Introduction:
Menopause is a normal phase of a woman's midlife that complicates her life, particularly during the perimenopause and menopausal phases, and the complexity grows when she becomes ill [1-5]. When a woman reaches her 40s or 50s, she begins to experience a natural decline in reproductive hormones such as oestrogen and progesterone, as well as a complete cessation of ovarian functions [2,4,6-8]. Menopausal health has a multi-dimensional impact on biological, physiological, and psychological aspects, causing imbalance as a result of the various types of symptoms and their severity [4,5,9-11]. However, the limited number of oestrogen production causes psychological and physiological changes in women, as well as declinations that manifest as menopausal symptoms [4,5,10]. Several studies have found that the majority of postmenopausal women, particularly those living in rural areas, are unaware of menopause or menopausal symptoms [3-5,12].
The menopausal phase is commonly known to experience menopausal symptoms such as physiological and psychological problems are significantly higher in women's midlife [8,9,13-16]. It is estimated that 85% of postmenopausal women have experienced menopausal symptoms or problems [3-5,12]. The variations in different socio-economic, demographic and lifestyle factors found to have influences on the severities of menopausal symptoms and also attainment of menopause in women [17-20]. Several researchers in India have reported the severity of various menopausal symptoms among women living in both rural and urban areas [1,3-5,7,20,21]. The objectives of this study are to determine the prevalence of menopausal symptoms and association between socio-economic, demographic and lifestyle variables among postmenopausal women in Assam, Northeast India.
Material and
Methods
The community-based cross-sectional study was undertaken among 300 postmenopausal rural women aged 42-60 years from Tinsukia district in Assam, Northeast India. The research participants are largely Nepali-speaking individuals in the country's North-eastern region, representing a diverse range of castes and ethno-tribal groups. Despite the fact that they are from different caste-groups and speak different languages, and linguistically are both members of the Tibeto-Burman or Indo-Aryan groups. A total of 345 postmenopausal women were identified and approached for data collection using the household survey method, where 300 research participants were willing to participate and/or meeting inclusion criteria in the present investigation. The overall rate of participation was 86.96%. The present study's relevant data was collected from January to April 2022. The research participants were married, had attained natural menopause, had at least one child, and did not have any chronic gynaecological issues or hysterectomy exposure, and had their last menstrual period twelve months ago. This cross-sectional study focuses on community-level participation of subjects recruited from Tinsukia, Assam's large inhabitant village 3No. Udaipur. A total of four clusters in Udaipur village were chosen at random and surveyed for data collection. The total number of participants had a mean age of 50.06±4.07 years. To avoid selection ambiguity, research participants who achieved menopause through surgical removal of the uterus, and were found to have any physical deformity and suffering due to chronic health and reproductive complications, or who did not have a history of childbirth or exposure to reproductive behaviours (e.g., pregnancy or parity), were excluded.[17,18] Before data collection, the objectives of the current investigation and the nature of participation were explained. The research participants' participation in the present study was entirely voluntary. The present study was carried out in accordance with the Helsinki Declaration's ethical guidelines for human research [22].
Collection of Data
The recalled method and face-to-face interviews were used to collect information on reproductive health issues and menopausal symptoms. The menopausal symptoms were collected under five broad types of domains of health status; i.e., vasomotor domain, psychological domain, physical domain, urogenital problem and sexual domain. The participants were questioned about any recent diagnoses of related diseases, measures to control symptoms, menopausal health awareness, and the severity of symptoms. Age, age at menarche, age at marriage and first child birth, birth parity, marital status, family type, education, occupation, and monthly income also were recorded socioeconomic and demographic factors.
Statistical Analysis
The Statistical Package for Social Sciences was used to analyse the data (SPSS version 16.0). The quantitative variables were represented using descriptive statistics (mean and standard deviations) and a 95% confidence interval (CI) of the mean. The Poisson distribution with 95% CI was also calculated for the average number of cases in different categorical variables. The mean differences in categorical variables were determined using one-way analysis of variance (ANOVA). Binary logistic regression (BLR) analysis was performed using the enter method to determine the odds ratio and 95%CI, as well as associations between various menopausal symptoms and socioeconomic, demographic, and lifestyle variables, while allowing for the control of various determinant variables. The dependent variables were created in the regression model by those women who experienced different menopausal symptoms separately. A discrete BLR analysis, however, was performed with all determinant variables that could be associated with different menopausal symptoms in postmenopausal women. The predictor variables were used as a set of categorical dummy variables in the BLR regression analysis, and the results were obtained by comparing them to the reference categories. A p-value of 0.05 or less was considered statistically significant.
