Keywords
risk factors - urogenital problem - perimenopausal women
Introduction
Menopause is the permanent cessation of menstruation which is retrospectively determined
following 12 months of amenorrhea during a midlife period and the most identifiable
event of the perimenopausal period. The year immediately preceding and the decade
afterward, however, are of far greater clinical significance. The perimenopausal period
encompasses the time before, during, and after menopause.[1] Menopausal health demands priority in the Indian scenario due to increased life
expectancy and the growing population of menopausal women. Most are either unaware
or do not pay adequate attention to urogenital problems.[2]
The most prevalent urogenital symptoms are vaginal dryness, vaginal irritation, and
itching. Other urogenital complaints include dyspareunia, vaginal bleeding, frequency,
nocturnal urgency, stress urinary incontinence, and urinary tract infections.[3] Increasing life expectancy has accompanied more women approaching menopause, and
a majority of these women may spend one-third of their lives in postmenopausal years.
Due to this growing population of menopausal women in India, their health demand is
becoming a top priority. There has been an alarming increase in the population in
India where there is a need to know factors contributing to the urogenital problems.[4] This study was undertaken in this context.
Methods
An explorative survey design was adopted for the study. The sample size was calculated
by using estimation of proportion, as the participants were from the hospital and
from the community; a purposive sampling technique was used to collect data. A total
of 200 women were selected from Justice K.S. Hegde Charitable Hospital and Urumane
Community under Natekal Public Health Center and aged 40 years and above who have
perimenopausal symptoms. In contrast, women who had congenital anomalies, were suffering
from severe medical illness or were critically ill, had undergone surgery, and were
on treatment were excluded from the study. Ethical consent for the work was given
by the ethical committee NUINS/CON/NU/IEC/ 2019–20/1471 of the institute on April
10, 2019. Written permission was obtained from the concerned authority. The study’s
purpose and objectives were explained to the subjects; before data collection, informed
written consent and participant information sheet was administered to the participants.
A demographic proforma consisting of 8 items and a checklist on factors contributing
to the urogenital problem consisting of 6 items were the tools used to collect data
from the women. The reliability of the tool was assessed by using Cronbach’s α, and
it was found that the tool was reliable (0.82). The tool was given to experts in the
field of community health, medical–surgical nursing, and public health for validation.
The data were analyzed by using frequency percentage, and the chi-square test was
used to find the association.
Results
The mean age of the women was 53 ± 6 years, most of the subjects had primary education
143 (71.5%), and the majority 156 (78%) were homemakers. The majority, 103 (51.5%),
had income between Rs. 3,500 and Rs. 4,000. The majority, 112 (56%), had more than
three children. The majority, 112(56%), belonged to a joint family. Total 156 (78%)
had a history of normal delivery. The study also revealed that 85 (42.5%) had urinary
tract infections, 49 (24.5%) had urinary retention, 30 (17.5%) had vaginal dryness,
17 (8.5%) had urinary incontinence, and 14(7%) had loss of libido ([Table 1]).
Table 1
Description of demographic characteristics of the subjects (N = 200)
|
S. No.
|
Demographic characteristics
|
Frequency
|
Percentage
|
|
1.
|
Age (y)
|
|
|
|
41–50
|
48
|
24
|
|
51–60
|
120
|
60
|
|
Above 60
|
32
|
16
|
|
2.
|
Education
|
|
|
|
No formal education
Primary education
Secondary education
|
20
143
37
|
10
71.5
18.5
|
|
3.
|
Occupation
|
|
|
|
Housewife
|
156
|
78
|
|
Working woman
|
44
|
22
|
|
4.
|
Income status (Rs.)
|
|
|
|
<3,000
|
19
|
9.5
|
|
3,500–4,000
|
103
|
51.5
|
|
4,000–4,500
|
59
|
29.5
|
|
>5,000
|
19
|
9.5
|
|
5.
|
No. of children in the family
|
|
|
|
1
|
10
|
5.0
|
|
2
|
61
|
30.5
|
|
3
|
112
|
56.0
|
|
More than 3
|
17
|
8.5
|
|
6.
