Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Assessment of menopausal symptoms using modified Menopause Rating Scale (MRS) among middle age women in Kuching, Sarawak, Malaysia

Assessment of menopausal symptoms using modified Menopause Rating Scale (MRS) among middle age... Background: Menopausal symptoms can be assessed by several tools, and can be influenced by various socio- demographic factors. Objectives: To determine the commonly reported menopausal symptoms among Sarawakian women using a modified Menopause Rating Scale (MRS). Methods: By using modified MRS questionnaire, 356 Sarawakian women aged 40-65 years were interview to document of 11 symptoms (divided into somatic, psychological and urogenital domain) commonly associated with menopause. Results: The mean age of menopause was 51.3 years (range 47 - 56 years). The most prevalent symptoms reported were joint and muscular discomfort (80.1%); physical and mental exhaustion (67.1%); and sleeping problems (52.2%). Followed by symptoms of hot flushes and sweating (41.6%); irritability (37.9%); dryness of vagina (37.9%); anxiety (36.5%); depressive mood (32.6%). Other complaints noted were sexual problem (30.9%); bladder problem (13.8%) and heart discomfort (18.3%). Perimenopausal women (n = 141) experienced higher prevalence of somatic and psychological symptoms compared to premenopausal (n = 82) and postmenopausal (n = 133) women. However urogenital symptoms mostly occur in the postmenopausal group of women. Conclusions: The prevalence of menopausal symptoms using modified MRS in this study correspond to other studies on Asian women however the prevalence of classical menopausal symptoms of hot flushes, sweating was lower compared to studies on Caucasian women. Background symptoms experienced by them can be group into: vaso- Menopause which is defined as complete cessation of motor, physical, psychological or sexual complaints. It menstruation for twelve months or more is a normal was also noted in some postmenopausal women with physiological change experienced by middle age women. long term estrogen deficiency, changes to the cardiovas- Some of menopausal symptoms experienced by these cular or bone which leads to osteoporosis has been women can be severe enough to affect their normal established. It is well documented that menopausal daily activities. Unfortunately majority of these women symptoms experienced by women affect their quality of are not aware of the changes brought about by meno- life [5-7]. Many published reports shows variations in pause [1-4]. These symptoms are directly resulted from menopausal symptoms between Asian and Caucasians depletion of estrogen level as women approaches meno- women, Asian women suffer lesser of somatic and psy- pausal stage and some of these women begin to experi- chological symptoms when compared to their western ences these menopausal symptoms early in the counterparts [8-11]. perimenopausal phase. The common climacteric Studies shown that perimenopausal and postmenopau- sal women have more menopausal complaints compared to premenopausal women. They were noted to complain * Correspondence: sarsalwi@fmhs.unimas.my significantlymoreofvasomotor,sexualand Department of Family Medicine, Faculty of Medicine and Health Sciences Universiti Malaysia Sarawak, Kuching, Malaysia © 2010 Rahman et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Rahman et al. Asia Pacific Family Medicine 2010, 9:5 Page 2 of 6 http://www.apfmj.com/content/9/1/5 psychological symptoms compared to premenopausal Reproductive Aging Workshop) classification which women [12-14]. divided menopause staging into: Postmenopausal;no Various tools or instruments have been designed to menstrual bleeding in the previous/last 12 months. Late measure and assess symptoms during the menopausal perimenopause; had menstruation in the previous/last 2- transition, among them is Menopause Rating Scale 12 months but not in the previous/last 2 months. Early (MRS) which is designed to assess menopause specific perimenopause; had increasing irregularity of menses health related quantity of life (QoL) to measure the without skipping periods (7 days difference from the severity of age/menopause-related complaints by rating beginning of a given cycle to the next, experienced after a profile of symptoms [15,16]. the previously regular cycle and Premenopause;minor Limited research data were available regarding meno- changes in cycle length particularly decreasing length of pausal symptoms experienced by women in Malaysia. the cycle. To aid statistical analysis, the early and late Although menopause related symptoms have been perimenopausal transition stages were grouped together extensively studied in the western countries, not much as perimenopausal stage [22,23]. data were available in Asia especially in South East Asia (3) Menopause Rating Scale (MRS) questionnaire were including Malaysia. All previous studies on menopausal used as a basis for assessing menopausal symptoms in in Malaysia were conducted in Peninsular Malaysia this study, this is a self-administered instrument which [17-21]. has been widely used and validated and have been used This study was conducted in Kuching, which is the in many clinical and epidemiological studies, and in capital city of Sarawak, the largest state in Malaysia and research on the etiology of menopausal symptoms to situated in the Island of Borneo. assess the severity of menopausal symptoms [16]. There is no documented or published data on meno- The MRS is composed of 11 items and was divided pausal study in Sarawak, and this study aimed to docu- into three subscales: ment the menopausal-related symptoms among middle (a) somatic-hot flushes, heart discomfort/palpitation, age women of Kuching, Sarawak by using modified sleeping problems and muscle and joint problems; (b) Menopause Rating Scale. psychological-depressive mood, irritability, anxiety and physical and mental exhaustion and (c) urogenital-sexual Methods problems, bladder problems and dryness of the vagina. Subjects and Setting Each of the eleven symptoms contained a scoring scale This is a cross-sectional study. Conducted from the from “0” (no complaints) to “4” (very severe symptoms). month of January 2007 to November 2007. This study The questionnaire was first translated into Malay lan- was approved by Universiti Kebangsaaan Malaysia guage by a group of experienced health-workers and Research and Ethical Committee. The interview was car- language experts, and then translated back to English to ried out among women ages of 40 to 65 years who vis- validate whether the original meaning of the question- ited the government health centers around Kuching, naire was maintained in the translation; a pilot study Sarawak, Malaysia. These health centers which provided was done on 60 women to validate the translated MRS primary care services are government healthcare centers questionnaires. The women were asked whether or not under the Ministry of Health, Malaysia. The inclusion they had experienced