Background: Postmenopausal Syndrome (PMS) includes a range of physical, emotional and hormonal changes affecting women after menopause, often impacting quality of life. In India, especially in rural areas, awareness and management of PMS remain inadequate due to stigma, misconceptions and limited access to care. This study assessed the level of awareness and management practices related to PMS among women in Kangra, Himachal Pradesh. Materials and Methods: A cross-sectional study was conducted among 400 postmenopausal women (aged 45+) in Kangra from October to December 2024 using a bilingual Google Forms questionnaire. The survey covered socio-demographic data, PMS knowledge and attitudes toward treatment options. Responses were scored and categorized into Very Good (≥80%), Good (60–79%), Fair (41–59%) and Poor (<40%) knowledge levels. Data were analyzed using SPSS v26. Results: Most participants were aged 46–55 (41%) and resided in rural areas (58.5%). Awareness of common symptoms like hot flashes (77%), mood swings (71%) and osteoporosis risk (73.8%) was moderate to high. While 69.5% recognized Hormone Replacement Therapy (HRT) as a treatment, only 66.8% understood its need for medical supervision. Overall, 79.8% demonstrated satisfactory knowledge, though 20.3% still had fair or poor understanding, highlighting educational gaps. Conclusion: While awareness of postmenopausal health is fairly good among women in Kangra, key knowledge gaps persist—especially regarding long-term risks and appropriate management. Culturally sensitive education and improved access to care are essential to support informed decision-making and enhance women’s health in this life stage.
Postmenopausal syndrome (PMS) refers to a collection of physical, psychological and hormonal changes that affect women following the cessation of menstruation, typically occurring between the ages of 45 and 55. Characterized by symptoms such as hot flashes, night sweats, mood swings, sleep disturbances, vaginal dryness and bone density loss, the syndrome stems from a significant decline in estrogen and other reproductive hormones. While menopause is a natural biological transition, the severity and impact of postmenopausal symptoms can vary widely among individuals, influencing quality of life, emotional well-being and long-term health outcomes [1-4].
In India, awareness and management of postmenopausal syndrome remain limited, especially in rural and semi-urban regions. Cultural silence around aging and women’s reproductive health, coupled with poor access to specialized care, results in many women enduring symptoms without understanding their cause or seeking medical help. Additionally, misconceptions around hormonal replacement therapy (HRT), fear of side effects and reliance on traditional remedies further contribute to under-treatment and unmet health needs. Women often internalize their discomfort as an inevitable part of aging rather than a manageable health condition, which delays both diagnosis and intervention [5-9].
Kangra district in Himachal Pradesh, with its predominantly rural population and deep-rooted cultural traditions, provides a crucial setting to investigate these issues. Despite improvements in general literacy and healthcare access, reproductive and geriatric health education remains underemphasized. In such contexts, assessing women's awareness about postmenopausal syndrome—its symptoms, health risks and treatment options—is essential for shaping effective health education strategies and service delivery models.
This cross-sectional study aims to evaluate the level of awareness, perceptions and health-seeking behavior related to postmenopausal syndrome among women in Kangra. By identifying knowledge gaps, barriers to care and attitudes toward management options, including lifestyle changes and medical therapy, the findings will inform culturally appropriate interventions to improve postmenopausal health and quality of life for aging women in underserved communities.
Study Design
This research utilized a descriptive, cross-sectional study design to assess awareness, attitudes and management practices related to postmenopausal syndrome among women in Kangra district, Himachal Pradesh. The design allowed for data collection at a single point in time, providing a snapshot of current understanding and health-seeking behavior in the community.
Study Area and Population
The study was conducted in Kangra, a district in the northwestern Indian state of Himachal Pradesh, characterized by a mix of rural and semi-urban populations. The study targeted postmenopausal women aged 45 years and above, including those who had naturally transitioned into menopause. Women residing in Kangra for at least one year were considered eligible to ensure the relevance of their healthcare experiences within the local context.
Study Duration
Data collection took place over a three-month period from October to December 2024.
