INTRODUCTION:

“There is no other gift greater than the gift of health. Nurse should aspire to develop the all-round physical, mental, social and spiritual health”.

During the middle age, many women think about their aging bodies and unfulfilled goals. Women will undergo significant menopausal transition or may face physiological and psychological health problem¹.

After the menopause there is an increased risk of the development of chronic diseases, which occur 10 years after the onset of menopause. These diseases are the major source of morbidity such as heart problem, osteoporosis, anxiety and depression and decreased Quality of Life. In order to consider the World Menopause Day on October 18^th/2014, IMS launched a new campaign with the theme that the prevention of diseases after menopause².

SIGNIFICANCE AND NEED FOR THE STUDY:

Nozer, K. Sheriar (2010) explained that the word menopause is “derived from the Greek word which means “month” (men) and “cessation” (pauses). It is a natural event for a woman’s life. Menopause occurs in 40’s or early 50’s and it gives an indicator that fertile phase is ending. It is also defined as, there is a cessation of primary functions of ovaries, the ovum is not ripened and the hormones are not released and uterine endometrium lining does not increase in size and there is a cessation of menstrual flow³.

According to United Nation Statistics, the population of the world is 6.8 billion in the year 2010. According to Indian menopause society, India has a large population which has already crossed the one billion mark with 71 million people over 60 years of age and the number of menopausal women about 43 million. It is estimated that in the year 2026, the population in India will be 1.4 billion, people over 60 years will be 173 million and the menopausal population will be 103 million. The average age of Indian menopausal women is 47.5 years⁴.

Shah Rashmi, (2010), conducted a study in Mumbai among 500 women (40-65 years) of the low socio-economic strata over 64% were menopausal. Women frequently complained of muscle and joint pain (37.4%) fatigue (35.6%), the other symptoms reported were hot flushes (19.4%), sweating (18.6%), insomnia (20.6%) and headache (13.8%). Psychological changes like mood disturbances are also apparent (27.6%) and uro-genital complaints (7.6%)⁵.

At menopause, ovarian secretion of androgens also decreases. Serum testosterone and androsterone levels decline from perimenopausal period onwards. These physiological changes cause the temperature alterations, breathing difficulty, vaginal dryness, shoulder stiffness, hand and leg joint pain, backache, dysuria and dysparunia⁵.

The word “Yoga” means “Yoke” or “Unity” translated from Sanskrit, the classical language of India. It also means “discipline” or “effort.” Yoga requires to make an effort to unify body and mind. It can do this by concentrating physical body through breathing and postures in order to build strength and flexibility. As explained yoga is an ancient discipline designed to bring balancing health to the physical, mental, emotional and spiritual dimensions of the individual. Menopause is associated with estrogen deficiency and leads to many physiological and psychological changes⁶.

Yoga is a complementary therapy, which is proved to be effective in reducing the menopausal symptoms. In the western country yoga has long been prescribed for anxiety reduction and is said to alleviate other menopausal symptoms including depression, hot flashes, mood swings and insomnia. The deep breathing exercise and yoga works on improving blood circulation by maintaining water and air circulation and increasing muscle tone and flexibility, It also massages the internal organs, strengthen the bones, makes the heart work efficiently and tones the interior and exterior muscles thus increasing the mood-regulating chemicals to the brain⁶.

Yoga is increasingly popular nowadays. According to experts at yoga is the most important alternative therapy available to the menopausal woman. Yoga helps a woman control her body and emotions by using her internal resources, each time of exercise, the adrenal glands are stimulated to convert the male hormone androstenedione in to oestrogen. A minimum of 30-minutes exercise sessions in a week will be enough to keep 'topped off' with estrogen. This, in turn, can reduce the likelihood of severe hot flashes⁷.

Yoga therapy has great practical relevance to modern medicine with promotion, preventive and curative potential. Especially the three limbs of yoga therapy namely asana, pranayama and dhyana promotes positive health, vitality, sense of wellbeing and increased quality of life. They are also effective in controlling and managing stress related, chronic degenerative, age and life style related disorders and also is simple, cost effective and easy to practice.

