KNOWLEDGE, BELIEFS AND PRACTICES OF ELDERLY WOMAN TOWARDS MENOPAUSAL STAGE

SUBMITTED BY:

AMPARO, ROVI RUZZEL LYNE M. BERNARDO, MARIA. SALVACION V. BONAYON, MA. CRISTINA M. LEYNES, JESSICA V. SUBMITTED TO:

____________ _________ NATIVIDAD HALOG DR.

Chapter 1 BACKGROUND Introduction

Since the beginning of times all woman experience menstruation and later in there life experiencing the menopausal stage. The students from Philippine College of Health and Science, would like to know more about the biggest issue in woman who is at the age of fifty to sixty, which is Menopause. Some of the elderly may know about this, but others may not. This will help the elderly woman or the respondent to know more about this issue and the health care provider can give more emphasize to the client. This study speaks to the importance of understanding the different influences on a womans menopause experience. Patient communication regarding menopause might be enhanced by providing women with an opportunity or option to discuss the topic with their health care providers. Caregivers should also be cautious of attaching preconceived ideas to the meaning and importance of the menopause experience. Menopause is a universal and individualized experience. It is a complex process, influenced by biological, psychological, and cultural factors. Research examining cross-cultural symptoms suggests that menopausal experiences vary among societies and groups. It is unclear whether reported menopausal differences among ethnicities relate to variations in occurrence, perception, or reporting of symptoms or to methodology challenges of cross-cultural inquiry. Elderly woman may view menopause in a neutral or positive way. Some did not identify any value attached to the experience

THE PROBLEM AND ITS

and others saw it simply as the cessation of menstruation. Symptoms reported included hot flashes and mood swings. Sometimes where medical knowledge was not present, folk knowledge or misinformation resided. A common phrase is that time when periods stop, which can be used by caregivers as a starting point for discussion. Elderly interest in the topic and their desire for more information might imply that they would welcome the topic being raised by health care providers. Some of the sources of information about menopause varied. Most women gained some sort of information from their mothers or other relatives, they asked there mothers on they experience menopause. During early menopause, many women are troubled to find they have difficulty remembering things, experience mental blocks or have trouble concentrating. Not getting enough sleep or having sleep disrupted can contribute to memory and concentration problems. Menopause does affect your bones. Normally your bones will go through a process where old bone is replaced by new bone cells. When you are young your body makes more new bone than it takes away in old bone. Your body's ability to handle this process changes with age, so that by the time you are about 35 there is less bone building than there is bone removal. During the menopause your estrogen levels drop. Estrogen is involved in the process of calcium absorption into the bones. All women will experience acceleration in bone density reduction as their estrogen levels drop.Filipino physicians generally regard the menopause as a significant condition. The majority of physicians surveyed would take time out to ask menopausal women about their symptoms and regard these as important. Almost all gynecologists sampled viewed the menopause as a pathological condition that required treatment while only two-thirds of the other specialists had the same view. Almost all the physicians surveyed knew that osteoporosis was one consequence of menopause. However, the awareness that cardiovascular disease was increased as a consequence of menopause was not as high in both gynecologists and other specialists. Both types of physicians have generally the same idea of the contraindications of hormone replacement therapy. Gynecologists, however, tend to be more cautious in giving HRT in conditions such as the presence of a stroke event, varicose veins and gallbladder stones. The availability of hormone replacement, as a treatment in menopause, was more readily volunteered by gynecologists than other physicians. Both types of physicians generally accept HRT, though, as beneficial to menopausal patients. Perception of adequacy of HRT was, as expected, higher among the gynecologists (91.1% versus 45.8%). However, with regard to the final management of menopausal women, about equal numbers of non-gynecologists would manage the menopause on their own and refer cases to gynecologists.

Theoretical and Conceptual Framework

The grandmother hypothesis is a theory to explain why menopause, rare in mammal species, arose in human evolution and how a long post-fertile period (up to one third of a female's life-span)could confer an evolutionary advantage. The grandmother hypothesis suggests that humans have "given up" their reproductive potential in later years in order to invest in the children they already have as well as their grandchildren. Naturally, this is an unconscious, biological adaptation that emerges over many generations and is not the result of individual decision-making. For such a hypothesis to be confirmed it would have to be demonstrated that children are significantly more likely to survive when a grandmother is present than when she isn't. The evolutionary biologist William Hamilton initially proposed the idea in a 1966 papers that built on the theoretical work of George Williams and Peter Medawar. But the grandmother hypothesis really took off during the 1980s and 90s on the basis of field data collected by Kristen Hawkes, an anthropologist at the University of Utah in Salt Lake City, and her colleagues. These researchers found that among Tanzanian hunter-gatherers, the Hadza, mothers faced a trade-off between foraging for food for themselves and any weaned offspring, and caring for new infants. But if grandmothers helped with foraging, they were rewarded with healthier, heavier grandchildren who weaned at a younger age. Over evolutionary time, this fitness boost could have selected for women who survived long past menopause, an anomaly among humans' evolutionary kin.

