ABSTRACT
Introduction:
Menopausal transition has an impact on health and well-being of women. Majority of rural women employed in manual labour, suffer from severe menopausal symptoms.
Aim:
To estimate the prevalence of menopausal symptoms among rural women and assess its association with sociodemographic factors.
Materials and Methods:
166 random women attending OPD in a rural center were enrolled in this cross sectional study. A pretested questionnaire was used to collect background details, menstrual and menopausal history. Menopause Rating Scale (MRS) was used to assess the menopausal symptoms.
Statistical Analysis Used:
The prevalence of any one of the menopausal symptoms during the last month was calculated. A ”t” test was used to determine the significance of mean difference between perimenopausal and postmenopausal groups. The association between menopausal symptoms and sociodemographic factors was assessed using Chi-square test.
Results:
Mean age of women was 48.9 ± 6.4 years. The mean age at menopause was 47.8 ± 2.45 years. 96.6 percent of participants had any of 11 menopausal symptoms with somato-vegetative domain being the most commonly affected. Joint and muscular discomfort was the commonest symptom (92.8%). During the menopause transition phase, 69.3% had poor quality of life. Statistically significant associations were found in women from lower socioeconomic classes (P = 0.002) and who have not reached menopause (P = 0.014).
Conclusion:
Majority of women (69.3%) having menopausal symptoms have poor quality of life. Improvement in the overall socioeconomic condition and focusing menopausal women in primary health care activities at field level will reduce the impact of menopausal symptoms.
Keywords: Menopause, prevalence, quality of life, rural women
Introduction
Menopause is described as “a point in time that follows one year after the complete cessation of menstruation, and the post-menopause describes years following that point”.[1] There will be a noticeable drop in estrogen levels. The function of the ovarian follicles is lost. “Menopause Transition Phase begins with menstrual cycle irregularity and extends to 1 year after permanent cessation of menses”.[1] This phase extends over a wide age range of 42–58 years.[1] Women experience several physical, mental, emotional, and social changes throughout the menopausal transition period. Additionally, a lot of women experience mood swings, irregular menstrual cycles, and abnormal menstrual bleeding during this phase of transition.[2]
Women, being the main caregivers in the Indian families, often go unnoticed and lack health-seeking during menopause because their symptoms are ignored in their homes and communities. The well-being of menopausal women is greatly affected by the common symptoms they experience, which include hot flushes, insomnia, mood swings, and joint pain. One of the symptoms faced by menopausal women is sexual problems, which are least discussed in a rural setup, and several social restrictions and stigma revolve around it even among females. These problems are sometimes made worse by a lack of support and healthcare resources. Increased suffering might result from delayed diagnosis and ineffective treatment due to a lack of expert care and health facilities in the rural areas focusing on menopause and related symptoms. Furthermore, rural women might be more responsible for home tasks and manual labor, which would further increase the physical and emotional symptoms of menopause. This creates a gap in healthcare equity, underscoring the need for targeted interventions.[3]
Menopause and menarche in girls vary in significance and are differently perceived. Multiple groups, both governmental and voluntary, focus on health education for menstrual hygiene, adolescent health, and maternal and reproductive health, leaving the menopausal women unnoticed. Menopausal women are neglected even in National health programs. Menopausal women lack fundamental health education and knowledge of the available treatments to ease their symptoms, something that neither the government nor the medical community has failed to address. Governments lack the funding and health policies necessary to include menopause-related diagnosis, counselling, and treatment services in their primary health care services.[2]
Menopausal symptoms can be distinguished under three domains: sexual and urogenital, psychomotor, and somato-vegetative.[4] Many women in rural areas mistakenly link their menopause symptoms to reasons other than menopause, and multiple studies have recorded false beliefs and misunderstandings about menopause.[5]
Due to improved education and healthcare, as well as longer life expectancy, the proportion of people aged 60 and above in India has risen from 5.3% to 5.7% in 1991 and 6.0% to 8.1% in 2020. The number of women over 45 years old is 9606923, which accounts for 26.68% of the total female population in the state, highlighting the significant importance of studying menopause and its impact on quality of life.[6,7]
Objectives
To estimate the prevalence of rural women aged 41–60 years experiencing menopausal symptoms and how it affects the quality of life.
