Factors Associated with Severe Menopausal Symptoms and Their Relationship with Sleep Quality and Quality of Life among Iraqi Postmenopausal Women

Abstract

Background: Although the population of postmenopausal women continues to grow worldwide, Iraqi evidence describing the severity of menopausal symptoms, the factors driving that severity, and their relationship to sleep and quality of life remains limited. Objective: To identify factors associated with severe menopausal symptoms among Iraqi postmenopausal women and to examine how symptom severity relates to sleep quality and quality of life. Methods: In this twelve-month cross-sectional study, 400 postmenopausal women were recruited from Alzahraa Teaching Hospital, Najaf, Iraq, using consecutive sampling. Symptom severity, sleep quality, and menopause-specific quality of life were measured with the Menopause Rating Scale (MRS), the Pittsburgh Sleep Quality Index (PSQI), and the Menopause-Specific Quality of Life Questionnaire (MENQOL), respectively, while physical activity was captured with the International Physical Activity Questionnaire—Short Form (IPAQ-SF). Independent predictors of severe menopausal symptoms (MRS total score >30) were identified using multiple logistic and multiple linear regression. Results: Participants had a mean MRS total score of 18.6±9.2, and 60 women (15.0%) met criteria for severe symptoms. Among the 391 women with complete PSQI data, 69.6% had poor sleep quality (PSQI>5). MRS total score correlated positively with PSQI global score (r=0.52, p<0.001) and with overall MENQOL score (r=0.61, p<0.001). Multiple logistic regression identified six independent predictors of severe symptoms: obesity (BMI ≥30 kg/m²; AOR=2.14, 95% CI 1.32–3.47, p=0.002), low physical activity (AOR=2.68, 95% CI 1.58–4.55, p<0.001), low educational attainment (AOR=1.87, 95% CI 1.12–3.12, p=0.017), current smoking (AOR=2.31, 95% CI 1.09–4.89, p=0.029), presence of a chronic disease (AOR=1.76, 95% CI 1.05–2.95, p=0.032), and menopause before age 45 (AOR=1.95, 95% CI 1.08–3.52, p=0.027). A multiple linear regression on the continuous MRS score reproduced these six predictors and additionally identified waist circumference as an independent correlate of severity (R²=0.34). Conclusion: Approximately 15% of postmenopausal women in this cohort experienced severe menopausal symptoms. Obesity, lack of physical activity, low education status, smoking habit, chronic diseases and younger age at menopause were associated with higher odds for severe symptoms which was strongly associated  with poorer sleep and lower quality of life. Interventions that are focused on lifestyle, especially regarding weight management and physical activity could be useful in alleviating this symptom burden.