Age and symptomatology of menopause in Indian women.
Menopause and a long post-menopausal life are peculiar to the human species. Figures for the mean age at menopause given by various authors are in the neighbourhood of 50 years. However, very little information is available about the age at menopause in Indian women.
This paper aims at establishing the age and symptomatology at menopause in Indian women.
For the purpose of this study menopause was defined as spontaneous cessation of menstruation for at least one year. Four hundred and ninety five women who had reached natural menopause were interviewed for the study. Three hundred and seventy of them were women who attended medical out patient department of the K.E.M. Hospital for minor complaints. They belonged to the lower socioeconomic group (Group I). One hundred and twenty five women belonging to higher socio-economic group (Group II) were friends and relations of the investigators. They were interviewed by home visits. The questionnaire elicited information on: age, age at menopause, age at menarche, history of dysmenorrhoea, number of children, whether surgical sterilization had been done and the presence or absence of "menopausal symptoms". The reproductive period was calculated from the age at menarche and the age at menopause. Blood pressure was recorded in 390 of these women. The data was analysed statistically. Data on 495 women (370 of Group I and 125 of Group II) was available for age at menopause, on 476 women (370 of Group I and 106 of Group II) for parity, and on 390 women (310 of Group I and 80 of Group II) for all other parameters.
Data in [Table 1] was analysed using two-tailed, unpaired, Student's "t" test. Data in [Table 2] was analysed using the test for differences in propertions. Data in [Table 3] was analysed using McNamar's modification of Chi Square test.
The age of women from Group I was 54.26 ± 8.68 years and that of women from Group II was 58.18 ± 9.26 years. [Table 1] shows that there was a significant difference between the two groups as far as the age at menopause and parity are concerned. The women in Group II reached menopause later and had fewer children than women in Group I. The difference between the two groups regarding the age at menarche and the reproductive period was statistically not significant.
As seen from [Table 2] the two groups differed significantly in the prevalence of menopausal symptoms, particularly with reference to headache and irritability.
As seen from [Table 3] women with a history of dysmenorrhoea were more prone to have menopausal symptoms than women without history of dysmenorrhoea.
Forty eight out of 390 women had been sterilized surgically. There was no statistically significant difference between the sterilized and non-sterilized women as far as the age at menopause was concerned.
Hypertension was present in 87 out of 310 women of Group I and in 37 out of 80 women of Group II. The difference between the two was statistically significant (p < 0.01).
There was no correlation between the age at menopause on one hand and either the age at menarche or parity on the other hand.
The mean age at menopause in Indian women was 45.03 years in this study. In western countries, the mean age at menopause is higher [Table 4]. Nutrition, climate and racial factors may be responsible for this difference. Nutritional factors play an important role in deciding the age at menopause. In some studies, it was found that the age at menopause was higher in better nourished than in the poorly nourished women. Difference between the two groups in this study was probably due to the differences in the socio-economic status and, by inference, nutritional status. Frommer has documented an increase in the age at menopause over the last one century. This may be because of improved hygiene, better nutrition and medical care. Jaszman et al have made a similar observation.
In the present study, we found no correlation between the age at menarche and the age at menopause. However, Beard has made the observation that the earlier the age at menarche the later the age at menopause. The cause for such a correlation is probably the same factors that lead to an early menarche, viz. better nutritional status and better living conditions, which also influence the age at. menopause and, as a result, increase the overall reproductive period. Some authors deny any such relationship between the two., , , 
In this study, the age at menopause bore no correlation with parity. The finding was in accordance with those of some authors.,, However, Beard and Soberon et al found a positive correlation between the age at menopause and parity in women belonging to higher socio-economic group but not in women in lower socio-economic group. The explanation given by Sober-on et al was as follows: during the natural event of pregnancy, blood levels of sex hormones are high and ovulation is supressed; hence more follicles remain in the ovary and this makes the ovary `last longer'. Soberon et al, in the same paper, have also criticised their own explanation on the grounds that the number of follicles thus `saved' is a tiny fraction of the total number of follicles in the ovary and that during pregnancy, though ovulation is suppressed, follicular atresia continues.
The difference in the prevalence of menopausal symptoms between the two groups was probably attributed to the tendency of the lower socio-economic group of women to ignore the symptoms as compared to the higher socio-economic group. In Aitken's series, 20% of women were asymptomatic while in this study, 70.51% of women were free of symptoms. This difference may be cultural.
The observation that women who admitted to having had dysmenorrhoea were more liable to have menopausal symptoms is probably consistent with the hypothesis that some women complain more than others and those who complain in one area of life would also complain in other areas. A similar association was noted in a report of Medical Women's Federation.
We do not have an explanation for the higher frequency of hypertension in Group II but the higher mean age might be one of the contributing factors; other factors such as obesity were not looked into in this study.
The authors wish to thank the Dean, Seth G.S. Medical College and K.E.M. Hospital, Bombay-400 012, for allowing us to publish the data.