To assess the association between the sociodemographic factors and menopausal symptoms among women aged 41–60 years attending the Rural Health and Training Center of a medical college.
Subjects and Methods
A Rural Health and Training Centre in South India was selected as the study area. This hospital based cross-sectional study was conducted from April 2023 to June 2023. The centre offers a wide range of outpatient services across all specialties. Participants for the study were enrolled following a quick briefing about menopause and related symptoms from the registration desk at the Outpatient department where they sought various medical services.
Sample size
Based on the research conducted by Kalhan et al.[8] in Haryana among rural middle-aged women, the expected prevalence of menopausal symptoms was 87.7%. With a 5% absolute precision and a 95% confidence interval, and substituting into the formula n = (1.96) 2 × 87.7 (12.3)/52, the calculated sample size was 166. Since the systematic random sampling technique was adopted, non-responders were not added to the sample.
Inclusion criteria
All women aged 41–60 years registered at the outpatient registration desk at the Rural Health and Training Centre of a private medical college who have given written consent to take part in the study.
Exclusion criteria
Patients who underwent hysterectomy or any other gynecological surgeries.
Patients on anxiolytics, antidepressants, hormone replacement therapies, and antipsychotics.
Patients with thyroid diseases as symptoms of thyroid disorder mimic menopausal symptoms and genital pathology.
Study tool
Part 1: Sociodemographic and background details – age, educational qualification, occupational status, socioeconomic class, type of family, marital status, and total number of family members.
Part 2: Menstrual history-regularity of menstrual cycles, age at menopause.
Part 3: Menopause Rating Scale (MRS) Questionnaire consisting of 3 domains: Somato-vegetative domain, Psychological domain, and Urogenital domain.[4] The 11 symptoms that were studied are depressive mood, irritability, physical and mental exhaustion, anxiety, sexual problems, bladder problems, dryness of vagina, hot flushes and sweating, heart discomfort, sleep problems, and joint and muscular discomfort.
Data collection
In March 2023, the Institutional Ethics Committee approval was obtained. Systematic random sampling was the method of sampling that was employed. A research invitation was extended to every fifth patient who registered at the outpatient desk. The next patient was approached if any of the invited patients declined to participate. The main reason for non-participation was found to be lack of time for the interview. All participants received a thorough explanation of the study before beginning the interview. A semi-structured questionnaire consisting of 3 sections was used to conduct face-face interviews with 166 female patients between the ages of 41 and 60. Around 10 patients per day were interviewed. Adequate time for each participant was provided to recall their menopausal symptoms in the last 1 month. A four-point Likert scale was used to estimate the severity of symptoms, and the total of all the symptoms produced the Overall Menopause Rating Scale (MRS) score. The highest MRS score that could be obtained is 44. The severity of menopausal symptoms was categorized using this score. Little or no symptoms are classified as scores of 0–4, mild symptoms as scores of 5–8, moderate symptoms as scores of 9–16, severe symptoms as scores of 17–44. The higher the score, greater the impairment of quality of life. A cut-off score of ≤8 (no and mild symptoms) suggested good quality of life, and scores >8 (moderate and severe symptoms) suggested poor quality of life.[8]
Data analysis
The gathered data was entered and analysed using Statistical Package for Social Sciences (SPSS). Categorical values are expressed as frequencies (n), and numerical values are expressed as mean and standard deviation. For each domain, the prevalence was assessed based on the participants’ experiences with any one of the menopausal symptoms during the last month. For both perimenopausal and postmenopausal women, the mean score and standard deviation for each menopausal symptom were determined individually. A ”t” test was used to determine the significance of the mean difference between the two groups. Menopausal symptoms severity and quality of life are reported as frequencies. The association between the menopausal symptoms and sociodemographic factors was assessed using the Chi-square test. Various sociodemographic factors, such as age, education status, occupational status, type of family, total number of family members, menopausal status, marital status, and socio-economic class, were adjusted by performing a logistic regression analysis, and adjusted odds ratio was obtained. α value of less than 0.05 was considered significant.
