CHAPTER ONE
Introduction
Background to the study
Naturally, at the mid life of every woman between the age of 45 to 55 years women generally complain of a lot of changes in their body systems like short or long menstrual cycle, from three weeks to three months, heavy or scanty menstruation and different types of health disturbances like gingivitis, tinnitus, heart palpitation, and urine incontinence. These often mark the onset of menopause.
Menopause is the cessation of normal menstrual flow due to decline in the sex hormones. This is in line with what Carlow (2003) observed about menopause. According to him at the end of reproductive phase the ovaries gradually becomes unable to respond to the hormones released by the pituitary gland. With these changes, fertility decrease and menstrual cycle becomes irregular and menstrual flow tampers off resulting in menopause with its physiological challenges. Samuel (2006) refers to menopause as a natural cessation of ovarian hormone production and usually, gradually and finally ending up in cessation of menstruation. He also described it as a change in life in which there is cessation of monthly menstrual flow. In this study menopause refers to the cessation of menstrual flow that starts at the midlife of every woman between the ages 45 – 55 years.
The cessation of menstruation is not immediate; it is a gradual, process consisting of a decline in the normal activities of the ovarian functions. This occur due to the fact that the amount of estrogen and progesterone the ovaries produce is no longer enough to bring about ovulation and keep the monthly periods or menses going (Ewuzie 2001). As a result of this the menstrual period becomes irregular followed by certain symptoms which make some women feel moody. In general this hormonal fluctuation occurs between one to three years before the menstruation stop completely. Although this transition varies from individual, to individual it can occur abruptly as in case of a situation where the ovary is removed surgically or damage due to chemotherapy (Dians and Magaret 2006). This transition occurs at the midlife of women and makes their lives different. Many women especially the less educated ones view or perceive these symptoms differently, (Nwoke and Onyeocha, 2008).
Menopause is usually accompanied with signs and symptoms. Signs according to Hornby (2009) is an event, an action, a fact that shows that something exists or is happening or may happen in future, while symptoms is a change in ones body or mind which shows that one is not healthy. Signs of menopause as used in the study are the events or things that are recognized as happening to women whose menstruation has ceased while symptoms are changes which the woman feels or knows by herself that something is happening to her. At this stage of life every woman experience different changes in their body makeup. These changes, which make them to complain, include hot flushes, urine incontinence, vaginal changes, insomnia, bone loss or osteoporosis, skin changes, irregular menstruation, and loss of libido.
Hot flushes are very disturbing signs of menopause, which are characterized by sweating, redness of skin, internal heat and restlessness occurring mainly on the upper part of the body. These cause serious concern to some women. Hot flushes are always accompanied by sudden intense and hot feeling on the face and upper body. It may last up to three minutes or five minutes before stopping (Okoye, 2007).
Another sign of menopause is urine incontinence (Ofoegbu, 2008). This referred to leakage of urine from the urethra or inability of the menopausal women to control urine flow. This is due to the withdrawal of estrogen, which plays an important role in maintaining the function of a woman’s vagina and surrounding tissues, like uterus, urinary bladder and urethra. During menopause these organs may weaken or shrink. When these changes occur in the bladder and urethra, they can lead to the involuntary leakage of urine, infection or painful urination.
Osteoporosis or bone loss as opined by Alan and Nathan (2003) is a condition in which calcium is lost from bone tissue and bone mass is depleted. It is important to note that bone formation is completed at the age of 25 years in a woman. After this age, the bone gradually begins to reduce in size, which is caused by a hormone called parathyroid hormone. This causes thinning, of the bone, thereby weakening the bones. This gradual process continues throughout life. Alan and Nathan further stated that estrogen prevents this action but once the estrogen reduces in its normal level in the body, it becomes serious and leads to osteoporosis, which occurs frequently in older women. Fisheri (1995) noted that irregular menstruation is the preempting sign of menopause. Sometimes the period may come on the 21st day, others on the 26th or 30th day. Sometimes also a period of two or three months may elapse before the menses reappears. At times the menstruation may be very heavy or very scanty.
