PERCEIVED EFFECTS OF MENOPAUSE TOWARDS SOCIAL AND

EMOTIONAL BEHAVIOR OF WOMEN IN DE LA SALLE

MEDICAL AND HEALTH SCIENCES INSTITUTE

An Undergraduate Thesis
Presented to the
Faculty of College of Nursing
De La Salle Medical and Health Sciences Institute
City of Dasmariñas, Cavite

In Partial Fulfillment
of the Requirements for the Degree
Bachelor of Science in Nursing

Ditan, Andrea Nicole B. Salvador, Jellen Joyce A.

Hemedes, Marinela Greanne T.

January 2019
 2

ABSTRACT

Name of Institution : De La Salle Medical and Health Sciences Institute

Address : City of Dasmariñas, Cavite, Philippines

Title : Perceived Effects of Menopause Towards Social and

Emotional Behavior of Women in De La Salle Medical and

Health Sciences Institute

Author : Andrea Nicole B. Ditan

Marinela Greanne T. Hemedes

Jellen Joyce A. Salvador

Degree : Bachelor of Science in Nursing

Funding Source : Personal

Cost : PhP 20,000

Date Started : June 2018SALAR

Date Completed : January 2019

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Objectives of the Study

A. General Objectives

The main objective of the study is to determine the perceived effects of

menopause towards social and emotional behavior of women in De La Salle

Medical and Health Sciences Institute.

B. Specific Objectives

1. To determine the profile of the respondents in terms of civil status,

educational attainment, monthly family income, and category of

employment.

2. To determine the perceived effects of menopause towards social and

emotional behavior of women in De La Salle Medical and Health Sciences

Institute.

3. To determine the significant difference in the perceived effects of

menopause towards social and emotional behavior of women in DLSMHSI

when they are grouped according to civil status, educational attainment,

monthly family income, and category of employment.

Scope and Delimitation of the Study

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The study was conducted in De La Salle Medical and Health Sciences

Institute in the City of Dasmariñas, Cavite.

The total number of respondents was sixty-five (65) whose age ranged from

35 to 50 years old, who still have menstruation regularly or irregularly and women

who are willing and able to participate in the study. However, women who had

menopause were not included in the study.

Methodology

The study utilized the Quantitative-descriptive Research Design in order to

determine the perceived effects of menopause towards social and emotional

behavior of women in De La Salle Medical and Health Sciences Institute.

Quantitative Research is used to obtain knowledge about certain phenomena.

Descriptive Research is a quantitative research method that attempts to collect

quantifiable information to be used for statistical analysis of the population sample.

It is a research tool that allows collecting and describing the nature of a certain

phenomenon.

In this design, the group is given a 20 item survey-type questionnaire and the

results were gathered at the end of the data gathering procedure and subjected for

statistical analysis using Frequency Distribution, Mean, t-test and f-test or One Way

Anova.

Findings
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The following findings were drawn from the research:

1. From the total of 65 respondents, in terms of civil status, 54 or 83.1% are

Married, 8 or 12.3% are Single, 2 or 3.1% are Widow and 1 or 1.5% are

Separated; for educational attainment, 46 or 70.8% are College Graduate, 18

and 27.7% are others (Masteral and Doctorate Degree); and 1 or 1.5% are

College level, for monthly family income, 25 or 38.5% are PhP 40,000 –

PhP59,999, 18 or 27.7% are PhP 60,000 – PhP 99,999, 14 or 21.5% are

under PhP 40,000, 6 or 9.2% are PhP 100,000 – PhP 249,000 and 2 or 3.1%

were PhP 250,000 and over; for category of employment 52 or 80% are

Teaching Staff and 13 or 20% are Non-teaching Staff.

2. From the 20 items pertaining to the perceived effects of menopause when

clustered according to social and emotional changes, 11 items pertain to

social changes and 9 items pertain to emotional changes. Numbers 3, 4, 5,

9, 10, 11, 17, 18 and 19 pertain to the effects of menopause towards

emotional behavior of women. The items which obtained the highest scores

are: menopause can make the women feel that they are getting older (3.65),

menopause can cause irritability and mood swings (3.62) and menopause

can make most women physically and emotionally unwell (3.45). All these

items were moderately perceived by the respondents. This shows that these

three conditions associated with menopause are familiar among the

respondents. Moreover, the rest of the items were fairly perceived by women
 6

in De La Salle Medical and Health Sciences Institute. The 5 items under

fairly perceived that obtained the lowest most score are: menopause can

bring depressive mood (3.23), feeling of sadness can also be experienced

due to loss of fertility or changes occurring in the body during menopause

(3.15), menopause can cause women to feel anxious and easily upset (3.14),

menopause can cause physical changes which can result to increasing

levels of insecurity (3.03), and one of the concerns that women may perceive

during menopause is the emotional change such as fear of unknown. This

reveals that majority of the respondents were not familiar with these

emotional changes associated with menopause. Numbers 1, 2, 6, 7, 8, 12,

13, 14, 15, 16, and 20 pertain to the effects of menopause towards social

behavior of women. The items which obtained the highest scores in social

changes are: Menopause can make women respond quickly to slightest

things with unexplainable anger (3.40), menopause can cause sleep

problems such as difficulty of falling asleep, difficulty in sleeping through and

waking up early that can lead to irritability (3.37) and menopause can cause

sexual problems such as change in sexual desire, activity and satisfaction

that can affect marital relationships (3.20). This shows that although these

three conditions associated with menopause obtained the highest scores,

these are not familiar among the respondents. The top 5 lowest score for

social changes associated with menopause are: menopause can cause

difficulty concentrating on their works (3.11), physical symptoms of

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menopause can cause a decline in women’s self-esteem (3.03), menopause

can cause difficulty concentrating on their works (3.00), menopause can

cause women to become less sociable (3.00), menopause can cause a

women forgetful (2.97) and women who are approaching to menopause can

cause women to be less sociable (2.97). This reveals that the respondents

are not familiar with the above mentioned social changes associated during

menopause. Overall, the effects of menopause towards social and emotional

behavior of women is fairly perceived with a mean of 3.18.

3. In terms of significant difference on the perceived effects of menopause

towards social and emotional behavior of women when grouped according to

civil status, the computed f-value of 2.231 is greater than 0.05 level of

significance using 3 and 61 degrees of freedom indicate that civil status is

not significant. The null hypothesis of no significant difference was accepted.

In terms educational attainment, the computed f-value 2.473 is greater than

0.05 level of level of significance using 2 and 62 degrees of freedom

indicates that educational attainment is not significant. The null hypothesis of

no significant difference was accepted. In terms of monthly family income,

the computed f-value 0.9657 is greater than 0.05 level of level of significance

using 4 and 60 degrees of freedom indicates that monthly family income is

not significant. The null hypothesis of no significant difference was accepted.

In terms of category of employment, the computed t-value -0.096 denotes

 8

that there is no significant difference at 0.05 level of significance. The null

hypothesis of no significant difference was accepted.

Conclusions

Based on the research findings, the following were concluded:

1. Majority of the respondents were married, college graduate, having monthly

family income of PhP 40,000 – PhP 59,999, and teaching staff.

2. Majority of the respondents fairly perceived the effects of menopause

towards social and emotional behavior of women in DLSMHSI.

3. There is no significant difference in the perceived effects of menopause

towards social and emotional behavior of women in DLSMHSI when they are

grouped according to civil status, educational attainment, monthly family

income and category of employment.

Recommendations

Based on the findings of the study the following recommendations are

presented:

1. Health Care Providers in the community including doctors, nurses and

nursing students to provide more information regarding the possible changes

and effects of menopause towards social and emotional behavior and its

associated conditions. These can be done through seminars, health

teachings or other activities that will help facilitate learning.

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2. For Schools of Nursing to actively participate in dissemination of information

about menopause and its signs and symptoms especially social and

emotional behavior to increase the number of women informed with

knowledge about this milestone.

3. Non-government or Government Organizations including women’s group

could also be a leader in conducting activities that will help educate women

about the effects of menopause towards social and emotional behavior of

women.

4. For Future Researchers, to replicate this study including wider course to

intensify the study not just focusing on the perceived effects of menopause to

the social and emotional behavior but as well as physical and sexual

changes associated with menopause. With broader knowledge, women will

be able to be informed regarding these changes for their preparation and

adaptation in this milestone.

APPROVAL SHEET

This undergraduate thesis entitled Perceived Effects of Menopause Towards

Social and Emotional Behavior of Women in De La Salle Medical and Health

Sciences Institute prepared and submitted by Andrea Nicole B. Ditan, Marinela Greanne
 10

T. Hemedes and Jellen Joyce A. Salvador in partial fulfillment of the requirements for the

degree Bachelor of Science in Nursing, has been examined and is recommended for

acceptance and approval for Oral Defense.

MARIA BERNADETTE R. DAPLAS, RN, MAN, EdD

Adviser

THESIS REVIEW PANEL

Approved by the committee on Oral Defense with a grade of ___________.

MA. JENNIFER A. ELLEMA, RN, MAN JULIETA M. DAMIAN, RN, MSN

Member Member

NAOMI M. DE ARO, RN, MAN, EdD

Chairman

Accepted and approved in partial fulfillment of the requirements for the degree

Bachelor of Science in Nursing.

RESTITUTA C. TAN, PhD, RM, RN, RGC

Dean, College of Nursing

ACKNOWLEDGMENT

First and foremost, the researchers would like to acknowledge and express

their sincerest gratitude to the following people who have contributed in the
 11

completion of this study by imparting their knowledge, skills and expertise to make

this study possible.

The researchers would like to thank the God Almighty for blessing them with

knowledge, guidance and strength during the entire course of the research that

made them persevere and complete the study.

To Professor Maria Bernadette R. Daplas, RN, MAN, EdD, the researchers’

Thesis Adviser, for her reviews and recommendations that enriched the content and

outcome of the study. Without her assistance and dedicated involvement in every

step throughout the process, this paper would have never been accomplished.

To Professor Naomi M. De Aro, RN, MAN, EdD, the Researchers’ Research

Course Professor, for imparting knowledge and enthusiasm that served as the basis

for their study.

To Professor Julieta M. Damian RN, MSN, Professor Ma. Jennifer A. Ellema,

RN, MAN and Professor Naomi M. De Aro, RN, MAN, EdD, the Panel Members, for

investing their time and knowledge to improve the study.

To Professor Loida A. Gutierrez, RN, MAN, the researchers’ assigned Ethics

Committee Member, for ensuring that the study does not have any ethical issues

concerning the tool and the data gathering procedure.

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To Professor Melanie H. Nolasco, RN, MAN, Professor Marjorie Fay P. Sta.

Maria, RN, MAN, PhD and Professor Monina G. Dimas, RN, MAN, the researchers’

Tool Validators.

To Professor Janice T. Ilano, the researchers’ Statistical Adviser, for her

expertise in the statistical treatment of the study and to Professor Peggy Anne

Orbe, English Editor, for her expertise for the grammatical improvement of the

manuscript.

Most importantly, none of this could have happened without the researchers’

respective families, Ditan Family, Hemedes, Family, and Salvador Family, for their

endless love, support and encouragement.

To their friends and colleagues for extending their helping hand whenever

they need it. This study would not be possible without the support of these people.

A. N. B. D.

M. G. T. H.

J. J. A. S.

Table of Contents

Page

TITLE PAGE 1
 13

ABSTRACT 2
APPROVAL SHEET 10
ACKNOWLEDGEMENT 11
TABLE OF CONTENTS 13
LIST OF TABLES 16
LIST OF FIGURES 17
CHAPTER
1 THE PROBLEM AND ITS BACKGROUND
Introduction 18
Theoretical Framework 21
Statement of the Problem 24
Hypothesis 25
Scope and Delimitation of the Study 25
Significance of the Study 26
Definition of Terms 27
2 REVIEW OF LITERATURE
Menopause and Its Signs and Symptoms 29
Conditions Associated with Menopause 37
Management of Menopause 40
Perceptions Regarding Menopause 46
Synthesis 53
3 RESEARCH METHODOLOGY
Research Design 56
Population and Sampling 56
Respondents of the Study 57
Research Instrument 58
Validation of the Instrument 59
Data Gathering Procedure 59
Phase 1: Social Preparation 59
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Phase 2: Data Gathering 60

Statistical Treatment 61
4 PRESENTATION, ANALYSIS AND
INTERPRETATION OF DATA
Problem 1 63
Problem 2 67
Problem 3 72
5 SUMMARY OF FINDINGS, CONCLUSIONS,
AND RECOMMENDATIONS
Summary 81
Findings 83
Conclusions 86
Recommendations 87
REFERENCES 89
APPENDICES
A Letter of Permission 101
Registrar 101
Dean of Office of Student Services 102
Director of Comprehensive Community
Health Training Program 103
Director of Alumni Relations Office 104
Director of Academic Quality Management 105
Director of Center for Innovative Education
and Technology Integration 106
Officer of Lasallian Access and Success Office 107
Director of Romeo P. Ariniego MD Library
Services 108
Dean of College of Humanities and Sciences 109
Dean of College of Pharmacy 110
 15

Dean of College of Medical Laboratory Science 111

Dean of College of Nursing 112
Dean of College of Rehabilitation Sciences 113
Dean of College of Medical Imaging and
Therapy 114
Director of Special Health Sciences High School 115
B Adopting a Research Instrument 116
C Certification from the College Ethics Committee 117
D Certification from the Validators 118
E Certification from the Statistician 119
F Certification from the English Editor 120
G Certification for Final Printing 121
H Informed Consent Form (English) 122
Informed Consent Form (Filipino) 123
I Research Instrument 124
J Curriculum Vitae 127

List of Tables

Table Page
 16

1 Perceived Effects of Menopause Towards Social

And Emotional Behavior of Women in DLSMHSI 67
2 Perceived Effects of Menopause Towards
Social and Emotional Behavior of Women in
DLSMHSI when they are grouped according to
Civil Status 73
3 Perceived Effects of Menopause Towards
Social and Emotional Behavior of Women in
DLSMHSI when they are grouped according to
Educational Attainment 74
4 Perceived Effects of Menopause Towards
Social and Emotional Behavior of Women in
DLSMHSI when they are grouped according to
Monthly Family Income 76
5 Perceived Effects of Menopause Towards
Social and Emotional Behavior of Women in
DLSMHSI when they are grouped according to
Category of Employment 78

List of Figures

Figure Page
 17

1 Perceived Effects of Menopause Towards Social

And Emotional Behavior of Women in DLSMHSI 24
2 Profile of the Respondents in Terms of Civil Status 63
3 Profile of the Respondents in Terms of Educational
Attainment 64
4 Profile of the Respondents in Terms of Monthly
Family Income 65
5 Profile of the Respondents in Terms of Category of
Employment 66

Chapter 1

THE PROBLEM AND ITS BACKGROUND

Introduction
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“Each individual woman’s body demands to be accepted on its own terms.”

- Gloria Steinem

Every human being has his/her own uniqueness. Women, as they age, a lot

of transformations occur within their bodies. They undergo cycles which could lead

to changes in their body. Starting from the onset of menarche; some having to

experience monthly painful periods; some experiences the painful bearing of a

child; until one reaches the menopausal stage – where their body undergoes a

decline in levels of hormones that could result to physical, emotional, social, sexual

and other changes that may affect their daily life. As this is part of a normal aging

process, women must learn on how to adapt the changes associated with

menopause.

