|Year : 2018 | Volume
| Issue : 3 | Page : 130-134
Study on prevalence and severity of urogenital complaints in postmenopausal women at a tertiary care hospital
Nidhi Gupta1, Manju Aggarwal2, Renuka Sinha3, Neha Varun1
1 Department of Obstetrics and Gynaecology, Hamdard Institute of Medical Sciences and Research and HAHC Hospital, New Delhi, India
2 Department of Obstetrics and Gynaecology, Jaypee Hospital, Noida, Uttar Pradesh, India
3 Department of Obstetrics and Gynaecology, Rama Medical College, Bhavanipur, Uttar Pradesh, India
|Date of Web Publication||21-Sep-2018|
110/7, First Floor, Gautam Nagar, New Delhi - 110 049
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objective: The objective of this study was (1) to find the prevalence of urogenital (UG) complaints after menopause, (2) to evaluate the various risk factors for UG problems in postmenopausal women, and (3) to assess the severity of the symptoms depending on the duration of menopause. Materials and Methods: This study is a prospective study conducted at the Specialty Outpatient Department in Safdarjung Hospital over a period of 1 year. Two hundred postmenopausal women during this period were screened for UG complaints by eliciting detailed history in a pro forma and were divided into two groups based on the duration of menopause. Women with preexisting complaints before menopause and those with some medical disorders such as diabetes, stroke, or neurological problems were excluded from the study. Data were analyzed by standard statistical analytical tests. Results: The prevalence of UG symptoms in our study was 67%. Group A constitutes 127 (63.5%) participants in which menopause attained was of 1–5-year duration. Group B comprises the women with >5-year duration of menopause and it includes 73 (36.5%) patients. Among the genital complaints, vaginal dryness was the most common complaint in both the groups (Group A: 62% and Group B: 48%) followed by vaginal discharge or infection (Group A: 28% and Group B: 25%). Around 19 (15%) in Group A and 10 (13.6%) in Group B were having burning micturition (dysuria), the most common complaint encountered. The UG complaints were not statistically significantly different in both the groups. The severity of the symptoms was significantly different in two groups with more severe complaints in Group A as compared to Group B. Conclusion: UG complaints associated with estrogen loss can occur episodically throughout a women's life, but it is most common and chronic in the duration in postmenopausal women.
Keywords: Menopause, postmenopausal women, urogenital complaints, vaginal dryness
|How to cite this article:|
Gupta N, Aggarwal M, Sinha R, Varun N. Study on prevalence and severity of urogenital complaints in postmenopausal women at a tertiary care hospital. J Mid-life Health 2018;9:130-4
|How to cite this URL:|
Gupta N, Aggarwal M, Sinha R, Varun N. Study on prevalence and severity of urogenital complaints in postmenopausal women at a tertiary care hospital. J Mid-life Health [serial online] 2018 [cited 2018 Dec 12];9:130-4. Available from: http://www.jmidlifehealth.org/text.asp?2018/9/3/130/241949
| Introduction|| |
The interest in menopausal problems has increased in recent years, due to the expansion of human life span. Women are spending more than one-third of their lives in menopausal period., Due to this fact, estrogen deprivation can cause vaginal atrophy symptoms and vasomotor symptoms, which critically diminish quality of life (QOL) in postmenopausal women. Although climacteric symptoms, particularly vasomotor symptoms, may be transient, atrophic symptoms affecting the vagina and lower urinary tract are often progressive and frequently require treatment.
Urogenital (UG) symptoms are one of the most common symptoms of menopause. These symptoms include vaginal dryness, itching, dyspareunia, and urinary incontinence (UI)., Although UG symptoms are common among menopausal symptoms, there are relatively few studies on this subject in the literature compared with other symptoms. Despite the high prevalence and diversity of UG symptoms, only 20%–25% of symptomatic women seek medical help; most women avoid complaining about vaginal and urinary symptoms during their postmenopausal years, which may be attributable to that the UG symptoms can be relieved rapidly after local estrogenic administration, and UG symptoms do not pose direct threat to life but have negative impact on QOL such as personal distress and discomfort, mistaken opinion that effective treatment is not available, cultural values, and the acceptance of these symptoms as a normal aspect of aging.,,
This led us to do this study in which the primary objective studied was to assess the prevalence and presence of various UG symptoms and the secondary objective was to assess the risk factors and severity of the symptoms depending on the duration of menopause.
