INTRODUCTION:

“A woman can put a smile on her face, act like everything is fine, when her life is slipping through the cracks of her fingers.”

Menopause is the transition period in a woman's life when her ovaries stop producing eggs, her body produces less estrogen and progesterone, and menstruation becomes less frequent, eventually stopping altogether. The term “menopause” has been derived from Greek words ‘men’ and ‘pausis’. The word ‘men’ means month and the word ‘pausis’ means cessation.¹ So, the word "menopause" was created to describe this change in human females, where the end of fertility is traditionally indicated by the permanent stopping of monthly menstruation or menses. Dutta² described the menstruation pattern prior to menopause. There can be gradual decrease in both amount and duration of menstruation. It may be supporting or delayed and ultimately lead to cessation. Menstruation can also be irregular with or without excessive bleeding. The clinical diagnosis of menopause is confirmed following stoppage of menstruation for twelve consecutive months without any pathology. A woman is declared to have attained menopause only retrospectively. Premenopause refers to the period prior to the menopause, postmenopause refers to the period after menopause and perimenopause refers to the period around menopause (40-55 years). Fluctuating levels of estrogen and progesterone can cause a variety of symptoms. Because each woman experiences menopause differently, some have many symptoms and some have very few. The symptoms of menopause are caused by changes in estrogen and progesterone levels. The ovaries make less of these hormones over time. The specific symptoms can be mild, moderate or severe and vary from woman to woman. Many women experience vasomotor symptoms at or around the time of menopause. Hot flushes and night sweats are considered primary menopausal symptoms that may also be associated with sleep and mood disturbances, as well as decreased cognitive function.

Martin and Manson³ stated that hot flushes interfere with quality of life in 15–20% women. David⁴ stated that a gradual decrease of estrogen generally allows menopausal women’s body to slowly adjust to the hormonal changes. Hot flushes and night sweats are at their worst for the first 1 - 2 years after the last period. Menopausal symptoms may last 5 or more years. Stern⁵ reported that 90% menopausal women gain weight, sometimes as much as 10-15 lbs, which mostly accumulates on the stomach area as opposed to the hips and thighs. All of these symptoms may lead to social impairment and work-related difficulties that significantly decrease overall quality of life. This increased economic burden is due to frequent visits to the physician. The loss of productivity at home and work is due to menopausal symptoms like sleep disturbances, mood swings and cognitive deficits. Some of the menopausal symptoms like hot flushes, night sweats lead to increased energy usage for air conditioning and laundry. So, this hygiene related personal cost also increases economic burden.Dutta² stated that normally bone formation (osteoblastic activity) and bone resorption (osteoclastic activity) are in balance. Following menopause, there is loss of bone mass by about 3-5 per cent per year due to deficiency of estrogen. It leads to osteoporosis and high risk of bones fracture in postmenopausal women. Menopause is a natural and expected part of a woman's development and does not need to be prevented. Menopause can be hard for some women especially when they are not prepared for it. Because the female hormones will stop its secretion, women may feel several changes in their bodies. Menopause is a natural part of life and does not necessarily require treatment. Three levels of approach can be considered for coping with menopause by balancing hormonal levels. These are categorized as: (1) Lifestyle Changes, (2) Alternative Medicine and (3) Drugs and Surgery. Women should always start with the least risky approach that is lifestyle changes and go on to riskier approaches, which are surgery or drugs only if necessary. Estrogen Replacement Therapy/Hormonal Replacement Therapy should not be an automatic prescription written at the time of menopause.

SIGNIFICANCE OF THE STUDY:

Srivastava⁶ states that India is a poor country, where attention should be given to disease prevention.According to Indian menopause society consensus report⁷, there were about 43 million Indian women over the age of 45. The average age of menopause in India was assessed to be 47.5 years. Approximately 35-40% of Indian women aged 40-65 suffered from osteopenia. Indian women were found to have low bone density due to a lack of both sufficient calcium intake and adequate exercise. Most cancers reported in Indian women were between 35 and 64 years. The general basic attitude of Asian menopausal women to the aging process is passive and they are willing to accept menopausal changes as a natural consequence of aging. But longevity and increasing life span after reproductive age in recent years have made dramatic changes in life style. The current situation has provoked great interest on quality of life of menopausal women.