Paradigm of the study Variables:

Independent
Ages (50-60 years old)

Dependent
Experiencing menopausal stage

Expected Outcome
Questions about menopausal stage

Civil Status

Single and Married

Single woman may have different views than married woman White collar job woman may have more ideas than woman who is in blue collar job and housewives.

Work

Blue collar job/ White collar job/ Housewives

Religion

Christian, Muslim, Orthodox etc.

Religion may also affect the knowledge of woman about menopausal stage. Having the wrong information about menopausal stage.

Educational Attainment

Knowledge deficit about menopause

Statement of the problem

This study will help to determine the knowledge of elderly woman about menopausal stage in Barangay Guijo San Jose Del Monte Bulacan Specifically, this study will try to answer the following questions: 1. What is the profile of the female respondents according to: A. Age B. Civil Status C. Work D. Religion E. Educational Attainment 2. What is the extent of knowledge of elderly woman about menopause?

3. What are there beliefs and practices about menopause? 4. Do they still believe that woman is unclean during menopausal stage? 5. Eating of blood containing food my bring back the menstrual flow? 6. What does blood clot mean to them? 7. Is there a significant relationship or the knowledge and beliefs on the Acceptance in menopausal stage?

Hypothesis
There is no significant relationship between beliefs and practices about menopausal stage and it may affect the knowledge of the elderly woman about this issue.

Scope and Delimitation of the study

This study will focus on the knowledge, beliefs and practices of 100 elderly women among the resident of Barangay Guijo San Jose Del Monte Bulacan. To let us know about the capacity of there knowledge and there belies and practices. It was limited to people who belong to certain religion and adhere to specific religious beliefs and practices. Since this study is limited to the Barangay Guijo San Jose Del Monte Bulacan findings may only be limited to the particular area.

Significant of the study

Respondent they will be educated about the issue after the result has been tabulated.

Nursing Service new ideas about the issue School Administrator they may emphasize it more on the lecture. Student they may know the issue incase somebody ask them, they know what to say. Future Research this may help as a guide in there future research Team- added knowledge about the issue on menopausal stage

Definition of terms
For following findings the operational style are: Beliefs this is what people believe might be true Elderly Woman female respondent ages 50 and above Knowledge extend in knowing a thing Menopause the end stage of menopausal flow of the woman Practices they have been doing in repetition either wrong or right Significant others the partner (e.g husband) Tabulated that has been counted Team the students conducting the research

Chapter II Review of related literature

The measuring of the menopause seems to be largely dependent on tradition. The generally accepted research definition of the menopause as the final menstruation is unhelpful when it comes to constructing categories which can be used in data analysis. Summarizing the researchers' categories of menopausal status was problematic when I was constructing figure 1 and is clearly shown in the disjunction in the time scale. While the probability of being menopausal increases with the duration of amenorrhea and age, this can be determined only retrospectively. This would seem to be at odds with a basic axiom of scientific methodology. If there is no objective way of detecting when a phenomenon is either present or not present (thereby creating at least two categories) then it cannot be quantified. By using this argument, menopause, despite its long research history and lay acceptance, can seem to be just such a phenomenon, and the construction of a variable based on arbitrary lengths of time from last menstrual period can be regarded as a method of avoiding this basic conceptual issue. A parallel, which may help to illustrate this point, would be to try to relate misbehavior in 14 year old boys to a "teenage" variable based on time since the voice broke. When we are attempting to infer causality it may be more fruitful to examine directly the hypothetical underlying biological processes or look for sociopsychological factors

specific to that age group. Speculation about the social implications and reasons for having groups of people defined as teenage or menopausal is interesting but beyond the scope of this empirical review.