the 11 menopausal symptoms criteria consisted of women between the ages of 40 to shown in the MRS in the previous one month (30 days), 65 years who had given consent to participate in this however it was noted from the pilot study, these women study. Pregnant and breast feeding women, women with had difficulties in rating the scale themselves, in order uncontrolled medical conditions such as hypertension, to minimize these difficulties, a face-to-face interviewed diabetes mellitus or heart disease, or who were under- was done rather than using self-administered respond. going treatment for cancer, or were in remission, or Modifications were also made on the grading method of who had history of drug or alcohol abuse and on hor- each item due to difficulties faced by the participant in mone replacement therapy were excluded from the identifying the severity of the symptoms hence the grad- study. ing was modified to “present” or “absent” of symptoms. Reliability analysis was performed on the modified Instrument and data collection Menopause Rating Scale questionnaires with Cronbach’s Questionnaires were divided into three sections: alpha of somatic subscale 0.712, psychological subscale (1) Socio-demographic data of the women, which 0.743 and urogenital subscale 0.821. Therefore, this included: age, race, religion, marital status, educational study determined the prevalence of menopausal symp- level, occupation and average household income. toms and not the severity of the symptoms. (2) Menopausal status of the women: The menopausal All women were interviewed in Malay language. Face- status was classified according to STRAW (Stages of to-face interview were done on all the women by trained Rahman et al. Asia Pacific Family Medicine 2010, 9:5 Page 3 of 6 http://www.apfmj.com/content/9/1/5 health personnel who had undergone training, as this Table 1 Socidemographic data of participants was important to make sure right answer were given, Sociodemographic Total(n = 356) % Data and explanations can be given if the women were in Age Group(years) doubt or unclear about the questions asked. At the 40 - 44 65 18.3 reception desk during registration, women who fulfill 45 - 49 100 28.1 thecriteriawereinvited to participateinthisstudy. 50 - 54 81 22.7 Explanations were given and written informed consent 55 - 59 73 20.5 was taken from them. 60 - 65 37 10.4 Statistical analysis The Statistical Package for the Social Sciences software Ethnic Distribution Version 14.0 (SPSS, Chicago, IL) was used for univariate Iban 101 28.4 analyses. The X² test was applied to compare the fre- Chinese 80 22.4 quencies of the symptoms among the different meno- Bidayuh 68 19.1 pausal status. The level P < 0.05 was considered as the Malay 57 16.0 cut-off value for significance. Melanau 22 6.2 Others(Lumbawang, 28 7.8 Kelabit, Kayan, Results Penan, Punan) Three hundred and fifty six women completed the study. The mean age of respondents in this study was Religion 50.83 ± 6.30 (SD) years. The mean age at menopause Christian 178 50.0 was 51.28 ± 2.28 (SD) years with median of 50 years. Muslim 75 21.1 Among these women, 82 (23.0%) were premenopausal, Buddhist 81 22.6 141 (39.6%) perimenopausal and 133 (37.4%) postmeno- Others 22 6.3 pausal. The Iban, Chinese and Bidayuh were the major- ity ethnic group in this study. Christians made up 178 Marital status (50.0%) of the participants, 256 (71.9%) were married Married 256 71.9 and 319 (89.6%) had 11 or less years of schooling. Widow/divorcee 87 24.5 Majority 164 (46.1%) of the participants were house- Single 13 3.6 wives and most of the participants 169 (47.5%) had a monthly household income below RM 1000 (US$ 312). Educational level (1 USD = RM 3.2). (Table 1) No formal 78 21.9 Table 2 shows the frequency of menopausal symptoms education as assessed by the modified MRS according to most fre- Primary level 96 27.0 quent complaints. The three most prevalent menopausal Secondary level 145 40.7 symptoms for all women (n = 356) were: joint and mus- Tertiary level 37 10.4 cular discomfort 285 (80.1%), physical and mental Occupation exhaustion 239 (67.1%) and sleeping problems 186 Housewife 164 46.1 (52.2%). This was followed by symptoms of hot flushes General worker 48 13.4 and sweating 148(41.6%), irritability 135 (37.9%), dryness Semi-professional 107 30.1 of vagina 135 (37.9%), anxiety 130 (36.5%), depressive Professional 37 10.4 mood 116 (32.6%), sexual problem 110 (30.9%), bladder problems 49 (13.8%) and heart discomfort/palpitation 65 Household income (18.3%). (monthly) Most of the somatic and psychological subscale symp- Below RM 1000 169 47.5 RM 1001 - RM 2000 69 19.4 toms occur in the perimenopausal group of women RM 2001 - RM 3000 78 21.9 compared to pre- and postmenopausal women. However RM 3001 - RM 4000 24 6.7 urogenital symptoms occurred most in postmenopausal RM 4001 - RM 5000 12 3.4 women.(Table 3). Above RM 5000 4 1.1 Discussion The mean age at menopause in this study was 51.28 ± 2.28 years. Although this is slightly higher than studies done in Peninsular Malaysia which reported mean age Rahman et al. Asia Pacific Family Medicine 2010, 9:5 Page 4 of 6 http://www.apfmj.com/content/9/1/5 Table 2 Frequency of menopausal symptoms among in many languages, although it is a self-administrated Sarawakian women aged 40-65 years in Kuching, questionnaires, it’s used were not only meant to assess Sarawak assessed by modified MRS the menopausal symptoms but also its severity, however, Menopausal symptoms n = 356 100% in our study, modification has to be done on the scaling 1. Joint and muscular discomfort 285 80.1 of theoriginalMRS becausewenoted that therespon- 2. Physical and mental exhaustion 239 67.1 dents had difficulties in rating the scales, this could be 3. Sleeping problems 186 52.2 explained by the fact that nearly half of the respondent 4. Hot flushes, sweating 148 41.6 studied never had formal education or only studied at 5. Irritability 135 37.9 primary level, and to minimize the reporting error, face to face interviewed were used instead of self adminis- 6. Dryness of vagina 135 37.9 tered by the respondents [15,16]. 