*Corresponding author: fshobeiri@yahoo.com
M
enopause is a natural part of the
aging process in women and is
defined as occurring 12 months
aer the last menstrual period and
marks the end of menstrual cycles.
1
Menopause is
a universal and physiological event in a woman’s
life occurring around the age of 50 years in most
developed countries.
2
It is caused by the aging of
ovaries leading to a decline in the production of
ovarian gonadotrophins estrogen and progesterone.
3
The deficiency of these hormones elicits various
somatic, vasomotor, sexual, and psychological
symptoms that impair the overall quality of life
(QoL) of women.
4
Fifty to 80% of women complain about
menopausal symptoms such as hot flashes, night
sweats, sleep disturbances, tiredness, and depression.
ey are the principal determinants of a reduced
health-related quality of life (HRQL), which is
detectable soon aer the onset of menopause.
5
e
World Health Organization (WHO) denes QoL as
“an individual’s perception of their position in life, in
the context of the culture and value system in which
they live, and in relation to their goals, expectations,
standards, and concerns”.
6
QoL is a multidimensional concept that has
been used in dierent elds of knowledge including
sociology, occupational functioning, politics,
marketing, climate, and health care.
7
Menopause-
related symptoms have a negative impact on the
QoL of perimenopausal women.
7
Budakoglu et al,
8
showed that the QoL in postmenopausal women is
worse than that of premenopausal women.
QoL can be assessed using both general and
specific tools employed for specific conditions.
General tools have generally no questions for
specic conditions and diseases. However, specic
tools with the same statements include some certain
questions for these. General instruments cannot
be used to assess the QoL in diseases since clinical
features are not equal. erefore, specic tools are
generally preferable for each condition assessed and
menopause is no exception.
9
However, both tool
types are used for measuring QoL in the literature.
In this systematic review study, we identified
general and specic instruments for assessing QoL
and determined the factors related to QoL in
menopausal women.
Using the major electronic databases, including
PubMed and Scopus, we searched for articles
review article
O M J [2015], V. 30, N. 3: 151–156
Assessment of Questionnaire Measuring Quality of
Life in Menopausal Women: A Systematic Review
Ensiyeh Jenabi
1
, Fatemeh Shobeiri
1
*, Seyyed M.M. Hazavehei
2
and
Ghodratollah Roshanaei
3
1
Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
2
Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
3
Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
ARTICLE INFO
Article history:
Received: 1 December 2014
Accepted: 6 April 2015
Online:
DOI 10.5001/omj.2015.34
Keywords:
Review, Systematic;
Questionnaires; Quality
of Life; Postmenopause;
Women.
ABSTRACT
Menopause is a natural part of the aging process in women and is dened as occurring 12
months aer the last menstrual period marking the end of menstrual cycles. Menopause has
a negative impact on the quality of life (QoL). Various generic and specic questionnaires
have been used for assessing dierent dimensions of QoL in menopausal women. e
purpose of this systematic review was to identify those general and specic instruments, and
to determine the factors that aect QoL in menopausal women. We assessed eight specic
and three general tools and found that some general and specic instruments, such as the
36-item short form (SF-36) and the Menopause Specic uality of Life uestionnaire
(MENQOL), were mostly used for assessment. e specic tools available were diverse.
Employment status and a high educational level in menopausal women were considered
to be protective factors in improving QoL. Identication of predicting factors of QoL,
such as body mass index, race, age, duration of menopause, and social and occupational
variables can help to improve the QoL of these women allowing planning of psychological
consultations and practical interventions.
152
E J, .
with the following key words: “(questionnaire
OR scale OR inventory) AND (quality of life)
AND (menopause OR menopausal)”. Articles
published up to November 2014 were included in
the search. e reference lists and related scientic
conference databases were searched for additional
data, and the authors of the studies were contacted
for any additional unpublished studies. Studies
were included irrespective of age, race, country,
and publication status. e studies retrieved were
mainly cross-sectional papers written in English
and assessed the QoL in a multi-dimensional
manner using general or specic questionnaires.
Two authors separately screened the title and
abstract of the retrieved studies and then reviewed
the full texts to extract the studies that met the
inclusion criteria of this systematic review. The
variables extracted included the first author’s
name, year, country, study design, and study results.