Foreign Literatures
According to Dr. Low Dog 2008, A report in the current issue of Menopause: Journal of the North American Menopause Society in Pittsburgh PA, in July 15, 2008 provides a reassurance of the safety of black cohosh (Cimicifuga racemosa) as a treatment for women experiencing menopausal symptoms. The finding is based on the most comprehensive review of black cohosh safety data to date and provides welcome news for women seeking alternatives to hormone replacement therapy (HRT) almost exactly one year after the startling revelation by the Women's Health Initiative that long-term, combination HRT can increase a woman's risk of breast cancer, heart attacks, stroke and blood clots."This paper supports the growing body of evidence on the safety of black cohosh, an herb used by Native Americans for centuries," said lead author Tieraona Low Dog, MD, Clinical Assistant Professor at the University of New Mexico Department of Family and Community Medicine and advisor to the NIH Center for Complementary and Alternative Medicine. "The findings should reassure the increasing number of women, who cannot or choose not to take HRT that safe options exist to treat their menopausal symptoms. The evaluation by Dr. Low Dog included pre-clinical and clinical research in estrogen-sensitive populations, including women at risk for breast cancer and breast cancer survivors, as well as human cell lines most relevant to breast cancer. The paper, entitled "Critical Evaluation of the Safety of Cimicifuga Racemosa in Menopause Symptom Relief," is the first to review all published literature pertaining to pre-clinical and clinical safety of various forms of black cohosh, as well as the FDA and World Health Organization adverse event reporting systems, monographs, compendia, internal unpublished data from a major manufacturer, foreign literature, and historical, anecdotal reports. "As menopausal women increasingly turn to alternatives, scientific evaluation of the safety and efficacy of the products is very important," said Margery Gass, MD, Professor of Clinical Obstetrics and Gynecology at the University of Cincinnati College of Medicine and President of the North American Menopause Society. In addition, the most studied commercially available formulation, RemiFemin

Menopause, has been shown in recent studies to have no effects on hormone levels or the growth of specific cell lines associated with some cancers. Unlike soy and red clover, which have weak estrogenic effects, RemiFemin is the only major alternative treatment for menopause symptoms that is non-estrogenic.Human clinical trials, uncontrolled reports and post-launch evaluations of over 2800 patients demonstrate a low incidence of adverse events with black cohosh (5.4%). Of the reported adverse events, 97% were minor and did not result in discontinuation of therapy, and the only severe events were not attributed to treatment with black cohosh. The report notes that, though low overall, adverse events associated with black cohosh may be dependent on the specific herbal preparation. While on January 2010 other literature has been done about menopause, comparing it to a contact lens. Going through menopause can be a frustrating time of life but a phase that every woman will at one-time or another experience. Although you have probably heard all about hot flashes, night sweats, insomnia, headaches, and all the various symptoms associated with the change of life, you might not have heard about menopause and contact lenses. If you have headed into peri-menopause, the initial years when the level of estrogen produced will begin to decrease, and if you wear contact lenses, you might begin to notice that your eyes no longer feel comfortable. The primarily problem has to do with dryness, which can be corrected. As you will discover in this article, menopause and contact lenses is an issue women across the globe deal with but you do not have to suffer in silence. Rather than assume everything is fine, if you are going through menopause and wear contact lenses, you should start by bringing the problem to your doctors attention so he or she can examine your eyes. Some menopausal women will begin to experience a scratchy feeling and notice a slight discharge but ignoring these symptoms could be dangerous. Obviously, these symptoms could be the beginning of a problem but you need to take steps to rule in and rule out things. For example, if your contacts do not fit correctly, you could experience trouble. If you are not cleaning your contacts properly and a lipid or protein deposit builds up, this too could create a problem. In addition, if you drink alcohol or caffeine, you could be having trouble with dry eyes. Even some over the counter or prescription medications can cause problems with the eyes. In other words, while menopause could be the problem with your contact lenses, you want to make sure it is not something else first. Once everything else has been dismissed, you would then consider menopause and contact lenses, as being the problem. The truth is that many women do report changes in how their contacts feel once they start into menopause. During this time, it is common to experience both dryness and tearing, again because of reduction in estrogen. However, other problems you might experience include swollen eyelids, decreased visual acuity, problems with visual coordination, and foreign body sensation. Through studies, doctors have identified that both a decrease and increase in estrogen levels do in fact have an affect on the eye. As you probably know, menopause is a time when estrogen begins to fall, typically occurring between the ages of 45 and 52. During this time, you need to remember that symptoms vary from one woman to another, as does the severity of those symptoms. Therefore, while you might have issues with menopause and contact lenses, another woman may not. Okay, so what can you do? If it has been determined that nothing else is going on, you can start by purchasing artificial tears at your local pharmacy or grocery store. These tears help relieve dryness of the eyes, thus providing you with some relief from the discomfort. The important thing is that not all brands of artificial tears are compatible with every brand of contact lens. Therefore, find out from your lens manufacturer the type of tears you can use. Another way to gain relief from discomfort of menopause and wearing contact lenses is to get the right nutrients so the body produces more tears. Things like omega-3 fatty acids, commonly found in salmon and other types of fish, along