People grow old and mature. They encounter challenges as they pass the

different stages of life, from infancy to childhood to adulthood. This is the same for a

female’s body as it keeps on undergoing changes physically along with hormonal

changes associated with years of aging which cannot be prevented. In life, women

undergo the natural cycle of menstruation as well as the menopausal stage as they

age. Menopausal stage is where a woman experiences absence of menstrual

periods which do not occur instantaneously but rather on a gradual process. It is

where the functions of the ovaries cease and because of this reason hormonal

changes take place which is believed to have a significant impact on the social and

emotional behavior of women undergoing menopausal stage.

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Menopause is a natural transition in a period of every woman’s life. It is the

time when ovaries no longer produce eggs. It is one of the age-related periods of

physiological transition of females. It is the final termination of menses in women’s

lives. When a woman does not have a menstrual period for at least a year or 12

months, it means that a woman had reached the menopausal stage (Cheever &

Hinkle, 2014).

According to Murphy, Phillips, & Hall (2011), approximately 6,000 women in

United States undergo menopause every day. By the year 2020, women ages 55

years and above who will experience menopause is estimated to be 46 million.

Afterwards, women will consume 40% of their lives in postmenopausal stage.

Furthermore, according to the Philippine National Demographic and Health Survey

(2013), it was reported that in the total population of 7,937 of selected women aged

30-49, 6.2% are estimated to have reached the menopausal stage. The

respondents from Luzon are 4,683 (59%) with 18% from national Capital Region

(NCR), 1,270 (16%) are from Visayas and 1,984 (25%) are from Mindanao.

However, Cone Health (2013) reported that US women reaching menopause are

approximately 37.5 million.

Today, many women are having misconceptions about the menopausal

symptoms. The lack of knowledge about the symptoms that they might encounter

during menopausal stage may create fear. They may perceive these symptoms as

a sign of developing other diseases. This is a crucial period where the presence of
 20

nurses and other health professional are needed as some women may need

guidance, right and appropriate information and support in facing this challenging

period of life. Women who will be experiencing menopause deserve love and tender

care. They need a major social support from the people around them because it can

contribute in managing their stressors and their feelings.

In this regard, the researchers would like to know how menopause would

affect their social and emotional behavior such as mood swings when they are with

their families, friends, or officemates. The researchers would also like to find out

what would they feel when they begin to notice or experience the physical changes

in their bodies. Many women who are experiencing physical changes may develop

a feeling of sadness. Moreover, the researchers would also like to know how

women perceive social and emotional changes associated with menopause.

The above-mentioned situation influenced the researchers to conduct a

study about the perceived effects of menopause towards social and emotional

behavior of women in DLSMHSI. The researches would like to explore more

knowledge regarding the effects of menopause as they have family members who

will be facing this period.

Theoretical Framework

This study was guided by the Roy Adaptation Model (RAM) which was

created in 1964 by Sister Callista Roy.

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This model provides a useful framework for providing nursing care for

persons in health and in illness. It views a person as an adaptive system when they

come in contact with internal and external environment. Environment is considered

as the source of stimulus that either threatens or develops a person’s unique

wholeness. A major responsibility of a person is to keep integrity in response to her

environmental stimulus (Martha, 2013).

According to Martha (2013), the theory consists of five major concepts that

interrelate with each other. These are person, environment, health, nursing and

adaptation. The first one is person which has a constant interaction with the

environment. Humans undergo various stages throughout their lives and as a

normal response, humans adapt to these changes through acquired or innate

system of adaptation. The second one is environment which could be a setting,

condition, circumstances or influences that a human can encounter throughout their

lives. This is also termed as a stimulus that can either be positive or negative. This

is categorized into three types which are the focal, contextual and residual stimuli.

The focal stimuli are the ones that confront the human system and require the most

attention. A contextual stimulus is defined as all other stimuli present that are

precipitated by the focal stimuli. The residual stimuli are additional environmental

factors present within the situation, but whose effect is unclear. The three types of

stimuli are associated with each other. They all influence the adaptation level which

is defined as the person’s ability to respond positively in a certain situation. The

 22

third one is health, which is defined as the total capacity of an individual to function

any alterations in their health such as illness which can cause an impact to the

adaptive ability of an individual. If an individual can adapt holistically, they will be

able to reach completeness and unity within themselves. However, if an individual

fails and cannot adapt accordingly, the integrity of the person can be affected. The

fourth one is nursing. Nurses play an important role especially in assessing the

individual behavior for adaptation as well as promoting a positive adaptation by

enhancing environment interactions and participate in helping an individual to react

positively to stimuli. Lastly, adaptation is the process and outcomes that result to

the capability of an individual to respond to the present stimulus/stimuli. This model

has four adaptive modes which are physiologic mode, self-concept, role function

and interdependent relations during health and illness. These adaptive modes aid in

promoting the integrity of an individual in terms of goals of survival, growth,

reproduction and mastery. The physiologic mode is also known as the “basic

needs.” This includes the physical and chemical interactions that are involved in the

function of living organisms. The self-concept mode is defined as the composite of

beliefs and feelings known to self by individuals. This involves body image and self-

ideals. The role function mode is the role that an individual occupies in the society.

Lastly, the interdependence mode focuses on the relations with significant others

and support system. In this mode, one maintains psychic integrity for nurturance

and affection.
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The aim of the study is to determine the perceived effects of menopause

towards social and emotional behavior of women in DLSMHSI. This theory is used

in the study because during this stage, women will encounter various bodily

changes reflected physically and may be noted emotionally and socially. These

changes can affect their daily lives. Women approaching menopause may view this

as a positive or negative event in their lives. Each individual has different perception

regarding adaptation through certain phenomenon. In order to face this transition,

proper adaptation regarding these changes should be done in order to prevent

serious problems associated with menopause such as anxiety. This theory can help

women in preparing themselves to adapt and accept the social and emotional

changes associated with menopause. Furthermore, the research would be able to

provide understanding regarding the changes that encompass the whole stages of

menopause.

Figure 1: Perceived Effects of Menopause towards Social and Emotional Behavior

of Women in De La Salle Medical and Health Sciences Institute

Civil Status Perceived Effects of

Educational Attainment
Menopause towards Social
 24

Figure 1 shows the perceived effects of menopause towards social and

emotional behavior of women in DLSMHSI. The demographic variables are the civil

status, educational attainment, monthly family income and category of employment

while the research variable is the perceived effects of menopause towards social

and emotional behavior of women in DLSMHSI.

Statement of the Problem

The study aimed to determine the perceived effects of menopause towards

social and emotional behavior of women in DLSMHSI.

The study sought to answer the following questions:

1. What is the profile of the respondents when they are grouped according to

civil status, educational attainment, monthly family income and category of

employment?

2. What are the perceived effects of menopause towards social and emotional

behavior of women in De La Salle Medical and Health Sciences Institute?

 25

3. Is there a significant difference in the perceived effects of menopause

towards social and emotional behavior of women in DLSMHSI when they are

grouped according to civil status, educational attainment, monthly family

income and category of employment?

Hypothesis

The hypothesis of the study is:

There is no significant difference in the perceived effects of menopause towards

social and emotional behavior of women in DLSMHSI when they are grouped

according to civil status, educational attainment, monthly family income and

category of employment.

Scope and Delimitation of the Study

The study focused on the perceived effects of menopause towards social

and emotional behavior of women of De La Salle Medical and Health Sciences

Institute. The respondents of the study were composed of female working in the

Academics of the institution. The following inclusions are: 1) women ages 35 to 50

years; 2) women who still have menstruation regularly or irregularly and; 3) women

who are willing and able to participate in the study. In addition, women who had

menopause were not included in the study.

However, the researchers initially intended to include all women in De La

Salle Medical and Health Sciences Institute who meet the criteria but failed to do so
 26

because of the following reasons: some declined or refused for personal reasons

and some were in the field and will be coming back later in the year.

The setting of the study was at De La Salle Medical and Health Sciences

Institute. The data gathering period was during the months of November and

December 2018.

Significance of the Study

The intent of the research is to determine the perceived effects of

menopause towards social and emotional behavior of women. It is believed to be

beneficial to the following persons:

Respondents. The results of the study may serve as a source of information on

the effects of menopause towards social and emotional behavior. Thus, it may help

them acquire a wider perception about the condition and added knowledge

regarding the symptoms that they will later be experiencing.

Significant others. The given data would guide husbands, children and

relatives on what to do as well as how to deal with women approaching

menopause. They may be able to understand more the natural changes that are

happening in a woman’s body.

Colleagues. This may also help the people around the women nearing

menopause to gain knowledge about changes that can be brought by menopause

 27

and its effect on emotional and social interaction of women. Subsequently, it may

help them understand the women’s condition better.

Future Researchers. The study may benefit future researcher/s because this

would serve as an additional reference for related studies. This study may also

motivate future researchers to include more data that are related to the effects of

menopause towards social and emotional behavior.

Definition of Terms

The following terms which were used operationally in the study are:

Category of Employment. It refers to a type of employment of the

respondent. It was grouped as whether the respondent belongs to teaching and the

non-teaching staff of DLSMHSI.

Civil Status. It refers to the respondent’s legal position in the society or

family situation which could simply mean single, married, widowed and separated

with or without children.

Educational Attainment. It refers to the academic status of the

respondents. In this study, it was grouped into elementary level, elementary

graduate, high school level, high school graduate, college level, college graduate

and others.
 28

Emotional behavior. It is a conscious reaction or strong feelings possessed

by women experiencing menopause. In this study, it was measured using the 5-

point Likert Scale. The rating scale is as follows: 5 – Strongly Agree, 4 – Agree, 3 –

Neutral, 2 – Disagree and 1 – Strongly Disagree.

Menopause. It is the permanent termination of woman’s menses due to

decreasing ovarian function (Cheever & Hinkle, 2014).

Monthly family income. It refers to the salary being received by the family

on a monthly basis. In this study, it is divided into: a) under PhP 40,000; b) PhP

40,000 – PhP 59,999; c) PhP 60,000 – PhP 99,999; d) PhP 100,000 – PhP 249,999

and; e) 250,000 and over (NEDA, 2015).

Social behavior. It refers to the interaction of women with other people like

family, friends, and workmates. In this study, it was measured using the 5-point

Likert Scale. The rating scale is as follows: 5 – Strongly Agree, 4 – Agree, 3 –

Neutral, 2 – Disagree and 1 – Strongly Disagree.

Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES

 29

This chapter includes the review of related literature and studies to shed light

on the topic under study. This includes the following topics: Menopause and its

Signs and Symptoms, Conditions Associated with Menopause, Management of

Menopause and Perceptions of Women Approaching Menopause.

Menopause and Its Signs and Symptoms

According to Cheever and Hinkle (2014), Menopause is the permanent

termination of woman’s menses due to decreasing ovarian function. They stated

that there are three phases of menopause which happens between 45 to 52 years

of age although it may occur as early as 42 or as late as 55. These are

perimenopause, menopause and post menopause. Perimenopause can possibly

occur as early as 35 years of age. The physical, emotional and menstrual changes

may be evident during the time. Menopause is a normal part of aging and

maturation. It is not a disease condition but a normal part of maturation. With this,

the ovaries are no longer active; the reproductive organs become smaller and no

more ova mature. Therefore, no ovarian hormones are being produced.

Postmenopause is the time from 1 year post-ceasing of menstruation. There are

symptoms that may be encountered during menopausal period like abnormal

vaginal bleeding, hot flashes, tiredness, stress, vaginal dryness and itching as well

as mood changes. However, Wang et al. (2017) defined menopause as an

essential transition in woman’s life because it marks the end of their reproductive

life. The average age of the onset of menopause is at 51 years of age. Based on
 30

their findings, socioeconomic characteristics of individuals with higher education

show relationship with a later age at natural menopause. The educational

attainment may affect the onset of menopause by means of physiological effects

based on lifestyle behavior and reproductive health. However, little is known

regarding the association of age and the onset of menopause. While Dillaway &

Burton (2011) stated that menopause is the cessation of women’s menstruation.

The biomedical definition of menopause is the absence of it in a period of twelve

months.

Mood swings is defined as the extreme or rapid change in mood due to

hormonal imbalance which is experienced during perimenopause and menopause.

In these stages, there is shifting of level of estrogen and progesterone that result in

mood swings. In addition, women discover themselves responding quickly to the

slightest things with unexplainable anger or irritability. There can be an emotional

stress experienced by women because of these mood swings and may likely affect

people around them (Australian Menopause Centre, 2017).

Menopausal period has three phases. During the final menstrual period, the

body experiences physical changes that lead to worries about body image,

hormonal changes, life stresses, sleep problems, infertility, and aging that

contribute to changes in emotional well-being of women. These changes can lead

to anxiety (Railton, 2017). According to the study, twenty three percent (23%) of the

menopausal women experiencing different changes in the body are suffering from
 31

anxiety. Anxiety is a natural response of the body to stress. It is a feeling of fear and

apprehension as defined by Legg (2016).

According to the University of Michigan Depression Center (2016), due to the

decline of estrogen in the body, there is a risk of anxiety that may turn to

depression. The reasons are unclear but it may be due to life stressors and

changes being experienced during the middle age. Depression and the onset of

menopause display many similar symptoms, including irritability, anxiety and

difficulty concentrating. Because of this, menopausal women suffering from

depression are undiagnosed and untreated.

Grimley (2018) stated that women undergoing menopause experience low

libido or low sexual desire since there is hormonal imbalance. Sexual desire is the

people’s interest in sex and in being sexual as defined by The North American

Menopause Society (2018). Menopausal women have reduced sexual interest that

affects both people in their relationship. Undesirable and lacking of sexual

excitement can result to relationship difficulties.

According to Patiala, Krishna, Nancy, & Pritam (2014), menopause affects

women’s health and sense of well-being through biological and physiological

changes. These changes with accompanying symptoms may occur earlier. The

symptoms women may experience involve hot flushes and/or night sweats, trouble

sleeping, vaginal dryness, mood swings, trouble focusing, less hair on the head,
 32

occurrence of facial hair, and an experience of age-related decline of physical and

mental capacity. Symptoms such as periodic sweating or hot flushes, depression,

insomnia, impaired memory, lack of concentration, nervousness, and bone and joint

complaints are more seen in rural communities.

Gunyanyi (2016) stated that Menopause is a natural phenomenon being

experienced by women when ovaries decrease in functioning which affects

women’s sexual response. It also affects women’s sexual desire, interest and

arousal. Based on the findings of the study, these sexual problems have a

significant impact on spousal relationship. The objectives of the study were to

explore the experiences of married women during menopause particularly on their

experiences of sexual intimacy as well as to determine coping strategies women

use in managing their experiences of menopause. Majority of the women in this

study reported experiencing multiple physiological symptoms. The women

encounter physiological symptoms such as hot flushes/night sweats and menstrual

changes. They described these symptoms as distressful, worrisome and

unpleasant. The women revealed that they become puzzled with the occurrence of

these symptoms which they have not acquired readiness in facing the symptoms.

According to Nahar (2014), menopause is being perceived differently by

each woman. The average age of a woman having menopause is 51 but some

others occurred during their forties and later in their fifties. As time passes by,

ovaries will produce lesser estrogen and menopausal symptoms might arise. There
 33

are some common psychological effects of menopause. These include mood

swings, irritability and greater anxiety and fearfulness. Some may undergo

depression and experience sleep disturbances. Others reported that they

experienced a decreased in libido. Emotional disturbances may worsen the

symptoms. Two common effects of menopause among women are the

development of anxiety and depression. Depression and anxiety during menopause

is often common. Perimenopausal women may start to manifest signs of anxiety

and depression in relation to the changes that their body might go through.