Operational definitions
Perimenopausal women
“Women in the period immediately prior to menopause characterized by irregular menstrual cycles, experienced after the previously regular cycles when the endocrinological, biological, and clinical features of approaching menopause”.[9]
Post-menopausal women
“Women who have not had a menstrual period for more than a year after menopause”.[9]
Results
Characteristics of study participants
In the study, 166 women between the ages of 41 and 60 were selected. The participants’ mean age was 48.9 ± 6.4 years. Of the participants, 54.2 percent were in the perimenopausal stage and 45.8% had reached menopause. The mean age at menopause among the study participants (1 year after the last menstrual period) was 47.8 ± 2.45 years. Table 1 shows the participants’ sociodemographic information, which includes their level of education, employment, socioeconomic status (as determined by the modified B. G. Prasad scale 2023), type of family, menopausal status, marital status, and number of family members. The majority of the participants were from nuclear families and were married. According to NFHS-5, rural women who are literate are 65.9% where the criteria they have used is women who completed 9th standard or higher and women who can read a whole sentence or part of a sentence whereas in this study literacy refers to women who know to read and write with full understanding in any language. Because of different criteria used and geographical variation, the vast difference may be noted.
Table 1.
Socio-demographic factors of study participants (41–60 years)
| Socio-demographic factors | Frequency (n) | Percentage (%) |
|---|---|---|
| Education | ||
| Literate | 49 | 29.5% |
| Illiterate | 117 | 70.5% |
| Occupational status | ||
| Employed | 82 | 49.4% |
| Unemployed | 84 | 50.6% |
| Socio economic status | ||
| Class 1 (Upper class) | 6 | 3.6% |
| Class 2 (Upper middle) | 61 | 36.7% |
| Class 3 (Middle) | 71 | 42.8% |
| Class 4 (Lower middle) | 21 | 12.7% |
| Class 5 (Lower) | 7 | 4.2% |
| Type of family | ||
| Nuclear family | 101 | 60.8% |
| Joint family | 65 | 39.2% |
| Menopausal status | ||
| Menopause attained | 76 | 45.8% |
| Menopause not attained | 90 | 54.2% |
| Marital status | ||
| Married | 141 | 84.9% |
| Unmarried | 3 | 1.8% |
| Separated | 22 | 13.3% |
| Number of family members | ||
| ≤4 | 107 | 64.5% |
| >4 | 59 | 35.5% |
Prevalence of menopausal symptoms by menopausal status
Table 2 lists the participants’ menopausal symptoms; In the past month, 96.6 percent of the participants claimed experiencing any of the 11 menopausal symptoms described in the methodology. Sexual issues were the least common complaint (16.3%), whereas joint and muscular pain was the most often mentioned symptom (92.8%). Due to uneasiness, rural women are not disclosing their sexual problems the way they share about their other health issues. Since many rural women are expected to engage in manual physical labor, joint and muscular discomfort was commonly reported. When comparing the symptoms by domain, the somato-vegetative domain is most likely to affect the participants, followed by the psychological and urogenital domains.
Table 2.