Disagreements were resolved by discussion between
the two authors.
To identify the tools used for measuring QoL,
we used the Medical Outcomes Trust/Scientific
Advisory Committee (SAC)
10
criteria to carry out
instrument assessment. e SAC dened eight key
attributes of health status and QoL instruments
including a) conceptual and measurement models,
b) reliability, c) validity, d) responsiveness, e)
interpretability, f) respondent and administrative
burden, g) alternative forms, and h) cultural and
language adaptation. In this study, we used the
criteria for the conceptual and measurement models.
We retrieved 2712 studies, including 2698
references through electronic databases and 14
references through checking references lists. A total
of 481 studies were excluded because of duplication,
and a further 2138 studies were excluded after
screening the titles and abstracts, and 31 excluded
aer reviewing the full texts. In total, 62 studies were
included [Figure 1].
The frequency of studies on the QoL in
menopausal women from various countries was as
follows: USA (n=9), Turkey (n=7), Iran (n=6),
Spain (n=7), China (n=5), Taiwan (n=5), Colombia
(n=4), India (n=4), and Poland (n=2). One study
each was published in Greece, Tanzania, France,
Canada, Australia, Japan, Poland, Brazil, Pakistan,
Korea, Saudi Arabia, Chile, and Ecuador.
In this review, eight specic and three general
tools were included for assessment [Table 1].
MENQOL
The Menopause Specific uality of Life
uestionnaire (MENQOL) is a validated
questionnaire for the assessment of menopausal
women’s symptoms and an effective instrument,
although most researchers have recommended an
investigation of the validity of this tool for use in
dierent cultures and nations.
A study by Nisar et al,
11
showed that the scores
of physical domain were signicantly more in the
postmenopausal group and menopause related
symptoms had a negative impact on the QoL of
postmenopausal women.
In a study by Poomalar,
7
menopause related
symptoms had a negative impact on the QoL of
perimenopausal and postmenopausal women and
the scores of physical domain were signicantly more
in the late postmenopausal group.
Abedzadeh et al,
12
also used this tool and
found that women who were employed, had a high
educational level, a menopause duration of less
than ve years, and who had income and marriage
satisfaction had a better QoL in the menopausal
period. In another study by Norozi et al,
13
in 2013,
the QoL in postmenopausal women correlated
with age, educational level, marital status, and
employment status.
SF-36
e 36-item short-form (SF-36) was designed for
use in clinical practice and research, health policy
evaluation, and general population surveys. It was
Records identied through database
search (n=2698)
Additional records identied
manually (n=14)
Records screened (n=2712)
Records screened after duplication
(n=2231)
Records excluded because they were
duplicates (n=481)
Full-text articles assessed for
eligibility (n=93)
Records excluded on the basis of
title and abstract (n=2138)
Studies included in quantitative
synthesis (systematic review)( n=62)
Full-text articles excluded because
they were not eligible (n=31)
Figure 1: Flow diagram of the studies identied and
excluded for use in systematic review process.
152
E J, .
OMAN MED J, VOL 30, NO 3, MAY 2015
153
E J, .
found that natural menopause is an independent
predictor of a lower QoL in physical functioning.
30
Budakoglu and colleagues
8
showed that the QoL
in postmenopausal women was worse than that of
premenopausal women. ey also showed that rural
populations of women were in need of public health
care in the postmenopausal period. In another study,
Pan et al,
44
reported an inverse association between
weight gain and changes in physical health in the
dimensions of physical functioning, physical role
limitations, bodily pain, general health, and vitality.
WHO QOL-BREF
The World Health Organization uality of Life
(WHOQOL-BREF) instrument comprises 26
items, which measure the following broad domains:
physical health, psychological health, social
relationships, and environment. e WHOQOL-
BREF is a shorter version of the original instrument
and can be used for assessing the QoL in dierent
cultures and populations using this instrument.
Ozkan et al,
31
showed that the QoL was signicantly
lower in women with vasomotor complaints. A high
Table 1: e general and specic instruments for assessing the quality of life in menopausal women.