Results
Table 1 depicts the socioeconomic
and demographic profile of rural postmenopausal women in Assam,
Northeast India. The mean age of menopausal women was estimated to
be 47.08±2.38 years (95% CI: 46.81-47.35) years. The majority of
women reached menopause between the ages of 46 years and 50 years,
and the average age at marriage is 21.23±0.13 years. The average age
at menarche was 13.3±0.08 years, with 55.52% of participants
attaining menarche at 13 years. Lower primary school (1st to 4th
standard) was the qualification level of 42.3% women, followed by
upper primary school (40.70%). Furthermore, the distribution of
monthly family income revealed that 68.9% of families earn ≤ Rs.
20000 per month, with the remaining 23.7% earning above Rs. 21000.
According to the findings, 95% of research participants were
married, 60.33% belonged to a nuclear family and had three children,
and 55% of women lived with four family members. Furthermore, the
findings revealed that 85.7% of menopausal women are experiencing
physical weakness, and the majority of postmenopausal women have no
knowledge or awareness of their menopausal health status. Utilizing,
ANOVA, mean age at menopause difference were found to be statically
significant between categories of age (F-value: 146.62; p<0.05),
monthly income (F-value: 3.10; p<0.05), and categorical mean
differences were shown in Fig. 1.
| Table 1: Descriptive analysis of socio-economic, demographic and lifestyle variables among rural menopausal women of Assam, India |
| Variables |
N (95% CI) |
Percentage (%) |
Mean |
SD |
95 % Confidence Interval of Mean |
F-value |
Lower Bound |
Upper Bound |
Total |
300 |
100 |
47.08 |
2.39 |
42.74 |
44.02 |
Age |
≤45 years |
31 (21.06-44) |
10.3 |
43.39 |
1.74 |
42.74 |
44.02 |
146.62
(p<0.01) |
46-50 years |
141(118.69-166.29) |
47.0 |
46.20 |
1.39 |
45.96 |
46.43 |
51-55 years |
90(72.37-110.63) |
30.0 |
48.58 |
1.54 |
48.25 |
48.90 |
≥56 years |
38(26.89-52.16) |
12.7 |
49.82 |
1.74 |
49.24 |
50.38 |
Types of Family |
Joint Family |
181 (155.59-209.37) |
39.67 |
47.13 |
2.44 |
46.77 |
47.49 |
0.27
(p>0.05) |
Nuclear Family |
119(98.58-142.40) |
60.33 |
46.99 |
2.31 |
46.57 |
47.41 |
Number of Children |
≤3 Children |
171(146.33-198.63) |
60.3 |
46.90 |
2.41 |
46.54 |
47.26 |
2.26
(p>0.05) |
≥4 Children |
129(107.7-15.28) |
39.7 |
47.32 |
2.35 |
46.91 |
47.73 |
Age at Menarche |
≤13 Years |
165(140.78-192.19) |
55.0 |
47.03 |
2.27 |
46.68 |
47.38 |
0.158
(p>0.05) |
≥14 Years |
135(113.19-159.79) |
45.0 |
47.14 |
2.53 |
46.71 |
47.57 |
Age at Marriage |
≤18 years |
33(22.15-46.34) |
11.0 |
46.42 |
2.51 |
45.53 |
47.31 |
2.82
(p>0.05) |
≥19 years |
267(235.92-01.01) |
89.0 |
47.16 |
2.36 |
46.87 |
47.45 |
Age at Menopause |
≤45 years |
127(267.01-335.93) |
42.33 |
47.40 |
2.47 |
46.97 |
47.84 |
2.16
(p>0.093) |
46-50 years |
122(267.01-335.93) |
40.67 |
46.77 |
2.14 |
46.8 |
47.15 |
51-55 years |
44(267.01-335.93) |
14.33 |
46.93 |
2.45 |
46.18 |
47.67 |
≥56 years |
4(267.01-335.93) |
1.33 |
45.50 |
4.04 |
9.06 |
