University of Nigeria Research Publications

Aut

hor

NWOSU, Nwanyioma Juliana PG/MED/97/24235

Title

Problems of Menopause and Coping Techniques Adopted by Women in Abia State

Facu

lty

Education

Dep

artm

ent

Educational Foundations

Dat

e

August, 2002

Sign

atur

e

PROBLEMS OF MENOPAUSE AND COPING TECHNIQUES ADOPTED BY WOMEN IN ABIA STATE

NWOSU, NWANYIOMA JULIANA (MRS.) PG/MED/97/ 24235

DEPARTMENT OF EDUCATIONAL FOUNDATIONS (GUIDANCE AND COUNSELLING)

UNIVERSITY OF NIGERIA, NSUKKA

AUGUST 2002 __4_

PROBLEMS OF MENOPAUSE AND COPING TECHNIQUES ADOPTED BY WOMEN

IN ABIA STATE.

A THESIS PRESENTED TO THE DEPARTMENT O F EDUCATIONAL FOUIVDATIONS, GUIDANCE AND COUNSELLKNG UNIT UNIVERSITY OF NIGERIA,

NSUKKA IN PARTIAL FULFILLMENT O F THE REQUIREMENTS FOR T H E AWARD O F T H E

DEGREE O F MASTER O F EDUCATION

NWOSU, NWANYIOMA JULIANA (MRS) PG/MED/97/24235

AUGUST, 2002.

APPROVAL PAGE

mrs PROJECT HAS BEEN APPROVED FOR THE DEPARTMENT OF EDUCATIONAL I~OUNDATIONS, UNIVERSITY OF NIGERIA, NSUKKA.

DR. B. A. OKEKE I * . SUPERVISOR

DEAN OF FACULTY

CERTI-FICATION

NWOSU, NWANYIOMA JULIANA, a postgraduate student of the Department

of Educational Foundations and with the Registration number PGMED/97/24235 has

satisfactorily completed the requirements for course and research work for the degree of

M. ED. The work embodied in this project is original and has not been submitted in part

or f i ~ l l for any other Diploma or Degree of this or any other University.

SUPERVISOR I-IEAD OF DEPARTMENT

This work is dedicated

To

Wornen in ~eneral.

My first gratitude goes to the Almighty God who gives knowiedge and

understanding and who sustained me throughout the duration of this study.

I remain foyal and highly thankful to my Supervisor Dr. 8. A. Okeke, who in

her unique way of smiling, gave me all the attention and advice that helped in making

this work a success. This study would not have been completed without the valuable

inputs made by my other Lecturers: Rev. Fr. Dr. M. Nwabisi, Dr. Iyke Ifdunmi. and Dr.

Ezeudu. I thank them also for their wonderful contributions.

I remain gratefir! to my resource persons kcdiruna and Lkenna who went round

all the autonomous c~mmunities to distribute and collect the questionnaires from the

respondents. My felicitatkn goes to m y able husband wha encouragd me both morally

and financially from the beginning to the end of this work.

My profi~und gratitude goes l a my children who were praying for my success

and who took over mummy's duties in the house fo see that my d r a m s came t!uough.

TABLE OF CONTEI'VTS

vii

s i

xii

I

I

4

5

5

6

7

7

Research

Research

Research

Research

Research

CHAPTER FIVE

Discussion of Results --------------------------------------------------------- 6 1

Discuscion of Findings -------------------------------------------------------- . L 6 I Sllnunary ------------------------------------------------------------------------ 70

Implications of' the Findings ------------------------------------------------- 7 1

Conclusion ----------------------------------------------------------------------- 72

Recommendations -------------------------------------------------------------- 73

Sllggestions for Further Studies ---------------------------------------------- 75

References ----------------------------------------------------------------------- 77

List of Tables

Table

I

2

3

4

5

6

7

Mean responses of the physical and emotional Problems

of ;Menopausal Women in Abia State ...................................

~Mean Responses of the age groupings of Menopausal Problems ---

Mean responses of education on menopausal problems in Abia

State --------------------------------------------------------------------------

Mean responses on the techniques used by non-literate and literate

Women in their coping strategies to menopause. -----------------------

Elicited counselling techniques Tor menopausal problems and

authorities that have used them -------------------------------------------

F-tests on significant differences in menopausal problems

Two-tailed t-test of significant difkrence between [he mean

responses of literate and non-literate women on their coping

Page

3 4

3 6

3 9

4 1

44

5 0

sii

:'vknopaust, which is the end of monthly mnslruation ifi a woman and which

brings -:o an etld her ability to become prepant, presents numerous physical and

emotional problems. Menopausal symptoms and cving strategies in wumerl in the

developed countries of the ~rorld are well dwumented. In traditional lgbs Society:

menopausal probkms have been existing without being publicly discussed or written.

Our women claim that they are poisoned bccause of lack of knowledge and experience

of menopausal symptoms and problems. Since our women are faced during ~hc" period

of menopause with obstacles or problems such as fatigue, headache, depression, anxiety:

nervousness. loss of appetite, shrinkage of vagina, hot ilushes, constipation, the thought

of coming to the end of their reproductive life and the loss of their husbands' affection.

the researcher wanted to know if lhere are no other ways of helping our women in their

menopause. The purpose of this stdy, therefore, is to identi& the probierns of

mencipuse and find out techniques women, in Abia State, can use 10 cope with

associated problems. Five research questions and two hypotheses were fomulated and in

order to answer these questions, lite~aturc m i e w and field works were undertaken. The

desigl used in the study was descriptive sunrey. The population for the study consisted

of 459 menopausal women in three age groupings randomly selected MM three out of

17 Lrml Ciovernment Arws in Abia State. The necessary informution was collected

f r ~ m the respondents by the use of questionnaire. To answer research questions 1 to 4,

the mem uas used. Any factor with a mean of 2.5 was accepted whereas a mean below

2.5 was rejected accorbing fa Asqwa (1998). With r w c i to research question 5 on

counselling techniques; seven counselling tc~hniqua were eIicited from ithe results

obtairwd in the study. To determine whdher thee age groupings did not significantly

influence mempausal problems (HQ1), the F-test at 5 percent level was L ~ C I and for

HOz where it was necessary to answer the question if there are no significanl differences

in the techniques u s d by literate and non-literate women in Abia State to cope with

menopausal pmbletns, t-tesd a1 5 percent level was used.

The study revealed many interesting findings. the highlights of which are:

-3 Occasional sensations oh burning heat, tendency of adding weight and becoming

abwtminded are physical and cmdona l problems: of memymud women in Abia

Stzte.

*:* Menopausal womcn between the ages of 50 to 70 years acccpt that loss of sex urge is

a problem.

*:* Both non-literate and literate rneni~pausal womm accepted involvement in more sex

to redore lost sexual satisfaction as a coping strategy,

*:* Aged menopausal women, 50 to 60 years and 60 to 70 pears, &dared that they

became absent-minded because of menopause.

*:* Sewn counseling techniques were elicited by studying I5 physical and emotion

problems of menopause nnd from evaluating the effkctiveness of 15 Coping

Strategies in this study.

Based on the findings, the Soltowing recommendations were m~ade:

'L ( 1 . Teachers, public health nurses, medical doctors and un~versity women associations,

as professional services, must be involved in educating women to begin to discuss

publicly their physical and emotional problems of menopause and the coping

strategies they use to reduce those problems.

2. All emancipated women associations have a role to play to inform other women

during their town union meetings, and August women annual meetings that

occasional sensations of' burning heat and absentmindedness suffered by women

during menopause are to be expected. It has become expedient that through women

organizations falsehoods and misconceptions that witchcrafts are involved in

making women uncomfortable during menopause be dispelled.

3. The fact that age is a factor af'fecting the way menopausal women rcspond to

menopausal problems, it is recommended that medical doctors should make their

services available to aging and aged women experiencing menopause by

establishing menopausal clinics (MC).

4. Since from this study, seven counselling techniques were elicited. it is

recommended that enterprising Guidance Counsellors set up Guidance Counselling

Centres (GCC) for aging and aged womcn in their menopause.

5. Social workers should utilizc the findings published in this study to settle cases of

misunderstanding between husbands and wives.

6. Governments at various levels in Nigeria arc being recommended to undertake mass

media to educate women on the management of menopatlse and the need for scx

education to their daughters.

lntmductioa

Background of the Study

Menopause and the symptoms that seem to go with i t have not been

sufficiently investigated in the Nigerian women. menopause is derived from two

Greek words men, month and pau6, stop which together mean the ceasation of the

menses. fn its strict sense, the word menopausx means no more or the termination

of menses. Some authors will uxprain menopause as the pausing af menstruation or

the last menstruation. Menopause can also be defined m the final ceasa~ion of

menstruation and, therefore, the end of a roman's reprductivc life. The term is

also seen as the irreversible ceasation of regular monthly uterine bleeding in the

adult human female, marking the cnd of her ability to become pregnant (Carter,

Dodds, Cunrlinghm, I962 Dalton, 1978; Cox, 1983; Hunter, Bat te~by and

Whitehead, 198G; AyersC Caboratorics, 1968; Asogwa, 19%; World Book

Encyclopedia, 1977; Nwarnarah, 1998; Umgbunarn, 1998; Guyton and Hall,

1968)+ Menopause can Be defined as t k second b n q r n m in the I I k of a couple

whereby the woman no longer sms her monthly peri id and pregnancy no longer

occurs. The average age of menopause is 5 1 years (Drmgenuellar, 1987; Friedman

and Moshy. 1986; Tindall? 1987).

