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Awareness of and attitudes toward menopause and hormone replacement therapy in an African community
International Journal of Gynecology & Obstetrics 76 Ž2001. 91᎐93
Social issues in reproductive health ᎐ Brief communication
Awareness of and attitudes toward menopause and hormone replacement therapy in an African community C.D. Mashiloane, J. Bagratee, J. MoodleyU MRCr UN Pregnancy Hypertension Research Unit and Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, Uni¨ ersity of Natal, Durban, South Africa Received 12 April 2001; received in revised form 1 October 2001; accepted 3 October 2001
Keywords: Awareness; Attitudes toward menopause; Black African women
Menopausal symptoms can be perceived as unpleasant yet unavoidable manifestations of the aging process in women. Black African women, in particular, may not be aware that the symptoms can be relieved. This study attempted to determine how perimenopausal, urban, African women experience menopause and what their attitudes are toward hormone replacement therapy. We interviewed 102 women age 45 years or above in Durban, South Africa. A structured questionnaire was used to collect their demographic data as well as their gynecological, medical, family, and social histories, and their employment status. In addition, there were questions on their knowledge of and attitude toward meno-
U
Corresponding author. Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of Natal, Congella, South Africa. Tel.: q27-31-2604250; fax: q27-31-2604427. E-mail address: [email protected] ŽJ. Moodley..
pause and hormone replacement therapy ŽHRT., and on their experience of menopausal symptoms. The 102 women’s demographic profiles are outlined in Table 1. Sixty-seven Ž66.2%. were menopausal. The mean age for menopause was 49.5" 7.4 years Ž95% CI s 42.1᎐56.9. and the average duration of menopause was 11 years. Most participants had good social support and only three lived alone. Forty-two Ž41.1%. were employed, 36 Ž35.3%. unemployed, and 24 Ž23.5%. pensioners. Fifty-two Ž50.9%. were unskilled, 38 Ž37.3%. skilled or semi-skilled, and 12 Ž11.7%. professional. Many Ž62.7%. had reached secondary education and 20.6% higher education. Eighty-one Ž79.4%. were aware of the existence of menopause; of these, 56.8% had heard of it from family or friends, 13 Ž16.8%. from their general practitioner, and 11 Ž13.6%. from publichealth facilities. All 81 women who knew of menopause said it was a normal, culturally acceptable period in a
0020-7292r01r$20.00 䊚 2001 Published by Elsevier Science B.V. on behalf of International Federation of Gynecology and Obstetrics. PII: S 0 0 2 0 - 7 2 9 2 Ž 0 1 . 0 0 5 6 5 - 3
92
C.D. Mashiloane et al. r International Journal of Gynecology & Obstetrics 76 (2002) 91᎐93
Table 1 Demographic profile of study population Ž n s 102. Mean age Žyears. Mean parity Mean body mass index ŽBMI. Menopausal women Ž%. Mean menopausal age Žyears.
54.2 3 35 66.2 49.5
Ci¨ il status Employed Ž%. Unemployed Ž%. Retiredrpensioner Ž%. Unskilled Ž%. Semi-skilledrskilled Ž%. Professional Ž%. Family support present Ž%.
41.1 35.3 23.5 50.9 37.3 11.7 97
Education Primary Ž%. Secondary Ž%. Higher Ž%.
16.7 62.7 20.6
Smokers Ž%. Alcohol users Ž%.
6.7 3.9
woman’s life. Moreover, 29% Ž24 of 81. said that they knew what menopausal symptoms were, and 23 said that treatment was available. Twenty percent in the age group 45᎐49 years and 41.3% in the group 50᎐69 years said they knew what the
symptoms were. There was a statistically significant linear increase of this perception with education Ž Ps 0.001.. Eight percent of those who only had primary education, 20% of those with secondary education, and 70% of those with higher education said that they were aware of the existence of menopausal symptoms. Table 2 highlights the prevalence of the different symptoms and the women’s awareness that they were menopause-related. Menopausal symptoms were experienced by 40% of the women. In our study, the mean age for menopause was 49 years. This is lower than the commonly reported age of 51.3 years in North American Caucasian women w1x but consistent with the mean age of 48 years showed in a report on Nigerian women w2x. Obviously, a larger sample of South Africa’s Black women population is needed to confirm our finding. Most women knew of menopause. Half had obtained their information from family or friends and the rest from their general practitioner, hospital or local clinic. This shows the importance of the community in spreading health-related information. However, very few women were aware of HRT. More widespread and detailed information is necessary. Although women commonly experienced actual
Table 2 Awareness of menopausal symptoms Ž n s 102. Symptom
Prevalence Ž%.
