Frequency of symptoms, determinants of severe symptoms, validity of and cut-off score for Menopause Rating Scale (MRS) as a screening tool: A cross-sectional survey among midlife Nepalese women

Abstract

BackgroundMajority of Nepalese women live in remote rural areas, where health services are not easily accessible. We determined the validity of Menopause Rating Scale (MRS) as a screening tool for identification of women with severe menopausal symptoms and cut-off MRS score for referral.MethodsA cross-sectional survey was carried out between February and August, 2008. Trained health workers administered MRS and a questionnaire to 729 women (40 to 65 years) attending health screening camps in Kaski district of Western Development Region of Nepal. Information about demographics, menopausal status, and use of hormone replacement therapy (HRT), chronic disease, self-perceived general health and reproductive history was also collected. Menopausal status was classified according to the Staging of Reproductive Ageing Workshop (STRAW). We calculated rates of menopausal symptoms, sensitivity, and specificity and likelihood ratios of MRS scores for referral to a gynaecologist. We also carried out multivariate analyses to identify the predictors for referral to a gynaecologist for severe symptoms.ResultsA total 729 women were interviewed. Mean age at menopause was 49.9 years (SD 5.6). Most frequently reported symptoms were, sleeping problems (574, 78.7%), physical and mental exhaustion (73.5%), hot flushes (508, 69.7%), joint and muscular discomfort (500, 68.6%) and dryness of vagina (449, 61.6%). Postmenopausal women (247, 33.9%) and perimenopausal (215, 29.5%) women together experienced significantly higher prevalence of all symptoms than the premenopausal (267, 36.6%) women. MRS score of ≥16 had highest ratio for (sensitivity + specificity)/2. Women who reported urogenital symptoms [OR 5.29, 95% CI 2.59, 10.78], and self perceived general health as poor [OR 1.29, 95% CI 1.11, 1.53] were more likely to be referred to a gynaecologist for severe menopausal symptoms. While women reporting somatic [OR 0.72, 95% CI 0.63, 0.82] and psychological [OR 0.86, 95% CI 0.74, 0.99] symptoms were less likely to be referred.ConclusionMRS may be used as a screening tool at a cut-off score of ≥16 with least misclassification rate. However, its utility may be limited by woman's general health status and occurrence of urogenital symptoms.

Utilidad de menopause rating scale (mrs) en indígenas colombianas en climaterio

“…Se observó que las mujeres en posmenopausia tuvieron puntuaciones significativamente superiores que las mujeres en período de premenopausia en todas las dimensiones y la puntuación total que prueba la validez nomológica de la escala 9 . Consistente con los hallazgos de estudios precedentes que observaron un comportamiento similar en las puntuaciones de las escalas en los diferentes períodos del climaterio [21][22][23][24][25] . En relación con las dimensiones de la MRS, en el presente estudio se identificaron sólo dos grandes dimensiones; la primera con un alto número de ítem para síntomas somáticos y urogenital; y la segunda, una gran participación de ítem psicológicos.…”

“…Es incuestionable que la cultura matiza la expresión a los cambios que se dan a lo largo de la vida. Ya se mencionó que la frecuencia de los síntomas que se atribuyen a la menopausia varía según las distintas características sociales, étnicas y culturales de las participantes en las investigaciones [21][22][23][24][25][26][27][28][29][30][31][32] . La cultura afecta los estilos de vida, hábitos alimentarios y sexualidad, con la inclusión de las experiencias que se dan en la menopausia, y pueden explicar en parte las diferencias en los síntomas relacionados con la menopausia que se observan en diferentes culturas [37][38][39] .…”

“…Esto hace necesario antes de la aplicación de un instrumento en una población distinta a la que participó en el proceso de diseño se corrobore el desempeño del mismo y la equivalencia lingüística de cada ítem 20 . La mayoría de los estudios con el uso de la MRS se han limitado a presentar la frecuencia de síntomas en mujeres de los cinco continentes no indígenas, afrodescendientes, caucásicas, hispanas asiáticas, e indígenas [21][22][23][24][25][26][27][28][29][30][31][32] ; sin explorar o corroborar la estructura de dimensiones que se propuso inicialmente y explorar explícitamente la validez nomológica. Además, las diferencias en el patrón de síntomas y de respuestas en mujeres de diferentes contextos sociales y culturales sugieren un desempeño factorial similar 19 .…”

A study of menopausal symptoms and its impact on lives of Nepalese perimenopausal and postmenopausal women

“…Similarly in another study done in Rupandehi District, the mean age of menopause was 46.81 years 9 . The mean age of menopause was 49.9 years in a study by Marahattaet al 10 , and Chuni et al in Kaski District 11 .…”

“…The menopause and perimenopausal age in developing countries have been reported to be earlier as compared to the developed countries 4 . The average age of menopause in western women is 52-53 years whereas it is 47-49 years in Asian women [7][8][9][10][11][12][13] .…”