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.