The document discusses quality of life during menopause. It defines quality of life as being influenced by social, health, economic and environmental factors. Menopause can be a key event that affects quality of life as it signifies a woman's overall biological status during middle age. While menopause was once seen as the beginning of the end, it is now seen as the beginning of a new successful aging phase. Improving quality of life during menopause requires addressing universal issues like health, education and nutrition as well as cultural issues like attitudes, beliefs and family support. Management requires a holistic approach considering the physical, mental, social and spiritual needs of women.

1. Quality of Life during Menopause Dr. Amit Sengupta MBBS, MD, Ph.D. MUMBAI-INDIA

2. 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

3. 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

4. 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

5. 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

6. 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 Pre- Peri - Post menopause ( 45 yrs to 55 years ) CLIMACTERIC ( 35 TO 65 YRS ) Aging-senility > 65 YEARS

7. CHANGING DEMOGRAPHY LIFE EXPECTANCY ( 35 YRS, 1947 ) MIDDLE AGE MISSING ( 67 YRS, 2001 ) FEMALE LIVES LONGER THAN MALES WHO- South East Asia

8. DEMOGRAHIC PATTERN PROPORTION OF MIDDLE-ELDERLY-DEPENDENTS ( ELDERLY 14% 2025; 7%1995; ) 1:4 IN DEVLOPING > BY 2020, 150 MILLION ( 10% OF POPULATION ) 1:2 IN DEVELOPED; AGE 0-14—NEGATIVE GROWTH RATE; 60 + GROWTH RATE 3/YR

9. Menopause in India Global - Women constitutes 70% of world’s 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.

10. HDI and GDI in Developing world HDI- Human development index ( LONGIVITY;KNOWLEDGE AND DECENT STD LIVING; life exp; adjusted income, education level ) GDI - Gender related development index (Captures inequalities, HDI:GDI > India—0.5; Developed countries-0.9) ( Vast disparity between different population groups )

11. INDIA - BOMBAY RAILWAY STATION

12. Population migration & distribution 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 URBANIZATION ( 25% 1990 ) ( 34% 2010 ) RAPID ECONOMIC GROWTH

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. 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. 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 )

16. Factors affecting menopause Cultural issues (subjective) A ttitude/Belief Symptoms expression/retrieval Mind - body – soul – spirit interactions Issues related to marriage/ reproductive status / conception / widows / divorce Traditional/religious/spiritual belief

17. 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

18. 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

19. 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