Menopausal symptoms and utilization of menopausal hormone therapy among women aged 40-60 years in Addis Ababa, Ethiopia: A cross-sectional study

Menopausal symptoms and utilization of menopausal hormone therapy among women aged 40-60 years in Addis Ababa, Ethiopia: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Menopausal symptoms and utilization of menopausal hormone therapy among women aged 40-60 years in Addis Ababa, Ethiopia: A cross-sectional study Tewodros Getahun Asfaw, Rahel Demissew Gebreyohannes, Milcah Temesgen Tesfaye This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4411857/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Sep, 2024 Read the published version in BMC Women's Health → Version 1 posted 10 You are reading this latest preprint version Abstract Background : The onset of menopause leads to diminished estrogen exposure, resulting in a high morbidity burden related to menopausal symptoms. Menopausal hormonal therapy is an effective therapy that offers more advantages than disadvantages for women aged less than 60 years or who have had menopause for less than 10 years. OBJECTIVE : This study aimed to assess the prevalence of menopausal symptoms, identify factors associated with menopausal symptoms, and assess the use of menopausal hormone therapy among women aged 40-60 years who visited the gynecological clinics of three hospitals in Addis Ababa, Ethiopia. Methods: A facility-based cross-sectional study was conducted from January 2022 to June 2022 at Gandhi Memorial Hospital, Tikur Anbessa Hospital and Zewditu Memorial Hospital on atotal of 296 middle-aged women. Data were collected using an interviewer-administered structured questionnaire and analyzed for sociodemographic factors, utilization of menopausal hormone therapy, and prevalence of menopausal symptoms using the menopause rating scale. Data were analyzed using SPSS version 25. Bivariate and multivariate logistic regression analyses were performed to identify independent predictors of each subscale of menopausal symptoms. The strength of the association was measured using odds ratios with 95% confidence intervals, and statistical significance was set at value P<0.05. Result : The prevalence of menopausal symptoms was 89.9%. According to menopausal rating scale, the frequency of reported symptoms was hot flushes (54.7%), muscle and joint pain (32.1%) on somatic subscale; physical and mental exhaustion (55.1%), irritability (48.6%) on psychological subscale; and sexual problems (41.3%), bladder problems (39.2%) on urogenital subscale. This study also showed that the age of women and monthly family income were significantly associated with all three subscales of the menopausal rating scale. There was no utilization of menopausal hormonal therapy to treat menopausal symptoms and to prevent complications. Conclusion : The prevalence of menopausal symptoms is high; however, the utilization of individualized administration of menopausal hormone therapy according to symptoms is negligible. It appears essential for these institutions to work on service availability and delivery of menopausal hormone therapy for those in need of wider benefits of their clients. Menopause Menopausal symptoms Ethiopia Gynecology Hot flushes Somatic symptoms Psychological symptoms Urogenital symptoms. Figures Figure 1 Figure 2 BACKGROUND With a few exceptions, women have longer life expectancies than do men in both developed and developing countries. The reasons relate to female biology, such as hormonal protective factors, and fatal risk factors associated with male working conditions, lifestyle, and a higher risk of injury.( 1 ) At the global level in 2019, approximately nine per cent of people were aged 65 years or older, with two-thirds of the world's older population now living in low-income and middle-income countries.( 2 ) According to the 2019 Revision of World Population Prospects, Ethiopia ’ s life expectancy in 2021 is 67.07 years.( 2 ) Menopause is a normal phase of life, similar to puberty; and should not be viewed as abnormal. For many women, it is a welcome change, with no further menses or premenstrual syndrome (PMS), and there is no need for contraception or concern for conceiving.( 3 ) A woman is said to have reached menopause if she remains amenorrhoeic for consecutive 12-months and demonstrates biochemical evidence of hypergonadotropic hypogonadism.( 4 ) The menopausal transition phase is characterized by an increasing irregularity in the menstrual cycle length. This irregularity is defined as the recurrence of a 7-day difference in cycle length over 10 cycles. This stage lasts 1–3 years and occurs when vasomotor symptoms such as hot flushes begin to occur.( 5 ) The menopause is that point in time when permanent cessation of menstruation occurs following the loss of ovarian activity. Perimenopause includes the years prior to the final menstrual period, during which menstrual cycles progress from a regular ovulatory and predictable pattern to irregular and increasingly anovulatory cycles, to eventual cessation of menses. This stage ends 12 months after the final menstrual cycle.( 6 ) Menopausal symptoms experienced by many women during menopausal transition and postmenopausal period.( 7 – 16 ) Hot flashes, one of the most common symptoms, typically resolve several years later, for about 15–20% of women untreated symptoms are severe enough to interfere with quality of life.( 17 – 21 ) For these women, estrogen therapy is the most effective treatment for relieving hot flashes, night sweats, vaginal dryness, and possible improvements in mood, sleep quality, and concentration. It also protects against osteoporotic fractures and prevents osteoporosis.( 22 – 28 ) These data indicate that the initiation of menopausal hormonal therapy soon after menopause in women with presumably normal arteries may not be at risk and may even derive beneficial cardiovascular effects. In contrast, initiation many years after menopause is susceptible to the proinflammatory and prothrombotic effects of estrogen among the associated atherosclerotic lesions, leading to excessive coronary risk. This timing hypothesis does not mean that recently menopausal women should be administered estrogen therapy for the primary prevention of coronary heart disease. Rather, clinicians are reassured in clinical practice of cardiac risks when considering the short-term use of menopausal hormonal therapy in women with bothersome vasomotor symptom relief.( 26 , 29 – 33 ) Concerns include increased risks of thromboembolic disease, endometrial cancer, gallbladder disease, and breast cancer as well as increased risks of dementia, cardiovascular events, stroke, and ovarian cancer.( 31 , 34 – 40 ) Accordingly, most people now believe that short-term menopausal hormonal therapy using the lowest effective dose is a reasonable option for women with severe-to-moderate menopausal symptoms who are recently menopausal and have satisfactory cardiovascular health.( 29 , 30 , 32 , 33 , 41 ) Short-term therapy is no more than 4–5 years because symptoms diminish after several years, whereas the risk of breast cancer increases with longer duration of hormone therapy.( 29 ) Assuming that the timing hypothesis is correct, a younger patient, during the menopausal transition, or a recently menopausal woman (final menstrual period 5 years ago) at a low baseline risk of coronary heart disease, stroke, and venous thromboembolism are reasonable candidates for short-term hormone therapy. In clinical practice, most women seeking interventions for hot flashes fall into this category. ( 8 , 9 ) As shown in a multicenter randomized trial conducted in Denmark in 2012, after 10 years of randomized treatment, women using hormone replacement therapy (HRT) early after menopause had significantly reduced risks of mortality, heart failure, and myocardial infarction without any apparent increase in cancer, venous thromboembolism, or stroke.( 42 ) According to the guidelines of the governing principles of the International menopausal Society (IMS) governing principles, Menopausal hormonal therapy (MHT) is the most effective therapy for urogenital atrophy and vasomotor symptoms. It may also improve sleep disturbances, mood swings, joint and muscle pain, and sexual dysfunction including reduced libido. IMS supports initiating treatment for MHT before the age of 60 years, and its use for 5 years in healthy women is safe.( 43 ) The World Health Organization recommends MHT as the most effective treatment for vasomotor symptoms (VMS) and genitourinary syndromes of menopause. It is also effective in the prevention of osteoporosis and is advantageous for women who have had menopause for less than 10 years or aged less than 60 years. ( 44 ) Women with no risk factors especially perimenopausal women, low-dose COCs are effective for treatment of vasomotor symptoms, irregular uterine bleeding, and maintenance of bone mineral density. However, menopausal symptoms can worsen during the pill-free period; therefore, so it should be used in continuous fashion.( 45 – 47 ) Accordingly, the Ethiopian standard treatment guidelines also recommend MHT for at least five years in healthy post-menopausal women aged < 60 years.( 48 ) Conjugated equine Estrogen and Estradiol are available in Ethiopia, Ethiopian food and drug authority, Ethiopia. ( 48 , 49 ) Menopause and its burden on women’s physical and psychosocial health are among the least studied issues in Ethiopia. The use of MHT is common and standard in different parts of the world, and little is known about the use of HRT in Ethiopia. In addition, menopausal symptoms, such as vaginal health, urogenital symptoms, and vasomotor symptoms, are not usually assessed and discussed in health facilities in Ethiopia despite their high prevalence in menopausal women.( 7 , 50 – 56 ) Hence, we aimed to assess the prevalence of menopausal symptoms, identify factors associated with menopausal symptoms, and use of menopausal hormone therapy among women aged 40–60 years who visited the gynecological clinics of three hospitals in Addis Ababa, Ethiopia. METHODS Study setting and design This facility-based cross-sectional study was conducted in three large hospitals in the capital city of Ethiopia, Addis Ababa: Tikur Anbessa Specialized Hospital (TASH), Gandhi Memorial Hospital (GMH) and Zewditu Memorial Hospital (ZMH), between January 2022 and June 2022. The study included 296 patients who visited the outpatient gynecological clinics of the hospitals. The required sample size was determined using single proportion population formula by assuming 95% confidence interval, 5% margin of error, and taking the second commonly reported individual symptom and variable that gives largest sample size, which is the prevalence of difficulty falling asleep (P = 49.6%) from a community based study conducted in Gullele sub-city of Addis Ababa, Ethiopia. ( 7 ) Adjustment were made for the population (less than 10 times the estimated sample size) using a finite population correction factor. Data collection procedures and analysis The average age of occurrence of the first symptoms of menopause is variable in different parts of the world, with evidence showing that the majority of women suffered and started to manifest menopausal symptoms in the age group of 40–60 years.( 7 , 57 , 58 ) According to Ethiopian standard treatment guidelines, hormone replacement therapy is recommended before the age of 60 years.( 48 ) Therefore, women aged 40–60 years who attended gynecological clinics in the three selected hospitals were recruited for the study. According to HMIS report of TASH, ZMH, and GMH between December 2020 and May 2021, the total number of patients evaluated and treated in the gynecologic clinics was 1096, 712, and 653 respectively; of these, 43.6%, 35%, and 31.2% of them aged 40–60 years, respectively. Therefore, 931 women aged 40–60 years were served by these three hospitals during the specified period. Pregnant or lactating women, women who were using hormonal contraceptives, women with uncontrolled medical conditions such as hypertension, hyperthyroidism, diabetes mellitus, or heart disease, women who were undergoing treatment for serious diseases such as cancer, and women who refused to participate were excluded from the study. Women were selected as they appeared for a clinic visit for various gynecological complaints, and information was collected until the desired sample size was achieved. Information was collected by three trained interviewers (BSC nurses) through face-to-face interview. The data were collected using a standard interviewer-administered questionnaire. The questionnaire was first prepared in English, then back-translated to Amharic, and translated back to English to maintain consistency. The study questionnaire was adapted from the Ethiopia Demographic and Health Survey 2011 questionnaire, a previous menopausal study, and menopausal symptoms were collected from participants according to an 11-item Menopause Rating Scale (MRS). The MRS is a self-reported subjective scale that has been used in different international populations and validated in clinical and epidemiological studies on menopausal symptoms.( 59 ) The MRS is composed of 11 items assessing menopausal symptoms and is divided into three subscales: ( 1 ) somatic: hot flushes, heart discomfort, sleeping problems, and muscle and joint problems; ( 2 ) psychological: depressive mood, irritability, anxiety, and physical and mental exhaustion; and ( 3 ) urogenital: sexual, bladder, and vaginal problems. The MRS has been translated into more than 22 languages that do not include the Amharic version. However, it was used in a study conducted in Ethiopia that used an English version. For the purpose of this research, the English version of the MRS was used. The draft Amharic translation of the MRS was made by the primary investigator, reviewed and finalized by committee consisted of a translator and three obstetricians (experts in the field), and one MSc holder in public health.