The relationship between the history of contraceptive use by age Menopause

in Posyandu Lansia, Group Monalisa in Siti Rejo district III, sub district of
Medan Amplas
Metia N Situmeang1, Mohd.RhizaZ.Tala2 ,IrinaKemalaNst 3, Andre Pasha
Ketaren4, Sari Harahap5
1
Medical College Student of North Sumatera University force in 2013
2
Lecture Staff Obstetric and Gynecology Department, Med. Faculty USU
3
Lecturer Staff Neurology Department, Med.Faculty USU
4
Lecturer Staff Cardiology Department, Med.Faculty USU
5
Lecturer Staff Internist Department, Med.FacultyUSU
email: situmeangmetia@yahoo.com
Running Title : Menopause and Hormonal Contraception

ABSTRACT

Background: Menopause was defined clinically as the time when a woman did
not menstruate for a year. The age of menopause in Indonesia vary between 45-
50 years old. Age <40 years is called premature menopause and age >53 years
called late menopause. One of the factors that influenced the age of menopause
was the use of contraception. Contraception in this case was a hormonal
contraceptive. This was caused the working of hormonal contraceptive suppress
the ovaries that could affect the length of a woman enters menopause. According
Dini Kasdu, by observing the working of hormonal contraception, it would cause
longer or older to enter the age of menopause.

Goals: The purpose of this study was to determine the relationship between
history of contraceptive use with menopause. The research design was analytic
study with cross sectional method.

Method: The population of the study was all postmenopausal women aged 45-60
years were written in Posyandu Lansia, Group Monalisa in Siti Rejo district III,
sub district of Medan Amplas.
Result: These samples of the research included 75 people who collected by using
total sampling method. The result of the study was processed using statistical test
by using Chi Square test with p 0.05 to determine whether there is a
relationship between a history of contraceptive use by age of menopause and to
investigate the relationship is significant or not.

Conclusion: From the results of the hypothesis test obtained p Value 0,000, for a
value of p <0.05 means that there is a relationship between a history of
contraceptive use with menopause.

Keywords: Menopause, Hormonal Contraception

INTRODUCTIONS
Menopause is a natural process experienced by each woman.
Menopause is an incident where a woman experiences menstrual bleeding
terakhir.1 Some studies show that 75% of women who experience menopause feel
menopause is an issue or disorder, while 25% do not mempermasalahkannya.2
When a woman enters menopause, estrogen and progesterone levels fall
dramatically because the ovaries stop responding follicle-stimulating-hormone
(FSH) and luteinizing-hormone (LH) produced by the pituitary gland in the brain.
In an effort to be the ovaries to function properly, the actual Brain has issued
FSH and LH more. But it will have no effect because both ovaries still can not
function normally. However, the tendency of the brain to produce more high FSH
can be detected in blood or urine and can be used as a simple test to detect
menopause.3
There are several factors that influence the age of menopause women,
the age at first menstrual period (menarche), employment status, parity, smoking,
use of hormonal contraception, penyakit.4,5
Based on the theory Kasdu (2002) which states that the use of
contraceptives, especially hormonal contraceptives in women who use it will be
longer or older to enter the age of menopause. Ha This can happen because of the
workings of contraceptives suppress ovarian function and therefore can not
memprodusi cell telur.4
 This study aims to determine the relationship between a history of
contraceptive use by age of menopause in women at Posyandu Lansia, Group
Monalisa in Siti Rejo district III, sub district of Medan Amplas.
METHODS
This research is an analytic cross sectional design, which is to
determine whether there is a relationship between a history of contraceptive use
with menopause. This research was conducted in Posyandu Lansia, Group
Monalisa in Siti Rejo district III, sub district of Medan Amplas. Affordable
population in this study were all postmenopausal women aged 45-60 years were
recorded in Posyandu Lansia, Group Monalisa in Siti Rejo district III, sub district
of Medan Amplas at the time of the study. The samples in this study using total
sampling technique, that of all affordable populations that meet the inclusion and
exclusion criteria, as follows: Female menopause naturally, aged 45-60 years and
the use of contraception, namely: the pill, inject, implant and IUD. While
ekslusinya following criteria: not willing to become respondent and was not
present when the study. The independent variable in this study is the use of
contraception, and the dependent variable of the study was the age of menopause.
The operational definition in this research that use of contraception is a type of
contraceptives used by the respondent (the pill, inject, implant, IUD), Hormonal,
if you wear one type of contraceptive pill, injection or implant, non-hormonal, if
put IUD while to Age menopause normally occurs in women aged between 45-50
years. Normal menopause, when menopause occurs between 45-50 years and late
menopause, if it occurs in those aged> 53 years.
Analysis of data using statistical program, the types of data analysis:
univariate and bivariate analysis. Hypothesis testing is done by using chi square
analysis test with p 0.05 to determine whether there is a relationship between a
history of contraceptive use by age of menopause and to investigate the
relationship is significant or not.
RESULTS

