Department of pharmacy practice, Srinivas College of Pharmacy, Valachil, post Farangipete, Mangalore-574143, Karnataka, India.
Menopause results from cease in ovarian follicular function and marks the end of menstruation. Most women experience menopause between the ages of 40 and 58 years. Hormone replacement therapy (HRT) in the form of estrogen alone or combined estrogen and progesterone formulations has been widely used to treat menopausal symptoms to improve women’s quality of life, control their climacteric symptoms and prevent osteoporosis. This study aims to investigate the knowledge and awareness of women towards menopausal hormone replacement therapy and its role in the management of menopause. A cross-sectional observational study was carried out in female population above 18 years of age for 1.5 months. Data was collected using a prestructured online questionnaire using social media platforms. The questionnaire consisted of questions about demographics, menstruation status and about awareness regarding menopause and hormone replacement therapy including menopausal symptoms, HRT treatment options, side effects of HRT etc. 101 participants cooperated with the survey ranging from 18 years and above. 61.4% (n=101) were not in the perimenopausal or menopausal stage, 17.8% were perimenopausal, 7.9% were menopausal and 12.9% were not sure which group they belonged to. Only 18.8?lt well informed about perimenopause/menopause while 66.3% had some knowledge about it and 18.8% are not informed at all. 36.6% had heard of HRT whereas 53.5% had no knowledge about it. This survey demonstrated that the awareness of women about menopausal hormone therapy was not comprehensive and they should be educated more about menopause and use of HRT. Even though some women are aware of HRT as a treatment option; however, a lack of both proper information and positive attitude towards HRT use was noted.
Perimenopause and menopause have affected approximately one billion women worldwide. Menopause is the permanent cessation of menstruation for 12?months. Once 12?months is reached, the woman will be post-menopause. The perimenopause is an ill-defined time period before the woman has her final period and is often associated with the start of a number of perimenopausal symptoms [1]. They might experience mood disturbances, depression, hot flashes, vasomotor symptoms, recurrent urinary tract infections, vaginal atrophy with alteration of the sexual life and libido, as well as osteoporosis and cardiovascular disease [2]. Globally, there has little formal teaching about the menopause at any stage of a women’s life and the media often present the menopause negatively. A consequence of this is that many women have little knowledge or awareness of what can be a very symptomatic life phase [1]. Hormone replacement therapy (HRT) in the form of estrogen alone or combined estrogen and progesterone formulations has been widely used to treat menopausal symptoms to improve women’s quality of life, control their climacteric symptoms and prevent osteoporosis [2]. In order to improve the provision of this treatment, it is important to determine the information women have already received from the media and other sources and what their anxieties are. Previous studies of women's knowledge and attitudes have mainly been carried out overseas or have centered around specialist clinics. The aim of this study was therefore to assess the knowledge and awareness of women in relation menopausal hormone therapy in order to improve the provision of this treatment.
OBJECTIVES
To assess the awareness of women towards menopausal hormone replacement therapy and its role in menopause.
METHODOLOGY
Study type: Cross-sectional observational study
Study site: Community based online survey
Sample size:
101 participants based on convenience sampling
Study Duration:
1.5 months
Inclusion criteria:
Female population from the age of 18 and who are willing to participate and voluntarily enrolled were included in the study
Exclusion criteria: Male population was excluded from the study
Data source:
The data was collected through online surveys using structured questionnaires adapted from previous studies and modified to suit our purpose. Questionnaire was prepared in English language including all relevant variables based on the objective of the study.
The tools used have two sections designed to address:
RESULT
A total of 101 women participated in the study and their responses to the questionnaire were analyzed and assessed. The mean age of the women was 32.6 ±5.3. The largest category belonged to the age group of 18-24 (53.5%), 20.8?longed to 25-40, another 20.8?longed to 41-60 and 5% were aged 60 and above. Majority (54.5%) were undergraduates while 28.7% held a postgraduate degree. 5.9% has primary education, 5% has high school education and 5.9% had higher secondary educational qualification. 42.5% of the participants were students and 31.5% were home makers while rest worked in private sectors, some involved in healthcare and remaining had other occupations. Regarding menstruating status of the participants, 61.4% were not perimenopausal/menopausal. 17.8% are perimenopausal i.e., they still have periods with perimenopausal symptoms and 7.9% were menopausal/post-menopausal. 12.9% were not sure which category they belonged to. Table 1 depicts the demographic data assessed.
Table 1 demographic data of the sampled women
When asked about the perimenopausal/menopausal symptoms experienced by women belonging to respective categories (n=37), 32.4% experienced hot flashes, 56.8% had aching joints, 32,4% had irregular periods, 64.9% experienced mood swings, 35.1% had sleep disturbances, 21.6% had memory problems, 18.9% had urinary problems, 37.8% had problems of hair loss and 13.5% experienced vaginal dryness or itching.