Prevalence of each menopausal symptom under 3 domains
| Menopausal symptoms | Frequency (n) | Prevalence % (95% CI) |
|---|---|---|
| Somato-vegetative domain | 162 | 97.6% (94.3–99.2) |
| Hot flushes, sweating | 90 | 54.2% (46.6–61.7) |
| Heart discomfort | 117 | 70.5% (63.2–77.0) |
| Sleep problems | 106 | 63.9% (56.3–70.9) |
| Joint and muscular discomfort | 154 | 92.8% (88.0–96.0) |
| Psychological domain | 158 | 95.2% (91.1–97.7) |
| Depressive mood | 109 | 65.7% (58.2–72.6) |
| Irritability | 113 | 68.1% (60.7–74.8) |
| Anxiety | 121 | 72.9% (65.8–79.2) |
| Physical and mental exhaustion | 151 | 91.0% (85.9–94.7) |
| Uro-genital domain | 105 | 63.3% (55.7–70.3) |
| Sexual problems | 27 | 16.3% (11.2–22.5) |
| Bladder problems | 85 | 51.2% (43.6–58.8) |
| Dryness of vagina | 70 | 42.2% (34.8–49.8) |
| Prevalence of any one menopausal symptoms in the past 1 month | 162 | 97.6% (94.3–99.2) |
Severity of menopausal symptoms
Figures 1 and 2 depict the severity of menopausal symptoms, with 6% of individuals having no or few symptoms (total score/=17). The severity is maximum reported for sleep problems followed by anxiety [Figure 1]. Menopausal Rating Scale scores show that 69.3% (n = 115) of the individuals had poor quality of life (total score > 8), which is relatively high [Figure 3].
Figure 1.
Severity of menopausal symptoms of women in the last 1 month
Figure 2.
Overall severity of menopausal symptoms in women in the last 1 month
Figure 3.
Menopausal women and their quality of life
When we compare the mean score of each symptom between perimenopausal and postmenopausal women, we find that the perimenopausal women had higher mean scores across all domains. The significance of the mean score obtained was evaluated using the ‘t’ test. Compared to perimenopausal women, symptoms like Sexual problems (P < 0.001) and physical and mental exhaustion (P < 0.001) are more among post-menopausal women [Table 3].
Table 3.
Mean score of each menopausal symptom by their menopausal status
| Menopausal symptoms | Peri-menopausal (n=90) | Post-menopausal (n=76) | P |
|---|---|---|---|
| Somato-vegetative domain | 6.37±3.44 | 5.65±2.94 | 0.162 |
| Hot flushes and sweating | 1.01±1.13 | 1.01±1.13 | 1.000 |
| Heart discomfort | 1.61±1.19 | 1.24±1.09 | 0.435 |
| Sleep related problems | 1.59±1.39 | 1.29±1.33 | 0.696 |
| Joint and muscular discomfort | 2.16±0.94 | 2.11±0.84 | 0.316 |
| Psychological domain | 7.08±3.81 | 4.97±3.09 | 0.062 |
| Depressive mood | 1.37±1.00 | 0.88±0.97 | 0.789 |
| Irritability | 1.73±1.22 | 1.08±1.17 | 0.711 |
| Anxiety | 1.87±1.21 | 1.18±1.10 | 0.396 |
| Physical and mental exhaustion | 2.11±1.34 | 4.97±3.09 | <0.001 |
| Uro-genital domain | 1.94±1.86 | 1.54±1.84 | 0.927 |
| Sexual problems | 0.30±0.71 | 0.16±0.43 | <0.001 |
| Bladder problems | 0.94±1.06 | 0.97±1.08 | 0.861 |
| Dryness of vagina | 0.70±0.74 | 0.41±0.70 | 0.6223 |
Association of quality of life of menopausal women and sociodemographic factors
In this study, it was found that a significant proportion of menopausal women experience a decline in their quality of life (QoL). Of the women surveyed, 69.3% reported having a poor quality of life during menopause. This high percentage indicates a considerable impact of menopausal symptoms on overall well-being. Table 4 shows the association between menopausal symptoms and sociodemographic factors. For analysis purposes women experiencing moderate and severe symptoms (total score > 8) are considered as having menopausal symptoms, and those with a score ≤8 (good quality of life with no or mild symptoms) are considered to not have menopausal symptoms. Statistically significant associations were found in women from lower socioeconomic classes (P = 0.002) and those who have not reached menopause (P = 0.014). Women belonging to lower socioeconomic classes (class 3, 4, and 5 of the modified B. G. Prasad classification) are at 3.59 times increased odds, and women who have not attained menopause are at 3.08 times increased odds of experiencing menopausal symptoms.