Consulted physician Ž%.
Aware that symptoms and menopause are related Ž%.
Hot flushes Irritability Moodiness Poor concentration Painful sexual intercourse Dry vagina Loss of libido Pruritis Dysuria Frequency Dry skin Backache Joint pain Insomniarhypersomnia
48 47 42.2 41 43
19 1 0 0 1
19 0 0 0 3
51 41 32 39 40 36.4 43.1 40 46
1 1 5 9 11 5 40 35 11
4 7.9 0 0 0 0 0 0 0
C.D. Mashiloane et al. r International Journal of Gynecology & Obstetrics 76 (2002) 91᎐93
menopausal symptoms, they had a poor understanding of them. Only 19% of them thought that ‘hot flushes’ were related to menopause. There was no difference in attitude toward menopause between the low- and higher-income groups. Attitude was positive in that the women who were aware of the existence of menopause said it was culturally and socially acceptable. Standing and Glazer Ž1992. w3x found no significant differences between low-income African᎐ American and higher-income Caucasian women. Generally, strong intergenerational support and its effects on interaction patterns, family structure, and living arrangements constitutes an information network for African women. These findings are similar to what has been reported of African᎐American families in the USA w4x.
93
Another aspect probably influencing the women’s positive attitude toward menopause is their lack of knowledge of menopausal symptoms. Women can only know them if they are given appropriate health information. References w1x McKinley SM, Brambilla DJ, Posner JG. The normal menopause transition. Maturitas 1992;14:103. w2x Okonofua FE, Lawal A, Bamgbose JK. Feature of menopause and menopause age in Nigerian women. Int J Gynecol Obstet 1990;31:341᎐345. w3x Standing TS, Glazer G. Attitudes of low-income clinic patients toward menopause. Health Care Women Int 1992;13:271᎐280. w4x Mutran KE. Intergenerational family support among Blacks and Whites: response to culture or to socio-economic differences. J Gerontol 1985;40Ž3.:382᎐389.
Social issues in reproductive health ᎐ Brief communication
Awareness of and attitudes toward menopause and hormone replacement therapy in an African community C.D. Mashiloane, J. Bagratee, J. MoodleyU MRCr UN Pregnancy Hypertension Research Unit and Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, Uni¨ ersity of Natal, Durban, South Africa Received 12 April 2001; received in revised form 1 October 2001; accepted 3 October 2001
Keywords: Awareness; Attitudes toward menopause; Black African women
Menopausal symptoms can be perceived as unpleasant yet unavoidable manifestations of the aging process in women. Black African women, in particular, may not be aware that the symptoms can be relieved. This study attempted to determine how perimenopausal, urban, African women experience menopause and what their attitudes are toward hormone replacement therapy. We interviewed 102 women age 45 years or above in Durban, South Africa. A structured questionnaire was used to collect their demographic data as well as their gynecological, medical, family, and social histories, and their employment status. In addition, there were questions on their knowledge of and attitude toward meno-
U
Corresponding author. Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of Natal, Congella, South Africa. Tel.: q27-31-2604250; fax: q27-31-2604427. E-mail address: [email protected] ŽJ. Moodley..
pause and hormone replacement therapy ŽHRT., and on their experience of menopausal symptoms. The 102 women’s demographic profiles are outlined in Table 1. Sixty-seven Ž66.2%. were menopausal. The mean age for menopause was 49.5" 7.4 years Ž95% CI s 42.1᎐56.9. and the average duration of menopause was 11 years. Most participants had good social support and only three lived alone. Forty-two Ž41.1%. were employed, 36 Ž35.3%. unemployed, and 24 Ž23.5%. pensioners. Fifty-two Ž50.9%. were unskilled, 38 Ž37.3%. skilled or semi-skilled, and 12 Ž11.7%. professional. Many Ž62.7%. had reached secondary education and 20.6% higher education. Eighty-one Ž79.4%. were aware of the existence of menopause; of these, 56.8% had heard of it from family or friends, 13 Ž16.8%. from their general practitioner, and 11 Ž13.6%. from publichealth facilities. All 81 women who knew of menopause said it was a normal, culturally acceptable period in a
0020-7292r01r$20.00 䊚 2001 Published by Elsevier Science B.V. on behalf of International Federation of Gynecology and Obstetrics. PII: S 0 0 2 0 - 7 2 9 2 Ž 0 1 . 0 0 5 6 5 - 3
92
C.D. Mashiloane et al. r International Journal of Gynecology & Obstetrics 76 (2002) 91᎐93
Table 1 Demographic profile of study population Ž n s 102. Mean age Žyears. Mean parity Mean body mass index ŽBMI. Menopausal women Ž%. Mean menopausal age Žyears.
