent was obtained from all participants prior to their inclusion in the study.

Ethical Approval and Trial Registration

Ethical approval for the study was obtained in accordance with the guidelines of the Clinical Trial Registry of India (CTRI).

Data collection

A predesigned and pretested questionnaire-cum-interview schedule was utilized to collect information regarding sociodemographic characteristics, awareness and attitudes towards perimenopause, nutritional status, food habits and dietary patterns and various perimenopausal symptoms categorized under physical, psychosomatic, vasomotor, psychological, sexual, urogenital symptoms, and others.

Assessment of body measurements

Anthropometric data, such as weight, height and the circumferences of the waist and hip, were systematically documented. Following this, the body mass index (WHO, 2004) [19] and waist-to-hip ratio (WHO, 2008) [20] were calculated.

Statistical analysis:

Data collected was organized, compiled and analysed in terms of mean and percentage.

Findings and Discussion

The study involved 90 perimenopausal women. Table 1 presents their socio-demographic characteristics. Approximately half of the participants were aged between 41 to 45 years, one-third were between 46 and 50 years old and the remaining 21 percent were between 36 and 40 years old. Half of the subjects were Hindu, while the rest were Sikh (49%). More than half of the subjects were postgraduates, followed by graduates and those with higher secondary education. Three-fourths of the subjects were housewives, while one-fourth were employed. Marital status showed that 88 percent were married, 3 percent were widows and 8 percent were divorced. Lastly, 80 percent of the participants belonged to nuclear families and 20 percent were from joint families 1). The mean perimenopausal age reported in this study was 41.8±3.91 years. The exact age at which perimenopause occurs varies across populations. Table 3 of the study, which surveyed 90 subjects, presents findings on awareness and attitudes regarding perimenopausal symptoms. Among the participants, 27 percent (n = 24) were aware of perimenopause, while the majority (73%) lacked awareness (Figure 2). Insufficient knowledge often leads to inadequate coping strategies and poor healthcare-seeking behaviours. This is evident in a Chinese study where only a small percentage of women sought medical care for menopausal symptoms (You et al., 2024) [12] . Research emphasizes the importance of education and support in effectively managing perimenopausal symptoms, suggesting that increased awareness could significantly enhance women's quality of life (Manisha, 2024; Soumya et al., 2024) [5,21] . [19] and WHR table (WHO, 2008) [20] . The data revealed that only 14 percent of the respondents had a normal BMI. Among the remaining 86 percent, 2 percent were underweight. Of the rest, 54 percent were overweight, 16 percent were classified as grade I obese, 20 percent as grade II obese, and 4 percent as grade III obese. When classified according to WHR, the majority of the subjects (92%) were obese. These findings underscore the prevalent obesity trends among the study population, highlighting the need for targeted interventions in managing nutritional health. [19] Table 5 investigated the food habits and dietary patterns of 90 respondents. More than two-thirds of the respondents (73%) were vegetarian, while approximately one-fifth (19%) were non-vegetarian and the remaining 8 percent were ova-vegetarian. Regarding daily meal frequency, about two-thirds (70%) consumed two meals a day, whereas the other third (30%) had three meals. When it came to skipping meals, roughly one-quarter (24%) did so regularly, while three-quarters (76%) skipped meals occasionally. Among those who skipped meals, around one-seventh (14%) did so daily, more than three-quarters (77%) skipped meals 2-3 times a week and about one-tenth (9%) skipped meals weekly. Breakfast was the most frequently skipped meal, with two-thirds (66%) skipping it, followed by dinner (20%) and lunch (14%). The data reveals that breakfast is the most frequently skipped meal, with a significant portion of individuals skipping it daily or multiple times a week, highlighting the need for interventions to promote regular breakfast consumption and address the associated health and lifestyle consequences. The primary reasons for skipping meals included lack of time (79%), dieting (17%), and absence of company (4%). A significant majority, over four-fifths (82%), reported fasting regularly, with the frequency being monthly for more than half (53%), weekly for nearly one-third (32%), and fortnightly for 15 percent of respondents. Table 6 of the study examined the prevalence of perimenopausal symptoms among the subjects, revealing a wide range of physical, psychosomatic, vasomotor, psychosocial, sexual and urogenital issues. Among the physical symptoms, 89 percent of the participants reported a decrease in strength and stamina, while 76 percent experienced aching muscles and joints. Psychosomatic symptoms were also prevalent, with 86 percent reporting disruptions in sleep and 77 percent experiencing mood swings.

