Various factors determined a woman perceptions about menopause. Menopausal status, social background, education, occupation, physical or emotional health, and general symptoms may influence the view of menopause. [17,18]
While menopause has been extensively investigated elsewhere, menopause and its related studies are very limited in Malaysia.
Many studies conducted in Asian women as well other parts of the world noted that women perception or attitudes towards menopause and how they themselves and society or the communities perceived menopause have mix responds, the similar findings were noted in this study, more than 50% of the women interviewed were not able or not sure what were their perceptions on menopause [2,19-25]
Ismail in his study reported 16% of women regards menopause as a ‘pity’, 60% was pleased and 24% of women felt it did not matter.NorHayati noted 73.1% of women did not view menopause as a medical condition and 71.7% did not feel they are less of a woman after menopause. [2,19]
Study done in Thailand by Chirawathul et al. (1994) noted that for rural women regarded menopause as a simple and natural biological event which do not need any treatment and they also feel better as they do not have to worry about pregnancy after menopause. Mazhar et al. (2003) noted, Pakistani women have different views about menopause; few see it as medical condition requiring treatment, whereas a majority consider it a natural transition. In contrast, majority of the women (69.1%) in this study were not sure either menopause is medical problem or not. [20,21]
Two community studies done in Taiwan in recent years revealed Taiwanese women were highly aware of menopause (97%), with a very positive attitude to accept menopause and demonstrated great willingness to receive medical treatment. Study by P.Leon et al. (2007) among middle age Ecuadorian women, showed positive attitudes towards menopause, 93.7% viewed it as a normal event and not a problem, 65.3% said it is a relief as there is no more pregnancy risk, 60.7% reported life is easier and calmer. Sinclair et al. (2003) noted that 80% of women agreed with the view that because the menopause is brought on by diminished hormone levels, it should be viewed as a medical condition and treated as such. Majority of them (76.2%) also disagree that a woman feels less of a woman after menopause. [25]
However, in this study, only 28.1% were relief of no more pregnancy risk; 22.5% agreed menopause is a natural process and only 21.9% agreed that menopause should be treated medically, while only 24.2% of the respondents feels less of a woman following menopause [20-24]
In this study it was noted that majority of the women, 69.1% were not sure either to treat menopause medically, while 62.1%, were not sure either natural approach with traditional medicine, herbal or alternatives medicine were better than hormonal approach.
In contrast, a study among Kelantanese women in Malaysia by NorHayati she noted, majority or 73.1% of her respondents did not view menopause as a medical condition. In a similar note, study done by Chirawathul et al. also concluded that Thai women regarded menopause as a simple and natural biological event which do not need any treatment while Mazhar et al. in their study among Pakistani women reported that among his respondent few see it as a medical condition requiring treatment, whereas a majority consider it as a natural transition. Larroy et al. (2020) in his study among Asian countries, menopause is treated as a natural aging process, and associated with higher social status and wisdom among the the communities. [19,20,21,27]. However, study by Sinclair et al, noted that majority of their respondents agreed with the view that, because the menopause is brought on by diminished hormone levels, it should be viewed as a medical condition and treated as such, while in two community studies done in Taiwan in recent years revealed Taiwanese women were highly aware of menopause (97%), with a very positive attitude to accept menopause and demonstrated great willingness to receive medical treatment. [19-25]
Majority of the respondents agreed that absence of menses after menopause is a relief 75.0% and 61.2% agreed that menopause causes unpleasant symptoms however only 28.1% agreed that they look forward to not worrying about pregnancy after menopause. This correspond with study by P.Leon et al. (2007) among middle age Ecuadorian women, showed positive attitudes towards menopause, 93.7% viewed it as a normal event and not a problem, 65.3% said it is a relief as there is no more pregnancy risk, 60.7% reported life is easier and calmer. Another study by Chirawathul et al. (1994) on Thai women, noted they feels better after menopause as they do not have to worry about pregnancy. [20,24] Meanwhile, in another study conducted by Wong et.al (2007) among middle-aged women in Kuala Lumpur noted most of the participants had positive attitude towards menopause. Majority agreed that menopause indicates loss of youth and fertility and a sign for aging. Responses relating positive reactions included that; menopause is a part of getting old, freedom from menstruation, pregnancy and child birth.
Negative attitude towards menopause such as, it is a disease, feeling no longer like a real Women, old and useless, loss of drive to perform daily chores were rejected by many most participants. Surprisingly, despite positive attitude towards menopause, many participants expressed nervousness, fear and sadness about approaching menopause. [26]
In this study, it could be concluded that majority of the respondents have not thought that menopause and sexual activity were related. This can be interpreted from the study because only 2.8% of the women agreed that sex is more enjoyable after menopause; and only 34.8% agreed that women are less sexually attractive after menopause and 24.2% feels like less than a woman after menopause.
When comparing at the status or stages of menopause, those with positive perception or attitude towards menopause in this study were generally among perimenopausal women in compare to pre or postmenopausal women, the same findings were noted by Larroy et al. (2020), Wong et al. (2007) and a few other studies conducted in Asian and European women where positive perceptions were shared more by younger women compared to older women in their post-menopausal stages. [19,20,22,24,26,27]
Level of educational standard and background were also noted to be a positive influence among women regarding menopause, this study and few other studies done have noted that women with higher educational background generally have a better and positive perception on menopause. [28-34]
While collecting data, it was noted that there was reservation among participants on sensitive questions especially on questionnaires regarding sex. This could be due to the norm of Malaysian and Asian society in which women were reluctant to discuss openly on this topic. Another limitation was the difficulty in translating the question into different local dialects/languages; but in order to minimize this effect, the researcher had conducted face-to-face interviews with the help of a translator and explanation was given to respondents who had problem understanding the questions.