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ISSN: 0951-3590 (print), 1473-0766 (electronic)
Gynecol Endocrinol, 2013; 29(10): 917920
! 2013 Informa UK Ltd. DOI: 10.3109/09513590.2013.819078

MENOPAUSE

Association between anthropometric indices and quality of life

in menopausal women
Masumeh Ghazanfarpour1, Somayeh Abdolahian2, Masoud Zare3, and Soodeh Shahsavari4
1

Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran,
Department of Midwifery, Islamic Azad University, Firuzabad, Fars, Iran, 3Community Health Nursing Education, School of University,
Mashhad University of Medical Sciences (MUMS), Mashhad, Iran, and 4Biostatistics department, Faculty of Paramedical Sciences, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
Abstract

Keywords

Objective: To investigate whether body mass index (BMI), abdominal obesity or fat distribution
influence the quality of life of postmenopausal women.Methods: Subjects in this cross-sectional
study were 233 postmenopausal women (aged 4570 years) with an intact uterus and ovaries
and who were sexually active and not using hormone therapy. Anthropometric measurements
were recorded and subjects were interviewed using a specific health-related quality of life
(HR-QoL) instrument, the MENQoL scale.Results: According to BMI values, 31.5% of the women
were obese, 42.2% were overweight, 25.8% were normal weight and none were underweight.
However, according to the MENQOL scale results, obese women scored significantly higher
on symptoms for physical domains. The women with the android pattern of fat distribution
had significantly higher scores in the vasomotor and physical domains (p50.05).Conclusions:
Obesity did not affect global HR-QoL in postmenopausal women, but appeared to have an
influence on the psychical domains. Other anthropometric measurements were not associated
with differences in HR-QoL. Keeping the anthropometric indices in the normal/premenopausal
might improve the quality of life in menopause women.

Anthropometric measurements, healthrelated quality of life, menopause, obesity

Introduction
In Eastern societies, menopause is considered to be a natural
process, and women view this change more positively than
in Western societies [1]. However, many women are unfamiliar
with the effects of menopause, and thus may not complain of
problems or seek professional attention for menopausal symptoms. The social status of women increases with age in some
societies, which can have a positive impact on their level of
nutrition, physical activity, as well as cognitive and emotional
functioning. Women in Eastern societies also appear to experience fewer negative climacteric symptoms during midlife.
For example, Asian women gain prestige and power in the
family and society as they age. However, in developed societies,
aging may be associated with loss of beauty, a fear of no longer
feeling loved and wanted, and loneliness [2].
Obesity is a multi-factorial disorder that is related to genetic
and metabolic factors, nutritional lifestyle and physical activity,
which in turn are conditioned by social, behavioral and cultural
factors [3]. Obesity and being overweight are known risk factors
for diabetes, high blood pressure, heart disease, gallbladder
disease, stroke and some forms of cancer [4].

Address for correspondence: Somayeh Abdolahia, Department of

Midwifery, Islamic Azad University, Firuzabad, Fars, Iran. Tel: +98 21
88073782. Fax: +98 21 26131179. E-mail: Hirsa_Sa_80@yahoo.com.

History
Received 14 November 2012
Revised 28 May 2013
Accepted 20 June 2013
Published online 29 July 2013

The effect of menopause on body fat distribution is unclear,

but some studies suggest that menopause is associated with
an accumulation of central fat and, in particular, intra-abdominal
fat [5]. Although weight gain during menopause is considered
to be a normal phenomenon, few studies have proved the
relationship between menopausal status and weight gain.
The relationship between obesity and health-related quality
of life (HR-QoL) has been widely investigated. Quality of life
(QoL) has been defined by the World Health Organization as the
individuals perceptions of their position in life in the context
of the cultural and value systems in which they live and in
relation to their goals, expectations, standards and concerns [6].
Obesity has been associated with compromised HR-QoL and
psychological well-being [7]. The prevalence of obesity and
obesity-linked illnesses is increasing, particularly in the urban
environment [8]. Therefore, poor physical functioning and
reduced QoL attributable to being overweight are important in
terms of public health, and should be addressed by preventive
measures and interventions to promote healthy living [7]. Most
general population studies conclude that QoL in many persons
with obesity is suboptimal [9]. The association between obesity
and HR-QoL is stronger in women than in men, in both physical
and mental or psychosocial dimensions [3].
At present, no studies have been conducted in Iran
to determine the relationship (if any) between obesity and
HR-QoL in postmenopausal women. Accordingly, this study
aimed to examine the association between anthropometric
indices (body mass index [BMI] and fat distribution) and
HR-QoL in menopausal women residing in Shiraz, a city in
southwestern Iran.