Skin change is another sign of menopause. Estrogen is responsible for maintenance of the skin contour in a woman. It is a fatty property to the skin that makes the skin smooth and shinny. However, during menopause the skin gradually starts losing its shinny property due to estrogen reduction. This contributes to shrinking of the skin which is also sign in the menopausal women as observed by Gail (1995)
Menopausal women also show some symptoms, one of such symptoms is dyspareunia which is pain during sexual intercourse, most menopausal women experienced it. This occurs due to that the virginal loses its lubricating property, that is the batholin gland athrophy and can no longer secret mucus that lubricates the virginal walls. This result in painful sexual intercourse which sometime would be accompanied by bleeding of virginal walls due to dryness.
Another symptom is memory loss, when entering menopause, women sometimes report that they feel fuzzy or are losing their mental sharpness. Okoye (2007) reported that estrogen does have a significant positive effect on memory. He further stated that a study shows that estrogen therapy can improve short term and verbal memory by sustaining nerve cells, particularly in the brain’s main memory centre, the hypothalamus.
Insomnia is lack of sleep during the night; the person may wake up and never go back to bed that night again. Kister (1980) observed that lack of confidence and irritability; very minor incidents tend to upset the women. He stressed that suddenly an easy calm lady becomes irritable, irrational and quarrelsome due to menopausal physiological changes in her body. According to Kister, all these lead to insomania. Generally, these women perceive menopause differently; some have negative perception while some have positive perception of menopause (Alagwu, 2006).
Perception is the ability to see, hear, or understand things; it is an awareness of something. Perception can be defined as whatever is experienced by a person. This is the process by which organisms interpret and organise sensations to produce a meaningful experience of the world around them (Peter & Donaled, 1977). Morgan, King and Schopler (2004) defined perception as a way one notice’s things especially with senses, like the ear, eye, nose and tongue or the ability to understand the true nature of something. They further stated it is also a process by which an individual analyses or views a situation. Enebechi (2007) defined perception as a process by which an individual understands things or events. According to Enebechi it is a process by which one becomes aware or internalizes a situation, or an existing factor.
According to Nweke (1992) there is a relationship between perception and psychological processing centre that will actually lead to internalization. Nweke (1992) classified the centre into three main processing centres which are internal factors, external factors and central nervous system before perception could be achieved. This implies that perception as may be observed in behavior is a consequence of both internal and external forces acting on the processing centre of the body. It is important to note that all the senses used to perceive the environment depend on the central nervous system (CNS) for interpretation. It then follows that perception is indicated in observed behavior.
In this present study, perception means process of becoming aware of changes in the body during menopause. Such changes include hot flushes, dryness of the skin, joint pains, headache, weight gain or loss, osteoporosis, urine incontinence, vaginal changes, irregular menstruation and loss of libido. Women who are at their midlife go from one hospital to the other in search of better health due to the changes that they noticed in their body. It has to be noted that the women’s way of perception is not the same. Some of the women perceive menopause as a disease or charm or even witchcraft attack from their enemy while some perceive menopause as a transition in life. This is inline with Alagwu (2006) submission that some women see menopause as a disease condition that may come from the enemy or witchcraft attack while some women perceive menopause as a normal phase in life. Menopausal women may adopt different ways or strategies of coping with menopause.
Coping strategies are acquired ways of responding to a changing situation. Kockrow and Christensen (2003) stated that coping strategies can be in the form of change in lifestyle pattern such as eating heavy food or taking regular exercise. Onuzulike (2007) referred to coping strategies as way or actions menopausal women adopt to deal with their present situation or condition. In this study, coping strategies are those practices the menopausal women adopt to enable them to continue with the activities of their daily living irrespective of the changes they are facing. Because menopause is a natural disturbing phenomenon in every culture, it is necessary to find out the perception and coping strategies adopted by the menopausal women in Igbo-Etiti L.G.A to cope with menopausal challenges.