Health Point⁸ reported that menopausal woman spends 1/3^rd of her life span in menopause. Therefore, it is necessary to expose menopausal women to planned teaching programme and finding out the effects toward improved quality of life of menopausal women. Lal⁹ reported that there were currently 65 million Indian women over the age of 45 and menopause often strikes Indian women as young as 30-35 years. The public awareness teaching module was presented in 30 Indian cities and it also distributed feedback forms to gauge Indian women's perception of menopause. The responses revealed that most women are not very well informed about menopause, and myths such as menopause being a 'disease' rather than a natural phenomenon were readily believed. It was found that even educated women believed that ill health was a part of menopause. Menopause is the most misunderstood biological change that happens to a woman and the changes can be traumatic and psychologically challenging for women. However, as the world marks World Menopause Day on October 18, millions of Indian women over 45 are finding it difficult to smile through it.

Dutta² stated that every woman with menopausal symptoms should be adequately explained with physiologic events. This will remove her fears and minimize the symptoms of anxiety, depression and insomnia.Duru¹⁰ stated that menopausal health demands priority in the Indian scenario due to the increase in life expectancy and growing population of menopausal women. Large efforts are required to educate and make women aware of menopausal symptoms. This will help in early recognition of symptoms, reduction of discomfort and enable them to seek appropriate medical care to avoid disability in future.Based on review of literature and personal experience during the clinical area posting for obstetrics and gynecological nursing experience and community area posting, the researcher found that many menopausal women were knowledge deficit regarding menopausal symptoms and coping strategies. Keeping all this in view, a need was realized to find out the effects of planned teaching in order to help menopausal women regarding menopausal symptoms and coping strategies.

OBJECTIVES OF THE STUDY:

1) To assess the pre-test level of knowledge regarding selected menopausal symptoms and coping strategies among menopausal women.

2) To administer a planned teaching programme regarding selected menopausal symptoms and coping strategies among menopausal women.

3) To assess the post-test level of knowledge regarding selected menopausal symptoms and coping strategies among menopausal women.

4) To evaluate the effectiveness of planned teaching programme regarding selected menopausal symptoms and coping strategies among menopausal women.

5) To associate the pre-test and post-test level of knowledge regarding selected menopausal symptoms and coping strategies among menopausal women with selected socio demographic variables.

HYPOTHESES:

H₁The post-test level of knowledge among menopausal women on selected menopausal symptoms and coping strategies will be significantly higher than the pre-test level of knowledge.

H₂There will be a significant association between pre-test levels of Knowledge regarding selected menopausal symptoms and coping strategies among menopausal women with selected socio-demographic variables.

H₃There will be a significant association between post-test levels of knowledge regarding selected menopausal symptoms and coping strategies among menopausal women with selected socio-demographic variables.

METHODOLOGY:

Research approach:

A quantitative evaluative research approach is adopted to assess the knowledge regarding selected menopausal symptoms and coping strategies among menopausal women.

Research design:

One group pre-test post-test research design, which belongs to pre-experimental design, was selected to assess the knowledge regarding selected menopausal symptoms and coping strategies among menopausal women.

Research setting:

The study was conducted in the selected areas of Mohali district, Punjab which are Village Daun and Desu Majra.

Target population:

The target population of study was menopausal women in the age group of 45-55 years residing in selected areas of Mohali District, Punjab.

Sample size and Sampling technique:

In the present study the 60 menopausal women in age group of 45-55 years residing in selected areas of Mohali district, Punjab were selected by using Non–Probability purposive sampling technique.