20
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M. Ghazanfarpour et al.

Gynecol Endocrinol, 2013; 29(10): 917920

Table 1. Demographic characteristics and medical

characteristics of the sample (233 postmenopausal
women).

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Methods
In this cross-sectional study, the menopause quality of life
(MENQoL) scale, a specific QoL questionnaire for postmenopausal women was used. First, we compiled a list of all 42 health
centers in Shiraz, and categorized them into five different areas
according to socioeconomic status. Then, five health centers were
selected by simple random sampling. Subjects were selected
randomly from each health center using cluster sampling until
an adequate sample size was reached (n 233). The sample size
was calculated to be 233 subjects.
Inclusion criteria for the postmenopausal women were:
(1) natural menopausal status, (2) intact uterus and ovaries and
(3) last menstrual period 1 year ago. Information on health
status was obtained from medical history and by physical
examination (done by one of the investigators, M.G., MSc
Midwife, Senior Lecturer). Exclusion criteria were: (1) hormone
replacement therapy; (2) neuromuscular or neurophysiologic
diseases, as determined from the medical history; (3) difficulty
in understanding and interpreting the questions; (4) hysterectomy;
and (5) currently menstruating.
All subjects were explained the study objectives, and they
signed a written informed consent form and a research privacy
form prior to study enrollment. The procedures in this study were
approved by the institutional review board and the ethics
committee of Shiraz University of Medical Sciences [10].
BMI was calculated as the weight in kilograms divided by the
square of the height in meters. Subjects were categorized as: underweight (BMI520 kg/m2), normal weight (BMI 2024.9 kg/m2),
overweight (BMI 2529.9 kg/m2) or obese (BMI  30 kg/m2).
Waist circumference was measured with an anthropometric
tape placed directly on the narrowest point between the lower rib
margin and the iliac crest, in a plane perpendicular to the long
axis of the body. All measurements were made while the subjects
stood balanced on both feet approximately 20 cm apart, and with
both arms hanging freely at their sides. Weight and height were
measured by one of the investigators, with the participant wearing
light clothing and no footwear.
Data collection and measurements
Each patient completed a three-part questionnaire. One of authors
(M.G., MSc Midwife, Senior Lecturer) was responsible to
supervise the completion of questionnaires and any clarifications
were made by her if needed. The first part contained questions on
sociodemographic characteristics such as age, educational level
(illiterate, less than secondary school, completed secondary
school or university), marital status (single, married, divorced
or widowed) and medical conditions of interest (hypertension,
diabetes, respiratory disease, kidney disease and heart diseases).
The second part comprised of the Menopause-Specific Quality of
Life questionnaire for women. It consisted of 29 items divided
into 4 domains: vasomotor (3 items), psychosocial (7 items),
physical (16 items) and sexual (3 items). All items followed the
same format, in which the woman was asked whether she had
experienced the item in the previous month. If so, she was then
asked to rate how much she was bothered by the item on a 7-point
Likert scale ranging from 0 (not at all bothered) to 6 (extremely
bothered). Therefore, higher scores meant that the subject had
worse symptoms. The total score of each questionnaire was
calculated for each subject.
This questionnaire was translated into Persian and evaluated
by experts. It was then translated back into English and
rechecked. Reliability of the Persian language version was verified
in a pilot study of 40 women who were not included in the main
study. Internal consistency with Chronbachs alpha was estimated
at 0.84.