54.2 3 35 66.2 49.5
Ci¨ il status Employed Ž%. Unemployed Ž%. Retiredrpensioner Ž%. Unskilled Ž%. Semi-skilledrskilled Ž%. Professional Ž%. Family support present Ž%.
41.1 35.3 23.5 50.9 37.3 11.7 97
Education Primary Ž%. Secondary Ž%. Higher Ž%.
16.7 62.7 20.6
Smokers Ž%. Alcohol users Ž%.
6.7 3.9
woman’s life. Moreover, 29% Ž24 of 81. said that they knew what menopausal symptoms were, and 23 said that treatment was available. Twenty percent in the age group 45᎐49 years and 41.3% in the group 50᎐69 years said they knew what the
symptoms were. There was a statistically significant linear increase of this perception with education Ž Ps 0.001.. Eight percent of those who only had primary education, 20% of those with secondary education, and 70% of those with higher education said that they were aware of the existence of menopausal symptoms. Table 2 highlights the prevalence of the different symptoms and the women’s awareness that they were menopause-related. Menopausal symptoms were experienced by 40% of the women. In our study, the mean age for menopause was 49 years. This is lower than the commonly reported age of 51.3 years in North American Caucasian women w1x but consistent with the mean age of 48 years showed in a report on Nigerian women w2x. Obviously, a larger sample of South Africa’s Black women population is needed to confirm our finding. Most women knew of menopause. Half had obtained their information from family or friends and the rest from their general practitioner, hospital or local clinic. This shows the importance of the community in spreading health-related information. However, very few women were aware of HRT. More widespread and detailed information is necessary. Although women commonly experienced actual
Table 2 Awareness of menopausal symptoms Ž n s 102. Symptom
Prevalence Ž%.
Consulted physician Ž%.
Aware that symptoms and menopause are related Ž%.
Hot flushes Irritability Moodiness Poor concentration Painful sexual intercourse Dry vagina Loss of libido Pruritis Dysuria Frequency Dry skin Backache Joint pain Insomniarhypersomnia
48 47 42.2 41 43
19 1 0 0 1
19 0 0 0 3
51 41 32 39 40 36.4 43.1 40 46
1 1 5 9 11 5 40 35 11
4 7.9 0 0 0 0 0 0 0
C.D. Mashiloane et al. r International Journal of Gynecology & Obstetrics 76 (2002) 91᎐93
menopausal symptoms, they had a poor understanding of them. Only 19% of them thought that ‘hot flushes’ were related to menopause. There was no difference in attitude toward menopause between the low- and higher-income groups. Attitude was positive in that the women who were aware of the existence of menopause said it was culturally and socially acceptable. Standing and Glazer Ž1992. w3x found no significant differences between low-income African᎐ American and higher-income Caucasian women. Generally, strong intergenerational support and its effects on interaction patterns, family structure, and living arrangements constitutes an information network for African women. These findings are similar to what has been reported of African᎐American families in the USA w4x.
93
Another aspect probably influencing the women’s positive attitude toward menopause is their lack of knowledge of menopausal symptoms. Women can only know them if they are given appropriate health information. References w1x McKinley SM, Brambilla DJ, Posner JG. The normal menopause transition. Maturitas 1992;14:103. w2x Okonofua FE, Lawal A, Bamgbose JK. Feature of menopause and menopause age in Nigerian women. Int J Gynecol Obstet 1990;31:341᎐345. w3x Standing TS, Glazer G. Attitudes of low-income clinic patients toward menopause. Health Care Women Int 1992;13:271᎐280. w4x Mutran KE. Intergenerational family support among Blacks and Whites: response to culture or to socio-economic differences. J Gerontol 1985;40Ž3.:382᎐389.