51.93 |
Family Size |
≥4 Members |
90 (72.37-110.63) |
55.0 |
47.02 |
2.46 |
46.51 |
47.54 |
0.76
(p>0.05) |
≥5 Members |
210 (182.55-240.40) |
45.0 |
47.10 |
2.36 |
46.78 |
47.43 |
Education |
1-4 standard |
130 (108.62-154.37) |
42.3 |
47.47 |
2.49 |
47.04 |
47.90 |
1.27
(p>0.01) |
5-8 standard |
122 (101.32-145.67) |
40.7 |
46.77 |
2.14 |
46.38 |
47.15 |
9-12 standard |
48 (35.39-63.64) |
14.7 |
46.81 |
2.59 |
46.06 |
47.56 |
Family Income (Rupees.) |
Rs. ≤20000 |
205 (177.90-235.07) |
68.3 |
47.33 |
2.27 |
47.02 |
47.64 |
3.10
(p<0.05) |
Rs. ≥20000 |
95 (76.86-116.13) |
31.7 |
46.54 |
2.54 |
46.02 |
47.05 |
Physical Weakness |
Yes |
257(226.53-290.43) |
85.7 |
47.02 |
2.26 |
46.73 |
47.29 |
1.31
(p>0.05) |
No |
43(31.12-57.92) |
14.3 |
47.46 |
3.02 |
46.53 |
48.40 |
Marital Status |
Married |
285(252.86-320.09) |
95 |
47.02 |
2.39 |
46.74 |
47.30 |
0.162
(p>0.01) |
Widow |
15(8.40-24.74) |
5.0 |
48.27 |
1.98 |
47.17 |
49.36 |
House Condition |
Bricked |
285(252.86-320.09) |
95.0 |
47.09 |
2.40 |
46.81 |
47.37 |
0.162
(p>0.05) |
Non-Bricked |
15(8.40-24.74) |
5.00 |
46.87 |
2.17 |
45.67 |
48.07 |
Parity |
≤2 |
119 (98.58-142.40) |
39.67 |
47.02 |
2.48 |
46.57 |
47.47 |
0.711
(p<0.05) |
≥3 |
181 (155.59-209.37) |
60.33 |
47.12 |
2.33 |
46.78 |
47.46 |
Age at First Pregnancy |
≤23 years |
180 (154.67-208.31) |
60.0 |
47.27 |
2.35 |
46.92 |
47.61 |
2.77
(p>0.05) |
≥24 years |
120 (99.49-143.49) |
40.0 |
46.80 |
2.43 |
46.36 |
47.24 |
Foetal Wastage |
No |
277 (245.34-311.60) |
92.30 |
47.11 |
2.38 |
46.83 |
47.39 |
0.645
(p>0.05) |
Yes |
23 (14.58-34.51) |
7.70 |
46.70 |
2.51 |
45.61 |
47.78 |
Knowledge of Menopause |
Yes |
283 (250.97- 317.95) |
94.3 |
47.10 |
2.33 |
46.84 |
47.38 |
0.764
(p>0.05) |
No |
17 (9.90-27.22) |
5.7 |
46.59 |
3.26 |
44.91 |
48.26 |
 |
|
Fig. 1: Box-plot showing the distribution of mean and standard errors of the age and family income and age at menopause among rural postmenopausal women of Assam, India |
Prevalence of menopausal symptoms among women
Table 2 depicts the frequency and 95% CI of menopausal symptoms among Nepali-speaking postmenopausal women of Assam, India. The majority of research participants reported symptoms of change in sexual desire or low desire for sexual intercourse (96.33%). Furthermore, profuse sweating with hot flushes (61.67%), followed by the hot flush (60.00%), was found to be more common in postmenopausal women. Furthermore, the findings revealed that pain during sexual intercourse (46.33%), lack of energy (39.67%), sleeping difficulties (37.00%), irritability (30.67%), tiredness (27.67%), vaginal dryness (27.67%), feeling depressed (27.33%), forgetfulness (26.33%), difficulty in concentration (22.00%), wanting to be alone (21.33%), anxiousness (20.67%), impatient with other people (19.67%), joint pain (16.00%), weight gain. The low prevalence of symptoms among postmenopausal women included urogenital problems such as urinary tract infection (4.00%) and dry and itchy skin (4.70%), followed by changes in skin texture (6.00%).