Ethical consideration:

Prior to data collection, the researcher had taken permission from the ethical committee of Mata Sahib Kaur College of Nursing, Mohali, the Sarpanches of selected areas of Mohali district, Punjab for the conduction of study in their villages and the participants in written form and they were ensured that confidentiality would be maintained under all circumstances.

Description of tool:

The self-administered structured questionnaire consists of-

Section-1- Socio demographic data consisted of 7 items which included age (in years), religion, educational status, occupation, family income per month in rupees, type of the family, and dietary habits

Section-2-Self-administered structured knowledge questionnaire consisted of 30 items of knowledge questionnaire regarding selected menopausal symptoms and coping strategies. The items were given one score for correct answer and zero score for wrong answer.

Description of planned teaching programme:

The planned teaching programme was titled “Teaching on selected menopausal symptoms and coping strategies”. The planned teaching programme was prepared to enhance the knowledge of menopausal women regarding selected menopausal symptoms and coping strategies. It consisted of the areas based on introduction, age at menopause, cause of menopause, menopausal symptoms - description and coping strategies, conclusion

Data collection:

The data collection was carried out from 15^th of February, 2012 to 29^th March, 2012. On day one, the purpose of study was explained to the sample and an informed written consent was taken before starting the study. A pre-test was conducted by administering a self-administered structured knowledge questionnaire to the selected 60 menopausal women. On the same day the planned teaching programme was administered to the subjects. The post-test was conducted by using the same self-administered structured knowledge questionnaire after seven days of the administration of planned teaching programme.

Data analysis:

Data was analyzed by using descriptive and inferential statistics. The frequency distribution of adolescent girls according to their socio-demographic variables was computed by frequency and mean percentage. Effectiveness of planned teaching programme and association between the findings of pre-test and post-test with selected socio demographic variables was found by Chi square test.

RESULTS:

The result is presented in three parts:

Section-1:

Frequency & percentage distribution of menopausal women according to their socio demographic variables

Section-2:

(a) Level of knowledge among menopausal women in pre-test and post-test regarding selected aspects of selected menopausal symptoms and coping strategies

(b) Effectiveness of planned teaching programme regarding selected menopausal symptoms and coping strategies among menopausal women

Section-3:

Association between level of knowledge among menopausal women regarding selected menopausal symptoms and coping strategies with selected socio demographic variables

Table 1.1 shows that majority of the menopausal women (40%) belong to the age group of 49-52 years. Most of the subjects (60%) were Sikhs. Most of the subjects (85%) were non-working and rest of the subjects (15%) was working. Majority of the subjects (53.3%) were from joint family and rest of the subjects (46.7%) were from nuclear family. Majority of the subject’s (60%) family income per month in rupees was 10,001-25,000 and minimum (16.7%) were having family income more than rupees 25,001 per month. Majority of subjects (58.3%) had studied up to primary standard and minimum (5%) were graduate and above graduate. Most of the subjects (76.7%) were vegetarian while minimum (6.7%) were eggetarian.

Section-1

Table– 1.1: Frequency and Percentage Distribution of Menopausal Women According to Their Socio Demographic Variables N = 60

S. No.	Characteristic	Frequency	Percentage
1.	Age (in years)
	45-48	18	30.0
	49-52	24	40.0
	>52	18	30.0
2.	Religion
	Hindu	16	26.7
	Muslim	04	06.7
	Sikh	36	60.0
	Christian	04	06.7
3.	Educational status
	Primary	35	58.3
	Matric	14	23.3
	Higher secondary	08	13.3
	Graduation & above	03	05.0
4.	Occupation
	Working	09	15.0
	Non working	51	85.0
5.	Family income/month (in Rupees)
	≤10000	14	23.3
	10001-25000	36	60.0
	≥25001	10	16.7
6.	Type of family
	Nuclear	28	46.7
	Joint	32	53.3
7.	Dietary habit
	Vegetarian	46	76.7
	Non-vegetarian	10	16.7
	Eggetarian	04	06.7

Table 2.1 reveals that in pre-test maximum subjects (44%) were having knowledge in the area of introduction to menopause and minimum subjects (31.8%) were having knowledge in the area of coping strategies of menopausal symptoms. In post-test maximum subjects (70.3%) were having knowledge in the area of introduction to menopause and minimum subjects (49.2%) were having knowledge in the area of description of menopausal symptoms. It shows that planned teaching programme enhanced their knowledge.