A strategy is a plan that is intended to achieve a particular purpose. It is also the process of planning something or putting a plan into operation (Hornby, 2009). Strategy as described by (Onuezulike, 2007) is the way menopausal women plan and change their life style to suit their present conditions. In this study, strategies are plans or actions adopted by the menopausal women to cope with menopausal conditions. For instance, the menopausal women plan new menu like making fruits and vegetables their major food. Some may practise yogo exercise to enable them to reduce excess fat in their body during menopause.
In support of this, Shelli (2009) listed seven simple strategies for menopausal women to make them look better, feel better and optimize health during menopause. The steps she listed include superfoods, food supplements, stress busters, sleep, sense of humor, physical exercises and rest.
There are many superfoods to add to menopausal sustenance like nuts which include Almonds: packed with protein, fiber, calcium, iron and vitamin E. Pecans: which are high monounsaturated level helps them fight high cholesterol Walnuts: this help mood change it contains the highest amount of Omega-3 which supports the brian function and also facilitate movement functions. It is also a good tool for weight management, it support memory thinking and mood suitability (Derek, 2000).
Consuming the right whole food are the foundation of overall health during menopause. One can lack essential nutrients for reasons like disliking certain food, not taking in enough calories and losing nutrients during cooking. The quality of food supply also affect stress level and life style. When this is the case, one’s body is deprived of the vitamins and minerals it needs to function at its best, then taking a supplement multivitamin is a wise choice. Such multivitamins are vitamin B, C, D and E. Cod liver oil (Adanne, 2008).
Stress Buster breathe away tension during, menopause working with ones breath is one of the easiest and simplest ways to relax. When one face stressful situation the body responds with shallow, rapid breathing as well as an accelerated pulse and an increase in blood pressure. Therefore, breathing whenever there is stress reduces tension like taking advantage of better, deeper breathing.
The important of sleep during menopause cannot be overstated. Sleep is a very nourishing and healing activity. Sleep is also important for concentration, memory formation and the repair of the damage to body’s cell during the day.
It is good to wear a smiling face and also equally good to laugh out some stressing condition. Laughing reduces the effect of hot flushes on menopausal women. Physical exercise, during menopause, helps reduce excess cholesterol in the body to avoid over weight which is a sign of menopause. Physical exercise also reduces arthritis during menopause. Lack of rest depletes the stress coping hormones and as they begin to diminish the ability to deal with challenges, vitality, confidence and optimism, will reduce. Therefore, rest if very vital condition during menopause. Some factors may influence the perception of menopause and coping strategies by women (Okpe, 2007).
One of the factors that are capable of influencing the perception and coping strategy of menopause in women is level of education. According to Shechy (1995) the educated women perceives menopause as a natural phenomenon. He opined that all the characteristics of menopause such as longer or shorter menstrual cycle, scanty or excessive menstrual flow, heat sensation, atrophy of reproductive organs, weight loss are known to the educated women through workshops and reading of articles on menopause. He classified level of education like primary schools, post primary and post secondary school. According to him, those women who have degree certificate and above have positive perception of menopause. Efunnwa (1988) concluded that those women with primary education and below have negative perception of menopause. Furthermore, age is another factor that has influence on the perception of menopause by women.
Imogie (1988) asserted that age has an influence on how people perceive menopause. According to him, the actual age of menopause is between the age of 45 to 55years and once the woman approaches that age she expects the cessation of her menses and sees it as another phase of life. Mylse (2000) opined that age has a lot of influence in menopause, according to her as there is early menstruation; there is also early menopause that comes before 45 years. She went further to state that this early menopause may be due to disease or Chemotherapy but all of them present signs and symptoms of menopause. Machelle (2003) asserted that once a woman has early menstruation like 9years, that it is likely that the person will go into menopause early. According to Machelle, as the woman menstruate, the eggs reduce in number and once eggs reduces, there will be no ovulation which leads to irregular or no menses resulting in menopause. Marriage can also affect perception of menopause.
