The factors associated with the quality of life among postmenopausal women

The current descriptive-analytical cross-sectional work was performed on 270 women aged 45–60 years covered by Hamadan health centers in 2018.

Using the data of previous studies [15] and the formula for determining the sample size [16], the minimum sample size was determined at 250 people. Considering 5% error and 80% power and considering the effect of cluster sampling design, the sample size was determined to be 270 postmenopausal women. In the present research, the participants were selected using the stratified sampling method. Accordingly, after listing health centers in Hamadan, some of these centers were selected using a cluster sampling method. Then, after gaining permits from the centers' authorities, the samples were selected from the population covered by each center. Finally, some women aged 45–60 years covered by the centers were selected, and the data were collected. The inclusion criteria were being 45–60 years, having normal menopausal, living in Hamadan, lack of alternative hormone therapy in the past six months, no history of hysterectomy, and lack of known systemic illness. The exclusion criteria also included non-responding to all items of the questionnaire and having any physical and mental illness based on their self-report.

All methods were performed in accordance with relevant guidelines and regulations. The word informed consent was obtained from all women; they were informed about the confidentiality of the information and the project's purpose, and only if they would like, they were enrolled in the study. The Ethics Committee approved this study with all consent process at Hamadan University of Medical Sciences.

The data collection tool used in this study consists of two parts completed by the women through the self-reporting method. The first part includes demographic information such as age, education level, economic status, marital status, smoking, job, physical activity, and supplemental Omega-3 s intake. Also, the second section includes the Menopausal Quality of Life Questionnaire (MENQOL). MENQOL designed by Hilditch et al. [17, 18] that assesses the QOL in 4 dimensions: (1) physical dimension with 16 questions (questions 11–26); (2) the psychosocial dimension with 7 questions (questions 4–10); (3) the sexual dimension with 4 questions (questions 27–29); and (4) vasomotor dimension with 3 questions (questions 1–3), respectively. This scale, which also was used in this study, is adopted to the Persian language and is appropriate for Iranian culture [17, 19]. The validity and reliability of the questionnaire have been confirmed in several similar studies. For example, the reliability of the MENQOL questionnaire was assessed using the test–retest based on intraclass correlation coefficients (ICCs). The coefficients were 0.79, 0.68, 0.92, and 0.77 for the psychological, physical, sexual, and vasomotor domains, respectively [6]. This questionnaire was on a seven-point Likert scale ranging from 0 to 7. A “zero” is identical that the woman has not experienced this specific symptom in the previous month; Score “one” demonstrates that the woman experienced the symptom, but it did not bother her; Scores “two” through “seven” demonstrate an increasing level of the bothering symptom, so that these scores indicate increasing levels of bother experienced from the symptom and correspond to the ‘‘1’’ through ‘‘6’’ checkboxes on the MENQOL [6, 20]. It is essential to be mention, with increasing MENQOL scores, levels of bother experienced from the symptom are increased as well.

According to the definition of WHO, menopausal health was considered menstruation cessation without medication for at least 12 months [4]. Before the study, necessary explanations were provided for the subjects regarding the study's objectives, and their informed consent was obtained. The subjects were selected and included in the study in terms of exclusion and inclusion criteria. The demographic characteristics questionnaire and QOL questionnaire of postmenopausal females were completed through a face-to-face interview.

The duration of the interview was around 25–30 min.

SPSS V.23 was used to analyze the collected data. The Mann–Whiney test and the Kruskal–Wallis test were used to compare different dimensions of QOL according to individual characteristics. The significance level of statistical tests was regarded as less than 0.05. The Kolmogorov–Smirnov test showed that data were not normally distributed, the Mann–Whiney U test and the Kruskal–Wallis test were used to compare MENQOL item scores.

The mean age of the women was 52.19 ± 3.98 years with a range of 45–60 years old. About 25.2% had an elementary education and 5.6% have university education; 77.8% were married and 14.8 were widow; about 11% had Clerk and 88.9% were housewives; 7.4% were smoking, and 59.6% had medium economic status; 47.8% usually exercise 3–5 times a week; 38.9% were taking supplemental Omega-3 s; 50.4% had been postmenopausal for less than 5 years and 40.6% for more than 5 years. Other demographic and characteristics of participants are presented in Table 1.

According to the association between Quality of Life and demographic variables, there was a significant association between the total QoL score and job, economy status, smoking, exercise, supplemental Omega-3 s intake, and postmenopausal stage (p < 0.01). As smokers, women had increasing levels of bother experienced from the symptom than non-smokers (mean = 3.67 ± 0.85 vs. 2.36 ± 0.99; p < 0.001). While the MENQOL scores for menopausal females who exercised more often (mean = 1.56 ± 0.7) had lower than those who exercised less than 3 times per week (mean = 3.27 ± 0.9; p < 0.001). However the lowest score was menopausal females who had taking supplemental Omega-3 s than those who hadn't taken it (mean = 2.15 ± 1.06 vs. 2.65 ± 0.97; p < 0.001). Though women who had postmenopausal stage less than 5 years stage (mean = 2.28 ± 0.87) had significantly lower MENQOL scores from those who had postmenopausal stage 5 or more years (mean = 2.63 ± 1.16; p < 0.001).