Table 4.
Association between menopausal symptoms and sociodemographic factors
| Socio-demographic Factors | Menopausal symptoms | Crude Odd’s ratio (95% CI) | p | Adjusted odd’s ratio (95% CI) | p | |
|---|---|---|---|---|---|---|
|
| ||||||
| Present (n=115) | Absent (n=51) | |||||
| Age | ||||||
| 41-50 years | 82 | 28 | 2.04 (1.03–4.04) | 0.039 | 0.79 (0.29–2.14) | 0.640 |
| 51-60 years | 33 | 23 | ||||
| Education | ||||||
| Illiterate | 81 | 36 | 0.99 (0.48–2.05) | 0.984 | 1.26 (0.54–2.94) | 0.586 |
| Literate | 34 | 15 | ||||
| Occupation status | ||||||
| Employed | 59 | 23 | 1.28 (0.66–2.49) | 0.461 | 1.19 (0.55–2.59) | 0.654 |
| Unemployed | 56 | 28 | ||||
| Type of family | ||||||
| Nuclear family | 73 | 28 | 1.43 (0.73–2.79) | 0.296 | 2.97 (0.99–8.85) | 0.051 |
| Joint family | 42 | 23 | ||||
| No. of family members | ||||||
| >4 | 43 | 16 | 1.31 (0.65–2.64) | 0.455 | 2.19 (0.73–6.57) | 0.163 |
| ≤4 | 72 | 35 | ||||
| Menopausal status | ||||||
| Menopause not attained | 71 | 19 | 2.72 (1.38–5.37) | 0.003 | 3.08 (1.26–7.54) | 0.014* |
| Menopause attained | 44 | 32 | ||||
| Marital history | ||||||
| Married | 102 | 39 | 2.41 (1.01–5.75) | 0.039 | 1.91 (0.72–5.03) | 0.193 |
| Unmarried/separated | 13 | 12 | ||||
| Socio economic status | ||||||
| Class 3, 4, and 5 (Lower class) | 77 | 22 | 2.67 (1.36–5.26) | 0.004 | 3.59 (1.63–7.92) | 0.002* |
| Class 1 and 2 (Upper class) | 38 | 29 | ||||
* denotes P< 0.05
Discussion
Prevalence of menopausal symptoms
Studying the prevalence of menopausal symptoms is essential for interpreting the overall health and quality of life of menopausal women. This study has given the prevalence of experiencing any one menopausal symptom experienced in the last month as 96.6 percent, with the somato-vegetative domain accounting for the highest number of complaints. Similar types of studies conducted in various settings have reported prevalence ranging from 87% to 96.6% which coincides with the current study.[8,9,10,11,12,13] The prevalence may have been high since this study was carried out among patients who attended the Rural Health and Training Centre, much like a hospital-based study. The common symptoms perceived were discomfort in the joint and muscles followed by they were exhausted physically and mentally, which agree with the results of other studies.[5,8,9] In line with a Pan-Indian study that revealed the mean age of menopause for Indian women to be 46.2 ± 4.9 years, the mean age at menopause is 47.8 ± 2.45 years in this study.[14] The median MRS overall score obtained in this study is 14 (moderate severity), which is very high to consider it as a major problem faced by rural women. Poor quality of life was seen in 69.3% of rural women, similar to a study done by Kalhan et al.[8] where quality of life was impaired in 70.2% study subjects. Another study done by Sudhaa et al. suggests that quality of life among rural women is poor than urban women.[15] After adjusting for various factors as seen in Table 4, the prevalence of menopausal symptoms is explained by 2 factors: lower socioeconomic status and premenopausal age group.