7. Anxiety 130 36.5 In our study, the classical presentation of menopausal 8. Dpressive mood 116 32.6 symptoms; hot flushes, sweating and night sweats were 9. Sexual problems 110 30.9 noted to be lower (41.6%) when compared to findings 10. Heart discomfort 65 18.3 from studies done on western women who were 11. Bladder problems 49 13.8 reported to be from 45% to 75%. Similar result were also noted in two other studies done in Malaysia by of menopause between 49.4 to 51.1 years and from Dhillon et al. (53.0%) and Ismail (57.l0%), however, our studies done in Thailand (48.7 years), Singapore (49.1 finding of low menopausal classical symptoms were years) and other studies on Asian and Caucasian shared by studies done in other Asian countries women, our findings still falls between the normal range [3,17,18,24-28]. of menopausal age [3,9,10,13,17,18,20,21]. In this study perimenopausal women were noted to The assessment tool that we used in our study was experience more of vasomotor symptoms when com- based on Menopause Rating Scale (MRS) questionnaire. pared to other menopausal group of women, and this Although in menopausal symptoms studies few assess- was also statistical significant (Table 3), this can be ment tools were available, we used the Menopause Rat- explained by the fact that in these group of women, ing Scale (MRS) questionnaires, these questionnaires has estrogen fluctuation during this phase occurs the most, been widely used in many epidemiological and clinical hence they will experienced the most vasomotor symp- research when investigating the menopausal symptoms, toms. Our findings were correspond to studies con- These questionnaires has been validated and translated ducted among Australia and other Caucasian women; Table 3 Frequency of menopausal symptoms in the participants according to menopausal status among Sarawakian women aged 40-65 using the modified MRS Subscale (menopausal symptoms) All (n = 356) Premenopausal (n = 82) Perimenopausal (n = 141) Postmenopausal (n = 133) Somatic 1. Hot flushes, sweating 148(41.6) * 29(35.4) 91(64.5) *, † 28(21.1) 2. Heart discomfort 65(18.3) 3(3.7) 40(28.4) *,† 22(16.5) 3. Sleeping problems 186(52.2) 24(29.2) 94(66.7) *,† 68(51.1) 11. Joint and muscular discomfort 285(80.1) 36(43.9) 129(91.4) * 120(90.2) ‡ Psychological 4. Depressive mood 116(32.6) 13(15.9) 67(47.5) 36(27.1) ‡ 5. Irritability 135(37.9) 29(35.4) 77(54.6) *,† 29(21.8) †‡ 6. Anxiety 130(36.5) 29(35.4) 78(55.4) *,† 23(17.3) 7. Physical and mental exhaustion 239(67.1) 36(43.4) 107(75.9) * 96(72.2) ‡ Urogenital 8. Sexual problems 110(30.9) 17(20.7) 58(41.2) † 35(26.3) ‡ 9. Bladder problems 49(13.8) 8(9.7) 14(9.9) 27(20.3) ‡,** 10. Dryness of vagina 135(37.9) 16(19.5) 58(41.2) * 61(45.9) ‡,** * Significant difference p < 0.05 compared to premenopausal † Significant difference p < 0.05 compared to postmenopausal. ‡ Significant difference p < 0.05 compared to premenopausal. ** Significant difference p < 0.05 compared to perimenopausal Rahman et al. Asia Pacific Family Medicine 2010, 9:5 Page 5 of 6 http://www.apfmj.com/content/9/1/5 where as high as 75% of perimenopausal women experi- Malay, so there is the question of accuracy in transla- enced bothersome vasomotor symptoms at some point tion, although this was done by a group of health-work- of their transitional period [24-30]. ers and language experts. Although MRS is a self From our study, joints and muscular discomfort; phy- reporting questionnaire, in view of substantial number sical and mental exhaustions and sleeping problems of women studied does not have formal education, in (Table: 2) which is from the somatic and psychological order to include these illiterate women, interviews were subscales were experienced most by perimenopausal fol- used instead. In collecting data, women are asked to lowed by postmenopausal women and these was also provide some retrospective information, such as meno- statistical significant differences when compared to pre- pausal symptoms experienced in the preceding one menopausal women. These findings were also noted to month, last menstruation etc. Hence recall bias is una- be corresponding to studies conducted Asian and Cau- voidable, especially for some elderly women. A final lim- casian women [3,7,10,13,18,19,27,28,31,32]. itation of this study is lack of information on regularity It is interesting to note that in our study, as much as of menstruation. Some subjects could have been mis- 35% to 45% of premenopausal women also reported classified into the incorrect menopause status group. similar symptoms (joint and muscular discomfort, physi- cal and mental exhaustion, anxiety, depressing mood, Conclusion irritability), this could be explained since most of the The study of middle- age women from Kuching, Sara- somatic or psychological symptoms experienced by wak between the ages of 40 and 65 years using modified these middle age women are not exclusively as a result Menopause Rating Scale (MRS), showed that the mean of changes due to menopause alone, it’scould also age of menopause was 51.28 ± 2.28 years. resulted from other physical, psychological or health The menopausal symptoms experienced by them were related problems which is related to aging in these similar to other Asian women but the prevalence classi- group of women which can represent as menopausal cal menopausal symptoms of hot flushes, sweating was like symptoms [7,13,22]. lower compared to studies on Caucasian women. In urogential subscale (sexual problems, bladder pro- The most common symptoms reported were from the blems and vaginal dryness), from our study the fre- somatic subscale; joint and muscular discomfort, physi- quency of these symptoms were experienced mainly by cal and mental exhaustion and sleeping problems. postmenopausal group of women and it was also signifi- The perimenopausal women had the most significant cant statistically when compared to other menopausal somatic complaints compared to postmenopausal and status (Table 3) and similar finding were documented premenopausal women, while postmenopausal women from other studies [3,18,25,27,32]. had the most significant urogenital symptoms compared Natural menopause may strongly contribute to sexual to pre- and perimenopausal women. changes experienced by these women, however its need to be emphasized that there are numerous factors which Acknowledgements contribute to declining sexual activities in middle age We wish to thank Universiti Kebangsaan Malaysia for the research grant for women following menopause [18,33-36]. this study. We also like to thank Sarawak Health Department, all the government polyclinics around Kuching for their assistant in conducting this In our study it was noted that somatic and psychologi- study. cal symptoms were experienced mainly by perimenopau- We would also like to thank the original authors of the Menopause Rating sal women compared to the postmenopausal or Scale (MRS) for the use of this instrument during this study. premenopausal women. However, in the urogenital or Author details sexual symptoms, the postmenopausal women were 1 Department of Family Medicine, Faculty of Medicine and Health Sciences reported to suffer the most compared to the other two Universiti Malaysia Sarawak, Kuching, Malaysia. Faculty of Resource Science and Technology, Universiti Malaysia Sarawak, Kuching, Malaysia. Department groups and similar findings were reported from other of Family Medicine, International Medical University, Kuala Lumpur, Malaysia. studies [2-4,13,18]. There are several limitations of this study. Although Authors’ contributions SARSA participated in the design, coordinating and carried out the study attempts were made to ensure that the study population and drafted the manuscript. wasasrepresentativeaspossibleofthe generalpopula- SRZ performed the statistical analysis and drafted the manuscript. tion of the Kuching, Sarawak, nevertheless it has to be VLKM participated in