( 59 ) The dependent variables were the MRS subscales of menopausal symptoms (somatic, psychological, and urogenital symptoms) and utilization of menopausal hormone therapy. The independent variables were socio-demographic characteristics (age, marital status, educational level, partner educational level, occupation, and monthly family income) and obstetric and gynecological characteristics ( parity, age at menarche, age at first and last delivery, history of oral contraceptive use, smoking history, and history of physician visit). Data were analyzed using SPSS version 25. Frequency distribution, percentages, mean, median, and cross-tabulation between the dependent and independent variables were calculated, and the basic socio-demographic characteristics of the respondents were summarized. Variables with P value < 0.25 during the bivariate analysis, were included in the multivariate analysis to determine the effect of confounding factors. Strength of the association was measured using odds ratios with 95% confidence intervals and statistical significance was set at value P < 0.05. Operational Definition Somatic symptoms: A woman was considered to have somatic symptoms if she complained of at least one of the following symptoms in the previous 1 month: hot flushes, sweating, difficulty in sleeping, muscle and joint discomfort, or heart discomfort. Psychological symptoms: A woman was considered to have psychological symptoms if she complained of at least one of the following symptoms in the previous 1 month: depressive mood, irritability, anxiety, and physical and mental exhaustion. Urogenital symptoms: A woman was considered to have urogenital symptoms if she complained of at least one of the following symptoms in the previous 1 month; sexual problems, dryness of the vagina, and bladder problems. Overall menopausal symptoms: If a woman complained of one of the following symptoms in the previous 1 month, she was considered to have menopausal symptoms: history of hot flush, sweating, heart discomfort, sleep disorders, depressive mood, nervousness, irritability, anxiety, physical and mental exhaustion, disorder of sexuality, urinary symptoms, vaginal dryness, and joint and muscle symptoms. Menopausal Hormonal Therapy: Defined in this study as any form of hormone therapy that consisted of estrogen and/or progestin prescribed to treat menopausal symptoms or to prevent complications like osteoporosis Hot flush: A sudden feeling of feverish heat and warmth in the upper body, which is usually most intense over the face, neck, and chest. Heart discomfort: Palpitation, racing heartbeat, tightness in chest Sleep disorders of menopause: Difficulty in falling asleep, difficulty in remaining asleep through the night, waking too early Depressive mood: Despondency, sadness, tearfulness, lack of drive, mood fluctuations Irritability: Nervousness, inner tension, feeling aggressive Anxiety: Inner restlessness, feeling panicky Physical and mental exhaustion: Poor concentration, forgetfulness Disorder of sexuality: reduced libido, sexual activity and satisfaction Vaginal dryness: Feeling of sore or itching in and around the vagina, pain, or discomfort during sexual intercourse Bladder problem: Symptoms during urination, frequent need to pass urine, accidental incontinence Joint and muscle discomfort: Pain in joints Sexually inactive: If a woman had no sexual contact in the previous 1 month considered as she was considered sexually inactive. Physician visits are either formal or informal meetings between patients and health professionals to get health advice or treatment plans for menopausal symptoms. Monthly family income classified according to employment income tax rates for Ethiopia( 60 ) Menarche was classified as early ( ≤ 12 years), medium (13 -14years), or delayed (> 14years)( 61 ) RESULTS Socio-demographic characteristics A total of 296 women aged between 40–60 years were invited for the interview, consented to participate in the study giving a response rate of 100%, and included in this study. Mean age of study participants was 46years (SD ± 6.1), 149/296 (50.3%) of the participants were in the age range of 40–44 years. Nearly three forth (211/296, 71.3%) of the participants were married, 120/296(40.5%) were housewives, and 72/296 (24.3%) were government employees. Almost one third of the participants (92/296, 31.1%) completed secondary education. Most participants had low and middle family incomes, according to the classification of employment income tax rates for Ethiopia. (Table 1 ) Table 1 Socio-demographic characteristics of study participants Variables Category Frequency Percent Age in years 40–44 149 50.3 45–49 81 27.4 50–54 24 8.1 55–60 42 14.2 Marital status Married 211 71.3 Single 29 9.8 Divorced 26 8.8 Widowed 30 10.1 Occupation House wife 120 40.5 Private business owner 35 11.9 Government employee 72 24.3 Private employee 58 19.6 Farmer 11 3.7 Education No formal education 54 18.2 Primary 81 27.4 Secondary 92 31.1 College and above 69 23.3 Monthly family income in Ethiopian birr ≤ 1650 8 2.7 1651–3200 91 30.7 3201–5250 92 31.1 5251–7800 40 13.5 7801–10900 40 13.5 > 10900 25 8.4 Gynecologic and Obstetrics characteristics The mean age of menarche was 14.8 years (SD ± 1.95) and almost half (51.4%, 152/296) of the participants had their menarche above the age of 14 years. Almost two third (202/296, 68.2%) of the participants were parous. Among the parous participants, almost one third (59/202, 29.2%) of them gave their first birth before age of 20years, and 69/202(34.1%) of them have had their last delivery in the age group of 30 to 34 years. Majority (165/296, 55.7%) of the respondents never use oral contraceptives. Most of the respondents (230/296, 77.7%) were sexually active in this sample as is shown in the table below (Table 2 ). Table 2 Obstetrics and gynecologic characteristics of participants Variables Category Frequency Percent Parity Nulliparous 94 31.8 Primiparous 40 13.5 Multiparous 124 41.9 Grandmultiparous 38 12.8 Age of menarche in years ≤ 12 31 10.5 13–14 113 38.2 > 14 152 51.4 Age at 1st delivery* in years < 20 59 29.2 20–24 60 29.7 25–29 56 27.7 30–34 17 8.4 35–39 8 4.0 40–44 2 1.0 Age at last delivery* in years < 20 8 4.0 20–24 10 5.0 25–29 46 22.8 30–34 69 34.1 35–39 53 26.2 40–44 12 5.9 ≥ 45 4 2.0 Oral contraceptive use Yes 131 44.3 No 165 55.7 History of smoking Yes 8 2.7 No 288 97.3 Current Sexual activity Active 230 77.7 Inactive 66 22.3 * n = 202, percentage Was calculated for 202 parous women. Menopausal symptoms on Menopausal Rating Scale History of menopausal symptoms in the previous one month of study period was collected by using Menopausal Rating Scale (MRS). The common symptom was physical and mental exhaustion which was complained by 163/296 (55.1%) women, followed by classical menopausal symptoms - hot flushes, which was complained by 162/296 (54.7%) women. Out of 230 women who were sexually active, only one-quarter (62/230, 27%) of them complained vaginal dryness during sexual intercourse. Based on the MRS, the two most frequently reported symptoms within each of the subscales were hot flushes (54.7%), muscle and joint pain (32.1%) on somatic subscale; physical and mental exhaustion (55.1%), irritability (48.6%) on psychological subscale; and sexual problems (41.3%), bladder problems (39.2%) on urogenital subscale. As per scoring of all domains, 266 (89.9%) of study participants had one or the other symptoms in the previous one month, contributing to 89.9% prevalence of menopausal symptoms. (Table 3 ) Table 3 Frequency of menopausal symptoms among participants Subscales Category Frequency Percentage Overall prevalence in each domain Somatic Symptoms Hot flushes, sweating Yes 162 54.7 Frequency percentage No 134 45.3 218 73.6 Heart Discomfort Yes 93 31.4 No 203 68.6 Sleeping problems Yes 80 27.0 No 216 73.0 Muscle and joint pain Yes 95 32.1 No 201 67.9 Psychological Symptoms Depressive mood Yes 103 34.8 222 75.0 No 193 65.2 Irritability Yes 144 48.6 No 152 51.4 Anxiety Yes 140 47.3 No 156 52.7 Physical and mental exhaustion Yes 163 55.1 No 133 44.9 Urogenital Symptoms Sexual problems** Yes 95 41.3 173 58.4 No 135 58.7 Bladder problems Yes 116 39.2 No 180 60.8 Dryness of vagina** Yes 62 27 No 169 73.5 Prevalence of overall menopausal symptoms 266 89.9 ** n = 230, percentage is calculated from those sexually active women (230). Menopausal symptoms stratified by age When stratified by age, the predominant symptoms experienced by the women varied. Hot flashes were the most reported symptoms in the age group of 40–44 and 45–49 years with (n = 73/149, 49.0%) and ( n = 55/81, 67.9%) respectively. In the age group of 50–54 years, Physical and mental exhaustion were the predominant symptoms ( n = 14/24, 58.3%). Sexual problems were the symptoms reported more by women of aged category 55–60 years (n = 25/32, 78.1%). (Figure-1) Menopausal symptoms stratified by MRS subscale As the scoring of all domains, 266/296(89.9%) of study subjects had at least one of the symptoms in the previous one month, contributing to 89.9% prevalence of menopausal symptoms. The distribution of symptoms by the MRS subscale is shown in Fig. 2 . Menopausal Hormone Therapy In this study, there were no a single woman who has ever used menopausal hormone therapy to treat menopausal symptoms or to prevent complications like osteoporosis, despite 60/269(20.3%) women having history of seeking help from health professionals for complaints of one or more menopausal symptoms. Determinant factors affecting MRS subscales of menopausal symptoms After binary logistic regression, variables with P ≤ 0.25 were further analyzed using multivariate logistic regression. Accordingly, age, income, and history of visits for menopausal symptoms were significantly associated with somatic-vegetative symptoms. The odds of having somatic menopausal symptoms in age group of 40–44 years women is about three times less likely compared with age group of 55–60 years [AOR = 0.317, 95%CI (0.102, 0.990)] , while the odds of having somatic menopausal symptoms in women with monthly family income of 3201-5250ETB and 5251-7800ETB were about 5.7 and 5.5 times less likely when compared with women with monthly family income of above 10900ETB [aOR = 0.175, 95% CI(0.042, 0.737)] and [aOR = 0.182, 95% CI (0.041, 0.912)] respectively. Moreover, the odds of having somatic menopausal symptoms were approximately 18 times higher in those women who had history of seeking help from health professionals for complaints of one or more menopausal symptoms [aOR = 18.554, 95% CI (4.11,83.71)] . (Table 4 ) Table 4 Bivariate and multivariate logistic regression for factors associated with somatic symptoms Variable Somatic symptoms p-value COR with 95%CI P-value AOR with 95%CI Yes No Age 40–44 89 60 0.003 0.247(0.09,0.62) 0.048 0.317(0.102, 0.990) 45–49 75 6 0.230 2.083(0.63,6.91) 0.166 2.761(0.656, 11.62) 50–54 18 6 0.283 0.500(0.14,1.77) 0.745 1.279(0.291, 5.624) 55–60 36 6 1 1 Education No formal education 48 6 0.020 3.265(1.21,8.84) 0.377 2.140(0.396, 11.56) Primary 56 25 0.802 0.914(0.45,1.85) 0.555 0.739(0.270, 2.021) Secondary 65 27 0.960 0.983(0.49,1.95) 0.569 0.768(0.310, 1.902) College & above 49 20 1 1 Monthly Family income <=1650 6 2 0.569 0.571(0.083,0.916) 0.441 0.356(0.026, 4.937) 1651–3200 77 14 0.940 1.048(0.312,3.518) 0.311 0.457(0.100, 2.083) 3201–5250 63 29 0.135 0.414(0.130,1.315) 0.017 0.175(0.042, 0.737) 5251–7800 23 17 0.032 0.258(0.075,0.890) 0.026 0.182(0.041, 0.912) 7801–10900 28 12 0.209 0.444(0.125,1.575) 0.233 0.417(0.099, 1.754) > 10900 21 4 1 1 Parity Nulliparous 76 18 0.236 0.497(0.16,1.58) 0.450 1.856(0.373,9.231) Primiparous 22 18 0.002 0.144(0.04,0.48) 0.079 0.218(0.040,1.192) Multiparous 86 38 0.019 0.266(0.09,0.80) 0.571 0.648(0.145,2.904) Grand multiparous 34 4 1 1 History of physician visit Yes 58 2 0.000 13.775(3.27,57.89) 0.000 18.554(4.11,83.71) No 160 76 1 1 COR: crude odds ratio; aOR: adjusted odds ratio The multivariate analysis revealed that age and monthly family income were significantly associated with menopausal psychological symptoms. Accordingly, the odds of having psychological menopausal symptoms were about four times more common among women in age group of 45–49 years compared with those in age group of 40–44 years [aOR = 3.909, 95%CI (1.738,8.795)]. In addition, the odds of having psychological menopausal symptoms are 3.4 and 3.1 times more common among women with monthly family income of 1651 to 3200 and 3201 to 5250 ETB than women with monthly family income above 10,900 ETB [aOR = 3.366, 95%CI (1.138,9.962)] and [aOR = 3.143, 95%CI (1.108,8.913)] respectively. (Table 5 ) Table 5 Bivariate and multivariate logistic regression for factors associated with psychological symptoms Variable Psychological symptoms p-value COR with 95%CI p-value aOR with 95%CI Yes No Age 40–44 97 52 1 1 45–49 71 10 0.000 3.806(1.811,8.000) 0.001 3.909(1.738,8.795) 50–54 20 4 0.086 2.680(0.870,8.257) 0.134 2.523(0.751,8.471) 55–60 34 8 0.055 2.278(0.983,5.281) 0.170 2.002(0.742,5.402) Monthly Family income <=1650 6 2 0.448 2.00(0.334,11.96) 0.573 1.762(0.246,12.61) 1651–3200 76 15 0.014 3.378(1.277,8.93) 0.028 3.366(1.138,9.962) 3201–5250 74 18 0.038 2.741(1.058,7.09) 0.031 3.143(1.108,8.913) 5251–7800 27 13 0.539 1.385(0.49,3.911) 0.315 1.782(0.577,5.504) 7801–10900 24 16 1.000 1.00(0.361,2.773) 0.924 1.056(0.344,3.244) > 10900 15 10 1 1 Parity Nulliparous 75 19 1 1 Primiparous 32 8 0.978 1.013(0.402,2.553) 0.487 1.461(0.502,4.249) Multiparous 85 39 0.065 0.552(0.294,1.037) 0.160 0.582(0.273,1.238) Grand multiparous 30 8 0.914 0.950(0.375,2.404) 0.407 0.622(0.202,1.914) History of oral contraceptives use Yes 92 39 0.092 0.635(0.374,1.078) 0.613 0.849(0.449,1.602) No 130 35 1 1 History of physician visit Yes 51 9 0.049 2.154(1.003,4.624) 0.144 1.847(0.811,4.207) No 171 65 1 1 COR: crude odds ratio; aOR: adjusted odds ratio The Multivariate logistic regression showed that the odds of having urogenital menopausal symptoms were approximately four and seven times higher in those women in age group of 50–54 and 55–60 years than those 40–44 years age group women with aOR= [4.029, 95%CI (1.353,11.995)] and aOR = [6.838, 95%CI (2.145,21.792)] respectively. In addition, the odds of having urogenital menopausal symptoms were five times higher in merchant women than housewife women [aOR = 5.305, 95%CI (1.968,14.30)]. Moreover, the presence of urogenital menopausal symptoms is associated with education, occupation, parity and income. (Table 6 ) Table 6 Bivariate and multivariate logistic regression for factors associated with urogenital symptoms Variable Urogenital symptoms p-value COR with 95%CI P-value aOR with 95%CI Yes No Age 40–44 73 76 1 1 45–49 47 34 0.191 1.439(0.834,2.484) 0.213 1.532(0.783,2.998) 50–54 16 8 0.113 2.082(0.840,5.160) 0.012 4.029(1.353,11.995) 55–60 37 5 0.000 7.704(2.870,20.68) 0.001 6.838(2.145,21.792) Occupation House wife 68 52 1 1 Merchant 27 8 0.032 2.581(1.084,6.146) 0.001 5.305(1.968,14.30) Government employee 36 36 0.370 0.765(0.425,1.374) 0.949 0.973(0.418,2.265) Private employee 33 25 0.977 1.009(0.536,1.901) 0.956 1.024(0.442,2.375) Farmer 9 2 0.124 3.441(0.713,16.61) 0.253 3.295(0.426,25.504) Education No formal education 44 10 0.004 3.385(1.468,7.805) 0.057 0.234(0.052,1.041) Primary 46 35 0.974 1.011(0.529,1.933) 0.028 0.320(0.116,0.883) Secondary 44 48 0.275 0.705(0.376,1.321) 0.009 0.328(0.143,0.753) College & above 39 30 1 1 Family monthly income <=1650 4 4 0.922 1.083(0.220,5.326) 0.503 2.079(0.244,17.704) 1651–3200 65 26 0.031 2.708(1.094,6.708) 0.049 3.683(1.007,13.467) 3201–5250 57 35 0.211 1.764(0.724,4.298) 0.209 2.121(0.657,6.845) 5251–7800 17 23 0.664 0.801(0.293,2.186) 0.608 1.413(0.377,5.302) 7801–10900 18 22 0.813 0.886(0.325,2.414) 0.490 1.519(0.463,4.983) > 10900 12 13 1 1 Parity Nulliparous 59 35 1 1 Primiparous 19 21 0.103 0.537(0.254,1.134) 0.169 0.522(0.206,1.318) Multiparous 60 64 0.035 0.556(0.322,0.961) 0.077 0.507(0.239,1.076) Grandmultiparous 35 3 0.002 6.921(1.981,24.18) 0.045 5.164(1.037,25.72) Age of menarche =14 99 53 1 1 History of ever use of COC Yes 64 67 0.003 0.491(0.307,0.785) 0.188 0.667(0.365,1.219) No 109 56 1 1 COR: crude odds ratio; aOR: adjusted odds ratio DISCUSSION In this study, the overall prevalence of menopausal symptoms in all domains was reported very high (89.9%). This finding is almost comparable to those from Delhi-India, Karnataka-India, South Korea, Kathmandu-Nepal, Pokhara-Nepal, Sri Lanka, China, and Ibadan-Nigeria. ( 8 , 9 , 13 , 15 , 16 , 62 – 65 ) The prevalence of menopausal symptoms in somatic, psychological, and urogenital domain was 73.6%, 75%, and 58.4%, respectively, which was found highly prevalent compared to other studies conducted in Addis Ababa.( 7 ) The higher prevalence of menopausal symptoms in this study could be partially explained by the difference in study populations with regard to age and the source population of participants. Again, there are variations in studies from China, Cambodia, India, and Nepal.( 14 , 65 – 68 ) Menopausal disorders vary with women cultural and socioeconomic background. This study also showed that the age and monthly family income of women were significantly associated with all three subscales of the menopausal rating scale. This study revealed that older women suffered more bothersome somatic and urogenital menopausal symptoms than younger (40–44 years old) women. It is scientifically sound that such menopausal symptoms are more common in older menopausal women, as serum estrogen levels are abolished. This finding is in agreement with a study conducted in Egypt, where Essa reported that the age of women was significantly associated with menopausal symptoms.( 10 , 69 ) Women with relatively low monthly family income (1651–3200 ETB) had more psychological and urogenital symptoms than women with higher family income(> 10900ETB), and people with low income had other stressors in addition to underlying medical illness. This finding was supported by a study conducted in Cambodia and India. ( 68 , 70 , 71 ) Factors such as occupation, education level, and parity were significantly related to urogenital symptoms. However, marital status, employment status, absence of a partner, smoking, menarche, sexual inactivity, and use of COC showed no relationship in this study, even though they were significant predictors associated with one or more menopausal symptoms, as reported in studies conducted in China, Saudi Arabia, India, the UK, Korea, and Egypt.( 10 , 69 – 76 ) Our cross-sectional analysis assessed the frequency of menopausal symptoms according to MRS; the two most commonly reported individual symptoms were physical and mental exhaustion (55.1%), followed by the most classical menopausal symptom i.e. hot flushes (54.7%). This finding of the prevalence of each menopausal symptom is low; again, the order of symptoms differs from the study findings in Malaysia, Nepal, Nigeria, Saudi Arabia, Addis Ababa, and Motta Ethiopia.( 7 , 54 , 77 – 80 ) This difference might reflect menopausal symptoms variation across study populations, ethnic and socio-demographic settings, sampling techniques and methodology. The least commonly reported menopausal symptom was vaginal dryness accounted 27% of sexually active women. As women progress to postmenopausal age, estrogen levels further decrease, resulting in vaginal atrophy, drynesss and other urogenital symptoms. Compared to other symptoms, urogenital symptoms were less common in these women, which may be because they adapt themselves to these symptoms over time, which is considered a cultural norm in Ethiopia, to become less sexually active toward old age. This has also been demonstrated in studies from India and Addis Ababa, Ethiopia. ( 7 , 70 ) An incredible finding of this study was the absence of a single woman from study participants who ever used hormone replacement therapy, even though there were about 60(20.3%) women who had a history of seeking help from health professionals for complaints of one or more menopausal symptoms. This difference was different among studies conducted in other countries. In a multi-ethnic Asian population study conducted in Singapore, overall MHT usage was 8.7%, but when stratified by ethnicity prevalence of MHT usage was 11.3% in Chinese, 8.6% in Indian, and 5.9% in Malay women( 81 ). The frequency of using menopausal hormone therapy was 40.1% in Portuguese women living in Porto( 82 ), 13% in the United States( 83 ), 13% in Australia( 84 ), 45% in Poland( 85 ), 16% in Germany( 86 ). The underlying reasons for the absence of MHT practices in hospitals in this study require further investigation. The strength of this study is that it attempted to address one of Ethiopia's least explored but essential health problems. The finding that the management of menopausal symptoms is not at all given in these large teaching hospitals is concerning and provides valuable insight for hospitals and policymakers to combat this deficiency. In addition, this study used a validated questionnaire for assessing menopausal symptoms; therefore, the information obtained from this study is valuable as baseline data for the research and maintains its comparability with studies from other settings. The study included only governmental health institutions, which may not reflect the practice of MHT in private institutions, and further investigation is recommended. CONCLUSION AND RECOMMENDATION The prevalence of menopausal symptoms is high, but individualized administration of hormone replacement therapy is non-existent in these institutions. It appears essential for these institutions to work on the service availability and delivery of menopausal hormone therapy for those in need of wider benefits of their clients. The underlying reason for the absence of ordering of menopausal hormonal therapy among health professionals working in gynecologic clinics requires further investigation. Abbreviations AAU=Addis Ababa University AOR=Adjusted Odd Ratio FMP = Final Menstrual Period GSM= Genitourinary Syndrome of Menopause GMH = Gandhi Memorial Hospital HMIS = Health Management Information System MHT= Menopausal Hormonal Therapy MRS= Menopausal Rating Scale RGOPD = Regular Gynecologic Outpatient Department TASH = Tikur Anbessa Specialized Hospital UK= United Kingdom US = Ultrasound VMS= Vasomotor Symptoms WHO = World Health Organization ZMH = Zewditu Memorial Hospital Declarations Ethics approval and consent to participate Ethical approval was obtained from the Institutional Review Board of the College of Health Sciences of Addis Ababa University. Data were collected after obtaining written informed consent from all participants. Data collection was confidential and no personal identifiers, such as name and phone number, were requested. All methods were performed in accordance with the relevant ethical standards and guidelines. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding None. Authors’ contributions TG conceptualized, curated, analyzed, and interpreted the participants’ data, and was the major contributor to writing the manuscript. RD contributed to the conceptualization, design, analysis, and writing of the manuscript. MT contributed to the conceptualization, design, analysis, and writing of the manuscript. All authors read and approved the final manuscript. Acknowledgements We acknowledge Addis Ababa University, College of Health Sciences, for providing us with the opportunity to conduct this study. We also thank the participants for their participation in the study. References Women, Ageing and Health: A Framework for Action. 2007. Nations U, of Economic D, Affairs S, Division P. 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Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 14 Sep, 2024 Read the published version in BMC Women's Health → Version 1 posted Editorial decision: Revision requested 04 Jul, 2024 Reviews received at journal 04 Jul, 2024 Reviews received at journal 17 Jun, 2024 Reviewers agreed at journal 16 Jun, 2024 Reviewers agreed at journal 13 Jun, 2024 Reviewers agreed at journal 11 Jun, 2024 Reviewers invited by journal 30 May, 2024 Editor assigned by journal 22 May, 2024 Submission checks completed at journal 16 May, 2024 First submitted to journal 13 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4411857","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":305431417,"identity":"e2e761a3-a820-4f9b-914b-993e0085e79b","order_by":0,"name":"Tewodros Getahun Asfaw","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYHACAxBRv/94AwMzUep5oFoYG84cIFnLjQQitdizN2+TulFxh5lx5hvDzwUVNgz87d0J+G3hOVYmnXPmGRuzdI6x9IwzaQwSZ85uwK9FIsdMOrftMA+bdI6BNG/bYQYDiVwCWuTfALX8OyzBI3nG+DdxWiR4gFoaDhtIgBjEaTmTVmydc+xwggFPWpk1kMdD0C/s7Yc33s6pAWphP7z5Nk+FjRx/ey9+LUDAIgGhOcARxENIOQgwf4Ba+IAY1aNgFIyCUTACAQC7fEKr1gjmSgAAAABJRU5ErkJggg==","orcid":"","institution":"Dilla University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Tewodros","middleName":"Getahun","lastName":"Asfaw","suffix":""},{"id":305431418,"identity":"3109d9a2-147f-4297-9fd3-f01db132e62a","order_by":1,"name":"Rahel Demissew Gebreyohannes","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rahel","middleName":"Demissew","lastName":"Gebreyohannes","suffix":""},{"id":305431419,"identity":"438e6cd4-ea39-46b8-9133-274a3ed41965","order_by":2,"name":"Milcah Temesgen Tesfaye","email":"","orcid":"","institution":"Wachemo University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Milcah","middleName":"Temesgen","lastName":"Tesfaye","suffix":""}],"badges":[],"createdAt":"2024-05-13 08:42:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4411857/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4411857/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-024-03359-7","type":"published","date":"2024-09-14T15:57:10+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57117016,"identity":"a05f4e9d-3164-424b-aef8-dc056851a0a3","added_by":"auto","created_at":"2024-05-25 01:54:31","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":206906,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMenopausal symptoms stratified by age\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Onlinedrawingimage1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4411857/v1/7a05b46d73ee6e8293ad116d.jpg"},{"id":57117017,"identity":"f5849b47-3374-4e80-b95e-eeed740143c1","added_by":"auto","created_at":"2024-05-25 01:54:31","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":66136,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePercentage of menopausal symptoms stratified by MRS subscale\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Onlinedrawingimage2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4411857/v1/7da1775a5098905ed0348ea6.jpg"},{"id":64618978,"identity":"8ffd8d7b-2524-44cc-acac-9429f4e3d4f6","added_by":"auto","created_at":"2024-09-16 16:10:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1618732,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4411857/v1/f445b023-4a8c-4209-9d1c-0956a24c5fa0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Menopausal symptoms and utilization of menopausal hormone therapy among women aged 40-60 years in Addis Ababa, Ethiopia: A cross-sectional study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eWith a few exceptions, women have longer life expectancies than do men in both developed and developing countries. The reasons relate to female biology, such as hormonal protective factors, and fatal risk factors associated with male working conditions, lifestyle, and a higher risk of injury.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) At the global level in 2019, approximately nine per cent of people were aged 65 years or older, with two-thirds of the world's older population now living in low-income and middle-income countries.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) According to the 2019 Revision of World Population Prospects, Ethiopia\u003csup\u003e\u0026rsquo;\u003c/sup\u003es life expectancy in 2021 is 67.07 years.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eMenopause is a normal phase of life, similar to puberty; and should not be viewed as abnormal. For many women, it is a welcome change, with no further menses or premenstrual syndrome (PMS), and there is no need for contraception or concern for conceiving.