STATEMENT OF THE PROBLEM:

“A study to assess the effectiveness of yoga therapy on menopausal symptoms among the menopausal women in selected rural areas at Madurai District.”

OBJECTIVES OF THE STUDY:

1. To find out the pre and posttest level of menopausal symptoms among the postmenopausal women in the experimental and control group.

2. To evaluate the effect of yoga therapy on menopausal symptoms among the postmenopausal women.

3. To determine the relationship between the menopausal symptoms among the postmenopausal women in the experimental and control group.

4. To find out the association between the level of menopausal symptoms with the selected demographic variables among the women in the experimental and the control group.

Hypotheses

H₁: The mean posttest score of menopausal symptoms is significantly lesser than the mean pretest score of menopausal symptoms among the women in the experimental group of postmenopausal women who had interventional strategies.

H₂: The mean posttest score of menopausal symptoms is significantly lesser in experimental group than the mean posttest score of menopausal symptoms in the control group.

H_6:There is a significant association between the pretest level of menopausal symptoms and the selected demographic variables among the women in the experimental and the control group.

Assumptions:

1. Regular practice of yoga maintains the general well being and minimizes the menopausal symptoms and strengthen the immune system.

2. The study assumes that the postmenopausal women may experience more menopausal symptoms.

3. Hormonal imbalances may be balanced or regulated when the maintenance of yoga therapy and diet from the beginning.

4. Yoga therapy may provide a source of distraction from daily life and enhance of self esteem.

5. Yoga therapy may be effective along with diet in relieving menopausal symptoms among postmenopausal women.

6. Practice of yoga therapy regularly results in holistic healing without harm effects.

Delimitations:

The following delimitation were applied

· Postmenopausal women between 45-60 yrs.

· Postmenopausal women experiencing from menopausal symptoms.

· Data collection period was limited to one year period.

· Since only rural postmenopausal women are included in this study, the results may not be generalized to urban women.

· The participants constitute a purposive sampling that may limit transferability of results to other populations.

· Only selected yoga therapy has been taught. They would introduce limited tips to overcome from menopausal symptoms. Those who are willing to accept for yoga therapy regularly with satisfactory manner without facing difficulties.

Conceptual Framework:

The conceptual framework for the study was derived from general system theory developed by Von Ludwig Bertanlaffy (1972) credited with originating the idea of general system theory.

METHODOLOGY:

Approach:

Quantitative approach was used to determine the effect of yoga therapy on postmenopausal women.

Design:

The research design selected for the study was quasi-experimental, non equivalent control group pre and posttest design.

Setting of the Study:

This study was conducted among post menopausal women, who are living in the selected villages

The postmenopausal women experienced the menopausal symptoms such as hot flashes, joint pain, body pain, general tiredness and sleeplessness. These villages women were not facilitated with special services related to prevention of postmenopausal problems, other than the common services from the primary health centre.

Sampling Process:

Seven villages were selected, according to the sampling criteria. Out of 7 villages, 4 villages were selected by simple random method. Samples were selected from these villages for the experimental and control group that, the postmenopausal women who are consented to participate in the study were included. The total number of subjects from each village were included in the lot count based on their house number and then the subjects were selected by purposive sampling technique.

Accessible Population:

Accessible population for this study is the postmenopausal women who are residing in the selected villages, between 45 to 60yrs.

Sampling Technique:

Samples were selected by purposive sampling technique. Samples were selected based on the following inclusion criteria.

Inclusion Criteria:

Postmenopausal women who are

· Between 1 yr to 10 yrs after menopause.

· Between 45-60 years of age.

· Having menopausal symptoms with the score of >20 in the 4’ Point Likert’s Menopausal Symptoms Scale.

· Able to understand and speak in Tamil or English.

· Married and living with their husband.

Exclusion criteria:

Women who

· Are working in the health field were excluded.