the design and coordinating of the study. All authors read and approved the final manuscript. stated owing to the sampling technique used this might not be entirely possible. Another limitation was, as this Competing interests was a cross sectional study, it does not exclude other The authors declare that they have no competing interests. confounding effects of the natural aging process that Received: 29 July 2009 may influence experience of symptoms. Thirdly, this Accepted: 22 February 2010 Published: 22 February 2010 study used modified MRS questionnaire, translated to Rahman et al. Asia Pacific Family Medicine 2010, 9:5 Page 6 of 6 http://www.apfmj.com/content/9/1/5 References 27. Loh FH, Khin LW, Saw SM, Jeannette JM, Ken Gu: The age of menopause 1. Williams RE, Levine KB, Kalilani L, Lewis J, Clark RV: Menopause-specific and the menopause transition in a multiracial population: a nation-wide questionnaire assessment in US population-based study shows negative Singapore study. Maturitas 2005, 52:169-180. impact on health-related quality of life. Maturitas 2009, 62(2):153-9. 28. Lam PM, Leung TN, Haines C, Chung TK: Climacteric symptoms and 2. Lu J, Liu J, Eden J: The experience of menopausal symptoms by Arabic knowledge about hormone replacement therapy among Hong Kong women in Sydney. Climacteric 2007, 10:72-7. Chinese women aged 40-60 years. Maturitas 2003, 30:45(2):99-107. 3. Peeyananjarassri K, Cheewadhanaraks S, Hubbard M, Zoa Manga R, 29. Guthrie JR, Dennerstein L, Taffe JR, Lehert P, Burger HG: The menopausal Manocha R, Eden J: Menopausal Symptoms in a hospital-based sample transition: a 9-year prospective population-based study. The Melbourne of women in southern Thailand. Climacteric 2006, 9:23-29. Women’s Midlife Health Project. Climacteric 2004, 7:375-389. 4. Chedraui P, Blümel JE, Baron G, Belzares E, Bencosme A, Calle A, et al: 30. Travers C, O’Neill SM, King R, Battistuta D, Khoo SK: Green Climacteric Impaired quality of life among middle aged women: A multicentre Latin Scale: norm in an Australian population in relation to age and American study. Maturitas 2008, 61(4):323-9. menopausal status. Climacteric 2005, 8:56-62. 5. Lee I, Wang HH: Pattern and related factors of self-care behavior among 31. Gold EB, Block G, Crawford S: Lifestyle and demographic factors in perimemenopausal women. Public Health Q 2001, 28:151-60. relation to vasomotor symptoms: baseline results from the Study of 6. Shanafelt TD, Barton DL, Adjei AA, Loprinzi CL: Pathophysiology and Women’s Health Across the Nation. Am J Epidemiol 2004, 159:1189-1199. treatment of hot flashes. Mayo Clin Proc 2002, 77:1207-1218. 32. Park YJ, Kim HS, Chang SO, Kang HC, Chun SH: Sexuality and related 7. Porter M, Penny GC, Russell D, Russell E: A population based survey of factors of postmenopausal Korean women. Taehan Kanko Hakhoe Chi women’s experience of the menopause. Br J Obstet Gynaecol 1996, 2003, 33(4):457-63. 103:1025-8. 33. Greendale GA, Lee NP, Arriola ER: The menopase. Lancet 1999, 353:571-580. 8. Oddens BJ, Boulet MJ, Lehert P, Visser AP: Has the climacteric been 34. Rekers H, Drogendijk AC, Valkenburg HA, Riphagen F: The menopause, medicalised? A study on the use of medication for climacteric urinary incontinence and other symptoms of the genitor-urinary tract. complaints in four countries. Maturitas 1992, 15(December (3)):171-81. Maturitas 1992, 15:101-111. 9. Pan HA, Wu MH, Hsu CC, Yao BL, Huang KE: The perception of 35. Milsom I, Ekelund P, Molander U, Arvidsson L, Areskoug B: The influence of menopause among women in Taiwan. Maturitas 2002, 25:41(4):269-74. age, parity, oral contraception, hysterectomy and menopause on the 10. Boulet MJ, Oddens BJ, Lehert P, Verme HM, Visser AP: Climacteric and prevalence of urinary incontinence in women. Journal of Urology 1993, menopause in seven South-east Asian countries. Maturitas 1994, 149:1459-1462. 19(October (3)):157-76. 36. Sherburn M, Guthrie JR, Dudley EC, O’Connell HE, Dennerstein L: Is 11. Fuh JI, Wang SJ, Lu SR, Juang KD, Chiu LM: The Kinmen women-health incontinence associated with menopause?. Obstet Gynecol 2001, investigation (KIWI): a menopausal study of a population aged 40-54. 98:628-633. Maturitas 2001, 39:117-24. doi:10.1186/1447-056X-9-5 12. Jong LF, Shun JW, Shiang RL, Kai DJ, Lung MC: The Kinmen women-health Cite this article as: Rahman et al.: Assessment of menopausal symptoms investigation (KIWI): a menopausal study of a population aged 40-54. using modified Menopause Rating Scale (MRS) among middle age Maturitas 2001, 39:117-12. women in Kuching, Sarawak, Malaysia. Asia Pacific Family Medicine 2010 13. Harvey C, Bee HT, Chia CA, Ee MC, Yap SC, Seang MS: The prevalence of 9:5. menopausal symptoms in a community in Singapore. Maturitas 2002, 41:275-282. 14. Lori AB, Crystal MS, Kavita N: Is This Women Perimenopausal. JAMA 2003, 289(7). 15. Green JG: Construction a standard climacteric scale. Maturitas 1998, 29:19-24. 16. Heinemann LAJ, Potthoff P, Schneider HP: International version of the menopause rating scale (MRS). Health Qual Life Outcomes 2003 1:28. 17. Ismail NN: A study on menopause in Malaysia. Maturitas 1994, 19(3):205-209. 18. Dhillon HK, Singh HJ, Rashidah S, Abdul Manaf H, Nik Mohd Zaki NM: Prevalence of menopausal symptoms in women in Kelantan, Malaysia. Maturitas 2006, 54:213-221. 19. Dhillon HK, Singh HJ, Nor Aliza AG: Sexual function in menopausal women in Kelantan, Malaysia. Maturitas 2005, 52:256-263. 20. Hamid A, Tey N, Ramli N: A study on age of menopause and menopausal symptoms among Malaysian women. Malaysian Journal of Reproductive Health 1989, 7(1):1-9. 21. Ismael NN: A study on the menopause in Malaysia. Maturitas 1994, 19:205-209. 22. World Health Organisation (WHO): Scientific Group on Research on the Menopause in the 1990s. Research on the menopause: Report of a WHO scientific group. WHO technical report series Geneva: WHO866. 23. Soules MR, Sherman S, Parrot E: Executive summary: stages of reproductive aging workshop (STRAW). J Women’s Health Gender-based Submit your next manuscript to BioMed Central 2001, 10(9). and take full advantage of: 24. Takeshi A: First Consensus Meeting on Menopause in the East Asian Region: Demography of the menopause and pattern of climacteric • Convenient online submission symptoms in the East Asian region. Geneva Foundation for Medical Education and Research 2003. • Thorough peer review 25. Dennerstein L, Duddley EC, Hopper JL, Guthrie JR, Burger HG: A • No space constraints or color figure charges perspective population-based study of menopausal symptoms. Obstet • Immediate publication on acceptance Gynecol 2000, 96:351-358. 26. McKinlay SM, Brambilla DJ, Posner JG: The normal menopause transition. • Inclusion in PubMed, CAS, Scopus and Google Scholar Maturitas 1992, 14:103-115. • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Asia Pacific Family Medicine Springer Journals

Assessment of menopausal symptoms using modified Menopause Rating Scale (MRS) among middle age women in Kuching, Sarawak, Malaysia

Loading next page...