Menopausal women have to cope with these changes.

Nosek, Kennedy, & Gudmundsdottir (2012) stated that there are three

aspects of distress during menopause – the primary experience of distress such as

anxiety, irritability and depression; the response related to the impact of the

symptoms and psychological state resulting from the emotional responses to

menopause or aging. One of the respondents reported different distressing

symptoms experienced such as hot flushes, night sweats, vaginal dryness,

decreased libido, mood changes, menstrual changes, and sleep disruption. One of

the concerns that women perceived during menopause is the emotional changes.

Woman experiencing distress is an emotional symptom. This could last for a day or

two. Fear may be experienced if this symptom would reoccur and this may affect

woman’s relationship and interaction with other people.

 34

According to Geukes, Van Aalst, Nauta, & Oosterhof (2012), menopause is a

significant stage in woman’s life that could bring negative effect on their life.

Menopausal symptoms may affect a woman’s quality of life. Menopause affects

women physically, emotionally and socially. Work has a vital role in life because it

gives a feeling of satisfaction. Women undergoing menopause has a higher

incidence of having absences due to sickness. Based on the findings of the study,

menopausal symptoms have a negative impact with regards to work performance of

women.

In another related study conducted by Landicho (2015), menopause is a

normal stage of life. Every woman will undergo menopause. Some of them may

experience severe symptoms like hot flushes while others are asymptomatic.

Menopausal women comprise a significant proportion of world’s population.

Women who reach 51 years old, symptoms related to decrease hormonal estrogen

are manifested. Symptoms may include hot flushes, vaginal dryness, mood swings,

impaired memory and concentration.

According to Office on Women’s Health (2018), as women experience

menopause, there is a gradual change in hormone levels which can have an impact

in menstrual cycle and produce symptoms such as hot flushes and sleeping

problems. Symptoms like pain during sex, urinary problems and irregular periods

can also be felt as women approaches menopause. Women in menopause

encounter sleeping problems due to low levels of progesterone. With low levels of
 35

estrogen, it can result in hot flashes which make women sweat during sleep called

night sweats. Also, many women in menopausal stage experience the urge to

urinate which would result to them to get up several times during sleep to urinate

because low levels of estrogen causes urethra to weaken. Feeling of sadness can

also be experienced due to loss of fertility or changes occurring in female’s body. In

terms of activities of women, they might become forgetful or have trouble focusing

due to depletion of hormone levels.

According to Chua (2013), Menopause happens when women’s ovaries stop

producing eggs which is the result of decline in production of estrogens and

progesterones. Symptoms of pre-menopause includes hot flushes, profuse

sweating, irritability, vaginal dryness, decreased sexual drive, fatigue, insomnia,

depression, headache, anxiety, nervousness, insecurity and mood swings. Some

women also gets upset easily, becomes hot-tempered, impatient and very sensitive

to the noise in the surroundings. According to the significant others of pre-

menopausal women, they face difficulty in dealing and communicating with them.

However, Hardy, Thorne, Griffiths & Hunter (2018) stated that menopausal

status has no impact on women’s performance at work. It is said that menopausal

status does not appear to be associated with work outcomes (absence,

performance, turnover intention and intention to leave the labor force). Most women

maintained high levels of self-rated performance at work despite menopause and

high levels of work stress.

 36

On the contrary, Newson (2017) stated that employed women who are

currently experiencing menopausal symptoms can have a significant impact on

attendance and performance in the workplace, with some women being

misdiagnosed as suffering from other conditions.

According to the study of Wani & Gupta (2012), women may experience

physical, emotional, social, as well as psychological disturbances during this period.

In India, urban women are starting to accept possible changes that will be

accompanied by menopause. However, social stigma hinders women from lower

socioeconomic classes of society from having the awareness regarding the

uncomfortable menopausal symptoms and possible treatments needed. Women

who are in the upper class can perceive menopause compared to those who belong

in the lower class. In a total of 103 women (53.6%) belong to the upper class and

the significance of this is that women who belong to this class is aware of the

possible treatments available for menopause.

Lastly, in a study of Gimba & Sinegugu (2015), menopause is a normal part

of aging. It is a natural life event that happens when the ovarian follicles decline that

leads to decrease in levels of estrogen and progesterone associated with an

increase level of luteinizing hormone and follicle stimulating hormone. During this

life event, periods stop and menopausal symptoms occur. Women during

menopause experience psychological problems such as depression, anxiety,

 37

irritability and social isolation. Health education and support are significant to avoid

serious complications.

Conditions Associated with Menopause

Anxiety is defined as an emotion which is distinguished by feelings of

tension, worried thoughts, and stress. Anxiety is caused by hormonal changes and

common experience symptoms among menopausal age women as stated by the

Beyond Blue (2018).

Lott and Stenson (2018) defined anxiety disorders shows a feature of

excessive fear and may result to behavioural and functional disturbances. It is the

severity of an anxious feeling that is out of ratio to the original trigger or stressor.

The study stated that forty million people in United States experience anxiety

disorder and is believed to be a common illness. According to Rivera (2018),

anxiety attacks are serious problems of menopausal women that occur while

experiencing other menopausal symptoms.

In the study of Jarvis (2013), depression refers to the feeling of lethargy and

hopelessness that last for a long time. Women who experience early menopause

are five times more likely to suffer from postmenopausal depression. Women with

postmenopausal depression tend to encounter these symptoms: lack of interest in

hobbies and work, tiredness, feeling of hopelessness and nervous tension.

 38

In a study of Baba, Khan, & Ali (2017), the decrease in hormones,

specifically estrogen in the body might lead to osteoporosis. Osteoporosis means

that there is a change in the structure of the bones that may lead to fractures which

usually happens in women over 50 years of age. The most helpful strategy for the

women is health education to be able to raise awareness and knowledge so that

early prevention and management may be done.

Newson (2018) also stated that the risk of having cardiovascular diseases

increase after the occurrence of menopause when hormone levels decline.

Hormones such as estrogens and testosterone are believed to have a significant

impact in the development of CVD in women. These hormones play a vital role in

endothelial function, vascular tone and as well as in cardiac function. One of the risk

factors for developing CVD is hypertension. The possibility of hypertension

experienced by women during the postmenopausal stage is more than twice the

possibility of it to be developed by the premenopausal women. Moderate

hypertension (<140/90 mmHg) causes more endothelial dysfunction and

cardiovascular diseases in women than in men.

According to De Kat et al. (2017), when women experience menopause at an

early age, they are prone to higher risk of developing cardiovascular disease.

However, considering about its mechanism is still unclear. Menopausal transition is

associated with adverse CVD risk factor levels. Based on the studies, chronological

aging or prior CVD risk contributes to be a major factor. Comparison between

 39

levels of CVD risk factors with menopausal status was done. This study

represented perceptions regarding the reproductive aging. Association of CVD risk

factors with menopausal status cannot be explained by chronological aging alone.

Based on the results, chronological aging and menopausal status contribute to the

CVD risk profile of aging women.

Lastly, Mosconi et al. (2017) also presented that female hormone is the

major risk for developing Alzheimer’s disease. Menopause transition is a midlife

neuroendocrine transition in women’s lives. Involving the neuroendocrine transition,

the related symptoms are most likely neurologically related. Age of menopause

falls at the prodromal phase of Alzheimer’s diseases. Estrogen depletion affects

bioenergetics. Brain uses glucose as its metabolic fuel in managing ATP which is

regulated by estrogen. Regulation of cerebral glucose during perimenopause

wavers down. Loss of brain estrogen, either by surgical removal of ovaries or

natural aging process results in the decline in glucose metabolism. As examined

among premenopausal women, perimenopausal and postmenopausal women can

be seen experiencing hypometabolism in the same brain regions as clinical AD

patients.

Management of Menopause
 40

Menopause is a natural occurrence in women’s lives and every woman

undergoes this stage. During this stage, women do not only undergo physical

changes but also social and emotional changes. In the process of menopause,

there are physical changes and alternations of hormones which can lead to

emotional changes such as mood swings, irritability, feeling of sadness, difficulties

with memory and concentration, and even depression. The emotional change also

affects the social behavior of women which requires management to be able to

cope up with change (Kalra, Agarwal, & Magon, 2012). They believed that the

involvement of different health care team is needed in order to ensure the excellent

quality of women’s life. Menopause has an influence to physical, emotional, social

and financial aspect of life. Holistic care of menopause is intended to be a patient-

centered approach. This includes the application of different health care resources

to ensure meeting all the needs of the patient with the use of pharmacological and

non-pharmacological therapies. In order to give a holistic care, menopause should

be supervised by gynecologists, endocrinologists, exercise counselors, public

health specialists, and orthopedic surgeons.

Mishra, Devanshi, & Mishra (2011) concluded in their study that regular

exercise helps in the improvement of the body’s overall function. The benefits of

regular exercise help an individual lose weight, improves mood and even reduce

the risk of developing chronic diseases. Before engaging to certain exercise,

women’s age, ability and individual preference should be considered. For women
 41

with Osteoporosis, Canada recommends a minimum of 20-30 minutes of weight

bearing exercise such as walking, dancing, step aerobics and running to a

moderate to vigorous intensity on most days to improve heart and health bone

strength. An exercise such as using free weights and machine is recommended 2 to

3 days per week. This improves muscle and bone strength, posture and mobility.

Balance training such as yoga and tai chi are also recommended to 2-3 days per

week to improve in mobility and balance leading to fewer falls and reduced fracture

risk. Although menopause should not be viewed as an impending declines but

rather a productive and wonderful beginning of good health program. This includes

lifestyle changes in diet, exercise and limiting smoking as well as drinking alcohol.

McCoy (2014) also stated that Menopause may result women to experience

emotional changes which includes difficulty of sleeping and decreased libido. It may

also trigger feelings of sadness or loss because some women view this as

pregnancy may no longer be achievable. Menopause related emotions can range

from mild mood swings to severe depression. Mild symptoms can be managed

through lifestyle changes such as finding time to relax and reduce stress.

Alternative therapies such as exercise, healthy diet, yoga and breathing exercises

can relieve menopausal symptoms. Some studies suggest that hormone

replacement therapy (HRT) which is believed to cure physical menopausal

symptoms may also soothe menopause-associated depression and anxiety.

However, not all studies consider this to be accurate.

 42

In addition, Dresden & Wilson (2018) explained that in the process of

menopause, hormonal fluctuations takes place. During this transition, the level of

estrogen drops that causes drastic changes throughout the body. Many of these

changes have a direct connection to menopausal mood swings. The impact of

these hormonal changes may not be limited to cause and effect relationship with

depression, anger and anxiety and due to hormonal change this may intensify these

feelings. This could be managed through lifestyle changes such as regular exercise

that promotes both physical and mental health as well as being active to help

relieve stress, improve mood and enhance the quality of concentration. A diet that is

rich in protein and omega-3 fatty acids can also help reduce menopausal mood

swings.

According to Hailes (2013), Cognitive Behavioral Therapy is one of the

management techniques that help an individual recognize the unhelpful thoughts

that influence depression and anxiety. Through this, it helps replace them with

helpful thoughts with incorporation of relaxation and breathing techniques to reduce

the impact of physical symptoms of anxiety. However, Davis (2016) defined CBT as

a form of psychotherapy that is used by counselors and therapists to educate

individuals to change their unwanted behavior by changing their thought patterns.

CBT aims to educate individuals about effective coping strategies in dealing with

different problems throughout life.

 43

Hailes (2013) further stated that severe depression and anxiety towards

menopause can be prescribed by a psychiatrist with antidepressant medication in

combination with communication therapy. According to The North American

Menopause Society (2018), women with moderate to severe depression during

menopause are often prescribed with antidepressant drug known as SSRIs

(Selective Serotonin Reuptake Inhibitors). However, consumption of this drug may

precipitate possible side effects such as diminishing sexual desire, trouble in

achieving and maintaining arousal and difficulty in achieving orgasm.

The North American Menopause Society (2018) likewise added that changes

in women’s moods were noticed in up to 23% of perimenopausal and

postmenopausal women. Symptoms such as anxiety, tension, nervousness, panic

and worry are the most common symptoms experienced by women. Low dose of

oral contraceptive may be recommended even if contraception is not desired.

These estrogen-progestin pills provide continues stable hormone levels and may

control mood swings other health benefits of this is regulation of uterine bleeding

and decreased risk for uterine and ovarian cancer. However, smokers at the age of

over 35 years old should not use oral contraceptives.

Aside from having struggles with possible aggravating menopausal

symptoms, many women go through personal and social changes at midlife which

affect their social interaction between two or more individuals. Menopause is not a

disease but a “Change of Life” (Sharma & Dogra, 2013). Some women are
 44

asymptomatic but most women experience negative impact on their lives. Issues

regarding social changes are classified into environmental, community, couple and

family. Sharma & Dogra (2013) further stated that menopausal women need

support in dealing with their menopausal symptoms. Women who have experienced

early menopause have more severe and complex impact on sexuality. Educational

programs, family group activities, and social upbringing can help to solve issues of

menopausal women. Health care providers must be sensitive to teach better

interpretation of good health practices and health approach among people. This can

be achieved by behavioral cognitive therapy, motivational interviewing and

empowerment collaboration with the Ministry of Health which will benefit the family

members and the women themselves.

According to the study of Afridi (2017), Menopause poses an impact on

interpersonal relationship of women experiencing menopausal symptoms. It

establishes major social support in women’s life and helps them cope with stressors

and problems in life. It has an influential effect on psychological health including

the relationship with a partner, relationship with children, and relationship with

friends. Other factors such as education and socioeconomic status were found to

affect the symptoms of menopause. Menopause is a stressful situation due to

beliefs of diminishing role in the society. Social Interaction with family and friends

are very effective to help menopausal women cope with life’s changes. A
 45

professional help from a counselor and a mental health professional is an effective

way and must be accessible.

Office on Women’s Health (2018) stated that in order to combat trouble in

concentrating, eat healthy and do not smoke. This may help improve memory.

Women must also stay socially and mentally active. Social interaction with other

people may help delay memory loss. To boost memory and focus, one must do

mental activities such as playing crossword puzzles. Treatment for urge to urinate

to prevent getting up several times during sleep includes limiting or avoiding

caffeine. Limiting and avoiding caffeine may also ease troubles in sleeping.

Chua (2013) stated that Menopause is a normal part of aging and pre-

menopausal symptoms are temporary. Estrogen Replacement Therapy (ERT) also

called Hormone Replacement Therapy (HRT) helps alleviate hot flushes, profuse

sweating, vaginal dryness and irritation. Healthier lifestyle is a good alternative

treatment to ERT. It involves eating foods such as fish, vegetables, fruits, and high

fiber. Foods rich in saturated fats such as dairy products and trans-fatty acids like

margarines should be avoided. Meditation, yoga and other relaxation techniques to

manage stress has been reported to be beneficial for menopausal women.

Lastly, Holmquist (2015) also explained that Menopause is a huge hormonal

change that affect personality. It challenges marriages as well as relationship with

children, relatives, and friends. To manage personality that affect relationships, the
 46

study stated some ways to deal with social changes such as spending time with

other people every day, watching a movie, baking pastries, dreaming up new

projects and adventures will help women to cope up with individuals while

experiencing menopausal symptoms.

