Assessment of clinical and psychological parameters in pre- and post-menopausal women: A cross-sectional study

Surekha Ramrao Rathod; Ashwini Narendra Jadhav; Abhay Pandurang Kolte; Devdatt Laxman Pitale

doi:10.4103/srmjrds.srmjrds_106_22

ORIGINAL ARTICLE

Year : 2023 | Volume : 14 | Issue : 1 | Page : 17-22

Assessment of clinical and psychological parameters in pre- and post-menopausal women: A cross-sectional study

Surekha Ramrao Rathod¹, Ashwini Narendra Jadhav¹, Abhay Pandurang Kolte¹, Devdatt Laxman Pitale²
¹ Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
² Department of Obstetrics and Gynaecology, INHS Asvini, Mumbai, Maharashtra, India

Date of Submission	17-Aug-2022
Date of Decision	19-Jan-2023
Date of Acceptance	23-Jan-2023
Date of Web Publication	18-Mar-2023

Correspondence Address:
Dr. Surekha Ramrao Rathod
Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur, Maharashtra
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/srmjrds.srmjrds_106_22

Abstract

Background: Literature evidence on periodontal disease-associated microorganism in pre-and postmenopausal women suggest a complicated relationship between steroid hormones, periodontal tissues, and microorganism. Aim: The objective of the study was to assess and contrast the periodontal health condition and quality of life (QoL) of pre-and postmenopausal women. Materials and Methods: 100 patients were divided into four groups, i.e., healthy pre-menopausal, periodontitis pre-menopausal, healthy post-menopausal, and periodontitis post-menopausal. Periodontal parameters such as Gingival Index (GI), Plaque Index (PI), Probing Pocket Depth, Clinical attachment levels, Simplified Oral hygiene index, and a Utian QoL questionnaire were filled by the patients. The differences between three groups were analyzed using a one-way ANOVA test at baseline and 3 months, followed by a post hoc Tukey test. Results: The PI, GI, and Simplified Oral Hygiene Index levels were significantly different between healthy premenopausal and postmenopausal subjects. QoL scores were compared between the healthy premenopausal and healthy postmenopausal subjects, among which no statistically significant difference was found with P = 0.705 when compared between the positive questions score and P = 0.730 when compared between the negative questions score of the two groups. Conclusion: This study shows that there is no relation between menopause and QoL in women with periodontitis before and after menopause.

Keywords: Periodontitis, post-menopause, pre-menopause, quality of life

How to cite this article:
Rathod SR, Jadhav AN, Kolte AP, Pitale DL. Assessment of clinical and psychological parameters in pre- and post-menopausal women: A cross-sectional study. SRM J Res Dent Sci 2023;14:17-22

How to cite this URL:
Rathod SR, Jadhav AN, Kolte AP, Pitale DL. Assessment of clinical and psychological parameters in pre- and post-menopausal women: A cross-sectional study. SRM J Res Dent Sci [serial online] 2023 [cited 2023 Mar 24];14:17-22. Available from: https://www.srmjrds.in/text.asp?2023/14/1/17/371996

Introduction

The menopause transition for women may be a significant health milestone with effects that go well beyond reproduction. Women's midlife and future health are influenced by concurrent biological, psychological, behavioral, and social changes in addition to menopause symptoms.^[1]

Ovarian function gradually deteriorates beyond the age of 30 years.^[2] The menopause transition starts around the age of 40 years, with reduced menorrhea because of fewer functional follicles, a drop in estrogen levels, and also a scarcity of response to pituitary Gonadotrophin-Releasing hormone, gonadotrophin, and follicular-stimulating hormone, missing periods are next.^[3] Menopause, which typically happens between the ages of 45 and 55 years, is the irreversible stop to menstruation brought on by a drop in ovarian follicular activity.^[4] In research of periodontal disease-associated microorganisms in pre-and postmenopausal women, Tarkkila et al. discovered an advanced relationship between steroid hormones, periodontal tissues, and microorganisms. Steroid hormones reduce the quantity of positive periodontal pathogens such as Porphyromonas gingivalis and Tannerella forsythia, which encompasses a positive impact on periodontal diseases.^[5] Gingivitis and periodontitis are the two most typical varieties of periodontal diseases. Periodontitis is brought on by inflammatory changes in the alveolar bone and periodontal ligament that are irreversible and harmful, eventually leading to tooth loss,^[6] disease is caused by the host's immunological response to an area biofilm. The host reaction is influenced by a range of behaviors such as smoking, poor oral hygiene, female hormone fluctuations, stress, and diabetes.^[7]