· Had undergone hysterectomy and salpingo - ophorectomy.

· Had received Hormone Replacement Therapy(oral contraceptives) within three months prior or more than the duration.

· Are already practicing or who had previous exposure to yoga therapy.

· Are unable to practice yoga at the day and time offered.

· Experience with un-natural menopause-e.g., surgical or radiotherapy for cervix cancer.

· Are physically unfit and have serious disease.

· Are not willing to give consent due to their own reasons (who do not believe on yoga, cultural restrictions non-response was primarily due to shy attitude, no interest or lack of time).

Pilot Study:

Pilot study was conducted with 10 samples from each group, these samples were not included in the main study. Written permission was obtained. Samples that fulfilled the inclusion criteria were selected after receiving a written consent. Confidentiality was assured to all the respondents and explained that their data would be used for study purposes.

Method and data collection procedure:

After selecting the sample, written permission was obtained. Informed consent was formally obtained prior to data collection including potential risks and benefits, duration of the study, informing them that they could withdraw from the study at any time. Participant’s data was kept confidential. With no name in the questionnaire (anonymity and privacy) confidentiality was assured. There was no risk associated with yoga therapy. Participants were informed to contact further for any future concerns.

FINDINGS AND DISCUSSION:

The postmenopausal women according their demographic variables both in the experimental and the control group respectively 9% and 0% women were from Muslim religion, 33% and 59% women were house wife 26% and 6% of them had thyroid problem, 33% and 2% of the women had scanty amount of bleeding and sterilization done 56% and 78%.

Figure:1 Bar diagram, shows the level of menopausal symptoms of pretest, post I and posttest II in the experimental and the control group.

Figure: 1 - Bar diagram on the Level of Menopausal Symptoms

Table:1, Shows that, the posttest II score is significantly lesser in the experimental group than the pretest score of menopausal symptoms and also there is a significant reduction in posttest II in the experimental group than control group.

Figure:2-Line diagram showing mean values of menopausal symptoms among the postmenopausal women. One way repeated measurement on menopausal symptoms by ANOVA test in the experimental and control group among postmenopausal women. Shows the mean score of pretest, posttest I and posttest II assessments on menopausal symptoms among the postmenopausal women. The Line diagram clearly indicates that, there is a lesser mean value in the experimental group compared with the control group, therefore there is a significant reduction on menopausal symptoms in the experimental group than control group.

Table:1 Comparison of pretest and posttest II mean menopausal symptoms score between the experimental and the control group among post menopausal women (n = 210).

Variable		Experimental group			Control group
Variable		Mean	SD	‘t’-value(p-value)	Mean	SD	‘t’-value (p-value)
Physiological symptoms	Pre test	11.34	2.11	30.06 (0.000***)	11.03	1.7	2.07 (0.041*)
Physiological symptoms	Post test II	5.08	1.34	30.06 (0.000***)	10.52	1.88	2.07 (0.041*)
Musculoskeletal symptoms	Pre test	8.68	1.59	32.29 (0.000***)	8.49	1.77	1.69 (0.092)
Musculoskeletal symptoms	Post test II	3.63	0.88	32.29 (0.000***)	8.05	1.68	1.69 (0.092)
Urological symptoms	Pre test	8.58	1.36	29.64 (0.000***)	8.71	1.53	3.29 (0.001**)
Urological symptoms	Post test II	3.69	1.003	29.64 (0.000***)	8.04	1.65	3.29 (0.001**)
Vulvovaginal symptoms	Pre test	11.32	1.39	36.04 (0.000***)	11.75	1.31	3.61 (0.005**)
Vulvovaginal symptoms	Post test II	4.96	1.2	36.04 (0.000***)	10.99	1.66	3.61 (0.005**)
Psycho sexual symptoms	Pre test	5.85	0.76	36.27 (0.000***)	5.73	0.62	5.18 (0.000***)
Psycho sexual symptoms	Post test II	2.59	0.71	36.27 (0.000***)	5.19	0.97	5.18 (0.000***)
Vasomotor symptoms	Pre test	11.38	1.67	33.72 (0.000***)	11.34	1.54	4.04 (0.000***)
Vasomotor symptoms	Post test II	5.09	1.29	33.72 (0.000***)	25.03	3.53	4.04 (0.000***)

* p<0.05, significant, ** p<0.01 and ***p<0.001 Highly significant.

