RAJIV GANDHI UNIVERSITY OF HEALTH

SCIENCES, BENGALURU, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION.

1 / NAME OF THE CANDIDATE AND ADDRESS / MS.PARVATHY SANTHOSH
SRI VENKATESHWARA INSTITUTE OF
NURSING SCIENCES,
BOMMANAHALLI, HOSUR ROAD,
BENGALURU- 560 068.
2 / NAME OF THE INSTITUTION / SRI VENKATESHWARA INSTITUTE OF
NURSING SCIENCES
BOMMANAHALLI, HOSUR ROAD,
BENGALURU- 560 068.
3. / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING
MENTAL HEALTH NURSING
4. / DATE OF ADMISSION OF THE COURSE / 14-6-2010
5. / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE EFFECTIVENESS OF YOGA ON MOOD CHANGES OF MENOPAUSAL WOMEN IN A SELECTED URBAN AREA OF BENGALURU”.

6. BRIEF RESUME OF THE INTENDED WORK.

INTRODUCTION

“Though her years were waning, her climacteric teased her like her Teens”

- Lord Byron

Health is the general wellbeing of a person in all aspects. It is also a level of functional or metabolic efficiency of an organism. Being a woman or a man has a significant impact on health. The health of a woman is of particular concern, as in many societies they are disadvantaged by discrimination rooted in socio cultural factors. Health and wellness are major concerns especially among women of today who lead a more stressful and demanding lives compared in the past. Women’s life stages are based on the reproductive cycle, beginning with menstruation and ending with menopause.1

Menopause is the common biological event that occurs in the life time of a woman during middle life. Menopause is not a disease and it is a physical transition and is natural. Menopause is a part of every woman’s life. Menopause is defined as a metamorphosis that is a complete change at the cellular level, where a woman changes from one person to another1.A menopausal woman’s wisdom is essential for survival, and the more we recognize this truth, the more menopauses will be celebrated in our culture. Menopause and post menopausal health is emerging as an issue owing to rapid increased longevity in urban middle aged women, who are evolving as a homogenous group2.

Menopause affects every woman differently. Some women have no symptoms, but some have changes in several areas of their lives. The emotional and psychological changes often start years before the 'official' start of menopause. As a woman is nearing menopause, she will experience symptoms from the changes their body is making. Many women are confused about how to deal with those symptoms3.

For instance, changing hormone levels due to woman’s monthly periods can affect her mood causing irritability and fearfulness. A study conducted by the University of Pennsylvania in Philadelphia suggests that many symptoms are attributed to menopause and the main ones are mood changes. As hormones fluctuate, it is perfectly normal to feel tense and irritable and cry easily. Good mental health is an important part of a woman’s overall health.3 It is important to remember that mental disorders are real medical illness that can't be willed or wished away. They affect both the mind and the body. The menopausal treatments actually focus on relieving the symptoms of menopause and in preventing any chronic condition.4

A menopausal natural remedy such as yoga can help immensely in curing the menopausal symptoms and making this natural passage in life for women a much more comfortable journey5.Yoga is a science of right living and it works when integrated in our daily life. It works on all aspects of the person: the physical, mental, emotional, psychic and spiritual. Yoga aims at bringing the different bodily functions in to perfect coordination so that they work for the good of the whole body. Yoga is an integration and harmony between thoughts, words, and deeds, or integration between head, heart and hands6.

6.1 NEED FOR THE STUDY

“The treatment themselves do not cure the condition; they simply restore the

body’s self-healing ability”.

- Leon chaitow

Health issues in India are always on a large scale and menopause is not an exception. As one of the world's most popular countries, India faces a variety of challenges dealing with menopause for several decades to come7. Indian population currently sits just over one billion and in 2015 Indian population will reach 165 million. More than 12% of the population will be above 60 years of age. Almost 50% of these will be women, a staggering population in menopausal and postmenopausal age. A total of 130 million menopausal Indian women are expected to live beyond menopause into old age by 20158.