The most serious problem associated with menopause is osteoporosis. Osteoporosis also ends up in less crestal alveolar bone per unit volume, which might result in a faster bone loss when diseases such as periodontal infections are present.^[8] Postmenopausal women with osteoporosis, which reduces bone mass and density, had decreased lower jawbone, in step with Kribbs. Periodontal tissues and disease advancement have long been believed to be influenced by disease progression.^[9] In estrogen-deficient women, there has been an increase in gingivitis, periodontal disease, tooth loss, and xerostomia, and hormone replacement therapy appears to have associated with lower levels of several markers of oral disease severity as a comparison to estrogen-deficient women.^[10] Menopause may be a significant life transition period that has been linked to increased vulnerability in one's well-being.^[11] While some cross-sectional research has revealed no link between menopausal status and mental state, longitudinal investigations have found an increased incidence of depressive symptoms and bad mood throughout the menopause transition period.^[12]

Several studies have checked out the impact of “menopausal symptoms” on the Quality of life (QoL) of menopausal women at different stages of the menopause phase.^[13] QoL is defined by the “World Health Organization” (1993) as a sense of their position in life in regard to the aim, aspirations, standards, and concerns within their culture and value system.^[14] Periodontitis and menopause both have a bearing on QoL, so it's a necessity to seem at both periodontitis and therefore the QoL of menopausal women. As a result, the present research will compare and evaluate periodontal health and QoL in premenopausal and postmenopausal women.

Materials and Methods

Study design

This cross-sectional study was conducted after being approved by the Ethical Committee of VSPM DCRC on March 20, 2020 (no-IEC/VSPDCRC/70/2020).

Study setting

This study was conducted on pre and postmenopausal women requiring treatment at the department of periodontics and implantology. It lasted 3 months, from March 31, 2020, to July 2020. All the patients to be included within the study were explained about the study protocols, questionnaire, and about filling up the questionnaire.

Study size

The sample size was decided considering the mean difference in QoL scores because the main outcome measure, from the study by Williams et al.^[15] considering the quality deviation 22.35 and 25.85 of two groups using the formula:

Participants

One hundred patients were separated into four groups, each with 25 patients [Figure 1], i.e., Group I healthy premenopausal, Group II periodontitis premenopausal, Group III healthy postmenopausal, and Group IV Periodontitis postmenopausal. All the participants provided written consent for the participation within the study. All procedures performed within the study were conducted in accordance with the moral standards given in 1964 Declaration of Helsinki, as revised in 2013. All clinical parameters were measured by one examiner after the patients gave their written consent. The patients were instructed to top off the questionnaire as described. Patients with gingival inflammation, clinical attachment loss (CAL) of 5 mm, and probing pocket depth (PPD) of less than or equal to than 6 mm were diagnosed with periodontitis. The revised Classification for Periodontal and Peri-implant Diseases and Conditions published by the American Academy of Periodontology in 2017 was accustomed to diagnose periodontitis.^[16]

Figure 1: Flowchart showing the derivation of sample size

Click here to view

Women who had an easy hysterectomy, diabetes, hypertension, cardiopathy, thyroid issues, or had periodontal surgery within the previous 6 months, and women who were taking hormone therapy were all excluded from the study.

Periodontal parameters such as the Gingival Index (GI) (Loe and Silness 1963),^[17] Plaque Index (PI) (Silness and Loe 1964),^[18] PPD, CAL (UNC-15, Hufriedy Chicago, IL), and the “Simplified Oral Hygiene Index” (OHIS) (Greene and Vermillion 1964)^[19] were assessed by both investigators. The Utian QoL questionnaire,^[20] which has 23 questions was modified to own 19 questions supported the occupational, health and emotion and validated by expert faculty. These questions were divided into positive and negative questions. The answers were presupposed to be marked using the 5 points scale within which point 1 stands for not true, point 3 stands for moderately true and point 5 stands for very true. Patients completed the questionnaire after the periodontal parameters were recorded [Table 1]. Data were coded and analyzed in STATA, version 10.1 (2011) (StataCorp, taxax, USA).

Table 1: Utian Quality of Life Scale

Click here to view

Statistics analysis

The change between baseline to 3 months was measured using a paired t-test, while the difference between two groups was measured using an unpaired t-test. The differences between the three groups were analyzed using a one-way ANOVA test at baseline and 3 months, followed by a post hoc Tukey test.

Results

Between the healthy premenopausal and postmenopausal subjects, a significant difference was seen in the PI, GI, and OHIS values, i.e., the mean PI for healthy premenopausal was 0.303, and for healthy postmenopausal, it was 0.452 with a significant P = 0.017 similar results were seen with the GI and OHIS values for these 2 groups. No statistically significant difference was observed between the PPD and CAL values when compared between the healthy premenopausal and postmenopausal subjects [Table 2].

