This study showed that out of various anthropometric, socio-economic and reproductive characteristics that may have influence the quality of life of postmenopausal women, waist-to-hip ratio, the severity of menopausal symptoms, and the adequacy of monthly household income are the most remarkable ones.
The results showed that QoL is negatively associated with the severity of menopausal symptoms. That is, for every one unit increase in the total score of MRS, the total score of QoL decreased by 0.420 units. This finding is in agreement with those of multiple studies showing the severity of menopausal symptoms to be in a negative association with QoL [29, 30, 32, 33, 38,39,40]. According to some estimates, 50 to 80% of women experience menopausal symptoms (physical or psychological), leading to a decline in QoL [15]. Menopause affects all aspects of health, and our study shows that QoL among postmenopausal women is jeopardized with the emergence of menopausal symptoms.
This study found family monthly income to be associated with QoL. The total score of QoL was 2.318 units higher among the women with adequate or higher monthly income comparing to those with less-than-adequate monthly income. The relationship between income/economic status and QoL has been confirmed in several studies [11, 26, 27, 34, 41, 42], all of which are consistent with our study. This finding might stem from the fact that women with higher socioeconomic statuses, due to proper nutrition and timely referrals to medical specialists, find it easier to cope with the side effects of menopause [27]. Moreover, favorable economic conditions are often associated with better-paying jobs and higher education levels in couples, which could in turn ease their adaptation to the changes during menopause and senility. What is well established is that QoL during menopause is influenced in consequential ways by physical, emotional, social, and economic factors [26].
No significant association was found between QoL and BMI, which is consistent with the findings of Fallahzade et al. [27] and Golmakany et al. [35], but inconsistent with those of several other studies [28, 31, 41, 43, 44]. In study of Fallahzadeh [28], women with a BMI equal to or less than 18.5 kg/m2 had better QoL.
The finding demonstrated waist-hip ratio, however, to be inversely associated with QoL, so that with each unit increase in waist-hip ratio the total score of QoL decreased by 11.380 units. Considering that waist-to-hip ratio is an indicator of obesity, QoL could be theoretically tied to obesity, but there remains a need for further investigation on this front.
The results also showed a negative correlation between duration of menopause and the total score of QoL, as well as its psychological-health and environment domains. This finding has been confirmed by other studies [36, 37]. Some studies, however, showed that women whose menopause was 5 years old or older showed better quality of life [28, 43]. While their study examined duration of menopause in two groups and with a five-year-old threshold, our study was performed with more precision and duration of menopause was calculated up to months. Therefore, this controversy could be attributed to the different method of data analysis and the study population.
There was not any significant correlation between age and QoL, which does not correspond with a number of studies [11, 27, 30, 37, 41, 43, 45, 46] and could be the result of differences in study population and data-collection tools.
A positive correlation was found between level of education (among the women and their spouses) and the total score of QoL along with all of its domain scores except the domain of relationships. This finding has also been confirmed elsewhere [11, 15, 27, 30, 36, 37, 41, 43, 46, 47].
Surely women with higher education levels have greater access to credible sources of information and health resources, and hence are more equipped to deal with the complications and symptoms of menopause, which in turn leads to better QoL [27]. On the other hand, higher education is often synonymous with higher income levels and more opportunities in one’s professional and social lives [11], which could also improve QoL.
The present study revealed that the total scores of QoL and the scores in the physical- and psychological-health domains were lower among the housewives compared with the employed women. The spouses’ occupations, however, showed no correlation with the QoL of the participating postmenopausal women. The relationship between employment status and QoL has been examined by several studies [27, 36, 41, 43, 46, 48,49,50], most of which found employed women to have a better QoL than housewives [27, 36, 43, 48], which is consistent with our study.
Norozi et al. have showed that retired postmenopausal women enjoy a better QoL than housewives [46], while the study of Shobeiri et al. found that QoL is stronger among housewife postmenopausal women comparing to employed women [41].
It could be speculated that a job or responsibility in an organization boosts confidence among middle-aged women and helps to improve their QoL [46]. The employed women seemed that had better social support [41]. Housewives, on the other hand, are less exposed to the social environment outsides their homes and are mostly occupied with household chores, personally carrying out many of the tasks that working, financially independent women often delegate to others.
The side effects of menopause could be associated with the burdens of housework, which further complicate matters and diminish QoL. Working women also tend to have better mental health than stay-at-home ones [27], and given their routine exposure to social settings outside the home, are better able to withstand the symptoms of menopause.
This study showed that QoL is in a negative correlation with the frequencies of pregnancy (gravida), delivery (parity), and vaginal birth. Consistent with our findings, the Fallahzadeh et al. study [27] showed that the frequency of pregnancy could be correlated with QoL, and Monterrosa-Castro [31] showed that QoL significantly decreases with parity. Some studies also showed that number of children was inversely associated QoL in postmenopausal women [41, 51]. Given the association of the number of children with the frequencies of pregnancies and delivery, this result is consistent with the result of the present study.
These findings indicate that multiparity and multiple childbirths could cause physical and psychological impairments and hence have a negative impact on QoL. Higher number children could increase parental stress and responsibility as well as financial problems [52]. Mothers’ concerns regarding childcare – providing a decent life for them, paying attention to comfort them – always take precedence over their own convenience, thus correlating with their QoL. It could also be inferred that the odds of stillbirth are increased with every pregnancy, as a significant negative correlation was found between QoL and the frequency of stillbirth.
Strengths and limitations
To mention the strengths of the present study, we excluded women whose menopause was longer than 3 years at the time of the study. It could have weakened the effects of aging on QoL. In addition, our study was conducted among general, Iranian postmenopausal women, which decreased participation bias.
Regarding limitations, the present study was conducted in two cities located in northern Iran, and its results may not be generalizable to other communities with different attitudes, customs, cultures, and lifestyles. Another important limitation of this study was that the present study was cross-sectional study and this design did not permit the assessment of the temporal sequence of QoL and effective factors, making it impossible to assess causal relations.