Variable
Marital status
Single
Married
Divorced or widow
Educational level
Illiterate
Less than secondary school
Secondary school
University
Chronic disease
Surgery
HTN
Diabetes
Musculoskeletal problems
Pulmonary disease
Heart disease
Kidney disease

N (%)
5 (2.1)
174 (74.7)
54 (23.2)
40
132
44
15

(17.2)
(56.7)
(18.9)
(6.4)

(9/39) 93
74 (31.8)
39 (16.7)
159 (68.2)
18 (7.7)
38 (16.3)
17 (7.3)

Results
A total of 233 postmenopausal women were enrolled into the
study. Mean age of the subjects was 54 years (range, 4564 years).
Regarding marital status, 2.1% of the subjects were single, 74.7%
were married and 23.2% were divorced or widowed. Table 1
shows the demographic characteristics and medical characteristics
of the subjects.
According to BMI values, 31.5% of the women were obese,
42.2% were overweight, 25.8% were normal weight and none
were underweight (Table 2). Total mean QoL score was 61.38.
Obese women scored significantly higher on symptoms for
physical domains.
The types of fat distribution were android in 88% of women
(abdominal obesity: waist-to-hip ratio 40.08) and gynoid in
11% of women (waist-to-hip ratio between 0.68 and 0.8). The
correlation between age of women and fat distribution was 0.265
(p50.05). Our results showed that women with the android
pattern of fat distribution had significantly higher scores in the
vasomotor (mean 8.55) and physical domains (mean 32.09)
(p50.05). Moreover, women in this sample who were considered
illiterate scored significantly higher on symptoms for all domains
(p50.05). Differences in marital status were also related to
significant differences in scores on the vasomotor domain; and
married women had higher scores for vasomotor symptoms
(Tables 2 and 3).

Discussion
In our study population, BMI was significantly related to scores
on the physical domain (p40.05). Among the three BMI groups,
women with obesity had the highest scores in the physical
domain. In other words, women who were obese had worse
physical functioning than their normal-weight counterparts. This
finding is in agreement with a study of obese and non-obese
Spanish women, which found that obesity did not affect overall
HR-QoL in postmenopausal women, but may have an influence
on the physical and sexual domains [5]. However, a study of
Indian women in Australia by Hafiz and colleagues reported no
statistically significant relationship between obesity and symptoms in any domain [2]. A survey of women in Spain found that
obese respondents had a self-reported HR-QoL lower than that
of women of normal weight [11].
Women with the android type of fat distribution had significantly more severe symptoms in the vasomotor and physical

Anthropometric and life quality in menopause women

DOI: 10.3109/09513590.2013.819078

919

Table 2. Mean and standard deviation (SD) of menopause quality of life (MENQoL) scale in menopausal women according to
their body mass index (BMI) and type of fat distribution.

Anthropometrics

MENQoL

Vasomotor
Mean (SD)

Psychosocial
Mean (SD)

Physical
Mean (SD)

Sexual
Mean (SD)

Total score
Mean (SD)

BMI
Normal (2024.9 kg/m2)
Overweigh (2529.9 kg/m2)
Obese (30 kg/m2 or higher)
Total
p Value

9 (5.68)
8.22 (5.92)
8.63 (32.12)
8.59 (33.75)
0.714

17.55 (9.37)
17.07 (9.05)
18.01 (8.28)
17.37 (8.79)
0.796

28.55 (16.63)
29.72 (17.21)
36.08 (15.45)
31.40 (16.85)
0.016*

4.12 (3.80)
3.87 (3.02)
3.76 (10.27)
3.87 (3.27)
0.822

59.22 (30.26)
58.89 (29.4)
66.49 (24.96)
61.38 (28.39)
0.187

Fat distribution
Gynoid
Android
Total
p Value

6.25 (5.82)
8.87 (5.81)
8.55 (5.85)
0.058

15.35 (8.89)
17.84 (8.70)
17.45 (8.74)
0.229

25.2 (16.68)
33.11 (17.07)
32.09 (17.15)
0.051

3.31 (2.45)
3.93 (3.34)
3.84 (3.25)
0.417

50.1 (29.82)
63.75 (28.28)
61.94 (28.68)
0.044*

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*Significant at 0.05 level.