There are physical and emotional pbllems of menopause. Some of the

emotional problems include: tiredness, imorn~~ia, anxiety, giddiness or dizziness,

forgethlness and ahsen t-mindedness, fear, depression. irritabi fi ty, a d nervousness.

The wcmt symptoms that generate health problems in women are the emotional or

non-specif'rc ones which had led to tbe following comments by same women

(Dalton. 1978; pp 162-163). One of the menopausal women said that she thought

she must be going insane while another one cried out that she felt so harassed that

the uhale world seamed to be mting on her shoulders. Yet another woman

confessed aloud that menopause was even tougher than pregnancy and labour.

Among older women. certain myths have surrounded menopause, imIuding

the fear of insanity, the ending of sexual desire and attractiveness, and the myths of

inevitable depression, adverse physical symptoms, and defeminisation (Butler and

Lewis, 1977).

Even though a vast majority of menopausal symptoms have a hormonal

bask, Dalton ( I 978) has advised menopausal women to avoid hot tea; coffee and

spicy foods as thee pmvoke the hot flushes. Thc author also advised them to diet

carefully because fat ones could get fatfer and the thin ones to get thinner. A good

night's rest also helps. Dalton (1978) has also recommended that menopausa1

women should consult with their doctors to prescribe oestrogen therapy where

appropriate. A wmart on oextrogen therapy shouId see her doctor at least every six

months for a check on her blood pressure. weight, and for a general examination.

Kauhan 1 9671, MaIIeson ( 1956) and Robert and Karla [ 1 995) Rave indicated that

oestmclgen replacement therapy may be used to mitigate various problems of

menopause.

According to Tindall (1987), Robert and Karla (1995): the period of

menopause affects the health status of the women folk &cause they are faced with

problems of fatigue, T~eadxhe, depression, anxiety, nemomness, lass of appetite,

shrinkage of vagina, hot flushes. constipation and the thought of coming to the end

of their reproductive era. Jacobson (1993) has written about the physiological and

psyc halogical health problems of women during menopause. Smith and Rey nard

(1991) and Cox (1983) in an apparent reference to the psychological impacts of

menopause on wornen contended that many women approach menopause with fear,

insecurity, loss of fertiIity, obesity and loss of their husbands' affection. A

fi~ndamental reason for emotional upset for women during menopause is that this

period r c p r a n t s the end of the reprdlnctive era and this can trigger hysteria in

some wornen depending on their marital s t a t ~ ~ s and family stand. A barren woman

who has lad scme hope that God will give her a child some day or a spinster with

hopes of getting married or a married woman with only female children can be

thrown into emotional health problems at the advent of menopause. As the author

went through literature an the subject a d with limited facilities in our library, she

noficed that the most difficult task in menopause is the health-associated problems.

She did not quite find enough literature on how to prevent and / or manage the

stress, depression, emotions and other health problems that accompany menopause

in women. Since menopause. therefom, has health implications for aging w~men's

health status, family life and counselling implications for guidance counsellor, the

researcher seeks to find out the problems of women in their menopause in Abia

State. It was against this background that this study on problems of menopause and

the coping techniques adopted by women in the author's home state was conceived.

Furthennore, the author hoped to elicit counselling techniques from her study in

order to help women in her area during this perturbing period.

Statement o f the Problem

In traditional lgfm society. menopausal problems have been existing

without being noticed. Women in menopause go nfm)~gh many problen~s in silemx

because they lack infom~ation and nwreness. Most of the lime we hear some

womcn 5vho are in their 40s and above umpTain of one sickness and the other

which if properly diagnosed could be menopausal problems. But because of lack of

knowledge and experience of menopausal symptoms and problems, such women

claim that they are poisoned. For thc modem educated Igba woman, the reported

health problems like anxiety, depression and nervousness caused by menopause

urill indeed present a social problem also. These are few of the problems, it does

appear there are a Iot more. These problems could pose obstacles to old women in

par~icular and younger ones later in life. Following h r n the above, the problem of

this study is to identify the problems of menopause, create awareness of

menopausal problems and to End out tw1miques used by the women to cope with

the problem.

Purpose of the Study

The main purpose of the study is the identificahn of probkms of

menopause and techiques used in coping with these problems.

Specifically, the study addressd the folEowing:

I. IdentifL the problems of menopause among Abia women. . . 11. Find nut how age influerim the probIms.

.., 111. Find out how education inil~lences the problems.

iv. Find out the techniques used by Biterare and non-literate women to cope

with the problems.

Significance of the Study

Sime in literature there is a tendency fbr diflerent cultural groups to see

menopause according to their cultural inclinations, it will be interesting to observe

who benefits from the study in Abia State. The findings of the study will probably

create awareness of rnenopausnl problems to those women who are on it and those

who are yet to be in it. Readers of the results af the study, men and women dike,

will find the project work informative, reference point, sympathetic, helpfuI and

pmctjcrtl in relieving the sufferings caused by m e n o p w .

With the help of progarnmes like seminm, workshop, publications in the

newspapers about the findings of this study, the public especially husbands will be

helped to understand and appreciate the rnenopusal problems of women and

become partners in helping them through those d i f i cd t periods. MenopausaI

victims wilI receive knec advice on their scxual behaviuur probably to scc

nlenopause as a normal and naturaI phenomenon ratha than end of their sexual life.

Since menwauw is associated with physiobgical a d psychological health

problems of all w m c n (Jacobson, 1983; Robert and KarIa, 19%; Smith and

Reyard, 199 1; Cox, 1983; Asogwa, 1998). so the Nigerian woman is involved. In

our socie!y-, the old ones do not want to talk n b u t sex or their experiences on scx in

the public. In this study zhe author will t v To brwk the secrecy about sex in the

family through a \vdl-stnlctured quesliormake on sex experiences during

menopause. W o m n will be asked to either respond verbally or \wile down how

they cow with the problems of menopause. Through talks to women organizations

in Abia State on menopausal problems, both the ywng and old women will discuss

face to face their problems 011 menopause during the study. The findings will be

utiIized by guidance counse lb~q social workers, women organizations, ,and non-

~overnmental organisations (I"4GOs) to seek peace in families and in the nation. L

Besides, all the identified strategies used by Abia women to cope with

menopausal problems wiIl be collated and refined as counselling techniques to help

wornen to ad-iust TO the problems of menopause.

Scope of the Study

'fie study focuses mainly on the physical and emotional problems of

women in menopause in Abia State in three Local Government Areas, namely:

Umuahia South, Umuahia Noflh and Iks~uano. The s t ~ ~ I y included all warnen

between the ages of 40 years and a b v e who are in their menopause.

Research Questions

The folTowing research questions guided the study:

What are the physical and emotional problems of menopausal womcn in

Abia State?

What influences Ao age groupings have on the problems?

What influence does education have on the prab!ems?

What technicpa are used by literate and non-literate women in coping \\ith

the probkmu?

Which counselhg techniques will be of help in the adjustment of thcse

problems.

Hypthwes

AlJ hypotheses will be tested at the 5 percen! level of significance. The

hypothcses to be tcsted are:

Hol Age groupings do not significanlly Influence nlempausal problems.

Ho There .are no significant differences in the techniques used by literate and

non-literate women in Abia State to cope with menopausal problems.

CHAPTER TWO

Difkrent authors have t r e a ~ d the topic of clinlacteric or menopause in

different ways. Having read the literature on the theoretical framework and the

empiricd sh~dies, tk present author has decided to organize the reviewed literature

under the following headings:

Concept of menopause

Age sf menopause

- management of menopause

- Education and menopause

- Counselling techniques.

Concept o f Menopause

Whereas menopause describes the %rial menstrual period, clin~acteric

describes the entire interval of the gradual transition Crom fertility and "feminity" to

senescence a d "old age*'. (Ayerst Labratorim, 1968). Dalton (1978) conceives

the phenomenon of menopause as a door leading to scniliry and also the gateway to

an era of serenity far the pslmenopaussl years are, for some women, charxtcrized

by conlidence, calnmess, sophistication, srablc mood and cndless energy. The term

climacteric covers the years before and after the last menstruation. a time when the

changes in the reproductive system were occurring (Dalton, 1978). In literature.

two types of menopause are distinguished, The natural rncnopctuse comes with the

natural cessation of menstruation as a woman approaches ord age. The natural Iife

of the ovaries is about 35 years. Changes in the reproductive system as menopausc

sets in arc very p d u a l . taking 5 - 7 years to compietc. At menopause= the ovaries

fail to producc oestrogen and progesterone and this failure may lead fa final

cmsation of menstruation. Artificial menopause results with the removal of the

ovaries artificially by surgery or by destruction through X-rap; radium or

contraception.

