European Journal of Scientific Research ISSN 1450-216X Vol.45 No.2 (2010), pp.261-269 EuroJournals Publishing, Inc. 2010 http://www.eurojournals.com/ejsr.

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Menopause Symptoms Questionaire (MSQ)

Busari, A. Olanike Department of Educational Psychology, Federal College of Education (Special) Oyo E-mail: olanikebusari@yahoo.com Tel- +2348088979187 Abstract The literature has suggested that menopause symptoms are conveniently divided into two groups: - these are psychological symptoms associated with immediate or eminent cessation of menses, and those physiological symptoms which appear after some years of menopause. The purpose of this study was to construct a questionnaire based on psychological and physiological symptoms which appear after some years of menopause, to obtain test-retest reliabilities of items and to factor analyze the instrument to empirically investigate the two-type of menopause. The first set of 51 items had mean test-retest reliabilities of 0.76 and yielded two clearly distinct factors in support of the two-type hypotheses. When items with factor loadings less than 0.35 were discarded, 25 items remained and the mean test-retest reliabilities of these items was 0.78. Again, two clearly distinct factors emerged defining psychological and physiological symptoms consistent with the literature. The retained items from the first questionnaire and the items from the second questionnaire loaded on the same factors both times. It was concluded that two types of menopause symptoms do, in fact exist and that this study has provided a reliable means of differentiating them.

Keywords: Menopause, Psychological and Physiological, Signs, Scale

1. Introduction
Menopause, the time when a woman stops having menstrual periods, is not a disease or an illness. It is a transition between two phases of a womans life. Many women experience a variety of symptoms as a result of the hormonal changes associated with the transition through menopause. Around the time of menopause, women often loose bone density and their blood cholesterol levels may worsen, increasing their risk of heart disease. The average age of Nigerian women at the time of menopause is 50 years. The most common age range at which women experience menopause is 48-55 years. If menopause occurs in a woman younger than 40 years, it is considered to be premature. Menopause is considered late if it occurs in a woman older than 55 years. For most women is a normal occurrence. Menopause is more likely to occur at a slightly earlier age in women who smoke, have never been pregnant, or live at high altitudes. This list of common symptoms that occur during perimenopause and menopause was developed from the real-life experiences of hundreds of women. All symptoms were experienced by numerous women and were either cyclical in nature or responded to treatments (both traditional and alternative) known to address hormonal imbalances.

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2. Previous Research
Menopause symptoms are conveniently divided into two groups: those acute (psychological) symptoms associated with immediate or eminent cessation of menses, and those later (physiological), symptoms which appear after some years of menopause. However, it is believed that three symptoms may be regarded as truly related to menopause. (i) cessation or irregularity of menses, (ii) the hot flush, and (iii) insomnia (Schiff et al 1992). The other host of symptoms sometimes ascribed to the menopause must be regarded as related to either the aging process or anxiety associated with a confrontation of aging. There is nevertheless, cascade effect which cannot be disregarded. Flushes may be severe enough to impair sleep, loss of sleep impairs energy; lack of energy decreases productivity; decreased productivity impairs interpersonal relationships cause mood depressions. Menopause, the final phase of the female reproductive ability, refers to the cessation of menstrual periods and is considered complete after one full year of amenorrhea. The manner in which menstruation ceases is variable. Occasionally it may cease abruptly, but as a rule the menstrual flow becomes gradually scantier, and the interval between periods is increased. As ovarian function further declines, the cycle may become irregular. Failure of ovulation may cause missed or shorter and less profuse periods, or functional uterine bleeding with prolonged and grossly irregular cycles. Menopause is associated with several disturbances, vasomotor instability causes irregularity in blood vessel diameter such fluctuation permits more blood to flow at times causing flushing of the skin, a feeling of warmth and profuse sweating. Other common symptoms include fatigue, dizziness, migraine, headaches, chest and neck pains, insomnia, excessive desire for sleep, and depression. Body weight changes sometimes occur and may be related to decreased thyroid function, decreased physical activity, or increased food intake as a substitute for emotional and social satisfactions. In women, abdominal and pelvic fat increases at a greater rate than subcutaneous fat during aging and may account for almost 60% of total body fat (Skerly et al 1990). Scalp and pubic hair tend to attenuate. The hair on the upper lip and chin may increase due to relative excess of androgen and deficiency of estrogen. Women with a history of previous nervousness or psychotic behaviour may show emotional disturbances: they become depressed, nervous, shorttempered, and irritable. They may loose sexual interest during this time although they may have an increased sexual drive later. It is important to bear in mind at the outset that the symptoms many women experience at the time of the menopause may be divided into two categories:- those that arise on an endocrinologic basis and are the result of estrogen lack of those of psychological origin. Symptoms arising primarily on the basis of a psychological disturbance include nervousness, irritability, headaches, insomnia, inability to concentrate spells of anxiety and depression, easy fatigability and a general decline in physical and mental energy and sense of well-being. The origin of the psychological disturbances that may arise in some women at the time of menopause are often multiple and complex. In some there is a history of similar emotional disturbances at other critical junctures in their lives-adolescence, marriage, pregnancy-the menopause simply representing another major alteration in the pattern of living to which they adjust with difficulty because of a fundamental underlying emotional instability. For other womens cessation of menstrual function may represent a partial loss of feminity, and hence unconsciously the menopause looms as a threat to their very existence as females and to their self-esteem. For practically every woman, the time of the menopause coincides with major changes in her family and social environment. In the case of the housewife, the children have grown up and left home, her husband is absorbed in and at the peak of his career, her once hectic and busy life and multiple home responsibilities are suddenly over, and she may feel neglected, passed by, and worst of all, no longer needed and without a worthwhile goal and purpose in life.