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eA woman is said to have reached menopause if she remains amenorrhoeic for consecutive 12-months and demonstrates biochemical evidence of hypergonadotropic hypogonadism.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe menopausal transition phase is characterized by an increasing irregularity in the menstrual cycle length. This irregularity is defined as the recurrence of a 7-day difference in cycle length over 10 cycles. This stage lasts 1\u0026ndash;3 years and occurs when vasomotor symptoms such as hot flushes begin to occur.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe menopause is that point in time when permanent cessation of menstruation occurs following the loss of ovarian activity. Perimenopause includes the years prior to the final menstrual period, during which menstrual cycles progress from a regular ovulatory and predictable pattern to irregular and increasingly anovulatory cycles, to eventual cessation of menses. This stage ends 12 months after the final menstrual cycle.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eMenopausal symptoms experienced by many women during menopausal transition and postmenopausal period.(\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) Hot flashes, one of the most common symptoms, typically resolve several years later, for about 15\u0026ndash;20% of women untreated symptoms are severe enough to interfere with quality of life.(\u003cspan additionalcitationids=\"CR18 CR19 CR20\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFor these women, estrogen therapy is the most effective treatment for relieving hot flashes, night sweats, vaginal dryness, and possible improvements in mood, sleep quality, and concentration. It also protects against osteoporotic fractures and prevents osteoporosis.(\u003cspan additionalcitationids=\"CR23 CR24 CR25 CR26 CR27\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThese data indicate that the initiation of menopausal hormonal therapy soon after menopause in women with presumably normal arteries may not be at risk and may even derive beneficial cardiovascular effects. In contrast, initiation many years after menopause is susceptible to the proinflammatory and prothrombotic effects of estrogen among the associated atherosclerotic lesions, leading to excessive coronary risk. This timing hypothesis does not mean that recently menopausal women should be administered estrogen therapy for the primary prevention of coronary heart disease. Rather, clinicians are reassured in clinical practice of cardiac risks when considering the short-term use of menopausal hormonal therapy in women with bothersome vasomotor symptom relief.(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan additionalcitationids=\"CR30 CR31 CR32\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eConcerns include increased risks of thromboembolic disease, endometrial cancer, gallbladder disease, and breast cancer as well as increased risks of dementia, cardiovascular events, stroke, and ovarian cancer.(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan additionalcitationids=\"CR35 CR36 CR37 CR38 CR39\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAccordingly, most people now believe that short-term menopausal hormonal therapy using the lowest effective dose is a reasonable option for women with severe-to-moderate menopausal symptoms who are recently menopausal and have satisfactory cardiovascular health.(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) Short-term therapy is no more than 4\u0026ndash;5 years because symptoms diminish after several years, whereas the risk of breast cancer increases with longer duration of hormone therapy.(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAssuming that the timing hypothesis is correct, a younger patient, during the menopausal transition, or a recently menopausal woman (final menstrual period 5 years ago) at a low baseline risk of coronary heart disease, stroke, and venous thromboembolism are reasonable candidates for short-term hormone therapy. In clinical practice, most women seeking interventions for hot flashes fall into this category. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAs shown in a multicenter randomized trial conducted in Denmark in 2012, after 10 years of randomized treatment, women using hormone replacement therapy (HRT) early after menopause had significantly reduced risks of mortality, heart failure, and myocardial infarction without any apparent increase in cancer, venous thromboembolism, or stroke.(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e According to the guidelines of the governing principles of the International menopausal Society (IMS) governing principles, Menopausal hormonal therapy (MHT) is the most effective therapy for urogenital atrophy and vasomotor symptoms. It may also improve sleep disturbances, mood swings, joint and muscle pain, and sexual dysfunction including reduced libido. IMS supports initiating treatment for MHT before the age of 60 years, and its use for 5 years in healthy women is safe.(\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe World Health Organization recommends MHT as the most effective treatment for vasomotor symptoms (VMS) and genitourinary syndromes of menopause. It is also effective in the prevention of osteoporosis and is advantageous for women who have had menopause for less than 10 years or aged less than 60 years. (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eWomen with no risk factors especially perimenopausal women, low-dose COCs are effective for treatment of vasomotor symptoms, irregular uterine bleeding, and maintenance of bone mineral density. However, menopausal symptoms can worsen during the pill-free period; therefore, so it should be used in continuous fashion.(\u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAccordingly, the Ethiopian standard treatment guidelines also recommend MHT for at least five years in healthy post-menopausal women aged\u0026thinsp;\u0026lt;\u0026thinsp;60 years.(\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e) Conjugated equine Estrogen and Estradiol are available in Ethiopia, Ethiopian food and drug authority, Ethiopia. (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eMenopause and its burden on women\u0026rsquo;s physical and psychosocial health are among the least studied issues in Ethiopia. The use of MHT is common and standard in different parts of the world, and little is known about the use of HRT in Ethiopia. In addition, menopausal symptoms, such as vaginal health, urogenital symptoms, and vasomotor symptoms, are not usually assessed and discussed in health facilities in Ethiopia despite their high prevalence in menopausal women.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR51 CR52 CR53 CR54 CR55\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eHence, we aimed to assess the prevalence of menopausal symptoms, identify factors associated with menopausal symptoms, and use of menopausal hormone therapy among women aged 40\u0026ndash;60 years who visited the gynecological clinics of three hospitals in Addis Ababa, Ethiopia.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting and design\u003c/h2\u003e \u003cp\u003eThis facility-based cross-sectional study was conducted in three large hospitals in the capital city of Ethiopia, Addis Ababa: Tikur Anbessa Specialized Hospital (TASH), Gandhi Memorial Hospital (GMH) and Zewditu Memorial Hospital (ZMH), between January 2022 and June 2022. The study included 296 patients who visited the outpatient gynecological clinics of the hospitals. The required sample size was determined using single proportion population formula by assuming 95% confidence interval, 5% margin of error, and taking the second commonly reported individual symptom and variable that gives largest sample size, which is the prevalence of difficulty falling asleep (P\u0026thinsp;=\u0026thinsp;49.6%) from a community based study conducted in Gullele sub-city of Addis Ababa, Ethiopia. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Adjustment were made for the population (less than 10 times the estimated sample size) using a finite population correction factor.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData collection procedures and analysis\u003c/h2\u003e \u003cp\u003eThe average age of occurrence of the first symptoms of menopause is variable in different parts of the world, with evidence showing that the majority of women suffered and started to manifest menopausal symptoms in the age group of 40\u0026ndash;60 years.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e) According to Ethiopian standard treatment guidelines, hormone replacement therapy is recommended before the age of 60 years.(\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e) Therefore, women aged 40\u0026ndash;60 years who attended gynecological clinics in the three selected hospitals were recruited for the study.\u003c/p\u003e \u003cp\u003eAccording to HMIS report of TASH, ZMH, and GMH between December 2020 and May 2021, the total number of patients evaluated and treated in the gynecologic clinics was 1096, 712, and 653 respectively; of these, 43.6%, 35%, and 31.2% of them aged 40\u0026ndash;60 years, respectively. Therefore, 931 women aged 40\u0026ndash;60 years were served by these three hospitals during the specified period.\u003c/p\u003e \u003cp\u003ePregnant or lactating women, women who were using hormonal contraceptives, women with uncontrolled medical conditions such as hypertension, hyperthyroidism, diabetes mellitus, or heart disease, women who were undergoing treatment for serious diseases such as cancer, and women who refused to participate were excluded from the study.\u003c/p\u003e \u003cp\u003eWomen were selected as they appeared for a clinic visit for various gynecological complaints, and information was collected until the desired sample size was achieved. Information was collected by three trained interviewers (BSC nurses) through face-to-face interview.\u003c/p\u003e \u003cp\u003eThe data were collected using a standard interviewer-administered questionnaire. The questionnaire was first prepared in English, then back-translated to Amharic, and translated back to English to maintain consistency. The study questionnaire was adapted from the Ethiopia Demographic and Health Survey 2011 questionnaire, a previous menopausal study, and menopausal symptoms were collected from participants according to an 11-item Menopause Rating Scale (MRS). The MRS is a self-reported subjective scale that has been used in different international populations and validated in clinical and epidemiological studies on menopausal symptoms.(\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe MRS is composed of 11 items assessing menopausal symptoms and is divided into three subscales: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) somatic: hot flushes, heart discomfort, sleeping problems, and muscle and joint problems; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) psychological: depressive mood, irritability, anxiety, and physical and mental exhaustion; and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) urogenital: sexual, bladder, and vaginal problems. The MRS has been translated into more than 22 languages that do not include the Amharic version. However, it was used in a study conducted in Ethiopia that used an English version. For the purpose of this research, the English version of the MRS was used. The draft Amharic translation of the MRS was made by the primary investigator, reviewed and finalized by committee consisted of a translator and three obstetricians (experts in the field), and one MSc holder in public health.(\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e) The dependent variables were the MRS subscales of menopausal symptoms (somatic, psychological, and urogenital symptoms) and utilization of menopausal hormone therapy. The independent variables were socio-demographic characteristics (age, marital status, educational level, partner educational level, occupation, and monthly family income) and obstetric and gynecological characteristics \u003cb\u003e(\u003c/b\u003eparity, age at menarche, age at first and last delivery, history of oral contraceptive use, smoking history, and history of physician visit).\u003c/p\u003e \u003cp\u003eData were analyzed using SPSS version 25. Frequency distribution, percentages, mean, median, and cross-tabulation between the dependent and independent variables were calculated, and the basic socio-demographic characteristics of the respondents were summarized.\u003c/p\u003e \u003cp\u003eVariables with P value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 during the bivariate analysis, were included in the multivariate analysis to determine the effect of confounding factors. Strength of the association was measured using odds ratios with 95% confidence intervals and statistical significance was set at value P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eOperational Definition\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eSomatic symptoms: A woman was considered to have somatic symptoms if she complained of at least one of the following symptoms in the previous 1 month: hot flushes, sweating, difficulty in sleeping, muscle and joint discomfort, or heart discomfort.\u003c/p\u003e \u003cp\u003ePsychological symptoms: A woman was considered to have psychological symptoms if she complained of at least one of the following symptoms in the previous 1 month: depressive mood, irritability, anxiety, and physical and mental exhaustion.\u003c/p\u003e \u003cp\u003eUrogenital symptoms: A woman was considered to have urogenital symptoms if she complained of at least one of the following symptoms in the previous 1 month; sexual problems, dryness of the vagina, and bladder problems.