Perceptions of Women Approaching Menopause

Some women view Menopause as a disease or the period of physical and

emotional disorder that needs treatment of various medicines. Some believed that

women can avoid many side effects by educating themselves and their families

about menopause. Various people also perceive different things. According to

Robles (2017), perception is defined as own subjective view of various aspects of

life. It is a means by which individuals formulate own personal opinions. However,

Hussein (2018) defined perception as the sensational experience that exists in the

world. While UK Essays (2013) stated that perception is defined as the process

which people are conscious of objects and incidents in the world. It is also a

process of one’s ultimate experience of the world which affects processing of

sensory input.

Menopause is a major change in women's life. It is marked as a cessation of

menstrual cycles and a rise of physical symptoms as stated by Group (2014) and

not a disease. Despite the discomforts it brings, menopause is manageable

and temporary and a natural experience of every women. Bello & Daramola (2016)

conducted a study which aims to determine the level of awareness and perceptions
 47

about the menopause and sex in perimenopausal women attending a general

outpatient clinic. Participants were women aged 40 years and above from Family

Medicine Department of University College Hospital. Women who already attained

menopause were excluded in the study. The total participants in the study were 352

women. 304 (86.4%) were aware of menopause and that menstruations would

come to an end. They are expecting menopause to happen between ages 41 and

65 years. 127 (36.1%) of the respondents expect symptoms and changes

associated with menopause. Their source of information regarding menopause are

their health care providers, reading books, friends and peers, relatives and from the

television or radio. 75 (21.4%) had a negative attitude towards menopause. 52 of

them felt that as they reach menopause, it would make them incomplete as a

women while 23 of them worries that menopause may result into illness. Some

(179; 50.9%) of the respondents believed that sexual intercourse after menopause

can result into ill health.

According to the study of Rikhotso, Makuwa & Mulaudzi (2015), every

woman has different perception towards menopause. Sociocultural factors such as

race, culture and ethnicity as well as multicultural factors and individual background

can influence a women’s perception towards menopause. African women perceived

menopause as a natural stage of life. They also perceived Menopause as being

free from monthly menstruation and a transition period toward infertility. The study

stated that women wanted to improve and promote health for all African women
 48

who will undergo menopausal stage. Women want to include health programs and

educational health information for all the African women who are not yet

menopause. In the study, women viewed menopause as either positive or negative.

Women who perceived positive attitude stated that menopause is a normal

phenomenon and it is the time that women no longer become pregnant. Some

stated that they will be happy due to not having of periods. Women who perceived

negative attitude stated that they do not have enough information and knowledge

regarding the occurrence of menopause.

Furthermore, the study of Karim et. al (2013) revealed that 90% of women

viewed menopause as a natural transition in life and 40% viewed menopause as a

good experience. The result also showed that women in eastern Muslim views

menopause as a relief from having repeated pregnancies. A study from India

showed similar results 57% of women experiencing menopause views menopause

a convenience.

The study of Adewuyi & Akinade (2010) showed that Nigerian women have

positive perception towards menopause. Positive perception is 64.5% while

negative perception shows 35%. It is also stated that Nigerian women who will

undergo menopause need to be well informed about signs and symptoms and

coping strategies regarding menopause. The 64.5% perceived that Menopause is

normal part of life when women are no longer become pregnant while the 35%
 49

stated that women are not aware about the changes going to encounter during

menopause.

Yeganeh, Boyle, Teedee and Vincent (2017) stated that because of having

background and knowledge regarding the possible effects of menopause, health

professionals may perceive the symptoms associated to menopause compare to

those who are not health professionals. Other health professionals are

knowledgeable regarding the possible treatments and interventions can be done

once disturbing symptoms of menopause occurs.

According to Erbil (2017), majority of women has a high perception regarding

negative attitudes towards this transition. Women with low depressive symptoms

and positive attitudes towards menopause had higher positive body image which

could affect their self-esteem. Women with an optimistic attitude towards

menopause tend to have a more positive body image and their depression level is

lower.

Ikeme, Okeke, Akogu, and Chinwuba (2011) stated that Menopause can

affect the physiological and psychological aspect of woman. The objective of their

study was to determine the knowledge and perception of menopause and its

symptoms among a sample of women in South East Nigeria. The study further

showed that married women were more likely to respond to any questionnaire on

menopause than single and separated women. Additionally, in terms of educational

 50

attainment, the highly educated ones were aware of menopause. Education had a

significant effect on perception of menopause. Based on the findings of the study,

women with high educational level will most likely to present themselves to hospital

for treatment and were keen to consult a doctor of any untoward effects of

menopause.

According to National Center for Education Statistics (2018), educational

attainment was defined as the highest level of education completed by an individual

that can either be a high school diploma or equivalency certificate, an associate's

degree, a bachelor's degree, or a master's or higher degree. The statistics shows

that as of 2017, women on pre-menopausal age (39%) had completed a bachelor’s

degree and (11%) had completed a master’s or higher degree and in relation to this,

findings revealed that menopause women who had completed a higher educational

attainment is more familiar with the process as well as the signs and symptoms

associated with menopause because of this women who have knowledge about

menopause can handle the situation well.

Mustafa & Sabir (2012) revealed that in terms of occupation, highest

percentage of menopaused women with previous knowledge about menopausal

symptoms and awareness about possible management such as hormonal

replacement therapy were among skilled and professional occupation. This

attributed to that those who have skilled and professional occupation have better

educational level. Whenever they would experience possible effects or symptoms of

 51

menopause, they are aware of various interventions could be performed to alleviate

presence of symptoms.

Lastly, in another study conducted by Laron et al. (2008), it was shown that

women have different perceptions on menopause. The participants were fifty-six

(56) women from Barangay Shilan aged 45 years. Women of Barangay Shilan also

have different knowledge regarding the changes that can happen during

menopause such as physical, psychological, emotional and sexual changes. Some

respondents also lack knowledge and have misconceptions about menopause. One

participant stated that when a woman gets angry, it is one of the signs that woman

is having menopause. According to another respondent, a woman having

menopause cannot have sex with her partner anymore. Based on the findings of

the study, 82.4% or forty-two (42) respondents stated that menopause is the time

when ovaries stop producing female hormones. 78.40% claimed that menopause is

normal part of growth and development which women experience. 72.5% of the

total population stated that when women are already menopause, they can no

longer bear a child. They understood that this period is a transition from fertility to

infertility. 27.5% of them revealed that menopausal depression is related to the

depleting levels of estrogen, progesterone, and androgen. 35 of the respondents

revealed that they can experience hot flushes during menopause. 58.8% of them

stated that menopause can result physical changes and fatigue due to hormonal

imbalance. Others claimed that Menopause can also result in vaginal dryness, skin

dryness and urinary urgency. They are aware that estrogen plays an important role
 52

in keeping skin smooth. 29.4% of them said that weight gain is a common sign of

menopause. The most anticipated emotional change during menopause is

irritability. 70.6% of the respondents claimed this. Next is forgetfulness accounting

68.6% of the respondents. Estrogen influences the cholinergic system which is the

most vital system for memory and cognitive function. The third is mood swings said

by the 49.0% of the respondents. Lastly, insomnia ranked fourth to the

emotional/physical change with a percentage of 45.1%. When a woman wakes up

from sleep because of hot flushes and sweating, it could result to insomnia. 66.7%

claimed that the decrease in sexual interest of women during menopause may be

associated with the physical change such as vaginal dryness that could result to

painful intercourse. In terms of medical management to cope with menopause,

twelve (12) of the respondents stated that hormone replacement therapy would be

helpful. However, 67.4% of them perceived the possible alternative strategy in

coping with the effects of menopause is the water therapy. Another alternative

strategies perceived by the respondents are regular exercise (51.0%) and using

lubricants and vaginal creams (19.6%).

Synthesis
 53

The study of Patiala, Krishna, Nancy & Pritam (2014) is similar to the present

study as the current study tackles about social and emotional changes that occur

during menopause and women’s perception towards this change. However, it is

different in such a way that their study also measured the physical changes during

menopausal period. In addition, the setting of their study focused on selected

communities in India while this study’s focus setting would be menopausal women

who are working in DLSMHSI.

The study of Geukes, Van Halst, Nauta & Oosterhof (2014) likewise showed

similarity in terms of the influence of both social and emotional factors on the work

ability of a women undergoing menopause. However, the difference of this study is

that it measures the work ability of a women using work ability index.

The present study is slightly similar to the study conducted at the University

of Michigan Depression Center (2016) which stated that women are at risk of

developing anxiety which could lead to depression. The university also mentioned

the emotional symptoms that women may encounter during menopause which are

given emphasis in the present study. In the study of Nosek, Kennedy, &

Gudmundsdottir (2012) and Gimba & Sinegugu (2015), both showed similarities in

the present study in a way that it tackled about distresses during menopause as

well as social isolation.

 54

On the contrary, the study of Gunyanyi (2016) showed difference from the

present study as it focused on effects of menopause towards sexual intimacy of

women. It affects women’s sexual satisfaction in terms of desire, interest and

arousal. The study also included coping strategies for women who are undergoing

menopause period. However, the study is somewhat similar to the present study as

these sexual problems which affect their marital relationship falls under the social

changes associated with menopause.

The study of Railton (2017) is different from the present study because it

focused more on the physical changes associated with menopause. However, the

present study also tackled the presence of the physical changes during menopause

which bring result to disturbance about body image, hormonal changes, infertility

and aging all which are contributory to emotional changes. The focus of the present

study is to determine the perceived effects of menopause towards social and

emotional behavior of women.

Nonetheless, the study of Grimley (2018) and The North American

Menopause Society (2018) were different in the present study because their study

is focused on the hormonal depletion and a decrease in sexual interest as well as

lack of sexual excitement in women undergoing menopause.

 55

The above studies showed similarities and differences from the present

study but the researchers intended to focus on the perceived effects of menopause

towards social and emotional behavior of women.

 56

Chapter 3

RESEARCH METHODOLOGY

This chapter discusses the research procedures used in this study. It is

divided into the following sections: 1) Research Design, 2) Population and

Sampling, 3) Respondents of the Study, 4) Research Instrument, 5) Validation of

the Instrument, 6) Data Gathering Procedure, and 7) Statistical Treatments

employed in the analysis of data.

Research Design

The study utilized the Quantitative-descriptive Research Design in order to

determine the perceived effects of menopause towards social and emotional

behavior of women in De La Salle Medical Health Sciences Institute. Quantitative

research is used to obtain knowledge about certain phenomena. Descriptive

research involves the observation, description and documentation of the features of

a certain condition as it naturally happens. It is used to describe characteristics of

population that is being studied (Polit & Beck, 2017).

Population and Sampling

The population of this study is composed of women who were classified as

teaching and non-teaching personnel in Academics of De La Salle Medical and

Health Sciences Institute. This study utilized Purposive Sampling Technique. It is a

 57

sampling method where researchers select the participants. Selecting of the

participants is based on direct judgment of the researchers about who would be the

most informative (Polit & Beck, 2017).

Respondents of the Study

The respondents included in the study are 65 women classified as 52

teaching and 13 non-teaching staff in Academics of De La Salle Medical and Health

Sciences Institute. To be specific, ten (10) respondents from Special Health

Sciences High School, six (6) respondents from College of Medical Imaging and

Therapy, nineteen (19) respondents from College of Nursing, one (1) respondent

from College of Medical Laboratory Sciences, one (1) respondent from

Comprehensive Community Health Training Program Department, one (1)

respondent from Romeo P. Ariniego, MD Library Services, eleven (11) respondents

from College of Humanities and Sciences, one (1) respondent from College of

Pharmacy, six (6) from Office of Student Services, three (3) from Office of the

Registrar, and six (6) from College of Rehabilitation Sciences. They were chosen

based on the following inclusion criteria: a) women ages 35 to 50 years; b) women

who still experience menstruation regularly or irregularly and; c) willing and able to

participate in the study. Women who had menopause were excluded from the

study. They were chosen as the respondents of the study to determine the

perceived effects of menopause towards social and emotional behavior.

 58

Civil status, educational attainment, monthly family income and category of

employment are the variables considered by the researchers in the study.

Research Instrument

The research instrument used in this study was adopted and modified by the

researchers from the study of Helena Rubinstein (2013) which is designed to

determine the perceived effects of menopause towards social and emotional

behavior of women in De La Salle Medical and Health Sciences Institute. Since the

reference is an open source, the author was notified in adopting a research

instrument. The instrument is divided into two parts, namely: 1) Demographic Profile

of the Respondents which contains the name (optional), monthly family income, civil

status, and category of employment; and 2) Statement Referring to the Social and

Emotional Behavior of Women measurable by the following: 5 – Strongly Agree, 4 –

Agree, 3 – Neutral, 2 – Disagree, and 1 – Strongly Disagree. For the purpose of

interpretation, strongly agree is equivalent to a mean score ranging from 4.21 to 5.0

and signifies as highly perceived. Agree is equivalent to a mean score ranging from

3.41 to 4.20 and signifies as moderately perceived. Neutral is equivalent to a mean

score ranging from 2.61 to 3.40 and signifies as fairly perceived. Disagree is

equivalent to a mean score ranging from 1.81 to 2.60 and signifies as lowly

perceived. And strongly disagree is equivalent to 1.00 to 1.80 and signifies not

perceived at all. The mean score was obtained from each item to determine the

perceived effects of menopause towards social and emotional behavior of women.

 59

Validation of the Research Instrument

To test the validity of the instrument, the following procedures were done:

The questionnaire was validated by Prof. Marjorie Fay P. Sta. Maria, RN,

MAN, Prof. Monina G. Dimas, RN, MAN and Prof. Melanie H. Nolasco, RN, MAN.

After integrating the corrections of the validators, the questionnaire was presented

to the thesis adviser, panel members, and ethics committee for approval prior to

data gathering.

Data Gathering Procedure

The researchers conducted the actual data gathering from the different

departments of Academics of DLSMHSI. The data gathering procedure was

divided into two phases: (a) social preparation and (b) data gathering.

Phase I – Social Preparation. The researchers prepared and submitted a

letter approved and signed by the thesis adviser and Dean of the College of

Nursing to the Office of the Registrar, Dean of the Office of Student Services,

Director of Comprehensive Community Health Training Program, Director of Alumni

Relations Office, Director of Academic Quality Management, Director of Center for

Innovative Education and Technology Integration, Officer of Lasallian Access and

Success Office, Director of Romeo P. Ariniego, MD Library Services, Dean of the

College of Humanities and Sciences, Dean of the College of Pharmacy, Dean of the

College of Medical Laboratory Science, Dean of the College of Nursing, Dean of the
 60

College of Rehabilitation Sciences, Dean of the College of Medical Imaging

Therapy, and to the Director of the Special Health Sciences High School in order to

obtain permission to conduct a survey regarding the perceived effects of

menopause towards social and emotional behavior of women in DLSMHSI.

Phase II – Data Gathering. After obtaining the permission for conducting the

survey, the researchers started the data gathering during the months of November

and December 2018 in the academics division of De La Salle Medical and Health

Sciences Institute. The content of the informed consent form which includes the

purpose of the study, how they were selected to be the respondents, the benefits

that they will gain, the scope of their participation, the possible discomforts that they

may encounter, the assurance of confidentiality and anonymity in the course of the

study and the duration of answering the questionnaire has been explained. The

consent forms were given to the respondents by the researchers. After obtaining

the signed informed consent forms, the researchers administered the adopted-

modified questionnaire to the different departments of academics division of

DLSMHSI. The respondents were instructed to answer the questionnaire. They

were encouraged to ask questions if the instructions seemed to be unclear.

