Syahputra, MI, et al.
: Association of Estradiol, Greene Climacteric Scale and Work Ability Index
ASSOCIATION OF ESTRADIOL LEVEL WITH MENOPAUSE
COMPLAINTS ASSESSED USING GREENE CLIMACTERIC SCALE AND
WORK ABILITY INDEX IN MENOPAUSE PARAMEDICS
M. Iman Syahputra1, M. Fidel Ganis Siregar1, Cut Adeya Adella1,
Hotma Partogi Pasaribu1, Indra G. Munthe1, Riza Rivany1
1
Department of Obstetrics and Gynecology
Faculty of Medicine Universitas Sumatera Utara
ABSTRAK
Tujuan:
Untuk mengetahui hubungan antara kadar
estradiol, keluhan menopause yang dinilai
dengan Skala Klimakterik Greene dan
Work Ability Index pada Paramedis
menopause.
Metode:
Penelitian ini merupakan analitik cross
sectional dengan jumlah sampel 52 wanita
paramedis menopause yang bekerja di
RSUP H. Adam Malik, RSU dr. Pirngadi
Medan dan RS Jejaring pada Desember
2018 menggunakan kuesioner dan
pengambilan serum darah.
Hasil:
Kadar estradiol (mean = 34,47 pg/ml)
memiliki hubungan yang signifikan
dengan skor Greene Climacteric Scale (p =
0,000) dan berkorelasi negatif sedang (r =
-0,586). Kadar estradiol menunjukkan
hubungan yang signifikan (p = 0,000) dan
berkorelasi positif sedang dengan skor
Work Ability Index (r = 0,472).
Simpulan:
Terdapat adanya hubungan antara kadar
estradiol, keluhan menopause yang dinilai
dengan Greene Climacteric Scale dan
kinerja paramedis menopause yang dinilai
dengan Work Ability Index.
Kata kunci:
Menopause, Greene Climacteric Scale,
Work Ability Index, Paramedis
Correspondence: M. Iman Syahputra, Dept. Obstetri & Ginekologi FK USU,
syahputra86.obgyn@gmail.com
ABSTRACT
Objectives:
To find the association between estradiol
level with menopause complaints assessed
using Greene Climacteric Scale and Work
Ability Index in menopause paramedics.
Methods:
This is an analytic study with cross
sectional design conducted at December
2018 with 52 menopause paramedics who
works at Adam Malik Central Hospital,
Pirngadi General Hospital and satellite
hospitals were obtained as study subject.
Study samples were obtained using
questionnaires and blood serum
examination.
Results:
Estradiol level (mean = 34,47 pg/ml) had a
significant association (p = 0,000) and
negative moderate correlation with Greene
Climacteric Scale score (r = -0,586),
Estradiol also showed significant
association (p = 0,000) and had a moderate
positive correlation with Work Ability
Index (r = 0,472).
Conclusion :
There is a significant correlation between
estradiol level, menopause complaints
assessed using Greene Climacteric Scale
and menopause paramedics work ability
assessed using Work Ability Index.
Keywords:
Menopause, Greene Climacteric Scale,
Work Ability Index, Paramedics
 Syahputra, MI, et al. : Association of Estradiol, Greene Climacteric Scale and Work Ability Index

INTRODUCTION
Menopause defined as the end of menstruation and confirmed after 1 year of amenorrhea
period. Menopause is a normal and natural condition in women at the end of her reproductive
phase. Menopause may occur naturally or spontaneously at the fifth decade of life or induced
by medical intervention such as surgery, chemotherapy, or pelvic radiotherapy. Menopause
developed due to follicle atresia and diminished activity of ovarian follicle 1. Most common
complaints in menopause includes : irregularity of menstrual cycle, hot flashes, vaginal
dryness, osteoporosis, cardiovascular disease, and decrease of sexual desire. Greene
Climacteric Scale is one of the method which may be used to assess degree of menopausal
complaints in perimenopause and post menopause women. This scale was made by Dr.
Greene with the purpose of assessing menopause period complaints with an easy,
comprehensive and valid method. This scale was divided into 4 subscale : psychological,
somatic, vasomotor and sexual desire. The application of this scale includes : symptom relief
assessment in patient receiving hormonal therapy, clinical trial of Hormone Replacement
Therapy, epidemiological study and base study about climacteric symptoms. The importance
of knowledge about menopause complaints severity may become apparent in its association
with the productivity of menopause women.2 Several studies about the influence of
menopause complaints to women’s quality of life had been conducted in Universitas
Sumatera Utara. A study by Silitonga HN et al at 2010 showed that depression and anxiety
symptoms in menopause paramedic may affect their capacity in handling daily workload..3
Siregar MFG at 2014 studied about the frequency of menopause complaints in
perimenopause and post menopause paramedic. Same researcher also studied about the
relationship of estradiol with vasomotor complaints in menopause paramedic.4 However,
none of the above studies explain about the direct effect of menopause complaints to the wor
ability of paramedic..