Table 3. Correlations between BMI, marital status and educational level with menopause quality of life (MENQoL) scale in
menopausal women.
Total quality of life score

Vasomotor

Psychosocial

Physical

Sexual

BMI
Normal
Overweight
Obese
p Value

57.79 (25.05)*
60.48 (33.33)
62.14 (27.77)
0.765

7.96 (4.84)
9.97 (5.90)
8.39 (5.80)
0.288

18.37 (9.08)
17.08 (9.54)
17.47 (8.72)
0.857

28.33 (13.61)
28.97 (18.46)
32.44 (16.73)
0.336

3.46 (3.35)
4.46 (4.09)
3.83 (3.09)
0.47

Marital Status
Single
Married
Divorced or Widow
p Value

34 (22.76)
61.57 (29.28)
62.79 (25.19)
0.092

8.75 (3.94)
8.77 (5.89)
8.17 (5.58)
0.8

10.40 (8.17)
17.14 (8.87)
18.81 (8.28)
0.093

15.60 (12.68)
30.94 (17.31)
34.5 (14.64)
0.041**

1 (1.22)
4.72 (3.11)
1.32 (2.36)
0.00**

Education level
Illiterate
Less than secondary school
Secondary school
University
p Value

69 (26.89)
65.32 (27.44)
52.14 (28.46)
34.07 (20.02)
0.00**

10.77 (5.74)
8.86 (5.75)
6.52 (5.49)
6.78 (5.29)
0.01**

19 (9.02)
18.79 (8.51)
14.32 (8.69)
10.27 (4.39)
0.00**

35.17 (15.01)
33.77 (16.41)
27.33 (17.21)
15.27 (11.88)
0.00**

4.05 (3.80)
3.90 (3.22)
4.07 (3.25)
2.2 (2.14)
0.334

*Mean (Standard deviation).

domains compared to women with the gynoid type. In other

words, the former subgroup had a lower quality of life. This
finding is in agreement with a study of women in the Netherlands
that showed that large waist circumference and high BMI
are important indicators of physical difficulties with the basic
activities of daily living [12]. In contrast, research in Spain
showed that women with abdominal obesity also scored lower in
the sexuality domain compared to women with non-abdominal
obesity [5].
A study by Ayatollahi and colleagues showed that the
mean age of menopause in women in Shiraz was 48.3 years
with a median age of 49 years [14]. Also, life expectancy has
increased dramatically in developing countries such as Iran [15];
therefore, it may be concluded that keeping the BMI in the normal
range can improve the quality of life during the menopausal
period.
At present, no studies have been conducted in Iran to determine the relationship (if any) between obesity and HR-QoL
in postmenopausal women. Additional research with specific,
validated HR-QoL instruments and longer follow-up periods
are necessary to confirm our results. Studies on the impact of
menopause on HR-QoL have focused on issues such as hormone
replacement therapy [8], with most studies showing deterioration
in HR-QoL after menopause [16]. Our results have practical
implications for the health of older women because the results

showed that obesity and the android type of fat distribution were
associated with a worse functional status.
Previous studies found that the level of education was
significantly related to the severity of menopausal symptoms
[17,18]. Several studies reported that unemployment and a low
level of education were associated with more severe menopausal
symptoms, whereas women with postsecondary education
tended to report less bothersome physical symptoms [19,20].
These findings are consistent with our results, where we found
that women considered illiterate in our sample had significantly
worse symptoms.
Marital status was significantly related to the severity of
vasomotor symptoms (p50.001). In contrast, a study of menopausal Indian women in Australia showed that there were
significant differences in the severity of sexual and physical
symptoms depending on marital status [11]. This contradicts
other research findings, which reported that there was no
significant association between marital status and severity of
symptoms [19].

Conclusions
Obesity did not affect global HR-QoL in postmenopausal
women, but appeared to have an influence on the psychical
domains. Other anthropometric measurements were not

920

M. Ghazanfarpour et al.

associated with differences in HR-QoL. Keeping the anthropometric indices in the normal/premenopausal might improve the
quality of life in menopause women.

Declaration of interest
The authors report no conflicts of interest and financial relationships for
this study.

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