|
Type of family
|
|
|
|
Nuclear family
|
88
|
44
|
|
Joint family
|
112
|
56
|
|
7.
|
Mode of delivery
|
|
|
|
Normal delivery
|
156
|
78
|
|
Caesarean
|
44
|
22
|
|
8.
|
Urogenital problems
|
|
|
|
Urinary tract infection
|
85
|
42.5
|
|
Urinary retention
|
49
|
24.5
|
|
Loss of libido
|
14
|
7.0
|
|
Vaginal dryness
|
35
|
17.5
|
|
Urinary incontinence
|
17
|
8.5
|
Assessment of risk factor showed that 24 (12%) had a habit of drinking alcohol, 19
(9.5%) chewed tobacco, 24 (12%) underwent removal of the uterus in the past, 43 (21.5%)
had diabetes, 86 (43%) had a history of hypertension, 25 (12.5%) had both diabetes
and hypertension, 5 (2.5%) underwent hormone replacement therapy, 44 (22%) had the
history of cesarean delivery, and 15 (7.5%) had a previous history of abdominal gynecological
surgery ([Table 2]).
Table 2
Assessment of risk factors of urogenital problems (N = 200)
|
S. No.
|
Risk factors
|
Frequency
|
Percentage
|
|
1.
|
Drinking alcohol
|
|
Yes
|
24
|
12
|
|
No
|
176
|
88
|
|
2.
|
Chewing tobacco
|
|
Yes
|
19
|
10
|
|
No
|
181
|
90
|
|
3.
|
History of removal of the uterus
|
|
Yes
|
24
|
12
|
|
No
|
176
|
88
|
|
4.
|
History of diabetes
|
|
Yes
|
43
|
21.5
|
|
No
|
157
|
78.5
|
|
History of hypertension
|
|
Yes
|
86
|
43
|
|
No
|
114
|
57
|
|
Both hypertension and diabetes
|
|
Yes
|
25
|
12.5
|
|
No
|
175
|
87.5
|
|
5.
|
Hormone replacement therapy
|
|
Yes
|
5
|
2.5
|
|
No
|
195
|
97.5
|
|
6.
|
Abdominal gynecological surgery
|
|
Yes
|
15
|
8
|
|
No
|
185
|
92
|
The chi-square value was 21.6 (p > 0.05) at a 5% level of significance; it indicates a significant association between
urogenital problems and risk factors ([Table 3]).
Table 3
Association of between urogenital problems with risk factors by using chi-square test
(N = 200)
|
Urogenital problems
|
Risk factors
|
Urogenital factors
|
Chi-square
|
DF
|
p-Value
|
|
<1
|
>2
|
|
Urinary tract Infection
|
48
|
37
|
|
|
|
|
Urinary retention
|
28
|
21
|
21.6
|
5
|
0.01
|
|
Loss of libido
|
4
|
10
|
|
Vaginal dryness
|
16
|
4
|
|
Urinary incontinence
|
13
|
4
|
The result depicts that there was an association between a selected demographic variable
with risk factors like occupation (0.023; p < 0.05), parity (0.023; p < 0.05), and mode of delivery (0.023; p < 0.05) ([Table 4]).
Table 4
An association between demographic variables and risk factors by using a chi-square
test (N = 200)
|
Demographic variables
|
Urogenital risk factors
|
Chi-square
|
DF
|
p-Value
|
|
Abbreviations: NS, nonsignificant; S, significant.
|
|
Age (y)
|
41–50
|
<1
|
>2
|
3.551
|
2
|
0.169
p > 0.05
NS
|
|
26
|
22
|
|
51–60
|
74
|
46
|
|
>60
|
24
|
8
|
|
Education
|
No formal education
|
13
|
7
|
3.45
|
2
|
0.180
p > 0.05
NS
|
|
Primary education
|
93
|
50
|
|
Secondary education
|
18
|
19
|
|
Occupation
|
Housewife
|
106
|
55
|
5.16
|
1
|
0.023
p < 0.05
S
|
|
Working woman
|
18
|
21
|
|
Income (Rs.)
