Experience of Menopause for Women in the Niamey Region, Republic of Niger

Introduction: Menopause is poorly documented in Africa. For most of the women living there, the experience of this period does not seem to be very problematic. For women living in rural areas, other concerns are more prominent. Methods: The study was prospective, quantitative and qualitative about 500 cases collected over a period of 6 months. The study involved postmenopausal women in the Niamey region of public services, in certain residential areas, or accompanying people in health structures. Parameters taken into account were sociocultural, antecedents, experience, knowledge, and management of menopause. The data was entered and analyzed using Microsoft Office Word 2010 and Microsoft Office Excel 2010 software. Results: The average age was 56.4 years with extremes of 40 and 80 years; 57% were still living with their husbands and 39% widows; 60.2% housewives; 53% uneducated, 17% have higher education; 60.2% had had at least 6 children and 39.6% had used contraception. The comorbidities observed were arterial hypertension (24.4%) and diabetes (7%). As for the representation that women made of menopause, for all of them, this stage is the beginning of old age. The most frequent signs were asthenia (86.2%) and mood disorders (70.6%). Almost all of the patients (99.8%) had not used hormonal treatment for the menopause and among them 27% the management of the menopause was with traditional means. Conclusion: Menopausal disorders are certainly a reality in our socio-cultural context. They are not a primary concern either through ignor-ance or resignation of the women concerned.


Introduction
With the increase in life expectancy, menopause has become a new stage in a woman's life. It is a physiological phenomenon marking the total and definitive cessation of ovarian functioning, yet the latter holds all of women's femininity under its control. The WHO had already estimated that in 2030, 1.2 billion women will be aged 50 or over [1]. It is experienced differently depending on the regions of the world, influenced by socio-cultural and economic factors. In Africa, women rarely consult a health center of treatment for menopause-related disorders.
This situation may be due to an experience of menopause specific to Nigerien women or to a lack of information on this stage of life and its therapeutic alternatives. The objective of our study was to analyze the experience of menopause for women in the Niamey region to improve their quality of life.

Patients and Method
This is a prospective, quantitative, and qualitative study about 500 cases collected over a period of 6 months. It concerned postmenopausal women in the Niamey region of public services, in certain residential areas or accompanying persons in health structures.
The inclusion criteria were the duration of confirmed menopause with a cessation of menstruation dating at least 2 years and an age greater than 40 years.
The noninclusion criteria were, among others, the refusal to participate and those whose age was less than 40 years.
Parameters taken into account were sociocultural, antecedents, experience, knowledge, and management of menopause. Patients were recruited at the level of the consultation services of the various health centers in the Niamey region. Data collection was carried out using questionnaires during an interview with the patient.
Data were entered and analyzed using Microsoft Office Word 2010 and Microsoft Office Excel 2010.
Ethical aspect: the study was approved by the Dean of the Faculty of Health Sciences of Abdou Moumouni University in Niamey as well as by the administrative authorities of the health centers concerned. The consent of all participants in this study was obtained.

Results
The average age of the women was 56.4 years with extremes of 40 and 80 years.
We noted that 53% of women were not educated and only 87 (17%) had a higher level the symptomatology is summarized in Table 2.
As for menopausal management, only one woman had used short-term  continuous-type menopausal hormone therapy. Thirty-seven women (7.4%) personally managed their menopause (Table 3 and Table 4): -46% of women with personal management used hygieno-dietetic means.
-27% of women used cosmetic means.
-27% of women used traditional means.
These means consist of the use of: -The leaves and fruits of acacia nilotica by their astringent and anti-inflammatory properties for intimate hygiene and to strengthen vulvovaginal tone.
-Shea butter against drying of the vagina and skin.
-Consumption of monkey bread and tapioca to improve vaginal lubrication.
For several years, awareness has been raised to avoid the introduction of traditional vaginal products which could be a risk factor for precancerous lesions. Open Journal of Obstetrics and Gynecology

Discussion
The improvement of better conditions has increased the life expectancy of wom- are not the subject of strong media coverage among women and the public. It appears from our study that asthenia is the most frequent sign with 86%. In Senegal, menopause is a situation considered unbearable by 50.6% of patients because of the functional symptoms [2]. They therefore indulge in various treat-Open Journal of Obstetrics and Gynecology ments such as traditional medicine and rarely consult [2] [6]. In our study, thirty-seven women, or 7.4%, managed their menopause on their own, 27% of whom used traditional means. Marta [8] noted that in Switzerland, the "experiential dimension" is associated with the "cognitive dimension", women relate the disorders they have already heard of and to which they have been socialized before the cessation of treatment occurs rules due to its medicalization. The most common sign in Cameroonian and Swiss women was hot flushes with 73% [8]. For Owajionyi Dienye [7] the results on the severity of menopausal symptoms showed that 28.25%, 49.84% and 21.9% had severe, moderate and mild menopausal symptoms, respectively.
The results of our study revealed that only one woman (or 0.2%) with a higher level of education had benefited from hormone treatment for menopause for a few years. In France, hormonal treatment for menopause is prescribed to 500,000 to 600,000 women [9]. Since the US study, the Women's Health Initiative (WHI) reported an increased risk of breast cancer and cardiovascular disease. These results have caused a drop from 50% in the 2000s to less than 10% currently [9].
The indications are now reduced to patients with disabling climacteric symptoms, at the minimum effective dose and for the minimum effective duration, with the need for gynecological monitoring and regular reassessment of the benefit of extending treatment or not [10] [11]. It is necessary to encourage research on menopause and its treatments. These will certainly be the coming objectives for the years [10].
African-American women do not perceive menopausal symptoms as problems for which women should seek medical attention [4]. Vasomotor symptoms are more common in African-American and Hispanic women (4). The study by Diouf et al. [6] in Dakar showed that the majority of providers (62%) were fa- Alone it is also used in decoction for the healing of the perineum postpartum. As for gynecological follow-up in our study, only 10.6% of women are followed by a gynecologist; 18.2% of women are regularly screened for cervical cancer and 8.8% mammography. In developed countries cervical cancer has moved to 12th place, it is accessible to screening, even better to primary prevention through vaccina- This study has a limitation, including the lack of long-term follow-up of patients, even several years, to better understand their experiences of menopause.

Conclusion
It emerges from this study and in light of data from the literature that menopause certainly causes inconvenience for a large part of the patients in the African environment in general and in Niger in particular. However, the lack of information, the distance from health centers and the lack of consideration of menopause in health policies lead to patients' reluctance to consult. Management of menopause must be integrated into the national reproductive health program.
Emphasis should be placed on carrying out collective awareness campaigns for the population on menopause.