The following paragraph will give an introduction and explain the significance of the survey in the nursing field.
The survey intent, aims, and the survey inquiry are mentioned in this chapter as well as in the background of the study. The World Health Organization (1990) reported that by the year 2030, approximately 1.2 billion adult women in the world will be at least 50 years old. It is predicted that there will be an increase in the number of older women in the future. According to the National Centre for Health Statistics (2003), women now have a life expectancy of 79.8 years. Although women's life expectancy has increased, concerns arise regarding their health status and quality of life.
The National Institute of Health (1991) developed a strategy to improve women's health. The initial National Institute of Working Conference (1993) suggested investigating the impact of menopause on women's health an...
d quality of life. In 1999, the research plan expanded to include diverse populations of women, leading to advancements in menopause research covering various aspects such as the menopausal transition, physiology, symptoms, and their interconnections. Consequently, there is a need for further studies on menopausal experiences in developing countries where women spend a significant portion of their postmenopausal lives. Menopause is a universal biological process that occurs in all midlife women.
According to the World Health Organization (1990), menopause is a significant event that occurs during the process of menopausal transition, encompassing the period before and after menopause. This transition represents a shift from reproductive ability to post-reproductive life as part of the aging process (Kaufert, 1990; Lock, 1986). Menopause signifies the cessation of menstruation and fertility due to depletion
of ovarian function (Lyons & Griffin, 2003).
The experience of menopause varies among women in midlife due to diverse socio-cultural norms and individual knowledge (George, 2002). Kaufert (1996) further elucidates that women's experience also relies on their health during this stage, which can be influenced by factors such as cultural beliefs about health and disease, attitudes towards medical interventions,reproductive histories,differences in environmental conditions at birth and throughout life,and exposure to diseases.
According to the bio-cultural perspective, the experience of menopause is influenced by both physiological and cultural factors (George, 2002). As stated by Lock (1986), menopause holds biological and socio-cultural significance. Cultural values, attitudes, and beliefs about mid-life are transmitted within a particular society, shaping a woman's understanding of her experiences. Eastern women view menopause as a natural process and perceive this life stage more positively compared to Western women. Hafiz and Eden (2007) suggest that the differences in attitudes towards menopause between Eastern and Western women are more influenced by cultural factors rather than biological ones. Menopausal women from Asia tend to experience fewer menopausal symptoms due to their elevated societal status in older age, which leads to respectful regard for older women as wise matriarchs within the family.
The perception of climacteric varies across cultures. Women from Europe and North America often encounter more menopausal symptoms and seek medical help more frequently. Additionally, as these women grow older, they may face a decrease in societal standing, resulting in reduced self-assurance and the formation of unfavorable attitudes. Rural women possess distinct requirements and confrontations during menopause (Price, 2007; 1m, 2008).
In rural areas, women often face neglect, isolation, and restricted access to healthcare facilities due to their unique
geographical and socio-cultural environment. In Pakistan, women lack awareness about the symptoms and long-term effects of menopause, considering it a natural part of life (Malik, 2008; Nusrat et al., 2008). While existing literature has explored various aspects of menopausal experiences for women in general, there is limited information available on the experiences of menopausal women in Pakistan. Only a few quantitative studies have been conducted in Pakistan on factors such as age, patterns, characteristics, attitudes, and symptom experiences among menopausal women (Malik, 2005; Nusrat et al., 2008; Wasti,
2006; Yahya & Rehman,
All of the studies conducted so far have utilized a questionnaire to gather data on women's menopausal experiences in Pakistan. However, none of these studies have employed a qualitative method. Therefore, it is crucial to incorporate a qualitative approach in order to gain a more comprehensive understanding of these experiences.
Significance of the Proposed Survey in Nursing
With advancements in technology and science leading to increased life expectancy, women are now living longer lives. Consequently, menopause becomes an inevitable phase of their existence. Conducting this survey would offer fresh perspectives and insights into the current knowledge regarding menopausal experiences among women residing in Karachi, Pakistan.