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The average, healthy-emotionally well-adjusted woman rapidly find other interests and outlets and even experiences improvement in general health and sense of well-being above and beyond the relief provided by the elimination of the physical and mental stresses involved in rearing a family. But for some the transition is extremely traumatic, and psychological disturbances of varying severity and duration appear. Thus there appears to be no such thing as a specific postmenopausal syndrome. The menopausal syndrome was the one most clearly associated with the psychological factors. Psychological symptoms have become so closely associated with the menopause that they are included in the definition of climacteric as the syndrome of endocrime, somatic and psychic changes occurring at the reproductive period in female (Daly, 1994). The association of psychological symptoms with the clinical features of the menopause has persisted, the psychological changes of the menopause may be tempestuous and even The most stable of woman could show outbursts of irritability, depression or hysteria Machaughton (1996) included psychological symptoms in his account of the clinical features of the menopause and ascribed them to fears of loss of feminity and reproductive potential, Gold and Josimovich (1990) stated that irritability emotional instability, depression and negativism are common manifestations of the menopause, but the relationship of these symptoms to hormonal changes is uncertain. Llewelyn-Jones (1988) listed the symptoms presented by 500 menopausal women attending clinic at the onset of menopause and included depression, insomnia and fatigue. However, he pointed out that there were the symptoms in women seeking aid at the time of the menopause and that they made up of only 25% of the female population. He suggested that the psychological symptoms were related more to individuals reaction to the realization of reaching the menopause rather than any direct effect of ovarian failure. Leheno (1989) presented a different view of the symptoms associated with the menopause. He maintained that psychological changes were few or insignificant in well-adjusted and well-informed women and suggested that symptoms arising from family problems and other issues were often wrongly attributed to the menopause, giving it an undeservedly bad reputation. Schiff et al (1992) expressed a similar view that psychological symptoms occurring at this time of life were erroneously attributed to the menopause by many women. The purpose of this study is to (attempt to develop such an instrument) create for understanding of signs and symptoms of menopause.

3. Hypotheses
For establishing the psycho-metric properties of this questionnaire, the following null hypotheses were formulated and tested. H1: Psychological and physiological symptoms will not differ significantly in the women experiencing menopause. H2: The reliability and distribution of the scores will not indicate that MSQ possess psychometric capable of differentiating between the two types of menopause. H3: The type of menopause symptoms chosen by the participants will not correlate with the three factors pattern of unrotated MSQ factors to evaluate interrelationships among the items. H4: The ranked scores of the items will not reveal a relatively continuous dimension between acute and later symptoms of menopause.

4. Research Method
The menopause symptoms Questionnaire a psychometric test to differentiate between the two type of menopause was constructed by: 1) Developing items from the literature that characterize the symptoms i.e. (acute (psychological) and later (physiological) symptoms) 2) Administering and factor analyzing these items on two separate samples.

