ASSESSMENT OF MENOPAUSAL SYMPTOMS AND QOL AMONG MENOPAUSAL WOMEN IN THE NORTH GUJARAT REGION

Menopause represents a natural biological transition marked by progressive ovarian follicular depletion and declining estrogen levels. This transition typically occurs between 40 and 55 years of age worldwide, yet regional differences are well-documented. Studies from India report an average menopausal age between 46 and 48 years, earlier than that of Caucasian populations. ^(1,2) The menopausal transition, consisting of premenopause, perimenopause, and postmenopause, brings physiological, psychological, and urogenital disturbances that can influence multiple domains of women’s HRQOL.

Vasomotor symptoms such as hot flushes and night sweats are among the earliest and most widely reported manifestations, occurring in up to 70–80% of women globally. ^[3] Psychological symptoms—anxiety, irritability, depressive mood and decreased memory—are commonly observed during perimenopause, often due to fluctuating estrogen levels. ^[4] Somatic symptoms including joint pain, fatigue, headaches, and bloating tend to increase significantly post-menopause and can negatively affect daily functioning and independence. ^[5] Urogenital atrophy results in vaginal dryness, dyspareunia, recurrent urinary symptoms, and declining sexual quality of life due to estrogen deficiency. ^[6]

Recent studies have emphasized wide cross-cultural variations in symptom prevalence. Asian women often report higher somatic complaints and lower vasomotor symptoms compared to Western populations. ^[7] Indian women present earlier menopause and higher severity of musculoskeletal complaints as documented in recent reviews. ^[8] A 2024 systematic review also identified physical inactivity, nutritional habits, and psychosocial stress as significant modifiers of menopausal symptom severity. ^[9]

Despite global recognition, significant gaps in awareness and healthcare access persist. Surveys from the Royal College of Obstetricians and Gynaecologists (RCOG) highlight that 58% of women lack access to menopause services, and most report inadequate information about menopause. ^[10] Similar trends are observed in India, where menopause-related discussions remain socially limited and symptom reporting is often delayed. ^[11]

Given these patterns, it is crucial to generate region-specific data from North Gujarat to inform public health policies and improve HRQOL among midlife women.

OBJECTIVES

Primary Objective

1. To estimate the severity of menopausal symptoms among women aged 40–60 years in North Gujarat.

Secondary Objectives

2. To assess HRQOL domains affected during menopausal transition.
3. To provide recommendations for targeted health interventions for menopausal women in the region.

METHODOLOGY

Study Design and Setting

This was a community-based cross-sectional observational study conducted among women residing in selected rural and urban areas of North Gujarat.

Sample Size

A total of 209 women aged 40–60 years who fulfilled the inclusion criteria were enrolled.

Inclusion Criteria

·       Women aged 40–60 years.

·       Natural menopausal transition (pre-, peri-, post-menopausal stages).

·       Willingness to participate and sign informed consent.

Exclusion Criteria

·       Pregnant or lactating women.

·       Women with surgical menopause (oophorectomy/hysterectomy).

·       Those unwilling to participate.

Instrument preparation:

·       The data were collected in the questionnaire including CRF (Case Report Form) and ICF (Informed Consent Form) were initially prepared in English, and then translated in the vernacular language Gujarati. Women’s informed consent was taken before to collection of data. The participants failed to complete one or more questions of the study were excluded from the final analysis.

Data collection:

·       A case record form was prepared to collect information from the participants. It is a self administered questionnaire, which consists of demographic details and experience of severity of symptoms and QOL were tested according to Menopause Rating Scale (MRS) and Menopause specific quality of life (MENQOL). It had been widely used in many clinical and epidemiological studies to evaluate the etiology, severity and quality of life of menopausal symptoms.

·       Socio-demographic detail comprised of Age, Area, BMI, Education level, Socio-economic status, marital status, and overall knowledge regarding questions were collected. The MRS is comprised of 11 domains which are divided into three sub scales: Somatovegetative domain- Hot flushes, Heart discomfort, Sleep problems, Joint and muscular discomfort. Psychological domain- Depressive mood, Irritability (feeling nervous), Anxiety, Physical and mental exhaustion (general decrease in performance, impaired memory, decrease in concentration, forgetfulness). Urogenital domain- Sexual problems, Bladder problems, Dryness of vagina. Each symptom scored from “0 to 4”, 0 being none or no complaint to 4 being very severe. The MENQOL is comprised of 29 domains which are divided into four sub scales: (1 to 3) Hot flushes, Night sweats, sweating. Psychological domain: (4 to 10)- Being dissatisfied with my personal life, Feeling Anxious, Experiencing poor memory, Accomplished less than I used, Feeling depressed, Being impatient with other people, Feeling of wanting to be alone. Physical domain: (11 to 26)- Flatulence, Aching in muscles and joints, Feeling tired or worn out, Difficulty sleeping, Aches in back of neck or head, Decreased in physical strength, decreased in stamina, Feeling a lack of energy, Drying skin, Weight gain, Increased in facial hair, Changes in appearance, Feeling bloated, Low backache, Frequent urination, Involuntary urination when laughing or coughing. Sexual domain: (27 to 29)- Changes in sexual desire, vaginal dryness during intercourse, Avoiding intimacy. Each symptom scored from “0 to 3”, 0 being not at all bothered to 3 Severe bothered.  After getting approval from an expert opinion, it was subjected to a pilot study in 60 randomly selected subjects whose data were not included in the final data. Minor modifications were done in questionnaire after the completion of the pilot study. Final data collection was initiated after the pilot study; subjects were randomly enrolled in the study as per inclusion criteria. Personal interview was the method used to retrieve information from each subject.