In the child bearing years of a mature woman, gonadotropic hormones

stscrcted by the pituitary @and under the stimulation of the hypothalamus interact

and interplay with the ovarian "female sex hormones'', to inthence normal

menstnral cycle and pregnancy. During menopause, high levels production of

oesrmgcn and progesterone first redwe and then block pihlitary produdion of'lhe

three gonad~tropic hormones in the mature reproducing woman (Ayerst

Labratories, 1968). As menopause persists, the ovariw h o m e unable la respond

and cannot increase or rdwe their production of oestrogen ad progesterone

thereby causing a hcrmnal imbalance (Dalton, 1978). Even though small

quantitics of oestrclgen are produced always in two adrenal glands and in peripheral

t iwes , the non-production of ovarian wstmgen is responsible for the unpleasant

symptoms or miseries of rnenopausc (Dalton; 1 978).

IShangm and Mrostmal Iliaturhsaca

Ovarian oatragen promotes the cholesterol balanec. contributes in the

building of the bones, nourishes the bid circulatory sysletn and increases the

elasticity of the skin (Dalton. 1478). Aflcr Inempause and with decreasing level of

aestrogen in the blood, cases of the narrowing of the arteries, particularly

narrowing of the blood vesselv of the heart will occur at a h u t the age of 75 years.

Therefare, mcnopausaf women may suffer from coronary heart disease and the

thinning of the bones, which have been f w d in 40% of women (Dalton, 1978).

The menstruating years in the life of a woman end in a \vide variety of ways

at the approach of menopause. Four or five patterns have been identified in women,

though son= wonlen will have a mixed grill (Dalton, 1978; L l q d , 1968; Rogers.

1963; PascRkis a & 1967; Mac Gregor, 1959). The following ending patterns or

disturbances have been reported:

1.

. . 11.

... 111.

iv.

In some women, there is a gradiral ending. Whereas menstnmtion initially lasted four or five days, it gradually lasts one or two days, then only one day or even one hour monthly, but nevertheless the cycle is ma inb ind and rnenstn~ation comes when expected.

There may bc occasional misstd menslnlation, possibly just an odd one, and then menstnmtion resumes again for a month or two before another is missed. In this type of ending pattern, there is m r e missed menstruation than actual menstruation. but each menstmtion lasts the expected number of days.

In some women, eyclic bleeding is missed for a month, resumes, then is absent for longer intervals; finally ceases after a two or three year period of irregularity,

There is the sudden ending of menstruation. which had previously been regular, the final menstruation lasting the nomal or nearly normal number of days.

V. A fifth pattern may be excessive bleeding before menopause.

The individual woman's afliitude to a missed or delayed menstruation

depends u p n her recent sexual activity and desire for pregnancy (Dalton,

1978). Thc i~ltiequency or absence of rnenstn~al bleeding for a month or

two may bring happiness or unhappiness.

Physical Symptoms and Pmblems of hfenopausc

This set of symptoms can also be described as vasomotor disturbances

(Ayerst Laboratories, 1968). Following the rnerrstrual irregularities of the

premenopausc, vasomotor disturbances popularly known as %or Rushes" or "hot

flashesWt swrats and palpih~ions do occur early as indicators of a woman's

climacteric. When menstruation ceases at menopause, anather stage of the

clin~acteric, the vasomotor disturbances become frequent. A1 postmenopause,

which has k e n descrikd as senile vaginitis. there are occasional manifestations of

the "hot ff ushes', swats and palpitations. Alterations or changes in M y sfrtrctures

and metabolism. which have been caused by the reduced aestrogen prodrrctian

during the climacteric years, give rise to a number of symptoms and subjective

complaints. Reichlirl (I968) has estimated that 800' of menopausal women suffer

to some beggee 1Re vasomotor disturbarlces. It has hsen said that the hot flushes and

sweats are as a resuh af vasomotor instability. The heat flushes are sudden wave-

like sensations of heat which last from a few smonds in half a ntinute to one

Iike sens~tions of heat which last from a few seconds to half a minute to one

minute. Flushes and sweats are more severe in anxious women (Paschkis a d.

1967; Beecham and Fonnan. 1963; Kuppeman. 1967; Tindall, 1987; Robert and

Karla, 1995).

Qeszmgela deficicmy according to research findings causes marked

regressive changes or atrophic conditions that mcur in many M y stnrcl'ures during

the climacteric. Atrophy affects the skin, mucous me~nbranes and all of the

reproductive or~ans, especially the genitalia. The vagina, for example. shortens and

becomes namwer and Iess elastic (Lang and Apnce. 1967; Krelzschmar and

Stoddard, 1964: Robert and Karla, 1995). Vaginal atrophy caused by

postmenopausal mtrogen deprivation may have several serious consequences like

irritating vaginal discharges and infection; reduced sexual sat is fac tion, atrophic

shrinking, thinning and drying of the vagina1 mwosa (atrophic vaginitis) which is

noticeable during attempted sexual intercowst. The resulting dyspareunia or

atrophic vaginitis causes a fwIing of guilt and sexual inadequacy in marital partners

(Masters nnd Johnson, 1966; Smith and Reynarct, 1991 ; Cox, 1983; Bobak, 1 m).

Almost dl p o s t m e n ~ u s d women, who complain of vaginal discharge admit that

they have some discomfort during intercourse md this may lead to abstinence From

sexual intercourse (Masters and Johnson, 1966: Cameron, 1966). According to

Masters and Johnson (1966) orgasm is generally shortened in duration wjth pai f id

uterine contractions during menopause. They have also repofid that elderly

wornen experience reduced anatomic ancl physiologic response to sexual

stimuIathn because of Foss of vaginal lubrication. The vagina of a woman who is

advanced in years loses much of its ability to expand voluntarily during xxuaI

intercourse. Dalton (1978) has reported that the effect of menopause on sexual

activity depends on one's experience during the menstmation years. If sex was

important then, it is likeIy to be even more enjqabIe once the fear of pregnancy is

permanently eradicated. If there was never much sexual excitement then, many

think of the menopause as e time when tlus activity may be slowed down or cven

stopped. Some authors believe that sexual desire end enjgment of sexual xt ivi ty

are unaffected by majority of women during menopause (Bachmann, Leiblum and

Sardle~, 7985; Hawton: Gath a d Day, 1994; Hunter 1990).

0estrogt.n deficiency may bring about metabolic changes such as

osteoporosis and atherosclemsis. Menopausal woman devcbp asteoprot ic

decalcification of the bnes. 25% of postmenopausal women sho~v close

asmiation bt%:een oestrogen deficiency d osteoporosis (thinning of bones).

Pain at the Tower back caused by ~steoporosis can be remedied by the use of

mteogen therapy (Ayent E,aboratories, 1968 P. 261. According to their findings,

premenopausaI women suffer less atherosclemsis or coronary heart disease than

menopausa! women. Also the incidence of coronary hem disease is at least 15 to

20 times gra te r in men than in women under the age of 40, bus the disp,arity

disappears aRer the menopause.

Pmbierns or Symptoms with m Emational Component.

Mc Candless ( 1 W) inferred that endocrine imbalance during menopause

seems to influence many emotional manifestations and vague psychosomatic

complaints of nlempausat syndrome. Mod of these sjrnptoms emanate from

psychological rewtion, disturbances and anxiety. MQSI common emotional

symptoms are: fixlings of nervousness, irritability. depression, melancholia,

hopelessness, fear, and worthlessness, as we11 as weepiness, frigidity, impaimlent

of mernoy9 and difficulties in concentrating. Frequently menopausal women

complain of ailments which are subjective in nature: insomnia, vertigo. hadache,

tachycardia, palpitations, and fatigability. Some women in their menopausal years

complain of muscle, joint and waist pains, loss of appetite, constipation, and

diarrhoea, numbness and crawling sensations of the skin, "spots before the eyes",

and " ringing in the ears'', and sensations of choking, and suffocation. Headaches,

which about one third of menopausal patients cite, are usually of the "nervous

tension" 'p, and not of the migraine type (Paschkis? Rakoff, Cantarow and Rupp,

1467; Bwchanl and Fonnan, 1963). Conmon symprorns as depression, imornnia

a d headache seem to be related to insuficient oestrogen in about 50% of women

that have menopausal syndrome (Kaufman, 1967; Kupperman, 19G7; Kuppaman,

'1963; Neugarlen and Kraines, 1965; Bakke> 1963; Malleson, 11956; Robert, 1'990;

Smith and Rqmard, 1991, Youngsorl, 19%). Dalton (1978) in her book added

family-life problernv to those we already know. Menopause causes dernot-aIlzing

feelings. Over 50 percent of rnenopausaI women feel tired, confused, initable and

incapacitated due to the effects of menopausal tension. Many Mhers arc indirectly

affected- husbands, children. colleagues, work-mates and friends. Cox (1983) and

TinndalI ( 1 987) have cited anxiety, depression, fatigue, shriveling and flattening of

breast, increased weight with increased appetite or decreased appetite, depression.

nervousness, h ~ d - x h e & insomnia, constipation, fibrositis, skin pigmentation,

development of waists and menopausal hypertension and arthritis as also

menopausal problems.