StudiesDimensions coveredNumber
of items
TypeInstrument
Poomalar, 2013
7
; Blumel, 2000
9
; Nisar,
2009
11
; Abedzadeh, 2013, 2011
12
;
Noroozi, 2013
13
; Williams, 2009
14
;
Som, 2012
15
; Bal, 2011
16
;
Nayak, 2012
17
; Bairy, 2009
18
;
Fallahzadeh, 2010
19
; Chen, 2008,
2007
20,21
; Caylan, 2014
22
;
Hilditch, 1999
23
; Ghazanfarpour,
2013
24
; Limpaphayom, 2006
25
;
Van Dole, 2012
26
; Timur, 2009
27
;
Yanikkerem, 2012.
28
Psychosocial; Physical; Sexual; Vasomotor29Specic Menopause
Specic
uality of Life
uestionnaire
(MENQOL)
Lima, 2012
29
;Zolnierczuk-
Kieliszek, 2012
30
; Ozkan, 2005
31
General health; Physical health;
Psychological; Health; Social
relationship; Environmental
26GenericWorld Health
Organization
uality of Life
(WHO QOL-
BREF)
Chen, 2012
32
; Giannouli, 2012
33
Psychological; Somatic Vasomotor; Probe
of sexual dysfunction
21SpecicGreene
Climacteric Scale
Chen, 2012
32
;Giannuli,
2012
33
;Greenblum, 2013
34
Occupational; Health related;
Emotional Sexual
23GenericUtian uality
life scale
(UQOL)
Ferrand, 2013
35
; Daley,2007
36
;
Lima, 2012
29
; Shin, 2012
37
;
Zolnierczuk-Kieliszek, 2012
30
;
Hautamaki, 2014
38
Depressed mood; Memory/
concentration problems; Somatic
symptoms; Vasomotor;Anxiety and fears;
Sleep problems; Sexual dysfunction;
Menstrual symptoms; Attractiveness
36SpecicWoman’s health
questionnaire
(WHQ)
Extremera, 2012
39
; Avis, 2003
40
;
Anderson, 2007
41
; Budakoglu, 2007
8
;
Fuh, 2003
42
; Chen, 2012
32
;
Chiu, 2008
43
; Pan, 2014
44
;
Laferrere, 2002
45
; Zolnierczuk-
Kieliszek, 2012
30
; Shyu, 2012
46
Physical functioning; Vitality/energy;
Physical role limitation; Bodily pain;
Mental health; Change in health;
Emotional role limitation; Health
perception; Social functioning
36Generice 36-item
short-form
(SF-36)
Buendia Bermejo, 2008
47
Physical health; Mental health; Partner
relationship; Social support;
Sexual relations
37SpecicMencav
Lima, 2012
29
; Calvo-Perez, 2013
48
;
Llaneza, 2007
49
Menopause and health; Psychological;
Sexuality; Couple relation
31SpecicCervantes Scale
Chedraui, 2014
50
Menopause and health; Psychological;
Sexuality; Couple relation
10SpecicCervantes Scale
Coronado, 2014
51
Menopause and health; Psychological;
SexualityCouple relation
16SpecicCervantes Short
Form Scale
Monterrosa-castro, 2012
52
;
Javadivala, 2013
53
; Chedraui, 2008
54
;
Chou, 2014
55
; Krajewska, 2007
56
;
Ornat, 2013
57
; Alquaiz, 2014
58
;
Ojenda, 2011
59
Somatic; Psychological; Urogenital11SpecicMenopause
Rating Scale
(MRS)
154
E J, .
educational level correlated with an improvement in
the QoL in menopausal women (years one to ve)
and women more than 10 years postmenopause had
a better QoL.
Greene Climacteric Scale
The Greene Climacteric Scale is a self-reported
questionnaire that measures 21 physical and
psychological symptoms associated with the
menopausal transition.
60
Giannouli et al,
33
reported
that the presence and identity of climacteric
symptoms had a negative impact on QoL.
Utian uality of Life Scale (UQOL)
e Utain uality of Life Scale (UQOL) assesses
how women perceive their life in each dimension
independently of somatic or psychological
complaints.