with flaxseed oil, are excellent options. With this, the oily part of your tear composition will improve, which helps stop tear evaporation. If the problem is serious, then you may need to have a punctal occlusion, which is when a small piece of acrylic or silicone called a punctal plug is inserted in the tear duct to help stop tear drainage, thus leading to moister eyes. Then, when it comes to problems with menopause and contact lenses, you will find that some lenses are actually designed specifically for people with dry eyes. In this case, talk to your eye care professional to determine if a different type of contact would be better for your eyes, especially while going through the change of life. This might include going with daily disposables so you begin each day with a new set of contacts, lower water lenses that have much higher water content than other types of contacts, or silicone hydrogels, which are new lenses that actually allow more oxygen to reach the eyes. Next, correcting the problem of menopause and contact lenses could be as simple as changing the type of care product you use. Although you might save some money by going with an off-brand or universal product, you should always use the products specified by your doctor and designed for the type of contacts you wear. In addition to making your eyes far more comfortable, your vision will be clearer and crisper. Remember, millions of people deal with dry eye syndrome, especially women going through the change of life. In fact, a doctor now say that as much as one in five people have this problem to some degree.As mentioned, with hormonal change, the problem becomes more of a concern for menopausal women. With this, both quality and quantity of tears falls below what would be considered an acceptable level. The result is pain and if not treated ulceration or scarring of the cornea could occur. Therefore, if you have a problem of menopause and contact lenses, you should be checked right away and make the appropriate changes to protect the health of your eyes. Another literature has been made in July 2009 and its all about balancing the hormone.Balance hormones, naturally. While hormone replacement therapy (HRT) used to be the gold standard when a woman entered menopause, many recent studies are now waving a red flag when it comes to introducing foreign hormones into the body. Not only do prescriptive hormones increase your risk of breast and uterine cancer, we now know that women who have heart disease may further increase their risk of a second heart attack by taking HRT. Heart disease is the number one cause of death for women, so this is a topic we all must take seriously. In The 24-Hour Turnaround TLC 7, I help you to understand the hormone fluctuations of perimenopause, a normal period of change leading up to menopause that usually lasts 4 to 5 years, as well as the decline of estrogen during menopause and how this can affect your physical and emotional state. I will give you some natural remedies, including hormone-friendly whole foods, increased cellular hydration, anti-aging exercise, and natural hormone balancers that can give you amazing relief from perimenopausal and menopausal symptoms. I will give you the opportunity to feel young and alive againeach and every 24 hours of your life. Many of the problems women experience with premenstrual syndrome, perimenopause, and menopause are associated with poor diet. The Definition Diet will give you plenty of healthy food choices to balance your hormones so you that feel healthy and active. Wear your heart rate monitor and exercise. I promise you that working out at a high heart rate can negatively alter the hormone environment in your body no matter what age you are! Staying in your Zone One when you exercise keeps your hormones in balance AND helps you loose the fat that is associated with hormone imbalance. Put on your heart rate monitor and get moving. Eat soy foods to balance hormones. New research continues to point to soy foods high in phytoestrogens to reduce or erase the symptoms of perimenopause and menopause. Phytoestrogens occur naturally in plants and mimic the effect of estrogen in the body without the harmful side effects. Include one or two