However, several challenges were encountered during the data gathering. There

were staffs that declined to be part of the study; some refused to answer the

questionnaire because of personal reasons; and others were in the field and will be

back later in the year. Despite these difficulties, the researchers patiently went back
 61

to the different offices to follow-up if there are still some questionnaires to be

retrieved. After all the questionnaires were answered and collected, the research

instrument was then tallied and subjected for statistical analysis.

Statistical Treatment of Data

To answer the specific problems and to test the hypothesis of the study, the

following statistical treatments were utilized: (a) Frequency Distribution, (b) Mean,

(c) T-test and, (d) f-test or One Way Anova.

Frequency Distribution. It gives a table of values of the observations which

includes how often they occur. It is a list of values and their frequencies. It can be

displayed as tables, bar graphs, pie charts, and others (Weiss, 2012). This was

used to determine the frequency of the respondents that belongs to each category

of the profile variables.

Mean. It refers to the average to obtain the central tendency of the data. It is

identified by adding all the data points in a population. Afterwards, the added data

points should be divided by the total number of points (Weiss, 2012). This was used

to determine the perceived effects of menopause towards social and emotional

behavior of women in De La Salle Medical and Health Sciences Institute.

T-test. It presents an opportunity to differentiate two groups. It also examines

the difference between two means (Jones, Schlomer, & Christine Bracamonte

Wiggs, 2014). This was used to determine if there are significant differences in
 62

perceived effects of menopause towards social and emotional behavior when the

respondents were grouped according to their category of employment.

f-test or One Way Anova. It is a technique to test the hypothesis that there is

no difference between two or more means (Goldstein, 2013). This was used to

determine if there are any significant differences in perceived effects of menopause

towards social and emotional behavior when the respondents were grouped

according to educational attainment, monthly family income, and civil status.

 63

Chapter 4

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This chapter presents, analyzes, and interprets the findings on specific

problems and hypothesis of the study. The data gathered on the profile of the

respondents and their perceptions on the effects of menopause are presented in

graphs and are described, analyzed and interpreted narratively.

Problem 1: What is the profile of the respondents when they are grouped

according to civil status, educational attainment, monthly family income and

category of employment?

Figure 2: Profile of the Respondents in Terms of Civil Status

2%
3% 12%

Single
Married
Widow
Separated

83%
 64

Figure 2 shows the profile of the respondents in terms of civil status. Civil

status is categorized into: a) single, b) married, c) widow, and d) separated. Out of

65 respondents, 54 or 83.1 percent are married, 8 or 12.3 percent are single, 2 or

3.1 percent are widow and 1 or 1.5 percent is separated. The findings shows that

majority of the respondents are married.

Figure 3: Profile of the Respondents in Terms of Educational Attainment

1%

28%

College Level

College Graduate

Others (Masteral and

Doctorate Degree)
71%

Figure 3 shows the profile of the respondents in terms of educational

attainment. Educational attainment is categorized into: a) elementary level, b)

 65

elementary graduate, c) high school level, d) high school graduate, e) college level,

f) college graduate and g) others. Out of 65 respondents, 46 or 70.8 percent are

college graduate, 18 or 27.7 percent are Masteral and Doctorate Degree holders

and 1 or 1.5 percent are college level. The results shows that majority of the

respondents are college graduate.

Figure 4: Profile of the Respondents in Terms of Monthly Family Income

1%
10%

22%

28%
Under PhP 40,000
PhP 40,000 - PhP 59,999
PhP 60,000 - PhP 99,999
PhP 100,000 - PhP 249,000
PhP 250,000 and over

39%

Figure 4 shows the monthly family income of the respondents. Monthly

Family Income is categorized into a) Under PhP 40,000 b) PhP 40,000 – 59,999 c)
 66

PhP 60,000 – PhP 99,999 d) PhP 100,000 – 249, 000 e) PhP 250, 000 and over.

Out of 65 respondents, 25 or 38.5 belong to salary bracket of PhP 40,000 – 59,000;

18 or 27.7 percent have salary bracket of PhP 60,000 – PhP 99,999; 14 or 21.5

percent has below PhP 40,000 salary; 6 or 9.2 percent have a salary bracket of

PhP 100,000 – 249, 000; and 2 or 3.1 percent have above PhP 250, 000 salary.

The findings shows that majority of the respondents have a monthly family income

of PhP 40,000 – 59,000.

Figure 5: Profile of the Respondents in Terms of Category of Employment

20%

Teaching Staff
Non-teaching Staff
80%

Figure 5 shows the respondents’ profile in terms of category of employment.

Category of employment is categorized into: a) teaching staff and b) non-teaching

 67

staff. Out of 65 respondents, 52 or 80 percent belongs to teaching staff and 13 or

20 percent belongs to non-teaching staff. The results shows that majority of the

respondents are teaching staff.

Problem 2: What are the perceived effects of menopause towards social

and emotional behavior of women in De La Salle Medical and Health Sciences

Institute?

Table 1. Perceived Effects of Menopause Towards Social and Emotional Behavior

of Women in De La Salle Medical and Health Sciences Institute

ITEMS Mean Std. Dev. Verbal Interpretation

1. Menopause can cause difficulty 3.00 0.84779 Fairly Perceived
concentrating on their works.
2. Menopause can make a woman
2.97 0.72821 Fairly Perceived
forgetful.
3. Menopause can make most women 3.45 0.72953 Moderately Perceived
physically and emotionally unwell.
4. Menopause can make the women 3.65 0.73805 Moderately Perceived
feel that she is getting older.
5. Menopause can cause irritability
3.62 0.70027 Moderately Perceived
and mood swings.
6. Menopause can cause sleep
problems such as difficulty of falling
asleep, difficulty in sleeping 3.37 0.80174 Fairly Perceived
through and waking up early that
can lead to irritability.
7. Menopause can cause a woman to
feel physically and mentally
3.11 0.7315 Fairly Perceived
exhausted (general decrease in
performance, impaired memory).
8. Menopause can cause sexual
problems such as change in sexual
3.20 0.81394 Fairly Perceived
desire, activity and satisfaction that
can affect marital relationships.
9. Menopause can cause women to
feel anxious and easily upset (inner 3.14 0.84552 Fairly Perceived
restlessness and feeling panicky).
 68

Table 1 shows the obtained score of the respondents in the perceived effects

of menopause towards social and emotional behaviour of women in De La Salle

Medical and Health Sciences Institute. The perceived effects of menopause

towards social and emotional behavior of women in DLSMHSI were measured

using the following scale: 1.00 to 1.81 as Not Perceived at all, 1.81 to 2.60 as Lowly

Perceived, 2.61 to 3.40 as Fairly Perceived, 3.41 to 4.20 as Moderately Perceived

and 4.21 to 5.00 as Highly Perceived.

Numbers 3, 4, 5, 9, 10, 11, 17, 18 and 19 pertain to the effects of

menopause towards emotional behavior of women. The items which obtained the

highest scores are: menopause can make the women feel that they are getting

older (3.65), menopause can cause irritability and mood swings (3.62) and

menopause can make most women physically and emotionally unwell (3.45). All

these items were moderately perceived by the respondents.

This shows that the respondents are familiar about these three conditions

associated with menopause.

Moreover, the rest of the items were fairly perceived by women in De La

Salle Medical and Health Sciences Institute. The 5 items under fairly perceived that

obtained the lowest most score are: menopause can bring depressive mood (3.23),

feeling of sadness can also be experienced due to loss of fertility or changes

occurring in the body during menopause (3.15), menopause can cause women to
 69

feel anxious and easily upset (3.14), menopause can cause physical changes

which can result to increasing levels of insecurity (3.03), and one of the concerns

that women may perceive during menopause is the emotional change such as fear

of unknown.

This reveals that majority of the respondents were not familiar with these

emotional changes associated with menopause.

Numbers 1, 2, 6, 7, 8, 12, 13, 14, 15, 16, and 20 pertain to the effects of

menopause towards social behavior of women. The items which obtained the

highest scores in social changes are: Menopause can make women respond

quickly to slightest things with unexplainable anger (3.40), menopause can cause

sleep problems such as difficulty of falling asleep, difficulty in sleeping through and

waking up early that can lead to irritability (3.37) and menopause can cause sexual

problems such as change in sexual desire, activity and satisfaction that can affect

marital relationships (3.20)

This shows that although these three conditions associated with menopause

obtained the highest scores, these are not familiar among the respondents.

The top 5 lowest score for social changes associated with menopause are:

menopause can cause difficulty concentrating on their works (3.11), physical

symptoms of menopause can cause a decline in women’s self-esteem (3.03),

menopause can cause difficulty concentrating on their works (3.00), menopause

 70

can cause women to become less sociable (3.00), menopause can cause a women

forgetful (2.97) and women who are approaching to menopause can cause women

to be less sociable (2.97)

This reveals that the respondents are not familiar with the above mentioned

social changes associated during menopause.

The study of Australian Menopause Centre (2017) stated that during

menopause, there is shifting of level of estrogen and progesterone that result in

mood swings. In addition, women discover themselves responding quickly to the

slightest things with unexplainable anger or irritability. There can be an emotional

stress experienced by women because of these mood swings and may likely affect

people around them. According to Railton (2017), menopausal period has three

phases. During the final menstrual period, the body experiences physical changes

that lead to worries about body image, hormonal changes, life stresses, sleep

problems, infertility, and aging that contribute to changes in emotional well-being of

women. These changes can lead to anxiety. Additionally, according to the study

conducted by Legg (2016), twenty three percent (23%) of the menopausal women

experiencing different changes in the body are suffering from anxiety. Anxiety is a

natural response of the body to stress. It is a feeling of fear and apprehension.

On the contrary, the findings of the study is different from the findings of a

study conducted by Erbil (2017) where majority of women has a high perception
 71

regarding negative attitudes towards this transition. Women with low depressive

symptoms and positive attitudes towards menopause had higher positive body

image which could affect their self-esteem. Women with an optimistic attitude

towards menopause tend to have a more positive body image and their depression

level is lower. Similar to the study of Grimley (2018), women undergoing

menopause experience low libido or low sexual desire since there is hormonal

imbalance. Menopausal women have reduced sexual interest that affects both

people in their relationship. Undesirable and lacking of sexual excitement can result

to relationship difficulties. According to Patiala, Krishna, Nancy, & Pritam (2014),

Menopause affects women’s health and sense of well-being through biological and

physiological changes. These changes with accompanying symptoms may occur

earlier. The symptoms women may experience involve hot flushes and/or night

sweats, trouble sleeping, vaginal dryness, mood swings, trouble focusing, less hair

on the head, occurrence of facial hair, and an experience of age-related decline of

physical and mental capacity. Symptoms such as periodic sweating or hot flushes,

depression, insomnia, impaired memory, lack of concentration, nervousness, and

bone and joint complaints are more seen in rural communities. Furthermore, Chua

(2013) stated that menopause happens when women’s ovaries stop producing

eggs which is the result of decline in production of estrogens and progesterones.

Symptoms of pre-menopause includes hot flushes, profuse sweating, irritability,

vaginal dryness, decreased sexual drive, fatigue, insomnia, depression, headache,

anxiety, nervousness, insecurity and mood swings. Some women also gets upset
 72

easily, becomes hot-tempered, impatient and very sensitive to the noise in the

surroundings. According to the significant others of pre-menopausal women, they

face difficulty in dealing and communicating with them.

According to the study of Hardy, Thorne, Griffiths & Hunter (2018),

menopausal status has no impact on women’s performance at work. It is said that

menopausal status does not appear to be associated with work outcomes

(absence, performance, turnover intention and intention to leave the labor force).

Most women maintained high levels of self-rated performance at work despite

menopause and high levels of work stress. On the contrary, Newson (2017) stated

that employed women who are currently experiencing menopausal symptoms can

have a significant impact on attendance and performance in the workplace, with

some women being misdiagnosed as suffering from other conditions.

Finally, the overall average mean of 3.18 which is interpreted as fairly

perceived shows that majority of women in DLSMHSI were not fully aware of the

conditions associated with menopause including social and emotional behavior.

Problem 3: Is there a significant difference in the perceived effects of

menopause towards social and emotional behavior of women in DLSMHSI when

they are grouped according to civil status, educational attainment, monthly family

income and category of employment?

 73

Hypothesis: There is no significant difference in the perceived effects of

menopause towards social and emotional behavior of women in DLSMHSI when

they are grouped according to civil status, educational attainment, monthly family

income and category of employment.

Table 2. Perceived Effects of Menopause Towards Social and Emotional Behavior

of Women in DLSMHSI when they are grouped according to civil status.
Civil Status Mean SD F-value Interpretation
Single 3.43 0.3412 2.231 NS
Married 3.15 0.4171
Widow 3.28 0.0354
Separated 2.45

Legend:
NS – Not Significantly different at 0.05 level
Df – 3 and 61
SD – Standard Deviation

Table 2 presents the perceived effects of menopause towards social and

emotional behavior of women in DLSMHSI when grouped according to civil status.

It was grouped into four (4) where single obtained a mean of 3.43 and SD of

0.3412; married had a mean of 3.15 and SD of 0.4171; for widow, a mean of 3.28

and SD of 0.0354 and; separated with a mean of 2.45.

The computed F-value of 2.231 is greater than 0.05 level of significance

using 3 and 61 degrees of freedom and interpreted as not significant. Thus, the null

hypothesis of no significant difference in the perceived effects of menopause

towards social and emotional behavior of women in DLSMHSI when grouped

according to civil status was accepted.

 74

This means that civil status does not differ the perception of women in

DLSMHSI regarding the effects of menopause towards social and emotional

behavior.

This study is contradicted by the study of Ikeme, Okeke, Akogu, & Chinwuba

(2011). They stated that Menopause can affect the physiological and psychological

aspect of woman because menopause causes changes within these aspects such

as hot fushes, night sweats and vaginal dryness. The objective of their study was to

determine the knowledge and perception of menopause and its symptoms among a

sample of women in South East Nigeria. The study further showed that married

women were more likely to respond to any questionnaire on menopause than single

and separated women. Married women were more likely to anticipate this milestone

as well as the occurrence of its changes.

 75

Table 3. Perceived Effects of Menopause Towards Social and Emotional Behavior

of Women in DLSMHSI when they are grouped according to educational
attainment.
Educational Attainment Mean SD F-value Interpretation

College Level 2.45 2.473 NS

College Graduate 3.23 0.3905
Others 3.08 0.4508

Legend:
NS – Not Significantly different at 0.05 level
Df – 2 and 62
SD – Standard Deviation

Table 3 presents the perceived effects of menopause towards social and

emotional behavior of women in DLSMHSI when grouped according to educational

attainment. It was grouped into seven (7) but only three (3) obtained most of the

scores where college level had a mean score of 2.45; college graduate had a mean

score of 3.23 and SD of 0.3905 and; others obtained a mean score of 3.08 and SD

of 0.4508.

The computed F-value of 2.473 is greater than 0.05 level of significance

using 2 and 62 degrees of freedom and interpreted as not significant. Thus, the null

hypothesis of no significant difference in the perceived effects of menopause

towards social and emotional behavior of women in DLSMHSI when grouped

according to educational attainment was accepted.

 76

This reveals that educational attainment does not differ the perception of

women in DLSMHSI regarding the effects of menopause towards social and

emotional behavior.