Perimenopausal women: The most affected
In this study we found out that the burden of menopausal symptoms was more on women in the perimenopausal phase with odds of 3.08.[8,16] A community-based study done in China has reported that women in the premenopausal age group had more symptoms when compared to the postmenopausal group similar to this study.[16] When compared to women in the postmenopausal stage, women in this phase typically report the most severe and frequent menopausal symptoms. This is mostly due to the fact that perimenopause is a time of greatest hormonal imbalance, which magnifies the vasomotor symptoms like palpitations, hot flushes, and night sweats. Moreover, this is the time when mood swings, irritability, and sleep issues are most common.[17] In a related study by Kalhan et al.,[8] premenopausal women showed a greater prevalence of psychological and somato-vegetative symptoms, whereas in this study perimenopausal women exhibited a greater prevalence of somato-vegetative and urogenital symptoms.
Perimenopausal women have unpredictable hormonal swings that might worsen their physical and emotional well-being, in contrast to postmenopausal women, whose symptoms may settle when hormonal levels fall.[16]
Socioeconomic class and menopausal symptom
The results of the study show women from lower socioeconomic status have more odds of developing menopausal symptoms when compared to higher socioeconomic status.[12,18,19,20] For analysis purposes, middle class, lower middle class, and lower class were combined as lower socioeconomic status. There are a number of possible causes for this phenomenon put forward by various authors:
Women from lower socioeconomic backgrounds frequently encounter obstacles to receiving healthcare, such as limited access to healthcare services, lack of insurance, and inability to pay for treatments, in addition to work in physically demanding or stressful occupations, which can make symptoms like exhaustion, joint pain, and sleep disturbances worse.[21]
A lower socioeconomic status is frequently linked to a lower level of health literacy, which results in a lack of knowledge regarding menopause and its symptoms.[22]
They experience higher levels of psychological stress, which includes limited social support, caregiving responsibilities, and unstable finances. Stressors like these might exacerbate especially mood-related symptoms like irritability, anxiety, and depression.[23]
Being from a lower socioeconomic background and going through the menopausal transition phase can be a “double burden” for many women.[23] Research indicates that women from lower socioeconomic status backgrounds are less likely to be prescribed or seek hormone replacement therapy (HRT), despite it being one of the best therapies available for controlling vasomotor symptoms. Furthermore, these women might not have easy access to lifestyle therapies like exercise, dietary changes, and stress management because of time and resource constraints or financial limitations.[24]
Menopause in rural women
In rural Tamil Nadu, societal stigma surrounding menopause plays a significant role in shaping women’s experiences and attitudes toward this natural transition, leading to emotional isolation, discomfort in discussing symptoms, and barriers to seeking medical care, further complicating the health and well-being of rural women.[11]
In many rural communities of India, menopause is traditionally seen as a private matter, often associated with aging and the end of a woman’s reproductive role. While some women may see it as a relief from menstruation and childbearing responsibilities, many others experience menopause as a marker of “social invisibility” and a loss of societal value. This devaluation reinforces the stigma, making it more difficult for women to openly acknowledge or seek help for menopausal symptoms.[12,22]
Limitations of the study
This study was conducted in the RHTC of a private medical college. The results cannot be generalized to the rural component of the state. There are potential chances of selection bias as women visiting an outpatient setting may have more severe symptoms than community-based participants.
Conclusion
A total of 69.3% of women going through menopause have poor quality of life. All the women who were found to have menopausal symptoms were referred to Gynaecologist for further evaluation and management. This highlights the importance of giving menopause more attention as a serious health concern. Improvement in the overall socioeconomic condition and sharing of household chores among the family members will have a reduced impact of menopausal symptoms among women in that family.
Recommendations
The study stresses the necessity for comprehensive therapy alternatives due to the high prevalence of symptoms. Hormone replacement therapy (HRT) is a very helpful treatment for reducing the severity of these symptoms, especially vasomotor irregularities.[25] However, since not all women may utilize hormone replacement therapy (HRT) due to contraindications, lack of awareness, and economic reasons, the implementation of non-hormonal therapies like cognitive behavioral therapy (CBT) and lifestyle modifications should be considered as part of a customized care plan to alleviate the symptoms. Health education in the form of awareness campaigns and rallies should be organized as a part of primary health care activities at the field level.