Moreover, high-socioeconomic status (SES) women had significantly lower vasomotor scores than those who had postmenopausal low-socioeconomic status (SES) (mean = 2.29 ± 1.81 vs. 3.34 ± 1.97; p < 0.001). Smokers (mean = 4.42 ± 1.94) increasing levels of bother experienced from the vasomotor symptom than non-smokers (mean = 2.68 ± 1.89; p < 0.001). While menopausal females who exercised more often had vasomotor scores (mean = 1.94 ± 1.66) lower than those who exercised less than 3 times per week (mean = 3.63 ± 1.91; p < 0.001). However menopausal females who had taking supplemental Omega-3 s more often had mean vasomotor scores lower than those who hadn't taken it (mean = 2.38 ± 1.87 vs. 3.08 ± 1.94; p < 0.001).

Although, there was a significant association between the psychosocial dimension of MENQOL and education, job, economic status, smoking, exercise, supplemental Omega-3 s intake, postmenopausal stage (p < 0.01), and marital status (p < 0.05). Through, educated women (mean = 1.35 ± 1.07) had significantly lower psychosocial scores than illiterate women (mean = 2.53 ± 1.18; p < 0.001). Clerk women (mean = 1.67 ± 1.24) had significantly lower psychosocial scores from housewife women (mean = 2.68 ± 1.07; p < 0.05). High-socioeconomic status (SES) women had significantly lower psychosocial scores than those who had postmenopausal low-socioeconomic status (SES) (mean = 1.32 ± 0.93 vs. 2.94 ± 1.25 p < 0.001). Smokers (mean = 4.31 ± 0.68) increasing levels of bother experienced from the psychosocial symptom than non-smokers (mean = 2.1 ± 1.17; p < 0.001). While menopausal females who exercised more often had psychosocial scores (mean = 3.68 ± 0.95) lower than those who exercised less than 3 times per week (mean = 0.85 ± 0.55); p < 0.001). However menopausal females who had taking supplemental Omega-3 s more often had mean psychosocial scores lower than those who hadn't taken it (mean = 1.99 ± 1.29 vs. 2.43 ± 1.24; p < 0.001). Also, married women (mean = 2.14 ± 1.26) had significantly lower psychosocial scores than divorce women (mean = 2.94 ± 1.15; p < 0.05).

While there was a significant association between the physical dimension of MENQOL and economy status, smoking, exercise, supplemental Omega-3 s intake, postmenopausal stage (p < 0.01), and job (p < 0.05). By way of, Clerk women (mean = 2.22 ± 0.87) had significantly lower physical scores than housewife women (mean = 2.68 ± 1.07; p < 0.05). High-socioeconomic status (SES) women had significantly lower physical scores than those who had postmenopausal low-socioeconomic status (SES) (mean = 1.88 ± 0.83 vs. 3.02 ± 1.08 p < 0.001). Smokers (mean = 3.46 ± 0.66) increasing levels of bother experienced from the physical symptom than non-smokers (mean = 2.57 ± 1.06; p < 0.001). While menopausal females who exercised more often had physical scores (mean = 1.79 ± 0.9) lower than those who exercised less 3 times per week (mean = 2.37 ± 0.92); p < 0.001). However menopausal females who had taking supplemental Omega-3 s more often had mean physical scores lower than those who hadn't taken it (mean = 2.38 ± 1.87 vs. 2.79 ± 0.98; p < 0.001).

However, there was a significant association between the sexual dimension of MENQOL and, job, marital status (p < 0.01), education, and exercise (p < 0.05). By way of, Clerk women (mean = 1.17 ± 1.49) had significantly lower sexual scores than housewife women (mean = 2.23 ± 1.79; p < 0.001). Also, married woman (mean = 2.67 ± 1.60) had significantly higher sexual scores from widow women (mean = 0.28 ± 0.94; p < 0.001). Educated women (mean = 1.40 ± 1.69) had significantly lower sexual scores than women with low levels of education (mean = 2.44 ± 1.50; p < 0.001). While menopausal females who exercised more often had sexual scores (mean = 1.65 ± 1.54) lower than those who exercised less 3 times per week (mean = 2.43 ± 2.05); p < 0.05) (Table 2).

Generally, the most dominant symptom, reported by 91.1% of the sample, was aching in muscles and joints ache. Besides, vasomotor symptoms with 2.80 ± 1.94 had the highest score, and sexual symptoms, with 2.12 ± 1.79 had the lowest score among the other dimensions. The mean Score of MENQOL in menopausal women was 2.45 ± 1.04. In the other words, we found that vasomotor symptoms had the highest mean scores and sexual symptoms had the lowest scores in all domains (Table 3).