ABSTRACT
Background:
Perimenopause is a transitional phase before menopause, characterized by hormonal fluctuations and irregular menstrual cycles, which can impact overall well-being and relationship. This study examines the prevalence of menopausal symptoms in perimenopausal women and their association with marital relationship.
Materials and Methods:
A cross-sectional study from November 2023 to February 2024 recruited 979 perimenopausal women aged 40-60 from 7 rural and 3 urban sectors of Khordha district, Odisha. On screening, 768 participants who fulfilled the inclusion criteria were assessed for the severity of menopausal symptoms using the Menopause Rating Scale and the Marital Relationship Questionnaire assessed marital relationship. A semi-structured interview was conducted to explore the partner’s support from a woman’s point of view. Chi-square and Bonferroni’s post hoc analysis were used to associate the severity of menopausal symptoms with marital relationship.
Result:
The prevalence of menopausal symptoms was 81.19% among the women whose mean age was 47.8 ± 5.2 years. On assessment, severe symptoms were more prevalent among 52.73% of women, whereas only 1.40% reported mild symptoms. There was a significant association between the severity of menopausal symptoms and marital relationship. On Bonferroni’s post hoc analysis, a significant association existed between mild symptoms with good marital relationship and severe menopausal symptoms with a poor relationship. The age and previous medical history were also associated with severe menopausal symptoms, whereas marital relationship was associated with previous medical history.
Conclusion:
In perimenopausal women, the symptoms significantly impact marital relationship. Effectively addressing the needs and challenges of menopause can facilitate a smoother transition, promoting better health outcomes and overall well-being for women during this phase.
KEYWORDS: Interpersonal relations, marriage, menopause, perimenopause, postmenopausal symptoms
INTRODUCTION
Natural menopause refers to the irreversible cessation of menstruation, caused by a decline in ovarian follicular activity or depletion of follicles.[1] Menopause is considered to occur naturally when amenorrhea persists for a full year in the absence of pathological, physiological, or clinical causes.[2] In Indian women, the average age of menopause is typically around 46.2 years.[3] The stages of reproductive aging workshop system, introduced in 2001, defined three primary stages in a woman’s reproductive life: the reproductive phase, menopausal transition, and postmenopause.[4] Perimenopause refers to the period that begins with the onset of menopausal signs and symptoms and ends 1 year after the final menstrual period, marking the transition from the reproductive to the nonreproductive stage of life.[1] Perimenopausal symptoms are categorized into four main types: somatic, urogenital, psychological, and sexual symptoms.[5] Hot flashes, insomnia, and vaginal dryness are recognized as the primary symptoms of the menopausal transition, with low moods also emerging as a significant feature during this phase.[6,7,8] According to the Study of Women’s Health Across the Nation (SWAN), sleep problems frequently manifest as waking up during the night.[9] Sexuality has an important role in a person’s health, well-being, self-esteem, and quality of life.[10] Menopausal symptoms are strongly associated with reduced marital happiness, particularly when it comes to mood and relationship dynamics.[11] Research reveals that sexual dysfunction develops throughout the menopausal transition, which might severely affect marital satisfaction.[12,13]
In many low- and middle-income countries like India, due to societal inequalities and discrimination, many women are unaware of the changes associated with menopause.[14] This lack of awareness is particularly pronounced in rural areas, where limited research has been conducted.[15,16] As a result, many women endure these symptoms silently, without adequate medical or emotional support, leading to compromised well-being and strained interpersonal relationships.
Menopause is a significant biological milestone in a woman’s life, yet it remains underdiscussed in India. While Indian research predominantly emphasizes physical symptoms such as hot flashes and joint pain, it often overlooks the psychosocial and relational impacts of menopause. Cultural taboos, limited health literacy, and social stigma, especially in rural and semi-urban areas, prevent many women from seeking support, leading to untreated symptoms and declines in mental well-being, marital satisfaction, and social functioning.
Marital relationships, which can be vital emotional support systems during this transition, are often strained by changes in intimacy, communication, and sexual health. Despite global evidence linking unmanaged menopausal symptoms to depression, anxiety, and relationship difficulties, India-specific data on these issues remain scarce. As sociodemographic changes reshape family structures and gender dynamics, understanding how menopause affects interpersonal and marital relationships becomes increasingly urgent.