Figure 1 Perimenopausal/menopausal symptoms experienced by sampled women
When asked about awareness and information about menopausal hormone therapy, only 18.8% were well informed about perimenopause/menopause while 66.3% had some knowledge about it. 14.9% had no information at all. A majority of the population who had knowledge sourced it from curriculum (32.6%) and rest from physician, family, friends and also some from social media.
Figure 1 source of information of the participants
As for awareness about menopausal hormone replacement therapy, 54(53.5%, n=101) had not heard about HRT and therefore were exempted from continuing the survey.
Figure 2 Knowledge about HRT in sampled women
Only 47 among 101(46.5%) participants were knowledgeable about HRT as a treatment option. Among them 38 (80.9%) believed HRT may be considered for treating menopausal symptoms and yet only 2.4% opted for it.
Figure 3 Data assessed about conditions for which HRT can be prescribed
93.6% said that their doctor never suggested them HRT for menopause and thus they have not opted it. 4.3% were not sure if they are currently using HRT. Reasons for not considering HRT is mainly the lack of awareness which made them think therapy is not required (57.1%). 35.7?lieved they are too young to start HRT. 72.3% expressed concerns about side effects like vaginal bleeding, breast swelling/cancer, bloating and weight changes.
Figure 4 Reasons for not using HRT for perimenopause/menopause
Table 2 illustrates the distribution of awareness and shows how informed the participants are about menopause and Hormone replacement therapy as a treatment option
Table 2 Distribution of awareness regarding menopausal hormone replacement therapy
DISCUSSION
Menopause is a critical transition period in the life of women which affects quality of life. In this study we summarized women’s awareness about menopausal hormone therapy and found very little consideration for HRT as a treatment option for perimenopausal/menopausal symptoms. This had mainly to do with the lack of awareness among elderly population about HRT. 93.6% of participants who had knowledge about HRT said that their physician never recommended HRT to them. This is supported by studies by Joyce C Harper et al [1] and MinFang Tao et al [3] which summarizes that many obstetrician-gynecologists have reported they were unlikely to change their prescribing practice following the WHI report on HRT. In the WHI randomized trial, combined hormone therapy increased breast cancer risk and interfered with breast cancer detection, leading to cancers being diagnosed at more advanced stages. However, the preponderance of observational studies has associated combined hormone therapy use with an increase in breast cancers that have favorable characteristics, lower stage, and longer survival compared with breast cancers diagnosed in nonusers of hormone therapy [4]. In this study, 57.1?els that treatment is not required for menopausal symptoms and only 2.4% sought clinical advice for perimenopause. Similar findings have been found in a study by Ye Zhu et al [5] in which majority of participants were unaware about the risks and benefits of menopausal hormone therapy. Some believed that menopausal hormone therapy could increase the risk of breast cancer while according to some participants (aged >40years), symptoms of menopause were part of the natural process of ageing and only few participants received treatments for peri-menopausal symptoms. These study results are consistent with other international studies and reported the same symptoms like hot flashes, aching joints, mood swings, irregular periods, sleep disturbances, memory problems etc. A recent study conducted among Saudi women on reported menopausal symptoms revealed that joint and muscle pain (80.7%), physical and mental exhaustion (64.7%), and hot flushes and sweating (47.1%) were the most reported symptom among midlife women [6]. It is important to note that this study has a limitation since most of the respondents were of a younger age and only a few of them were in the perimenopausal period, suggesting that the sample might not have accurately represented the actual rate of HRT use among the female population.
FUTURE PROSPECTIVES
This study could be extended to a longer duration thereby ensuring better results and power of the study.
CONCLUSION
This survey indicates lack of knowledge and exposure, regarding menopausal hormone therapy and menopause management among various age groups, that in turn might influence the acceptance of HRT among general population. This fact necessitates the need to strengthen the education of women which would be subsequently helpful in disseminating information to general public. Mass media also can serve as an important tool to reach the women and this was proved by Fatemeh Bakouei (2013) on the impact of mass media (television, radio, journals, newspaper, medical doctors, and medical team) among menopausal women to create an awareness, to manage the condition and thereby increasing their quality of life. As long as indications, contraindications and personalization are well controlled, HRT is safe and effective for menopausal women initiating treatment before the age of 60 years. This would help in better menopause management and improving quality of life in the society.
ACKNOWLEDGEMENT
I am thankful to the Management of Srinivas college of Pharmacy, Mangalore for providing all the necessary facilities to carry out this research work.
REFERENCES
Riya Fathima V. , Christy T. Chacko, A. R. Shabaraya, Menopausal Hormone Therapy And Its Awareness In Women, Int. J. of Pharm. Sci., 2024, Vol 2, Issue 9, 986-993. https://doi.org/10.5281/zenodo.13820255
10.5281/zenodo.13820255
