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Introduction
With increasing life expectancy, women spend a third of their lives after menopause. It is estimated that 5 million postmenopausal women will live in Iran in 2021.1
Most women experience physical and mental complications including; hot flashes and night sweats, dizziness, tachycardia, irregular heart, atrophy of the vaginal mucosa and irritability bladder, mood changes, sleep disturbances, headaches, muscle pain, joint pain, difficulty concentrating, irritability, anger and depression during their postmenopausal.23 It is estimated that 26% to 33% of women experience their first episode of depression in their menopausal period.4 Actually, these physical and mental complications decrease the quality of life (QOL) during menopausal period.5
Menopausal complications are various between different individuals and populations.3 In fact, several factors including; age, occupation, marital status and educational level have been proposed as affecting factors on menopausal QOL.6 Researchers believed that reproductive history can affect the menopausal symptoms.789 There is a significant relationship between parity and menopausal symptoms.9 In fact, the risk of hot flash is lower among women who have higher number of live births.7 Also, infertile women experience severe vaginal dryness and lower libido during their menopausal transition.8 In contrast, another study demonstrated lower hot flash episodes among infertile women.10
Pregnancy and childbirth are valuable women's role in Islamic countries such as Iran.11 So, deprived of valuable maternal role can be experience prolonged stress and subsequent complications that have impact on QOL in infertile women.12 On the other hand, aging and menopause is associated with loss of fertility and some physical and psychological changes in women. Furthermore, the QOL in women with unnatural fertility period is unclear. Therefore, the current study was designed to evaluate the QOL among Iranian infertile women in postmenopausal period.
Materials and Methods
1. Study subjects
This PhD thesis (Grant Number: 891381) approved by the Ilam University of Medical Sciences and conducted from January-November 2015. In this cross-sectional study Iranian infertile women in the postmenopausal period were evaluated. Since there is no registration system for access to the study population, sampling was carried out using both snowball and social networking methods. Iranian disadvantage, disabled or elder are supported by Welfare Organization and Imam Khomeini Relief Committee. Therefore, we searched all eligible persons who were receiving services from these organizations. Finally, duplicate persons in both snowball and advocacy organizations searches were excluded from sampling.
The inclusion criteria were - postmenopausal women with no history of pregnancy, at least one year since the start of menopause. All women with abnormal menopause such as menopausal induced by surgery, drugs or chemotherapy were excluded from study. After careful consideration addresses obtained from professional and social networking, 224 infertile women in the postmenopausal period were identified. Considering the exclusion criteria and elimination of 13 women, finally 211 women were eligible for the study.
2. Study methods
We used both demographic and QOL questionnaire for data collection. Both questionnaires were created by using scientific books, similar researches and converge with the social and cultural environment.13 In demographic questionnaire, all variables including age, education level, occupation, marriage duration, number of marriage, duration of infertility, duration of infertility treatment and financial provider were recorded.
The QOL questionnaire included 41 items which measures the QOL in five dimensions13 including: socioeconomic (13 items), mental health (18 items), religiousness (5 items), physical health (3 items), and future imagining (2 items). Two 5 points Likert scoring included 'always' to 'never' and 'totally agree' to 'totally disagree' were used to determine the participant's responses. The scores were, 1 = never, 2 = occasionally, 3 = frequently, 4 = often and 5 = always. Also, totally agree = 5, agree = 4, no comment =3, disagree = 2 and strongly disagree= 1. Although some questions were assigned scores in reverse. The final score was obtained by summing the scores for all questions. The questionnaire score range was 41 to 205 and higher score represents a greater level of QOL. Based on the total score achieved for each individual, participants were divided into 3 groups. The total score less than 52 represents a poor QOL, 52 to 154 moderate qualities of life and more than 154 represents good QOL.13
The questioner validity and reliability were obtained by content validity and internal consistency with Cronbach' s alpha 0.942. After explaining the purpose of the study and informed consent to participate in the study, the questionnaires were completed by the participants. In individuals who were illiterate, the questionnaires were completed by a trained researcher.