 
/lp/springer-journals/assessment-of-menopausal-symptoms-using-modified-menopause-rating-mdngE9eINO
Publisher
Springer Journals
Copyright
Copyright © 2010 by Rahman et al; licensee BioMed Central Ltd.
Subject
Medicine & Public Health; General Practice / Family Medicine; Primary Care Medicine
eISSN
1447-056X
DOI
10.1186/1447-056X-9-5
pmid
20175928
Publisher site
See Article on Publisher Site

Abstract

Background: Menopausal symptoms can be assessed by several tools, and can be influenced by various socio- demographic factors. Objectives: To determine the commonly reported menopausal symptoms among Sarawakian women using a modified Menopause Rating Scale (MRS). Methods: By using modified MRS questionnaire, 356 Sarawakian women aged 40-65 years were interview to document of 11 symptoms (divided into somatic, psychological and urogenital domain) commonly associated with menopause. Results: The mean age of menopause was 51.3 years (range 47 - 56 years). The most prevalent symptoms reported were joint and muscular discomfort (80.1%); physical and mental exhaustion (67.1%); and sleeping problems (52.2%). Followed by symptoms of hot flushes and sweating (41.6%); irritability (37.9%); dryness of vagina (37.9%); anxiety (36.5%); depressive mood (32.6%). Other complaints noted were sexual problem (30.9%); bladder problem (13.8%) and heart discomfort (18.3%). Perimenopausal women (n = 141) experienced higher prevalence of somatic and psychological symptoms compared to premenopausal (n = 82) and postmenopausal (n = 133) women. However urogenital symptoms mostly occur in the postmenopausal group of women. Conclusions: The prevalence of menopausal symptoms using modified MRS in this study correspond to other studies on Asian women however the prevalence of classical menopausal symptoms of hot flushes, sweating was lower compared to studies on Caucasian women. Background symptoms experienced by them can be group into: vaso- Menopause which is defined as complete cessation of motor, physical, psychological or sexual complaints. It menstruation for twelve months or more is a normal was also noted in some postmenopausal women with physiological change experienced by middle age women. long term estrogen deficiency, changes to the cardiovas- Some of menopausal symptoms experienced by these cular or bone which leads to osteoporosis has been women can be severe enough to affect their normal established. It is well documented that menopausal daily activities. Unfortunately majority of these women symptoms experienced by women affect their quality of are not aware of the changes brought about by meno- life [5-7]. Many published reports shows variations in pause [1-4]. These symptoms are directly resulted from menopausal symptoms between Asian and Caucasians depletion of estrogen level as women approaches meno- women, Asian women suffer lesser of somatic and psy- pausal stage and some of these women begin to experi- chological symptoms when compared to their western ences these menopausal symptoms early in the counterparts [8-11]. perimenopausal phase. The common climacteric Studies shown that perimenopausal and postmenopau- sal women have more menopausal complaints compared to premenopausal women. They were noted to complain * Correspondence: sarsalwi@fmhs.unimas.my significantlymoreofvasomotor,sexualand Department of Family Medicine, Faculty of Medicine and Health Sciences Universiti Malaysia Sarawak, Kuching, Malaysia © 2010 Rahman et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Rahman et al. Asia Pacific Family Medicine 2010, 9:5 Page 2 of 6 http://www.apfmj.com/content/9/1/5 psychological symptoms compared to premenopausal Reproductive Aging Workshop) classification which women [12-14]. divided menopause staging into: Postmenopausal;no Various tools or instruments have been designed to menstrual bleeding in the previous/last 12 months. Late measure and assess symptoms during the menopausal perimenopause; had menstruation in the previous/last 2- transition, among them is Menopause Rating Scale 12 months but not in the previous/last 2 months. Early (MRS) which is designed to assess menopause specific perimenopause; had increasing irregularity of menses health related quantity of life (QoL) to measure the without skipping periods (7 days difference from the severity of age/menopause-related complaints by rating beginning of a given cycle to the next, experienced after a profile of symptoms [15,16]. the previously regular cycle and Premenopause;minor Limited research data were available regarding meno- changes in cycle length particularly decreasing length of pausal symptoms experienced by women in Malaysia. the cycle. To aid statistical analysis, the early and late Although menopause related symptoms have been perimenopausal transition stages were grouped together extensively studied in the western countries, not much as perimenopausal stage [22,23]. data were available in Asia especially in South East Asia (3) Menopause Rating Scale (MRS) questionnaire were including Malaysia. All previous studies on menopausal used as a basis for assessing menopausal symptoms in in Malaysia were conducted in Peninsular Malaysia this study, this is a self-administered instrument which [17-21]. has been widely used and validated and have been used This study was conducted in Kuching, which is the in many clinical and epidemiological studies, and in capital city of Sarawak, the largest state in Malaysia and research on the etiology of menopausal symptoms to situated in the Island of Borneo. assess the severity of menopausal symptoms [16]. There is no documented or published data on meno- The MRS is composed of 11 items and was divided pausal study in Sarawak, and this study aimed to docu- into three subscales: ment the menopausal-related symptoms among middle (a) somatic-hot flushes, heart discomfort/palpitation, age women of Kuching, Sarawak by using modified sleeping problems and muscle and joint problems; (b) Menopause Rating Scale. psychological-depressive mood, irritability, anxiety and physical and mental exhaustion and (c) urogenital-sexual Methods problems, bladder problems and dryness of the vagina. Subjects and Setting Each of the eleven symptoms contained a scoring scale This is a cross-sectional study. Conducted from the from “0” (no complaints) to “4” (very severe symptoms). month of January 2007 to November 2007. This study The questionnaire was first translated into Malay lan- was approved by Universiti Kebangsaaan Malaysia guage by a group of experienced health-workers and Research and Ethical Committee. The interview was car- language experts, and then translated back to English to ried out among women ages of 40 to 65 years who vis- validate whether the original meaning of the question- ited the government health centers around Kuching, naire was maintained in the translation; a pilot study Sarawak, Malaysia. These health centers which provided was done on 60 women to validate the translated MRS primary care services are government healthcare centers