| Materials and Methods|| |
This study is a prospective observational study conducted in the menopausal specialty clinic of Safdarjung Hospital over a period of 1 year. All the women who attained menopause either naturally or surgically who presented first time to the clinic for any complaints were evaluated for the UG symptoms with the help of predesigned questionnaire. Natural menopause was defined as the cessation of menstruation for at least 1 year. Surgical menopause was defined as menopause after bilateral oophorectomy with or without hysterectomy.
On follow-up visits, those women were also included who developed UG complaints which were not present at the first visit. Women with preexisting complaints before menopause and those with some medical disorders such as diabetes, stroke, or neurological problems were excluded from the study. Based on the duration of menopause, the women included in the study were divided into two groups. Group A constitutes the women in which the duration of menopause was 1–5 years and Group B constitutes the women with the duration of menopause >5 years.
The questionnaire contained questions about their demographic data including age, age of menopause, weight, height, number of pregnancies and births, route of delivery, marital status, any addiction such as smoking or alcohol, personal details such as sleep pattern or dietary habits, regular exercise, educational level, and income through open-ended questions. UG symptoms' assessment included vaginal dryness, vaginal discharge or infection, dyspareunia, loss of libido, urgency, burning micturition, and UI. Severity of each symptom was assessed by asking whether it had occurred within the past 4 weeks and assessed the prevalence and severity (mild symptom defined as symptom less than twice a week, moderate symptom as symptom between 3 and 5 days/week, and severe symptom as more than 6 days/week). Data were analyzed by standard statistical analytical tests.
| Results|| |
This is a prospective observational study in which all the new registered cases of menopausal women with varied duration of menopause were screened. It constituted the 300 women who came to specialty menopausal clinic for any complaints after menopause. Among these women, 200 postmenopausal females were having UG complaints and were included in the study, making that the prevalence of UG symptoms in our study was 67%.
Among 200 women included in the study, 138 (69%) were in the age group of 45–55 years, 46 (23%) were in the age group of 56–65 years, and rest of the females, that is, 16 (18%) were >65 years' age group. Based on the duration of menopause, two groups were made as shown in [Table 1]. Group A constitutes 127 (63.5%) participants in which menopause attained was of 1–5-year duration. The mean age in this group was 51.3 years. Group B comprises the women with >5-year duration of menopause and it includes 73 (36.5%) patients. The mean age in Group B was 58.5 years.
All the participants were asked about the various UG complaints with the help of predesigned questionnaire. Among the genital complaints, vaginal dryness was the most common complaint in both the groups (Group A: 62% and Group B: 48%) followed by vaginal discharge or infection (Group A: 28% and Group B: 25%). Around 19 (15%) in Group A and 10 (13.6%) in Group B were having burning micturition (dysuria), the most common complaint encountered. The UG complaints were not statistically significantly different in both the groups and tabulated in [Table 2]. This implies that the prevalence of the UG complaints was not related significantly to the duration of menopause.
The various risk factors such as parity, body mass index (BMI), educational status, literacy, smoking or alcohol intake, and regular exercise was evaluated in both the groups. These risk factors were not affecting the presence of UG complaints in both the groups [Table 3].
On applying Fisher's exact test, it has been observed that the UG symptoms are dependent on educational status and BMI. The UG complaints were significantly higher in illiterate and lean (BMI <25) women in the initial years of menopause as compared to literate and obese women (BMI >25) who were having more complaints in later years of menopause.
The severity of all the UG complaints were assessed and divided into the mild, moderate, and severe. On applying statistical analysis, severity of the symptoms was significantly different into two groups with more severe complaints in Group A as compared to Group B as tabulated in [Table 4].