The main objective of this survey is to enhance nurses' comprehension of menopausal adult females and instruct them on how to manage their menopausal symptoms and overall health during this phase of life. In addition, nurses will gain an understanding of the various factors that can influence women's experience with menopause. Irrespective of their location or role, nurses, healthcare workers, and nurse practitioners will be capable of providing tailored health education based on each woman's socio-cultural background. They can also arrange
sessions where women can exchange their experiences and receive guidance on coping with their menopausal symptoms. It is crucial for nurses in hospitals and other healthcare facilities to possess knowledge about the midlife menopausal symptoms encountered by women so they can effectively comprehend and address their menopause.
The previous research on menopausal symptoms can be utilized to further investigate the climacteric experience of women residing in Karachi, Pakistan. This research may also assist others who wish to explore different aspects of menopause in the same country.
Study Purpose and Aims
The purpose of this study is to examine the climacteric experience of women living in Karachi, Pakistan. The aims include gaining insight into women's perceptions of menopause, understanding the impact it has on their lives, exploring challenges faced by menopausal women, and identifying strategies used to manage these challenges.
What is the climacteric experience of adult females living in Karachi, Pakistan?
Chapter TWO - Literature Review
Menopause is a natural process that all women around the world experience in their midlife. Menopause is defined as the depletion of ovarian function, leading to the cessation of menstruation and the end of fertility (Lyons & Griffin 2003). This section provides an overview of the literature reviewed, relevant to the study, and highlights the research conducted on this topic. The forthcoming literature is divided into different sections. First, it discusses the physiology of the human menstrual cycle and the mechanisms initiating menopause. Second, it explores the historical development of research on menopause. Third, it examines the concepts and meanings associated with menopause. Fourth, it examines factors influencing and affecting menopausal experiences. Finally, it compares studies conducted in both USA and South Asia.
Cycle Physiology and the Mechanism of Menopause Initiation
The human menstrual cycle is regulated by the hypothalamic pituitary-ovarian axis and consists of four (4) events. The first event is the release of follicle-stimulating hormone (FSH), which stimulates ovarian follicle development and estradiol production (Hiller, Reichert & Van, 1981). Throughout the menstrual cycle, estrogen maintains low levels of gonadotropin by negatively influencing hypothalamic gonadotropin-releasing hormones such as luteinizing hormone (LH) and FSH secretion (Yen, Tsai, Vandenberg & Rebar, 1972). Subsequently, FSH induces an increase in ovarian estrogen secretion leading to a positive feedback LH surge (Young & Jaffe, 1976). The third event involves the LH surge triggered by estrogen stimulation as a response from the hypothalamus and pituitary gland. This positive feedback loop between estrogen and LH secretion has been used as a test for assessing hypothalamic-pituitary function (Weiss, Nachtigall & Ganguly, 1976).
The final stage of the menstrual cycle, called ovulation, involves the ovaries releasing eggs. This is triggered by a rush of luteinizing hormone (LH) and results in the development of the corpus luteum. The corpus luteum then stimulates progesterone secretion, which is needed for pregnancy (Vande et al, 1970). In women, menopause is thought to be caused by ovarian failure and follicle depletion. However, recent studies on menopausal women suggest that clinical symptoms and new information indicate potential involvement of the central nervous system.
(Weiss et al, 2004). The Study of Women's Health across the Nation (SWAN) aimed to investigate if changes in the hypothalamic-pituitary response to estrogen feedback could potentially cause menopause in older reproductive-age women. Three groups of women were studied: those who had an increase in both estrogen and LH release, those who
experienced an increase in estrogen without LH release, and those who did not have an increase in either estrogen or LH release. Older reproductive-age women commonly had cycles without ovulation and high levels of estrogen, suggesting that the positive impact of estrogen on LH secretion failed to initiate and stimulate ovulation.
In women with anovulatory patterns, the levels of follicular estrogen did not decrease LH secretion as it did in younger reproductive age women. This suggests that there is a decreased estrogen-negative feedback on LH secretion. The conclusion was that there is hypothalamic-pituitary insensitivity to estrogen in aging perimenopausal women.