| Table 2: Menopausal symptoms among rural postmenopausal women of Assam, India |
| Symptoms |
N |
95% CI |
Percentage |
Vasomotor Domain |
Hot flushes |
180 |
154.67-208.31 |
60.00 |
Night Sweats |
70 |
54.57-88.44 |
23.33 |
Profuse Sweating Along with the Hot Flushes |
185 |
159.3213.66 |
61.67 |
Psychological Domain |
Feeling Anxious |
62 |
47.54-79.48 |
20. 67 |
Forgetfulness |
79 |
62.54-98.46 |
26.33 |
Irritability |
32 |
21.89 to 45.17 |
30.67 |
Difficulty in Concentration |
66 |
51.04-83.97 |
22.00 |
Feeling Depressed |
82 |
65.22-101.78 |
27.33 |
Impatient with other People |
59 |
44.91-76.11 |
19.67 |
Wanting to Be Alone |
64 |
49.29-81.73 |
21.33 |
Physical Domain |
Joint Pain |
48 |
35.39-63.64 |
16.00 |
Lack of Energy |
119 |
98.58-142.40 |
39.67 |
Tiredness |
83 |
66.11-102.89 |
27.67 |
Weight Gain |
38 |
26.89-52.16 |
12.67 |
Difficulty in Sleeping |
111 |
91.31-133.67 |
37.00 |
Changes in the Texture of Skin |
18 |
10.67-28.45 |
6.00 |
Dry and Itching Skin |
14 |
7.65-23.49 |
4.70 |
Hyperpigmentation of the Skin |
26 |
16.22-36.08 |
8.67 |
Urogenital Problem |
Frequent Urination |
19 |
2.81-14.42 |
6.30 |
Urinary Tract Infections |
12 |
0.03-5.57 |
4.00 |
Sexual Domain |
Change in Sexual Desire |
289 |
256.65-324.31 |
96.33 |
Pain during sexual intercourse |
139 |
116.85-164.12 |
46.33 |
Vaginal Dryness |
83 |
66.11-102.89 |
27.67 |
Binary logistic regression analysis and association of socio-economic, demographic and lifestyle factors with menopausal symptoms
Table 3 depicts the relationship between menopausal symptom severity and socioeconomic, demographic, and lifestyle factors, however, only determinants variables with significant associations with different menopausal symptoms (p<0.05) are included in the tables and results are depicted below:
| Table 3: Binary Logistic Regression analysis and association of menopausal symptoms with socio-economic, demographic and lifestyle variables among rural menopausal women of Assam, India |
| Symptoms |
Variables |
Wald |
Exp.(B)
Odd* |
95% CI |
p |
Hot flush |
Physical weakness (yes) |
3.725 |
0.53 |
0.27-1.01 |
0.049 |
Profuse sweating along with the Hot Flushes |
Physical weakness (yes) |
4.747 |
0.49 |
0.25-0.93 |
0.029 |
Family income (Rs. ≤20000) |
3.554 |
1.65 |
0.98-2.76 |
0.049 |
Forgetfulness |
House condition (non-bricked) |
6.32 |
4.49 |
1.39-14.50 |
0.048 |
Irritability |
Age at Menopause (≤45 years) |
4.01 |
3.82 |
1.03-14.18 |
0.045 |
Age at Menopause (46-50 years) |
5.21 |
3.29 |
1.18-8.64 |
0.022 |
Difficulty on Concentration |
Education (1-4 standard) |
4.89 |
2.62 |
1.11-6.14 |
0.027 |
Education (5-8 standard) |
3.71 |
2.35 |
0.98-5.60 |
0.054 |
Feeling depressed |
Age (51-55 years) |
5.54 |
3.31 |
1.22-8.99 |
0.019 |
Family size (≤4 members) |
4.88 |
2.47 |
1.10-5.53 |
0.027 |
Impatient with other People |
Age (≤45 years) |
5.82 |
0.10 |
0.01-0.65 |
0.016 |
Age at menopause (≤45 years) |
10.06 |
15.34 |
2.83-82.95 |
0.002 |
Age at menopause (46-50 years) |
5.63 |
4.12 |
1.28-13.29 |
0.018 |
Family type (Nuclear) |
4.64 |
2.31 |
1.07-4.96 |
0.031 |
Wanting to Be Alone |
Education (1-4 standard) |
4.82 |
2.40 |
1.09-5.26 |
0.028 |
Education (5-8 standard) |
6.24 |
2.94 |
1.26-6.85 |
0.012 |
Lack of Energy |
Education (5-8 standard) |
5.48 |
2.44 |
1.15-5.14 |
0.015 |
Tiredness |
Age (≤45 years) |
5.95 |
0.13 |
0.02-0.66 |
0.015 |
Age (46-50 years) |
7.90 |
0.16 |
0.04-0.57 |
0.005 |
Age at menopause (≤45 years) |
12.32 |
12.81 |
3.08-53.24 |
0.000 |
Age at menopause (46-50 years) |
9.98 |
6.43 |
2.02-20.39 |
0.020 |
Weight gain |
Total children (≤3 Children) |
5.85 |
0.35 |
0.15-0.82 |
0.016 |
Skin texture |
Family size (≤4 members) |
3.68 |
0.28 |
0.07-1.03 |
0.049 |
Dry and Itching skin |
Parity (≤2) |
4.6 |
0.29 |
0.06-0.86 |
0.030 |
Hyperpigmentation of the skin |
Family size (≥4 Members) |
1.55 |
