The mean age at menopause in this study was 51.28 ± 2.28 years. Although this is slightly higher than studies done in Peninsular Malaysia which reported mean age of menopause between 49.4 to 51.1 years and from studies done in Thailand (48.7 years), Singapore (49.1 years) and other studies on Asian and Caucasian women, our findings still falls between the normal range of menopausal age [3, 9, 10, 13, 17, 18, 20, 21].
The assessment tool that we used in our study was based on Menopause Rating Scale (MRS) questionnaire. Although in menopausal symptoms studies few assessment tools were available, we used the Menopause Rating Scale (MRS) questionnaires, these questionnaires has been widely used in many epidemiological and clinical research when investigating the menopausal symptoms, These questionnaires has been validated and translated in many languages, although it is a self-administrated questionnaires, it's used were not only meant to assess the menopausal symptoms but also its severity, however, in our study, modification has to be done on the scaling of the original MRS because we noted that the respondents had difficulties in rating the scales, this could be explained by the fact that nearly half of the respondent studied never had formal education or only studied at primary level, and to minimize the reporting error, face to face interviewed were used instead of self administered by the respondents [15, 16].
In our study, the classical presentation of menopausal symptoms; hot flushes, sweating and night sweats were noted to be lower (41.6%) when compared to findings from studies done on western women who were reported to be from 45% to 75%. Similar result were also noted in two other studies done in Malaysia by Dhillon et al. (53.0%) and Ismail (57.l0%), however, our finding of low menopausal classical symptoms were shared by studies done in other Asian countries [3, 17, 18, 24–28].
In this study perimenopausal women were noted to experience more of vasomotor symptoms when compared to other menopausal group of women, and this was also statistical significant (Table 3), this can be explained by the fact that in these group of women, estrogen fluctuation during this phase occurs the most, hence they will experienced the most vasomotor symptoms. Our findings were correspond to studies conducted among Australia and other Caucasian women; where as high as 75% of perimenopausal women experienced bothersome vasomotor symptoms at some point of their transitional period [24–30].
From our study, joints and muscular discomfort; physical and mental exhaustions and sleeping problems (Table: 2) which is from the somatic and psychological subscales were experienced most by perimenopausal followed by postmenopausal women and these was also statistical significant differences when compared to premenopausal women. These findings were also noted to be corresponding to studies conducted Asian and Caucasian women [3, 7, 10, 13, 18, 19, 27, 28, 31, 32].
It is interesting to note that in our study, as much as 35% to 45% of premenopausal women also reported similar symptoms (joint and muscular discomfort, physical and mental exhaustion, anxiety, depressing mood, irritability), this could be explained since most of the somatic or psychological symptoms experienced by these middle age women are not exclusively as a result of changes due to menopause alone, it's could also resulted from other physical, psychological or health related problems which is related to aging in these group of women which can represent as menopausal like symptoms [7, 13, 22].
In urogential subscale (sexual problems, bladder problems and vaginal dryness), from our study the frequency of these symptoms were experienced mainly by postmenopausal group of women and it was also significant statistically when compared to other menopausal status (Table 3) and similar finding were documented from other studies [3, 18, 25, 27, 32].
Natural menopause may strongly contribute to sexual changes experienced by these women, however its need to be emphasized that there are numerous factors which contribute to declining sexual activities in middle age women following menopause [18, 33–36].
In our study it was noted that somatic and psychological symptoms were experienced mainly by perimenopausal women compared to the postmenopausal or premenopausal women. However, in the urogenital or sexual symptoms, the postmenopausal women were reported to suffer the most compared to the other two groups and similar findings were reported from other studies [2–4, 13, 18].
There are several limitations of this study. Although attempts were made to ensure that the study population was as representative as possible of the general population of the Kuching, Sarawak, nevertheless it has to be stated owing to the sampling technique used this might not be entirely possible. Another limitation was, as this was a cross sectional study, it does not exclude other confounding effects of the natural aging process that may influence experience of symptoms. Thirdly, this study used modified MRS questionnaire, translated to Malay, so there is the question of accuracy in translation, although this was done by a group of health-workers and language experts. Although MRS is a self reporting questionnaire, in view of substantial number of women studied does not have formal education, in order to include these illiterate women, interviews were used instead. In collecting data, women are asked to provide some retrospective information, such as menopausal symptoms experienced in the preceding one month, last menstruation etc. Hence recall bias is unavoidable, especially for some elderly women. A final limitation of this study is lack of information on regularity of menstruation. Some subjects could have been misclassified into the incorrect menopause status group.