METHOD
This was an analytic study with cross sectional design conducted in December 2018. 52
menopause paramedic in Adam Malik Central Hospital, Pirngadi General Hospital, and
satellite hospitals were obtained as study subjects. Study data were obtained using
questionnaires and blood serum examination. Data were then analyzed using descriptive
statistic, Spearman and Pearson correlation test. P-value of < 0,05 was considered
significant.
 Syahputra, MI, et al. : Association of Estradiol, Greene Climacteric Scale and Work Ability Index

RESULT AND DISCUSSION

From Table 1, mean of serum estradiol level in study subjects was 34,47 pg/ml. Parity
showed a significant association (p = 0,002) and had a moderate negative correlation with
estradiol serum level (r = -0,424). BMI also showed a significant association (p = 0,002) and
had a moderate positive correlation with estradiol serum level (r = 0,490).
Table 1. Correlation of Subject’s Characteristics with Estradiol Serum Level
Characteristics Estradiol (Mean = 34,47 pg/ml)
Mean P R
Age 52,15 0,500*
Parity 2,61 0,002 -0,424
BMI 27,30 0,000 0,490
Length of 2,83 0,385*
Menopause
Spearman test, p<0,05 considered significant, *not significant

Greene Climacteric Scale showed a significant association (p = 0,000) and had a strong
negative correlation with Work Ability Index score (r = -0,758).

Table 2. Correlation of Work Ability Index Score With Greene Climacteric Scale Score
Parameter Work Ability Index
P R
Greene Climacteric Scale 0,000 -0,758
Spearman test, p<0,05 considered significant, *not significant

Estradiol serum level showed a significant association with Greene Climacteric Scale (p =
0,000) and had a moderate negative correlation (r = -0,586). Estradiol serum level also
showed a significant association (p = 0,000) and had a moderate positive correlation with
Work Ability Index score (r = 0,472).
Table 3. Correlation of Estradiol Serum Level with Work Ability Index Score and
Greene Climacteric Scale Score
Parameter Estradiol
P R
Greene Climacteric Scale 0,000 -0,586
Work Ability Index 0,000 0,472
Spearman test, p<0,05 considered significant, *not significant

Based on study subjects characteristics, the highest level of estradiol were obtained from
those in the age group of 45-50 years old, nuliparous, obese, “very good” Work Ability Index
score, and had been in menopause phase for 1-2 years. Significant association was found
between parity with Greene Climacteric Scale, Work Ability Index and serum estradiol level.
Meanwhile, BMI showed a significant association with the estradiol serum level of study
 Syahputra, MI, et al. : Association of Estradiol, Greene Climacteric Scale and Work Ability Index

subjects. In menopause women, estradiol and estron were produced from the conversion of
adrenal androgen in the liver, kidney, brain, adrenal gland, and adipocyte tissue.
Aromatization process in the peripheral tissue had an association with body weight. Obese
women had a tendency for higher estrogen level compared to underweight women due to the
higher degree of aromatization process. Estradiol level may also influenced by parity. In a
study by Barrett et al, parous women had a higher estradiol level and lower progesterone
level compared to nulliparous women in the same reproductive phase.5,6,7,8
A previous study showed, a significant negative correlation was found betseen menopause
complaints and work ability in healthy women workers. Menopause complaints may reduce
productivity, increasing sick-leave days, and increasing the overall cost of health care
insurance.9 Griffith et al, found that menopause complaints such as reduced concentration,
fatigue, memory problems, depression, and reduced confidence were the contributing factors
for impairment of work ability. 10 A study by Gartoulla et al found that vasomotor complaints
had a strong independent association with the impairment of work ability. 11
CONCLUSION
The finding of this study shows that menopause complaints may impair Work Ability Index
in menopause paramedics. Reduced Work Ability Index in an important profession such as
paramedics may be a threat to patient safety. The correlation of estradiol serum level with
menopause complaints and Work Ability Index warrants further research for the benefit of
hormonal therapy in menopause paramedics.
ACKNOWLEDGMENT
Thank you for the Head of Obstetrics and Gynecology Department Universitas Sumatera
Utara, and all of the staff who contributes to this research.

REFERENCES
1. Takahashi M, Singh RS, Stone J. A Theory for the Origin of Human Menopause.
Front Genet. 2017;7:222. 2017.
2. Greene, JG. Factor Analysis of Climacteric Symptoms: Toward a Consensual
Measure. Unpublished Report. Department of Psychological Medicine, University of
Glasgow. 1990
3. Silitonga HN, Siregar MFG, Hutapea H, Nasution S. Depresi dan Cemas Masa
Perimenopause dan Pascamenopause Pada Paramedis RSUP H Adam Malik dan RS
Jejaring Medan. 2010.
4. Siregar MFG. Estradiol Serum Levels in Menopausal Women with and without
Vasomotor Syndrome in Medan. IOSR Journal of Dental and Medical Sciences. KnE
Medicine. 2016.
5. Barrett ES, Parlett LE, Windham GC, Swan SH. Differences in ovarian hormones in
relation to parity and time since last birth. Fertil Steril. 2014;101(6):1773-80.e1.
 Syahputra, MI, et al. : Association of Estradiol, Greene Climacteric Scale and Work Ability Index

6. Murray, et al. Biokimia Harper Edisi 27. EGC 2009:46330.

7. Findlay, JK, et al. Estrogen Signaling in the Regulation of Female Reproductive
Functions. Springer 2010
8. Casper RF. Regulation of estrogen/progestogen receptors in the endometrium. Int J
Fertil Menopausal Stud. 2014;41:16-21.
9. Reeuwijk KG, Robroek SJW, Niessen MAJ, Kraaijenhagen RA, Vergouwe Y, Burdorf
A. The Prognostic Value of the Work Ability Index for Sickness Absence among
Office Workers. PLoS ONE 10(5): e0126969. 2015
10. Griffith A et al. EMAS recommendations for conditions in the workplace for
menopausal women. Maturitas 85 (2016) 79–81
11. Gartoulla P, Bell RJ, Worsley R, Davis SR, Menopausal vasomotor symptoms are
associated with poor self-assessed work ability, Maturitas 87 (2016) 33–39.