This study is contradicted by the study of National Center for Education

Statistics (2018) where educational attainment was defined as the highest level of

education completed by an individual that can either be a high school diploma or

equivalency certificate, an associate's degree, a bachelor's degree, or a master's or

higher degree. The statistics shows that as of 2017, women on pre-menopausal

age (39%) had completed a bachelor’s degree and (11%) had completed a master’s

or higher degree and in relation to this, findings revealed that menopause women

who had completed a higher educational attainment is more familiar with the

process as well as the signs and symptoms associated with menopause because of

this women who have knowledge about menopause can handle the situation well.

Additionally, according to Ikeme, Okeke, Akogu & Chinwuba (2011), the

highly educated ones were aware of menopause. Education had a significant effect

on perception of menopause. Based on the findings of the study, women with high

educational level will most likely to present themselves to hospital for treatment and

were keen to consult a doctor of any untoward effects of menopause.

 77

Table 4. Perceived Effects of Menopause Towards Social and Emotional Behavior

of Women in DLSMHSI when they are grouped according to monthly
family income.
Monthly Family Income Mean SD F-value Interpretation
under PhP 40, 000 3.23 0.4811 0.9657 NS
PhP 40,000 – PhP 59,999 3.26 0.357
PhP 60,000 – PhP 99,999 3.03 0.4653
PhP 100,000 – PhP 249,000 3.24 0.1855
PhP 250,000 and over 3.03 0.7425
Legend:
NS – Not Significantly different at 0.05 level
Df – 4 and 60
SD – Standard Deviation

Table 4 presents the perceived effects of menopause towards social and

emotional behavior of women in DLSMHSI when grouped according to monthly

family income. It was grouped into five (5) where under PhP 40, 000 had a mean

score of 3.23 and SD of 0.4811; PhP 40,000 – PhP 59,999 had a mean score of

3.26 and SD of 0.357; PhP 60,000 – PhP 99,999 obtained a mean score of 3.03

and SD of 0.4653; PhP 100,000 – PhP 249,000 had a mean score of 3.24 and SD

of 0.1855 and; PhP 250,000 and over obtained a mean score of 3.03 and SD of

0.7425.

The computed F-value of 0.9657 is greater than 0.05 level of significance

using 4 and 60 degrees of freedom and interpreted as not significant. Thus, the null

hypothesis of no significant difference in the perceived effects of menopause

towards social and emotional behavior of women in DLSMHSI when grouped

according to monthly family income was accepted.

 78

This means that monthly family income does not differ the perception of

women in DLSMHSI with regards to the effects of menopause towards social and

emotional behavior.

According to study of Wani & Gupta (2012), Menopause is defined as the

absence of menses for more than 12 months. However, along with this event,

women may also experience physical, emotional, social, as well as psychological

disturbances during this period. In India, urban women are starting to accept

possible changes that will be accompanied by menopause. However, social stigma

hinders women from lower socioeconomic classes of society from having the

awareness regarding the uncomfortable menopausal symptoms and possible

treatments needed. Women who are in the upper class can anticipate menopause

compared to those who belong in the lower class. In a total of 103 women (53.6%)

belong to the upper class and the significance of this is that women who belong to

this class is aware of the possible treatments available for menopause.

 79

Table 5. Perceived Effects of Menopause Towards Social and Emotional Behavior

of Women in DLSMHSI when they are grouped according to category of
employment.
Category of Employment Mean SD t-value Interpretation

Teaching Staff 3.18 0.3846 -0.096 NS

Non-teaching Staff 3.19 0.5474

Legend:
NS – Not Significantly different at 0.05 level SD – Standard Deviation
Df – 63
Table 5 shows the perceived effects of menopause towards social and

emotional behavior of women in DLSMHSI when grouped according to category of

employment. It was grouped into two (2) where teaching staff had a mean score of

3.18 and SD of 0.3846 and non-teaching staff obtained a mean score of 3.19 and

SD of 0.5474.

The t-value of -0.096 denotes that there is no significant difference at 0.05

level of significance in terms of the perceived effects of menopause towards social

and emotional behavior of women in DLSMHSI in relation to their category of

employment. Thus, the null hypothesis stating that there is no significant difference

in the perceived effects of menopause towards social and emotional behavior of

women in DLSMHSI when they are grouped according to category of employment

was accepted.
 80

This reveals that the perception of women in DLSMHSI with regards to the

effects of menopause towards social and emotional behavior does not differ

regardless of category of employment.

The findings of the study is negated by Mustafa & Sabir (2012) where in

terms of occupation, highest percentage of menopaused women with previous

knowledge about menopausal symptoms and awareness about possible

management such as hormonal replacement therapy were among skilled and

professional occupation. This attributed to that those who have skilled and

professional occupation have better educational level. Whenever they would

experience possible effects or symptoms of menopause, they are aware of various

interventions could be performed to alleviate presence of symptoms.

In addition, Yeganeh, Boyle, Teedee & Vincent (2017) stated that because of

having background and knowledge regarding the possible effects of menopause,

health professionals may perceive the symptoms associated to menopause

compared to those who are not health professionals. Other health professionals are

knowledgeable regarding the possible treatments and interventions can be done

once disturbing symptoms of menopause occurs.

 81

Chapter 5

SUMMARY, FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS

This chapter presents the summary of the study, findings, conclusions and

recommendations.

Summary

This study was pursued with the objective of determining the perceived

effects of menopause towards social and emotional behavior of women.

To achieve this, the following problems were answered:

1. What is the profile of the respondents when they are grouped according to

civil status, educational attainment, monthly family income and category of

employment?

2. What are the perceived effects of menopause towards social and emotional

behavior of women in De La Salle Medical and Health Sciences Institute?

3. Is there a significant difference in the perceived effects of menopause

towards social and emotional behavior of women in DLSMHSI when they are

grouped according to civil status, educational attainment, monthly family

income and category of employment?

It was hypothesized that there is no significant difference in the perceived

effects of menopause towards social and emotional behavior of women. The

 82

respondents of the study are female working in the Academics of the institution.

There were a total of sixty five (65) respondents. Fifty-two (52) out of 65

respondents are teaching staff and thirteen (13) are from the non-teaching staff.

The researchers only included women ages 35 to 50 years, women who still have

menstruation regularly or irregularly and women who are willing and able to

participate in the study. However, women who had menopause were not included in

the study.

The researchers utilized the Quantitative-descriptive Design. This type of

research design is used to obtain knowledge about certain phenomena. Descriptive

research involves the observation, description and documentation of the features of

a certain condition as it naturally happens. It is used to describe characteristics of

population that is being studied. Applying this research design improved the

studies’ outcome as it helped gather the information in an organized manner in

order to have a comprehensive analysis of the data gathered. The perceived effects

of menopause towards social and emotional behavior of women was determined

the same as their demographic information in terms of civil status, educational

attainment, monthly family income, and category of employment.

The research instrument is an adopted modified questionnaire. It is

composed of personal information such as their civil status, educational attainment,

monthly family income and category of employment; and an assessment of the

perceived effects of menopause towards social and emotional behavior of women

 83

which is composed of 20 statements and answerable using a 5-point Likert scale

where 1 is Strongly Disagree, 2 is Disagree, 3 is Neutral, 4 is Agree, and 5 is

Strongly Agree.

The researchers conducted their study in De La Salle Medical and Health

Sciences Institute. The permission was obtained from every Dean and Head of the

departments under the Academics. In the analysis of data, Frequency Distribution,

Percentage, Mean, t-test and f-test were used in the statistical treatment of data to

answer the specific problems stated in the study.

Findings

The following findings were drawn from the research:

1. From the total of 65 respondents, in terms of civil status, 54 or 83.1% are

Married, 8 or 12.3% are Single, 2 or 3.1% are Widow and 1 or 1.5% are

Separated; for educational attainment, 46 or 70.8% are College Graduate, 18

and 27.7% are others (Masteral and Doctorate Degree); and 1 or 1.5% are

College level, for monthly family income, 25 or 38.5% are PhP 40,000 –

PhP59,999, 18 or 27.7% are PhP 60,000 – PhP 99,999, 14 or 21.5% are

under PhP 40,000, 6 or 9.2% are PhP 100,000 – PhP 249,000 and 2 or 3.1%

were PhP 250,000 and over; for category of employment 52 or 80% are

Teaching Staff and 13 or 20% are Non-teaching Staff.

 84

2. From the 20 items pertaining to the perceived effects of menopause when

clustered according to social and emotional changes, 11 items pertain to

social changes and 9 items pertain to emotional changes. Numbers 3, 4, 5,

9, 10, 11, 17, 18 and 19 pertain to the effects of menopause towards

emotional behavior of women. The items which obtained the highest scores

are: menopause can make the women feel that they are getting older (3.65),

menopause can cause irritability and mood swings (3.62) and menopause

can make most women physically and emotionally unwell (3.45). All these

items were moderately perceived by the respondents. This shows that these

three conditions associated with menopause are familiar among the

respondents. Moreover, the rest of the items were fairly perceived by women

in De La Salle Medical and Health Sciences Institute. The 5 items under

fairly perceived that obtained the lowest most score are: menopause can

bring depressive mood (3.23), feeling of sadness can also be experienced

due to loss of fertility or changes occurring in the body during menopause

(3.15), menopause can cause women to feel anxious and easily upset (3.14),

menopause can cause physical changes which can result to increasing

levels of insecurity (3.03), and one of the concerns that women may perceive

during menopause is the emotional change such as fear of unknown. This

reveals that majority of the respondents were not familiar with these

emotional changes associated with menopause. Numbers 1, 2, 6, 7, 8, 12,

13, 14, 15, 16, and 20 pertain to the effects of menopause towards social
 85

behavior of women. The items which obtained the highest scores in social

changes are: Menopause can make women respond quickly to slightest

things with unexplainable anger (3.40), menopause can cause sleep

problems such as difficulty of falling asleep, difficulty in sleeping through and

waking up early that can lead to irritability (3.37) and menopause can cause

sexual problems such as change in sexual desire, activity and satisfaction

that can affect marital relationships (3.20). This shows that although these

three conditions associated with menopause obtained the highest scores,

these are not familiar among the respondents. The top 5 lowest score for

social changes associated with menopause are: menopause can cause

difficulty concentrating on their works (3.11), physical symptoms of

menopause can cause a decline in women’s self-esteem (3.03), menopause

can cause difficulty concentrating on their works (3.00), menopause can

cause women to become less sociable (3.00), menopause can cause a

women forgetful (2.97) and women who are approaching to menopause can

cause women to be less sociable (2.97). This reveals that the respondents

are not familiar with the above mentioned social changes associated during

menopause. Overall, the effects of menopause towards social and emotional

behavior of women is fairly perceived with a mean of 3.18.

3. In terms of significant difference on the perceived effects of menopause

towards social and emotional behavior of women when grouped according to

 86

civil status, the computed f-value of 2.231 is greater than 0.05 level of

significance using 3 and 61 degrees of freedom indicate that civil status is

not significant. The null hypothesis of no significant difference was accepted.

In terms educational attainment, the computed f-value 2.473 is greater than

0.05 level of level of significance using 2 and 62 degrees of freedom

indicates that educational attainment is not significant. The null hypothesis of

no significant difference was accepted. In terms of monthly family income,

the computed f-value 0.9657 is greater than 0.05 level of level of significance

using 4 and 60 degrees of freedom indicates that monthly family income is

not significant. The null hypothesis of no significant difference was accepted.

In terms of category of employment, the computed t-value -0.096 denotes

that there is no significant difference at 0.05 level of significance. The null

hypothesis of no significant difference was accepted.

Conclusions

Based on the research findings, the following were concluded:

1. Majority of the respondents were married, college graduate, having monthly

family income of PhP 40,000 – PhP 59,999, and teaching staff.

2. Majority of the respondents fairly perceived the effects of menopause

towards social and emotional behavior of women in DLSMHSI.

 87

3. There is no significant difference in the perceived effects of menopause

towards social and emotional behavior of women in DLSMHSI when they are

grouped according to civil status, educational attainment, monthly family

income and category of employment.

Recommendations

Based on the findings of the study the following recommendations are

presented:

1. Health Care Providers in the community including doctors, nurses and

nursing students to provide more information regarding the possible changes

and effects of menopause towards social and emotional behavior and its

associated conditions. These can be done through seminars, health

teachings or other activities that will help facilitate learning.

2. For Schools of Nursing to actively participate in dissemination of information

about menopause and its signs and symptoms especially social and

emotional behavior to increase the number of women informed with

knowledge about this milestone.

3. Non-government or Government Organizations including women’s group

could also be a leader in conducting activities that will help educate women

about the effects of menopause towards social and emotional behavior of

women.
 88

4. For Future Researchers, to replicate this study including wider course to

intensify the study not just focusing on the perceived effects of menopause to

the social and emotional behavior but as well as physical and sexual

changes associated with menopause. With broader knowledge, women will

be able to be informed regarding these changes for their preparation and

adaptation in this milestone.

 89

REFERENCES

Adewuyi, T.D., & Akinade, E.A. (2010). Perception and attitudes of Nigerian Women

towards menopause. Retrieved from

https://ac.els-cdn.com/S1877042810017374/1-s2.0-S1877042810017374-

main. pdf?_tid=c36728df-f050-4324-9e38-d094555636b6&acdn

at=1528772979_c36 fdaf7960f0052d7f1ce303f4d24d4

Afridi, I. (2017). Psychological and social Aspects of menopause.

https://www.intechopen.com/books/a-multidisciplinary-look-at-menopause/

psychological-and-social-aspects-of-menopause

Ama, N. & Ngome, E. (2013). Menopausal perceptions and experiences of older

women from selected sites in Botswana. Retrieved from

http://file.scirp.org/Html/1-1990029_34135.htm

Australian Menopause Centre (2017). Mood swings. Retrieved from

https://www.menopausecentre.com.au/information-centre/symptoms/mood-

swings/

Baba, U., Khan, N., & Ali, I. (2017). An Assessment of knowledge and level of

awareness among postmenopausal women regarding management and control

of osteoporosis, 3(2), 46–48. Retrieved from

http://www.homesciencejournal.com/archives/2017/vol3issue2/PartA/3-3-61-

795.pdf

Bello, F. A. & Daramola, O. O. (2016). Attitude to the menopause and sex amongst

middle-aged Women in a family medicine clinic in Ibadan, Nigeria. Obstetrics

 90

and gynecology international. Retrieved from

https://www.hindawi.com/journals/ogi/2016/2031056/

Beyond Blue (2018). Anxiety. Retrieved from

https://www.beyondblue.org.au/the-facts/anxiety

Cheever, K. & Hinkle, J. (2014). Assessment and management of female

physiologic processes, Brunner and Suddarth's Medical-Surgical Nursing 13th

edition, Chapter 56, pp. 1615 & 1642. Quezon CIty, Philippines: C&E

Publishing, Inc.

Chua, P.S. (2013). Menopause. Heart to heart talk. Cebu Cardiovascular Center.

Retrieved from

http://www.cebudoctorsuniversity.edu/2013/colleges/medicine/hospital/cardio/c

hua101.html

Cone Health (2013). Menopause statistics. The Network for exceptional care.

Retrieved from

https://localtvwghp.files.wordpress.com/2013/02/menopause-statistics.pdf

Davis, K. (2016). Cognitive Behavioral Therapy (CBT): How does CBT work?

Medical News Today, (February 2016), 1–8. Retrieved from

https://www.medicalnewstoday.com/articles/296579.php

De Kat, A. C., Dam, V., Onland-Moret, N. C., Eijkemans, M. J. C., Broekmans, F. J.

M., & Van Der Schouw, Y. T. (2017). Unraveling the associations of age and

menopause with cardiovascular risk factors in a large population-based study.