servings of soy in your daily dietit is inexpensive, dairy free, and low in saturated fat. But even more, soy is a complete protein source, and can help to keep your hormones stable and help to relieve the intrusive symptoms of perimenopause and menopause. Soy helps reduce your rate of heart disease, breast cancer, and osteoporosis, according to new studies. The rates of these diseases are much lower for Asian women, who traditionally have a diet high in soy, than for Americans. Another literature has been done in September 2008 about the connection of menopause and memory loss. Is there really a co-relation? Memory loss or cognitive decline is most common in women who are perimenopausa, which usually spans five or six years before they experience their last menstrual period. This condition is often described as a foggy or hazy feeling and an inability to concentrate or learn new information. Studies show menopause and memory loss at this early phase might be minimized with hormone replacement therapy. Menopause and memory loss can be troubling to women who are at the peak of their careers and need sharp minds to compete in the business world. The use of hormones during perimenopause may improve brain function in these younger women. Research shows, however, that concentration and the ability to retain new information rebounds after perimenopause, with or without hormone supplements. The research also found that taking hormones beyond perimenopause might hasten the decline of memory as the brain ages. Researchers studied the effects of menopause and memory loss at four stages of the process. They found hormone replacement therapy may be effective on memory during the early stages but detrimental if used five years or more after a woman enters menopause. Another study linked menopause and memory loss with anxiety and depression. All the women tested reported they had trouble remembering, but a battery of tests did not bear out those perceptions, except in women who suffered depression or anxiety. Menopause and memory loss in depressed women might be caused by the disorder, which prevents the brain from encoding new information. They may not be forgetting information, but rather never really learning it. The researchers also noted that women of this age might be coping with aging parents and other stressors that contribute to anxiety. They may also be busy with their careers and distracted when new information is presented. Memory problems are common complaints from people who feel stressed or anxious. In some cases, menopause and memory loss might be connected to common symptoms during this period in a womans life. If she suffers from hot flashes and night sweats that disrupt sleep, it could interfere with concentration during the day. Fatigue is another typical complaint during menopause that might lead to cognitive problems. Some studies show that diet and exercise can help ease the symptoms of menopause, including memory loss. Increasing foods in the diet that contain omega-3 fatty acids, for example, may help improve memory as well as improve heart function. Exercise can help combat fatigue by increasing energy levels and improving sleep patterns. Keeping the mind active and sharp, by doing such things as crossword puzzles or studying a foreign language, can help curb memory loss during menopause as well. Some say that woman undergoing menopausal stage is having benefits in hot flushes, in this literature we can find out if there is really a benefit in hot flushes. This article has been made in February 27, 2011. Hot flashes that bedevil many women in menopause might actually be a good thing, depending on when they strike, according to new data from a long-running government study. Women who had hot flashes at the start of menopause but not later seemed to have a lower risk for heart attack and death than women who never had hot flashes, or those whose symptoms persisted long after menopause began. By contrast, among the few women who developed hot flashes late in some cases many years after menopause began there were more heart attacks and deaths when compared with the other groups. The research involved more than 60,000

women followed for an average of almost 10 years. Its the first to examine timing of menopausal symptoms and subsequent risks for heart problems and deaths, said co-author Dr. JoAnn Manson, chief of preventive medicine at Harvards Brigham and Womens Hospital. Recent studies linked hot flashes with higher blood pressure and cholesterol levels, which could suggest a higher risk for heart problems, but the new research offers a more detailed look, Manson said. Lead author Dr. Emily Szmuilowicz, an endocrinologist with Northwestern Universitys medical school, said the results should reassure millions of women who experience hot flashes or night sweats, which are essentially hot flashes that can be bothersome enough to awaken women. The results suggest there may be a positive side to having these annoying symptoms, Szmuilowicz said. Dr. Elsa-Grace Giardina, a Columbia University specialist in womens heart disease who was not involved in the study, said the research has several limitations and that more rigorous study is needed to prove the results. Few women developed hot flashes long after menopause began, and for at least some, previous use of hormone pills may have increased their risks for heart problems, Giardina said. But more than one-third of the women with late-onset symptoms never used hormones, and Szmuilowicz said the researchers took past hormone use into consideration and still found timing of symptoms played a role.

Foreign Studies
According to Dr. Rachel Browne and Dr. Jill Stalk 2011 there are really mysteries in menopause when a woman reaches the age 40. This Study has been made in July 18, 2011. HOT flushes, night sweats, mood swings and the end of a womans natural fertility all before age 40. This is the disturbing reality of premature menopause, and a new study shows it may be much more common than doctors realised.A British study of almost 5000 women, one of the most comprehensive yet into premature menopause, showed that 7.4 per cent of women experienced the condition. Previous international studies suggested only 1 per cent of women were affected.The average age of menopause is about 51 but premature menopause, or premature ovarian failure, affects women under 40, in what is supposed to be their reproductive prime. The figures have intrigued medical experts. They are unable to say whether the condition is becoming more common perhaps a result of modern lifestyles or has previously been underdiagnosed.The data, presented at the European Society of Human Reproduction and Embryology conference in Stockholm, reveal that about 6 per cent of women in the study had unexplained premature menopause. Another 1.4 per cent had had surgery that had brought on the condition. A co-author of the study, Rumana Islam, from Imperial College in London, said more research was needed into the condition. In cases of unexplained premature menopause, the study found that smokers and women from a lower socio-economic background were more likely to be affected. Most cases of unexplained premature ovarian failure have no identified cause, although a minority are due to genetic or auto-immune problems, Dr Islam said, adding: As we learn more about premature ovarian failure, we should be able to identify which aspects of low socioeconomic status are associated with this problem.Many women with premature menopause go undiagnosed, as the condition is not widely recognised by GPs. As well as experiencing symptoms such as hot flushes, mood swings and sleep problems, women who go through premature menopause have an increased risk of cardio-vascular disease, dementia, osteoporosis