Table 2.2 depicts that maximum menopausal women (56.7%) were having average knowledge and 43.3% were having poor knowledge score in pre-test. After planned teaching programme session, most of them were having average (96.7%) followed by good (3.3%) knowledge score. Chi square test was used to find out the effectiveness. The obtained value (34.261) shows that (p _(2,0.05) = 0.000) planned teaching programme was highly significant. Hence, the research hypothesis (H₁) was accepted.

Section – 3

Table 3.1 a: Association between Level of Knowledge Among Menopausal Women Regarding Selected Menopausal Symptoms and Coping Strategies with Selected Demographic Variables

S. No	Characteristics	Test	χ2	p-value
1.	Age (in years)	Pre-test	0.724	0.868^NS
1.	Age (in years)	Post-test	7.962	0.054^NS
2.	Religion	Pre-test	0.724	0.868^NS
2.	Religion	Post-test	7.962	0.054^NS
3.	Education	Pre-test	10.593	0.032*
3.	Education	Post-test	32.845	0.000***
4.	Occupation	Pre-test	4.477	0.034*
4.	Occupation	Post-test	0.365	1.000^NS
5.	Monthly income of the family (in rupees)	Pre-test	11.894	0.003**
5.	Monthly income of the family (in rupees)	Post-test	1.897	0.387^NS
6.	Type of family	Pre-test	7.186	(0.010*)^#
6.	Type of family	Post-test	0.009	1.000^NS
7.	Dietary habits	Pre-test	0.118	0.943^NS
7.	Dietary habits	Post-test	1.709	0.425^NS

NS= Non Significant, *= Mild significance of p-value< 0.05**= Significance of p-value < 0.05.

Table 3.1 depicts that level of knowledge was not significantly associated with age, religion and dietary habits of the subjects as calculated by Chi square test in both pre-test and post-test. Hence, the research hypotheses (H₂and H₃) were rejected. In case of education of the subjects level of knowledge was found significant in both pre-test and post-test. Hence, the research hypotheses (H₂and H₃) were accepted both in pre-test and post-test. In case of occupation of the subjects a significant association was found with level of knowledge during pre-test while during post-test there was no significance. Hence, research hypothesis was accepted in pre-test (H₂) and rejected in post-test (H₃). In case of association with monthly income of the family and type of familyof the subjects there was no significance with level of knowledge during pre-test while during post-test it was found highly significant. Hence, research hypothesis was rejected in pre-test (H₂) and accepted in post-test (H₃).

RECOMMENDATIONS:

Based on the findings of the study the following recommendations are made:

1. A similar study can be done on subjects with different socio demographic characteristics.

2. Taking a control group in quasi-experimental design can do similar study.

3. A comparative study can be done between a rural and urban community.

4. A comparative study can be done between pre-menopausal and post-menopausal women.

5. Similar study can be done on a larger sample for wider generalization.

CONCLUSION:

The following conclusions were drawn on the basis of the findings of the study. The findings showed that:

1. Maximum score of the subjects in pre-test was in the area of introduction to menopause and minimum score was in the area of coping strategies of menopausal symptoms. Maximum score for post-test was in the area of introduction to menopause and minimum score was in the area of description of menopausal symptoms.

2. The statistical analysis, which was done between pre-test and post-test knowledge scores, indicates a gain in the knowledge of menopausal women. Hence, it was concluded that planned teaching programme was effective as a method to improve knowledge regarding selected menopausal symptoms and coping strategies among menopausal women. Hence, hypothesis (H₁) was accepted.