This study is, therefore, critically needed to bridge this knowledge gap. It aims to analyze the prevalence of menopausal symptoms among perimenopausal women and assess their impact on personal and social relationships with partners. The findings will provide essential evidence to inform culturally sensitive health education, counseling strategies, and community-based interventions, ultimately aiming to enhance the overall health, emotional well-being, and marital satisfaction of women during the menopausal transition, within the Indian context.
METHODS
Study design and setting
A cross-sectional analytical research design was used to conduct a study at villages in the Khordha district of Odisha, India. The study is reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for cross-sectional studies.[17]
Study population
Women were recruited through quota sampling from Khordha district, Odisha, India, from November 2023 to February 2024. A total of two quotas were selected, consisting of seven rural and three urban sectors. Women between 40 and 60 years were screened for menopausal symptoms using the menopausal symptoms screening tool. All consenting perimenopausal women between 40 and 60 years of age were included in the study. The women were excluded from the study (Exclusion Criteria) [Figure 1].
Figure 1.
Schematic representation of data collection. PCOS: Polycystic ovary syndrome
Sample size
The sample size of 384 was estimated based on the prevalence of menopausal symptoms of the previous study[16] with the expected proportion with 5% absolute precision and 95% confidence level. Two quotas were selected: urban and rural. To combat the design effect in quota sampling, the estimated sample size was doubled, which was 768. From both the quotas, urban and rural, 512 and 256 participants were selected. The selection of two separate quotas for urban and rural participants was necessary to ensure a comprehensive and representative analysis of menopausal symptoms and their impact on relationship across different socioeconomic and environmental contexts.
Assessment method
The women were screened through the menopausal symptom screening tool to assess self-reported menopausal symptoms, which comprised 11 questions. Women scoring <4 were considered to have no menopausal symptoms and were excluded from the study. Among 979 screened participants, 768 were selected for the study [Figure 2]. The selected women were administered a Menopause Rating Scale (MRS) and a semi-structured marital relationship questionnaire. Face-to-face semi-structured interviews were conducted to gather extensive data on women’s health and marital relationship. The ethical review committee approved the study vide reference number (IEC/AIIMS BBSR/Nursing/2023-24/02). Permission was also obtained from the Chief District Medical and Public Health Officer, Khordha, Odisha.
Figure 2.
Flow diagram of the study participants as per Strengthening the Reporting of Observational Studies in Epidemiology guidelines. *Others: Carcinoma (n = 1), Premature menopause (n = 1), Very sick (n = 2) History of uterine and ovarian abnormalities, chronic menstrual abnormality (n = 2), Widow (n = 1)
Measures
The sociodemographic questionnaire collected nine information, including age, menopause attained, residence, education, occupation, income, socioeconomic class, years of marriage, type of family, and previous medical history. Menopausal symptom severity was assessed using the MRS,[18] containing 11 questions in 3 domains (somatic, psychological, and urogenital). Each question is scored on a scale of 0–4 (0 = none and 4 = severe), with total scores ranging from 0 to 44. Higher scores indicate more severe symptoms. The total score responses are further as no symptoms (0–4), mild (5–8), moderate (9–16), and severe (≥17).
Marital relationship with a partner was assessed by a self-administered marital relationship questionnaire that comprised 15 items categorized into three subscales: intimacy, communication, and sexual activities. Every question was scored on a scale of 0–2 (0 = never, 1 = occasionally, and 2 = always). A cumulative score of 30 was obtained by assigning a score of 0–2 to each question (0 – never, 1 – occasionally, and 2 – always). The overall score was then categorized as a very good relationship (0–10), good relationship (11–20), and poor relationship (21–30). A lower total score reflects a better marital relationship, while a higher score suggests areas where relationship difficulties exist.
A semi-structured interview schedule consisted of 10 items measuring the dimensions of the couple’s relationship during the menopausal phase. It was conducted to explore the partner’s support from a woman’s point of view.
The tool’s content was validated by eight experts. The experts verified the item’s relevance, accuracy, and appropriateness. The necessary changes were made in the tools based on the suggestions of the validators. Reliability was established using the test–retest method.
