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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 25  |  Issue : 1  |  Page : 33-38

Determinants of surgically induced menopause in rural North Karnataka


Department of Epidemiology and Biostatistics, KAHER, Belagavi, Karnataka, India

Date of Submission02-Aug-2019
Date of Acceptance04-Feb-2020
Date of Web Publication14-Apr-2020

Correspondence Address:
Prof. Naresh Kumar Tyagi
Department of Epidemiology and Biostatistics, KAHER, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmgims.jmgims_47_19

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  Abstract 


Objective: The objective of the study was to quantify the effect of surgically induced menopause (SIM) on quality of life as assessed by religion, body mass index (BMI), sexual problem, menstrual history, blood spotting after intercourse, menopausal symptoms, and psychological disorder in the age group of 40–55 years of women. Materials and Methods: In this cross-sectional study, 712 rural women, comprising of 40 women (aged 40–55 years) with SIM, were surveyed, by inverse cluster sampling with proportional to population size. The aim was to study SIM and its determinants; menopause anthropometric data, menopause symptoms, and associated psychosocial symptoms. The data was analyzed using bivariate and multivariate techniques. Results: Around 6.4% of Hindu women had SIM, followed by Muslim (6.2%) and others (1.1%). SIM was significantly high in BMI group <25. The differences of SIM in regularity of menstruation were significant. Similar results were observed in sexual problem, menstrual flow, blood spotting after intercourse, blood spotting between periods, pain in periods, physical and mental exhaustion, heart discomfort, sleep problem, irritability, and dryness of the vagina. The sexual activity significantly hampered after SIM, further, unadjusted Odds Ratios (ORs) were not in line with adjusted OR. With regularity of menstruation problem, the SIM increases significantly, as indicated by adjusted and unadjusted ORs, the similar results were seen by menstrual flow and blood spotting after intercourse. The SIM by adjusted and unadjusted ORs was similar in other determinants. The Logistic regression model has been calibrated for sensitivity and specificity above 90% and accuracy as high as 97.8%. The modulated probabilities have been provided for the users of the model. Conclusion: The results of the bivariate analysis of surgical menopause by its covariates and regression model constructed are valuable for health-care providers, as reference for diagnosis, and to pacify patients for consequences of the prognosis.

Keywords: Household survey, modulated probabilities, receiver operating characteristic curve, surgically induced menopause


How to cite this article:
Patil SH, Tyagi NK, Prasad JB. Determinants of surgically induced menopause in rural North Karnataka. J Mahatma Gandhi Inst Med Sci 2020;25:33-8

How to cite this URL:
Patil SH, Tyagi NK, Prasad JB. Determinants of surgically induced menopause in rural North Karnataka. J Mahatma Gandhi Inst Med Sci [serial online] 2020 [cited 2020 Oct 20];25:33-8. Available from: https://www.jmgims.co.in/text.asp?2020/25/1/33/282355




  Introduction Top


Surgical menopause is the cessation of menses resulting from surgical removal of the uterus, leaving one or both ovaries,[1] caused by estrogen deficiencies, arising from surgical or natural premenopausal physiological changes or due to sociopsychological changes.[2]

Most of the hysterectomies occur in the age group of 35 and 45 years and more than half by the age of 45 years. Surgical primary ovarian insufficiency is the leading cause of ovarian hormone deficiency in premenopausal women, affecting the quality of life.[3],[4] The Mayo Clinic Cohort Study of Oophorectomy and Aging reported that bilateral oophorectomy risk enlarged for all-cause mortality (28%), and out of total mortality, stroke (62%), coronary heart disease (33%), cognitive impairment (60%), osteoporosis and bone fractures (50%), parkinsonism (80%), sexual dysfunction (40%–110%). In addition, these studies highlighted greater risks with earlier age at the time of surgical primary ovarian insufficiency.[5],[6],[7]

Women with surgical primary ovarian insufficiency experienced more severe and frequent menopausal symptoms than natural menopause.[7] Untreated menopause symptoms such as hot flushes, sleep disturbance, fatigue, decreased sexual desire, anxiety, and depressed mood have been observed, impacting the quality of life and increasing the risk of other diseases.[8],[9],[10],[11],[12] The similar results have been reported by several studies from developing and developed countries.[13],[14] Hence, the present cross-sectional study has been carried out in the rural community of North Karnataka, with the objective to quantify the effect of surgically induced menopause (SIM) on quality of life as assessed by religion, body mass index (BMI), sexual problem, menstrual history, blood spotting after intercourse, menopausal symptoms, and psychological disorder in the age group of 40–55 years.


  Materials and Methods Top


In this cross-sectional study, 712 rural women, comprising 40 women with SIM (aged 40–55 years) were surveyed by inverse cluster sampling with proportional to population size, using precoded and pretested data collection instrument during October 2016–April 2017 in rural Belagavi district of North Karnataka. A pilot survey was carried out to standardize the data collection instrument.

