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menopause

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menopause

  1. 1. Quality of Life during Menopause Dr. Amit Sengupta MBBS, MD, Ph.D. MUMBAI-INDIA
  2. 2. How do we define quality of life? <ul><li>* Quality of life Index (QLI) </li></ul><ul><li>A product of the interplay among social, health, economic and environmental condition which affect human and social development </li></ul><ul><li>*std. definition </li></ul>
  3. 3. What is the purpose of QoLI ? <ul><li>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 </li></ul>
  4. 4. Can menopause be a key event? <ul><li>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. </li></ul><ul><li>Physiological events e.g., adolescence, menarche, pregnancy, menopause, senility/aging etc, </li></ul><ul><li>Pathological events e.g., Diabetes, cancer, hypertension etc </li></ul>
  5. 5. Significance of menopause <ul><li>Menopause basically signifies overall status of middle aged women passing through a particular biological event </li></ul><ul><li>We need menopause- QoLI as a tool to understand, assess, improve their status before, during and after the event </li></ul>
  6. 6. Menopause- present status <ul><li>Menopause (? Aging in India) was believed </li></ul><ul><li>to be the beginning of the end, </li></ul><ul><li>Now it is the beginning of a new phase </li></ul><ul><li>(Middle age) of successful aging in urban India </li></ul>Reproductive period 15 – 35 YEARS Pre- Peri - Post menopause ( 45 yrs to 55 years ) CLIMACTERIC ( 35 TO 65 YRS ) Aging-senility > 65 YEARS
  7. 7. CHANGING DEMOGRAPHY <ul><li>LIFE EXPECTANCY </li></ul><ul><li>( 35 YRS, 1947 ) </li></ul><ul><li>MIDDLE AGE MISSING </li></ul><ul><li>( 67 YRS, 2001 ) </li></ul><ul><li>FEMALE LIVES LONGER THAN </li></ul><ul><li>MALES </li></ul>WHO- South East Asia
  8. 8. DEMOGRAHIC PATTERN <ul><li>PROPORTION OF MIDDLE-ELDERLY-DEPENDENTS ( ELDERLY 14% 2025; 7%1995; ) </li></ul><ul><li>1:4 IN DEVLOPING > BY 2020, </li></ul><ul><li>150 MILLION ( 10% OF POPULATION ) </li></ul><ul><li>1:2 IN DEVELOPED; </li></ul>AGE 0-14—NEGATIVE GROWTH RATE; 60 + GROWTH RATE 3/YR
  9. 9. Menopause in India <ul><li>Global - Women constitutes 70% of world’s poorest and 90% of the landless </li></ul><ul><li>In India, 60% of women beyond 50 are widow </li></ul><ul><li>80% or more stay in extended family </li></ul><ul><li>More than 80% suffers AFFECTIVE/NEUROTIC syndrome (  hysterectomy,  infertile) </li></ul><ul><li>More than 60% are anemic between 15- 60yrs </li></ul><ul><li>More than 50% suffers osteoporosis </li></ul><ul><li>Indians are prone to DM and CAD. </li></ul>
  10. 10. HDI and GDI in Developing world <ul><li>HDI- Human development index </li></ul><ul><li>( LONGIVITY;KNOWLEDGE AND DECENT STD LIVING; life exp; adjusted income, education level ) </li></ul><ul><li>GDI - Gender related development index </li></ul><ul><li>(Captures inequalities, HDI:GDI > India—0.5; Developed countries-0.9) </li></ul><ul><li>( Vast disparity between different population groups ) </li></ul>
  11. 11. INDIA - BOMBAY RAILWAY STATION
  12. 12. Population migration & distribution <ul><li>Short term </li></ul><ul><li>AS MID LEVEL SWELLS ( BOON FOR ECONOMY) </li></ul><ul><li>Long term </li></ul><ul><li>MORE ELDERLY — MORE WIDOW WITHOUT SUPPORT </li></ul><ul><li>SUGGESTED INTERVENTION </li></ul><ul><li>Social Mechanism to care for the ELDERLY </li></ul><ul><li>PROMOTE EXTENDED FAMILY </li></ul>URBANIZATION ( 25% 1990 ) ( 34% 2010 ) RAPID ECONOMIC GROWTH
  13. 13. 12 10 5 Musculoskeletal pain/cramps 20.5 17 2 Psychosomatic 38.5 32 1 Menstrual irregularity % N 83 Morbidity expressed during Perimenopause
  14. 14. 16.2 28 Vasomotor/Flushing 26.6 46 Musculoskeletal symptoms 26.6 46 CVS/Palpitations % N=173 MAJOR 3 BROAD GROUPS Morbidity expressed during Menopause
  15. 15. Factors affecting menopause <ul><li>Universal issues ( PQLI-quantifiable) </li></ul><ul><li>Demographic change </li></ul><ul><li>Economic & Social security (HDI), </li></ul><ul><li>Nutrition, safe environment (HDI) </li></ul><ul><li>Education access, life skill development, awareness (HDI), </li></ul><ul><li>Life expectancy (HDI), Disease burden (MRS!!!) </li></ul><ul><li>Women right issues - gender equality (GDI ) </li></ul>
  16. 16. Factors affecting menopause <ul><li>Cultural issues (subjective) </li></ul><ul><li>A ttitude/Belief </li></ul><ul><li>Symptoms expression/retrieval </li></ul><ul><li>Mind - body – soul – spirit interactions </li></ul><ul><li>Issues related to marriage/ reproductive status / conception / widows / divorce </li></ul><ul><li>Traditional/religious/spiritual belief </li></ul>
  17. 17. Management modalities <ul><li>PEOPLE BUY BENEFITS AND NOT PRODUCT </li></ul><ul><li>BENEFIT MAY BE IN THE FORM OF HRT, COUNCELLING, ALTERNATIVE MEDICINE </li></ul><ul><li>AWARENESS INFLUNECES DELIVERY OF THE BENEFITS </li></ul>
  18. 18. Intervention principles <ul><li>Body – medical check up, exercises, diet, HRT / drugs etc </li></ul><ul><li>Mind - counseling, meditations, psychotherapy </li></ul><ul><li>Social – extended family norm </li></ul><ul><li>Spiritual – service of mankind, reading religious text, prayers, all path leads to one GOD </li></ul>
  19. 19. Intervention Approach (Improve QLI) <ul><li>EDUCATION – improves body-mind interaction ( Knowledge / Awareness) </li></ul><ul><li>ECONOMY – improves Nutrition & self confidence </li></ul><ul><li>AVAILABILITY of service – improves Health seeking behavior & expression </li></ul><ul><li>AUDIT – Promotes EBM vis-a-vis cultural practices </li></ul>

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