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4.1.1. Step 1 For the administration of the questionnaire to the first sample 51 items were developed from symptoms of the two types of menopause discussed in the literature. Forty-two of the 51 items were statements about symptoms with five response choices Reflecting the degree to which the symptom is present for the participant and would select one of five alternative responses most descriptive of herself. The final item had only two response choices. This item asked whether or not the participants was taking hormonal prescriptive, including oral contraceptives before the cessation of their menses. The participants constituting the first sample were 42 volunteer female teachers From 3 different schools in Ibadan North Local Government Area of Oyo State who described themselves as menopausal individuals. These participants were given the 51-item questionnaire once at the beginning and again at the end of a 2-week period. After this questionnaire was given the second time, the participants were asked to indicate on their questionnaire the type that best described their experience with menopausal symptoms. The purpose of the two administration for the first sample was to yield test-retest reliability of the items. Factor analysis was performed on the results of the second administration. 4.1.2. Step II Two types of menopause symptoms emerged from and were defined by the factor analysis of the data from administration of the questionnaire to the first sample. This questionnaire was then revised by eliminating those items which were not correlated with the factors, and by rewriting items for increased clarity. The resulting, revised questionnaire had 25 items (see table 1). Twenty-four of these 25 items were statements about symptoms with five response choices reflecting the degree to which the symptom is present for S completing the questionnaire. Twelve (12) of these 24 items were characteristics of acute (psychological) symptoms and twelve (12) characteristics of later (physiological) symptoms of menopause. The final item consisted of a paragraph describing each of the two types of menopausal symptoms and instructions to the participants to select which type she believes was the most accurate description of her experience of menopause symptoms. This revised questionnaire was administered to a second sample to examine Whether or not the items would continue to be reliable, and would continue to generate the same factors item questionnaire. The subjects in the second sample were 38 female teachers from three different secondary schools in Akinyele Local Government Area of Oyo State who described themselves as having menopause symptoms, and who had not participated in the previous administrations of the 51-item questionnaires. These participants were given the 25-item questionnaire once at the beginning and again at the end of a 2-week period. This 25-item questionnaire was scored so that each participant was given a score of 1-5 for each item. The score of 5 was assigned when S responded to always experiencing a symptom characteristic of acute (psychological) menopause symptoms. A score of 1 was assigned if participants responded to never experiencing this symptom. Conversely, a score of 1 was assigned if participants responded to always experiencing a symptom characteristic of later (physiological) menopause symptoms; and a score of 5 was assigned if another participant responded to never experiencing this symptom. Thus, the 12 items describing symptoms characteristic of later (physiological) menopause were scored in reverse order to those of later (physiological) menopausal stage. The scores of 2,3 and 4 were assigned in order to correspond to the scoring pattern described above. The twenty-fifth item, having only two choices, was scored so that those participants who responded that they were most like the description of acute (psychological) symptoms of menopause were given a score of 5, and those who responded that they were most like the description of later (physiological) menopause symptoms were given a score of 1. Thus it was expected that those with later (physiological) menopause

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symptoms would receive lower total scores. Since the highest possible score was 125 and the lowest possible score was 29, the midpoint between these extremes was 77.

5. The Results of Hypotheses Testing

In this section of the paper, results of analysis of research hypotheses are presented. 5.1. Results of Testing H1 The 51-item questionnaire first underwent a correlational analysis to examine the reliability of the items over the 2-week period of time. All items yielded reliability coefficients equal to or greater than 0.600 and the average coefficient based on Z-score transformation was 0.76. Following this correlational analysis, a principle components factor analysis (Cooley and Lohnes 1975) was performed on the second administration of the questionnaire. This was to examine whether or not participants were responding differently to those items, theoretically characteristic of later (physiological) menopause symptoms. The requirement that a factor possess an Eigen value greater than 1 was the criterion for the number of factors (of a limit of ten) was considered. Using this criterion, the first three factors were extracted from the correlations among items. These three factors accounted for 42.57 percent of the datas variance, while the other seven factors accounted for and additional 10.46 percent of the total variance. Those items with factor loading greater than 0.350 were assigned to one of the three factors. For those items meeting this criterion, the highest loading determined the factor to which the item was assigned. Using this procedure, no items were assigned to the third factor and 27 items which did not meet criterion were eliminated. The items which were assigned to the first factor were all characteristic of acute psychological symptoms of menopause while those items which were assigned to the second factor were all characteristic of later (physiological) symptoms of menopause.
Table 1: Results Summary of H1 Items on the Menopause Symptoms Questionnaire (MSQ)
1 Never 1. 2. 3. 4. 5. 6. 7. I become easily irritable, agitated and impatient (Psy) I have chest and neck pains ,burning tongue, burning roof of the mouth and bad taste in the mouth (Psy) I feel depressed and troubled sleeping throughout the night. (Psy) I have increase in allergies and changes in body odour (Psy) I feel exhausted, lethargic or tired. (Psy) I am experiencing loss of libido and dryness in vagina. (Psy) I am experiencing dizziness , lightheadedness, episodes of loss of balance (Psy) I feel tense , nervous ,anxious , feeling ill at ease, mood swing and sudden tears (Psy) I have excessive desire for sleep and disturbing memory lapses. (Psy) I have aching, sore joints , muscles and tendons. (Phy) I sweat profusely and experiencing 2 Rarely 3 Sometimes 4 Often 5 Always

8. 9. 10. 11.