and premature death. Dr Islam said the poor quality of life experienced by women with premature menopause was on par with other chronic health problems. Most shocking to us was the huge impact on quality of life that these women reported, she said. Quality of life impairment was in the range of other serious chronic conditions such as diabetes and rheumatoid arthritis. Dr John Eden, a reproductive endocrinologist at the University of NSW, agreed that women with premature menopause can suffer poor quality of life but said many of the symptoms could be managed with hormone replacement therapy. He questioned the link between early menopause and low socio-economic background but agreed it could often be under-diagnosed. Its often not thought of when a younger woman presents with menopause symptoms, he said. I am often the third or fourth doctor they see before getting a diagnosis. Professor Henry Burger, consultant endocrinologist with the Jean Hailes Foundation for Womens Health, was surprised by the studys finding on the prevalence of premature menopause: The general impression is that one in 100 women will experience menopause before age 40. The prevalence in their study is quite a lot higher than that. Jane Elliott, president-elect of the Australasian Menopause Society, said unexplained premature menopause could come as a terrible shock to women who suffer from physical as well as psychological symptoms. Age, pattern and symptoms of menopausal woman study has been made in January 2010. The termination of reproductive period of life in a woman is marked by the cessation of the menstrual periods and is known as menopause. The transition from reproductive to non-reproductive years, known as Climacteric, is a period of declining ovarian function, which usually becomes clinically apparent over two to five years around menopause. The menopause is a biologic phenomenon unique to the human species. All other animals continue with their reproductive potential until old age. The occurrence and timing of reproduction-related events such as menarche, first birth and menopause play major roles in a womans life. The age at natural final menstrual period is an important risk indicator for subsequent morbidity and mortality The risk of cardiovascular disease and osteoporosis tends to be higher in women with earlier menopause On the other hand the women who experience an earlier menopause are protected against breast cancer. Age at menopause has also been related to all-cause mortality. Snowdon et al2 have shown that in a community-based cohort study, there was 95% increase in all-cause mortality associated with non-surgical menopause occurring before 40 years as compared with menopause at the age of 50 years or older. The women aged 40-49 years at menopause were also at 35% higher risk of mortality compared with women aged 50 years or older at natural menopause. The average age at menopause has not changed for centuries. Aristotle (3rd century B.C), Paulus Aeginata (7th century AD) and Gilberts Anglicus (13th century AD) all quote an age of 50 for the menopause. According to Rosenwaks, age at menopause has been remarkably constant over the past 500 years at around 51.5 years. However, age per se, is not as important as the events surrounding menopause. Most estimates of age at natural menopause are based on samples of Caucasian women in western societies. The studies conducted on non-Caucasian societies have reported younger age at menopause than those of Caucasian women. African, Hispanic, Chinese and Thai women have an earlier age at menopause whereas Japanese and Malaysian women reported an age similar to women of European descent Clinically menopause is important because the decline in estrogen often causes symptoms that adversely affect quality of life. Numerous physical and psychological symptoms have been attributed to the hormonal changes of menopause. The pattern and frequency of these symptoms differ in different societies. The international data show that the symptoms associated with menopause are irritability (92%), lethargy (88%), depression (78%), hot flashes and night sweats (75%), headaches (71%),