The Empty Nwt Syndrome

Mc Candless (1964)? Robert (1990). Smith a d Reynard (1991), Bobak et

al. (1989). Matthew (1994). and Royston (19901, consider the subjective symptoms

relating to almost every system of the body that might develop around the time of

the menopause as signs of the "menopausal syndrome". Dalton (1978) writes that

ihe menqauval years art. unfortunately aRen traumatic for women in other ways. It

has k e n calculated that in the space s f five years around her fifiieth birthday. the

average wonEn will lose her mother t!uough death, her daughter dhrough marriage

and kcorne a grandparent. According to Katherine Dalton (1978). there are also

those whose children leave home for college or whose husband changes his job or

receive his final promotion. Detinitely some women may be upset by these events,

which may wuse some emotional impulses. This is why some psychologists refer

to any ernotianal problems caused by these happenings as the "empty nest

sydrome". In the diagnosis of the emotional problems, it might be necessap- to

distinguish between those emotions vrihich have a hrrnonal hasis (oestrogerl.

deficiency) and those based on an aging woman's IowIy life from a family . p i n t of

view.

Age and Menopsoae

The exact time of menopause in women is very individualistic. In the

United States of America, the average age of the menopause is 52 yars and in

Great Britain, it is 48 years with a range belwem 45 and 55 years. Women whose

menstruation ceases before 415 yeas ate said to have a "premature menopause"'.

The age of onset of n~enopause depends on heredity, good fimd and health habits of

individual. Smoking habits da affwt the probable agc at which he menopause may

occur, (Gait, 1087; Gilbert, 1997: Robert and Karla 1995, Friedman and Mosby,

1986; Robert, 1990; Tindall, 1087; Cox 1983; Youngson, 1995). The international

Health Foundation in 1969 (Daltm. 1978) studied the subject and interviewed 2000

women between 45 and 35 years. 72% of the women agreed that a& menopause if

*as g d to be frce fiom menstmation. The figures for tk various countries ranged

from 66% in ItaIy la 39% in tk United Kingdom. Drwgenueller (1987') repred

the mean age of menopause to be 5F years. Robert and Karla (2995) indicated that

menopause occurred m u n d 45 to 50 y m s of age. Menopause: is considered to

occur prematurely if it is mticed bcfore 40 years of age (Barlow, 1996). The

average age of menopause in the United Kingdom is 51 y w (Friedman and

Moshy, 1986). Menopause occurs betwen the ages of 45 and 52 years but is not

uncommon to most women of 'between age$ of 45 and 53 or 54 years still

menstruating regularly* Average age used to be 47 years in Britain and America but

is now 51 years because of general improvemcn~ in health, vigour and

dekmination of women to slay young (Tindall, t 987).

According to Cox (1983) menopause can begin from late 30'9 and late 50's

but commonly during the 40's for most wornen, premcnopause star& Between ages

of 45 and $5, While a few experience menopause before the age of 40, fewer

women experience it later than 60 (Robert, 1996). In rare cases between the ages of

60 and 70. the endometrium of the uterus may thicken as in [lie activity yean of a

wornan. When that happens, menstruation may occur - (Roysron, 1990) and this explains why some women over thc age of' 60 years may conceive. Uzuegbuna~n

(1 998) found 40 to 60 years as the perid range of menopause in Anambra and

Enugu Sta ta ;of Nigeria. The start off ages were 40,45, and 50 y a m depending on

individual biological constitution. Osborn (1988) and Ha~iton et al. (1994) haw

reported that with increasing age, levels of' sexual desire dccrease in both scxes and

low sexual desire become more common, particularIy with women in the their late

40s. and 50s. Hunter (1990) found a stepwisc decrease in sexual interest across the

menopausal ages of peri-, and post-menopause.

Manaprnent of Menopause

Medics and Ihe concaned public have over the years devised mcdicai and

I-mn-medical n~e~hods 10 alkviatc the problems cncountmd by women during the

menopause. DaIton (197 8) has ohenled that long-tcml wstrogen therapy has been

used to treat the dwreasc in hcight experienced by menopausal women. Katherine

Dalton also noted that the sore vagina and painful coital penetration suffcrcd by a

woman in her menopause could be relieved by giving oestrogen either as a cream to

be used locally or by tabIes. She also contended that some cream could be used lo

combat the natural skin dryness and special shan~poo used for greasy hair. A good

number of physicians fecl that the adverse consequcnces of the climacteric could be

reversed by the use of oestrogen therapy. A medical doclor before treating a

nlenopausal woman should first make a diagnosis to reassure himsclf that the

symptoms are not those of xcampanying diseases but of menopause. The main

purpose oB msrrogcn therapy is to ease at arneliorale the padent's physiologic

adjustment to the falling aestragm level of the n ~ m p a u s n l periods (Pearl and

Plotz, 1964; Lammed, 1962). Oestrogen therapy alleviales many physical

symptoms associated with mempausal syndrome (KauFman 1967; Rhoades 19G7).

A dmrnatic reversal oi the consequences of vaginal atrophy (lsiael, 1467,) is

p r d u c d when ocstrogen treatment is given. Wallach and H e m m a n ( 1 954)

conrend that wstrogen k r a p y prevents ar clinically rerluces atrophi'c' changes

involving adjacent urinary stn~ctures, muscles and ligaments.

They also reported that the therapy prevenfs or retards postmenopausal

osteoporosis but does not r a tme bone already daalc i f id . Atherosclerosis i s

prevented by ocstrogen treatment perkson, Staniler, and Fahen, 1964; Davis,

Jones, and Jardim, 96 I 3; Marmorstsn gt aJ.; 1958). They have presented evidence

that when menopause was managed with OesZrogen drnirlistration. p s t -

menopausal serum cholesterol is lowered, alpha lipoprotein is lowred and this

results in the lowering of the cholesterol- phospholipid ratio. Goldfarb (1%7), Hunt

and Beecham (1966) reported that oestmgen cream ointments or suppository have

been useful in relief of vaginal, vulva, and urethral atrophy. For some cases of

atrophic vaginitis, oral oestrogen therapy, they said, was k i n g advocated. The

same authors mummended local p~parat ion of oestmgen and corticoids as relief

for pitus vulvae. Dalton (1978) has reporfed thaa the effect of oestrogens on the

management of menopausal sympton-1s was dmrnatic though she feared that long

term use nf the therapy could predispose women to a risk of cancer. Also rx;r&agen

therapy should not be given to women, who have a pas-! history of mmnary

thrombosis or have h igh b l d pressure, cancer of the breast, womb or ovary.

diaktes or liver disease. Pearl and Plotz (1964) and hrnmert (1%Z) have said that

oestrogen hormone, became of its pmver of salt and water retenrion, stlould not bc

given to patients with severe kidney disease, or carcliae decompensati~n. For

fibmid patients, the dosage should Ix low.

Oestrogen administration causes a number of side effects on su~ceptible

patients such as: gastroinratind disturbances, fluid retention and wigh t gain,

vaginal discharge. a d skin pignlenta'tion (Paschkis a a!; 1967; GreenMatt, 1965;

Kupperman, I %?; Rhuades. 1967; Kistner. 1967). One disadvantage of oatween

t k n p y is that i r causes tissue prolifmrion and uterine bleeding. Some clinicians

add progesterone tn the mtmgen replacement therapy to control the occurrence of

bleeding (Gddfarb. 1967; Hunt and Beeham, 1966). However, management of

vaginal bleeding in post-menopausal palients must be carefilly evaluated to isolate

cases due to wsttogen therapy, because about 33% of such bleeding may be

malignant in origin (Parks, 1967).

Apart from The ovarian hormone, &ragen, other hornones Rave been used

to manage the erects of menop.dusal symptoms. Dalton ( 1 978) has rcported thar the

male hmnone. testosterone is valuable in rapidly stopping tnenopausal flushes and

depression when it is given in a combined tabkt with cestrogen. Testostercme also

improvos the sex urge and ac t iv i~ . Clonidine is a drug which Iowcrs blood

pressure and i n very smilll doses relieves menopausal flushes in those women who

are unable to tolerate oestrogens (Dalton, 1978). Katherine Dalton also wrote that

drug Bromocriptine, which lowers a raiscd prolactin level. couId be used to restore

lost sex interest. She said that pyridoxine or vitamin B~ is valuable in removing the

depression in menopausal women.

It is atlvisable for climacteric patients to see their doctors at least hvice a

year to adjust their treatments according to their needs. Gyneacologists recommend

physical examination, palpation of the breasts. inspection of the cervix, and

cytologic studies of the cervix and vagina as rqular check-up measures for patients

rpceiving menopausal therapy peecham and Forman, 1963 p. 67 1 : Feu1 and PIotz,

1964; Hunt and Beecham, 1966).

Dalton (1 978) has recommended the use of cosmetics, beauty treatments

(make-up) and cosm~tic surgery as ways to rnanap,e skin wrinkles that develop

especially on the face m u n d the eym md mouth, and on the neck. She advised

menopausal wnrnen to avoid hot tea and coft'ee as well as spicy foods because they

provoke the hol flushes. She advised women to diet carcfilly, remernkring that

during this phase of life, it is very easy for the fat ones to get fatter and the thin

women to get thinner. DaTton (1978) has also advised tvornen in their rnen0pau.w to

take a good night's rest and to utilize: "cat-naps'' after lunch.

