DISCUSSION
Menopause and its complications can impair the feeling of well-being and
health, and affect quality of life. Although the menopausal age is the
same as in past years, women have started to spend about one-third of
their lives in menopause due to the increase in the average life
expectancy.13 The intensity and effect of menopausal
symptoms differ among people and societies. Some women may experience
more severe symptoms that can have a profound impact on their personal
and social performance, and quality of life, and cause them to encounter
numerous serious problems in their lives. Therefore, the severity of
menopause symptoms can affect their quality of life, both
physiologically and psychologically.14
The age of menopause differs from society to society. The menopausal age
in Turkey varies between 48–51 years.15 In the study
presented herein, the average age of going through natural menopause in
the women was calculated as 47.79 ± 4.5 (38–58) years. In the current
study, 37.9% of the participants were found to have a negative attitude
regarding menopause, whereas 62.1% had a positive attitude. When
research examining the attitudes of women regarding menopause in the
literature were evaluated, reports of both positive and negative
attitudes were found. An Iranian study found that 6.3% of women had a
negative attitude towards menopause, whereas 71% had a neutral
attitude, and 22.8% had a positive attitude.16 In a
study regarding self-awareness during menopause in Austria, Bloch (2002)
found that 35.3% of women in the climacteric period had negative
feelings regarding menopause, whereas 33.3% had positive emotions,
27.5% were neutral, and 3.9% had indifferent
emotions.17 One study found that women with a negative
attitude towards menopause reported more frequent complaints when
compared to women with a positive attitude.18 In the
study presented herein, the psychological and genitourinary complaint
scores of the women who had negative attitudes about menopause were
found to be higher than those of women who had positive attitudes. Women
with a positive attitude reported significantly fewer symptoms of
menopause.
In general, a higher level of education has been associated with better
health, income, and more opportunities in the social and working lives
of women. The reason why women during menopause with high levels of
education had a higher physical quality of life scores may have been due
to the fact that they were more advantageous in regular access to health
care, they were informed, and they consulted physicians. According to
the research, a negative relationship was found between the level of
knowledge and the severity of menopause symptoms.19That is to say, less educated women experience more severe symptoms, and
highly-educated women are more aware of the menopause symptoms, the
strategies to deal with them, and are more likely to look for treatment
for their symptoms. A study conducted in Taiwan reported increasing
menopausal complaints due to an increased level of
education.20 In the study presented herein, the
results showed that women with a higher level of education women had a
positive attitude about menopause and healthy living.
This study has found a relationship between the marital status,
educational status, presence of chronic diseases and menopausal status
of the women, and the severity of their menopause symptoms. Symptom
severity was found to be lower in the married women. However, symptom
severity was found to be lower as the education level increased. With a
clear statement, menopausal symptoms were felt less in participants who
were married or had a high level of education. The menopausal period is
also a process in which a large number of chronic diseases appear.
Sometimes it can be quite difficult to distinguish between symptoms
caused by chronic diseases and those caused by estrogen deficiency.
Numerous studies have reported that more symptoms of menopause were
observed among women with chronic diseases.21
In reducing the psychological and vasomotor symptoms, exercise is
recommended during the menopausal and perimenopausal periods. Doing
exercise generally has positive effects on the mood and sleep disorders
in women. Vasomotor symptoms, such as hot flashes and night sweats, are
improved with weight loss involving physical activity in obese women who
have a higher body mass index.22 It also has a
positive relationship with lowering cholesterol, triglycerides,
apolipoprotein, and glucose levels23, and accordingly,
is associated with reducing the symptoms of hot
flashes.24 On the contrary, a controlled 6-month study
showed no relationship between weight change, and mental and physical
quality of life.25 Poppel et al. showed that physical
activity did not reduce vasomotor and mental symptoms during
menopause.26 A study involving Australian middle-aged
women stated that exercise was beneficial for somatic and psychological
symptoms, such as depression and anxiety, but not for vasomotor symptoms
or sexual function.27 As a result of estrogen
deprivation during the menopause transition, the sex drive of women
decreases, and vaginal dryness, signs of thinning of the wall of the
womb and sexual dysfunction commonly occur. A study of 42 women in the
postmenopausal period, who were divided into 2 groups of aerobic or
resistance exercise programs, 3 days a week for 8 weeks, did not report
any effects on genitourinary complaints or sexual
symptoms.26 However, in a cross-sectional study of 151
women who practiced physical activity, improvement in sexual symptoms
was reported.28 In the study presented herein, the
somatic, psychological, and genitourinary complaints of the women who
stated that they pursued a sedentary life were found to be higher than
those whose physical activity was at mild to moderate levels.
It is known that the level of estrogen in the blood is lower in women
who smoke when compared to non-smokers. It can be thought that lower
estrogen levels may cause more severe menopausal
symptoms.29 The presented study also found a
significant relationship between smoking and menopausal symptoms. In
several studies, the source of information about menopause has been
reported as the Internet and friends.30,31 Asian women
did not report the need for information because they perceived menopause
as a natural transition period.32 In the presented
study, approximately half of the participants stated that they had
knowledge of menopause symptoms in advance, whereas 59.4% stated that
they had discussed menopause symptoms with other individuals.