Health-care-seeking Behavior of Postmenopausal Women in an Urban Slum of Srikakulam Town

Abstract

Introduction:

The majority of Indian women tend to ignore and neglect their menopausal symptoms, which can diminish in intensity over time, leading to a reduced health-related quality of life. We aimed to assess the health-care-seeking behavior of postmenopausal women in light of the increasing burden of menopausal symptoms.

Methodology:

A cross-sectional study was carried out within urban neighborhoods, involving 384 postmenopausal women aged 45–60, to investigate the health-related issues they faced. The Menopause Rating Scale (MRS) was used to assess the symptoms experienced during the postmenopausal stage. In addition, a predesigned and pretested questionnaire was used to gather information on their health-care-seeking behavior. The participants underwent a comprehensive physical examination, including anthropometric measurements. To analyze the data, descriptive statistics were used.

Results:

The results showed that 34% of the 384 women were between the ages of 45 and 49 years. Based on the MRS assessment, it was found that around 70% of women experienced mild symptoms, whereas 24% had moderate symptoms, and a mere 2% reported severe symptoms. Regarding treatment, approximately 85% of women had sought medical intervention. However, satisfaction with the treatment was reported by only 71% of the participants. Among the women with modest symptoms, 70% received medical care, compared to 28% of the women with moderate symptoms. Women who were employed, widowed, three-generation family women, and Class IISES women made the most use of health-care facilities, with 90%, 89%, 88%, and 97%, respectively.

Conclusion:

The prevalence of faint symptoms was significantly higher than that of moderate and severe symptoms. Although most women sought treatment, many were unsatisfied with it. Therefore, behavior modification communication is necessary among postmenopausal women who seek medical care. In addition, the National Health Mission should incorporate components addressing the specific health requirements of postmenopausal women.

INTRODUCTION

Menopause is a natural and significant transition in a woman’s life that is often surrounded by misconceptions and taboos.^[1,2] It has implications for women’s health and fertility, and with improvements in lifestyle, health care, and longevity, more women are living beyond the menopause age and coping with its effects.^[3] In India, menopause is viewed positively due to the perceived benefits, such as freedom from cultural restrictions and the burdens associated with childbirth and menstruation. Older women who have gone through menopause enjoy a higher social status and are often given administrative roles. However, medical opinion considers menopause as a condition linked to various physical and psychological problems, ranging from hot flashes to severe cardiovascular and bone diseases.^[4]

According to the World Health Report, menopause typically occurs between the ages of 45 and 55 years, marking the beginning of a significant phase in women’s lives.^[5] In 1990, the global population included approximately 467 million women aged 50 and above, with 40% residing in industrialized regions and 60% in developing regions.^[6] However, projections indicate that by 2030, the distribution will shift, with 24% living in industrialized regions and 76% in developing regions. In the context of India, it is estimated that the number of postmenopausal women will reach 103 million by 2026. The average age at which menopause occurs is recorded as 47.5 years, and the average life expectancy for these women is 71 years.^[7]

The premature aging of women can be attributed to various challenges and disparities they face, such as inadequate nutrition, reproductive health concerns, hazardous work environments, violence, and lifestyle-related diseases. These factors collectively contribute to an increased risk of chronic conditions that persist beyond menopause. Poverty, solitude, and estrangement are common in old age.^[4] Health-care-seeking behavior is crucial for population health outcomes.^[8] Delayed medical care increases the risk of unfavorable outcomes. Unfortunately, most postmenopausal women do not seek treatment due to cost, normalizing their symptoms, or unawareness of treatment availability.^[9]

Efforts have focused on women of reproductive age, with little consideration for the requirements of women in their late reproductive years or postmenopausal age. Women in developing nations consider menopausal symptoms natural and do not seek medical attention. Disparities in socioeconomic status, nutritional status, and physical activity affect postmenopausal women’s physiological and psychological health.^[10] Optimizing health care for middle-aged women requires understanding their experiences, symptom descriptions, and explanations, as well as the factors that influence them.^[11] While menopause is not a disease, its symptoms and severity can be challenging, as they are subjective. Hence, we aimed to assess the health-seeking behavior of postmenopausal women in light of the increasing burden of menopausal symptoms.

METHODOLOGY

We conducted a cross-sectional survey in an urban slum, which is the field practice area of a tertiary hospital, to gather data from all postmenopausal women aged 45–60 who had ceased menstruating for more than a year. Women who refused to provide assent were excluded from the study. A sample size of 384 (32% postmenopausal women) was selected using proportional sampling. Systematic random sampling was used to conduct a house-by-house survey until the required sample size was achieved. The evaluation of menopausal symptoms involved the utilization of a predesigned and pretested pro forma in conjunction with the Menopause Rating Scale (MRS), which facilitated the grading of the obtained results. To assess health-care-seeking behavior, a predesigned questionnaire was employed. Before commencing the investigation, written consent was obtained from the participants, and the study received clearance from the institutional ethics committee (IEC). The data were entered into an Excel sheet and analyzed using Open-epi Online Software tool. The results were presented in tables and graphs as frequency and percentages.

RESULTS

In our study, we found that the majority of the 384 postmenopausal women were aged between 45 and 49 years (35%), and most of them were Hindus (59%). The urban field practice area where our study was conducted is predominantly Hindu. We evaluated the severity of menopausal symptoms in all the women using the MRS. Our findings indicate that 269 (70%) women had mild symptoms, 92 (24%) had moderate symptoms, and only 8 (2%) had severe symptoms [Figure 1]. None of the women in our study cohort experienced the most severe form of menopausal symptoms according to MRS.

