Study Of Reproductive Health Status And Health Care Needs In Peri-menopause Women In Community

Perimenopausal, a period between premenopausal and postmenopausal time, refers to a stage when women are undergoing the transition from childbearing sexual maturity to old age without fertility. It generally occurs between the ages of40to60. During the period, many factors influence women’s physical and mental health as well as their life qualities, including:physical, psychological and social changes. When a woman cannot adapt the transition smoothly,she will encounter a decline in the quality of her life,depression.anxiety, insomnia, memory loss, decreased libido and other negative emotion, which have had affected their marital relationship and health status to some extent.With the advanced technology and rapid progress in the society, the life expectancy is longer than ever before, increasing attention has been paid to perimenopausal care. Firstly, perimenopausal women accounted for a larger proportion of the population, thus, menopausal health care service has become an urgent need. Domestic and international studies have shown that women are lack of the knowledge of menopause in developing countries and regions, and perimenopausal health related education needs further promotion.Secondly, according to the study at home and abroad, the presence of perimenopausal symptoms are mainly related to the declined ovary function, lowered levels of the estrogen. Moreover, the incidence and severity of perimenopausal symptoms also closely related to the racial, social and cultural background, genetic, nutritional structure, the individual’s physical and health status, neuropsychiatric factors, living conditions and social environment. Perimenopausal women, owing to their physical and psychological dysfunction, could suffer from low-level-estrogen-related diseases which would affect their health and quality of life. Previos study showed that the incidence of perimenopausal symptom among the women was high in many countries, ranging from50%to95%. The symptoms could last for a long time, in serious cases; the time could cover up to10years. In2005, an investigation on1,124women in a community of Shanghai revealed that the prevalence of perimenopausal symptoms was62.37%; the rate was relatively high and suggested that the normal life of the women might be affected by the perimenopausal symptoms.China has staged into aging society. In1998, the number of people over60was more than126million, accounting for10%of the whole population. The aging problem in big cities is more serious, thus carrying out the perimenopausal healthcare service is: not only very important to perimenopause health, but also the foundation for the healthcare of the seniors.In order to improve the health status of perimenopausal women, using sampling method, we administered a face-to-face questionnaire investigation among perimenopausal women aged40to60, taking advantage of the general government screening of gynecological diseases among the urban women aged over40. At the same time, we also tried to get a comprehensive understanding of the current reproductive health status of perimenopausal women and their needs for the reproductive healthcare service based on the screening results.Objective:The objectives of the study were to describe the current prevalence of the perimenopausal symptoms and their demands for healthcare services; to understand their level of knowledge on reproductive health; to analyze the effects of demographic, social, economic and behavioral factors on the presence of their perimenopausal symptoms and related cognition; to explore the relationship between perimenopausal symptoms and social support; to provide basic information and decision-making evidence for understanding the health status of perimenopausal women in the community, intensifying their healthcare knowledge and social adaptation, promoting their health, improving their life qualities, and conducting targeted health education and intervention.Method:Our study is a cross-sectional study conducted in a community. The voluntary perimenopausal women aged40to60who had been involved in the gynecological screening between July2011and December2011were sampled as study subjects. Sample size (730) was estimated according to the prevalence (62.37%) of perimenopausal symptoms among women in Shanghai in2005(provided by Shanghai Family Planning Guidance Center). Finally, we planned to include800women from20neighborhood committees in East Nanjing Road community in Huangpu district, with40eligible subjects from each committee.Data collection:A uniform questionnaire was adopted and the investigation was administered among qualified sujects by trained investigators. The content of investigation included:demographic and socio-economic situations,perimenopausal symptoms, score of Kupperman, cognitive status concerning perimenopausal reproductive health (the hormone replacement therapy, healthcare related knowledge and attitude demand for healthcare knowledge) and Social support Rating scale (SSRS).After questionnaire investigation,all the objects then had a gynecological checkup. Database was established with EpiData3.0Software and data analysis performed using SPSS13.0statistical analysis software.Result:In total,800women were recruited with737completed the questionnaires interview in the study. The respond rate was92.1%.1. The prevalence and distribution of perimenopausal symptoms:503out of737perimenopausal women (68.2%) had perimenopausal symptoms. Hot flash and sweating(54.0%), joint pain (51.0%),sexual disorder (48.0%),dizzy (43.1%)and fatigue (40.6%) are the top5common symptoms. Univariate analysis showed that perimenopausal symptoms were related with age (p<0.001), occupation (p<0.001) and social economic status (SES)(p=0.023). Perimenopausal women aged from50-55, with education under junior school, retired or laid-off, or with low SES had higher prevalence of perimenopausal symptoms. The menstrual, sexual satisfaction, health status and social support were also related to the occurrence of perimenopausal symptoms(p<0.001). The multivariate analysis showed that employ status, sexual satisfaction and menopausal status were related to the occurrence of perimenopausal. 2. The perimenopausal reproductive health knowledge and health care demands:The average knowledge score was7.48±2.11in737respondents (full score is10). The maximum is10and the minimum is0. Women in different age, with different education status, SES, chronic disease status and perimenopausal symptom status had different levels of knowledge in perimenopausal health(p<0.05). The multivariate analysis showed that the social economic status and menopausal status were related to the score of perimennpausal health knowledge. Only24(3.2%) of the perimenopausal respondents were using or had hormone replacement therapy (HRT). Only9.2%of the respondents ever received perimenopausal health care consultation.72.8%of the respondents were willing to know the perimenopausal knowledge.38.1%chosed newspaper/magazine and30.3%chosed audiovisual media as the main methods to obtain healthcare knowledge.3. The correlation of the occurrence of perimenopausal symptoms and social support: It was found that the mean score of social support was35.81(sd=6.58), with the maximum and minimum being53and15respectively. Women in different age, with different education status, employ status marriage status got different level of social support (p<0.001). Relatively younger, higher education, employed and married women had a significantly higher social support than others. Statistically significant differences were not observed within different SES groups (P>0.05). When the respondents meet with emergency,60.6%of them would ask spouse or families for economic supports and helps.15.8%of the respondents never took part in group activities. The scores of different social support dimensions had a significant negative correlation with the kupperman index with r=-0.370for SSRS total score,p<0.001, r=-0.398in subjective support, r=-0.242in objective support and r=-0.315in support availability.4. The prevalence of gynecological diseases:The total prevalence of gynecological diseases in the perimenopausal respondents was71.9%. The most common disease was uterine fibroid, the prevalence is40.7%. Senile vaginitis ranked the second, the prevalence was15.5%. The prevalence of breast lobular hyperplasia was69.5%, which was the most common in breast diseases. Conclusion:1. The prevalence of perimenopausal symptoms in community perimenopausal women is high, which has severely affected the physical and mental well being of perimenopausal women. In addition to biological treatment, health education and psychological intervention are necessary in the health care for perimenopausal women.2. The awareness and perceptions of health knowledge is weak among the perimenopausal women. Tailed health education programs should be developed and implemented to improve their health awareness.3. The degree of perimenopausal symptoms is significantly associated with social supports. The social support system should be improved in order to help perimenopausal women get through the period smoothly.4. The prevention of senile vaginitis, uterine fibroid and breast disease should be paid more attention. An effective method of education to improve the knowledge of gynecological diseases in perimenopausal women should be taken into account.