Data analysis:

·       Data was collected, coded, entered in Microsoft Excel and analyzed using the IBM SPSS version 2.0 (IBM SPSS Software, Ahmedabad, Gujarat, India). For categorical variables, data was presented as frequencies, percentages, Mean and Standard deviation.  Results were described in tables.

Ethical considerations

·       The protocol, study procedures along with the informed consent form (ICF) was submitted to the Institutional Research Review and Ethics Committee, Mehsana, for ethical approval prior to the commencement of the study. This study was conducted in accordance with the principles of the Helsinki Declaration and good clinical practice guidelines for studies involving human subjects.

Confidentiality:

·       Collected data was kept confidential and was not being disclosed to anyone. Protected file only be accessible to authorized personnel.

 

 

 

 

Among the 209 menopausal women included in the study, menopausal symptoms were widely prevalent across all domains of the MENQOL scale (Table 4). A substantial proportion of participants reported experiencing vasomotor, psychosocial, physical, and urogenital symptoms, indicating a significant impact on health-related quality of life.

Vasomotor symptoms were commonly reported, with hot flushes/flashes (75.1%), night sweats (76.6%), and excessive sweating (76.6%) affecting a large majority of women. Psychological symptoms were also prominent; anxiety or nervousness (80.9%), depressive mood (72.2%), and dissatisfaction with personal life (67.5%) were frequently reported.

Physical symptoms showed the highest prevalence overall. Nearly all women reported muscle and joint pain (94.7%), fatigue or exhaustion (92.3%), low backache (95.7%), and bloating (95.2%), highlighting the substantial physical burden of menopause. Urogenital complaints were also common, with vaginal dryness during intercourse (87.1%), changes in sexual desire (87.6%), and frequent urination (84.2%) affecting a majority of participants.

Severity of Symptoms Based on MENQOL Scores (Table 4: Mean ± SD)

The severity of menopausal symptoms, as reflected by mean MENQOL scores, further reinforced the dominance of physical symptoms. The highest mean scores were observed for Feeling bloated (1.92 ± 0.85), Flatulence or gas pains (1.88 ± 0.88), Weight gain (1.79 ± 0.96), Aching in muscles and joints (1.77 ± 0.85), Feeling tired or worn out (1.65 ± 0.81).

Vasomotor symptoms such as hot flushes (1.32 ± 1.00) and night sweats (1.34 ± 0.99) were moderate in severity but consistently present. Urogenital symptoms including vaginal dryness (1.31 ± 0.79) and changes in sexual desire (1.21 ± 0.68) contributed meaningfully to reduced quality of life. Psychological symptoms, although slightly lower in mean scores, were persistent and impactful.

The present study demonstrates that menopausal symptoms are highly prevalent and multidimensional among women in the North Gujarat region, significantly impairing health-related quality of life. Physical symptoms were the most dominant, followed by vasomotor and Urogenital complaints, a pattern consistent with findings reported in Indian and international studies from 2023-2025, reinforcing the need for region-specific intervention.

The high burden of musculoskeletal pain, fatigue, bloating, and weight gain observed in this study aligns with recent evidence suggesting that estrogen deficiency contributes to increased inflammation, altered fat distribution and musculoskeletal discomfort during menopause. Similar findings have been reported in studies from South India and other Asian populations, where physical symptoms were the leading contributors to poor MENQOL scores. ^{(12, 13, 14)}

Vasomotor symptoms such as hot flushes and night sweats were experienced by more than three-quarters of the study population. This prevalence is comparable to reports from global menopause surveys, including studies conducted in Asia and Europe, which document vasomotor symptoms in 60–80% of menopausal women, and with a 2024 European multicountry survey. ^{(15, 16)} However, the severity scores in the present study were moderate, suggesting possible cultural differences in symptom perception and tolerance.

Psychological symptoms such as anxiety, irritability, and depressive mood were frequently reported, reflecting the neuroendocrine effects of hormonal fluctuations during menopause. Similar associations between menopause and psychological distress have been reported in recent cross-sectional studies, which highlight menopause as a vulnerable period for mental well-being. ⁽¹⁷⁾

Urogenital symptoms, including vaginal dryness and reduced sexual desire, were reported by more than 85% of women. These findings are consistent with global literature describing the genitourinary syndrome of menopause (GSM) as a persistent and often under recognized contributor to poor quality of life. ⁽¹⁸⁾ Cultural barriers and limited awareness may further exacerbate under reporting and lack of treatment for these symptoms.

The widespread prevalence and severity of menopausal symptoms observed in this study underscore the need for early screening, education, and targeted interventions at the community level. The presence of significant symptom burden even among women in the early menopausal transition highlights the importance of initiating preventive and supportive strategies at younger ages. Improving awareness about menopause, expanding access to counseling services, and integrating menopause management into primary healthcare can play a crucial role in improving HRQOL. Both hormonal and non-hormonal treatment options, lifestyle modification, and psychosocial support should be emphasized in menopause care programs.

Menopausal symptoms are highly prevalent among women in the North Gujarat region and exert a substantial negative impact on health-related quality of life, particularly in the physical and urogenital domains. These findings highlight menopause as a significant public health concern requiring comprehensive, culturally sensitive, and accessible healthcare interventions.

Acknowledgment:

The authors want to acknowledge all respondents, gynecologists and medical staff for the smooth conduction of this clinical study.

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