Education and Menopause

The anatomy and physiology of the literate and non-literate woman are the

m e , hut education tends to reduce fear nr micty among menopau-d women and

dsa tends to help literate w m e n to manage menopause better (The World Rook

Encyc-iapaedk 1977). Educated women who are hI1y emancipated and who

understand the hormonal and psyshoIogica1 ba~es of menopause, are more likely to

participate in discussion groups, warkshops and serninm to keep themselves

informed (Dalton, 1978). Education helps to enlighten women to appreciate that

there artre two ,pups of menopausal symptoms: the specific and non-specific ones.

Wen a woman begins to observe hot flushes: dry, pale md thin vagina: itching and

painful vagina; or hquency in pasing urine, it will occur to her that these

symptoms are climacteric in nature and signs of approaching menopause or

menopause itself. A!) this is due to deficient nestragen productinn of the ovaq at

menopause. The non-spzcific or vagrre psychological symptoms compise

tiredness, sleeplessness and anxiev (DaItan, 1978). lndeed the same a&nr had

demonstrated that there are permanent mmd changes at menopause. For instance,

an easy-going wnmen may be turned fnto a shrew; a highly strong irtdividual turned

into a cqring lunatic; a happyp lucky women into an ovenvwked, restIess,

nagging hitch; and R spry house~ife turned into an ahent-minded professor. who

puts the cat in the 6 d - p and the milk on the doorstep (Dalton, 1978). W-hm

Neupmen and Kntines (19%) studied the attitude of educated women to

rnempause and the follawing questiort: "what is the best thing abnut the

rnen~pause"? \as put to them, their responses were as follows: 44% replied " not

having to bother abut menstruation", 30% replied "not being swrried a b u t

getting pregnant; and 14% replied "achievement of better rdationship with husband

and water enj~yrnent of sex life". According to Dalton ( I 978) the lnternntional

Health Foundation in 1969 studied the subject md interviewed 2000 educated

warnen between 45 and 55 years of age. and 72% a-d that after menopause it

was good to be h e from pregnancy. The figures for the various countries ranged

from 66% in Italy to 79% in the UnTted Kingdom. Psychologhxl probIcms

emanating from menopause may vary amcording to the women's family strwcture or

background including litemcy (Tiidall 1987). According to the research findings of

Miller ((1984), menopause has been fnund to be a rdief from fear of pregnancy, the

hassle of menstruation and inconveniences of contraception for women who have

had many chi'ldren. Whereas for hmen and unmmicd women, menopause can give

a lot of emotional upset. Wxucghunm (199'3) in her study of five ways of how Igho

wnrnen in Nigeria managed their menopausal crises found out that rural and the

non-literate women had IittIe or no knnwled2e of management methods for

mmopau.w. The non-litmate women in hambra w d E n u p States of Nigeria did

nut use Hornone replacement therapy (HRT), did not visit the doctor, nor had any

treatment or even dieting to manage menopausal miseries. Obviously, the non-

Iitmtc gmup did not avail themselves of reading mater ia l~ on menopause or old

age. Uzuegbunam (1 998) perceived a gap in the management of menopause among

Nigerian women especiaIly those of them residing in the mraI ma!. Among the

I i t m t e women, Uzughnarn (19%) rgortcd that 26.3% used hormone wpIacernent

therapy; 68. 4% consulted with the doctor; 3 I . 6% received no treatment for their

menopausal problems. About 89?/0 of literate lgb-women dieted in order to adjust

to menop~usal problems. Of those educated, only 39% read materials on

In literature, some c~unselling techniques hasre been used tn counsel women in their menopause and these me:

1. Since counsellors know that n~enopausal sjmptoms bring about stress and

disturbances in the home, they usually counsel not only the patients but also

other family rncmkrs though pmLpmmes (Cox, 1983; TjndaII. 1987;

M i l k 1 984, Roystan, 1990).

2. Attempts to dispel the fantasies and misconceptions that menopau-se b r i n ~ s

serbus illness and it is the end of sex life, Indeed women should ~ g x d

menopause as a stage of liberation h m the nuisance of r n e n L ~ t i o n and

the x s p n s i hilitips of pmnthaod f k o r a , 1 986; Leihlum, 985;

3. Wjnning of sympathy of husbands to appreciate the ordeals of their wives at

rnenflpause instad of getting a ~ 0 ~ d svfth them [Dalton, 1978). Gail

(1 995) nates that since the time of menopause coincides with other st-mssful

circumstances in a u~omm's life. such as caring for aged parents, swing

children pow up and Ieme home and other mid-life zidjustment~, partners

should indeed accommodate the problems of their wives during the period

of menopause.

4. Discussion among peer groups or club formation.

Dalton, (1978) told a stmy of women mderpduates at Girtan College,

Cambrid~e in the twenties, who were discussing the menopausal problems

and hat flushes that their mothem md female tutors w e e experiencing: they

agreed that as they were dl emmcipted and fi11ly understood the facts of

l i f ~ , they would never have to suffer the ordeal of flushes. They formed a

Menop;tusa/ Club, promising to keep in touch with one another and give full

accounts of how they faired through that great age. When the time came,

each one. of them mpa-iencecl the flushes and other menopausal symptoms

to a greater or lesser extent. in spite of their full howledge of the events of

life. Ncvedheless. the free flow of infnmation among them reduced

tensions.

5. Changing attitudes, that is, using the power of positive thinking, for

exmpIe:

- Not being womed abut getting pregnant

- Not having to ~nny ahout menstruation

- Achieving better reIatianship with husband and greater enjoyment of

sex 1Ife (Dalton. 1978). For many women, menopause is a synbd of

loss of the ability to k r children and such women accept the situation

as normaI (Gilkrt, 1997).

6. Evohtion of prapammes on how to cope with menopausal problems

[Dalton. 1973).

7. How can I help rnysdf since mencipau.sa1 sjmptorns vary h r n women to

women? @altnn, 1978).

8. Talks to women groups at meetings ~ w m m h , 19%).

9. Menopausal women are advised to have a good night's rest. which is not

mces.wily the same as a goud night sleep. hy avoiding tm many blankets

which will only encourage the night sweats (Dalton. 1978).

10. How can a drrctor help? Refore a doctor recommends harmone therapy, a

definite diagnosis is essential. Usually, it is quite e a q for a doctor to tell if a

patient is pregnant or undergoing the menopause, if she is pregnant, her

breasts will be hll, She may have symp t~ms o f early-morning sickness and

of passing urine during the night. On examination, her vagina is moist and

the neck of the womb is soft. On the other hand. if she is entering

menopause, her breasts will begin to decrease in size. She may have

menopausal symptoms. especially flushes. On examination, her vagina will

he pale and dry. and the neck of the womb firm and smdter. Even the

menopausal wornan's shape alters as her breasts k g i n to sag and she

develops the spare tyre and mibdle-age spread. The thin skin. the greying

hair. the w-rinkles. the dry vagina, and deformed finper and toes me all tell-

tale s i p s . If M h e r confinnation is needed, a blood test will show a rise in

falTicle r;tirnuIating hormnne and luteinjziing harmone. If the banes are badly

affected, the= will also be a rise in the blood calcium and phosphate I~vels

(Dalton. '1978).

1 I . Some countries, Like Britain and the U.S.A. have gone ahead to establish

rnenagausd clinics throughmt their countries to counsel and treat patients.

12 Menopause has demornlising effects. Over SO percent of women fml tired,

confused, irritahls and incapacitated due to the effects of menopausal

tension. Many others are indirectly affected -husbands, children.

colleagues, work mates and friends @a1 ton, 1978).

Summary of Literature

In this Chapter, the author attempted to look at the findings and views of

other authors a b u t menopause. Most of the pubTished materials on menopause

represent the view of workers in the temperate countries of the world. Authors have

defined nlenopause in various ways but in essence the meaning is essentially the

m e : menopause i s defined as the final ceasation of menstrualion and the end of a

woman's reproductive life. Numerous problems have Been listed in literature as

being as.wciated with menopause. Some of the problem9 are physiobgical and

others are psychological in nature. Among the listed menopausal problems are:

fatigue. headache. depression, anxiety, nervousness, loss of appeti te. shrinkage of

the vagina and the shriveling of the breasts. absent-rnindcdness, sweats a d

palpitafions popularly known as "hot flushes"or "hot flashes", irritability,

ceasation of normal monthly menstruation. etc. Some of these problems have health

implications on the life of a woman, and these problems may a f k t her routine

househord roles, and her inability to satisfy. her partner's sexual demands. This

may bring problcms in the family life. These problems have implications to the

guidanee counsellor.

The use of hormow therapy to treat hormone deficiency during menopause

was reviewed and the health implications noted. The Intluenccs of age and

education on menopausal probkms were carefulIy laken note oE

There is a gap in litemure as regards to zhe lack ot'adquate m a r c h ~vork

done on the management of r~empausaT problems of women in the developing

countries of the w d d especially Africa. The coping strategies adopted by the Igbo

woman and less priwieledged women in Nigen'a arc lacking in literature. What

counselling kchniqucs are available to thc Nigerian woman for coping with the

menopausa! phenomenon needed to be research4 upon?

It was against this background that the study on the identification of the

probTems of menopause and coping techniques &opted by women in Abia State

was conceived. Their implications for the health status of women; and the guidance

counsellor aroused the author's interest for undertaking this study.

