Frequency of symptoms, determinants of severe symptoms, validity of and cut-off score for Menopause Rating Scale (MRS) as a screening tool: a cross-sectional survey among midlife Nepalese women.

Neena Chuni,Chandrashekhar T Sreeramareddy

doi:10.1186/1472-6874-11-30

Abstract

BackgroundMajority of Nepalese women live in remote rural areas, where health services are not easily accessible. We determined the validity of Menopause Rating Scale (MRS) as a screening tool for identification of women with severe menopausal symptoms and cut-off MRS score for referral.MethodsA cross-sectional survey was carried out between February and August, 2008. Trained health workers administered MRS and a questionnaire to 729 women (40 to 65 years) attending health screening camps in Kaski district of Western Development Region of Nepal. Information about demographics, menopausal status, and use of hormone replacement therapy (HRT), chronic disease, self-perceived general health and reproductive history was also collected. Menopausal status was classified according to the Staging of Reproductive Ageing Workshop (STRAW). We calculated rates of menopausal symptoms, sensitivity, and specificity and likelihood ratios of MRS scores for referral to a gynaecologist. We also carried out multivariate analyses to identify the predictors for referral to a gynaecologist for severe symptoms.ResultsA total 729 women were interviewed. Mean age at menopause was 49.9 years (SD 5.6). Most frequently reported symptoms were, sleeping problems (574, 78.7%), physical and mental exhaustion (73.5%), hot flushes (508, 69.7%), joint and muscular discomfort (500, 68.6%) and dryness of vagina (449, 61.6%). Postmenopausal women (247, 33.9%) and perimenopausal (215, 29.5%) women together experienced significantly higher prevalence of all symptoms than the premenopausal (267, 36.6%) women. MRS score of ≥16 had highest ratio for (sensitivity + specificity)/2. Women who reported urogenital symptoms [OR 5.29, 95% CI 2.59, 10.78], and self perceived general health as poor [OR 1.29, 95% CI 1.11, 1.53] were more likely to be referred to a gynaecologist for severe menopausal symptoms. While women reporting somatic [OR 0.72, 95% CI 0.63, 0.82] and psychological [OR 0.86, 95% CI 0.74, 0.99] symptoms were less likely to be referred.ConclusionMRS may be used as a screening tool at a cut-off score of ≥16 with least misclassification rate. However, its utility may be limited by woman's general health status and occurrence of urogenital symptoms.

Highlights

Majority of Nepalese women live in remote rural areas, where health services are not accessible
Mean age of the women according to menopausal status were as follows: premenopausal 45.1 years (SD = 2.78), perimenopausal 49.14 years (SD = 2.01), postmenopausal 55.67 years (SD = 5.6)
Validity of Menopause Rating Scale (MRS) as a screening tool The sensitivity, specificity, positive predictive values and likelihood ratios for different MRS scores to identify the women who are likely to be referred to a gynaecologist for severe menopausal symptoms are shown in table 6 and in Figure 1 by non-parametric receiver operating characteristic (ROC) curves

Summary

Introduction

Majority of Nepalese women live in remote rural areas, where health services are not accessible. We determined the validity of Menopause Rating Scale (MRS) as a screening tool for identification of women with severe menopausal symptoms and cut-off MRS score for referral. Menopause is a condition caused by the depletion of ovarian function followed by cessation of menstruation in women. It has been shown that menopausal symptoms vary according to racial groups. Studies have reported that somatic and psychological symptoms are less frequent among Asian women as compared to Caucasian women [4,5,6,7]. Menopausal symptoms may vary according to menopausal status. Sexual and psychological symptoms are more frequent among perimenopausal and postmenopausal women [8,9,10]

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