Historical Development of Research Support on Menopause
In 1993, the first National Institute working conference recommended research on menopause. In 1999, the NIH research agenda included focusing on diverse populations of women. The Seattle Midlife Women's Health Study was a longitudinal study conducted from 1990 to 2000. It analyzed FSH levels during different phases of menopausal transition (early, middle, and late) using a menstrual cycle calendar. The study compared reproductive age women to perimenopausal women's menstrual patterns and urinary estrone and FSH levels during late reproductive, early menopausal transition, and postmenopausal transition phases.
Study of Women's Health Across the Nation (SWAN) commenced in September 1994 with the aim of portraying the timeline, biological and psychosocial aspects of menopausal transition. Another objective was to illustrate the impact of this transition on health and risk factors for age-related chronic conditions. The study emphasized the inclusion of multi-ethnic and community-based samples. SWAN involved a daily hormone survey spanning several years, as well as annual blood draws, interviews, clinical tests, and questionnaires.
Multiple cultural groups of adult females, including Africans, Chinese, Japanese, Hispanics, and
White Americans, were included in this survey. The workshop called the phases of generative aging work store (STRAW) took place in Park City, USA in 2001. The purpose of this workshop was to develop a standardized system for studying menopause. The advantage of this system is that researchers and clinicians can compare cases and data across different studies, allowing women to understand the timing and duration of menopause.
This system follows a sequence of seven phases. The Reproductive Interval is encompassed by phases -5 to -3, the Menopausal passage by phases -2 to -1, and the station Menopause by phases +1 to +2 (Soules et al, 2001). In March 2005, the office of medical applications of research in the USA held a conference on managing symptoms related to climacteric to better understand their correlation with the phase of climacteric passage. A longitudinal study, known as the Seatle midlife adult females' wellness survey, was conducted from 1990 to 2006. It aimed to chart the natural passage to menopause for a population-based sample of white, Asian, and African American adult females aged between 35 and 55 (n=375) (Soules et al, 2001).
The woman's wellness diary was used to record daily activities for three days each month. In addition, a monthly urine sample was taken for hormonal analysis and an annual evaluation of overall health and symptoms was conducted using ratings from 0 (no presence) to 4 (extremely present). The intensity of hot flashes increased after the final menstrual period (FMP). Symptoms associated with menopausal transition, including hot flashes, sleep disruptions, low mood, anxiety, fatigue, and dryness in the vagina were found to be related to hormonal fluctuations. Other factors
also influenced the severity of these symptoms. Changes in bodily functions during menopause can lead to medical complications. SWAN studies have excluded other conditions linked to menopause such as cardiovascular disease and osteoporosis.
In the late and early stages of menopausal transition, there may be an increase in the size of the carotid artery (Wikdman et al, 2008). Women often experience a decrease in mood during this time (Bromberger, 2007; Forests et al, 2008).
Concepts or Meanings of Menopause
Menopause is a significant and complex phase of life that impacts women globally. It brings about both physical and emotional challenges (George 2002; Lyons & Griffen 2003). In the Victorian era, menopausal women were viewed as aging women with deteriorating bodies and negative attitudes (McCrea, 1983). Every woman experiences menopause between the ages of 48 and 55 (George, 2001), but its perception varies among individuals. There is a question regarding whether it should be seen as a medical issue or a life transition (James & Deborah, 1997; Lyons & Griffen, 2003).
There are four main interpretations of climacteric. First, there is the biological or biomedical interpretation. Second, there is the developmental and natural event interpretation. Third, there is the feminist interpretation, seeing it as a natural female process. And fourth, there is the postmodern interpretation, which relates to physiological, social, and cultural dimensions (Gosden, 1985).
A biological definition of climacteric refers to the permanent cessation of menstruation resulting from a loss of ovarian follicular activities and signifies the end of fertility (Gosden, 1985). The final menstrual flow is the biological marker that indicates a woman's transition from a productive to a non-productive stage.
Adult females experience symptoms such as hot flashes, sweating,
palpitations, vaginal dryness, sleep disturbances, forgetfulness, difficulty concentrating, and irritability during the climacteric phase. The biologic or biomedical perspective also considers menopause as a disease and supports the use of hormonal replacement therapy (George, 2002). These physiological changes are often seen as symptoms that may require medical intervention. In the past, menopause was primarily viewed from a medical perspective (James ; Deborah, 1997), with physicians treating it as a disease. However, menopause is now recognized as a natural and developmental event in a woman's life and considered normal.