CHAPTER THREE

Rasearch Method

A description of the procedure and method used in cmying out the ~eseizrch

is given in this chapem. The areas covered are the design of the study, population of

the study, sample and sampling technique. instrument fbr data collection and

validation of the instn~ment. Other ams covered are reliahili'ty of the instrument,

method of data collection and method of' data analysis.

D w i p of the Study

The study is a descriptive survey. It is designed la obtain information on

problems of menopause and coping techniques adopted by women of Abia State.

The: questionnaire was used to elicit information b r n rajmndents.

Population of the Study

According to the Nigerian census or 1 9 1, the population of Abia State was

2. 297. 978. Men were 1: 108, 357 in number whereas women numbered

1 .I 89.62 1.

Abia state women are p u p d based on their age grades. Only 540 women

out of the 1, 189. 621 women in Abia State formed the population or the study.

T h m wQmen involved in 'the s~udy were randomly chosen from thee autonomous

Comnlunitie~ acmrding to their age grades.

Sample and Sampling Technique

Thc method adopted for the sampling of the subjects for lthe study was

stratified random sampling. The sub-division is explained stage by stage in the

folIowing manner. Abia State is made up of 17 Local Governrnen~ Areas, out of

which, three LGAs were randornIy samp!ed for the study. Each Lmal Government

Area consists of n number of autonomous communities. For the study and out of

convenience, three autonomous communities from each h a 1 Government Area

wwe likewise rarldomly sampfed. This subdivision or stratifimtion produced nine

sarnpk of the respondents for each factor investiga~ed. From each autonomous

community. the researcher randomly sampled tIue dirkrent age grades of 40 to 50

years, 50 to 60 years, and 60 to 70 years. The invetigator was able to get the l ist of

women in the age grades in the autonomous communities through the letter of

approval given to her by the Chairman of each Local Government Area. From that

list, women for the study %ere selected.

Twrenty women were sampld from each age grade in each autonomous

commimity through balloting by the nine research assistants. Sixty women in the

~hree age grades, therefore, filled the questionnaires in each autonomous

community. In three autonomous cornunit ies in each h a 1 G o v e n m n ~ Area7

180 wumen wJere involved. Therefore, a total of 5411 women were randomly

selected fir the study. At the end, 458 respondents returned their questionnaires

whereas 82 did not.

Instrument for Data Collection

'T'1-e instrument for data collectior~ for this study was structured

questinnnaire. The importance of the use of questionnaires mostly in educational

research is thad they provide fast means of eliciting infomation from respondents

espxially on a h a d topic. Here, the questionnaire was divided into three

sections. Section A covercd the background of the .respondents. Section B sought

for informlation on the problems of memymuse, while Section C covered

information on coping strategies. The response format of the questionnaires Ts the

four p i n t rating scale (Asogwa, IW8: Uzuegbunam, 1998) as show Below:

Strongly Agree - (S*) - - 4

Agree - (4) - - 3

Disagree - (n) - - 2

Strongly Disagree - (SA) - A 1

Validation o f the Instrument

To establish the content validity of the instn~ment, the questionnaire was

qiven to spialists in 'Measurement and EvaIuation. a CounuelIor and Health C

Educationist for scrutiny and approval. Based on their comments which were:

some questbns were lengthy, some qucstims were combined instead of being

single for easy response, coping techniques should be elicited and not to be

formulated by the researcher, a trial test must be conducted, the final draft of the

instrument was produced.

Trial Test

A lrial test was conducted. Re-structured questionnaires were distributed to

21 respondents. For each age group at 41) to 50 years, 50 to 60 years, and 60 to 70

years, the questionnaires were given to three non-literates and four literates.

Appendix 2 contains the data as collated from the responses of the test.

Reliability of the Instrument

A modified version of the Kudder - Richardson formula by Cronbach

(Nworgu, 1992) was used to establish the degree of internal consistency of the

research instrument. Both the K - R formula as wel1,as Cronbach alpha deal with

dichotomously and multiple scored items as invoived in this study. The coefficient

alpha obtained was 0.99. This means that the instrument used has high reliability.

Method of Tlrrta Adminiatration and Collection

For the main test? the researchcr gavc out one set of 60 questionnaires to

each autonomous carnilunity or nine sets of 540 questionnaires fix the nine

autano~mus. co~nnlunifies through nine research assistants. The researcher

collected them through the research sssislants' help, after the respondents had filled

them. The research assistants made sure that most of the questi~maires were

collected.

Method of Data Analysis

The data \;ls analysed using mean and standard deviation for the research

questions.

In taking decisions, a mean oF2.5 and above was accepted (A) while n mean

below 2.5 was re-jetted (R). The 2.5 decision p i n t wa9 d e t e r m i d by finding tbe

mean ofthe four-point scale (Appendix 5[c]).

The F - test was used to test the HOI because three groupings were involved. The t-

test was used to test the second null hypothesis (H02) involving only two groups.

CHAPTER FOUR

Presentation of Results and Analysis of data

This chapter deals with the presentation of the results and analysis of data.

The five research questions were answered by analyzing the data colIected. The

two null hypotheses were tested at the 5 percent Ievel of significance.

Research Question 1

What are the physical and emotional problerns of menopausal women in

Abia Statc? Table 1 presents the results of the data collected for answering this

rrsearch question.

Table 1 ;

Mean responses of the physical and emotional problenls of menopausal women in

Abia State

I

2 / Occasional sensations of burning heat

S N o

I I

.- 5

5 Devehprnent of winkles on my face

- X

2.16

Factors

2.82 L

4.

Remark

R 1 I Severe headaches A

I

1 3 i Painful sexual intercourse at initial penetration I 2.11 I i Rener enjo)'ment of sexuaI intercourse 3 -09

6 Loss of sex urge

7 TrnT

I

8 1 Tendency of adding weigh1 I I

I

Becoming thinner 1

10

R I

2.64

Have deformed fingers

R I \

12

A

Irritating vaginal discharge

1 3

Note: A = Accepted

R = Re-iected

N = 458

I

2.00

2.09

I I Urinate frequentIy

The respondents os shown in Table 1 agreed that occasional sensations of burning

heat, better enjoyment of sexual intercourse, tendency of adding weight and

becoming absent-minded are the physical and emotional problems which they, as

menopausal women, suffer in Abia State. The women of Abia State, who were

experiencing menopauses, rejected the f~llowing problems as not affecting a

majority of them: Severe headaches, painFuI sexual intercourse at in i tiaJ

penetration, development of winkles on their f'aces; toss of sex urge, problem of

R

2.23

Have become absent-minded

14 ' Hardly deep 2.20

2.26 15

2.55

R

R Feel depressed

- A

I

becoming thinner, fceling dizzy, deformed fingers and irritating vaginal discharges.

They did not consider urinating frequently, inability to sleep ald feeling depressed

as part of the problems of majority of them.

R ~ e a r r h Quedian 2

What influences do age group have orl the menopausal problems?

Tabk 2:

Mean responses OF the age groupings of menopausal problems.

Factors

Phy siml and ernlstiolaal

-- Severe headaches

Occasion~l sensations of

burning heat

Painful sexual intercourse a t

initial penetration

Better enjoyment of sexual

intercourse

my face

Loss of sex urge

- X Remarks

Groupings

X Remarks X Remarks I

50 - 60 Yrs 60 - 70 Yrs

7 1 Becoming thinner 1.59 R -

8 Tendency of adding w i g h t 2.69 A

9 Feel dizzy 2.07 R I

1 10 / Have deformed fingers 11 Irritating vaginal discharge I I 1 R

1 12 ) Urinate frequently 1 2.55 A 13 Have become absent-minded I I R

1 14 1 Hardly sleep ( 2.07 R

1 15 1 Feel depressed 1 2.31 R

Note: Total Number = 458

There is evidence from Table 2 of some age influences on some of the

factorsfprobIemu investigatd. All the ~hree-age grouping of 40 to 50 years: 50 to

60 years and 60 to 70 years unanimously agreed that only occasional sensations of

bunling heat and better enjuymcnt of sex affected a11 women in Abia State. For the

two age groups of 40 - 50 years and 50 to 60 years, the women are agreed that only

one problem was of great concern to them in common: tendency of adding weight.

The older groups of 50 to 60 years and 60 to 70 years agreed that they lost their sex

urge and becamc absenl-minded.

A close look at the results of Table 2 also reveaI that for women in the age bracket

of 40 to 50 years, but in their menopause, had the peculiar problems of urinating

frequently and suffering painfill sexual intercourse at initial penetration.

Menopausal women aged 60 to 70 years agreed Ithat development of winkies on

their Faces was a major problem. I t is interesting to obsenfe that all menopausal

women re-jected severe headaches, Becoming thinner, feeling dizzy, and having

deformed fingers, irritating vaginal discharges, hardly being able to sleep and

feeling depressed a~, problc~ns affecting them in Abia State.

Research Quezstion 3

What influence does education have on the problems?