61
In a study by Greenblum
34
in 2013,
menopausal symptoms commonly associated with
the menopausal transition and early postmenopause
negatively affected QoL. Giannouli and his
collegues
33
believed that a normal body mass index,
married status, higher education, employment, good
nancial status, physical exercise, and a high calcium
diet were associated with a better QoL.
Woman’s Health Questionnaire (WHQ)
e Woman’s Health uestionnaire (WHQ) was
developed to measure the perceptions of a range of
physical and emotional symptoms in middle-aged
women.
62
Daley et al,
36
believed that obese women
had higher vasomotor and somatic symptom scores
than women of normal weight during menopause.
In a study by Ferrand,
35
the level of national wealth,
human development, cultural constraints, and social
inequality were likely to explain how country and
class aected QoL.
MENCAV
Buendia Bermejo et al,
47
showed that MENCAV is a
valid and reliable questionnaire for assessing the QoL
in menopausal women. e questionnaire includes
37 items and ve dimensions.
Cervantes Scale
e 31-item Cervantes Scale is an advanced and
validated tool. e scale’s short forms have 16 and
10 items.
Llaneza and his colleagues
49
showed that obesity
did not aect the global health-related QoL.
Menopause Rating Scale (MRS)
In their study, Monterrosa-Castro et al,
52
showed
that age, menopause status, body mass index, race,
marital, and working status increased Menopause
Rating Scale (MRS) scores. Table 2 shows the
dierent factors related to the QoL in menopausal
women in the literature.
is review study shows that both general and
specic instruments were used for assessing the QoL
in menopausal women with specific instrument
such as SF-36 and MENQOL most frequently used.
e application of specic tools has signicantly
increased since 1999. We found several specic tools
were used for the assessment of QoL in menopausal
women, but in some studies general tools were used.
In a review study, Schneider et al,
66
compared
the sum-score of the SF-36 with the score of the
somatic and psychological dimension of the MRS.
They reported that the severity of menopausal
symptoms were the best reector of the prole of the
QoL dimensions. In this review study, employment
status and a high educational level in menopausal
women were considered to be protective factors in
improving QoL.
The main predicting factors of QoL in
menopausal women were found to be dierent in
various populations because of dierences in age,
Table 2: Dierent factors related to the quality of
life in menopausal women as given in the literature.
Related Factors Study
Body mass index Williams
14
; Ceylan
22
; Anderson
41
;
Monterrosa-Castro
52
; Daley
36
;
Fallahzadeh
19
Giannouli,
33
;
Ghazanfarpour
24
; Jones
63
Marital
dimension
Monterrosa-castro,
64
; Ceylan
22
;
Norozi
13
; Abedzadeh
12
Economical
dimension
Bal
16
; Ceylan
22
; Giannouli
33
;
Zolnierczuk-Kieliszek
30
; Abedzadeh
12
Age Chedraui
65
; Fallahzadeh
19
; Norozi
13
;
Abedzadeh
12
Educational level Bal
16
; Ceylan
22
; Giannouli
33
; Norozi
13
;
Ozkan
31
; Zolnierczuk-Kieliszek
30
;
Abedzadeh
12
Working status Ceylan
22
; Bal
16
; Blumel
9
; Monterrosa-
Castro
52
; Norozi
13
; Fallahzadeh
19
;
Giannouli
33
; Abedzadeh
12
Duration of
menopause
Abedzadeh
12
; Som
15
Parity Abedzadeh
12
; Monterrosa-Castro
52
Race Monterrosa-Castro
52
154
E J, .
OMAN MED J, VOL 30, NO 3, MAY 2015
155
E J, .
race, body mass index, duration of menopause, as well
as social and occupational variables. us, identifying
these related indicators can help to improve the QoL
of these women through planning psychological
consultations and practical interventions.
CONCLUSION
is review study showed that some general and
specic instruments such as SF-36 and MENQOL
were the most frequently used tools for assessing
QoL in menopausal women. Some studies used
general tools for assessing the QoL in menopausal
women and the specic tools used were diverse.
Disclosure
e authors declared no conict of interest. is article is part
of a PhD thesis supported by Hamadan University of Medical
Sciences.
Acknowledgements
We would like to thank the University’s vice-chancellor of
education and vice-chancellor of research and technology for
their nancial support to carry out the study.
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