The aim was to study SIM and its determinants; anthropometric variables, menopause symptoms, and associated psychosocial and menopause symptoms.

Statistical methods

To study SIM and its determinants; the sample size was computed for anthropometric variables, menopausal symptoms, and associated psychosocial and menopause symptoms, keeping in mind the feasibility, assuming 95% Confidence Interval (CI) and 10% expected error in the estimation of the parameters.

95% CI of odds ratio (OR) was computed as:

95% CI of OR

where “a” is the number of SIM women and “b” is not SIM in reference group. “c” and “d” are the similar figures for study group for OR.

The probability of SIM was computed as:

, and the logistic regression model =where k is the number of explanatory variables, ai is the corresponding logistic regression coefficients, and P is the probability of SIM and q = 1 − p, the probability of not SIM. Receiver operating characteristic (ROC) curve has been given along with modulated probabilities, to be used by health-care providers as reference example.

Data were analyzed using Excel and IBM SPSS 22, Bangalore, Karnataka, India version.


  Results Top


Seven hundred and twelve rural women comprising 40 women with SIM and 550 women with menopause (in the age range of 40–55 years) constituted the study material.

[Table 1] reveals that maximum, i.e., 6.4%, of Hindu women had SIM, followed by Muslim (6.2%) and others (1.1%); however, the difference was not statistically significant. SIM was significantly higher (9.6%, P < 0.05) in BMI group <25 and decreased to 0.9% in BMI group 30 and above. The differences of SIM in regularity of menstruation were significant at P < 0.001; the similar results were observed in sexual problem (P < 0.01), menstrual flow (P < 0.05), blood spotting after intercourse (P < 0.001), blood spotting between periods (P < 0.05), pain in periods (P < 0.001), physical and mental exhaustion (P < 0.001), heart discomfort (P < 0.001), sleep problem (P < 0.05), irritability (P < 0.001), and dryness of the vagina (P < 0.01).
Table 1: Surgically induced menopause by its covariates in women of age 40-55 years

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[Table 2] reveals that the OR differences by BMI groups were statistically significant at P < 0.001; however, the similar unadjusted figure did not show any significant results. The sexual activity significantly decreased (P < 0.01) after SIM; however, the unadjusted OR did not exhibit statistically significant differences. With regularity of menstruation problem, the SIM increased significantly (P < 0.01), as indicated by adjusted and unadjusted ORs, the similar results were observed by menstrual flow and blood spotting after intercourse (P < 0.01). The SIM by adjusted and unadjusted ORs was not statistically significant by other covariates. However, all the factors in the model influenced the onset of SIM significantly.
Table 2: Odds ratio estimate by logistic regression and comparable unadjusted

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Diagnostic evaluation of logistic regression model

[Table 3] reveals the likely sensitivity and specificity of the model as 92.5 and 90.8%, respectively. However, sensitivity and specificity can be adjusted as per requirement of the research, as per the need for screening or diagnosis. The area under the ROC curve (accuracy) is 97.8% with 95% CI 96.5%–99.2%.
Table 3: Sensitivity and specificity of the model at different cut of points

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  Discussion Top


Menopause symptoms (physical and mental exhaustion, heart discomfort, hot flushes, sleep problem, depressive mood, irritability, anxiety, and dryness of the vagina) vary differently in perimenopause age with the most common hot flushes, followed by night sweat, vaginal dryness, and mood swings.[4] Menopause symptoms and their consequences cause a lot of hardship in the physiological process of attaining menopause providing invaluable input for health-care providers and public health personnel to enable appropriate health-care/health education.[3] Hence, for the present study, 712 rural women, comprising 40 women with SIM (aged 40–55 years) were surveyed by inverse cluster sampling with proportion to population size to meet the objectives of the study, from October 2016 to April 2017 in North Karnataka.

The proportion of SIM was higher (around 6.4%) in Hindu women, followed by Muslim. SIM was significantly higher in BMI group <25 and decreased consistently with BMI. The differences of SIM in “regularity of menstruation” groups were significantly different (P < 0.001), and the similar results were observed in “sexual problem,” “menstrual flow,” “blood spotting after intercourse,” “blood spotting between periods,” “pain in periods,” “physical and mental exhaustion,” “heart discomfort,” “sleep problem,” “irritability,” and “dryness of the vagina.” Findings were in line with those of other studies in developing and developed countries.[6],[7]

Logistic regression analysis was carried out to study the effect of menopausal symptoms on SIM and to know the differences in direct and indirect effects of the factor affecting surgical intervention to achieve menopause. The results are encouraging with Nagelkerke square (R2 = 0.69, accuracy of model = 0.98 with 95% CI: 0.97–0.99, P < 0.001), identifying 96.6% surgical and nonsurgical menopause women correctly. The results are in accordance with the findings of other studies.[15],[16] The likely sensitivity and specificity of the logistic regression model constructed for the use of healthcare providers were 92.5% and 90.8%, respectively. However, sensitivity and specificity can be adjusted as per requirement of the research objectives (for screening or diagnosis purposes) [Figure 1].
Figure 1: Receiver operating characteristic curve for surgically induced menopause, area: 97.8%, 95% confidence interval: 96.5–99.2

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The findings are useful for health-care providers, as reference for diagnosis, and to pacify patients for acceptance of the prognosis. These findings should be taken with care, as the study is from a rural area, with almost no obesity.