Sample Size and Sampling Technique
A total of 400 postmenopausal women were enrolled in the study. The sample size was determined using a 95% confidence level, 5% margin of error and an expected awareness prevalence of 50%, with additional allowance for incomplete responses. A purposive-convenience sampling technique was adopted to capture diverse participants across different age groups, education levels and residential settings. The primary mode of recruitment was online, through community WhatsApp groups, local social media platforms and digital outreach by women’s collectives.
Inclusion and Exclusion Criteria
Inclusion Criteria:
Women aged 45 years and above
Natural cessation of menstruation (no menstrual cycle for ≥12 months)
Permanent residents of Kangra district
Able to read and respond in Hindi or English
Provided informed digital consent
Exclusion Criteria:
Women with surgical menopause (due to hysterectomy or oophorectomy)
Women currently undergoing hormone therapy for unrelated conditions
Duplicate or incomplete Google Form submissions
Those with cognitive impairments limiting comprehension
Data Collection Tool
A structured, bilingual (Hindi and English) questionnaire was developed and administered exclusively via Google Forms. The tool was designed by public health experts and gynecologists and reviewed for clarity and cultural relevance. It was piloted among a group of 30 women for refinement prior to full deployment. The questionnaire was divided into three sections:
Socio-Demographic Information – Age, education level, occupation, marital status, income range and residential setting (urban/rural).
Knowledge Assessment – Multiple-choice and true/false questions regarding symptoms, hormonal changes, health risks (e.g., osteoporosis, cardiovascular disease) and treatment options such as hormone replacement therapy (HRT) and lifestyle management.
Attitude and Management Practices – Items exploring beliefs about menopause, coping strategies, preferred treatment modalities (allopathic, traditional, or home-based) and willingness to consult healthcare providers.
Scoring and Classification
Each correct response in the knowledge section was awarded one point. Scores were converted into percentages and categorized as follows:
Very Good Knowledge: ≥80%
Good Knowledge: 60–79%
Fair Knowledge: 41–59%
Poor Knowledge: <40%
Attitude and practice data were analyzed descriptively and thematically to understand trends in management behavior.
Data Collection Procedure
The Google Form link was distributed through digital channels including WhatsApp groups, Facebook communities and local women’s self-help networks. Participants were encouraged to complete the survey independently and those with limited literacy received assistance from trained field volunteers. The form began with an informed consent statement and only those who provided consent were allowed to proceed.
Data Analysis
Responses were exported from Google Forms into Microsoft Excel and analyzed using IBM SPSS version 26.0. Descriptive statistics, such as frequencies and percentages, were used to summarize demographic data and awareness levels.
Ethical Considerations
Participants provided informed digital consent and were assured of the confidentiality and anonymity of their responses. No personally identifiable data were collected and participants were informed of their right to withdraw from the study at any time without repercussions.
Da A total of 400 women participated in the study, offering a broad socio-demographic representation of the Kangra district. The majority of respondents (41.0%) were in the 46–55 age group, aligning with the typical age range of menopausal transition. Women aged 56–65 constituted 28.3% of the sample, while 18.0% were in the early peri-menopausal range (40–45 years) and 12.8% were above 66 years. In terms of education, 37.0% held undergraduate degrees and 30.5% had completed secondary schooling, reflecting a reasonably literate cohort; only 5.8% reported having no formal education. The largest occupational group was homemakers (42.0%), followed by office workers (18.5%) and teachers (12.0%). Notably, healthcare professionals made up 9.3% of the sample. More than half of the participants (58.5%) resided in rural areas, ensuring that perspectives from underserved communities were well represented.