BMC Medicine, 15(1), 2. Retrieved from

 91

https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0762-8

Dillaway, H. E., & Burton, J. (2011). Not done yet?! Women discuss the “End” of

Menopause. Women’s studies, 40(2), 149–176.

https://www.tandfonline.com/doi/abs/10.1080/00497878.2011.537982

Dresden, B. D., & Wilson, D. R. (2018). What causes mood swings during

menopause ?. (May 2017), 1–8. Retrieved from

https://www.medicalnewstoday.com/articles/317566.php

Erbil, N. (2017). Attitudes towards menopause and depression, body image of

women during menopause. Retrieved from

https://www.sciencedirect.com/science/article/pii/S2090506817300726

Geukes, M., Van Aalst, M. P., Nauta, M. C. E., & Oosterhof, H. (2012). The impact

of menopausal symptoms on work ability. Menopause, 19(3), 278–282.

Retrieved from

https://www.ncbi.nlm.nih.gov/pubmed/21997498

Gimba, S. M., & Sinegugu, D. (2015). Dearth of literature on barriers to provision of

psychiatric Nursing care in Nigeria: Findings from a literature review.

International journal of Nursing and Midwifery, 7(2), 16–20. Retrieved from

https://www.researchgate.net/publication/290219492_Dearth_of_literature_on_

barriers_to_provision_of_psychiatric_nursing_care_in_Nigeria_findings_from_a

_literature_review

Goldstein, H. (2013). Introduction to f-testing in linear regression models, 1–13.

Retrieved from
 92

http://www.uio.no/studier/emner/sv/oekonomi/ECON4130/h13/lecture-note-on-

f-test.pdf

Grimley, A. (2018). Low libido and menopause. My second spring. Retrieved from

https://mysecondspring.ie/menopause-symptoms/changes-in-libido-and-sex-

drive

Group, E. (2014). What is menopause?. Retrieved from

https://www.globalhealingcenter.com/natural-health/what-is-menopause/

Gunyanyi, O.J. (2016). Experiences of menopause on sexual intimacy and coping

strategies used among Karen married women.

Hailes, J. (2013). Menopause management. Jean Hailes for women's health.

Retrieved from

https://jeanhailes.org.au/health-a-z/menopause/menopause-management

Hardy, C., Thorne, E, Griffiths, A. & Hunter, M. (2018). Work outcomes in midlife

women: The impact of menopause, work stress and working environment.

Retrieved from

https://womensmidlifehealthjournal.biomedcentral.com/articles/10.1186/s40695

-018-0036-z#Sec3

Holmquist, K. (2015). Menopause : Advice for Coping with “Change on the Deepest

Level". Retrieved from

https://www.irishtimes.com/life-and-style/people/menopause-advice-for-coping-

with-change-on-the-deepest-level-1.2163886

Hussein, R. (2018). How perception affect us: The Pathways and Types of
 93

Perception. Retrieved from

https://blog.cognifit.com/how-perception-affects-us-the-pahways-and-types-of-

perception/

Ikeme, A.C.C., Okeke, T.C., Akogu, S.P.O. and Chinwuba, N. (2011) Knowledge

and perception of menopause and climacteric symptoms among a population

of women in Enugu, South East, Nigeria. Retrieved from

https://www.scirp.org/(S(vtj3fa45qm1ean45vvffcz55))/reference/ReferencesPap

ers.aspx?ReferenceID=2292222

Jarvis, S. (2013). What is postmenopausal depression?. Retrieved from

https://patient.info/blogs/sarah-says/2013/02/what-is-postmenopausal-

depression

Jones, A., Schlomer, G., & Wiggs, C. (2014). Understanding t-tests: A How to

Guide. University of Arizona, 1–5. Retrieved from

http://gabrielschlomer.weebly.com/uploads/2/8/8/5/28853963/understanding_t_

test_0.pdf

Kalra, B., Agarwal, S., & Magon, S. (2012). Holistic care of menopause:

Understanding the Framework. Journal of Mid-Life Health, 3(2), 66–69.

http://www.jmidlifehealth.org/article.asp?issn=0976-7800;year=2012;volume=3;

issue=2;spage=66;epage=69;aulast=Kalra

Karim, F., Ghazi, A., Ali, T., Jabbar, S., Naz, S., Aslam, R. (2013). Women’s

perception towards menopause. Retrieved from

https://www.jsp.org.pk/Issues/JSP%2018%20(3)%20July%20-
 94

%20September%20 2013%20PDF/Asifa%20Ghazi%20OA.pdf

Landicho, A.M. (2015). Cross-sectional study on the relationship of aerobic exercise

and prevalence of hypertension among menopausal Filipino women ages 40

years old and above in Dasmariñas, Cavite.

Laron, L.F., Aguimbag, M. G., Anas, L.C., Ano, J.A., Cawa, D. L., & Pica, R. N.

(2008). Perception on menopause among women of Barangay Shilan, La

Trinidad, Benguet. Bengue State University. National Library of the Philippines.

Legg, T. (2016). Anxiety overview. Healthline. Retrieved from

https://www.healthline.com/health/anxiety

Lott, A. & Stenson, A. (2018). Anxiety disorder. Anxiety.org. Retrieved from

https://www.anxiety.org/what-is-anxiety

Martha, R.A. (2013). Nursing theory utilization and application. Journal of chemical

information and modeling (Vol. 53). Rerieved from

http://stikespanritahusada.ac.id/wp-content/uploads/2017/04/Nursing-Theory-

Utilization-Application-2014-CD.pdf

McCoy, K. (2014). Menopause and your emotions. Everyday health. Retrieved from

https://www.everydayhealth.com/hs/guide-to-managing-menopause/emotional-

symptoms/

Mishra, N., Devanshi, & Mishra, V. (2011). Exercise beyond menopause: dos and

don′ts. Journal of mid-life health, 2(2), 51. Retrieved from

http://www.jmidlifehealth.org/article.asp?issn=0976-7800;year=2011;volume=

2;issue=2;spage=51;epage=56;aulast=Mishra
 95

Mosconi, L., Berti, V., Guyara-Quinn, C., McHugh, P., Petrongolo, G., Osorio, R. S.,

… Brinton, R. D. (2017). Perimenopause and emergence of an Alzheimer’s

bioenergetic phenotype in brain and periphery. Plos one, 12(10), 1–17.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0185926

Murphy, P., Phillips, G., & Hall, A. (2011). Women's health. The American congress

of obstetricians and gynecologists office of communications. Retrieved from

https://www.acog.org/-/media/NewsRoom/MediaKit.pdf

Mustafa, G. N., & Sabir, J. M. (2012). Perception and experience regarding

menopause among menopaused women attending teaching hospitals in Erbil

City. Global journal of health science, 4(3), 170–178.

http://www.ccsenet.org/journal/index.php/gjhs/article/view/16783

Nahar, J. (2016). Anxiety and depression during pre and post menopausal period,

2010–2011. Retrieved from

http://repository.library.du.ac.bd/xmlui/bitstream/handle/123456789/974/Jebin%

20Nahar.pdf?sequence=1

National Center for education statistics (2018). Educational attainment. Retrieved

from

https://nces.ed.gov/programs/coe/indicator_caa.asp

National Economic and Developmental Authority. (2015). Retrieved from

http://www.neda.gov.ph/

Newson, L. (2018). Menopause and cardiovascular disease. Post reproductive

health, 24(1), 44–49. Retrieved from

 96

http://journals.sagepub.com/doi/10.1177/2053369117749675

Newson, L. (2017). Menopause and work - new guidelines. Retrieved from

https://www.menopausedoctor.co.uk/menopause/menopause-work-new-

guidelines

Nosek, M., Kennedy, H. P., & Gudmundsdottir, M. (2012). Distress during the

menopause transition: a rich contextual analysis of midlife women’s narratives.

Sage Journals, 2(3), 1–10. Retrieved from

http://journals.sagepub.com/doi/10.1177/2158244012455178

Office on Women’s Health (2018). Menopause symptoms and relief.

womenshealth.gov. Retrieved from

https://www.womenshealth.gov/menopause/menopause-symptoms-and-

relief#references

Patiala, D., Krishna, T., Nancy, B., & Pritam, K. (2014). A Study to Assess the

Perception of women towards physiological problems faced at menopause in

selected community, 7(2). Retrieved from

http://www.indianjournals.com/ijor.aspx?target=ijor:bfunj&volume=7&issue=2&

article=012

Philippine National Demographic and Health Survey. (2013). Philippines. Retrieved

from

https://dhsprogram.com/pubs/pdf/fr294/fr294.pdf

Polit, D.F. & Beck, C.T. (2017). Nursing research: generating and assessing

evidence for nursing practice. Quezon CIty, Philippines: C&E Publishing, Inc.
 97

Railton, D. (2017). What is the link between menopause and anxiety?. Medical

news today. Retrieved from

https://www.medicalnewstoday.com/articles/317552.php

Rikhotso, S.R., Makuwa, G.N. & Mulaudzi, F.M. (2015). The perceptions of African

Women regarding natural menopause in Mamelodi, Tshwane District.

Retrieved from

https://pdfs.semanticscholar.org/d159/9aac3843063b894fc89fa4c65060dda219

0f.pdf

Rivera, R. (2018) Can menopause cause anxiety attacks? Calm clinic. Retrieved

from

https://www.calmclinic.com/anxiety/causes/menopause

Robles, R. (2017). What is perception and why is it important?. Retrieved from

http://www.quora.com/What-is-perception-and-why-is-it-important

Rubinstein, H. (2013). The meanings of menopause : identifying the bio-psycho-

social predictors of the propensity for treatment at menopause Helena

Rubinstein. PhD Thesis Cambrige University, 1–267. Retrieved from

https://www.repository.cam.ac.uk/bitstream/handle/1810/245082/The%20Mean

ings%20of%20Menopause.pdf;sequence=1

Sharma, A., Dogra, Y. (2013). Trends of AUB in tertiary centre of Shimla Hills.

Journal of mid-life health, 4(1), 67–68. Retrieved from

http://www.jmidlifehealth.org/article.asp?issn=09767800;year=2013;

volume=4;issue=1;spage=67;epage=68;aulast=Sharma
 98

The North American Menopause Society (2018). Decreased desire. Retrieved from

https://www.menopause.org/for-women/sexual-health-menopause-

online/sexual-problems-at-midlife/decreased-desire

The North American Menopause Society (2018). Depression, mood swings,

anxiety. Retrieved from

http://www.menopause.org/for-women/sexual-health-menopause-

online/causes-of-sexual-problems/depression-mood-swings-anxiety

UK Essays (2013). Definition and the five stages of perception. Retrieved from

https://www.ukessays.com/essays/psychology/definition-and-the-five-stages-of-

perception-psychology-essay.php?vref=1

University of Michigan Depression Center (2016). Depression during menopause.

Retrieved from

http://www.depressiontoolkit.org/women/menopause.asp

Wang, M., Hu, R.-Y., Wang, H., Gong, W.-W., Wang, C.-M., Xie, K.-X., … Li, L.-M.

(2017). Age at natural menopause and risk of diabetes in adult women: findings

from the China Kadoorie Biobank Study in Zhejiang Area. Journal of Diabetes

Investigation, 1–14. Retrieved from

https://onlinelibrary.wiley.com/doi/abs/10.1111/jdi.12775

Wani, J. & Gupta, A. (2012). Money & menopause: The relationship between

socioeconomic class and awareness about menopause in women in

Mumbai, India. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3696148/
 99

Weiss, N. (2012). Introductory statistics. Retrieved from

https://www.pearson.com/us/higher-education/product/Weiss-Introductory-

Statistics-9th-Edition/9780321691224.html

Yeganeh, L., Boyle, J. & Teedee (2017). Knowledge and attitudes of health

professionals regarding menopausal hormone therapies. Retrieved from

https://www.tandfonline.com/doi/abs/10.1080/13697137.2017.1304906?jour

alCode=icmt20
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APPENDICES

APPENDIX A
LETTER OF PERMISSION
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
 116

APPENDIX B

LETTER OF NOTIFICATION TO ADOPT A RESEARCH INSTRUMENT

July 25, 2018

Helena Rubinstein
Cambridge University

Dear Madam:

Good day!

We, the incoming Fourth year Nursing students of De La Salle Medical and Health Sciences Institute
located at Congressional Ave., Dasmarinas City, Cavite 4114 Philippines, are conducting a research
study entitled “Perceived Effects of Menopause Towards Social and Emotional Behavior of
Women in De La Salle Medical and Health Sciences Institute”.

In line with this, we are notifying you that the said researchers are adopting the research
tool/instrument used in your study entitled “The Meanings of Menopause: Identifying the Bio-
Psycho-Social Predictors of the Propensity for Treatment at Menopause”. We will be adopting
and modifying the research instrument.

We are hoping for a positive response regarding this matter.

Respectfully Yours,

Ditan, Andrea Nicole B.

Hemedes, Marinela Greanne T.
Salvador, Jellen Joyce A.

Noted by:

Sgd.
MARIA BERNADETTE R. DAPLAS, RN, MAN, EdD
Thesis Adviser
 117

APPENDIX C
CERTIFICATION FROM THE COLLEGE ETHICS COMMITTEE
Form 005

DE LA SALLE MEDICAL AND HEALTH SCIENCES INSTITUTE

College of Nursing
City of Dasmariñas, Cavite

CERTIFICATION FORM THE COLLEGE ETHICS COMMITTEE

This is to certify that the research study of:

 Ditan, Andrea Nicole B.

 Hemedes, Marinela T.
 Salvador, Jellen Joyce A.
entitled Perceived Effects of Menopause Towards Social and Emotional Behavior of Women in
De La Salle Medical and Health Sciences Institute have presented their study for ethical review of
the College Ethics Committee, and have complied with the following requirements:

written description of how explanation would be done to the respondents

consent form with the recommended contents (suited to the nature of the study)
after ensuring that proper information has been given to the respondents before they
sign

validated instrument/ data collection tool (either adapted & modified or originally
constructed) with corresponding annotation of references/ basis/ author/ theory

parts of the paper/ conduct of the study duly written without violation of any ethical
rules/ principles

Very truly yours,

______________________________________
Signature of College Ethics Committee Member over Printed Name
Date:

Noted by:

______________________________________
Signature of College Ethics Committee Member over Printed Name
Date:
 118

APPENDIX D
CERTIFICATION FROM THE VALIDATORS
 119

APPENDIX E
CERTIFICATION FROM THE STATISTICIAN
 120

APPENDIX F
CERTIFICATION FROM THE ENGLISH EDITOR
Form 008

DE LA SALLE MEDICAL AND HEALTH SCIENCES INSTITUTE

COLLEGE OF NURSING
City of Dasmariñas, Cavite

CERTIFICATION FROM THE ENGLISH EDITOR

This is to certify that the research study of:

 Ditan, Andrea Nicole B.

 Hemedes, Marinela T.
 Salvador, Jellen Joyce A.
entitled Perceived Effects of Menopause Towards Social and Emotional
Behavior of Women in De La Salle Medical and Health Sciences Institute was
edited by the undersigned.

Very truly yours,

____________________________________
Signature of Editor over Printed Name

Date:

APPENDIX G
 121

CERTIFICATION FOR FINAL PRINTING

 122

APPENDIX H
INFORMED CONSENT
INFORMED CONSENT FORM (ENGLISH)

I, ________________________, am being asked to participate in a research entitled, “Perceived

Effects of Menopause Towards Social and Emotional Behavior of Women in De La Salle Medical
and Health Sciences Institute”. This research is being conducted by Andrea Nicole B. Ditan,
Marinela Greanne T. Hemedes and Jellen Joyce A. Salvador under the supervision of their thesis
adviser Prof. Ma. Bernadette R. Daplas.