Table 3: Mean responses of ducation on menopausal problems in Abia State

Factors

Physical and emotional problems

Severe headaches

Occasional sensations of burning heat

Painful s e w 1 intercourse at initial penetration

Betzer enjoyment of sexual intercourse

IkveIoprnenl of vi?inkles on face

Loss of sex urge

kcclming thinner

Tendency of adding wight

Feel d i z q

Have defnrmd fingers

Irritating vaginal discharge

Urinate frequently

Have become absmt-minded

Hardly sleep

Feel depressed

Non-literate Literate 7 N =221 N = 237 - X Remark X Remark

Note; A = Accqted

R = Rejectcd

N = 458

From Table 3, education appears to have very little influence on the n~enopausal

problems of Abia Stare women. Both non-literatc and literate women accepted that

occasional sensathns of burning heat, and becoming absent-minded were

menop~usal problems to them. Both groups of womcn enjoyed sexual intercourse

better d u ~ h g menopause. A difference was found only in rht: te~dency OF adding

weight. White non-literate women rejected adding weight; the Fitcrate wonwn

acceptd adding u ~ i g h t during menopause. In this study, it was remarkable that

groups of women rejccted severe headaches, painhl sexual intercourse at

initial penetration, devehp~nenf of wrinkles orl face, IOSS of sex urge and h o m i n g

thinner as problems during their metmpause. Education made 'PK) impact on either

n d i t e m t e or literate women on feeling dizzy, having deformed firlgers, irritating

vaginal discharge- inability to deep or feeling depressed during menopause.

Rwesrch Qucatinn 4

What twhniq~re~ are used by literate and non-literne women in coping with

the .problems of menopause?

Table 4:

Mean responses on the techniques used by non4tente and literate women in their

coping strategies KI menopause

Factors

Avoidance of hot spices to reduce

heat sensations

Reading materials on menopause helps - . - -

To restore lost sexual satisfaction,

1 got involved in more sex

Peer group discussions on

menopausal problems reduce tensions

Effkctive orientation exercise

through women organizations

Enough activities to occupy my time

Creating awareness that painful

sex during menopause may be expected

Going Iate to bed solved my

Enough romance before sex

X Remarks

Literate

- X Remarks

29 A sn~all quantity of alcohol also improves 2.98 A

25

Self Management SkilIs Ih

3 0 9 - A

p r e p a s me bctter for sex

Rewards from partner after sex reassures

me of h i s continued love - 3.23 A TFTI

Results on Table 4 reveal that both non-literate and literate women in Abia State

2.96 A

30

are a p e d that avoidance of hot spices reduced heat sensations, peer group

discussions on menopausal problems reduced tensions, effective orientation

sex

Sex provides me with a good night sleep

exercise though wornen organizatiom md enough activities 10 occupy their time

w x e techniques that helped them to cope with menopausal problems. It is

3.24 A

interesting to note that both don-literate and literate women agreed that they got

3.12 A

involved in more sex during menopause to resfore losf wxual satisfaction. The two

groups agreed also that a small quantity of alcohol improved their sex life and

prwided them with a good night sleep. Literate women as well as mn-literate

women agreed lhal enough romance &fore s x and eating we41 improved and

prepared them ktter for ex. Surprisingly, both non-literate and literate

menopausal women in Abia State were assured of their partner's love if he

rmvardcd then1 after sex. Education did not create my barriers in women i t 1

agreeing that self-management skills and creating awareness that painful sex may

be expected during menopause coufd help them as coping strategies. Non-literate

and literate women re-j&ed either going late or early to bed as a coping w a t e a for

menopausal problems. Whereas women, who did not receive any formal education,

re*ted reading nlaterials on menopause to ahwiafe their problems, the ducated

uwnen agreed that reading such materials helped them. It must be noted that there

were 458 women respondents in this study.

Research Question 5

Which counselling teclniqucs will be of help in the adjustment of these

problems?

From the review of literature as recorded in chapter 2 of ths text, 12

counselling techniques have been identified. From the results presented in Table 1.

fbur out sf the 15 physicd and emotional problems investigated in menopausal

women in Abia State were relevant (agecd' to). On Table 2, all the three-age

groupings agreed that only hvo out of the 15 physics! and mmtisnal problems

applied Ito t k m . From Table 3, it is discovered thai both nm-literate and literate

menopausat women agreed that only tk of the 15 physical and emotional

problems studied were applicable to them, On Table 4, the respandents have agreed

that 12 out of the 15 coping strategies to mempauw, which were investigated,

helped them to adjust fo their menopausal problems. From the entire study.

therefore, the following counsdling techniques have been elicited:

Table 5: Elicited counselling techniques for menopausal problems and authorities

that have used them

Counsel ling Techniques

Counselling Patients and Family Members

Wornen, thcir partners and children will be counseled in

Abia State to regard he absent-mindedness experienced by

their wives and mothers during menopause as normal and to

be expected during that perid. Also occasional sensations of

burning heat is natural as this study and otl~ers have shown.

Husbands and children should be made r~ accept tluaugh

counselling the ovcr activities of their wives and mothers

during menopause as something normal because it is a m n s

of adjusting to this period of life. Creating awareness that

painfuI sex is to be expected is beneficial to the menopausaI

woman as we11 as to her partner. Whether the woman g m to

bed early or late should be accepted as nonnal and should

not annoy husbands at all. To show t h a ~ ~ h c husband

appreciatm the p d i c m e n t of his wife at menopause, he

will be cuunseI1d 10 reward her after Sex.

- Authorities

Paschkis et

al. 1967:

IsraeI, 1967;

Robert and

Karla, 1995.

Dispelling Fan t a s k and Misconceptions

Guidance CowseElors like the author should inform

women in Abia Sfate that the occasional sensations of

burning heat are physiological prucases not due to

poisoning by any person. So womn should dispel the

fantasitls a d mi.scowcptions that menopause kings sehous

illness and it is the end of sex life. To cope with the

wcasional sensahns of burning heat, the women are

ad&& to avoid hot spices incliding hot tea and coffee.

Contrary to end of sex life, this study has shown that

menopausal women have a better en,ioyment of sexuaI

intercourse. The women could ind t~d have improvcd sex life

if they ate well, took some quantity of aIcohoI and if their

husbands romanced them enough before sex.

45

Parks

(1 967);

B x h a n n

et a!. (I985);

Hawton el

ai: (1994)

and Hunter

(1 990);

Dalton

( 1 978)

Winning of Sympathy of Husbands

This counselling technique will be directcd to

husbands and men to apprcciate the ordeals of their wives or

partners at menopause instead of getting annoyed with them.

A man whose wife has k c o m absent-mindcd should show

pity and not deride her. When some women in their

menopause cornplain of loss of sex urge or conlplain of

painful scx during sexual intercourse, these problems should

be understood as occasioned by changes in biological

pmccsscs. h woman engages in enough activities ta keep

herself busy because all hcr children including her daughter

might f lax left the house or daughters gotten married. She is

busy to avoid mental deprcssion. At thc period of

menopause, husbands are advised to intensifj rornances of

their wives before sex and to reward them after scx SO that

tlic woman does not feel rejected because she is aged or

agrng.

Discussion among Pees Groups or Club Formation

It pays for women to discuss among themselves when they

are faced with menopause. The author will use this

counseiling technique with Abia women who are used

already to age g d c formations. Dalton (1978) a p e d that

the technique of peers forming clubs or discussing among

3 U

Oal ton

(1 97Q

Gilbert

(1987). and

Gail (1995).

Dalton

(1 978)

themselves helped u group of womcn undergraduates at-

Girlon College, Cambridge in the twcnties. In this study,

reading materials on menopause, peer group discussions on

menopausal problems and effective oricntation exercise

through women organizations generated positive responses

from menopausal wornen. This counselling techniquc will lit

thc study arca women because they are already formed in

women organizations in the four Igbo Markct Days 01' Eke,

Orie, Afor and Nhvo. 'l'hese organizations will be good

counselling fora

Changing Atiitudes Counselling Techniques

The fact that menopausal women in Abia State got

involvcd in more sex to restore lost sexual satisfaction and

had to take some small quantity of alcohol to improve their

sex lifc, indicate rhat already this counselling tcclinique will

be well-reccived by the women. Dalton ( 1 978), Bachmann ct

al. (1985), Hawton et al. (1 994) and Huntcr (1990) belicved

that menopausal wonlen en"joyed sex better because they

were no longer worried about getting pregnant, not worried

about monthly menstruation and they achicved bettcr

relationship with their husbands because they were ready for

sex frequently than betbre menopause. The power of positive

thinking is very beneficial in the use of this counselling

technique.

Ilal ton

Bachmann

ct al. (1985),

Iiakton et

al. (1994)

and Hunter

Evdution of Programmes on How to Cope With

Menopausal Problems

When m e Imks at the results presented on Table 4,

one is satisfied that the Abia women responded positively to

self-managen~enl skills to solving Their menopausal

problems. Dalton (1978) emphasized on the evoIution of

progamma by individual women in coping with

menopausal problems because the symptoms of menopause

vary from woman lo woman. 'Tlx mmpausal women

investigated in Abia State a g e d that:

(i) Enough x t iv i ties to occupy ones time

(2) Reading materials on menopause helped them to

cope wirh their hdividual menopausal problems.

Thjs counselling !echmique of calling on every

woman t o devise personal strategies to wpe with

the problen~s of menopause must be stressed in

thc society.