Figure 1

Distribution of study participants as per their menopausal symptoms

Regarding health-care-seeking behavior, we found that 166 (43%) women preferred government hospitals, 111 (29%) preferred private hospitals, and 6 (2%) preferred self-healing. Most women (67%) walked to the health-care facility, and 212 (55%) took 15–30 min to reach the facility. Of the 384 women, 326 (85%) had received treatment, but only 273 (71%) were satisfied with it. Most women (41%) spent between 100 and 500 rupees on postmenopausal symptoms monthly, whereas 5 (1%) spent over 1000 rupees, and 192 (57%) obtained medications from a private facility. In 166 (49%) cases, women made their own health-care decisions, and in 83 (24%) cases, their spouses made the decision. Caregiving was the top health concern for 179 (53%) women, whereas finances were the top concern for 155 (46%) women [Table 1].

Table 1

Health-care-seeking behavior among postmenopausal women

We compared health-care-seeking behavior with the severity of symptoms using MRS and found that 194 (69%) of the 194 women with mild symptoms sought treatment, compared to 79 (28%) of the 79 women with moderate symptoms. All 7 (2%) women with severe symptoms had received treatment. Among women with mild postmenopausal symptoms who did not seek health care, 39 (72%) had not received any treatment for their condition [Table 2].

Table 2

Association between health-care-seeking behavior and severity of symptoms

Regarding health-care-seeking behavior, we found that 287 (85%) women sought treatment, of which 82 (88%) belonged to a three-generation family, and 133 (86%) belonged to a nuclear family. Eighty-nine percent of widows and 84% of married women had received treatment for postmenopausal symptoms. Most illiterate women (85%) utilized health-care facilities, whereas 22 (14%) illiterates and 19 (16%) who had completed primary education did not utilize any health-care facilities for their menopausal symptoms. The utilization of health-care services increased as women’s education level increased. We also found that 20 (90%) employed women and 42 (97%) women of Class II socioeconomic status utilized health-care facilities the most [Table 3].

Table 3

Association between health-care-seeking behavior and different variables of postmenopausal woman

DISCUSSION

In our study, we found that the majority of postmenopausal women believed that the medical issues they encountered were the result of aging and denied receiving treatment for their condition. Among the 334 women surveyed, 233 (69%) experienced mild postmenopausal symptoms, 80 (23%) individuals reported moderate postmenopausal symptoms, whereas only 7 (2%) experienced severe symptoms. In a study conducted in Mohali, the findings revealed a contrasting picture, with 44% of participants experiencing severe psychological distress, 21% reporting moderate psychological symptoms, 19% suffering from severe urogenital symptoms, and 17% experiencing severe somatic symptoms.^[12] Of the women surveyed in our study, 166 (49.70%) preferred government hospitals, 111 (33%) preferred private hospitals, and 6 (1%) preferred to heal themselves. While 287 out of 334 women (85%) had received treatment, only 205 (71%) were satisfied with it. Among those who received medications, 57% obtained them from a private hospital. The greatest health-related concerns of the women surveyed were caretaking and finances, with 179 (53%) and 155 (46%) citing these issues, respectively. However, many women were reluctant to discuss these topics, considering them taboo and attributing the prevalent issues to age-related factors.

In a study conducted in Nepal, it was found that 69.2% of the participants relied on sanitation methods to alleviate their symptoms, whereas 51.3% engaged in physical activity.^[13] Regarding treatment, approximately 62% sought medical care, 11.1% consulted traditional physicians, and a small percentage opted for hormone replacement therapy (HRT). On the other hand, a similar study carried out in Delhi reported that 64.5% of postmenopausal women were not receiving any treatment, with only 35.5% receiving treatment for various symptoms and none of them using HRT.^[9] The primary reason cited for not receiving treatment was the inability to afford the cost of medications (19.5%), and some women mentioned a lack of motivation to take their prescribed medications (12.5%). In the same study, it was observed that 83% of women from joint families received treatment for their symptoms, whereas 11% of women from nuclear families did not. In addition, 36.6% of postmenopausal women from the lower-middle class and 34.9% from the upper-lower class were undergoing treatment, whereas 65.1% of those from the upper-lower class were not receiving any treatment.

In a study conducted in Bengaluru, only 21.7% of participants received treatment for menopausal symptoms, which is lower than the current study.^[14] Few women in the study resorted to using calcium or ayurvedic medicine to address their menopausal symptoms. The participants held the belief that these symptoms were typical for their age, would resolve on their own, and therefore, did not require serious attention. Some women lacked awareness regarding the availability of treatment options, while others refrained from seeking medical care due to familial or financial limitations. Similar to the findings of our study, approximately 9% of respondents stated that they do not like to visit hospitals or consume pills.

There are few limitations in our study. Our study includes women from a specific geographic area, which limits the generalizability of the findings to other populations. Our study did not explore the cultural or societal factors that may influence women’s attitudes and beliefs about menopause and treatment.

CONCLUSION

Identifying and managing postmenopausal symptoms early can improve the quality of life for women going through this transition. The findings of this study suggest the need for greater awareness, education, and support for women experiencing menopause, particularly in the context of preventative care. Establishing postmenopausal clinics can be an effective approach toward addressing the needs of these women.