Menopause is a natural stage of aging: a qualitative study – BMC Blogs Network

With reference to Codex guidelines for research (http://www.codex.uu.se/en/index.shtml), personal data including the name was not collected in order to maintain the confidentiality of the information. Before commencement of the interview, the purpose of the interview and its voluntary nature, confidentiality of the information and the use of a tape recorder, were explained to the women. Informed written consent was obtained prior to start the interview with the woman. Ethical clearance was obtained from the Ethics Review Committee of the Faculty of Medical Sciences, University of Sri Jayewardenepura and Kristianstad University, Sweden.

The complete picture of how women in Sri Lanka experience menopause is illustrated by an overall theme Menopause is a natural stage of aging and associated with three qualitatively different categories and six subcategories (Table 3).

The theme was based on that the women experienced a change of their body conceived as a natural stage of their aging process which made them view themselves as valuable as before becoming infertile. The categories are described, along with quotes to illustrate the range of experiences and ideas articulated by different participants, as indicated within brackets by the participants career.

The category Entering a new stage of life meant that the women were aware that menstruation had come to a complete and permanent cessation with associated health risks. The women reported that at first they became scared, thinking that they were pregnant when their menstruation ceased for a long time.

After a while, they realized that their menstruation had come to an end and that it was normal for their age, as well as for women in general, regardless of generational affiliation. The women felt relieved, as they did not have to worry anymore about pregnancies and could therefore continue life in a more relaxed manner.

I feel happy about stopping menstruation because I dont have to be afraid of pregnancy and use any family planning method. I feel free now. (Housewife)

Sometimes it gives me relaxation that Im no longer having problems with pain and monthly bleeding. I can live relaxed. No more bleedings and troubles with that. (Teacher).

The women expressed that they experienced bleeding, which sometimes was troublesome, after the complete and permanent cessation of menstruation. Some women had only experienced slight bleeding and did not have any problems at all, as their menstruation just suddenly stopped, while others experienced heavy bleeding with a resultant low level of hemoglobin, which eventually led to blood transfusion and removal of the womb.

I had heavy bleeding with some clots. I had this bleeding few months and I went to a doctor with my husband. Anyway I was treated for the bleeding and later my menstruation stopped completely. The doctor told me that there was a lump in the womb and removed it through a surgery. They removed the womb too. (Housewife).

According to the participants, entering menopause also involved becoming aware of menopause- related health risks such as heart problems, osteoporosis, cancer, diabetes, pressure, arthritis, and elevated cholesterol levels, which they had learned from health care personnel and from the media. The women described how to prevent some of these health problems by undergoing screening for cancer and taking calcium to prevent bone problems during menopause as well as using some type of milk products to prevent osteoporosis.

I think it is very important to take vitamins at this age. They said that our bones are not strong enough now. Anyway I dont know why those things happen after stopping menstruation. (Housewife).

We get many health problems during this time. Some mentioned that we get bone problems. They also said that osteoporosis is common after menopause and they told we are at risk of heart attacks and cancer. (Teacher).

The women also described menopause as a stage in life during which the body had to undergo several changes. They experienced changes such as loss of energy and body strength, weight gain or loss, excessive sweating, sleepiness, burning sensations, irritability, forgetfulness, reduced sexual appetite and pain during intercourse, thinning hair, and skin changes such as dark spots and wrinkles. They were, however, not concerned about these changes as they understood that these changes were natural, and that generations before them had dealt with the same symptoms.

Also I realized that I have wrinkles in my face. There were some dark spots too. I have seen those in other women in the same age and I thought it is the same for all. (Housewife)

I think it is the end of our energetic life as a woman. While we had menstruation, we were healthy, good looking, and had more energy. But now, it has changed. (Self-employee).

The category Managing menopause comprised the womens experiences of different remedies to ease the menopausal symptoms together with religious activities and the value of feeling important to others.

According to the women, they managed menopause mostly on their own by adopting various strategies.

I think after stopping menstruation, we do not want to worry about it. Its something natural and common to all. After having children, we do not want to worry about it know. We have a lot to do at this age. We have to think about it and do it. If we regret and stay without doing anything, there is no point of it. (Housewife).

Some of them had tried hormonal therapy for a short time, but did not find it effective. They also practiced different cultural remedies to regain lost energy during menopause.

Hathawariya (wild asparagus), gotukola (Centella asiatica). I also add curry leaves and garlic to these kanji also. These home remedies are good for health. (Housewife)

Women described how they engaged in religious activities to avoid health-related problems during menopause and to set aside menopausal symptoms. The women stated that meditation and religious Pooja (activities performed fervently by Buddhists seeking blessings) made them feel more energetic.

I chant pirith (Buddhist chanting) every night before sleep. Then I can sleep well. I do meditation also before sleep. It helps to avoid sleep problems. (Housewife)

I think that, I can avoid many problems related to menopause by doing religious activities. I believe in spiritual effects on our lives. (Self-employee).

When health problems and bodily changes occurred due to menopausal transition, the women simply ignored them by focusing on their responsibilities to their families. By interacting with others and consequently shifting focus to other people, like helping relatives with practical matters or talking with friends, they overcame their own health problems.

I can forget about all these by attending to my work activities and my sons studies. (Housewife)

The women emphasized that being helpful to others would help them in avoiding getting menopause-related health problems, as unselfish actions was perceived as facilitating protection against evil.

Because of the family responsibilities, I have to forget all those problems. Life is still the same as before. (Housewife)

Talking to friends about menopausal problems helped the women to manage health problems during and after menopause. It was expressed as especially important if the woman was single or had lost her spouse. The women stressed that losing a spouse or having grown-up children leave the home were common reasons for ill health and aggravated the health problems related to menopause. Still, the participants expressed an ambiguous attitude to discussing menopausal changes with others. Cessation of menstruation was especially considered as a confidential matter at an early stage of menopause, as it could be a sign of pregnancy. The women stated that their shyness of talking about menstrual matters faded with age. According to the participants, sharing menopausal experiences with other women was good practice, as it prevented women from hiding health concerns that could lead to serious health problems.

If I have a problem, I talk with my close friends. Most of us are older than 45years, and we have similar problems. (Teacher)

There are a lot of women of my age nearby my house. We all do religious activities together. I always share my things with them. They bring me herbal drinks when I have stomach pain. They are always there to support me. (Housewife).

The womens experience of menopause was that it was not the end of life, but rather the end of a particular stage of aging, which necessitated overcoming and dealing with health issues and bodily changes. Many of the women mentioned how the menopause had brought about positive changes in their life pattern as they now had different needs to be accomplished before the end of their life.

The women viewed themselves as valuable as they continued to be engaged in different household activities and viewed these as responsibilities that they naturally assumed for their children, spouses, or other members of their families.

Although Im getting old, I cant stop working. I have to earn to look after my family. Sometimes Im not well to go for work. But I cant get leave always. (Labourer)

Even though their body had changed and they did not have the same strength as before the menopause they meant that the menopause did not prevent them from carrying out their responsibilities.

I feel that Im losing my young life. My body is not like before. But I dont worry about it. Its nature. We all die. Im also getting close to it. But we still have time to look after our children and help them with their families. (Housewife).

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Menopause is a natural stage of aging: a qualitative study - BMC Blogs Network