Dalton

Talks To Women Groups at Meetings

This councelling technique was clTeclively med by

Nwamarah in 1 998. Since menopause has demoralizing

effects on women: it pays to talk to thcm whcn thcy arc: alone

at wornen p u p nicetings. Over 30 percent of women fed

tired, confused, irritable md incapacitated due to the erects

of menopausal tension. A good guidance co~uncellor can use

the results obhined in this study to make women happy

again during group meetings assuring then that they are not

alone.

Nwamarah

( 1 998)

Hypothesis 1: Age groupings do not significantly i,nfluerlce menopausal problems

5 0

Table 6: F-tests on significant differences in menopausal problems among the

age groups of 40 - 50 years, 50 to 60 years and 60 to 70 years

Factors

Occasional

sensations of

burning heat

Painful sexual

intercourse at

initial

penetration

Better

enj oyment of

qesual

intercourse

k v e l q r n a t of

wrinkles on my

face

Loss OF sex urge

Tendency of

adding weight

Calculated

F Valve

F = sst - SSE

11.7

13.83

- 304.33

1 73.25

10 1 .O3

14.9 t

Tabutar

F 0.05 = 3.0

V,f

3-d.f.SST

V245S=

d.f SSE

3.0

3 .O

3 .O

3 .O

3 .O

-- 3 .O

Remarks

Reject or

Accept

Ha

Reject Ho

Reject Ho

Accept

Ho

Rcject Ho

Reject Ho

Reject Ho

Note:NI= lG0,N2= 151 a r i d N ~ = 147

Total N - 458 Significant at P -= 0.05

Tabular F 0.05 = 3

V I = 2 = d.f. SST

V2 = 455 = d.f. SSE

- X 1 = the mean of menopausal women of 40 - 50 years old for each factor.

- X 2 = the mean of menopausal women of 50 - 60 years old for each hctor

30.56

1213.49

g

h

- X 3 = the mean of mnopausal women of 60 to 70 years old for each factor

2.1 1

2.90

--

N1 = the number of menopausal women aged 40 to 50 years tbr each factor.

2.07

3 .07

3 .O

3.0

I urinare

frequently

I have becornc

abscn t-mi nded

N; = the number of menopausal women aged 50 to GO years for each factor.

Reject Ho

I

Reject Ho

2.55

1.75

N3 = the number of menopausal women aged 60 to 70 years for each factor

The data on the F-test provided in Table 6 reveal very interesting resu'lts. Please

observe that the F-test values corresponding to each menapausal problernffactor

atd the appropriate remarks of accept or reject are specific in their statistical

interpretations. For those individual comparisons or items where the calculated F-

value was greater' than the tabular F-value, the null hypothesis of no significant

difference between the age groupings in the factor compared was rejected. This 1

means that the averages of'the factor compared deferred significantly at 5% level (P I

< 0.05). On the other hand, the null hypothesis was accepted if the tnean of any

factor compared between the age groups did not differ significantly at 5% level (P

> 0.05).

Hypothesis 2

There are no significant differences in the techniques used by literate and

non-literate women in Abia Sbte to cope with menopausa1 problems.

To test hypothesis 2? mean of literate women was compared with the mean

of non-literate women in 12 of the 15 coping strategies. Using the t-test at 5 percent

level (P < 0.05). Data needed to test this hypothesis are presented in Table 7.

5 3

Table 7: Two-tailed t-test of significant difkrence between the mean responses of

litcrate and non-literate women on their coping strategies.

Factor

Avoidance of hot spices to reduce heat sensations.

To restore h t sexual satisfaction, I got invhed ,in more Sex.

Peer group discussions, on rnenopausa! probiemf reduce tensions.

Enective orientatton exercise through m e n wganisatibns

Ercough activities to mmpy my time

Enough romance before sex prepares me better fw sex.

Creatmg awareness that painful sex during menopause Be expected.

Rewards from partner after sex reassures me of his continued lave.

Self management skills

I Eating wen improves my sex fife

A smalt quantity of alcohd also improves sex.

Sex provides me wlfh a good night sleep

- X

Literate --

2.52

3. I 4

3.46

3.49

3.41

3.34

2.97

2.96

3.3

3.22

2.91

3.12

Remark

Reject

Accept

Accept

Accept

Accept

Accept

A m p t

Reject

Accept

AccepC

Accept

Accept

Note: Nl = 221. Nz = 23 7

Significant at P < 0.05

df = n l + n 2 - 2 = 4 5 8 - 2

N I is the number of Non-literate menopausal women

Nz is the number of Literate menopausal women

TPle analysis in Table 7 nevcals that tiv8 itcms had calculated t-value greater than

the table I-value. Hmcc the null hypothesis of no significant diEereme between

Iikrate a d non-litctate menopauml women in their coping strategies was rz=jecred

while the null hypothesis for the remaining I 0 factors was accepted.

Findings

It was discovered from the study that:

I Occasional sensations of burning heat; tendency of adding weight and

becomilig absent-minded are physical and emotional problems of

menopausal women in Abia State.

2 Menopausal women have a better en.jo-ymcnt of sexual intercourse

3 Menopausal women 40 to 50 years old suffer painfid sexual intercourse at

initial peneltration whereas menopausal women behveen the ages of50 to 70

reject painfill sexual interc~urse at initial penetration as a menopausal

problenl.

Whereas women between 40 to 60 years reject development of wrinkles on

their faces as a menopausal probFem, wonlefi 60 10 70 years accept the

development o f wrinkles on their faces as problematic.

'IenopausaI women between the ages of 50 lo 70 years accept that loss of

sex urge is a problem.

Women of 40 to 58 ymrs in Abia State rejected that they suffered any loss

of sex urge during menopmst.

Whereas meni~pausal women between the ages of 40 to 60 years accepted

that they were adding weight7 those women of GO to 70 years rejecrcd the

tetdency of adding weight as a menopausal problem.

Only 40 to $0 ymr old women accepted urinating frequently as a physical

atd emotional problem of menopause.

50 to 70 year old menopausal women in Abia State thought that urinating

frequently was not a probIem.

A g d menopausal women. 50 to 60 years and 60 to 70 years; declared that

t l q became absent-minded because of menopause.

Younger menopausal women (40 to 50 years old) rejected absent-

mindedness as a problem.

All the three age groupings of 40 to 50 years, 50 to 60 years, and 60 to 70

years were unanimous in their acceptance that only wcasionall sensations of

burning heat and better enjoyment of sex affected all women in their

menopuse in Abia State.

Both nan-litemte and literate women accepted thaf occasional sensations of

burning h a t and becoming absent-minded were '~nenopausal problems to

them.

Both groups sf'women Inon-literate and literare) enjoyed sexual intercourse

better during menopause.

Wherem non-literate women did not add weight at menopause, the literate

ones ncceptcd adding weight.

Education had no influerlcc. on both non-literate and literate women on I 1

o t k physical and emotional problems at merlopuse (Table 3).

Both non-literate and literate women in M i a State accepted the following

cqing strategies as being helpful to them to withstand menopausal

problems:

Avoidance oFhot spices to reduce heat ser~ations.

Peer group discussions of menopausal probkrns reduce tensions

* E f f i t i v e orientation exercise through women organistiom. 4t Emugh activities zo ~ccupy their time.

Both non-lirerate and literate menopausal women accepted invo!vement in

more sex to restore lost sexual satisfaction as a coping strategy.

Literate a d non-literate women agreed that n small quantity of alcohol

improved their sex life and that sex provided them with a good night sleep.

Enough romance before Sex and eating well improved and prepred

mnopausal women, in Abia State. better for sex.

21 Both educated and non-educated women accepted that self-managenlent

skills and crrating awareness that pairifrrl sex may be expeckd during

menopause helped them to cope with the problems of menopause.

22 Literate women in Abis State a g e d that reading materials on mencpause

alleviated their menopausal problems, whereas non-literate women rejected

any such benefit.

23 From studying the 15 physical and emotional problems of menopause and

fionl: evaluating the effectitwms ~f the 15 coping strategies in this study.

seven counselling techniques have k e n elicited.

* Counselling patknrs and family members together (Pmhkis 4 1967; Israel, 1967, Robefi and Karla, 1995)

aL Dispelling fantasies and misconceptions (Parks 1967; Bachmann et

al. 1985: Hawton et al. 1994; Hunter 1990 and Dalton, 1978)

C Winning or sympathy of husbands. Dalton (IW8), Gilbert (1997)

and Gail (11995) employed this counselling technique on husbands

for them 60 appreciate the ordeals of their w i v e at menopause.

Discussion among peer groups or club formation. A youp of

colkge girls at Girton Cdleage, Cambridge employed this strategy

palton, 1978).

* Changing attitudes. ahis counselling technique will be well- received by women Because the study indicated that nlenopausal

women in Abia State whu had suffered sex deprivation because of

fears of pregnancy, got involved in more sex when menopause

l h r a t e d them (Dalton, 1978); Bachmann et al. 1985; Havdon et al.

1994 Hunter, 1990).

Evolution of programmes on how to cope with menopausal

problems (Daf ton, 1978). The power of self-management skiIls is a

case in point.

rTs Talks to women groups ~t meetings. Talking to women at meetings

has proven mssl effective iJ'+lwamarah, 1998).

24 ?he null hypothesis