Awareness Regarding Postmenopausal Health among Women of Low Socioeconomic Class

Abstract

Background. Menopause is a natural phase in a woman's life, but in poor settings it is often surrounded by silence, fear and wrong beliefs. Pakistan has one of the youngest mean ages at menopause in the world, and a large number of postmenopausal women live in households earning less than the minimum wage. Despite these conditions, the extent of women's awareness about their changing bodies, the associated long-term health risks due to estrogen deficiency and the available treatment options is still unknown. Very few studies have been conducted in Pakistan, all consistently indicating poor knowledge; however, data on women belonging to the lower socioeconomic class is not available. Objective. This study aimed to determine the knowledge, attitude and health-seeking behaviour of low socioeconomic class postmenopausal women regarding menopausal changes and to identify the factors associated with poor awareness among this group. Methods. This was a hospital based descriptive cross sectional study carried out in the gynaecology outpatient department of advance teaching hospital in Pakistan over a period of six months. A total of 240 postmenopausal women aged 45 to 65 years, belonging to the low socioeconomic class (defined as a monthly household income of less than PKR 40,000 or roughly USD 140), were enrolled using non-probability consecutive sampling. Women with surgical menopause, known psychiatric illness, or those unwilling to participate were excluded. Data were collected through face-to-face interviews with a pre-tested, structured questionnaire translated and back-translated into Urdu. Socio-demographic characteristics, knowledge of menopause (definition, age, symptoms, long-term complications, and treatment options), attitudes towards menopause, and care-seeking behaviour were inquired about. The knowledge score was calculated on 15 items and divided into three categories: poor (<6) average (6-10) and good (>10). Data was entered and analysed in SPSS version 26. Descriptive statistics were computed for the variables of interest. The Chi-square test was used to observe an association between the knowledge level and socio-demographic variables. Results. The mean age of the participants was 53.4 ± 5.6 years, and the mean age at menopause was 47.2 ± 3.8 years. Most of the women were illiterate (59.2%) and worked as housewives (77.5%). Only 34.2% knew the correct definition of menopause, and 40.0% knew the average age at which it usually occurs. Hot flushes were the most recognised symptom (45.8%), followed by mood changes (36.7%). Regarding long-term complications, only 15.8% were aware of an increased risk of osteoporosis, and 12.5% were aware of an increased risk of cardiovascular disease. Only 7.5% had heard of hormone replacement therapy. Attitudinally, 59.2% of the women felt that menopausal symptoms should be silently endured, 40.0% felt that a woman loses her femininity after menopause, and 24.2% felt that a husband can marry another woman after his wife becomes menopausal. Only 44.2% had ever consulted a doctor for menopausal complaints. Overall knowledge was poor in 67.1% of women, average in 24.2% and good in only 8.7%. A statistically significant association was found between knowledge score and educational level (p<0.001) and monthly income (p<0.01). Conclusion. Knowledge of postmenopausal changes and long-term health risks is limited among Pakistani women of low socioeconomic status.  Negative attitudes and silent suffering remain common. Education and family income are the main determinants of awareness. Thus, targeted health education at the primary care level, employing female community health workers, and incorporating menopausal counselling into routine gynaecology and family medicine clinics are essential to improving the quality of life of this neglected population.

Keywords. Postmenopause; awareness; knowledge; attitude; low socioeconomic class; Pakistan; women's health