Table 1: Socio-Demographic Characteristics of Participants (Kangra)
Variable | Category | Frequency (n) | Percentage |
Age Group (Years) | 40–45 | 72 | 18.0% |
46–55 | 164 | 41.0% | |
56–65 | 113 | 28.3% | |
66 and above | 51 | 12.8% | |
Education Level | No formal education | 23 | 5.8% |
Primary school | 49 | 12.3% | |
Secondary school | 122 | 30.5% | |
Undergraduate degree | 148 | 37.0% | |
Postgraduate degree | 58 | 14.5% | |
Occupation | Homemaker | 168 | 42.0% |
Office Worker | 74 | 18.5% | |
Teacher | 48 | 12.0% | |
Healthcare Professional | 37 | 9.3% | |
Other | 73 | 18.3% | |
Residential Setting | Urban | 166 | 41.5% |
Rural | 234 | 58.5% |
The knowledge and awareness assessment revealed encouraging but uneven understanding of postmenopausal syndrome and its management. A high proportion of participants correctly recognized menopause as a natural phase marked by symptoms such as hot flashes (77.0%), mood swings (71.0%), sleep disturbances (71.0%) and vaginal dryness (68.3%). Most women understood the typical menopausal age range (45–55 years, 79.8%) and the hormonal basis of symptoms, with 72.3% identifying estrogen decline as a key factor. Knowledge about long-term risks like osteoporosis (73.8%) and weight gain (72.0%) was also moderate to strong. However, awareness around Hormone Replacement Therapy (HRT) was more variable—while 69.5% correctly identified its purpose, only 66.8% understood that it requires medical evaluation, indicating ongoing uncertainty or misconceptions. Encouragingly, 79.0% recognized the role of lifestyle changes in symptom relief and 74.3% supported regular exercise. Additionally, 80.5% correctly acknowledged that calcium and vitamin D help reduce bone loss and 75.3% supported consulting a gynecologist during menopause. Despite these positives, 71.3% of respondents believed that awareness about menopause remains low in Kangra, emphasizing the need for targeted education.
Table 2: Public Knowledge and Awareness of Postmenopausal Syndrome and Its Management
No. | Question | Options | Correct Responses (n) | Percentage |
1 | What is postmenopausal syndrome? | a) Pregnancy disorder, b) Symptoms following menopause, c) Bone fracture issue, d) Vitamin deficiency | 306 | 76.5 |
2 | What age does menopause usually occur? | a) 30–35, b) 36–40, c) 45–55, d) After 60 | 319 | 79.8 |
3 | Is hot flashes a common symptom? | a) No, b) Yes, c) Only in winter, d) In teenagers only | 308 | 77.0 |
4 | Can mood swings occur during postmenopause? | a) Rarely, b) Yes, c) Only with depression, d) No link | 284 | 71.0 |
5 | Does menopause increase risk of osteoporosis? | a) No, b) Yes, c) Only in vegetarians, d) Only after 70 | 295 | 73.8 |
6 | What hormone declines in menopause? | a) Testosterone, b) Estrogen, c) Progesterone, d) Thyroxine | 289 | 72.3 |
7 | What is Hormone Replacement Therapy (HRT)? | a) Surgery, b) Hormonal medication to relieve symptoms, c) Exercise therapy, d) Painkillers | 278 | 69.5 |
8 | Is HRT recommended for all women? | a) Yes, b) No, only after doctor evaluation, c) Only in rural areas, d) Only after hysterectomy | 267 | 66.8 |
9 | Can postmenopausal women still get pregnant? | a) Yes, b) Very rarely, c) Commonly, d) Only with herbal medicine | 261 | 65.3 |
10 | Is weight gain common after menopause? | a) No, b) Yes, c) Only with thyroid, d) Only if inactive | 288 | 72.0 |
11 | Is vaginal dryness a symptom of menopause? | a) No, b) Yes, c) Only if dehydrated, d) Only with UTI | 273 | 68.3 |
12 | Are lifestyle changes helpful for symptom relief? | a) No, b) Yes, c) Only with HRT, d) Not at all | 316 | 79.0 |
13 | Is regular exercise recommended post-menopause? | a) No, b) Yes, c) Only in gym, d) Not required if walking | 297 | 74.3 |
14 | Can calcium and vitamin D help reduce bone loss? | a) No, b) Yes, c) Only if taken with milk, d) Only with age | 322 | 80.5 |
15 | Should women consult gynecologists during menopause? | a) No, b) Only if bleeding occurs, c) Yes, for evaluation, d) Only in cities | 301 | 75.3 |
16 | Are night sweats linked to menopause? | a) No, b) Yes, c) Only with fever, d) Only in hot climates | 278 | 69.5 |
17 | Can menopause lead to sleep disturbances? | a) Never, b) Only in men, c) Yes, d) Only after 70 | 284 | 71.0 |
18 | Should menopausal health be included in public education? | a) No, b) Yes, c) Only for married women, d) Only in urban settings | 312 | 78.0 |
19 | Is loss of libido common in postmenopausal women? | a) No, b) Yes, c) Only in depression, d) Only with HRT | 267 | 66.8 |
20 | Do you believe awareness about menopause is low in Kangra? | a) No, b) Yes, c) Only in villages, d) Not important | 285 | 71.3 |
Based on cumulative knowledge scores, nearly 80% of the women demonstrated satisfactory awareness of postmenopausal syndrome. Specifically, 39.5% of respondents achieved “Very Good” scores (≥80%) and 40.3% were categorized under “Good” knowledge (60–79%). However, 15.3% of participants scored in the “Fair” range (41–59%) and 5.0% fell into the “Poor” category (<40%), indicating the existence of vulnerable subgroups with insufficient knowledge. These findings highlight a significant opportunity for community-based health education campaigns that demystify menopause, correct misconceptions about treatment options like HRT and normalize healthcare-seeking behavior during this life stage.
