Quality of Life during Menopause

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Quality of Life during Menopause

• Dr. Amit Sengupta
• MBBS, MD, Ph.D.
• MUMBAI-INDIA

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How do we define quality of life?

• Quality of life Index (QLI)
• A product of the interplay among social,
  health, economic and environmental condition
  which affect human and social development
• std. definition

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What is the purpose of QoLI ?

• To provide a tool for the community
  development which can be used to monitor key
  events that encompasses the social, health,
  environmental, economic dimension of the quality
  of life

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Can menopause be a key event?

• Yes, any defined state in health or disease
  that potentially affects the human physiology or
  psychology during the entire life span can be a
  key event.
• Physiological events e.g., adolescence, menarche,
  pregnancy, menopause, senility/aging etc,
• Pathological events e.g., Diabetes, cancer,
  hypertension etc

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Significance of menopause

• Menopause basically signifies overall status of
  middle aged women passing through a particular
  biological event
• We need menopause- QoLI as a tool to understand,
  assess, improve their status before, during and
  after the event
• 
  

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Menopause- present status

• Menopause (? Aging in India) was believed
• to be the beginning of the end,
• Now it is the beginning of a new phase
• (Middle age) of successful aging in urban India

Reproductive period 15 35 YEARS
Aging-senility gt 65 YEARS
Pre- Peri - Post menopause ( 45 yrs to 55 years
) CLIMACTERIC ( 35 TO 65 YRS )
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CHANGING DEMOGRAPHY

• LIFE EXPECTANCY
• ( 35 YRS, 1947 )
• MIDDLE AGE MISSING
• ( 67 YRS, 2001 )
• FEMALE LIVES LONGER THAN
• MALES

WHO- South East Asia
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DEMOGRAHIC PATTERN

• PROPORTION OF MIDDLE-ELDERLY-DEPENDENTS ( ELDERLY
  14 2025 71995 )
• 14 IN DEVLOPING gt BY 2020,
• 150 MILLION ( 10 OF POPULATION )
• 12 IN DEVELOPED

AGE 0-14NEGATIVE GROWTH RATE 60 GROWTH RATE
3/YR
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Menopause in India

• Global - Women constitutes 70 of worlds poorest
  and 90 of the landless
• In India, 60 of women beyond 50 are widow
• 80 or more stay in extended family
• More than 80 suffers AFFECTIVE/NEUROTIC syndrome
  ( ? hysterectomy, ? infertile)
• More than 60 are anemic between 15- 60yrs
• More than 50 suffers osteoporosis
• Indians are prone to DM and CAD.

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HDI and GDI in Developing world

• HDI- Human development index
• ( LONGIVITYKNOWLEDGE AND DECENT STD LIVING
  life exp adjusted income, education level )
• GDI - Gender related development index
• (Captures inequalities, HDIGDI gt India0.5
  Developed countries-0.9)
• ( Vast disparity between different population
  groups )

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INDIA - BOMBAY RAILWAY STATION
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Population migration distribution
RAPID ECONOMIC GROWTH

• URBANIZATION
• ( 25 1990 )
• ( 34 2010 )

• Short term
• AS MID LEVEL SWELLS ( BOON FOR ECONOMY)
• Long term
• MORE ELDERLY MORE WIDOW WITHOUT SUPPORT
• 
  SUGGESTED INTERVENTION
• Social Mechanism to care for the
  ELDERLY
• PROMOTE EXTENDED FAMILY
  

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Factors affecting menopause

• Universal issues (
  PQLI-quantifiable)
• Demographic change
• Economic Social security (HDI),
• Nutrition, safe environment (HDI)
• Education access, life skill development,
  awareness (HDI),
• Life expectancy (HDI), Disease burden (MRS!!!)
• Women right issues - gender equality (GDI)

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Factors affecting menopause

• Cultural issues (subjective)
• Attitude/Belief
• Symptoms expression/retrieval
• Mind - body soul spirit interactions
• Issues related to marriage/ reproductive status /
  conception / widows / divorce
• Traditional/religious/spiritual belief

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Management modalities

• PEOPLE BUY BENEFITS AND NOT PRODUCT
• BENEFIT MAY BE IN THE FORM OF HRT, COUNCELLING,
  ALTERNATIVE MEDICINE
• AWARENESS INFLUNECES DELIVERY OF THE BENEFITS

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Intervention principles

• Body medical check up, exercises, diet, HRT /
  drugs etc
• Mind - counseling, meditations, psychotherapy
• Social extended family norm
• Spiritual service of mankind, reading religious
  text, prayers, all path leads to one GOD

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Intervention Approach (Improve QLI)

• EDUCATION improves body-mind interaction (
  Knowledge / Awareness)
• ECONOMY improves Nutrition self confidence
• AVAILABILITY of service improves Health seeking
  behavior expression
• AUDIT Promotes EBM vis-a-vis cultural practices

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