\u003c/p\u003e \u003cp\u003eOverall menopausal symptoms: If a woman complained of one of the following symptoms in the previous 1 month, she was considered to have menopausal symptoms: history of hot flush, sweating, heart discomfort, sleep disorders, depressive mood, nervousness, irritability, anxiety, physical and mental exhaustion, disorder of sexuality, urinary symptoms, vaginal dryness, and joint and muscle symptoms.\u003c/p\u003e \u003cp\u003eMenopausal Hormonal Therapy: Defined in this study as any form of hormone therapy that consisted of estrogen and/or progestin prescribed to treat menopausal symptoms or to prevent complications like osteoporosis\u003c/p\u003e \u003cp\u003eHot flush: A sudden feeling of feverish heat and warmth in the upper body, which is usually most intense over the face, neck, and chest.\u003c/p\u003e \u003cp\u003eHeart discomfort: Palpitation, racing heartbeat, tightness in chest\u003c/p\u003e \u003cp\u003eSleep disorders of menopause: Difficulty in falling asleep, difficulty in remaining asleep through the night, waking too early\u003c/p\u003e \u003cp\u003eDepressive mood: Despondency, sadness, tearfulness, lack of drive, mood fluctuations\u003c/p\u003e \u003cp\u003eIrritability: Nervousness, inner tension, feeling aggressive\u003c/p\u003e \u003cp\u003eAnxiety: Inner restlessness, feeling panicky\u003c/p\u003e \u003cp\u003ePhysical and mental exhaustion: Poor concentration, forgetfulness\u003c/p\u003e \u003cp\u003eDisorder of sexuality: reduced libido, sexual activity and satisfaction\u003c/p\u003e \u003cp\u003eVaginal dryness: Feeling of sore or itching in and around the vagina, pain, or discomfort during sexual intercourse\u003c/p\u003e \u003cp\u003eBladder problem: Symptoms during urination, frequent need to pass urine, accidental incontinence\u003c/p\u003e \u003cp\u003eJoint and muscle discomfort: Pain in joints\u003c/p\u003e \u003cp\u003eSexually inactive: If a woman had no sexual contact in the previous 1 month considered as she was considered sexually inactive.\u003c/p\u003e \u003cp\u003ePhysician visits are either formal or informal meetings between patients and health professionals to get health advice or treatment plans for menopausal symptoms.\u003c/p\u003e \u003cp\u003eMonthly family income classified according to employment income tax rates for Ethiopia(\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eMenarche was classified as early (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;12 years), medium (13 -14years), or delayed (\u0026gt;\u0026thinsp;14years)(\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eSocio-demographic characteristics\u003c/h2\u003e\n \u003cp\u003eA total of 296 women aged between 40\u0026ndash;60 years were invited for the interview, consented to participate in the study giving a response rate of 100%, and included in this study. Mean age of study participants was 46years (SD\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;6.1), 149/296 (50.3%) of the participants were in the age range of 40\u0026ndash;44 years. Nearly three forth (211/296, 71.3%) of the participants were married, 120/296(40.5%) were housewives, and 72/296 (24.3%) were government employees. Almost one third of the participants (92/296, 31.1%) completed secondary education. Most participants had low and middle family incomes, according to the classification of employment income tax rates for Ethiopia. (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSocio-demographic characteristics of study participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eAge in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u0026ndash;54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55\u0026ndash;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHouse wife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate business owner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGovernment employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollege and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003eMonthly family income in Ethiopian birr\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;1650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1651\u0026ndash;3200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3201\u0026ndash;5250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5251\u0026ndash;7800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7801\u0026ndash;10900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;10900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eGynecologic and Obstetrics characteristics\u003c/h2\u003e\n \u003cp\u003eThe mean age of menarche was 14.8 years (SD\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.95) and almost half (51.4%, 152/296) of the participants had their menarche above the age of 14 years. Almost two third (202/296, 68.2%) of the participants were parous. Among the parous participants, almost one third (59/202, 29.2%) of them gave their first birth before age of 20years, and 69/202(34.1%) of them have had their last delivery in the age group of 30 to 34 years.\u003c/p\u003e\n \u003cp\u003eMajority (165/296, 55.7%) of the respondents never use oral contraceptives. Most of the respondents (230/296, 77.7%) were sexually active in this sample as is shown in the table below (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eObstetrics and gynecologic characteristics of participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNulliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrandmultiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eAge of menarche in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u0026ndash;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003eAge at 1st delivery* in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u0026ndash;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u0026ndash;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"7\"\u003e\n \u003cp\u003eAge at last delivery* in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u0026ndash;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u0026ndash;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eOral contraceptive use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eHistory of smoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCurrent Sexual activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eActive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e* n\u0026thinsp;=\u0026thinsp;202, percentage Was calculated for 202 parous women.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eMenopausal symptoms on Menopausal Rating Scale\u003c/h2\u003e\n \u003cp\u003eHistory of menopausal symptoms in the previous one month of study period was collected by using Menopausal Rating Scale (MRS). The common symptom was physical and mental exhaustion which was complained by 163/296 (55.1%) women, followed by classical menopausal symptoms - hot flushes, which was complained by 162/296 (54.7%) women. Out of 230 women who were sexually active, only one-quarter (62/230, 27%) of them complained vaginal dryness during sexual intercourse.\u003c/p\u003e\n \u003cp\u003eBased on the MRS, the two most frequently reported symptoms within each of the subscales were hot flushes (54.7%), muscle and joint pain (32.1%) on somatic subscale; physical and mental exhaustion (55.1%), irritability (48.6%) on psychological subscale; and sexual problems (41.3%), bladder problems (39.2%) on urogenital subscale. As per scoring of all domains, 266 (89.9%) of study participants had one or the other symptoms in the previous one month, contributing to 89.9% prevalence of menopausal symptoms. (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eFrequency of menopausal symptoms among participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSubscales\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eOverall prevalence in each domain\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"8\"\u003e\n \u003cp\u003eSomatic Symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eHot flushes, sweating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003epercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"7\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"7\"\u003e\n \u003cp\u003e73.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eHeart Discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSleeping problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMuscle and joint pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"8\"\u003e\n \u003cp\u003ePsychological Symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eDepressive mood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"8\"\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"8\"\u003e\n \u003cp\u003e75.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eIrritability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePhysical and mental exhaustion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003eUrogenital Symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSexual problems**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003e58.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eBladder problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eDryness of vagina**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003ePrevalence of overall menopausal symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e** n\u0026thinsp;=\u0026thinsp;230, percentage is calculated from those sexually active women (230).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eMenopausal symptoms stratified by age\u003c/h2\u003e\n \u003cp\u003eWhen stratified by age, the predominant symptoms experienced by the women varied. Hot flashes were the most reported symptoms in the age group of 40\u0026ndash;44 and 45\u0026ndash;49 years with (n\u0026thinsp;=\u0026thinsp;73/149, 49.0%) and (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;55/81, 67.9%) respectively. In the age group of 50\u0026ndash;54 years, Physical and mental exhaustion were the predominant symptoms (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;14/24, 58.3%). Sexual problems were the symptoms reported more by women of aged category 55\u0026ndash;60 years (n\u0026thinsp;=\u0026thinsp;25/32, 78.1%). (Figure-1)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eMenopausal symptoms stratified by MRS subscale\u003c/h2\u003e\n \u003cp\u003eAs the scoring of all domains, 266/296(89.9%) of study subjects had at least one of the symptoms in the previous one month, contributing to 89.9% prevalence of menopausal symptoms. The distribution of symptoms by the MRS subscale is shown in Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eMenopausal Hormone Therapy\u003c/h2\u003e\n \u003cp\u003eIn this study, there were no a single woman who has ever used menopausal hormone therapy to treat menopausal symptoms or to prevent complications like osteoporosis, despite 60/269(20.3%) women having history of seeking help from health professionals for complaints of one or more menopausal symptoms.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eDeterminant factors affecting MRS subscales of menopausal symptoms\u003c/h2\u003e\n \u003cp\u003eAfter binary logistic regression, variables with P \u0026le; 0.25 were further analyzed using multivariate logistic regression. Accordingly, age, income, and history of visits for menopausal symptoms were significantly associated with somatic-vegetative symptoms. The odds of having somatic menopausal symptoms in age group of 40\u0026ndash;44 years women is about three times less likely compared with age group of 55\u0026ndash;60 years \u003cstrong\u003e[AOR\u0026thinsp;=\u0026thinsp;0.317, 95%CI (0.102, 0.990)]\u003c/strong\u003e, while the odds of having somatic menopausal symptoms in women with monthly family income of 3201-5250ETB and 5251-7800ETB were about 5.7 and 5.5 times less likely when compared with women with monthly family income of above 10900ETB \u003cstrong\u003e[aOR\u0026thinsp;=\u0026thinsp;0.175, 95% CI(0.042, 0.737)] and [aOR\u0026thinsp;=\u0026thinsp;0.182, 95% CI (0.041, 0.912)]\u003c/strong\u003e respectively. Moreover, the odds of having somatic menopausal symptoms were approximately 18 times higher in those women who had history of seeking help from health professionals for complaints of one or more menopausal symptoms \u003cstrong\u003e[aOR\u0026thinsp;=\u0026thinsp;18.554, 95% CI (4.11,83.71)]\u003c/strong\u003e. (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBivariate and multivariate logistic regression for factors associated with somatic symptoms\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSomatic symptoms\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCOR with 95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAOR with 95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.247(0.09,0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.048\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.317(0.102, 0.990)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.083(0.63,6.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.761(0.656, 11.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u0026ndash;54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.500(0.14,1.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.745\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.279(0.291, 5.624)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55\u0026ndash;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.265(1.21,8.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.140(0.396, 11.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.802\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.914(0.45,1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.739(0.270, 2.021)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.960\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.983(0.49,1.