Statistical analysis
Data were analyzed through descriptive and inferential statistics. Categorical data were reported as the frequency and percentage. Descriptive statistics used in the study were mean, frequency, and percentage. Inferential statistics used in the study were the Chi-square test, Fisher’s exact test, and the post hoc test (Bonferroni’s test). For the semi-structured interview schedule, the most common interview responses were identified and categorized as different themes. Those themes were further subcategorized into subthemes and presented in frequency and percentage.
RESULTS
Descriptive statistics of the sample
During the study period, a total of 768 women who presented with menopausal symptoms were enrolled and analyzed. The mean age of the participants was 47.8 ± 5.2 years [Table 1]. A majority of these women, accounting for 67.18%, had already attained menopause at the time of assessment. The overall prevalence of menopausal symptoms among the study population was found to be 81.19%, indicating that a significant proportion of women undergoing midlife transition experienced notable physiological or psychological changes associated with menopause.
Table 1.
Sociodemographic characteristics of perimenopausal women (n=768)
| Variable | Frequency (%) |
|---|---|
| Age (years), mean±SD | 47.8±5.2 |
| Menopause attained | |
| Yes | 516 (67.19) |
| No | 252 (32.81) |
| Resident | |
| Rural | 512 (66.67) |
| Urban | 256 (33.33) |
| Educational | |
| No formal education | 75 (9.80) |
| Primary school certificate | 325 (42.30) |
| Middle school certificate | 188 (24.50) |
| High school certificate | 119 (15.50) |
| Graduate | 11 (1.40) |
| Profession | 50 (6.50) |
| Occupation | |
| Unemployed | 758 (98.70) |
| Skilled worker | 4 (0.50) |
| Clerks | 1 (0.10) |
| Profession | 5 (0.70) |
| Income (INR) | |
| <10,0001 | 226 (29.43) |
| 10,002–29,972 | 368 (47.92) |
| 29,972–49,961 | 140 (18.23) |
| 49,962–74,755 | 34 (4.42) |
| Socioeconomic class (modified Kuppuswamy scale) | |
| Upper | 16 (2.10) |
| Upper-middle | 150 (19.53) |
| Lower-middle | 252 (32.81) |
| Upper-lower | 225 (29.30) |
| Lower | 125 (16.30) |
| Years of marriage | |
| ≤24 | 398 (51.82) |
| 25–29 | 189 (24.61) |
| 30–34 | 111 (14.45) |
| ≥35 | 70 (9.12) |
| Type of family | |
| Nuclear | 137 (17.84) |
| Joint | 631 (82.16) |
| Medical history (HTN, DM, obesity, and heart disease) | |
| Yes | 621 (80.90) |
| No | 147 (19.10) |
SD: Standard deviation, DM: Diabetes mellitus, HTN: Hypertension, INR: International normalized ratio
Pattern and severity of menopausal symptoms
An evaluation of the types of menopausal symptoms revealed that irritability was the most commonly reported symptom, affecting 95.40% of women. This was followed by joint and muscular discomfort reported by 90%, hot flashes by 85.50%, and sleep disturbances by 82.40% of the participants [Table 2]. Such findings emphasize that menopausal transition is associated not only with physical complaints but also with significant emotional and psychological symptoms that could interfere with a woman’s quality of life. Regarding the severity of symptoms, it was observed that a majority of the women (52.73%) experienced severe menopausal symptoms, characterized by the intensity and frequency of complaints. In contrast, only a small fraction, about 1.40%, reported having mild symptoms [Table 3].
Table 2.