Association between the menopausal symptoms and the demographic variables:

There was a significant association between the menopausal symptoms and the demographic variables such as the educational status (χ²value= 9.12 at ‘p’ value 0.26).

There was no significant association between the menopausal symptoms and the demographic variables such as the type of family, premenstrual syndrome, age at marriage, number of delivery, personal habit, relaxation therapy, nature of bleeding, miscarriage and sterilization, menopausal diet, health resource, menarche, frequency of menstruation, duration of menstrual bleeding, dysmenorrhea, age at 1^st delivery, hormonal therapy, menstrual cycle, irregularities in menstruation, menopause attained and years after menopause of the postmenopausal women in control group.

There was no significant association between the pretest level of menopausal symptoms and the demographic variables such as the menopausal diet, health resource, menarche, frequency of menstruation, duration of menstrual bleeding, nature of bleeding, dysmenorrhea, age at 1^st delivery, hormonal therapy, menstrual cycle, irregularities in menstruation, menopause attained and years after menopause of the postmenopausal women in control group.

LIMITATIONS:

The study findings are applicable to a specific population, The study findings may not be generalized to the entire population because of cultural specification and different type of life style.

· The posttest effects were only observed in the experimental group in short term and with an average follow up in between.

· Improvements in the outcomes such as intention to use, selected study areas have unequal proportion of female population. So researcher found it difficult to randomize equally in the areas.

· Implementation required trained professionals.

CONCLUSIONS:

The following conclusions were drawn from the current study findings.

· The researcher suggested that regular practice of yoga therapy is effective in minimizing the menopausal symptoms.

· Women in experimental group benefited with regular practice of yoga.

It was necessary to introduce the yoga therapy in rural areas because,

· Women were not aware of yoga therapy,

· It was easy to practice yoga regularly,

· Yoga therapy does not have side effects.

The current study findings do portray that, the intervention was effective on reducing the menopausal symptoms. The postmenopausal women have a lot of queries related to care of themselves during postmenopausal period such as dietary modification, initiation of yoga therapy and modification of life style in order to balance their hormone level. The subjects were cleared related to care of themselves during postmenopausal period after the yoga therapy.

The yoga therapy is a simple, cost effective and easy to practice. It should be practiced at least twice a day. This practice is found to be helpful in today’s life style because of high level of stress and goal oriented life. Yoga can cause difficulties like body pain and discomfort for few days for the beginners. But with habitual practice one can realize the effects of yoga therapy within couple of weeks along with dietary pattern. Yoga (Yoga therapy -Vitamin Y) can help to minimize the postmenopausal symptoms and also the need of drugs in the future.

REFERENCES:

1. http://timesofindia.indiatimes.com / Indian Menopause Society (2016)

2. http://www.indian menopause society.org (2015)

3. Yoga Therapy and Menopause "Mit freundlicher Genehmigung von Maimu Opmann, Estonia und Lia Lappalainen, Finland 2010

4. US Census Bureau. Population survey, female population March 2002. Available at: http://www. Census.gov/population. Joann E. and Manson, 2002

5. Journal of Yoga - Ontogenetic and Therapeutic Investigation, Sept 2010 (Volume 02, Issue 01), Page -14

6. J. Midlife Health. 2013 Journal of midlife health Indian menopausal society. Jul-Sep; 4(3): 182–187.

7. Shah Rashmi, Menopausal symptoms in urban Indian women. Obstetrics and Gynecology today: 667-670.

Received on 10.11.2018 Modified on 04.12.2018

Asian J. Nursing Education and Research. 2019; 9(2):169-173.

DOI: 10.5958/2349-2996.2019.00035.1