Table 2: Comparison between all clinical parameters (plaque index, gingiva index, simplified oral hygiene index, probing pocket depth, clinical attachment loss) healthy premenopausal and healthy postmenopausal

Click here to view

The comparison between the clinical parameters between the periodonttis premenopausal and postmenopausal groups showed no statistically significant difference, however, the mean values of GI, OHIS, and CAL were slightly greater, i.e., 1.257, 2.493, 5.956, respectively, in the periodontitis postmenopausal group when compared with the periodontitis premenopausal group [Table 3].

Table 3: Comparison between all clinical parameters (plaque index, gingiva index, simplified oral hygiene index, probing pocket depth, clinical attachment loss) periodontitis premenopausal and periodontitis postmenopausal

Click here to view

QoL scores were compared between the healthy premenopausal and healthy postmenopausal subjects, amongst which no statistically significant difference was found with P = 0.705 when compared between the positive questions score and P = 0.730 when compared between the negative questions score of the two groups [Table 4].

Table 4: Comparison of quality of life between healthy premenopausal and healthy postmenopausal

Click here to view

When the QoL scores were compared between the periodontitis premenopausal and periodontitis postmenopausal subjects, among which no statistically significant difference was found with P = 0.4154 when compared between the positive questions score and P = 0.9107 when compared between the negative questions score of the two groups [Table 5].

Table 5: Comparison of quality of life between periodontitis premenopausal and periodontitis postmenopausal

Click here to view

Discussion

The delicate and variable homeostasis of the periodontium is greatly influenced by the endocrine system. Due to endocrine problems (lower estrogen), vitamin and calcium deficiencies, as well as a number of psychological variables, women's oral symptoms appear to get worse throughout menopause. Dysesthesia, tooth decay, periodontitis, desquamative gingivitis, and an osteoporotic jawbone are contraindications for menopausal women. Traditional dental gadgets and implants are also not recommended for them.^[21]

Periodontal tissue and periodontal disease progression have been linked to sex hormones. The effect of menopause on periodontium was studied by Bhardwaj and colleagues, who discovered that female sex hormones are neither necessary nor sufficient to trigger gingiva changes. They can, however, influence periodontal tissue responses to microbial plaque, thereby contributing to periodontal disease.^[22]

In this study, the healthy pre-and post-menopausal groups differed statistically significantly in the PI, GI, and OHIS values. When compared between the periodontitis pre- and post-menopausal groups, there was found no significant difference between which was similar to the results of Wulandari et al. who discovered no variations in oral hygiene between perimenopausal and postmenopausal women.^[22] Between premenopausal and postmenopausal women, Qasim et al. discovered substantial changes in PI, salivary flow, calculus index, and pocket depth.^[23] The mean plaque, gingival, and bleeding scores were considerably higher among osteoporotic women in a study done by Richa et al. on osteoporotic and nonosteoporotic periodontitis post-menopausal women, indicating an association between osteoporosis and periodontal diseases in post-menopausal women.^[24],[25]

QoL indicators are used to evaluate the subjective impact of undesirable oral conditions and/or their consequences on everyday life. These metrics have emerged as a complement to clinical features, allowing for a much more thorough assessment of people's and populations' health. Ferreira et al.^[26] discovered in a systematic review on the influence of periodontal disease on QoL that periodontal illness can have a detrimental impact on adults' oral health-related QoL, with the severity of the disease having a bigger negative impact.

In the present study, the QoL was evaluated using the Utian QoL questionnaire a nonstatistically significant difference was found for the positive as well as negative questions when compared in the premenopausal and postmenopausal healthy as well as periodontitis women. These results were not similar to that of the study by Williams et al.^[15] were the QoL was compared between the postmenopausal women with poor oral health and Postmenopausal women with Good oral health and it was reported that the postmenopausal women with poor oral health showed a significantly poorer QoL. Elsabagh et al.^[14] found that postmenopausal women in the study had a significant prevalence of menopausal symptoms, which had a negative impact on their QoL. The limitations of this study could be that the questionnaire outcomes depend on the mental condition of the women answering the questions and also smaller sample size. Future studies with larger sample size are required to validate the results.

Conclusion

Premenopausal and postmenopausal women with periodontitis reported similar QoL scores, according to this study. Healthy postmenopausal however showed increased PI, GI, and OHIS when compared to the healthy premenopausal which indicates women should be aware of the consequences of menopause on periodontal health and take action to improve it.