Alagwu (2006) observed that married women understand menopause better and regard it as a normal stage of life in women. This is because men who understand their wife normally encourage them during menopause. Alagwu stressed in her study that married women perceive menopause positively due to the encouragement they receive from their husband whenever they complain of menopausal signs and symptoms. Marchell (2003) also asserted that married women understand menopause better whenever they share their menopausal problems with their husbands. She further stated that unmarried women when they notice that they have reached menopause always frown at it, since they fill that their chances of getting married is minimal.
Okoli (2007) opined that almost all unmarried menopausal women end up their lives in spiritual houses complaining that enemies do not want them to get married. She further stated that from creation God made man and woman, therefore, that any menopausal woman who shares her problem with her husband feels relived and moreover that a problem shared is a problem solved.
The extent to which menopausal women generally perceive menopause and the coping strategies they adopt do not appear to have received adequate research attention. This cannot be less true about menopausal women in Igbo–Etiti LGA. Finding out this, therefore one then prompted to ask, what is the perception of menopausal women in Igbo-Etiti and what are the coping strategies they adopt? The above in essence represent the need for this study.
Statement of the Problem
By nature women go through a lot of physiological changes such as menstruation and menopause in- their life. At puberty, a young woman is faced with menarche or the beginning of menses with its physiological challenges, while at middle age the woman is faced with menopause and corresponding challenges. Menopause is a natural event that every woman expects, occurring between the ages of 45 to 55years, an average of 51 years in every woman. The characteristic feature of menopausal women is cessation of menstruation with its signs and symptoms: like hot flashes, either weight gain or weight loss, painful sexual intercourse, itching of the vulva, headache, insomnia, fatigue, inability to concentrate, fainting, and memory loss.
In some cultures, this stage usually brings quarrel between the menopausal women and their relations. Some regard it as a problem while some turn it to be illness inflicted on them by enemies and relations who do not want them to enjoy their children’s wealth. Due to this, some of them search for better health by going from place to place like hospitals and prayers houses. Some even resort to native doctors, not realising that health can never be the same at this age as compared to youthful age. The appreciation and management of menopause depends essentially on the woman’s perception of this natural transition in their life. The perception tend to vary based on the personal characteristics of the women such as level of education, age and marital status. Many women have difficulties coping with the problem of menopause essentially because of their perception of the courses and the manifestation of the situation. It is possible that women in Igbo-Etit LGA in Enugu State also encounter this problem thereby not being able to cope with the stress of menopause. Besides the women may have had appropriate information on menopausal challenges and its coping strategies. Finding out this, certainly, will represent a positive step forward to promote the perception and coping strategy. In view of this, therefore, one is then inclined to ask what are the perception and coping strategies adopted by women in Igbo-Etiti LGA. The above in essence represent the reason and thrust for the study. Therefore the investigator deem it necessary to establish women’s perception and coping strategies among menopausal women in Igbo-Etiti LGA. Enugu State regarding their menopausal condition and also if their perception is a function of some social demographic factors, as a prelude to promoting the health of women during the transitory period of menopause.
Purpose of the Study
The purpose of the study is to find out the menopausal perception and coping strategies among menopausal women in Igbo-Etiti LGA of Enugu State. Specifically the study seeks to find out menopausal women’s perception on
- concept of menopause among menopausal women;
- causes of menopause among menopausal women;
- signs and symptoms of menopause among menopausal women;
- coping strategies adopted by among menopausal women;
- difference in women’s perception of menopause according to the level of education of the women.
- difference in menopausal perception according to the age of women.
- difference in menopausal perception according to marital status of women.
- difference in coping strategies according to the level of education of the women.
- difference in coping strategies according to age of the women.
- difference in coping strategies according to marital status of the women