Menopause, although often stressful, should not be seen as a disease but rather as a normal part of the aging process. The fact that women are now living longer suggests that menopause will be seen as a natural occurrence rather than a medical condition. However, due to the health risks associated with menopause, such as osteoporosis and cardiac diseases, doctors will likely continue to treat it and its symptoms. Menopause is also viewed as a feminist concept that highlights its naturalness within the female experience.
Menopause can be seen as a transition in a woman's life, and if she acknowledges it as such, she will try to adapt and cope with it (Lyons & Griffen, 2003). Menopause is now considered to have physiological, social, and cultural aspects. The meaning of menopause can be either positive or negative, depending on a woman's culture, her position in society, and the physiological changes that occur as a result of menopause. Lyons and Griffen (2003) also introduced another meaning, which is "confusion," bridging the gap between natural processes and disease development.
An adult female may experience uncertainty and confusion about menopause due to a
lack of knowledge and understanding. When menopause is seen as "confusing," it can lead to anxiety and uncertainty, further complicating the already complex nature of menopause. Surgical menopause refers to menopause resulting from surgical interventions such as oophorectomy or hysterectomy. The symptoms of surgical menopause are similar to natural menopause but occur abruptly and are more severe. These physical and psychological symptoms are caused by sudden hormonal changes. How menopause is perceived by women can vary, with some seeing it as a natural event while others view it as a medical event. This perception ultimately influences a woman's experience of menopause. There are various factors that contribute to the menopausal experience in women.
Factors Influencing the Menopause Experience
Menopause is influenced by both biological and cultural factors. Environmental conditions, dietary habits, birthrate, and familial differences can contribute to the variations in menopausal experiences (Beyene, 1986). Additionally, a woman's culture teaches her how to respond to this life event. If a woman's role in her society is primarily focused on childbearing, she may perceive menopause as the end of her significance (James & Deborah, 1997). George (2002) argued that cultural norms, societal influences, and personal knowledge about menopause all contribute to how women experience this stage in their lives. Moreover, Elliot, Berman, and Kim (2005) suggested that culture encompasses all aspects of an individual's existence and can influence their beliefs and overall experience of menopause.
According to Ellen (2005), women who experience infertility consider menopause to be a normal and natural event after struggling for so long to become pregnant. Infertility is seen as unnatural because it disrupts the normal stages of life, but menopause is viewed positively
as a normal event. It is commonly believed that all women experience menopausal symptoms in the same way, but Avis (2002), Flint (1975), and Yahyeh and Rehan (2006) argue that cultural differences also influence the experience of menopausal symptoms.
The occurrence and frequency of menopausal symptoms vary among different cultures and societies. A survey by Avis (2002) included women aged 40-55 from various racial and cultural backgrounds in the United States in order to compare their menopausal symptoms. The results revealed two consistent factors across all five groups. The first factor was hot flashes and night sweats, while the second factor comprised psychological and psychosomatic symptoms. Caucasic women were found to experience more psychosomatic symptoms, whereas African American women reported more vasomotor symptoms. This pattern of occurrence suggests that there is no universal menopausal symptom syndrome consisting of both vasomotor and psychological symptoms.
On the other hand, Im et al. (2008) found that white women prioritize generational and lifestyle differences over cultural differences when it comes to experiencing menopausal symptoms. In a study of Indian women, Flint (1975) discovered that only a few women experienced issues beyond menstrual changes. Lock (1986) uncovered that Japanese women have lower rates of depression and vasomotor symptoms compared to Western women. A cross-cultural comparison by Avis (1993) revealed that nearly all symptoms were less prevalent in Japanese women compared to those in the US and Canada. Price et al. (2007) determined that women living in isolated environments without a social support system tend to experience more severe menopausal symptoms and feel a loss of control over both physical and psychological symptoms. Ultimately, it is clear that the experience of menopausal symptoms
varies among women.