Prevalence of menopausal symptoms (n=768)
| Symptoms | Score, frequency (%) | ||||
|---|---|---|---|---|---|
|
| |||||
| None - 0 | Mild - 1 | Moderate - 2 | Severe - 3 | Very severe - 4 | |
| Hot flashes, sweating (episodes of sweating) | 135 (17.60) | 200 (26.00) | 218 (28.40) | 147 (19.10) | 68 (8.90) |
| Heart discomfort (unusual awareness of heartbeat, heart skipping, heart racing, tightness) | 330 (42.97) | 235 (30.60) | 162 (21.09) | 39 (5.08) | 2 (0.26) |
| Sleep problems (difficulty in falling asleep, difficulty in sleeping through, waking up early) | 111 (14.50) | 200 (26.00) | 236 (30.70) | 169 (22.00) | 52 (6.80) |
| Depressive mood (feeling down, sad, on the verge of tears, lack of drive, mood swings) | 315 (41.00) | 218 (28.40) | 172 (22.40) | 55 (7.20) | 8 (1.00) |
| Irritability (feeling nervous, inner tension, feeling aggressive) | 33 (4.30) | 128 (16.70) | 239 (31.10) | 258 (33.60) | 110 (14.30) |
| Anxiety (inner restlessness, feeling panicky) | 287 (37.40) | 246 (32.00) | 159 (20.70) | 52 (6.80) | 24 (3.10) |
| Physical and mental exhaustion (general decrease in performance, impaired memory, decrease in concentration, forgetfulness) | 119 (15.50) | 188 (24.50) | 298 (38.80) | 124 (16.10) | 39 (5.10) |
| Sexual problems (This is taken exactly from the STRAW Tool) | 304 (39.60) | 242 (31.50) | 183 (23.80) | 39 (5.10) | 0 |
| Bladder problems (difficulty in urinating, increased need to urinate, bladder incontinence) | 147 (19.10) | 217 (28.30) | 209 (27.20) | 138 (18.00) | 57 (7.40) |
| Dryness of vagina (sensation of dryness or burning in the vagina, difficulty with sexual intercourse) | 303 (39.50) | 232 (30.20) | 176 (22.90) | 50 (6.50) | 7 (0.90) |
| Joint and muscular discomfort (pain in the joints, rheumatoid complaints) | 8 (1.04) | 64 (8.33) | 261 (33.99) | 288 (37.50) | 147 (19.14) |
Table 3.
Distribution of dimensions of marital relationship in perimenopause (n=768)
| Questions | Frequency (%) | ||
|---|---|---|---|
|
| |||
| Never | Occasionally | Always | |
| Aging impacts relationship | 251 (32.68) | 293 (38.15) | 224 (28.90) |
| Reduced affection | 260 (33.85) | 322 (41.93) | 187 (24.22) |
| Impairment in understanding | 178 (23.20) | 308 (40.10) | 282 (36.70) |
| Husband’s involvement in chores | 396 (51.60) | 253 (32.90) | 119 (15.50) |
| Cares during illness | 292 (38.00) | 288 (37.50) | 188 (24.50) |
| Increased irritability | 209 (27.21) | 316 (41.15) | 243 (31.64) |
| Reduced importance of relationship | 272 (35.40) | 295 (38.40) | 201 (26.20) |
| Quality time spent | 238 (31.00) | 329 (42.80) | 201 (26.20) |
| Involvement in decision-making | 233 (30.34) | 296 (38.54) | 239 (31.12) |
| Sharing feelings | 319 (41.54) | 283 (36.85) | 166 (21.61) |
| Settling disagreement | 294 (38.30) | 289 (37.60) | 185 (24.10) |
| Increase in quarrels | 214 (27.87) | 314 (40.88) | 240 (31.25) |
| Reduced sexual interest | 275 (35.80) | 302 (39.30) | 191 (24.90) |
| Decreased in frequency of sexual activity | 216 (28.10) | 328 (42.70) | 224 (29.20) |
| Decreased quality of sexual activity | 272 (35.40) | 301 (39.20) | 195 (25.40) |
Association of menopausal symptoms with marital relationship
Further analysis revealed a significant association between the severity of menopausal symptoms and the quality of marital relationships (P < 0.05) [Table 4]. Women experiencing mild symptoms were significantly more likely to report very good or good marital relationships, as demonstrated by Bonferroni’s post hoc analysis [Table 5]. On the other hand, those with severe symptoms tended to report relationships that were either good or poor, suggesting that the distress associated with severe menopausal symptoms might negatively impact relational harmony. In addition to symptom severity, both age and a history of previous medical illnesses were significantly associated with more severe menopausal symptoms [Table 6]. Similarly, a history of medical problems among women was found to influence the quality of their marital relationships, indicating that the broader health status of women can have implications beyond physical well-being, affecting intimate partner dynamics as well. There was a significant association of the severity of menopausal symptoms with marital relationship (P < 0.05) [Table 4]. On Bonferroni’s post hoc analysis, a significant association of mild symptoms with a very good and good marital relationship (P < 0.05) was found [Table 5]. Menopausal symptoms affect perimenopausal women depending on the severity of the symptoms; mild symptoms are frequently linked to very good relationship, moderate symptoms to both good and very good relationship, and severe symptoms to either good or poor relationship quality [Tables 4 and 5].