questionnaires. The women were asked whether or not under the Ministry of Health, Malaysia. The inclusion they had experienced the 11 menopausal symptoms criteria consisted of women between the ages of 40 to shown in the MRS in the previous one month (30 days), 65 years who had given consent to participate in this however it was noted from the pilot study, these women study. Pregnant and breast feeding women, women with had difficulties in rating the scale themselves, in order uncontrolled medical conditions such as hypertension, to minimize these difficulties, a face-to-face interviewed diabetes mellitus or heart disease, or who were under- was done rather than using self-administered respond. going treatment for cancer, or were in remission, or Modifications were also made on the grading method of who had history of drug or alcohol abuse and on hor- each item due to difficulties faced by the participant in mone replacement therapy were excluded from the identifying the severity of the symptoms hence the grad- study. ing was modified to “present” or “absent” of symptoms. Reliability analysis was performed on the modified Instrument and data collection Menopause Rating Scale questionnaires with Cronbach’s Questionnaires were divided into three sections: alpha of somatic subscale 0.712, psychological subscale (1) Socio-demographic data of the women, which 0.743 and urogenital subscale 0.821. Therefore, this included: age, race, religion, marital status, educational study determined the prevalence of menopausal symp- level, occupation and average household income. toms and not the severity of the symptoms. (2) Menopausal status of the women: The menopausal All women were interviewed in Malay language. Face- status was classified according to STRAW (Stages of to-face interview were done on all the women by trained Rahman et al. Asia Pacific Family Medicine 2010, 9:5 Page 3 of 6 http://www.apfmj.com/content/9/1/5 health personnel who had undergone training, as this Table 1 Socidemographic data of participants was important to make sure right answer were given, Sociodemographic Total(n = 356) % Data and explanations can be given if the women were in Age Group(years) doubt or unclear about the questions asked. At the 40 - 44 65 18.3 reception desk during registration, women who fulfill 45 - 49 100 28.1 thecriteriawereinvited to participateinthisstudy. 50 - 54 81 22.7 Explanations were given and written informed consent 55 - 59 73 20.5 was taken from them. 60 - 65 37 10.4 Statistical analysis The Statistical Package for the Social Sciences software Ethnic Distribution Version 14.0 (SPSS, Chicago, IL) was used for univariate Iban 101 28.4 analyses. The X² test was applied to compare the fre- Chinese 80 22.4 quencies of the symptoms among the different meno- Bidayuh 68 19.1 pausal status. The level P < 0.05 was considered as the Malay 57 16.0 cut-off value for significance. Melanau 22 6.2 Others(Lumbawang, 28 7.8 Kelabit, Kayan, Results Penan, Punan) Three hundred and fifty six women completed the study. The mean age of respondents in this study was Religion 50.83 ± 6.30 (SD) years. The mean age at menopause Christian 178 50.0 was 51.28 ± 2.28 (SD) years with median of 50 years. Muslim 75 21.1 Among these women, 82 (23.0%) were premenopausal, Buddhist 81 22.6 141 (39.6%) perimenopausal and 133 (37.4%) postmeno- Others 22 6.3 pausal. The Iban, Chinese and Bidayuh were the major- ity ethnic group in this study. Christians made up 178 Marital status (50.0%) of the participants, 256 (71.9%) were married Married 256 71.9 and 319 (89.6%) had 11 or less years of schooling. Widow/divorcee 87 24.5 Majority 164 (46.1%) of the participants were house- Single 13 3.6 wives and most of the participants 169 (47.5%) had a monthly household income below RM 1000 (US$ 312). Educational level (1 USD = RM 3.2). (Table 1) No formal 78 21.9 Table 2 shows the frequency of menopausal symptoms education as assessed by the modified MRS according to most fre- Primary level 96 27.0 quent complaints. The three most prevalent menopausal Secondary level 145 40.7 symptoms for all women (n = 356) were: joint and mus- Tertiary level 37 10.4 cular discomfort 285 (80.1%), physical and mental Occupation exhaustion 239 (67.1%) and sleeping problems 186 Housewife 164 46.1 (52.2%). This was followed by symptoms of hot flushes General worker 48 13.4 and sweating 148(41.6%), irritability 135 (37.9%), dryness Semi-professional 107 30.1 of vagina 135 (37.9%), anxiety 130 (36.5%), depressive Professional 37 10.4 mood 116 (32.6%), sexual problem 110 (30.9%), bladder problems 49 (13.8%) and heart discomfort/palpitation 65 Household income (18.3%). (monthly) Most of the somatic and psychological subscale symp- Below RM 1000 169 47.5 RM 1001 - RM 2000 69 19.4 toms occur in the perimenopausal group of women RM 2001 - RM 3000 78 21.9 compared to pre- and postmenopausal women. However RM 3001 - RM 4000 24 6.7 urogenital symptoms occurred most in postmenopausal RM 4001 - RM 5000 12 3.4 women.(Table 3). Above RM 5000 4 1.1 Discussion The mean age at menopause in this study was 51.28 ± 2.28 years. Although this is slightly higher than studies done in Peninsular Malaysia which reported mean age Rahman et al. Asia Pacific Family Medicine 2010, 9:5 Page 4 of 6 http://www.apfmj.com/content/9/1/5 Table 2 Frequency of menopausal symptoms among in many languages, although it is a self-administrated Sarawakian women aged 40-65 years in Kuching, questionnaires, it’s used were not only meant to assess Sarawak assessed by modified MRS the menopausal symptoms but also its severity, however, Menopausal symptoms n = 356 100% in our study, modification has to be done on the scaling 1. Joint and muscular discomfort 285 80.1 of theoriginalMRS becausewenoted that therespon- 2. Physical and mental exhaustion 239 67.1 dents had difficulties in rating the scales, this could be 3. Sleeping problems 186 52.2 explained by the fact that nearly half of the respondent 4. Hot flushes, sweating 148 41.6 studied never had formal education or only studied at 5. Irritability 135 37.9 primary level, and to minimize the reporting error, face to face interviewed were used instead of self adminis- 6. Dryness of vagina 135 37.9 tered by the respondents [15,16]. 