They are influenced by an individual's socio-cultural background, which includes their environment, lifestyle, knowledge, values, beliefs, and perception of menopause. This also impacts women's overall menopause experience. If menopause is seen negatively, women will experience more severe symptoms and struggle to manage themselves, leading them to seek medical treatment and view menopause as a threat. A comparison of studies conducted in the USA and South Asia by George (2002) aimed to explore the experiences of American women from different cultural and socio-cultural backgrounds.
He discovered that the experiences of American adult females were not similar; they were all unique in their experiences. Some of them were experiencing severe menopausal symptoms while others did not experience any at all. Some of them were confused as they were unaware of what to expect. Some experienced depression while others felt relief from childbirth and monthly periods. Some were looking forward to the future. In another online study of white midlife women, Im, Liu, Dormire, and Chee (2008) found that white women believe that generational and lifestyle differences are more important than cultural differences in experiencing menopausal symptoms. They are optimistic and try to cope with the symptoms. Women needed help with menopausal symptoms and were dissatisfied with the advice they received from doctors. They used humor as a coping mechanism for menopause to boost their inner strength and motivate them to overcome adversity.
Monetary value, Storey, and Lake ( 2007 ) conducted a survey on the experiences of adult females populating in a rural country of Canada. The survey found that adult females considered menopause as a alteration of life and expressed high concern about their general wellness
and the alterations their organic structures undergo. The adult females emphasized the need for understanding the severity of menopausal symptoms, including physical, psychological, and societal changes, and sought reliable information. Menopause significantly impacted their personal relationships as they were unable to share their experiences with their hubbies. To cope, they relied on social support and humor.
In a study conducted by Elliott, Berman, and Kim (2002), Korean Canadian adult females were surveyed on their experiences with menopause. The findings revealed that these women consider menopause as a natural process and desired comprehensive knowledge about all aspects of it to effectively manage this stage of life. However, they faced difficulties in communicating with healthcare professionals. Although they were hesitant to share their experiences with their husbands, they expressed the need to share their feelings with someone else.
Hafiz, Liu and Eden (2007) conducted a survey among Indian adult females to explore their experiences of climacteric. The results showed that the participants had positive socio-cultural thoughts and attitude towards menopause, considering it as a natural event similar to birth and death. They were not concerned about going through menopause. However, they reported experiencing more physical and psychological symptoms rather than vasomotor symptoms like hot flashes and sweating. The study also found that physical and psychological symptoms were higher in Asian women.
Research in Pakistan
In Pakistan, several quantitative studies have been conducted on the age, pattern, characteristics, attitudes, and symptoms experienced by menopausal women (Malik, 2005; Nusart et al., 2008; Wasti, 1992; Qazi, 2006; Yahya & Rehman, 2002). However, there have been no qualitative studies conducted on the experience of menopause yet.
Wasti et Al (1993) carried out a survey in
Karachi, investigating the characteristics of climacteric among three socio-economic urban groups. The total sample size comprised 750 menopausal adult females. The findings indicated that 20% of women belonged to the poorest group, while 50% were part of the other groups. The survey revealed a lower prevalence of menopausal symptoms among women. However, Wasti suggested that the incidence of menopausal issues is likely to increase as life expectancy rises. Additionally, it was observed that the average age for experiencing natural climacteric was 47 years.
According to a survey conducted by Yahya and Rehan (2002) on age, form, and symptoms of climacteric among rural adult females of Lahore, a sample size of 130 adult females from 20 small towns was taken. The study found that the average age at climacteric was 49 ± 3.6 years. The most common symptoms reported were lethargy (56.4%), forgetfulness (57.7%), urinary symptoms (56.2%), agitation (50.8%), depression (38.5%), insomnia (38.5%), hot flashes (36.2%), and dyspareunia (16.9%).
According to his findings, the average age of climacteric in different regions varied. It was lower in Caucasic, but similar in Africa and South America, and higher in Iran, Egypt, and UAE. Additionally, the frequency of symptoms was lower among Caucasians. The researcher suggested further studies on local biologies and the socio-cultural factors contributing to these differences. In a study conducted by Malik (2005) in Karachi, he investigated the knowledge and attitudes towards climacteric and Hormonal Replacement Therapy (HRT) among postmenopausal women. The study included a sample size of 102 women who had already gone through menopause.