Public health systems both government and private are over burdened with problems of women in adolescent and child bearing age. As a result it hardly addresses the specific health needs of older women, they are often neglected9. Middle age in women is burdened by physical, psychological and emotional issues. Physical and psychological disturbances are caused by a transition point in the womens life called menopause. Menopause refers to the end stage or a natural transition in a woman’s reproductive life. For women in India the average age of menopause is 47.5 years of age10.

Numerous physical and psychological symptoms have been attributed to the hormonal changes of menopause. Changing hormone levels due to menopause can affect her mood causing irritability and fearfulness. Mood swings, one of the common menopausal symptoms can be frustrating not only for women, but for their family as well11. There are many ways to combat with menopausal symptoms. The common ones are hormonal therapy, exercise sessions, yoga and meditation. Yogic sessions help the women to lighten the mood and their day12. Among the many benefits that set yoga apart from the other forms of physical exercise is the effect yoga postures and breathing practice have not only on the muscles and bones of one’s body, but also on organs and glands13.

For women at midlife and beyond, yoga offers a primary form of menopause medicine that can help them adjust to hormonal changes and cope with a wide range of symptoms. The spiritual science of yoga recognizes that equilibrium in the physical body helps to bring emotional balance and mental clarity14. In suryanamaskar yoga the sun is represented as the pranic channel which carries the vital, life-giving force.Surya namaskar is composed of three elements: energy, form and rhythm.15

The pranayama yogic session is generally defined as breath control. Pranayama utilizes breathing to influence the flow of prana in the energy channels of the entire body. Yoga is, instead, an adaptive discipline that can support the body through the myriad of biological changes; it can also support our minds and emotions, and allow us to come to a perspective on the inner processes that are happening16. Yoga’s approach to health during menopause and beyond is based on the premise that the body should be allowed to function as efficiently, effectively and naturally as possible. Yoga can have positive effects on menopausal women, and can help them to understand their body and mind better17.

Current mental health issues are focusing on community based mental health services. The issues of menopausal mood changes are least undertaken by the present society.The menopausal mood changes that affects the family wellbeing in turn has its effect on the societal well being. Thus the current topic gains its significance in India where the importance of alternative medicine like yoga which are proved to reduce mood changes are taught for maintaining the mental wellbeing. Hence the researcher is interested to undertake this study.

6.2 REVIEW OF LITREATURE:

The review of related literature forms an important chapter in a thesis where its purpose is to provide the background to and justification for the research undertaken. Review of literature enables the researcher to position their project relative to other work. Review for this research study can be categorized under the following headings.

6.2.1 Studies related to the prevalence of mood changes in menopausal women

6.2.2 Studies related to effectiveness of yoga on mood changes in menopausal

women

6.2.1 Studies related to the prevalence of mood changes in menopausal women.

A prospective study was conducted in India in the year 1981. The study aimed in solving the difficulties that Indian women have to face during climacteric period. The samples were 405 married menopausal women between 40 and 55 years of age from the general population. Data was collected using Menopausal Rating Scale. Results indicated that hot flashes, night sweats, insomnia and mood changes were clearly associated with menopause. Among these menopausal women only 10% had apparently sought medical treatment18.

A cross sectional descriptive study was conducted on peri menopausal symptoms in Sri Lankan women in the year 1999. The objective of the study was to determine the types of perimenopausal symptoms associated with the natural menopause and to make a preliminary assessment of the influence of perimenopausal symptoms on household work, employment duties and social life. The samples were 403 women after natural menopause chosen randomly from 4 selected groups. The data collection tool was Menopausal Rating Scale. The result suggested that the peri menopausal symptoms reported were insomnia (57.8%), joint pains (55.8%), night sweats (55.6%), mood changes (35.3%) and headache (33.3%) 19

A prospective study was conducted in Malaysia in the year of 2004. The study aimed to document the 16 symptoms commonly associated with menopause, in menopausal women living in Kelantin. A Semi Structured Questionnaire on Menopausal Rating Scale was administered to 326 naturally menopausal healthy women to assess the prevalence of 16 common symptoms that have been repeatedly reported in the literature. The prevalence of atypical symptoms were tiredness (79.1%), reduced level of concentration(77.5%), musculoskeletal aches(70.6%), backache(67.7%), night sweats-(53%), headache(49.4%), mood swings (51%), sleep problems(45%) and anxiety(39%)20.