The investigator hopes to determine the perceived effects of menopause towards social and
emotional behavior of women in DLSMHSI from this research.

While participating in this study, I am expected to answer the tool/questionnaire during the time of
data gathering.

The nature of this study has been explained to me by Ms. Ditan/Ms. Hemedes/Ms. Salvador. I
understand that the anticipated benefits of my participation will be: 1) obtaining knowledge regarding
the effects of menopause and; 2) acquiring knowledge in possible preparation in facing the effects of
menopause such as emotional changes, social changes and dealing with other people.

The researcher will make every effort to safeguard the confidentiality of the information that I will
provide. Any information obtained from this study that can be identified with me will remain
confidential and will not be given to anyone without my permission.

If at any time I would like additional information about this project, I can contact Ms. Ditan at
09269478294, Ms. Hemedes at 09054007569 or Ms. Salvador at 09650621898.

I understand that I have the right to refuse to participate in this study. I also understand that, if I do
agree to participate, I have the right to change my mind at any time and stop my participation in the
above described project. My signature indicates that:
 I have been given opportunity to ask any and all questions about the described project and
my participation, and that all of my questions have been answered to my satisfaction.
 I have been permitted to read this document and I have been given a signed copy of it.
 I am at least eighteen years old.
 To the best of my knowledge and belief, I have no physical or mental illness or weakness
that would be adversely affected by my participation in the described project.
_________________________________ _________________
Signature over Printed Name of Participant Date

_________________________________ ________________
Signature over Printed Name of Witness Date
 123

INFORMED CONSENT FORM (FILIPINO)

Ako si ________________________, ay inaanyayahan sumali sa isang pag-aaral na may pamagat

na “Perceived Effects of Menopause Towards Social and Emotional Behavior of Women in De La
Salle Medical and Health Sciences Institute”. Ang pag-aaral na ito ay isinasagawa nina Andrea
Nicole B. Ditan, Marinela Greanne T. Hemedes at Jellen Joyce A. Salvador sa ilalim ng
pangangasiwa ng kanilang thesis adviser na si Prof. Ma. Bernadette R. Daplas.

Hangad ng mga mananaliksik na malaman ang epekto ng menopause sa emosyon, sa pakikitungo

sa ibang tao at pag-uugali ng mga kababaihan na nagtatrabaho sa DLSMHSI mula sa pananaliksik
na ito.
Habang ako ay lumalahok sa pag-aaral na ito, ako ay inaasahan na magsagot ng mga katanungan
na ibibigay ng mga mananaliksik.
Ang kalikasan ng pag-aaral na ito ay naipaliwanag sa akin ni Ms. Ditan/Ms. Hemedes/Ms. Salvador.
Nauunawaan ko na ang mga inaasahang benepisyo ng aking paglahok ay: 1) magkaroon ng
kaalaman tungkol sa emosyon, sa pakikitungo sa ibang tao at pag-uugali ng mga kababaihan at; 2)
magkaroon ng kaalaman sa mga posibleng paghahanda sa mga epekto ng menopause katulad
nang pagbabago sa emosyon, sa pakikitungo sa ibang tao at pag-uugali na maaari kong gawin
kapag dumating ang panahon na ako ay maging menopause.

Ang mga mananaliksik ay pakakaingatan ang mga impormasyon na aking ipapamahagi. Anumang
impormasyon na makuha mula sa pag-aaral na ito tungkol sa akin ay mananatiling kompidensiyal at
hindi ipapamahagi sa iba nang walang pahintulot mula sa akin.

Kung ako ay mayroong karagdagang katanungan tungkol dito, maaari kong makontak sina Ms.
Ditan sa 09269478294, Ms. Hemedes sa 09054007569 o si Ms. Salvador sa 09650621898.

Nauunawaan ko na may karapatan akong tumangging sumali sa pag-aaral na ito. Nauunawaan ko

din na kapag pinaunlakan ko ang pagsali dito, mayroon akong karapatan na umatras kahit kailan
kung magbago ang aking isip sa paglahok sa pananaliksik. Ang aking lagda ay nagpapahiwatig na:

 Ako ay nabigyan ng pagkakataon na magtanong tungkol sa pag-aaral na ito at sa aking

paglahok. Lahat ng aking mga katanungan ay nasagot.
 Ako ay pinahintulutan na basahin ang dokumentong ito at ako ay nabigyan ng kopya nito.
 Ako ay higit labingwalong taong gulang.
 Sa abot ng aking kaalaman at paniniwala, ako ay walang pisikal o mental na sakit o
kahinaan na maaapektuhan ng aking pakikilahok sa inilarawang proyekto.

_____________________________________ _________________
Lagda sa Nakalimbag na Pangalan ng Kalahok Petsa

_____________________________________ _________________
Lagda sa Nakalimbag na Pangalan ng Saksi Petsa
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APPENDIX I
Research Instrument

De La Salle Medical and Health Sciences Institute

College of Nursing
City of Dasmariñas, Cavite
RESEARCH INSTRUMENT

A Questionnaire on the Perceived Effects of Menopause Towards Social and

Emotional Behavior of Women in De La Salle Medical and Health Sciences
Institute
Part I. Demographic Data
Instruction: Please put a check mark (✓) on the corresponding answers that refer to
information about you and your answer to the questions asked in each number.
Name (Optional):__________________________________
Civil Status:
( ) Single
( ) Married
( ) Widow
( ) Separated
Educational Attainment:
( ) Elementary Level
( ) Elementary Graduate
( ) High School Level
( ) High School Graduate
( ) College Level
( ) College Graduate
( ) Others, Pls. specify: _____________
Monthly Family Income:
( ) under PhP 40, 000
( ) PhP 40,000 – PhP 59,999
( ) PhP 60,000 – PhP 99,999
( ) PhP 100,000 – PhP 249,000
( ) PhP 250,000 and over
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Category of Employment:
( ) Teaching Staff
( ) Non-teaching Staff
Part II. Perceived Effects of Menopause Towards Social and Emotional
Behavior
Please check (✓) the appropriate box that pertains to your perception of the effects
of menopause.
5 – Strongly Agree
4 – Agree
3 – Neutral
2 – Disagree
1 – Strongly Disagree
ITEMS 5 4 3 2 1

1. Menopause can cause difficulty

concentrating on their works.
2. Menopause can make a woman forgetful.

3. Menopause can make most women

physically and emotionally unwell.
4. Menopause can make the women feel that
she is getting older.
5. Menopause can cause irritability and mood
swings.
6. Menopause can cause sleep problems such
as difficulty of falling asleep, difficulty in
sleeping through and waking up early that
can lead to irritability.
7. Menopause can cause a woman to feel
physically and mentally exhausted (general
decrease in performance, impaired
memory).
8. Menopause can cause sexual problems
such as change in sexual desire, activity and
satisfaction that can affect marital
relationships.
9. Menopause can cause women to feel
anxious and easily upset (inner restlessness
 126

and feeling panicky).

10. Menopause can bring depressive mood
(feeling down, sadness, on the verge of
tears, lack of drive, mood swings).
11. Women during menopause can become
emotionally unstable.
12. Women who are approaching to menopause
can have a decrease interest in social life.
13. Menopause can cause women to be less
sociable.
14. During menopause, a woman feels that she
has no value at work.
15. Physical symptoms of menopause can
cause a decline in women’s self-esteem.
16. Menopausal symptoms such as agitation
and irritability might lead to negative impacts
to work performance and dealing with other
people.
17. Menopause can cause physical changes
which can result to increasing levels of
insecurity.
18. At menopause, feeling of sadness can also
be experienced due to loss of fertility or
changes occurring in the body.
19. One of the concerns that women may
perceive during menopause is the emotional
change such as fear of unknown.
20. Menopause can make women respond
quickly to the slightest things with
unexplainable anger.
 127

APPENDIX J
CURRICULUM VITAE

Name: Andrea Nicole B. Ditan

Address: Blk 34 Lot 14 Angela Street, Mondo Bambini

Subdivision, Biñan, Laguna

Date of Birth: November 17, 1998

Place of Birth: Manila

Gender: Female

Religion: Roman Catholic

E-mail: aditan017@gmail.com

Name of Father: Ronald D. Ditan

Occupation: Self-employed

Name of Mother: Carmela B. Ditan

Occupation:
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EDUCATIONAL BACKGROUND

Tertiary: De La Salle Medical and Health Sciences Institute

(2015 - 2019)

Congressional Rd., City of Dasmariñas, Cavite

Secondary: Canossa School (2011-2015)

19 F. Gomez St, Santa Rosa, 4026 Laguna

Elementary: Holy Spirit School (2010-2011)

Davao Street South City Homes, Santo Tomas, Biñan, 4024

Southernside Montessori School (2005-2010)

Katihan Rd, Poblacion, Muntinlupa, 1776 Metro Manila

Pre-School: Sunshine Christian School

Bilibid Rd, Poblacion, Muntinlupa, Metro Manila

AWARDS / RECOGNITIONS YEAR

Second Honor 2011

Best in Computer 2007

Best in English 2006

MEMBERSHIPS

Organization Position YEAR

LINGAHP Member 2018 - 2019

LINGAHP Member 2017 – 2018

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LINGAHP Member 2016 - 2017

Girl Scout of the Philippines Member 2009 - 2010

Girl Scout of the Philippines Member 2008 – 2009

Girl Scout of the Philippines Member 2007 – 2008

SEMINARS ATTENDED YEAR

Interdisciplinary Conference 2018

De La Salle University Medical Center
Dasmariñas, Cavite

Multidisciplinary Conference 2018

De La Salle Medical & Health Sciences Institute
Dasmariñas, Cavite

Basic Life Support Training 2017

De La Salle Medical & Health Sciences Institute
Dasmariñas, Cavite

Introduction to La Salle Seminar 2016

De La Salle Medical & Health Sciences Institute
Dasmariñas, Cavite

Integrated Management of Childhood Illness Training 2016

De La Salle Medical & Health Sciences Institute
Dasmariñas, Cavite

National Service & Training Program 2015

De La Salle Medical & Health Sciences Institute
Dasmariñas, Cavite
 130

CURRICULUM VITAE

Name: Marinela Greanne T. Hemedes

Address: 170 Emerald Cor. Pearl St. Shineland Village, Brgy.

Sala, City of Cabuyao, Laguna

Date of Birth: June 8, 1998

Place of Birth: Sta. Rosa, Laguna

Gender: Female

Religion: Roman Catholic

E-mail: marinelagreanne@yahoo.com.sg

Name of Father: Nino A. Hemedes

Occupation: Self-employed

Name of Mother: Kathryn Hazel P. Tangcangco

Occupation: Registered Nurse

 131

EDUCATIONAL BACKGROUND

Tertiary: De La Salle Medical and Health Sciences Institute

(2015 - 2019)

Congressional Rd., City of Dasmariñas, Cavite

Secondary: Lady Of Rose Academy (2015-2016)

Cabuyao, Laguna

Dominican College (2012-2014)

Sta. Rosa, Laguna

Child Jesus Academy (2011-2012)

Cabuyao, Laguna

Elementary: Child Jesus Academy (2005-2011)

Cabuyao, Laguna

Pre-School: Child Jesus Academy

AWARDS / RECOGNITIONS YEAR

Best in Araling Panlipunan 2015

Best in Economics 2015

Miss Acquaintance 2015

Best in Filipino 2011

Best in Computer 2011

Best in Science 2011

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MEMBERSHIPS

Organization Position YEAR

LINGAHP Member 2016 - 2017

CAT Alpha Officer 2013 – 2014

Girl Scout of the Philippines Member 2007 – 2008

SEMINARS ATTENDED YEAR

Interdisciplinary Conference 2018

De La Salle University Medical Center
Dasmariñas, Cavite

Multidisciplinary Conference 2018

De La Salle Medical & Health Sciences Institute
Dasmariñas, Cavite

Basic Life Support Training 2017

De La Salle Medical & Health Sciences Institute
Dasmariñas, Cavite

Introduction to La Salle Seminar 2016

De La Salle Medical & Health Sciences Institute
Dasmariñas, Cavite

Integrated Management of Childhood Illness Training 2016

De La Salle Medical & Health Sciences Institute
Dasmariñas, Cavite

National Service & Training Program 2015

De La Salle Medical & Health Sciences Institute
Dasmariñas, Cavite
 133

CURRICULUM VITAE

Name: Jellen Joyce A. Salvador

Address: 389 San Nicolas III, Bacoor City, Cavite

Date of Birth: November 2, 1998

Place of Birth: Las Piñas City

Gender: Female

Religion: Roman Catholic

E-mail: jellen0298@gmail.com

Name of Father: Eric C. Salvador

Occupation: Self-employed

Name of Mother: Maricel A. Salvador

Occupation: Registered Pharmacist

 134

EDUCATIONAL BACKGROUND

Tertiary: De La Salle Medical and Health Sciences Institute

(2015 - 2019)

Congressional Rd., City of Dasmariñas, Cavite

Secondary: The Bearer of Light and Wisdom Colleges (2011 - 2015)

409 Bee Bien Bldg., Molino I, Bacoor City, Cavite

Elementary: The Bearer of Light and Wisdom Colleges (2006 - 2011)

409 Bee Bien Bldg., Molino I, Bacoor City, Cavite

Little Angels Learning Center (2005 – 2006)

Infant Jesus Subd., Molino II, Bacoor City, Cavite

Pre-School: Little Angels Learning Center (2004 – 2005)

Infant Jesus Subd., Molino II, Bacoor City, Cavite

St. John Calvin School (2003 – 2004)

Infant Jesus Subd., Molino II, Bacoor City, Cavite

AWARDS / RECOGNITIONS YEAR

Dean’s Lister 2016 – 2017

Top 8 2016 – 2017

Valedictorian 2015

1st Honors 2013 – 2014

 135

1st Honorable Mention 2012

Valedictorian 2011

1st Honors 2007 – 2010

3rd Honors 2004 – 2006

MEMBERSHIPS

Organization Position YEAR

LINGAHP Member 2018 - 2019

LINGAHP Member 2017 – 2018

LINGAHP Member 2016 - 2017

School Publication Editor-in-Chief 2014 – 2015

Journalism Club President 2014 – 2015

School Publication Editorial Writer 2013 – 2015

Mathematics Club President 2013 – 2014

SEMINARS ATTENDED YEAR

Interdisciplinary Conference 2018

De La Salle University Medical Center
Dasmariñas, Cavite

Multidisciplinary Conference 2018

De La Salle Medical & Health Sciences Institute
Dasmariñas, Cavite

Basic Life Support Training 2017

De La Salle Medical & Health Sciences Institute
Dasmariñas, Cavite

Introduction to La Salle Seminar 2016

De La Salle Medical & Health Sciences Institute
Dasmariñas, Cavite
 136

Integrated Management of Childhood Illness Training 2016

De La Salle Medical & Health Sciences Institute
Dasmariñas, Cavite

National Service & Training Program 2015

De La Salle Medical & Health Sciences Institute
Dasmariñas, Cavite

Regional Schools Press Conference 2015

Lipa City, Batangas

Division Schools Press Conference 2014

Bacoor City, Cavite

Regional Schools Press Conference 2014

Dasmariñas City, Cavite