Acknowledgments

The authors would like to thank Dr. Suresh Ughade, INCLEN Fellow and EX-Faculty in the Department of PSM Government Medical College and Hospital, Nagpur, for his contribution in carrying out the statistical analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Gordon JL, Rubinow DR, Eisenlohr-Moul TA, Xia K, Schmidt PJ, Girdler SS. Efficacy of transdermal estradiol and micronized progesterone in the prevention of depressive symptoms in the menopause transition: A randomized clinical trial. JAMA Psychiatry 2018;75:149-57.
2.	Kaźmierczak W, Fiegler P, Przybyłek K, Kamiński K, Fiegler-Mecik H, Wegrzyn P. Wpływ zmian okresu menopauzy na stan tkanek przyzebia [Changes to the periodontium in postmenopausal women]. Ginekol Pol 2005;76:163-7.
3.	Mutneja P, Dhawan P, Raina A, Sharma G. Menopause and the oral cavity. Indian J Endocrinol Metab 2012;16:548-51.
4.	Harlow SD, Paramsothy P. Menstruation and the menopausal transition. Obstet Gynecol Clin North Am 2011;38:595-607.
5.	Tarkkila L, Kari K, Furuholm J, Tiitinen A, Meurman JH. Periodontal disease-associated micro-organisms in peri-menopausal and post-menopausal women using or not using hormone replacement therapy. A two-year follow-up study. BMC Oral Health 2010;10:10.
6.	Shah A. Periodontitis a review. Med Clin Rev 2017;3:14.
7.	Ahmad P, Arshad AI, Della Bella E, Khurshid Z, Stoddart M. Systemic manifestations of the periodontal disease: A bibliometric review. Molecules 2020;25:4508.
8.	Güncü GN, Tözüm TF, Cağlayan F. Effects of endogenous sex hormones on the periodontium – Review of literature. Aust Dent J 2005;50:138-45.
9.	Abraham A, Pullishery F. The effect of menopause on the periodontium a review. IOSR-JDMS 2015;14:79-82.
10.	Bhardwaj A, Bhardwaj SV. Effect of menopause on women's periodontium. J Midlife Health 2012;3:5-9.
11.	Santoro N, Epperson CN, Mathews SB. Menopausal symptoms and their management. Endocrinol Metab Clin North Am 2015;44:497-515.
12.	Bondarev D, Sipilä S, Finni T, Kujala UM, Aukee P, Laakkonen EK, et al. The role of physical activity in the link between menopausal status and mental well-being. Menopause 2020;27:398-409.
13.	Whiteley J, DiBonaventura MD, Wagner JS, Alvir J, Shah S. The impact of menopausal symptoms on quality of life, productivity, and economic outcomes. J Womens Health (Larchmt) 2013;22:983-90.
14.	Elsabagh EE, Allah ES. Menopausal symptoms and the quality of life among pre/post menopausal women from rural area in Zagazig City. Life Sci J 2012;9:283-91.
15.	Williams KA, Shamia H, DeBaz C, Palomo L. Quality of life and poor oral health: A comparison of postmenopausal women. Dent J (Basel) 2016;4:44.
16.	Caton JG, Armitage G, Berglundh T, Chapple IL, Jepsen S, Kornman KS, et al. A new classification scheme for periodontal and peri-implant diseases and conditions – Introduction and key changes from the 1999 classification. J Clin Periodontol 2018;45 Suppl 20:S1-8.
17.	Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963;21:533-51.
18.	Silness J, Loe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condtion. Acta Odontol Scand 1964;22:121-35.
19.	Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13.
20.	Utian WH, Janata JW, Kingsberg SA, Schluchter M, Hamilton JC. The utian quality of life (UQOL) scale: Development and validation of an instrument to quantify quality of life through and beyond menopause. Menopause 2018;25:1224-31.
21.	Dutt P, Chaudhary S, Kumar P. Oral health and menopause: A comprehensive review on current knowledge and associated dental management. Ann Med Health Sci Res 2013;3:320-3. [PUBMED] [Full text]
22.	Wulandari P, Masulili SL, Masulili LS, Tadjoedin FM, Puspitadewi SR, Baziad A. Differences in periodontal severity between perimenopausal and postmenopausal women with chronic periodontitis. Pesqui Bras Odontopediatria Clín Integr 2019;19:e5091.
23.	Qasim AA, Al-Nuaimy KM, Ahmed A. Assessment of periodontal status among premenopausal and postmenopausal women in Mosul city. J Edu Sci 2012;25:73-6.
24.	Mascitelli L, Pezzetta F, Goldstein MR. Menopause, vitamin D, and oral health (AUGUST 2009). Cleve Clin J Med 2009;76:629.
25.	Richa, R Y, Puranik MP, Shrivastava A. Association between osteoporosis and periodontal disease among postmenopausal Indian women. Journal of Investigative and Clinical Dentistry 2017;8.
26.	Ferreira MC, Dias-Pereira AC, Branco-de-Almeida LS, Martins CC, Paiva SM. Impact of periodontal disease on quality of life: A systematic review. J Periodontal Res 2017;52:651-65.