Way Forward
In order to determine the level of stigma and awareness around menopausal symptoms among rural women, more research should be done in the communities to evaluate the health-seeking behavior of menopausal women and to conduct focus groups or in-depth interviews. Since there are currently few studies in this area, research should focus on identifying the risk variables linked to menopausal symptoms.
Author contributions
RA: Concepts, design, definition of intellectual content, literature search, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing, manuscript review, guarantor. MSA: Concepts, design, definition of intellectual content, literature search, data analysis, statistical analysis, manuscript preparation, manuscript editing, manuscript review, guarantor. SV: Concepts, data analysis, statistical analysis, manuscript preparation, manuscript editing, manuscript review, guarantor.
List of Abbreviations
| Abbreviation | Definition |
|---|---|
| MRS | Menopause Rating Scale |
| RHTC | Rural Health and Training Center |
| HRT | Hormone Replacement Therapy |
| CBT | Cognitive Behavioural Therapy |
Conflicts of interest
There are no conflicts of interest.
Ethical policy and Institutional Review board statement
The approval was obtained from Institutional Ethics Committee of SRIHER (reference number – CSP-MED/23/MAR/85/58).
Patient declaration of consent statement
Obtained.
Funding Statement
Nil.
References
- 1.Hoffman, Schorge, Bradshaw, Halvorson, Schaffer, Corton. Williams gynaecology. Third. McGraw-Hill Education. 2016:1297. [Google Scholar]
- 2.Menopause [Internet. [[Last acessed on 2025 Jul 08]]. Available from: https://www.who.int/news-room/fact-sheets/detail/menopause .
- 3.What Is Menopause?[Internet] National Institute on Aging. 2024. [[Last accessed on 2025 Jul 08]]. Available from: https://www.nia.nih.gov/health/menopause/what-menopause .
- 4.Heinemann K, Ruebig A, Potthoff P, Schneider HPG, Strelow F, Heinemann LAJ, et al. The Menopause Rating Scale (MRS) scale:a methodological review. Health Qual Life Outcomes. 2004 Sep 2;2:45. doi: 10.1186/1477-7525-2-45. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Nagaraj D, Ramesh N, Devraj D, Umman M, John AK, Johnson AR. Experience and Perceptions Regarding Menopause among Rural Women: A Cross-Sectional Hospital-Based Study in South Karnataka. J Midlife Health. 2021;12:199–205. doi: 10.4103/jmh.JMH_196_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017:a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392:1736–88. doi: 10.1016/S0140-6736(18)32203-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Area and Population. Statistical Hand Book of Tamil Nadu. 2021 [Google Scholar]
- 8.Kalhan M, Singhania K, Choudhary P, Verma S, Kaushal P, Singh T. Prevalence of Menopausal Symptoms and its Effect on Quality of Life among Rural Middle Aged Women (40-60 Years) of Haryana, India. Int J Appl Basic Med Res. 2020;10:183–8. doi: 10.4103/ijabmr.IJABMR_428_19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Sundararajan M, Srinivasan V. Prevalence of menopausal symptoms and health-seeking behavior of school teachers with menopausal symptoms in Kumbakonam, South India. International Journal Of Community Medicine And Public Health. 2023;10:1224–31. [Google Scholar]
- 10.Singh A, Pradhan SK. Menopausal symptoms of postmenopausal women in a rural community of Delhi, India: A cross-sectional study. J Midlife Health. 2014;5:62–7. doi: 10.4103/0976-7800.133989. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Ganitha G, Premalatha P, Kannan I. A Study of the Age of Menopause and Menopausal Symptoms among Women in a Rural Area of Tamil Nadu, India. Journal of SAFOMS. 2017;5:87–91. [Google Scholar]