3. Statistics
After data collection, analysis was carried out in IBM SPSS for Windows version 20.0 (IBM Co., Armonk, NY, USA) using descriptive statistic. The χ2 test was used to test the categorical variable. However, if the expected values for each cell of table were less than 5, then a Fisher's test was used. A P value of 0.01 or less was considered significant.
Results
1. General characteristics of the study subjects
Overall 211 infertile women in the postmenopausal period were studied. The most frequent age group was reported in 45 to 50 years women (47.4%). About, 84.8% of studied women were housekeeper. Overall, 59.2% of research sample were illiterate. Based the results of present study, there was significant relationship between age and financial provider whit status of QOL. Demographic characteristics and other factors related to the QOL in infertile women during the postmenopausal period are presented in Table 1.
Discussion
Marriage and establishment of a family is highly regarded among Muslims and families will be more stable with women childbearing.14 So infertility is considered a defect among Muslim women which threatens them with physical and psychological problems.15 Therefore, in the current study, the QOL was evaluated among Iranian infertile women in postmenopausal period.
Although studies have reviewed QOL of menopausal women,316 results showed that menopausal period is associated with negative effects on women QOL.16 Williams et al.3 showed that the demographic characteristics as well as menopausal symptoms experienced by menopausal women affected their QOL during menopause.
Most previous studies have investigated the physical and mental dimensions of QOL during menopause.51617 However, the relationship between reproductive history and menopausal QOL has been confirmed, these studies neglected the impact of reproductive history on menopausal QOL. A study reported that employment and number of children decrease the risk of menopausal complications.18 Therefore in the present study we evaluated the QOL among Iranian postmenopausal infertile women using a valid and reliable instrument.13
We have not found studies that reviewed the QOL during menopause in Iranian infertile women. One Iranian qualitative study, however, reviewed the life experiences of infertile women during their postmenopausal period. The results showed that some factors such as psychological insecurity, problems in social interaction and cultural issues affect the QOL in infertile women in postmenopausal period.11 Another study in line with this results showed that infertile Muslim women experience some complications in their social and personal life.19
Few studies, outside Iran have proposed some correlation between reproductive history and symptoms after menopause. 810
Based on our results, the socioeconomic status, mental health, religiousness, physical health, and future imagining are important dimensions of QOL among infertile women in postmenopausal period. In traditional societies, infertile women experience various challenges including individual, familial, social, economical, depression and anxiety. These challenges have effects on their QOL.202122
A study evaluated the relationship between reproductive history and menopausal symptoms among 291 premenopausal women urban women in Philadelphia. The results of this study demonstrated that libido sexual dysfunction and vaginal dryness were higher among women who experience infertility (OR: 1.86, 95% CI: 1.05-3.31) and (OR: 2.79, 95% CI: 1.19-6.94) erspectively.8
Based on the results of our study, only 6.7% of our study population had a good QOL during their postmenopausal period. Also, the QOL is moderate in most participants (84.8%) similar to another Iranian study.23
Other studies in line with our study found that socio - economic status has an important impact on QOL during postmenopausal period.1724
In a study conducted on rural women in Turkey, the results showed that physical complications such as hot flashes and sweats are the most common symptoms of postmenopausal period that affect the quality of women's lives.12 In another study, Guangzhon postmenopausal women experience lower sexual desire and feeling faint memory.5
The present study had some limitations. Inaccessibility of comprehensive database of infertile postmenopausal women in Iran increased the risk of forgetfulness the subjects that may be impact on our results. Also we used of specific postmenopausal QOL questioner.13 Therefore; compression of QOL in fertile and infertile women is not possible.
Most Iranian infertile women in the postmenopausal period have poor or moderate QOL. Considering the socioeconomic, mental health, religiousness, physical health, and future imagining are main dimensions of QOL in infertile menopausal women, identification and training of these factors will improve the QOL of infertile menopausal women.
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