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.768(0.310, 1.902)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollege \u0026amp; above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eMonthly Family income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;=1650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.571(0.083,0.916)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.356(0.026, 4.937)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1651\u0026ndash;3200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.940\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.048(0.312,3.518)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.457(0.100, 2.083)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3201\u0026ndash;5250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.414(0.130,1.315)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.175(0.042, 0.737)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5251\u0026ndash;7800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.258(0.075,0.890)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.026\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.182(0.041, 0.912)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7801\u0026ndash;10900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.444(0.125,1.575)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.417(0.099, 1.754)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;10900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNulliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.497(0.16,1.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.450\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.856(0.373,9.231)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.144(0.04,0.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.218(0.040,1.192)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.266(0.09,0.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.648(0.145,2.904)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrand multiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eHistory of physician visit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.775(3.27,57.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e18.554(4.11,83.71)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eCOR: crude odds ratio; aOR: adjusted odds ratio\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe multivariate analysis revealed that age and monthly family income were significantly associated with menopausal psychological symptoms. Accordingly, the odds of having psychological menopausal symptoms were about four times more common among women in age group of 45\u0026ndash;49 years compared with those in age group of 40\u0026ndash;44 years \u003cstrong\u003e[aOR\u0026thinsp;=\u0026thinsp;3.909, 95%CI (1.738,8.795)].\u003c/strong\u003e In addition, the odds of having psychological menopausal symptoms are 3.4 and 3.1 times more common among women with monthly family income of 1651 to 3200 and 3201 to 5250 ETB than women with monthly family income above 10,900 ETB \u003cstrong\u003e[aOR\u0026thinsp;=\u0026thinsp;3.366, 95%CI (1.138,9.962)] and [aOR\u0026thinsp;=\u0026thinsp;3.143, 95%CI (1.108,8.913)]\u003c/strong\u003e respectively. (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBivariate and multivariate logistic regression for factors associated with psychological symptoms\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePsychological symptoms\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCOR with 95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eaOR with 95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.806(1.811,8.000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.909(1.738,8.795)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u0026ndash;54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.680(0.870,8.257)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.523(0.751,8.471)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55\u0026ndash;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.278(0.983,5.281)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.002(0.742,5.402)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eMonthly Family income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;=1650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.00(0.334,11.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.762(0.246,12.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1651\u0026ndash;3200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.378(1.277,8.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.028\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.366(1.138,9.962)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3201\u0026ndash;5250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.038\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.741(1.058,7.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.143(1.108,8.913)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5251\u0026ndash;7800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.539\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.385(0.49,3.911)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.782(0.577,5.504)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7801\u0026ndash;10900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00(0.361,2.773)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.056(0.344,3.244)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;10900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNulliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.013(0.402,2.553)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.461(0.502,4.249)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.065\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.552(0.294,1.037)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.582(0.273,1.238)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrand multiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.950(0.375,2.404)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.407\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.622(0.202,1.914)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eHistory of oral contraceptives use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.092\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.635(0.374,1.078)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.849(0.449,1.602)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eHistory of physician visit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.049\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.154(1.003,4.624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.847(0.811,4.207)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eCOR: crude odds ratio; aOR: adjusted odds ratio\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003eThe Multivariate logistic regression showed that the odds of having urogenital menopausal symptoms were approximately four and seven times higher in those women in age group of 50\u0026ndash;54 and 55\u0026ndash;60 years than those 40\u0026ndash;44 years age group women with \u003cstrong\u003eaOR= [4.029, 95%CI (1.353,11.995)]\u003c/strong\u003e and \u003cstrong\u003eaOR\u003c/strong\u003e=\u003cstrong\u003e[6.838, 95%CI (2.145,21.792)]\u003c/strong\u003e respectively. In addition, the odds of having urogenital menopausal symptoms were five times higher in merchant women than housewife women \u003cstrong\u003e[aOR\u0026thinsp;=\u0026thinsp;5.305, 95%CI (1.968,14.30)].\u003c/strong\u003e Moreover, the presence of urogenital menopausal symptoms is associated with education, occupation, parity and income. (Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBivariate and multivariate logistic regression for factors associated with urogenital symptoms\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eUrogenital symptoms\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCOR with 95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eaOR with 95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.439(0.834,2.484)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.532(0.783,2.998)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u0026ndash;54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.082(0.840,5.160)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.029(1.353,11.995)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55\u0026ndash;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.704(2.870,20.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.838(2.145,21.792)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHouse wife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.581(1.084,6.146)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.305(1.968,14.30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGovernment employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.765(0.425,1.374)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.949\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.973(0.418,2.265)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.009(0.536,1.901)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.024(0.442,2.375)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.441(0.713,16.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.295(0.426,25.504)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.385(1.468,7.805)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.234(0.052,1.041)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.974\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.011(0.529,1.933)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.028\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.320(0.116,0.883)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.705(0.376,1.321)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.328(0.143,0.753)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollege \u0026amp; above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eFamily monthly income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;=1650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.083(0.220,5.326)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.503\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.079(0.244,17.704)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1651\u0026ndash;3200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.708(1.094,6.708)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.049\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.683(1.007,13.467)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3201\u0026ndash;5250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.764(0.724,4.298)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.121(0.657,6.845)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5251\u0026ndash;7800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.664\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.801(0.293,2.186)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.608\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.413(0.377,5.302)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7801\u0026ndash;10900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.886(0.325,2.414)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.519(0.463,4.983)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;10900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNulliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.537(0.254,1.134)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.522(0.206,1.318)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.035\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.556(0.322,0.961)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.507(0.239,1.076)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrandmultiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.921(1.981,24.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.045\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.164(1.037,25.72)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eAge of menarche\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;=12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.741(0.337,1.629)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.673(0.239,1.893)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u0026ndash;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.526(0.320,0.865)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.638(0.341,1.192)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;=14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eHistory of ever use of COC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.491(0.307,0.785)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.667(0.365,1.219)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eCOR: crude odds ratio; aOR: adjusted odds ratio\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, the overall prevalence of menopausal symptoms in all domains was reported very high (89.9%). This finding is almost comparable to those from Delhi-India, Karnataka-India, South Korea, Kathmandu-Nepal, Pokhara-Nepal, Sri Lanka, China, and Ibadan-Nigeria. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan additionalcitationids=\"CR63 CR64\" citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e–\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe prevalence of menopausal symptoms in somatic, psychological, and urogenital domain was 73.6%, 75%, and 58.4%, respectively, which was found highly prevalent compared to other studies conducted in Addis Ababa.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) The higher prevalence of menopausal symptoms in this study could be partially explained by the difference in study populations with regard to age and the source population of participants. Again, there are variations in studies from China, Cambodia, India, and Nepal.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan additionalcitationids=\"CR66 CR67\" citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e–\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e) Menopausal disorders vary with women cultural and socioeconomic background.\u003c/p\u003e \u003cp\u003eThis study also showed that the age and monthly family income of women were significantly associated with all three subscales of the menopausal rating scale. This study revealed that older women suffered more bothersome somatic and urogenital menopausal symptoms than younger (40–44 years old) women. It is scientifically sound that such menopausal symptoms are more common in older menopausal women, as serum estrogen levels are abolished. This finding is in agreement with a study conducted in Egypt, where Essa reported that the age of women was significantly associated with menopausal symptoms.