Hence, in our study, the presence of UG symptoms does not depend on the duration of menopause, but severity depends on the duration. The symptoms were more severe in the initial years of menopause, but the severity has been decreased over the time with the passing years of menopause. It implies that the women in their later years of menopause had milder symptoms as compared to initial years. This may be because the women's body had adjusted for the low levels of circulating steroid hormones (estrogen and progesterone).
| Discussion|| |
The menopause is a physiological event that occurs in all women who reach midlife. In menopausal women, genital atrophy occurred due to estrogen deficiency which ultimately leads to vaginitis, itching, and obvious narrowing of the vagina. It affects not only the vagina but also urinary tract and bladder.
Huang et al. in their study found that the mean age of the study population was 53.8 ± 7.4 years, and in another study by Fazel et al. in 2011, the mean age of participants was 56.81 ± 8.13 years. Soontrapa et al. found that the mean age of the participants was 57.1 years. In our study, we have divided into two groups on the duration of menopause, and the mean age was 51.3 and 58.5 years in Group A and Group B, respectively.
Chin et al. in 2009 found that the prevalence in their study was 63%, which is higher than that reported in the clinical trial literature but comparable to our study, that is, the prevalence reported in our study was 67%.
In a study in 2009, they have found that the vaginal dryness was the most common vaginal symptom, occurring in 121 women (48%). This was rated as severe or very severe in 56 of 121 (46%). Thirty-one of 251 (12%) women experienced urinary symptoms. The Women's Health Initiative study showed that the prevalence of vaginal dryness was 27.0%, irritation 18.6%, and vaginal discharge 11.1%.
Fazel et al. in 2011 indicated that 42.2% of the participants experienced vaginal dryness, 16.1% vaginal itching, 21.5% vaginal discharge, and 36.7% dyspareunia. In a study in Istanbul, Turkey, by Yesiltepe et al., similar figures were reported: vaginal discharge (23%), dyspareunia (45.3%), and urologic problems (68.8%).
Fazel et al. (2011), 54% of the cases experienced incontinence whereas in another Iranian study by Chaychyan, 28.4% of participants in Tehran, Iran, were affected by incontinence. In Bozkurt et al. study, 4.1% experienced vaginal discharge, which was different in the experienced vaginal discharge. Dyspareunia was reported to be rising to age 60 but remaining constant up to 10%. Soontrapa et al. in 2011 found in their study that the UG symptoms had a high prevalence (vaginal dryness 71.2%, dyspareunia 52.0%, and incontinence 62.4%).
There are not many studies till date which have told about the UG complaints based on the duration of menopause. There is one study in 2014 by Aydin et al. in which it has been found that the UG complaints decrease with the increase in the duration of menopause. In their study, 470 (43.8) women up to 20-month duration of menopause, 236 (22.2) participants between 21 and 40 months, 146 (13.6) women between 41 and 60 months, 45 (4.2) women between 61 and 80 months, and 174 (16.2) women with >80-month duration of menopause were having UG complaints. This is consistent with our study as we have also found that the number of patients decreases as the duration increases. In our study, 127 (63.5%) participants in which menopause attained were of 1–5-year duration and 73 (36.5%) patients were with >5-year duration of menopause.
In our study, among the genital complaints, vaginal dryness was the most common complaint in both the groups (Group A: 62% and Group B: 48%) followed by vaginal discharge or infection (Group A: 28% and Group B: 25%). Around 19 (15%) in Group A and 10 (13.6%) in Group B were having burning micturition (dysuria), the most common complaint encountered.
In a study by Aydin et al. in 2014, urinary symptoms, dysuria (P = 0.001), and urgency (P = 0.021) were more common among higher parity women. Nocturia occurred more frequently in obese women (P = 0.013) and nonsmokers (P = 0.036). Women with higher parity (P = 0.001), lower educational status (P = 0.007), and higher BMI (P = 0.019) were more frequently concerned about UI. Lower educational status was associated with vaginal pain (P = 0.002), itching (P = 0.001), and discharge (P = 0.011). Higher parity was associated with vaginal itching (P = 0.001), discharge (P = 0.007), and burning (P = 0.012). BMI was the only factor that was significantly associated with the appearance of at least three urinary symptoms, with each one-unit increase in BMI increasing the risk of urgency (P = 0.001), nocturia (P = 0.001), and frequency (P = 0.009).