7. Anxiety 130 36.5 In our study, the classical presentation of menopausal 8. Dpressive mood 116 32.6 symptoms; hot flushes, sweating and night sweats were 9. Sexual problems 110 30.9 noted to be lower (41.6%) when compared to findings 10. Heart discomfort 65 18.3 from studies done on western women who were 11. Bladder problems 49 13.8 reported to be from 45% to 75%. Similar result were also noted in two other studies done in Malaysia by of menopause between 49.4 to 51.1 years and from Dhillon et al. (53.0%) and Ismail (57.l0%), however, our studies done in Thailand (48.7 years), Singapore (49.1 finding of low menopausal classical symptoms were years) and other studies on Asian and Caucasian shared by studies done in other Asian countries women, our findings still falls between the normal range [3,17,18,24-28]. of menopausal age [3,9,10,13,17,18,20,21]. In this study perimenopausal women were noted to The assessment tool that we used in our study was experience more of vasomotor symptoms when com- based on Menopause Rating Scale (MRS) questionnaire. pared to other menopausal group of women, and this Although in menopausal symptoms studies few assess- was also statistical significant (Table 3), this can be ment tools were available, we used the Menopause Rat- explained by the fact that in these group of women, ing Scale (MRS) questionnaires, these questionnaires has estrogen fluctuation during this phase occurs the most, been widely used in many epidemiological and clinical hence they will experienced the most vasomotor symp- research when investigating the menopausal symptoms, toms. Our findings were correspond to studies con- These questionnaires has been validated and translated ducted among Australia and other Caucasian women; Table 3 Frequency of menopausal symptoms in the participants according to menopausal status among Sarawakian women aged 40-65 using the modified MRS Subscale (menopausal symptoms) All (n = 356) Premenopausal (n = 82) Perimenopausal (n = 141) Postmenopausal (n = 133) Somatic 1. Hot flushes, sweating 148(41.6) * 29(35.4) 91(64.5) *, † 28(21.1) 2. Heart discomfort 65(18.3) 3(3.7) 40(28.4) *,† 22(16.5) 3. Sleeping problems 186(52.2) 24(29.2) 94(66.7) *,† 68(51.1) 11. Joint and muscular discomfort 285(80.1) 36(43.9) 129(91.4) * 120(90.2) ‡ Psychological 4. Depressive mood 116(32.6) 13(15.9) 67(47.5) 36(27.1) ‡ 5. Irritability 135(37.9) 29(35.4) 77(54.6) *,† 29(21.8) †‡ 6. Anxiety 130(36.5) 29(35.4) 78(55.4) *,† 23(17.3) 7. Physical and mental exhaustion 239(67.1) 36(43.4) 107(75.9) * 96(72.2) ‡ Urogenital 8. Sexual problems 110(30.9) 17(20.7) 58(41.2) † 35(26.3) ‡ 9. Bladder problems 49(13.8) 8(9.7) 14(9.9) 27(20.3) ‡,** 10. Dryness of vagina 135(37.9) 16(19.5) 58(41.2) * 61(45.9) ‡,** * Significant difference p < 0.05 compared to premenopausal † Significant difference p < 0.05 compared to postmenopausal. ‡ Significant difference p < 0.05 compared to premenopausal. ** Significant difference p < 0.05 compared to perimenopausal Rahman et al. Asia Pacific Family Medicine 2010, 9:5 Page 5 of 6 http://www.apfmj.com/content/9/1/5 where as high as 75% of perimenopausal women experi- Malay, so there is the question of accuracy in transla- enced bothersome vasomotor symptoms at some point tion, although this was done by a group of health-work- of their transitional period [24-30]. ers and language experts. Although MRS is a self From our study, joints and muscular discomfort; phy- reporting questionnaire, in view of substantial number sical and mental exhaustions and sleeping problems of women studied does not have formal education, in (Table: 2) which is from the somatic and psychological order to include these illiterate women, interviews were subscales were experienced most by perimenopausal fol- used instead. In collecting data, women are asked to lowed by postmenopausal women and these was also provide some retrospective information, such as meno- statistical significant differences when compared to pre- pausal symptoms experienced in the preceding one menopausal women. These findings were also noted to month, last menstruation etc. Hence recall bias is una- be corresponding to studies conducted Asian and Cau- voidable, especially for some elderly women. A final lim- casian women [3,7,10,13,18,19,27,28,31,32]. itation of this study is lack of information on regularity It is interesting to note that in our study, as much as of menstruation. Some subjects could have been mis- 35% to 45% of premenopausal women also reported classified into the incorrect menopause status group. similar symptoms (joint and muscular discomfort, physi- cal and mental exhaustion, anxiety, depressing mood, Conclusion irritability), this could be explained since most of the The study of middle- age women from Kuching, Sara- somatic or psychological symptoms experienced by wak between the ages of 40 and 65 years using modified these middle age women are not exclusively as a result Menopause Rating Scale (MRS), showed that the mean of changes due to menopause alone, it’scould also age of menopause was 51.28 ± 2.28 years. resulted from other physical, psychological or health The menopausal symptoms experienced by them were related problems which is related to aging in these similar to other Asian women but the prevalence classi- group of women which can represent as menopausal cal menopausal symptoms of hot flushes, sweating was like symptoms [7,13,22]. lower compared to studies on Caucasian women. In urogential subscale (sexual problems, bladder pro- The most common symptoms reported were from the blems and vaginal dryness), from our study the fre- somatic subscale; joint and muscular discomfort, physi- quency of these symptoms were experienced mainly by cal and mental exhaustion and sleeping problems. postmenopausal group of women and it was also signifi- The perimenopausal women had the most significant cant statistically when compared to other menopausal somatic complaints compared to postmenopausal and status (Table 3) and similar finding were documented premenopausal women, while postmenopausal women from other studies [3,18,25,27,32]. had the most significant urogenital symptoms compared Natural menopause may strongly contribute to sexual to pre- and perimenopausal women. changes experienced by these women, however its need to be emphasized that there are numerous factors which Acknowledgements contribute to declining sexual activities in middle age We wish to thank Universiti Kebangsaan Malaysia for the research grant for women following menopause [18,33-36]. this study. We also like to thank Sarawak Health Department, all the government polyclinics around Kuching for their assistant in conducting this In our study it was noted that somatic and psychologi- study. cal symptoms were experienced mainly by perimenopau- We would also like to thank the original authors of the Menopause Rating sal women compared to the postmenopausal or Scale (MRS) for the use of this instrument during this study. premenopausal women. However, in the urogenital or Author details sexual symptoms, the postmenopausal women were 1 Department of Family Medicine, Faculty of Medicine and Health Sciences reported to suffer the most compared to the other two Universiti Malaysia Sarawak, Kuching, Malaysia. Faculty of Resource Science and Technology, Universiti Malaysia Sarawak, Kuching, Malaysia. Department groups and similar findings were reported from other of Family Medicine, International Medical University, Kuala Lumpur, Malaysia. studies [2-4,13,18]. There are several limitations of this study. Although Authors’ contributions SARSA participated in the design, coordinating and carried out the study attempts were made to ensure that the study population and drafted the manuscript. wasasrepresentativeaspossibleofthe generalpopula- SRZ performed the statistical