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eWomen with relatively low monthly family income (1651–3200 ETB) had more psychological and urogenital symptoms than women with higher family income(\u0026gt; 10900ETB), and people with low income had other stressors in addition to underlying medical illness. This finding was supported by a study conducted in Cambodia and India. (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFactors such as occupation, education level, and parity were significantly related to urogenital symptoms. However, marital status, employment status, absence of a partner, smoking, menarche, sexual inactivity, and use of COC showed no relationship in this study, even though they were significant predictors associated with one or more menopausal symptoms, as reported in studies conducted in China, Saudi Arabia, India, the UK, Korea, and Egypt.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR70 CR71 CR72 CR73 CR74 CR75\" citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e–\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eOur cross-sectional analysis assessed the frequency of menopausal symptoms according to MRS; the two most commonly reported individual symptoms were physical and mental exhaustion (55.1%), followed by the most classical menopausal symptom i.e. hot flushes (54.7%). This finding of the prevalence of each menopausal symptom is low; again, the order of symptoms differs from the study findings in Malaysia, Nepal, Nigeria, Saudi Arabia, Addis Ababa, and Motta Ethiopia.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan additionalcitationids=\"CR78 CR79\" citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e–\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e) This difference might reflect menopausal symptoms variation across study populations, ethnic and socio-demographic settings, sampling techniques and methodology.\u003c/p\u003e \u003cp\u003eThe least commonly reported menopausal symptom was vaginal dryness accounted 27% of sexually active women. As women progress to postmenopausal age, estrogen levels further decrease, resulting in vaginal atrophy, drynesss and other urogenital symptoms. Compared to other symptoms, urogenital symptoms were less common in these women, which may be because they adapt themselves to these symptoms over time, which is considered a cultural norm in Ethiopia, to become less sexually active toward old age. This has also been demonstrated in studies from India and Addis Ababa, Ethiopia. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAn incredible finding of this study was the absence of a single woman from study participants who ever used hormone replacement therapy, even though there were about 60(20.3%) women who had a history of seeking help from health professionals for complaints of one or more menopausal symptoms. This difference was different among studies conducted in other countries. In a multi-ethnic Asian population study conducted in Singapore, overall MHT usage was 8.7%, but when stratified by ethnicity prevalence of MHT usage was 11.3% in Chinese, 8.6% in Indian, and 5.9% in Malay women(\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e). The frequency of using menopausal hormone therapy was 40.1% in Portuguese women living in Porto(\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e), 13% in the United States(\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e), 13% in Australia(\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e), 45% in Poland(\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e), 16% in Germany(\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e). The underlying reasons for the absence of MHT practices in hospitals in this study require further investigation.\u003c/p\u003e \u003cp\u003eThe strength of this study is that it attempted to address one of Ethiopia's least explored but essential health problems. The finding that the management of menopausal symptoms is not at all given in these large teaching hospitals is concerning and provides valuable insight for hospitals and policymakers to combat this deficiency. In addition, this study used a validated questionnaire for assessing menopausal symptoms; therefore, the information obtained from this study is valuable as baseline data for the research and maintains its comparability with studies from other settings. The study included only governmental health institutions, which may not reflect the practice of MHT in private institutions, and further investigation is recommended.\u003c/p\u003e "},{"header":"CONCLUSION AND RECOMMENDATION","content":"\u003cp\u003eThe prevalence of menopausal symptoms is high, but individualized administration of hormone replacement therapy is non-existent in these institutions. It appears essential for these institutions to work on the service availability and delivery of menopausal hormone therapy for those in need of wider benefits of their clients. The underlying reason for the absence of ordering of menopausal hormonal therapy among health professionals working in gynecologic clinics requires further investigation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAAU=Addis Ababa University\u003c/p\u003e\n\u003cp\u003eAOR=Adjusted Odd Ratio\u003c/p\u003e\n\u003cp\u003eFMP = Final Menstrual Period\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGSM= Genitourinary Syndrome of Menopause\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGMH = Gandhi Memorial Hospital\u003c/p\u003e\n\u003cp\u003eHMIS = Health Management Information System\u003c/p\u003e\n\u003cp\u003eMHT= Menopausal Hormonal Therapy\u003c/p\u003e\n\u003cp\u003eMRS= Menopausal Rating Scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRGOPD = Regular Gynecologic Outpatient Department\u003c/p\u003e\n\u003cp\u003eTASH = Tikur Anbessa Specialized Hospital\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUK= United Kingdom\u003c/p\u003e\n\u003cp\u003eUS = Ultrasound\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVMS= Vasomotor Symptoms\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWHO = World Health Organization \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eZMH = Zewditu Memorial Hospital\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Review Board of\u0026nbsp;the College of Health Sciences of Addis Ababa University. \u0026nbsp;Data\u0026nbsp;were collected after\u0026nbsp;obtaining written informed consent\u0026nbsp;from all participants.\u0026nbsp;Data collection was confidential and no personal identifiers, such as name and phone number, were\u0026nbsp;requested. All methods were performed in accordance with\u0026nbsp;the relevant ethical standards and guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTG conceptualized, curated, analyzed, and interpreted the participants’ data, and was the major contributor to writing the manuscript.\u0026nbsp;RD contributed to the conceptualization, design, analysis, and writing of the manuscript.\u0026nbsp;MT contributed to the conceptualization, design, analysis, and writing of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge Addis Ababa University, College of Health Sciences, for providing us with the opportunity to conduct this study. We also thank the participants for their participation in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWomen, Ageing and Health: A Framework for Action. 2007. \u003c/li\u003e\n\u003cli\u003eNations U, of Economic D, Affairs S, Division P. World Population Prospects 2019 Highlights. \u003c/li\u003e\n\u003cli\u003eSperoff\u0026rsquo;s CLINICAL GYNECOLOGIC ENDOCRINOLOGY AND INFERTILITY, 9th edition. \u003c/li\u003e\n\u003cli\u003eHolte A. Influences of natural menopause on health complaints: A prospective study of healthy Norwegian women. Maturitas. 1992;14(2):127\u0026ndash;41. \u003c/li\u003e\n\u003cli\u003eCramer DW, Xu H, Harlow BL. Family history as a predictor of early menopause. Fertil Steril [Internet]. 1995;64(4):740\u0026ndash;5. Available from: http://dx.doi.org/10.1016/S0015-0282(16)57849-2\u003c/li\u003e\n\u003cli\u003eS.H. P, J. B, A. G, T. E. Impact of recent evidence on use of hormone therapy in the South African private sector (2001-2005). South African Fam Pract. 2008;50(6). \u003c/li\u003e\n\u003cli\u003eYisma E, Eshetu N, Ly S, Dessalegn B. Prevalence and severity of menopause symptoms among perimenopausal and postmenopausal women aged 30-49 years in Gulele sub-city of Addis Ababa, Ethiopia. BMC Womens Health. 2017 Dec 8;17(1):124. \u003c/li\u003e\n\u003cli\u003eWaidyasekera H, Wijewardena K, Lindmark G, Naessen T. Menopausal symptoms and quality of life during the menopausal transition in Sri Lankan women. Menopause. 2009;16(1):164\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eOlaolorun FM, Lawoyin TO. Experience of menopausal symptoms by women in an urban community in Ibadan, Nigeria. Menopause. 2009;16(4):822\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003eChedraui P, Aguirre W, Hidalgo L, Fayad L. Assessing menopausal symptoms among healthy middle aged women with the Menopause Rating Scale. Maturitas. 2007;57(3):271\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eSierra B, Hidalgo LA, Chedraui PA. Measuring climacteric symptoms in an Ecuadorian population with the Greene Climacteric Scale. Maturitas. 2005;51(3):236\u0026ndash;45. \u003c/li\u003e\n\u003cli\u003ePandey A, Karki C, Shrivastava VR, Shrestha D, Gautam P. Study of menopausal symptoms using menopause rating scale at a tertiary care center: A descriptive cross-sectional study. J Nepal Med Assoc. 2020;58(230):725\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eSharma S, Adhikari L, Karmacharya I, Kaphle M. Menopausal Symptoms among Postmenopausal Women of a Selected Municipality: A Cross-sectional Survey. J Nepal Med Assoc. 2021;59(243):1155\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eOjha N, Bista KD, Bajracharya S, Katuwal N. Genitourinary Syndrome of Menopause among Postmenopausal Women in a Tertiary Care Centre: A Descriptive Cross-sectional Study. J Nepal Med Assoc. 2022;60(246):126\u0026ndash;31. \u003c/li\u003e\n\u003cli\u003eSubedi A, Shrestha J, Chaudhary JK. Menopausal Symptoms among Postmenopausal Women Visiting Outpatient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study. J Nepal Med Assoc. 2022;60(251):617\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003eAdhikari D, Bhurtyal A. Menopausal symptoms among middle-aged women and care providers\u0026rsquo; readiness to deliver menopausal services: an observational study in Kavrepalanchok, Nepal. Sex Reprod Heal Matters [Internet]. 2022;29(2). Available from: https://doi.org/10.1080/26410397.2022.2141255\u003c/li\u003e\n\u003cli\u003eKronenberg F. Menopausal hot flashes: A review of physiology and biosociocultural perspective on methods of assessment. J Nutr. 2010;140(7). \u003c/li\u003e\n\u003cli\u003eVeerus P, Fischer K, Hovi SL, Karro H, Rahu M, Hemminki E. Symptom reporting and quality of life in the Estonian Postmenopausal Hormone Therapy Trial. BMC Womens Health. 2008;8:1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eAvis NE, Crawford SL, Greendale G, Bromberger JT, Everson-Rose SA, Gold EB, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eBansal R, Aggarwal N. Menopausal hot flashes: A concise review. J Midlife Health. 2019;10(1):6\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eBarnard ND, Kahleova H, Holtz DN, Del Aguila F, Neola M, Crosby LM, et al. 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Biology and Diseases of the Ferret: Third Edition. 2014. 401\u0026ndash;419 p. \u003c/li\u003e\n\u003cli\u003eShumaker SA, Legault C, Rapp SR, Thal L, Wallace RB, Ockene JK, et al. Estrogen Plus Progestin and the Incidence of Dementia and Mild Cognitive Impairment in Postmenopausal Women. 2015;289(20):2651\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eAssaf AR, Ph D, Lasser NL, Ph D, Trevisan M, Black HR, et al. new england journal. 2003;523\u0026ndash;34. \u003c/li\u003e\n\u003cli\u003eDennerstein L, Smith AMA, Morse C, Burger H, Green A, Hopper J, et al. Menopausal symptoms in Australian women. Med J Aust. 1993;159(4):232\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eInvestigation O. Conjugated Equine Estrogens and Coronary Heart Disease. 2015;166. \u003c/li\u003e\n\u003cli\u003eStudy H. Postmenopausal Hormone Therapy and Stroke. 2015;168(8):861\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eHulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, et al. Randomized Trial of Estrogen Plus Progestin for Secondary Prevention of Coronary Heart Disease in Postmenopausal Women. 2015;280(7). \u003c/li\u003e\n\u003cli\u003eHarman SM, Brinton EA, Cedars M, Lobo R, Manson JE, Merriam GR, et al. KEEPS: The Kronos Early Estrogen Prevention Study. Climacteric. 2005;8(1):3\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eSchierbeck LL, Rejnmark L, Tofteng CL, Stilgren L, Eiken P, Mosekilde L, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: Randomised trial. BMJ. 2012;345(7881). \u003c/li\u003e\n\u003cli\u003eBaber RJ, Panay N, Fenton A. 2016 IMS Recommendations on womens midlife health and menopause hormone therapy. Climacteric. 2016;19(2):109\u0026ndash;50. \u003c/li\u003e\n\u003cli\u003eSa Ra Lee, Moon Kyoung Cho, Yeon Jean Cho, Sungwook Chun, Seung-Hwa Hong, Kyu Ri Hwang, Gyun-Ho Jeon, Jong Kil Joo, Seul Ki Kim, Dong Ock Lee, Dong-Yun Lee, Eun Sil Lee, Jae Yen Song, Kyong Wook Yi, Bo Hyon Yun, Jung-Ho Shin, Hee Dong Chae corresponding. The 2020 Menopausal Hormone Therapy Guidelines. Menopausal Horm Ther Guidel [Internet]. 2020; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475284/#B101\u003c/li\u003e\n\u003cli\u003eLee SR, Cho MK, Cho YJ, Chun S, Hong S-H, Hwang KR, et al. The 2020 Menopausal Hormone Therapy Guidelines. J Menopausal Med. 2020;26(2):69. \u003c/li\u003e\n\u003cli\u003eShifren JL, Gass MLS, Kagan R, Kaunitz AM, Liu JH, Pinkerton JA V., et al. The North American Menopause Society recommendations for clinical care of midlife women. Menopause. 