3. It was concluded that H₂and H₃were accepted in case of educational status as knowledge levels of menopausal women was found to be associated with their educational status.

4. It was concluded that H₂and H₃were rejected in case of age, religion and dietary habits as these socio demographic variables were not found to be associated with knowledge levels of menopausal women.

5. There was found an association of prior knowledge level of menopausal women in the pre-test with their occupation, type of family, income of family per month in rupees. Hence, H₂was accepted for these above mentioned socio demographic variables.

6. H₃ was rejected in case of occupation and type of family of menopausal women, as these socio demographic variables were not found to be associated with their post-test knowledge level.

REFERENCES:

1. Menopause. The free encyclopedia. [Internet]. October 2009. [Cited on 2011 Dec, 23]. Available from: http://en.wikipedia.org/wiki/Menopause

2. Dutta DC. Textbook of Gynaecology including contraception. New central book Agency (P) Ltd. Kolkata. Fifth edition. Revised reprint: 2009. P 56-57.

3. Martin KA, Manson JAE. Approach to the Patient with Menopausal Symptoms. The Journal of Clinical Endocrinology and Metabolism. Vol.93, No. 12 4567-4575.2008.

4. Zieve D. Menopause. A.D.A.M. Medical Encyclopedia. [Internet]. Last reviewed: September 13, 2011. [Cited on 2011 Dec, 28]. Available from: http://wwwncbi.nlm.nih.gov/ pubmedhealth /PMH0001896/

5. Stern G. Are There Natural Alternatives for Managing Menopausal Symptoms? Consumer health answers. [Internet]. 2011 May, 6. [Cited on 2011 Dec, 26]. Available from: http://www.consumerhealthanswers.com/MenopauseRelief/

6. Srivastava Saroj. Indian Menopause Society. [Internet]. 2011. Available from: http://www.indianmenopausesociety.org/

7. Jyothi U. Third consensus meeting of Indian Menopause Society. [Internet]. Journal of midlife health. 2010. Vol 1. Page 43-47. [Cited on 2012 Feb, 12]. Available from: http://www.jmidlifehealth.org/article.asp?issn=09767800;year=2010;volume=1;issue=1;spage=43;epage=47;aulast=Unni

8. Health Point. [Internet]. 2008 April 22.[Cited on 2012 Jan, 6]. Available from: http://au.lifestyle.yahoo.com/health/reference/ article/-/8652389/hot-flushes/

9. Lal N. making menopause easier. [Internet]. 2011 Sept, 22.[Cited on 2012 Feb, 2]. Available from: http:// nwww .india together.org /2006/ oct/wom - menopaus.htm

10. Duru S. Menopause Definitions. [Internet]. 2011 Sept, 20. [Cited on 2011 Dec, 15]. Available from: http://www.india nwoman 35 plus.com /MENOPAUSE % 20DEFINITIONS.html

Received on 10.10.2014 Modified on 28.10.2014

Int. J. Adv. Nur. Management 2(4): Oct. - Dec., 2014; Page 210-215

S. No.	Selected aspects of selected menopausal symptoms and coping strategies	Pre-test		Post-test
S. No.		Mean frequency	Percentage (%)	Mean frequency	Percentage (%)
1	Introduction to menopause	26.4	44	42.2	70.3
2	Description of menopausal symptoms	21.1	35.2	29.5	49.2
3	Coping strategies of menopausal symptoms	19.1	31.8	29.6	49.3
4	Management	21	35	32	53.3

Knowledge	Pre-test (f=60)		Post-test (f=60)		χ²	p-value
Knowledge	N	%	N	%	χ²	p-value
Poor	26	43.3	0	0.0	34.261
Average	34	56.7	58	96.7		0.000***
Good	0	0.0	2	3.3