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crashing fatigue. (Phy) My lower back, abdomen, and the 12. inner sides of my thighs hurt me continuously. (phy) I am experiencing irregular, shorter, 13. lighter, heavier and longer cycles. (Psy) I begin to add a lot of weight and 14. experiencing tenderness in breast (Phy). I am experiencing incontinence 15. ,especially upon sneezing, laughing urge incontinence (Psy) I am experiencing gastrointestinal 16. distress, indigestion, flatulence ,gas pain, nausea(Phy) I have pains which may diminish or 17. disappear for several minutes and then reappear (Phy) 18. My heart beat rate increased (Phy) I have tinnitus, ringing in ears, bells, 19. whooshing, buzzing (Phy) I have feelings of dread 20. ,apprehension and doom (Phy) I feel inability to concentrate and 21. forgetful, disorientation and have mental confusion(psy) I feel a general decline in physical 22. and mental energy (Phy) I have skin problems ,changes in the 23. fingernails, softer, crack or break easily (Phy) I feel electric shock sensation under 24. the skin and in the head (Phy) I experience hot flushes , night 25. sweats and /or cold ,flashes clammy feeling The additional item concerning the type of menopause symptom chosen by the participants, correlated with the two factors with loadings of 0.489 and 0.389 respectively. The extraction of these two factors, an acute (Psychological) symptoms and later (Physiological) symptoms of menopause. The additional item concerning the type of menopause symptoms chosen indicated that there are two types of menopause symptoms. These factors also suggested that a psychometric measure capable of differentiating between these two types could be developed.

5.2. The Results of Testing H2 The items which were retained as a result of the first factor analysis included the 12 items which loaded on the acute (psychological) symptoms factor, the 12 item-which loaded on the later (physiological) symptoms factor, and the 1 item concerning the type of menopause symptoms chosen by the Ss. This item loaded on both factors as indicated above. These 25 items, listed in table 1, defined the Menopause Symptom Questionnaire (MSQ). The MSQ underwent a correlational analysis to determine test-retest reliability over the 2-week period. The reliability coefficients equal to or greater than 0.648, and the average coefficient based on Z-score transformation was 0.78. The twenty-fifth item which consisted of a paragraph describing each of these two types of symptom had a high test-retest reliability of 0.933. The test-retest reliability of the participants total scores on the MSQ was 0.87. A principal components factor analysis (Cooley and Lohnes, 1975) was performed to evaluate the interrelationships among the 25 items. Ten factors were extracted and the requirement that a factor possess an Eigen value greater than (1) was the criterion for the number of factors to be considered.

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Using the criterion, three factors again emerged from the correlations among the items. These three factors accounted for 54.56 percent of the datas variance.
Table 2: Results Summary of H2

MSQ Item test-retest Reliability Coefficients

MSQ Item No 1 2 3 4 5 6 7 8 9 10 11 12 13 R 0.722 0.823 0.784 0.767 0.796 0.687 0.810 0.805 0.747 0.900 0.840 0.736 0.875 MSQ Item No 14 15 16 17 18 19 20 21 22 23 24 25 R 0.685 0.719 0.920 0.761 0.805 0.670 0.757 0.791 0.646 0.720 0.822 0.931

5.3. The Results of Testing H3 In testing this hypothesis it is investigated whether the type of menopause symptoms chosen by the participants will correlate with the factor pattern of the three unrotated MSQ factors to evaluate interrelationships among the items.
Table 3: Results Summary of H3

Factor Pattern of the three Unrotated MSQ Factors

Item Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Percent Total variance accounted for Eigen values Factor 1 -0.241 0.590 0.189 0.438 0.319 0.579 0.622 0.416 -0.268 0.499 0.247 0.588 0.300 0.596 0.470 -0.211 0.256 0.610 0.344 0.320 0.522 0.270 0.237 0.488 0.596 25.604 3.474 Factor 2 0.676 0.319 0.505 0.318 0.514 -0.267 -0.248 -0.289 0.565 -0.284 0.486 0.317 0.484 0.230 -0.278 0.590 0.496 -0.277 0.434 0.580 0.316 0.469 0.412 -0.249 -0.597 21.329 2.899 Factor 3 -0.287 0.366 -0.298 0.344 0.316 -0.230 0.322 -0.313 0.294 -0.212 0.357 0.327 0.320 0.396 0.412 -0.019 -0.236 0.401 0.346 0.350 0.327 -0.249 0.300 -0.273 0.387 7.634 1.002 h2 0.674 0.538 0.384 0.409 0.467 0.455 0.550 0.356 0.477 0.368 0.419 0.548 0.426 0.560 0.461 0.395 0.365 0.614 0.430 0.563 0.477 0.350 0.312 0.366 0.865 54.567