Table 4.
Association of menopausal symptoms with marital relationship (n=768)
| Variables | Marital relationship | df | Fisher’s exact test | P | ||
|---|---|---|---|---|---|---|
|
| ||||||
| Very good (%) | Good (%) | Poor (%) | ||||
| Menopausal symptoms | ||||||
| Mild | 11 (100) | 0 | 0 | 4 | 294.65 | 0.00* |
| Moderate | 35 (9.90) | 317 (90.10) | 0 | |||
| Severe | 0 | 265 (65.40) | 140 (34.60) | |||
| Total=768 | 46 | 582 | 140 | |||
*P<0.05 is significant, Fisher’s exact test
Table 5.
Bonferroni post hoc analysis for the association of menopausal symptoms with marital relationship (n=768)
| Variables | Marital relationship | df | Fisher’s exact test | ||
|---|---|---|---|---|---|
|
| |||||
| Very good frequency (%); P | Good frequency (%); P | Poor frequency (%); P | |||
| Menopausal symptoms | |||||
| Mild | 11 (100); 0.00 | 0 | 0 | 4 | 294.65 |
| Moderate | 35 (9.90); 0.00* | 317 (90.10); 0.00* | 0 | ||
| Severe | 0 | 265 (65.40); 0.00* | 140 (34.60); 0.00* | ||
| Total=768 | 46 | 582 | 140 | ||
*P<0.05 is significant
Table 6.
Partner’s support and coping strategies of women in relationship conflicts (n=768)
| Frequency (%) | |
|---|---|
| Partner’s support in managing symptoms | |
| a. Accompanies to routine checkup visits to hospital | 167 (21.74) |
| b. Helps in daily household chores | 67 (8.70) |
| c. Helps to cope with the symptoms | 55 (7.10) |
| d. Allow to take rest irrespective of time | 34 (4.40) |
| e. Accompany the physiotherapist for joint and muscular pain | 12 (1.50) |
| f. Sits along during sleepless nights | 10 (1.30) |
| g. Create a suitable environment during hot flashes | 5 (0.65) |
| Coping strategies during relationship conflicts | |
| a. Do not take any particular action | 223 (29.03) |
| b. Visit to holy places. communication | 96 (12.50) |
| c. With the help of family members, including children | 61 (7.90) |
| d. By communication | 56 (7.20) |
| e. By shopping | 15 (1.90) |
| f. Attending different celebrations together | 13 (1.60) |
| g. Preparing good food for each other | 7 (0.91) |
| h. Spending time with friends | 5 (0.65) |
| i. Counseling/support groups | 2 (0.26) |
Changes in marital dynamics and women’s perceptions during menopausal transition
During the transition phase (29.80%) of women reported an increase in conflicts with their spouses, (16.01%) that reduced intimacy among partners, whereas (15.01%) women expressed that due to their focus on raising their children, they invested least in their relationship with their partners [Figure 3]. During the interview, women reported that nearly half of the husbands had health issues while one-fourth were affected by filariasis and alcoholism was also an issue among 1% of the husbands leading to problems in marital relationship [Figures 4 and 5]. Further perception of women was also evaluated toward menopause; it was also found that 25% of the women perceive menopause as the period for religious engagement and 14% perceive that menopausal symptoms interfere with daily living. It has also been reported by 13% of women that they are unable to do daily household activities; 11% of women have felt no changes during the transition phase. Menopause is viewed as a time when women should not worry about their periods by 10% of women, and 7% of women view it as a time when family time is reduced. Only 3% of women reported menopause as a period of social withdrawal, while 17% of women gave various other explanations.
Figure 3.
Prevalence of menopausal symptoms
Figure 4.
