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Menopause Live - IMS Updates
InFocus

Date of release: 06 January, 2014

Menopause issues in Nigeria

Africa, except for a few areas, such as South Africa or the African Mediterranean countries, is usually missing from international medical forums or conferences that discuss menopause-related issues. For many of us, Africa is still an enigma although one may speculate that the problems surrounding the climacterium are similar to those elsewhere in the world. A study from the city of Enugu, Nigeria, sheds some light on knowledge of postmenopausal hormone therapy (PHT) in women who attended a local university hospital gynecology clinic [1]. In short, the knowledge and perception of PHT among women of South-East Nigeria were found to be poor and related to the level of education. A total of 432 women were randomly selected for the survey, out of which 168 (39%) had knowledge of PHT and only 48 (11%) had taken it in the past. Currently, none was using PHT despite experiencing menopausal symptoms. The majority of women perceived climacteric symptoms as part of the aging process.

Comment

Since the above study appeared in a local journal that cannot be accessed through the internet, I could only read its small Abstract in PubMed. But then I realized that the same investigators had published another report on the same cohort in 2011, in a journal which is open for free downloading [2]. The women's age was 45–60 years, all living in the city of Enuglu, and recruited while attending a gynecology clinic. This of course points at a clear, potential selection bias, and the results cannot be extrapolated to rural Nigeria or to other populations. For example, 61% of the women had a university education, and an additional 17% were teachers or had graduated from a secondary school. The participants filled a self-administered pre-tested questionnaire, which was designed to cover background details, menstrual history, climacteric symptoms and the general health of the women. Based on cohort characteristics, it was not surprising to find that 86% of the cohort wrote that they had knowledge of menopause, whereas the few illiterate ones had never heard or recognized menopause and climacteric symptoms; rather, they took it as part of their life. The source of information was more from friends/mothers (42%), and least from churches (22%). Interestingly, women were cautious in their comments in regard to their husbands' attitude to menopause-related issues: 33% said their husbands sympathized with them, but 8% revealed that their husbands were indifferent to their problems. A little more than half of the women admitted that they had sought some type of medical treatment, including a visit to gynecology clinics (22%), other medical clinics (11%), native doctor/sorcerer (3%), priests (3%) and some just used self-prayers (14%).
 
Another study from the city of Benin in Nigeria demonstrates the diversity in core data within the same country [3]. Postmenopausal women were approached independently at home and in their places of work and requested to complete a prepared questionnaire (n = 533). To ensure that all the social classes were involved, women in their homes, offices and markets were randomly selected for interview. The age range was 47–78 (mean 57 ± 6) years. About 67% of the women had heard of the word menopause and correctly described it as permanent cessation of menstrual bleeding. Most of them first came into contact with the word menopause from books (24%) and through discussion with friends and co-workers (21%). Freedom from monthly bleeding was cited by 51% of the responders as the major benefit of the menopause. Adjustment to menopause was regarded as 'very well' by 77% of the cohort, yet 65% revealed that menopause affected their sex life and that they are no longer sexually active. Only 7.3% of the women, all of whom had a post-secondary school level of education, were aware of PHT. None of the women studied were on/ever had actual hormone treatment. Similar trends were recorded in an earlier study from the University College Hospital, Ibadan, Nigeria [4]. The investigators interviewed 676 postmenopausal women, who filled a structured questionnaire. The majority of the women had a positive attitude to the menopause and indicated that it did not affect their relationships with their spouses or children. For most of the women (71%), sexual life ended with menopause. None of the women was on PHT.
 
Nigeria probably represents the situation prevailing in other black African countries, where a large proportion of the population is poor, lives out of the major cities, and has limited access to modern medicine. A small survey from Ghana asked a simple, basic question: how women in low-resource settings manage menopausal symptoms without PHT [5]. The study showed that the majority of the women used a combination of non-hormonal medications and complementary and alternative medicine, including dietary modifications, exercise, and other lifestyle changes to effectively manage menopausal symptoms. Sources of information about menopause influenced participants' perceptions, attitudes, and self-management choices. It seems that exposure to good-quality information on menopause is pivotal but not available in many places, and therefore, educational projects must receive there a high priority. Perhaps the International Menopause Society should try to make contacts with interested parties in Africa and promote knowledge on all aspect of menopause wherever needed.

Amos Pines


Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel



    References

  1. Okeke TC, Akogu SP, Ekwuazi KE, Ezenyeaku CC, Ikeako LC. A survey of womens knowledge and perception of hormone replacement therapy (HRT) in Enugu, South East Nigeria. Niger J Med 2013;22:332-5.


    http://www.ncbi.nlm.nih.gov/pubmed/24283095

  2. Ikeme A, Okeke TC, Akogu S, Chinwuba N. Knowledge and perception of menopause and climacteric symptoms among a population of women in Enugu, South East Nigeria. Ann Med Health Sci Res 2011;1:31-6


    http://www.ncbi.nlm.nih.gov/pubmed/23209952

  3. Ande AB, Omu OP, Ande OO, Olagbuji NB. Features and perceptions of menopausal women in Benin City, Nigeria. Ann Afr Med 2011;10:300-4.


    http://www.ncbi.nlm.nih.gov/pubmed/22064257

  4. Adekunle AO, Fawole AO, Okunlola MA. Perceptions and attitudes of Nigerian women about the menopause. J Obstet Gynaecol 2000;20:525-9.


    http://www.ncbi.nlm.nih.gov/pubmed/15512643

  5. Odiari EA, Chambers AN. Perceptions, attitudes, and self-management of natural menopausal symptoms in Ghanaian women. Health Care Women Int 2012;33:560-74.


    http://www.ncbi.nlm.nih.gov/pubmed/22577742