  Conclusion Top


The results of the bivariate analysis of surgical menopause by its covariates and regression model constructed are valuable for health-care providers, as reference for diagnosis, and to pacify patients for consequences of the prognosis. However, sensitivity and specificity can be adjusted as per requirement of the research objectives (for screening or diagnosis purposes).

Acknowledgment

We acknowledge the Hon. Vice-Chancellor, Prof. Dr. Vivek A. Saoji, and Prof. Dr. V. D. Patil, The Registrar, KAHER, for permitting and encouraging the research. We sincerely thank Ms. Rupa V. Chougule for extending help in preparation of the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Brett KM. Can hysterectomy be considered a risk factor for cardiovascular disease? Circulation 2005;111:1456-8.  Back to cited text no. 1
    
2.
Bhattacharya SM. Effects of tibolone on health-related quality of life in menopausal women. Int J Gynaecol Obstet 2007;99:43-5.  Back to cited text no. 2
    
3.
Asante A, Whiteman MK, Kulkarni A, Cox S, Marchbanks PA, Jamieson DJ. Elective oophorectomy in the United States: Trends and in-hospital complications, 1998-2006. Obstet Gynecol 2010;116:1088-95.  Back to cited text no. 3
    
4.
Wright JD, Herzog TJ, Tsui J, Ananth CV, Lewin SN, Lu YS, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol 2013;122:233-41.  Back to cited text no. 4
    
5.
Shuster LT, Rhodes DJ, Gostout BS, Grossardt BR, Rocca WA. Premature menopause or early menopause: Long-term health consequences. Maturitas 2010;65:161-6.  Back to cited text no. 5
    
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Faubion SS, Kuhle CL, Shuster LT, Rocca WA. Long-term health consequences of premature or early menopause and considerations for management. Climacteric 2015;18:483-91.  Back to cited text no. 6
    
7.
Sarrel PM, Sullivan SD, Nelson LM. Hormone replacement therapy in young women with surgical primary ovarian insufficiency. Fertil Steril 2016;106:1580-7.  Back to cited text no. 7
    
8.
Benshushan A, Rojansky N, Chaviv M, Arbel-Alon S, Benmeir A, Imbar T, et al. Climacteric symptoms in women undergoing risk-reducing bilateral salpingo-oophorectomy. Climacteric 2009;12:404-9.  Back to cited text no. 8
    
9.
Nachtigall L. Hot flashes: Is a hot flash just a hot flash? Menopause 2014;21:551-2.  Back to cited text no. 9
    
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Thurston RC, El Khoudary SR, Sutton-Tyrrell K, Crandall CJ, Gold E, Sternfeld B, et al. Are vasomotor symptoms associated with alterations in hemostatic and inflammatory markers? Findings from the Study of women's health across the nation. Menopause 2011;18:1044-51.  Back to cited text no. 10
    
11.
Rossouw JE, Prentice RL, Manson JE, Wu L, Barad D, Barnabei VM, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA 2007;297:1465-77.  Back to cited text no. 11
    
12.
Kronenberg F. Hot flashes: Epidemiology and physiology. Ann N Y Acad Sci 1990;592:52-86.  Back to cited text no. 12
    
13.
Sarrel P, Portman D, Lefebvre P, Lafeuille MH, Grittner AM, Fortier J, et al. Incremental direct and indirect costs of untreated vasomotor symptoms. Menopause 2015;22:260-6.  Back to cited text no. 13
    
14.
Geukes M, van Aalst MP, Robroek SJ, Laven JS, Oosterhof H. The impact of menopause on work ability in women with severe menopausal symptoms. Maturitas 2016;90:3-8.  Back to cited text no. 14
    
15.
Mahajan N, Kumar D, Fareed P. Comparison of menopausal symptoms and quality of life after natural and surgical menopause. Int J Sci Stud 2016;3:74-7.  Back to cited text no. 15
    
16.
Appiah D, Schreiner PJ, Bower JK, Sternfeld B, Lewis CE, Wellons MF. Is surgical menopause associated with future levels of cardiovascular risk factor independent of antecedent levels? The CARDIA Study. Am J Epidemiol 2015;182:991-9.  Back to cited text no. 16
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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