Reasons for impaired intimacy in marital relationship
Figure 5.
Husband’s health issues affecting the marital relationship. DM: Diabetes mellitus, HTN: Hypertension
DISCUSSION
The purpose of this study was to ascertain the prevalence and severity of menopausal symptoms among perimenopausal women and explore their association with marital relationship quality. In the present study, the mean age of menopause was 47.8 years, which was consistent with findings from other studies conducted in India.[16,19,20,21] The Indian Menopause Society’s multicentric study, conducted across 21 cities, reported the average menopausal age for Indian women as 45.59 ± 5.59 years and the perimenopausal age as 44.69 ± 3.79 years.[3]
In contrast, studies from western countries such as the United States and Australia indicate a higher mean age of menopause, ranging from 50 to 52 years.[22,23] The SWAN study reported a mean age of 51.4 years among American women. Ethnic and regional variations in menopausal age have been attributed to genetic, nutritional, reproductive, and environmental factors.[24] Notably, countries like Italy have reported the lowest mean age of menopause at 42 years,[25] while Turkish women have a later age of menopause at 50.66 ± 4.15 years.[26]
In this study, 81.19% of perimenopausal women reported experiencing menopausal symptoms. This prevalence is similar to that found in a population-based study conducted in China, where 77.2% of women reported menopausal symptoms.[27] The findings are also in line with Indian data. A study in Karnataka reported a symptom prevalence of 88% among rural women.[19] The slight discrepancies across studies may result from regional and cultural differences in health-seeking behavior and symptom perception.
Regarding the severity of symptoms, 1.40% of women in our study experienced mild symptoms, 45.83% had moderate symptoms, and 52.73% reported severe symptoms. These findings differed from those of a China study, which reported that only 3.8% of women experienced moderate-to-severe symptoms, and 11.9% experienced mild symptoms.[27] This contrast may be attributed to higher awareness, access to healthcare, and better-coping mechanisms among women in China.
Hot flashes were reported by 85% of women in our study, highlighting their prevalence as one of the earliest vasomotor symptoms. This result is considerably higher than those observed in European and Asian populations.[28] For instance, the prevalence of hot flashes was 35.4% among Spanish women, 31.2% among Caucasian women, 20.5% among Chinese women, and 17.6% among Japanese women.[29] Cultural attitudes, social affiliations, family relationships, and overall well-being likely contributed to these variations.[28] These differences likely reflect cultural perceptions of menopause, dietary practices (such as soy consumption), and genetic predispositions.
In the present study, 95.4% of women experienced irritability, with nearly half reporting the symptom as severe or very severe. This is notably higher than international reports. A comparative study found that 41.2% of perimenopausal women in the U. S. reported irritability more often than premenopausal women.[30] Irritability has been closely associated with hormonal fluctuations during the perimenopausal period and is often accompanied by mild-to-moderate depressive symptoms, particularly in women with a history of depression or chronic stress.[8,31]
Joint and muscular pain was the second most prevalent symptom in our study, with 90% of women reporting it. This aligns with global evidence where musculoskeletal discomfort is among the most commonly reported symptoms. In Germany, nearly 70% of menopausal women experienced joint pain.[18] Findings are comparable to those of a Puducherry-based study in India, where 71% of women reported muscular discomfort during the menopausal transition.[32] Fatigue and tiredness were also commonly associated with joint and muscle pain, as reported in other studies.[16,33,34] The high prevalence may be influenced by Vitamin D deficiency, low physical activity, and postural stress from household work, especially in Indian rural and semi-urban settings.