forgetfulness (64%), weight gain (61%), insomnia (51%), joint and muscle pain (48%), palpitations (44%), crying spells (42%), constipation (37%), dysuria (20%), decreased libido (20%). The real clinical importance of the menopause today lies in the increasing longevity of the women in 20th century. The life expectancy for both men as well as women in Pakistan is increasing, with more women living in their post-menopausal age. Though we can develop health programs for menopausal women using existing foreign data, differences in climate, culture, living conditions, level of education and health awareness, race and diet call for collecting our own data, and designing peri and post menopausal health strategies according to the identified health problems in our socio-cultural aspect. The data on menopause in Pakistan are scarce and scanty. Except the study of Wasti et al few reports that exist primarily deal with biochemical aspects or hormone replacement therapy. The present study was undertaken to explore the age at menopause and symptom complex associated with menopause. Have you ever though of menopausal age link, something like when mom through it. This article has been made in May 26, 2011. The age at which women go through menopause depends a lot on when their relatives did, with women whose mothers and sisters went through it early likely to do the same, a study said. But the age of menopause is not entirely inherited, with a significant impact from so-called environmental factors, added study author Danielle Morris at the Institute of Cancer Research in the United Kingdom. "Genes have an important effect on age at menopause, but lifestyle also matters, and so women can affect their age at menopause by their behaviors," she added. For instance, women who smoke tend to undergo menopause roughly 1-2 years earlier than former or non-smokers, while women who have never given birth also experience menopause earlier. Age at menopause is an essential aspect of fertility, Morris and her team wrote in the journal Menopause, since a woman's ability to conceive ends roughly 10 years before she experiences menopause. Previous research has also found that women who experience menopause relatively late in life have a higher risk of breast and endometrial cancers, but a lower risk of cardiovascular disease. According to the National Institute on Aging, the average age at which a woman reaches menopause, or has her last period, is 51. Morris and her team compared women who were more or less related, reasoning that different relatives will share different amounts of genes and their environment. The sample came from a large study designed to investigate the causes of breast cancer among women living in the United Kingdom. Among those participants, the team selected 2,060 women between the ages of 31 and 90 who had a first-degree relative who was also taking part in the study. Both early and late menopause appeared to run in families, the researchers found -- but so did usual-age menopause. Specifically, women whose sisters and mothers underwent menopause during a typical age were between 2 and 7 times more likely to do the same. Study says that estrogen effects concentrations. This study has been made in January 24, 2011. Women are often concerned when they experience increasing difficulty concentrating, poor short-term memory, and fuzzythinking during middle age. However, difficulty concentrating and these other symptoms typically dont point to serious problems like dementia or Alzheimers, but instead are indicative of low estrogen levels. Medical researchers have long known that estrogen plays an important role in cognitive functioning, but the exact nature of that role has remained unclear. However, recent research published in the Journal of American Medicine sheds some light on estrogens affects on neural activity and a persons power to concentrate. A team of investigators from the Yale University School of Medicine tested this link by testing 46 menopausal women ranging in age from 33 to 61. Three weeks prior to the investigation, the subjects were started on either a placebo or estrogen treatment. The doctors then recorded brain activity as the women endeavored

to memorize and remember nonsense words or foreign letters. When the brain activity patterns of the two groups were examined, researchers concluded that the women who were given estrogen had more rapid neural responses than women in the placebo group. These findings suggest that estrogen aids older womens brains to maintain the same kind of accelerated neural activity of younger people. However, although estrogen stimulated neural activity, when administered to postmenopausal women it did not actually augment their memory. Women experiencing serious memory problems after menopause thus will probably not benefit from any type of estrogen therapy, but issues like difficulty concentrating, on the other hand, most likely will improve with increased levels of estrogen. Nowadays, some of us dont believe in acupuncture, but theres one study about acupuncture as hormone regulatory therapy. This has been made on July 2011. A small study released in March found that acupuncture reduces hot flashes and mood swings in postmenopausal women. This confirms what other recent health headlines indicate - acupuncture is clearly a better option than HRT (hormone replacement therapy) for treating menopause symptoms. Early this year, big news also came out of the U.K., where a large study of over one million postmenopausal women took place. The findings show that women who took HRT in the early stages of menopause were at higher risk of developing breast cancer than those who took it five or more years after menopause began. This is a big deal because popular belief was that younger women who began HRT earlier into menopause had little risk of developing side effects. In other words, the women who were thought to be at the lowest risk were found to be at the highest. These findings fuel an already blazing fire over the potential dangers of HRT, which include increased risk of not only breast cancer but also heart problems, stroke and blood clots. These risks were highly publicized in 2002, when another large-scale HRT study, the Women's Health Initiative, was halted three years ahead of schedule. Researchers pulled the plug when they realized that women were experiencing severe side effects at high rates. Although detractors are quibbling about the method used in the latest research from Britainit was an observational study rather than a randomized trialthe findings support the notion that artificially upping women's hormone levels is probably not very safe. They also highlight an inherent problem with introducing foreign substances to treat menopause symptoms. The body's hormonal balance, and therefore overall homeostasis, is thrown into disarray during menopause. It's uncomfortable and an enormous burden for a lot of women. But it's also a normal part of life. Regulating the body's existing components rather than replacing something that's not meant to be there anymore is safer and more consistent with the natural aging process. Regulation is the bread and butter of acupuncture. Menopause symptoms usually get acupuncturists thinking about the kidneys. In TCM-style acupuncture, the most common approach is to address Kidney Yin Deficiency. Many of the common symptoms associated with menopausehot flashes, night sweats, emotional instability, insomnia, poor memory, headache, lack of concentration, and drynessfall into this pattern. Kidney Essence, which is related to brain marrow, belongs to Kidney Yin, thus poor memory and mental confusion occur when Kidney Yin is deficient. Similarly, aching bones and low back soreness are a result of Kidney Essence/Yin failing to nourish the bones. This is part of why acupuncturists treat the kidneys in cases of osteoporosis, which becomes increasingly common as women near menopause. Kidney Yin nourishes the body fluids that keep the bones lubricated and strong. In addition to affecting bone health, when body fluids are depleted, there is general dryness throughout the body. This can lead to constipation, dry mouth, scanty dark urine and vaginal dryness. Any Yin Deficiency also is associated with what's called Empty or False Heat, which gives rise to hot flashes, night sweats, and face flushing.