analysis and drafted the manuscript. tion of the Kuching, Sarawak, nevertheless it has to be VLKM participated in the design and coordinating of the study. All authors read and approved the final manuscript. stated owing to the sampling technique used this might not be entirely possible. Another limitation was, as this Competing interests was a cross sectional study, it does not exclude other The authors declare that they have no competing interests. confounding effects of the natural aging process that Received: 29 July 2009 may influence experience of symptoms. Thirdly, this Accepted: 22 February 2010 Published: 22 February 2010 study used modified MRS questionnaire, translated to Rahman et al. Asia Pacific Family Medicine 2010, 9:5 Page 6 of 6 http://www.apfmj.com/content/9/1/5 References 27. Loh FH, Khin LW, Saw SM, Jeannette JM, Ken Gu: The age of menopause 1. Williams RE, Levine KB, Kalilani L, Lewis J, Clark RV: Menopause-specific and the menopause transition in a multiracial population: a nation-wide questionnaire assessment in US population-based study shows negative Singapore study. Maturitas 2005, 52:169-180. impact on health-related quality of life. Maturitas 2009, 62(2):153-9. 28. Lam PM, Leung TN, Haines C, Chung TK: Climacteric symptoms and 2. Lu J, Liu J, Eden J: The experience of menopausal symptoms by Arabic knowledge about hormone replacement therapy among Hong Kong women in Sydney. Climacteric 2007, 10:72-7. Chinese women aged 40-60 years. Maturitas 2003, 30:45(2):99-107. 3. Peeyananjarassri K, Cheewadhanaraks S, Hubbard M, Zoa Manga R, 29. Guthrie JR, Dennerstein L, Taffe JR, Lehert P, Burger HG: The menopausal Manocha R, Eden J: Menopausal Symptoms in a hospital-based sample transition: a 9-year prospective population-based study. The Melbourne of women in southern Thailand. Climacteric 2006, 9:23-29. Women’s Midlife Health Project. Climacteric 2004, 7:375-389. 4. Chedraui P, Blümel JE, Baron G, Belzares E, Bencosme A, Calle A, et al: 30. Travers C, O’Neill SM, King R, Battistuta D, Khoo SK: Green Climacteric Impaired quality of life among middle aged women: A multicentre Latin Scale: norm in an Australian population in relation to age and American study. Maturitas 2008, 61(4):323-9. menopausal status. Climacteric 2005, 8:56-62. 5. Lee I, Wang HH: Pattern and related factors of self-care behavior among 31. Gold EB, Block G, Crawford S: Lifestyle and demographic factors in perimemenopausal women. Public Health Q 2001, 28:151-60. relation to vasomotor symptoms: baseline results from the Study of 6. Shanafelt TD, Barton DL, Adjei AA, Loprinzi CL: Pathophysiology and Women’s Health Across the Nation. Am J Epidemiol 2004, 159:1189-1199. treatment of hot flashes. Mayo Clin Proc 2002, 77:1207-1218. 32. Park YJ, Kim HS, Chang SO, Kang HC, Chun SH: Sexuality and related 7. Porter M, Penny GC, Russell D, Russell E: A population based survey of factors of postmenopausal Korean women. Taehan Kanko Hakhoe Chi women’s experience of the menopause. Br J Obstet Gynaecol 1996, 2003, 33(4):457-63. 103:1025-8. 33. Greendale GA, Lee NP, Arriola ER: The menopase. Lancet 1999, 353:571-580. 8. Oddens BJ, Boulet MJ, Lehert P, Visser AP: Has the climacteric been 34. Rekers H, Drogendijk AC, Valkenburg HA, Riphagen F: The menopause, medicalised? A study on the use of medication for climacteric urinary incontinence and other symptoms of the genitor-urinary tract. complaints in four countries. Maturitas 1992, 15(December (3)):171-81. Maturitas 1992, 15:101-111. 9. Pan HA, Wu MH, Hsu CC, Yao BL, Huang KE: The perception of 35. Milsom I, Ekelund P, Molander U, Arvidsson L, Areskoug B: The influence of menopause among women in Taiwan. Maturitas 2002, 25:41(4):269-74. age, parity, oral contraception, hysterectomy and menopause on the 10. Boulet MJ, Oddens BJ, Lehert P, Verme HM, Visser AP: Climacteric and prevalence of urinary incontinence in women. Journal of Urology 1993, menopause in seven South-east Asian countries. Maturitas 1994, 149:1459-1462. 19(October (3)):157-76. 36. Sherburn M, Guthrie JR, Dudley EC, O’Connell HE, Dennerstein L: Is 11. Fuh JI, Wang SJ, Lu SR, Juang KD, Chiu LM: The Kinmen women-health incontinence associated with menopause?. Obstet Gynecol 2001, investigation (KIWI): a menopausal study of a population aged 40-54. 98:628-633. Maturitas 2001, 39:117-24. doi:10.1186/1447-056X-9-5 12. Jong LF, Shun JW, Shiang RL, Kai DJ, Lung MC: The Kinmen women-health Cite this article as: Rahman et al.: Assessment of menopausal symptoms investigation (KIWI): a menopausal study of a population aged 40-54. using modified Menopause Rating Scale (MRS) among middle age Maturitas 2001, 39:117-12. women in Kuching, Sarawak, Malaysia. Asia Pacific Family Medicine 2010 13. Harvey C, Bee HT, Chia CA, Ee MC, Yap SC, Seang MS: The prevalence of 9:5. menopausal symptoms in a community in Singapore. Maturitas 2002, 41:275-282. 14. Lori AB, Crystal MS, Kavita N: Is This Women Perimenopausal. JAMA 2003, 289(7). 15. Green JG: Construction a standard climacteric scale. Maturitas 1998, 29:19-24. 16. Heinemann LAJ, Potthoff P, Schneider HP: International version of the menopause rating scale (MRS). Health Qual Life Outcomes 2003 1:28. 17. Ismail NN: A study on menopause in Malaysia. Maturitas 1994, 19(3):205-209. 18. Dhillon HK, Singh HJ, Rashidah S, Abdul Manaf H, Nik Mohd Zaki NM: Prevalence of menopausal symptoms in women in Kelantan, Malaysia. Maturitas 2006, 54:213-221. 19. Dhillon HK, Singh HJ, Nor Aliza AG: Sexual function in menopausal women in Kelantan, Malaysia. Maturitas 2005, 52:256-263. 20. Hamid A, Tey N, Ramli N: A study on age of menopause and menopausal symptoms among Malaysian women. Malaysian Journal of Reproductive Health 1989, 7(1):1-9. 21. Ismael NN: A study on the menopause in Malaysia. Maturitas 1994, 19:205-209. 22. World Health Organisation (WHO): Scientific Group on Research on the Menopause in the 1990s. Research on the menopause: Report of a WHO scientific group. WHO technical report series Geneva: WHO866. 23. Soules MR, Sherman S, Parrot E: Executive summary: stages of reproductive aging workshop (STRAW). J Women’s Health Gender-based Submit your next manuscript to BioMed Central 2001, 10(9). and take full advantage of: 24. Takeshi A: First Consensus Meeting on Menopause in the East Asian Region: Demography of the menopause and pattern of climacteric • Convenient online submission symptoms in the East Asian region. Geneva Foundation for Medical Education and Research 2003. • Thorough peer review 25. Dennerstein L, Duddley EC, Hopper JL, Guthrie JR, Burger HG: A • No space constraints or color figure charges perspective population-based study of menopausal symptoms. Obstet • Immediate publication on acceptance Gynecol 2000, 96:351-358. 26. McKinlay SM, Brambilla DJ, Posner JG: The normal menopause transition. • Inclusion in PubMed, CAS, Scopus and Google Scholar Maturitas 1992, 14:103-115. • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit

Journal

Asia Pacific Family MedicineSpringer Journals

Published: Feb 22, 2010

References