Sexual dysfunction was another concern during menopause. In this study, only one-fourth of women reported experiencing sexual issues, when compared to reports from women in Iran (36.28%)[34] and the United States (43%).[35] Cultural reluctance to discuss sexual matters, particularly in rural Indian communities, may contribute to underreporting. The discrepancies between our findings and those of other studies could be attributed to differences in sample size, cultural factors, and women’s perspectives and knowledge about menopause. Other studies have highlighted that vaginal atrophy, dryness, and dyspareunia significantly contribute to sexual dysfunction, leading many women to avoid sexual intimacy postmenopause.[36,37,38,39]
In our study, menopausal symptoms impacted the marital relationship. A significant association was found between symptom severity and marital relationship quality (P < 0.05). Women with mild symptoms often reported very good relationships, while those with severe symptoms reported good or poor relationship. In contrast, a study found a weaker association between menopausal symptoms and marital distress in the U. S., suggesting that sociocultural and partner-support factors may play a more significant role in determining relationship satisfaction.[40] Some research suggested that sexual issues during menopause affected women’s relationship with their partners.[12,41] In India, studies have consistently shown that male partners often lack awareness or empathy toward menopausal changes for their wives.[42] A qualitative study found that sexual disharmony during menopause has been reported to affect relationships in three distinct ways: reduced sexual activity, negative body image, and emotional disconnect.[11]
This study also sheds light on the psychosocial aspects of menopause in Indian culture. A notable proportion of women in our study reported that family obligations, children’s responsibilities, and household duties led them to deprioritize their health and marital relationships. Only 10% of women viewed menopause as a time of relief from menstruation, while 3% associated it with social withdrawal. Similar observations were made in a qualitative study, which found that rural women often accept menopause passively due to societal expectations and limited health literacy.[42]
Furthermore, social support played a role in how women experienced menopausal symptoms. In Indian culture, women going through the perimenopausal transition have often placed less emphasis on their own well-being, as their attention is typically directed toward raising children and meeting social responsibilities.[11,43] This shift in focus, coupled with the increased demands of household duties, has sometimes led women to deprioritize their personal needs, including their relationship with their partners.
This study found no significant association between sociodemographic factors and marital status, except for a significant association between a woman’s medical history and her marital status. In contrast, a study from Pakistan found that demographic factors influenced marital relationship during menopause.[41] Rural women’s reluctance to disclose details about their relationship may have contributed to the differences in findings.
Social support has been identified as a buffer against the negative effects of menopausal symptoms. A cross-sectional study found that perceived emotional support significantly reduced the severity of psychological symptoms in Chinese women.[27] Unfortunately, in the Indian context, such support systems are often lacking or underutilized, particularly in patriarchal rural communities.
In Indian society, women are often expected to remain strong and fulfill family responsibilities without complaint during menopause, while men’s involvement in supporting their partners has typically been minimal or negative.[44,45] These cultural and partners’ expectations placed additional strain on women during this transitional phase.[46]
A key strength of this study is the use of both self-administered questionnaires and in-depth interviews, which provided rich, detailed insights into the impact of menopausal symptoms on marital relationship. The large, community-based sample covering both rural and urban areas enhances the generalizability of findings. In addition, the door-to-door community-based survey approach accurately reflects the prevalence and severity of menopausal symptoms, reducing selection bias. This study has several limitations. The reliance on self-reported data may have social desirability bias. In addition, underreporting of symptoms is possible, particularly among rural women who may have underreported symptoms due to limited awareness or social taboos. Moreover, retrospective reporting of symptoms and menstrual history introduces the possibility of recall bias, such as menopausal symptoms from preceding weeks, menstrual regularity, and the last menstrual period, which also makes recall bias unavoidable.
CONCLUSION
The study revealed a high prevalence of menopausal symptoms among perimenopausal women, with irritability, joint pain, hot flashes, and sleep disturbances being the most frequently reported, and most women experiencing these symptoms with considerable severity. Menopausal symptoms significantly affect the quality of marital relationships, with mild symptoms associated with very good relationships and severe symptoms leading to both good and poor relationship quality. Key outcomes from this study stress the need for routine screening of menopausal symptoms in primary care settings. Nurses play a key role in counseling, support group facilitation, and partner education. Tailored strategies are needed for urban and rural populations, addressing lifestyle and healthcare access. In addition, advocacy for improved access to both hormonal and nonhormonal therapies is needed. This research underscores the importance of strengthening support systems and improving healthcare services to enhance the well-being and quality of life for perimenopausal women and their families.
Data availability statement
Data supporting the results reported in this study can be obtained from the corresponding author upon reasonable request.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
The authors thank all faculty members, for their constant support and encouragement throughout the study and to all women who made it possible to complete this research project.
Funding Statement
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data supporting the results reported in this study can be obtained from the corresponding author upon reasonable request.