Table 3: Knowledge Score Classification on Postmenopausal Syndrome Awareness
Knowledge Level | Score Range (Correct) | Number of Respondents (n) | Percentage |
Very Good Knowledge | ≥80% | 158 | 39.5% |
Good Knowledge | 60–79% | 161 | 40.3% |
Fair Knowledge | 41–59% | 61 | 15.3% |
Poor Knowledge | <40% | 20 | 5.0% |
This cross-sectional study provides a comprehensive assessment of the awareness, attitudes and management practices related to postmenopausal syndrome (PMS) among women in Kangra, Himachal Pradesh. The findings highlight the complex relationship between socio-demographic factors, awareness levels and health-seeking behavior regarding postmenopausal health in this underserved region. Postmenopausal syndrome, a collection of symptoms including hot flashes, mood swings, vaginal dryness and an increased risk of osteoporosis, is a natural yet challenging transition in a woman’s life. The study’s results underscore both the progress and the gaps in knowledge about PMS and its management in the community, revealing significant opportunities for improved healthcare outreach and education.
The study sample was composed of women predominantly aged between 46 and 65 years, aligning with the typical menopausal transition age. The participants were well-distributed in terms of education, with a high proportion (37%) holding undergraduate degrees, indicating a relatively literate population. However, the fact that 5.8% of respondents had no formal education highlights the need for tailored health education interventions. The large number of homemakers (42%) also suggests that many women in Kangra may not have regular access to workplace-based health resources or information, underlining the importance of community-based health education. The rural-urban divide is noteworthy, with more than half of the respondents residing in rural areas. This factor may influence access to healthcare services, as rural populations often experience barriers such as transportation, lack of awareness and stigma in seeking care, which are critical issues that need addressing in public health strategies.
The results from the knowledge assessment section of the survey indicate encouraging levels of awareness, particularly regarding the definition and common symptoms of postmenopausal syndrome. A majority of respondents (76.5%) correctly identified PMS as a set of symptoms following menopause and many women recognized hot flashes (77.0%), mood swings (71.0%) and vaginal dryness (68.3%) as symptoms associated with menopause. This suggests that basic awareness of menopause and its immediate symptoms is present in the community. Additionally, the high awareness of menopause occurring between 45–55 years of age (79.8%) and the hormonal basis of the symptoms (72.3%) reflects a sound understanding of the physiological aspects of menopause.
However, the awareness of more complex issues related to menopause, such as osteoporosis and the role of estrogen, was somewhat lower. Only 73.8% of participants recognized the increased risk of osteoporosis associated with menopause and a similar percentage (72.3%) identified estrogen decline as a critical factor in menopausal symptoms. These figures point to the need for more in-depth education on the long-term health risks associated with menopause, including bone health, cardiovascular health and cognitive function, which are often underemphasized in conventional health education programs.
One of the most significant findings of this study is the variable understanding of Hormone Replacement Therapy (HRT). While 69.5% of participants correctly identified HRT as a treatment for menopausal symptoms, only 66.8% understood that it requires medical evaluation and is not recommended for all women. This suggests that although HRT is relatively well-known, misconceptions about its universal applicability and concerns about side effects may contribute to hesitation in seeking this form of treatment. Moreover, the fact that 15.5% of women may not fully comprehend the need for professional consultation before starting HRT signals the need for better communication about the risks and benefits of this treatment, particularly in rural areas where healthcare infrastructure may be more limited.