|
<3,000
|
8
|
11
|
5.47
|
3
|
0.140
p > 0.05
NS
|
|
3,500–4,000
|
68
|
35
|
|
4,000–4,500
|
34
|
25
|
|
>5,000
|
14
|
5
|
|
No. of children
|
1
|
3
|
7
|
11.52
|
3
|
0.023
p < 0.05
S
|
|
2
|
32
|
29
|
|
3
|
80
|
32
|
|
>3
|
9
|
8
|
|
|
|
|
Type of family
|
Nuclear family
|
51
|
37
|
1.09
|
2
|
0.579
p > 0.05
NS
|
|
Joint family
|
73
|
39
|
|
Mode of delivery
|
Normal delivery
|
107
|
49
|
13.0
|
1
|
0.023
p < 0.05
S
|
|
Cesarean delivery
|
17
|
27
|
Discussion
Menopause is a physiological event that occurs in all women who reach midlife; in
the present study the mean age of the women was 53 ± 6 years, whereas the study conducted
in an Estonian postmenopausal women showed the mean age group of 53.3 years.[5] In a study by Swanson et al (2017), the mean age was 53.1.[6] In the present study, 190 (95%) women were multiparous; similar findings were observed
by Oliveira et al (2013), where a majority of the women were multipara.[7] The present study depicts that 143 (71.5%) women had primary education and similar
finding was shown in a study by Oskayi (239 [48.8%]).[8] In the present study majority 156 (78%) of the women were homemakers; similar finding
was obtained from the study by Suchithra et al, where the majority of the women were
homemakers.[9] The study also revealed that 85 (42.5%) women had urinary tract infections; the
study by Ai-Badr et al showed that 50 to 60% of women will develop urinary tract infections
in their lifetimes.[10] In the present study, 49 (24.5%) women had urinary retention, 14 (7%) had loss of
libido, and 17 (8.5%) had urinary incontinence; similar findings can be observed in
the 2016 study by Nath et al, which showed loss of libido (34.6%), vaginal dryness
(26.5%), incontinence of urine (21.5%), and recurrent urinary tract infections (7.7%).[4] The present study depicts 30 (17.5%) women who had vaginal dryness. A study by Gupta
et al (2018) showed that vaginal dryness was the most common complaint 62%.[11]
The present study shows that factors like the habit of drinking alcohol in 24 (12%)
women, chewing tobacco in 19 (9.5%) women, 24 (12%) women with a history of hysterectomy,
43 (21.5%) women having diabetes, 86 (43%) women with a history of hypertension, 25
(12.5%) having both diabetes and hypertension, 5 (2.5%) who underwent hormone replacement
therapy, 44 (22%) with the history of cesarean delivery, and 15 (7.5%) women who had
a previous history of abdominal gynecological surgery were of importance. These findings
were supported by the study of Chang et al which revealed that diabetic mellitus (odds
ratio [OR] = 1.653; 95% confidence interval [CI] 1.105–2.474) was the risk factor
for urinary problems.[12] Similar findings were obtained in the study by Sensoy et al (2013), which showed
that hypertension, diabetes, and parity are associated with urinary incontinence as
risk factors.[13] These findings were also supported by Biswas et al (2017) that the history of gynecological
operation (adjusted odds ratio 3.84 [1.16–12.66]) was the factor.[14]
The chi-square value was 21.6 (p > 0.05) at a 5% level of significance. It indicates there was a significant association
between urogenital problems and risk factors. Also, there was an association between
a selected demographic variable with risk factors like occupation (0.023; p < 0.05), parity (0.023; p < 0.05), and mode of delivery (0.023; p < 0.05); it was correlated with the study by Singh et al (2013) which shows that
multiparty, vaginal delivery, and menopause were found to be significantly associated
with overall incontinence.[15]
Conclusion
This study highlights the urogenital problems experienced by perimenopausal women.
There is a need to develop informational and educational programs that create awareness
among women about these problems so that they can recognize these symptoms early and
address them correctly.
This study focused on the identification of risk factors of urogenital problems. The
study was limited to only a single community of women population and focused only
on the identification of risk factors. This study can be enhanced by undertaking specific
interventions to improve the quality of life in women with urogenital problems. Health
awareness will help women to become aware of many problems and be able to prevent
any further complications.