2014;21(10):1038\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003ePitkin J, Smetnik VP, Vad\u0026aacute;sz P, Mustonen M, Salminen K, Ylikangas S. Continuous combined hormone replacement therapy relieves climacteric symptoms and improves health-related quality of life in early postmenopausal women. Menopause Int. 2007;13(3):116\u0026ndash;23. \u003c/li\u003e\n\u003cli\u003eADMINISTRATION AND CONTROL AUTHORITY STANDARD TREATMENT GUIDELINES Third Edition , 2014. 2014; \u003c/li\u003e\n\u003cli\u003eEthiopian Food and drug authority and Ministry of health. Ethiopian Essential Medicines List Sixth Edition. Online J. 2020;4\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eEshetu N, Ly S, Yisma E. Knowledge and Attitude of Women Aged 30-49 Years towards Menopause in Gulele Sub-City of Addis Ababa, Ethiopia. Ann Glob Heal. 2017;83(1). \u003c/li\u003e\n\u003cli\u003eGebretatyos H, Ghirmai L, Amanuel S, Gebreyohannes G, Tsighe Z, Tesfamariam EH. Effect of health education on knowledge and attitude of menopause among middle-age teachers. BMC Womens Health. 2020;20(1):1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eIdris IM, Amr DA. Women\u0026rsquo;s awareness about menopausal symptoms and its management: a cross-sectional study in 2 selected settings of Asmara, Eritrea. Glob Reprod Heal. 2021;6(4):e54\u0026ndash;e54. \u003c/li\u003e\n\u003cli\u003eTsehay DS, Mulatie MM, Sellakumar GK. Determinants of menopausal symptoms and attitude among middle aged women: The case of Dangila town, Northwest Ethiopia. Innovare J Soc Sci. 2014;2(1). \u003c/li\u003e\n\u003cli\u003eAyenew A, Yechale M, Nigussie A, Ayalew N. Women\u0026rsquo;s Knowledge of Concept of Menopause, Severity, and Climacteric Stage Among Women in Middle Age in Northwest Ethiopia: Community-Based Cross-Sectional Study. Res Sq [Internet]. 2021;July(2):1\u0026ndash;26. Available from: https://doi.org/10.21203/rs.3.rs-638981/v1\u003c/li\u003e\n\u003cli\u003eAl-Baghdadi O, Ewies AAA. Topical estrogen therapy in the management of postmenopausal vaginal atrophy: An up-to-date overview. Climacteric. 2009;12(2):91\u0026ndash;105. \u003c/li\u003e\n\u003cli\u003eShams-eldin AA. KNOWLEDGE , ATTITUDE AND SEVERITY OF MENOPAUSAL SYMPTOMS AMONG WOMEN ATTENDING PRIMARY HEALTH CARE CENTERS IN CAIRO , EGYPT By. 2018;47(2). \u003c/li\u003e\n\u003cli\u003eKibret B tefera, Biruk G. Mariam. Menopausal Experiences among Women in Addis Ababa. Int J Psychiatry. 2019;4(1). \u003c/li\u003e\n\u003cli\u003ePeeyananjarassri K, Cheewadhanaraks S, Hubbard M, Zoa Manga R, Manocha R, Eden J. Menopausal symptoms in a hospital-based sample of women in southern Thailand. Climacteric. 2006 Jan 1;9(1):23\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eHeinemann K, Ruebig A, Potthoff P, Schneider HPG, Strelow F, Heinemann LAJ, et al. The Menopause Rating Scale (MRS) scale: A methodological review. Health Qual Life Outcomes. 2004;2:1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eHarris T, Seid E. 2019/20 survey of the Ethiopian tax system The Institute for Fiscal Studies. 2019; Available from: http://www.ifs.org.uk\u003c/li\u003e\n\u003cli\u003eZegeye DT, Megabiaw B, Mulu A. Age at menarche and the menstrual pattern of secondary school adolescents in northwest Ethiopia. BMC Womens Health. 2009;9:29. \u003c/li\u003e\n\u003cli\u003eSingh A, Pradhan S. Menopausal symptoms of postmenopausal women in a rural community of Delhi, India: A cross-sectional study. J Midlife Health. 2014;5(2):62. \u003c/li\u003e\n\u003cli\u003eArticle O. Experience and Perceptions Regarding Menopause among Rural Women: A Cross‑Sectional Hospital‑Based Study in South Karnataka. 2021;199\u0026ndash;205. \u003c/li\u003e\n\u003cli\u003eRyu K, Park H, Kim YJ, Yi KW, Shin JH, Hur JY, et al. Maturitas Comparison of various menopausal symptoms and risk factor analysis in Korean women according to stage of menopause. Maturitas [Internet]. 2020;140(February):41\u0026ndash;8. Available from: https://doi.org/10.1016/j.maturitas.2020.05.023\u003c/li\u003e\n\u003cli\u003eFong M, Mb C, Wun YT, Meng S, Mb P. Menopausal Symptoms and the Menopausal Rating Scale Among Midlife Chinese Women in Macau , China Menopausal Symptoms and the Menopausal. 2014;(October):37\u0026ndash;41. \u003c/li\u003e\n\u003cli\u003eAarti K. Maharashtra-2015. 2015;(June):Part IV--C Extra 44 (17th July 2015 ). Available from: http://www.webcitation.org/query?url=http%3A%2F%2Fegazzete.mahaonline.gov.in%2FForms%2FGazetteSearch.aspx%3FMenuID%3D1124\u0026amp;date=2015-09-02\u003c/li\u003e\n\u003cli\u003eArmo M, Sainik S. Assessment of Menopausal Symptom Using Modified Menopause Rating Scale among Rural Women of Rajnandgaon in Chhattisgarh , a Central India Region. 2020; \u003c/li\u003e\n\u003cli\u003eThapa R, Yang Y. Menopausal symptoms and related factors among Cambodian women. Women Heal [Internet]. 2020;60(4):396\u0026ndash;411. Available from: https://doi.org/10.1080/03630242.2019.1643815\u003c/li\u003e\n\u003cli\u003eEssa R. Factors Associated with the Severity of Menopausal Symptoms among menopausal Women Factors Associated with the Severity of Menopausal Symptoms among menopausal Women Rasha Mohamed Essa , 2 Noha Mohamed Mahmoud. 2020;(March). \u003c/li\u003e\n\u003cli\u003eKhatoon F, Sinha P, Shahid S, Gupta U. Assessment of menopausal symptoms using modified menopause rating scale (MRS) in women of Northern India. Int J Reprod Contraception, Obstet Gynecol. 2018;7(3). \u003c/li\u003e\n\u003cli\u003eSatapathy SP, Karmee N, Dash R. Prevalence of menopausal symptoms and its association with various factors among women in post menopausal age group: a cross-sectional study. Int J Reprod Contraception, Obstet Gynecol. 2020;9(9):3837. \u003c/li\u003e\n\u003cli\u003eAlquaiz JM, Siddiqui AR, Tayel SA, Habib FA. Determinants of severity of menopausal symptoms among Saudi women in Riyadh city. Climacteric. 2014;17(1):71\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eDuffy OK, Iversen L, Hannaford PC. Factors associated with reporting classic menopausal symptoms differ. Climacteric. 2013;16(2):240\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eEssa RM, Mahmoud NM. Factors Associated with the Severity of Menopausal Symptoms among menopausal Women Rasha Mohamed Essa , 2 Noha Mohamed Mahmoud. IOSR J Nurs Heal Sci. 2018;7(2):29\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eZhang L, Gu M, Mueck AO. Menopausal Symptoms and Associated Social and Environmental Factors in Midlife Chinese Women. 2020; \u003c/li\u003e\n\u003cli\u003eLee M, Kim J, Park MS, Yang J, Ko Y, Ko S, et al. Factors Influencing the Severity of Menopause Symptoms in Korean Post-menopausal Women. 2010;758\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eAlwi S, Abdul S, Zainudin SR, Lee V, Mun K. Assessment of menopausal symptoms using modified Menopause Rating Scale ( MRS ) among middle age women in Kuching , Sarawak , Malaysia. 2010;1\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eChuni N, Sreeramareddy CT. Frequency of symptoms , determinants of severe symptoms , validity of and cut-off score for Menopause Rating Scale ( MRS ) as a screening tool : A cross-sectional survey among midlife Nepalese women. 2011; \u003c/li\u003e\n\u003cli\u003eAdefuye PO, Adefuye BO, Lamina MA, Shorunmu TO, Akindele RA. Menopause in Sagamu, southwest Nigeria. 2017;Vol. 94(No. 12). Available from: https://www.ajol.info/index.php/eamj/article/view/178678\u003c/li\u003e\n\u003cli\u003eAlDughaither A, AlMutairy H, AlAteeq M. Menopausal symptoms and quality of life among Saudi women visiting primary care clinics in Riyadh, Saudi Arabia. Int J Womens Health. 2015 Jun 29;7:645\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eSoh BP, Man REK, Tham YC, Fenwick E, Yong TT, Wong TY, et al. Hormone Replacement Therapy (HRT): Utilisation Rates, Determinants and Impact on Health-Related Quality of Life in a Multi-Ethnic Asian Population. J Clin Diagnostic Res. 2020;14(1):2009\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eLucas R, Barros H. Life prevalence of hormone replacement therapy and profile of users have not changed among women with self-reported menopause in the last two decades in Porto, Portugal. Climacteric. 2008;11(1):26\u0026ndash;31. \u003c/li\u003e\n\u003cli\u003eMccarty ME, Thomas HN. Differences in patient-reported hormone therapy use for menopause symptoms by provider specialty. Climacteric [Internet]. 2021;0(0):1\u0026ndash;5. Available from: https://doi.org/10.1080/13697137.2021.1945026\u003c/li\u003e\n\u003cli\u003eVelentzis LS, Banks E, Sitas F, Salagame U, Tan EH. Use of Menopausal Hormone Therapy and Bioidentical Hormone Therapy in Australian Women 50 to 69 Years of Age : Results from a National , Cross-Sectional Study. 2016;1\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eG\u0026oacute;recka K, Krzyżanowska M. Prevalence of menopausal hormone therapy and alternative methods , health benefits experienced by peri- and postmenopausal Polish women. 2022;21(1):27\u0026ndash;36. \u003c/li\u003e\n\u003cli\u003eHeinig M, Braitmaier M, Haug U. Prescribing of menopausal hormone therapy in Germany : Current status and changes between 2004 and 2016. 2021;(December 2020):462\u0026ndash;71. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Menopause, Menopausal symptoms, Ethiopia, Gynecology, Hot flushes, Somatic symptoms, Psychological symptoms, Urogenital symptoms.","lastPublishedDoi":"10.21203/rs.3.rs-4411857/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4411857/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The onset of menopause leads to diminished estrogen exposure, resulting in a high morbidity burden related to menopausal symptoms. Menopausal hormonal therapy is an effective therapy that offers more advantages than disadvantages for women aged less than 60 years or who have had menopause for less than 10 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOBJECTIVE\u003c/strong\u003e: This study aimed to assess the prevalence of menopausal symptoms, identify factors associated with menopausal symptoms, and assess the use of menopausal hormone therapy among women aged 40-60 years who visited the gynecological clinics of three hospitals in Addis Ababa, Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA facility-based cross-sectional study was conducted from January 2022 to June 2022 at Gandhi Memorial Hospital, Tikur Anbessa Hospital and Zewditu Memorial Hospital on atotal of 296 middle-aged women. Data were collected using an interviewer-administered structured questionnaire and analyzed for sociodemographic factors, utilization of menopausal hormone therapy, and prevalence of menopausal symptoms using the menopause rating scale. Data were analyzed using SPSS version 25. Bivariate and multivariate logistic regression analyses were performed to identify independent predictors of each subscale of menopausal symptoms. The strength of the association was measured using odds ratios with 95% confidence intervals, and statistical significance was set at value P\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e: The prevalence of menopausal symptoms was 89.9%. According to menopausal rating scale, the frequency of reported symptoms was hot flushes (54.7%), muscle and joint pain (32.1%) on somatic subscale; physical and mental exhaustion (55.1%), irritability (48.6%) on psychological subscale; and sexual problems (41.3%), bladder problems (39.2%) on urogenital subscale. This study also showed that the age of women and monthly family income were significantly associated with all three subscales of the menopausal rating scale. There was no utilization of menopausal hormonal therapy to treat menopausal symptoms and to prevent complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The prevalence of menopausal symptoms is high; however, the utilization of individualized administration of menopausal hormone therapy according to symptoms is negligible. It appears essential for these institutions to work on service availability and delivery of menopausal hormone therapy for those in need of wider benefits of their clients.\u003c/p\u003e","manuscriptTitle":"Menopausal symptoms and utilization of menopausal hormone therapy among women aged 40-60 years in Addis Ababa, Ethiopia: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-25 01:54:26","doi":"10.21203/rs.3.rs-4411857/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-05T03:12:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-04T23:10:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-17T05:03:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"89936724508559558517006545363106834289","date":"2024-06-16T14:54:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"292895673117854819182349704325446076309","date":"2024-06-14T02:54:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230685911305520501759550821130510756889","date":"2024-06-12T03:05:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-30T22:37:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-22T09:49:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-16T12:24:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2024-05-13T08:41:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8c674cf3-73f7-4503-aaba-96167d937ca0","owner":[],"postedDate":"May 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-16T16:00:16+00:00","versionOfRecord":{"articleIdentity":"rs-4411857","link":"https://doi.org/10.1186/s12905-024-03359-7","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2024-09-14 15:57:10","publishedOnDateReadable":"September 14th, 2024"},"versionCreatedAt":"2024-05-25 01:54:26","video":"","vorDoi":"10.1186/s12905-024-03359-7","vorDoiUrl":"https://doi.org/10.1186/s12905-024-03359-7","workflowStages":[]},"version":"v1","identity":"rs-4411857","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4411857","identity":"rs-4411857","version":["v1"]},"buildId":"cTy_lsJlmDsVRNrSptgXS","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}