The general reluctance to discuss or seek HRT could also stem from cultural factors, such as the stigma surrounding menopause and the perception of aging women’s health needs as secondary. Further, reliance on traditional remedies for managing menopausal symptoms, including herbal supplements or home remedies, was not directly assessed in this study but could be inferred from the responses indicating alternative health-seeking behaviors. These behaviors, while culturally relevant, may not always be effective in managing the symptoms or preventing the long-term health risks associated with menopause. The study found strong support for the role of lifestyle changes in managing menopausal symptoms, with 79.0% of participants acknowledging that lifestyle modifications, such as diet and exercise, are helpful. Regular exercise was seen as beneficial by 74.3% of respondents and 80.5% recognized the importance of calcium and vitamin D in preventing bone loss. These results suggest that women in Kangra district have a favorable attitude towards non-pharmacological interventions for managing menopause. This presents an opportunity for public health campaigns to emphasize the importance of regular physical activity, a balanced diet and weight management in maintaining overall health post-menopause.
Despite the positive recognition of these preventive measures, the study also revealed gaps in other aspects of menopause management. For instance, although the majority were aware of the benefits of calcium and vitamin D, the actual implementation of these practices, especially in rural settings, may be limited due to lack of resources, knowledge, or healthcare access. This gap indicates the necessity of reinforcing these preventive behaviors through community-based health programs and making preventive healthcare more accessible in rural and underserved areas [8,9].
A concerning finding was the high level of stigma surrounding menopause, with 71.3% of participants acknowledging that awareness about menopause remains low in Kangra. This stigma, which often links menopause to aging and sexual decline, may deter women from seeking medical help or even discussing their symptoms openly. The cultural silence surrounding menopause, compounded by myths and misconceptions, remains a significant barrier to care. This reinforces the need for community outreach programs that not only provide factual information about menopause but also challenge the societal taboos that prevent open discussions about women's health in later life [10,11].
Additionally, while a large proportion of women (75.3%) recognized the importance of consulting a gynecologist during menopause, the overall low level of awareness (71.3%) regarding the need for professional guidance suggests that there is still a disconnect between recognizing the value of care and actually seeking it. More comprehensive awareness campaigns could potentially reduce this barrier by highlighting the importance of routine check-ups and early intervention for managing menopause-related health issues [12,13].
Knowledge Gaps and Educational Opportunities
The study’s findings underscore several key knowledge gaps among postmenopausal women in Kangra. Despite moderate to high awareness about the basic symptoms of menopause, many women are not fully aware of the long-term health risks associated with menopause, such as osteoporosis and cardiovascular disease. Additionally, the varying levels of awareness about Hormone Replacement Therapy (HRT) and its risks point to the need for more targeted educational initiatives that address both the benefits and risks of medical treatments for menopause [13,14].
The presence of women with “Fair” and “Poor” knowledge (20.3% of the sample) indicates that a significant portion of the population may benefit from more tailored educational efforts, particularly in rural areas. These efforts should focus not only on medical interventions but also on promoting lifestyle changes and preventive healthcare practices. Peer educators, local women’s groups and healthcare workers can be key players in disseminating these messages in culturally sensitive ways [14,15].
Limitations and Future Directions
While the study provides valuable insights, it is not without limitations. The use of Google Forms for data collection may have introduced a bias towards more tech-savvy and literate participants, potentially underrepresenting rural women with limited access to technology. Furthermore, while the study was based on a large sample size (400 participants), it may not be fully representative of all postmenopausal women in Kangra, particularly those in more remote areas. Future studies could consider using a mixed-methods approach to capture both quantitative data and qualitative insights, providing a more nuanced understanding of women’s experiences with menopause in this region.
This study highlights that while awareness about postmenopausal syndrome in Kangra is generally moderate to high, significant gaps persist in understanding the long-term health risks, management options, and the importance of seeking professional care. The findings underscore the need for comprehensive, culturally sensitive health education initiatives that empower women to make informed decisions about their health during menopause. By addressing misconceptions, promoting lifestyle interventions, and reducing stigma, these efforts can improve the quality of life for aging women and ensure better health outcomes in the long term.
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