0.21 |
0.34-10.46 |
0.015 |
Frequent urination |
Age (46-50 years) |
3.70 |
4.87 |
0.97-24.51 |
0.054 |
Age at menarche (≤13 years) |
3.59 |
4.76 |
0.96-7.90 |
0.058 |
Urinary Tract Infections |
Age at first pregnancy (≤23 years) |
4.86 |
4.71 |
1.18-18.73 |
0.027 |
Vaginal dryness |
Age (≤45 years) |
7.10 |
9.09 |
1.79-46.07 |
0.008 |
| [*Only significant associations with considered
variables in BLR analysis were shown in the above Tables] |
Vasomotor Domain: Hot flushes were significantly lower association with physical weakness (Odds: 0.527; p<0.05), and profuse sweating and hot flush were significantly associated with physical weakness (Odds: 0.485; p<0.029) and family income (i.e., Rs. ≤20000) (Odds: 1.645; p<0.05).
Psychological Domain: Irritability showed 3-fold significantly higher association with age at menopausal i.e., ≤45 years and 46-50 years (p<0.05). Similarly, difficulty concentration and wanting to be alone were significantly associated with 1-4 standard and 5-8 standard of education status (p<0.05), and forgetfulness was also associated with non-bricked house conditions (Odds: 4.49; p<0.05). The symptom 'impatient with others' had significantly lower risks with age ≤45 years (Odds: 0.103; p<0.05), but shown a higher associated risks with age at menopause of ≤45 years (Odds: 15.34; p<0.01), 46-50 years (Odds: 4.12; p<0.05), and nuclear family type (p<0.05). Further, symptom 'feeling of depression' has shown significant associations with age 51-55 years (Odds: 3.31; p<0.05) and ≤4 family size (Odds: 2.47; p<0.05).
Physical or Somatic Domain: The physical symptom of lack of energy associated with education status 5-8 standard (Odds: 2.44; p<0.01). Similarly, 'tiredness' has a lower risk with age groups ≤45 years, 46-50 years (p<0.05), and but significantly higher associations with age at menopause (e.g., ≤45 years and 46-50 years) (p<0.01). Weight gain and skin texture were associated with the number of children (≤3 number) and family size (≤4 number), respectively (p<0.05). The results also indicated significantly lower associations of dry and itchy skin and hyperpigmentation with ≤2 parity (Odds:0.229; p<0.05) and family size (≤4 number)(Odds:0.213; p<0.05).
Urogenital problems: Frequent urination showed a significant association with age group 46-50 years (Odds: 4.87; p<0.05), and age at menarche group ≤13 years (Odds: 4.76; p<0.05), whereas, Urinary Tract Infection has higher association with age at first pregnancy ≤23 years (Odds:4.71; p<0.05).
Sexual Domain: Dryness of vagina has significantly higher association with age group ≤45 years (Odds: 9.09; p<0.01).
Discussion
The prevalence of menopausal symptoms and the age of menopause differs for women from different geographical areas, ethnic communities, and socioeconomic status, demographic, and lifestyle factors [1,2-6,20]. The estimated mean menopausal age for women worldwide was 44 to 55 years, and the age range for developing countries was 48-52 years, with the mean age range varying between 44 to 55 years [4,8,20,23-25,31]. The mean age of menopause in Indian women ranged from 40.3 to 48.8 years [1,4] and 41.9 to 49.4 years [26], with menopause estimated to be 48.67 years [1] and 48.26 years [4,26]. The present study found that more than half (68.00%) of women reached menopause between 46 and 50 years. The overall mean menopausal age of women experiencing menopause was estimated to be 47.08±2.38 years (Table 1), which was corroborated by research studies conducted among Ao Naga (51.33 years) [21], English women (52.1 years) [27], South Indian women (48.67 years) [1], Nepali women (47.0 years) [28], Indian tribal women (48.85 years), and caste population [18], Mediterranean region (47.9 years) [25], Delhi women (47.9 years) [29], Rajbanshi (50.0 years) [20], and middle-aged women of Jammu (56.59 years) [30].