A study was conducted in the year 2004 in United States of America on menopausal transition, mood and cognition. The aim of the study was to identify the preventive strategies for women presenting with risk factors for cardiovascular, cognitive and mood disorders and to include preventive strategies for women presenting with risk factors. The study was based on interview based on Depression Rating Scale. The study concluded that depressive symptoms in middle age are due to the person’s individualized exposure to mood changes during menopause21.

A study was conducted in Australia regarding depressed mood in the middle aged women. The aim of the study was to identify the determinants of depressed mood. The sample consists of 438 women aged 45 to 55 years of age, of this 72% completed the Centre For Epidemiological Studies Depression Scale to measure the depressed mood. Variables measured at baselines and annually included negative mood, psychosocial factors, hormone level, health and life style factors. The study identified that women most likely to have depressed mood are in the age group of 55-65 years of age22.

6.2.2 Studies related to effectiveness of yoga on mood changes in menopausal women

A randomized controlled trial study was conducted in India by Swami Vivekananda Yoga Research Foundation in the year 2008. The aim of the study was to assess the effectiveness of yoga on climacteric symptoms, perceived stress and personality in perimenopausal women. The sample consists of 120 menopausal women who were randomly assigned to yoga and control group. The yoga group practiced an integrated approach to yoga therapy comprising of ‘suryanamaskar’, ‘pranayama’ and ‘avarthan dyan’, whereas the control group practiced a set of simple physical exercises under supervision of trained teacher for 8 weeks. The results showed a significant difference between groups in vasomotor symptoms, and a marginally significant difference in psychological factors including mood changes, irritability and night sweats. The study identifies the effectiveness of integrated approach to yoga therapy on climacteric symptoms and perceived stress in menopausal women23.

A historical study conducted in the year 2010 on mind body therapy for menopausal symptoms. The study was a systematic review with 21 papers representing 18 clinical trials, including 12 randomized control trials, 1 non randomized controlled trials and 5 un controlled trials. The aim of the study was to assess the effectiveness of yoga, mind meditation based programme and relaxation responsive training. Data collection was done by using Menopausal Rating Scale. Interventions include yoga and meditation based programmes and other relaxation practices including muscle relaxation and breathe based techniques, relaxation responsive training and low frequency sound wave therapy. The study findings suggested that yoga based and other mind-body therapies may be beneficial for alleviating specific menopausal symptoms24.

A study conducted by the University of Illinois in United States of America in the year of 2010 on physical activity and mental health outcomes during menopause. The study examines the effect of a 4 month randomized controlled exercise trial on mental health outcomes in 164 previously low active middle aged women. Participants completed Body Composition and Fitness Assessment and a Battery of Psychological Measures at the beginning and end of 4 month randomized controlled exercise trial. The subjects were grouped under three groups, yoga group, walking group and control group. The result indicated that walking and yoga were effective in enhancing positive affect and menopausal related quality of life and reducing negative affect. .Yoga proved to enhance mood and menopause related quality of life25.

A study was conducted in Iran at the University of Medical Sciences. The aim of the study was to assess the effectiveness of yoga on menopausal symptoms. The sample consists of 47 post-menopausal women aging from 45-63 years participated in a 12 weeks yoga intervention. The Menopausal Rating Scale Questionnaire was given to collect the data. The study suggests that yoga is a powerful tool that can help menopausal women accept and nourish the inevitable change of life26.

A qualitative study conducted in United States of America to assess the participant perspective of yoga intervention for menopausal symptoms. A sample of 11 menopausal women participated in the study. A Semi Structured Interview Schedule was conducted to gather the data. The study concluded that yoga was effective in the relief of menopausal symptoms including mood changes, irritability and insomnia27.

SUMMARY:

From the above studies, it is understood that mood changes are prevalent in menopausal women. Many women are unaware of its consequences and it subsequently deteriorates the family as well as social well being. Yoga was found to be an effective therapy in the management of mood changes in menopause. Although yoga is an Indian derived form of therapy only few studies are conducted in India on the effectiveness of yoga on treatment of mood changes in menopause.