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Principal components technique. The estimate of communality (h2) was the sum of the squared factor loadings for each variable. Only factors with eigen values greater than 1.00 were extracted while the other seven factors accounted for an additional 16.14 percent of the total variance. The factor pattern of the three factors is presented in table 3.

The MSQ scores obtained from the participants after the 2-week period of time are presented in table 4, while the scores generally dropped by one point between participants, there was a gap of 14 points between the twenty-ninth and the thirtieth rank-ordered participants. While the midpoint score of 77 had been considered for a line of demarcation between the two types of menopause symptoms, this midpoint fell within the sizeable 14 point gap. Thus the ranked scores revealed a relatively continuous dimension within the higher scores acute (psychological symptoms) and within the lower scores (later (physiological symptoms), but with a large hiatus existing between these polar dimensions. This pattern of scores suggests that two types of menopause symptoms can be identified by the MSQ. 5.4. Results of Testing H4 In this research, it is assumed that the ranked scores of the items will not reveal a relatively continuous dimension between acute and later symptoms of menopause.
Table 4: Results Summary of H4

List of Ranked Scores obtained from second Pilot Administration of MSQ

Ranked Scores 104 103 102 99 97 96 95 94 94 93 92 90 90 89 88 85 83 Ranked Scores (cont.) 82 67 66 65 64 63 58 56 56 55 52 51 49 48 47 46 45 N = 38

6. Summary and Concluding Remarks

The extraction of the two factors, the reliability of the items and distribution of the scores into two groups all suggest that the MSQ is a psychometric capable of differentiating between the two types of menopause symptoms. This finding is important for three reasons. First, it substantiates Schiff et al (1992) assertion that there are two types of menopause symptoms-acute symptoms associated with immediate or eminent cessation of menses and those later symptoms which appear after some years of menopause. Second, because the two types manifests at different times and require different treatments, it may be necessary to determine clients type of symptom. Third, the MSQ allows reliable and efficient differentiation between the two types of symptoms for future research on therapy tailored to each type, of symptom, acute (psychological) and later (physiological) symptoms.

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One such possible treatment is behaviour modification, which has been shown to be an effective therapy for acute (psychological) symptoms of menopause might be further explored as a treatment which may be more effective with one of the two types of the symptoms. Research has suggested that one of the physiological effects of muscle relaxation treatment is a reduction in muscle tension (Lehrer, 1989). If, as asserted by Schiff et al (1992) the discomfort in menopause symptoms is related to acute symptoms such as insomnia, the hot flush while the later symptoms is related to decline in physical and mental energy, profound sweating, then Stress Inoculation Training (SIT) may be more effective with acute (psychological) symptoms. Further research is necessary to ascertain whether the pairing of muscular relaxation with the onset of menopause would lead to an alleviation of the discomfort experience by women with the acute (psychological) menopause symptoms.

References
[1] [2] [3] [4] [5] [6] [7] [8] Daly, (1994) Estrogens and the aging process, J.A.M.A. 196: pp 219. Gold & Josimovich, (1990). Nonhormonal treatment of the menopausal syndrome-obstet. Gynecol. pp 33:795. Llewelyn-Jones, (1988). Post-menopausal bleeding. Am J. obstet. Gynecol. 77:pp 1216. Lohnes, (1971). Ovarian function and woman after the menopause. N. Engl. J. Med. pp280:364. Leheno, (1989) Estrogens in the menopause and post-menopause. Am J. Obstet. Gynecol. 73: pp 1000. Machaughton, (1996) Post-menopausal symptomatology, maturation index, and plasma estrogen levels. Obstet Gynecol. 45: pp625 Schiff et al. (1992) The menopause and the Climacteric Disorders in Obstetrics and Gynaecology (end ed. Pp 204-227). London: Butter worth & Co. Skerlj, (1990). Menopause, Human reproduction: Conception and Contraception, U. S. A: Roic Publishes Inc.

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