Several studies have reported that variations in the symptoms are obtained among postmenopausal women are results of various bio-social and psychological factors which may occurred due to hormonal imbalance, socio-cultural expectations, ageing transitions, nutritional status [3,8,13,25,31-33]. The present study found a high prevalence of change in sexual desire (96.33%) (Table 2), and researchers have found a similar prevalence of symptoms among menopausal women [4,5,25,28,30,33]. The results of changing sexual desire were found to be similar to those reported by Thomas et al. [4] (88.0%). The symptoms of profuse sweating and hot flush (61.67%) and hot flush (60.0%) are consistent with the findings of Akhtar et al. [30](i.e., 62.0%). According to the findings of studies conducted on the Indian subcontinent and ethnic populations, the prevalence of hot flushes ranges from 45.0% to 78.2%. [8, 23, 25, 30-35].
Anxiety, forgetfulness, irritability, difficulty concentrating, feeling depressed, impatient with others, and wanting to be alone were reported to range between 20% and 25% among rural postmenopausal women in Assam, India (Table 2). Several studies have found night sweats to be one of the most common menopausal symptoms reported in postmenopausal women [4,30]. According to Khatoon et al. [3], irritability (25.61%), sleep problems (29.75%), and depressive mood (32.28%) are common among menopausal women. The findings showed that urogenital problems (e.g., 6.30% frequent urination and 4.00% urinary tract infection) were lower among rural postmenopausal women (Table 2), which is consistent with the findings of Bairy et al. [1] and Thomas et al. [4].
The BLR analysis revealed
significant variation in the association of different socioeconomic,
demographic, and lifestyle variables with menopausal symptoms such
as hot flush and profuse sweat from the vasomotor domain;
forgetfulness, irritation, difficulty concentrating, feeling of
depression, impatient with others, and wanting to be alone from the
psychological domain; and lack of energy, tiredness, weight gain,
skin texture, dry and itching skin, and hyperpigmentation from the
physical domain among rural postmenopausal women.(Table 3)
Several studies have shown an
association between menopausal symptoms and variations of
socioeconomic, demographic, lifestyle variables and reproductive
factors [17,19,36-39]. Hot flashes, vaginal dryness, and joint
pain were all related to age of postmenopausal (p<0.05) [40]. The
present investigation also showed that postmenopausal women's
symptoms, such as "feeling depressed," "impatient with others,"
"tiredness," "frequent urination," and "vaginal dryness," were
significantly related to age (p<0.05). Marital status was associated
with the urogenital level, the psychological level, and the physical
level, and education was associated with the psychological level,
physical level, and urogenital level [40]. The findings revealed a
significant relationship between education level and menopausal
symptoms such as "difficulty on concentration" and "wanting to be
alone" in rural menopausal women (p<0.05) (Table 3). According to
Makara-Studziska et al. [19], menopausal symptoms were most severe
in women with the lowest levels of education, socioeconomic status,
and employment. Additionally, research studies have demonstrated a
stronger connection between women's quality of life and menopausal
symptoms [17,19,37,38].
Conclusion
More than half of the women in this study went through menopause between the ages of 46 and 50 years.
The present study discovered a high prevalence of menopausal symptoms in rural postmenopausal women. In the present study,
menopausal symptoms are the most underrated and unnoticed health issues among the rural women. Any precautionary and curative
measures to alleviate menopausal symptoms were noted, however, the women's vulnerability to menopausal symptoms may be connected
to their rural backgrounds, educational levels, lifestyles, and awareness and access to healthcare facilities, or both.
Furthermore, the symptoms are best treated with hormone therapies and medications that are currently available, but participants
demonstrated a lack of awareness and ignorance about the symptoms. To alleviate the health-related consequences of menopausal
symptoms, the population requires increased awareness, knowledge dissemination, and assistance, particularly among rural and
uneducated women.
Acknowledgement
The authors are gratefully acknowledged for the help and cooperation of villagers, village-level authorities
and research participants during the fieldwork and data collection. The extended help and cooperation of the Department of
Anthropology, Sikkim University is also being acknowledged. The financial support in the form of UGC-Non-NET fellowship is
also gratefully acknowledged.
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