According to her findings, the average age of women at climacteric was 147.4±3 years old. Additionally, she discovered that most respondents had
a positive attitude towards climacteric and viewed it as a natural event. However, there was a lack of sufficient knowledge about climacteric and hormone replacement therapy (HRT). In her survey conducted in Hyderabad, Qazi (2006) focused on the age, shape, symptoms, and associated issues among 800 urban women experiencing climacteric.
The average age at climacteric was found to be 47.16. The notable symptoms of climacteric were low backache concern, fatigue, ball hurting, sleep perturbation, and night sweats. Common climacteric associated issues included Ischemic Heart Disease, Hypertension, and Diabetes mellitus. It was noted that the symptoms and issues differed from other studies conducted within the country and abroad, indicating potential socio-cultural and dietary differences. Nusrat et al. (2008) conducted a study on the knowledge, attitude, and experience of climacteric. The study involved a sample size of 863 menopausal women. The researcher concluded that the majority of women perceive climacteric as a natural event and have a positive attitude towards it. However, many women were unaware of menopausal symptoms and related health effects. While they were bothered by the symptoms, they did not seek treatment.
The age at natural climacteric in Pakistan ranges from 45-51 years, with an average of 48 years (Malik, 2008; Qazi, 2006; Yahya & Rehan, 2006). Similar findings have been observed in other studies conducted in Pakistan. Pakistani women view climacteric as a natural and normal stage of life and aging process, with a positive attitude towards it (Malik, 2005; Nusart et al, 2008; Yahya & Rehman, 2002). These findings align with similar studies conducted in Eastern countries like India, China, and Korea.
The Pakistani women have limited knowledge about the symptoms of menopause and its
impact on their health and quality of life (Malik, 2008; Nusrat et al., 2008; Yahya & Rehan, 2006). Many women experience menopausal symptoms but do not seek treatment or consultation due to a positive attitude, poverty, and lack of awareness (Malik, 2008; Nusrat et al., 2008). Qazi (2006) discovered differences in the prevalence of symptoms within the country, attributing them to socio-cultural and dietary variations. In rural areas of Lahore, Yahyeh and Rehan (2006) found a relatively lower prevalence of various symptoms compared to Caucasian women.
Researcher suggested the importance of analyzing local biological science and understanding the socio-cultural bases of these differences. The literature provides a summary of important information about the physiology and induction process of this phenomenon, as well as different perceptions and meanings from various schools of thought. It also addresses the historical development in climacteric research and highlights factors closely involved in influencing climacteric experience, as well as studies conducted on this subject. Eastern women perceive climacteric as a natural process, resulting in a more positive attitude compared to Western women.
They are concerned about climacteric symptoms but want to handle it positively. In Pakistan, quantitative studies have been done on this topic, but they did not provide insight into women's understanding. Qualitative research is needed to explore women's experiences related to this phenomenon ( George, 2002 ).
Chapter THREE - Study Design and Methodology
This chapter discusses the approach used in this study, the design and rationale, the study population, as well as the sample and sampling methods.
Data devising, information
- Improve essays
- Awareness essays
- Trust essays
- Farewell essays
- Visit essays
- Accident essays
- Driving essays
- Volunteering essays
- Excellence essays
- Knowledge essays
- Ignorance essays
- Growing Up essays
- Mistake essays
- Failure essays
- Peace Corps essays
- Expectations essays
- Luck essays
- Challenges essays
- Decision essays
- Sacrifices essays
- Struggle essays
- Vacation essays
- Memories essays
- Event essays
- Gift essays
- Party essays
- Incident essays
- Flight essays
- Obstacles essays
- Problems essays
- Success essays
- Personal Experience essays
- Overcoming Challenges essays
- Benefits of Volunteering essays
- Childhood Memories essays
- Car Accident essays
- Driver essays
- Driving under the Influence essays
- Volunteer Experience essays
- Nightclub essays
- Hospital essays
- Physician essays
- Health Care Provider essays
- Universal Health Care essays
- Readmission essays
- Adaptation essays
- Adventure essays
- Adversity essays
- Aging essays
- Alcohol essays