- 12.Sivapragasam R, Rajini S, Rajalakshmi S, Priyanga K, Rajesh V, Priyadharshini R. A Community-Based Cross-Sectional Study about the Quality of Life in Postmenopausal Women in Rural Puducherry. Indian J Community Med. 2020;45:96–9. doi: 10.4103/ijcm.IJCM_91_19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Natarajan N, Nandi P, Ka N, S L. Investigating the Prevalence of Menopausal Symptoms and Medico-Social Dimensions of Menopause in Rural Puducherry, India: A Cross-Sectional Analytical Study. Cureus. 2024;16:e55841. doi: 10.7759/cureus.55841. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Ahuja M. Age of menopause and determinants of menopause age: A PAN India survey by IMS. J Midlife Health. 2016;7:126–31. doi: 10.4103/0976-7800.191012. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Sharma S, Mahajan N. Menopausal symptoms and its effect on quality of life in urban versus rural women: A cross-sectional study. J Midlife Health. 2015;6:16–20. doi: 10.4103/0976-7800.153606. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Du L, Xu B, Huang C, Zhu L, He N. Menopausal Symptoms and Perimenopausal Healthcare-Seeking Behavior in Women Aged 40-60 Years: A Community-Based Cross-Sectional Survey in Shanghai, China. Int J Environ Res Public Health. 2020;17:2640. doi: 10.3390/ijerph17082640. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Delamater L, Santoro N. Management of the Perimenopause. Clin Obstet Gynecol. 2018;61:419–32. doi: 10.1097/GRF.0000000000000389. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.OJHAS:2022-4-3. Banskota N, Mondal N. Associations Between Menopausal Symptoms with Socio-economic, Demographic and Lifestyle Variables among Postmenopausal Women of Assam, Northeast India [Internet] [[Last accessed on 2025 Jul 08]]. Available from: https://www.ojhas.org/issue84/2022-4-3.html .
- 19.Assessment of Menopausal Symptom Using Modified Menopause Rating Scale among Rural Women of Rajnandgaon in Chhattisgarh. a Central India Region [Internet] [[Last accessed on 2025 Jul 08]]. Available from: https://www.jsafog.com/abstractArticleContentBrowse/JSAFOG/21778/JPJ/fullText .
- 20.Kamath N. Prevalence and Severity of Menopausal Symptoms Among Women –A Community-Based Cross-Sectional Study. [[Last accessed on 2025 Jul 08]];Online web of Health and Allied Sciences [Internet] 2021 Available from: https://www.ojhas.org/issue77/2021-1-2.html . [Google Scholar]
- 21.Role of Socioeconomic Status in Defining Perception of Women about Menopause-related Myths and Facts [Internet] [[Last accessed on 2025 Jul 08]]. Available from: https://www.jsafoms.com/abstractArticleContentBrowse/JSAFOMS/22986/JPJ/fullText .
- 22.Singh V, Sivakami M. Normality, Freedom, and Distress: Listening to the Menopausal Experiences of Indian Women of Haryana. In: Bobel C, Winkler IT, Fahs B, Hasson KA, Kissling EA, Roberts TA, editors. The Palgrave Handbook of Critical Menstruation Studies [Internet] Singapore: Palgrave Macmillan; 2020. [[Last accessed on 2025 Jul 08]]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK565663/ [PubMed] [Google Scholar]
- 23.Divya KL, Nimithamohan K, Bilimale AS, Muralidhar K, Krupp K, Madhivanan P. Role of Social Support in Reducing the Severity of Menopausal Symptoms among Women Living in Rural Mysuru, Karnataka: An Analytical Cross-sectional Study. J Midlife Health. 2024;15:12–8. doi: 10.4103/jmh.jmh_180_23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Pallikadavath S, Ogollah R, Singh A, Dean T, Dewey A, Stones W. Natural menopause among women below 50 years in India: A population-based study. Indian J Med Res. 2016;144:366–77. doi: 10.4103/0971-5916.198676. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Warren MP, Shu AR, Dominguez JE. Feingold KR, Ahmed SF, Anawalt B, Blackman MR, Boyce A, Chrousos G, et al., editors. Menopause and Hormone Replacement. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc. 2000. [[Last accessed on 2025 Jul 08]]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK279050/ [PubMed]