Vasomotor symptoms were prevalent among the respondents, with 76 percent experiencing hot flashes and 91 percent reporting sweating. Psychosocial symptoms were notably high, with 86 percent of the participants reporting anxiety, 95 percent feeling depressed and 91 percent experiencing irritability. Sexual symptoms included changes in sexual desire (57%) and avoidance of intimacy (31%). Urogenital symptoms were also reported, with 41 percent experiencing vaginal dryness and 52 percent having bladder problems. Additionally, 56 percent of the respondents reported heart discomfort (Figure 3) Sexual and urogenital symptoms, such as decreased sexual desire and vaginal dryness, align with findings (Taziki et al., 2024) [22] from a Middle Eastern study, where 71.3 percent of women reported sexual problems. These data underscore the multifaceted nature of perimenopausal symptoms and highlight the need for comprehensive care and support during this transitional phase

Conclusion

The lack of awareness surrounding perimenopause highlights a crucial gap in knowledge that must be addressed through targeted education and improved healthcare support. Enhancing understanding of perimenopause can significantly improve women's quality of life during this transition, benefiting not only individuals but also their families and communities. Despite the widespread prevalence of symptoms such as hot flashes, mood changes, and joint pain, many women report limited knowledge about menopause management, emphasizing the urgent need for accessible, evidence-based healthcare services and educational resources 1 . Implementing comprehensive educational programs and accessible healthcare services tailored to perimenopausal women is essential, as these initiatives can improve symptom management and promote healthier lifestyle choices. The lack of open discussions and inadequate guidance from healthcare professionals, particularly regarding symptoms affecting sexual health, underscores the need for enhanced medical education and training (Simic et al., 2024) [23] . A biopsychosocial approach that integrates both pharmacological and non-pharmacological strategies such as cognitive behavioural therapy, yoga, and mindfulness has shown potential in alleviating symptoms like hot flashes, depression, and anxiety, ultimately improving overall wellbeing (Evans et al., 2024) [10] . Additionally, health coaching interventions have demonstrated effectiveness in enhancing self-management abilities and satisfaction with healthcare services (Wan et al., 2024) [24] . Furthermore, incorporating contraceptive consultations into perimenopausal care can help manage symptoms while reducing the risk of unplanned pregnancies, ensuring a more individualized approach to treatment (Belcher et al., 2024) [25] . The need for culturally sensitive and personalized care is particularly evident among women from diverse backgrounds, as healthcare systems often fail to accommodate non-Western populations, exacerbating barriers to effective management (Kirchengast, 2024) [26] .

Online communities have emerged as valuable platforms for women to share experiences and coping strategies, yet many still feel unprepared for the intensity and duration of perimenopausal symptoms. This highlights the importance of bridging knowledge gaps through structured education, healthcare support and proactive symptom management ( Shepherd et al., 2024) [27] . By integrating education, medical support, and diverse treatment options, a more holistic and inclusive approach to perimenopausal care can be achieved. Addressing these gaps through comprehensive healthcare strategies will not only enhance the quality of life for perimenopausal women but also contribute to broader well-being ( [5, 10, 23, 26, 27] .

Recommendations

Increasing awareness and education through comprehensive programs is crucial, as these initiatives have been shown to improve knowledge, alleviate symptoms, and enhance overall well-being by providing accurate and accessible information on perimenopause (McFeeters et al., 2024) [28] . Strengthening healthcare support by establishing specialized clinics and training healthcare providers is vital, as nurses and other professionals play a key role in counselling and guiding women through this transition with evidence-based care (Flanagan & Fantasia, 2024) [29] . In addition, nonpharmacological interventions including regular exercise, a balanced diet, clinical yoga, and mindfulness-based cognitive therapy have been empirically supported to reduce symptoms and improve quality of life (Evans et al., 2024; Abd Elmoneem et al., 2024) [10,30] . For women experiencing severe symptoms, pharmacological options such as hormonal contraceptives and menopausal hormone therapy should be considered based on individual risk profiles and preferences, as these treatments can provide effective relief (Flanagan & Fantasia, 2024) [29] . Addressing mental health is also essential, with counselling and cognitive behavioural therapy for insomnia playing a crucial role in psychological well-being during menopause (Evans et al., 2024) [10] . Encouraging research and innovation in new treatments and management strategies will further improve care options. Simultaneously, strengthening community and family support through social programs can foster greater understanding and assistance within households (Manisha, 2024) [5] . Finally, policy reforms ensuring comprehensive insurance coverage and workplace accommodations for women experiencing severe perimenopausal symptoms are critical to creating a more supportive environment that enhances their overall quality of life (Evans et al., 2024) [10] .

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