Chapter 3 Methodology and Procedures Research Design

The study will apply the descriptive method wherein the data gathered from the questioner will be analyzed. The knowledge, beliefs and practices of elderly woman towards the case of menopausal stage will be assessed and reported as they are.

Locale and Population

A survey will be conducted on the attitudes and opinion of Barangay Guijo San Jose Del Monte Bulacan, with ages from 50 to 60 years old towards the different factors affecting the knowledge, belief and practices of elderly woman in cases of menopausal stage. The population size of residents is around 450.

The sample and sampling technique

The 30% percent of the resident of Barangay Guijo San Jose Del Monte Bulacan are the respondent of this study. A listing of barangay resident with Their addresses will be requested. The respondent will be selected through Random sampling. The knowledge, beliefs, practices and opinion of the elderly woman towards certain factors affecting knowledge will be noted. The distribution of the population is shown on table 1.

Research Instrument
The research questionnaire will consist of ten questions representing the different factors affecting the knowledge, beliefs and practices of elderly woman towards the menopausal stage. (Sample question attached) The check list questionnaire also made use of the five point likert scale.

5 Point use of Likert Scale

Value 5 4 3 Limits 4.50 5.00 3.51 4.50 2.51 3.50 Verbal Interpretation Malakas na Pagsangayon Sangayon Medyo Sangayon

2 1

1.51 2.50 1.00 1.50

Hindi Sangayon Malakas na hindi Pagsangayon

The sample and sampling technique

The 30% percent of the resident of Barangay Guijo San Jose Del Monte Bulacan are the respondent of this study. A listing of barangay resident with Their addresses will be requested. The respondent will be selected through Random sampling. The knowledge, beliefs, practices and opinion of the elderly woman towards certain factors affecting knowledge will be noted. The distribution of the population is shown on table 1.

Table 1 Distribution of sample size according to age of respondent

Elderly woman with Age 50 Elderly woman with Age 60

60 40

Total: Data Gathering Procedures

100

Members of the group will meet in one place. All together they will go to the barangay office to let the staff know that the group will be distributing the questionnaires to the residents. The distribution will be done by group with the help of some staff of the barangay. The profile of the respondents and list of factors affect the knowledge of the elderly woman are contained in the questionnaire.

Statistical Treatment
1. Frequency Percentage P = F/N x 100

P- Percent F- Frequency N2 Total number of respondents 100 constant 2. Weighted Mean (X) X = sum of the products (frequency level x level of agreement) __________________________________________________ Sum of the frequency (# of the respondent) Number of respondents for each weight multiplied by the weight of each value Scale The product were added and divided by the total number if respondents The quotient is the weighted mean for the particular items of questionnaire checklist

Formula: X = W1N1 + W2N2 + W3N3 _______________________ N1 + N2 + N3

Questionnaire:
Pangalan: ____________________________ Edad:____________ Adress: _________________________________________________ May Asawa: ____Meron ____Wala

Pinakamataas na antas na narating: _______________________________ Mga tanong: 1. Naniniwala pa ba kayo na kapag may regla ang isang babae, siya ay hindi malinis? 2. Ang pag kain ng ulam na may Malakas na Pag sangayon Sangayon Medyo Hindi Sangayon Sangayon Malakas na Hindi Pagsangayon

sakasamang dugo ay maibabalik ang nawalang dugo? 3. Ang paglabas ng buo-buong dugo ay nakakasama sa katawan? 4. Nagtatapos ang regla ng isang babae sa edad na 50-60 taong gulang? 5. Nakakababa ng libido ng babae ang pag tigil ng regla? 6. Nakararamdam ng pagbago bago ng damdamin? 7. Nakakaramdam ng matinding pagkapagod. 8. Madalas makaramdam ng sakit ng ulo? 9. Madalas na pag-papawis 10. Nakakaramdam ng pagkalungkot