In our study, results are comparable to this study as BMI and educational status were significantly associated with UG complaints in both the groups.
Our study made a significant contribution to a small group of studies done to assess the prevalence of patient's seeking consultation in terms of UG symptoms. There were few limitations of this study which the populations were observed in our study as they were in the menopausal specialty clinic, so it cannot reflect to all menopausal women, and the method used to classify these symptoms is based on detailed questions and the clinical symptoms without any clinical examination, urine investigations, and urodynamic assessment.
| Conclusion|| |
Due to the high prevalence of UG symptoms, physicians need to increase their attention to these symptoms which can be done by improving patient–physician communication. The risk factors for urinary and vaginal symptoms should be assessed thoroughly in postmenopausal women to facilitate earlier treatment. Educational status and BMI are significantly associated with UG complaints and the duration of menopause. As the duration of menopause increases with the passing years, the women are having milder UG complaints.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Sakondhavat C, Choosuwan C, Kaewrudee S, Soontrapa S, Louanka K. Prevalence and risk factors of urinary incontinence in Khon Kaen menopausal women. J Med Assoc Thai 2007;90:2553-8.
Nappi RE, Lachowsky M. Menopause and sexuality: Prevalence of symptoms and impact on quality of life. Maturitas 2009;63:138-41.
Sturdee DW, Panay N; International Menopause Society Writing Group. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric 2010;13:509-22.
Bozkurt N, Ozkan S, Korucuoğlu U, Onan A, Aksakal N, Ilhan M, et al.
Urogenital symptoms of postmenopausal women in Turkey. Menopause 2007;14:150-6.
Huang AJ, Luft J, Grady D, Kuppermann M. The day-to-day impact of urogenital aging: Perspectives from racially/ethnically diverse women. J Gen Intren Med 2009;14:123-30.
Archer DF. Efficacy and tolerability of local estrogen therapy for urogenital atrophy. Menopause 2010;17:194-203.
Nappi RE, Davis SR. The use of hormone therapy for the maintenance of urogynecological and sexual health post WHI. Climacteric 2012;15:267-74.
Huang AJ, Thom DH, Kanaya AM, Wassel-Fyr CL, Van den Eeden SK, Ragins AI, et al.
Urinary incontinence and pelvic floor dysfunction in Asian-American women. Am J Obstet Gynecol 2006;195:1331-7.
Fazel N, Shomoossi N. The prevalence of urogenital symptoms and associated risk factors in post-menopausal women of Sabzevar, Iran (2009). Middle-East J Sci Res 2011;7:733-7.
Soontrapa N, Soontrapa S, Kaewrudee S, Somboonporn W, Sakondh C. Urogenital symptoms in postmenopausal women: A hospital-based prevalence study. Urogynaecologia 2011;25:e13, 46-9.
Chin SN, Trinkaus M, Simmons C, Flynn C, Dranitsaris G, Bolivar R, et al.
Prevalence and severity of urogenital symptoms in postmenopausal women receiving endocrine therapy for breast cancer. Clin Breast Cancer 2009;9:108-17.
Pastore LM, Carter RA, Hulka BS, Wells E. Self-reported urogenital symptoms in postmenopausal women: Women's health initiative. Maturitas 2004;49:292-303.
Oskay UY, Beji NK, Yalcin O. A study on urogenital complaints of postmenopausal women aged 50 and over. Acta Obstet Gynecol Scand 2005;84:72-8.
Chaychyan S. Prevalence of Incontinence in Women Admitted to Shahid Akbarabadi Hospital 1386-87 (2006-2007). Proceedings of the 8 Iranian Congress of Obstetrics and Midwifery; 2008. p. 75.
Aydin Y, Hassa H, Oge T, Yalcin OT, Mutlu FS. Frequency and determinants of urogenital symptoms in postmenopausal Islamic women. Menopause 2014;21:182-7.
[Table 1], [Table 2], [Table 3], [Table 4]