Collecting data this research in Posyandu Lansia, Group Monalisa in Siti Rejo
district III, sub district of Medan Amplas, Sumatra Utara.
Characteristics of Respondents
In this study, the characteristics of the respondent is all postmenopausal women
aged 45-60 years were 75 people at Posyandu Lansia, Group Monalisa in Siti
Rejo district III, sub district of Medan Amplas.
1. Age
The frequency distribution of the respondent's age can be seen in table
following:
Table 5.1. Frequency Distribution of Respondents Age
NO Age n Percentage(%)
1. 45 2 2,7
2. 46 1 1,3
3. 47 2 2,7
4. 48 3 4,0
5. 50 1 1,3
6. 51 3 4,0
7. 52 1 1,3
8. 53 13 17,3
9. 54 5 6,7
10. 55 5 6,7
11. 56 6 8,0
12. 59 8 10,0
13. 60 25 33,3
Total 75 100
From table 5.1. it is known that the majority of respondents aged 60
years old, as many as 25 people (33.3%) and the least was 3, which were 46 years
old (1.3%), 50 years (1.3%) and 52 years ( 1.3%).
1. Latest Education
The frequency distribution of the respondents' education level can be seen in the
following table:
 Table 5.2. Frequency Distribution of Respondents Education Level
NO Level of education n Percentage(%)
1. Sarjana 2 2,7
2. Diploma 14 18,7
3. SLTA/sederajat 29 38,7
4. SLTP/sederajat 18 24,0
5. SD 12 16,0
Total 75 100
From table 5.2. it is known that most levels of education respondents
were high school / equivalent as many as 29 people (38.7%) and the least was
Bachelor of as much as 2 (2.7%).
2. Works
The frequency distribution of respondents work can be seen in the following
table:
Table 5.3. Work Frequency Distribution of Respondents
NO Work n Percentage(%)
1. PNS 13 `17,3
2. Wiraswasta 26 34,7
3. Tidak bekerja 36 48,0
Total 75 100
From table 5.3. it is known that most respondents do not work as many
as 36 people (48.0%) and the least is working as a civil servant 13 people
(17.3%).

Results Analysis Data

1. Univariate Analysis
a. Contraceptive Use
Table 5.4. Frequency distribution of contraceptive use in Posyandu Lansia,
Group Monalisa in Siti Rejo district III, sub district of Medan Amplas.
NO Contraception n Percentage(%)
1. Hormonal 42 56,0
2. Non-hormonal 33 44,0
 Total 75 100
According to the table 5.4. obtained data on contraceptive use in
postmenopausal women at Posyandu Lansia, Group Monalisa in Siti Rejo district
III, sub district of Medan Amplas, that as many as 42 people (56.0%) of
respondents use a method of hormonal contraception and as many as 33 people
(44.0%) of respondents who use non-hormonal contraceptive method.
b. Old Contraceptive Usage By Type
Table 5.5. Usable Frequency Distribution Based on Type Contraception in
Posyandu Lansia, Group Monalisa in Siti Rejo district III, sub district of Medan
Amplas.
Usable (year) Contraception
Hormonal Non-Hormonal Total
% % %
1 3 4,0 0 0 3 4,0
2 8 10,7 0 0 8 10,7
3 9 12,0 0 0 9 12,0
4 6 8,0 0 0 6 8,0
5 10 13,3 33 44,0 43 57,3
6 3 4,0 0 0 3 4,0
7 2 2,7 0 0 2 2,7
8 1 1,3 0 0 1 1,3
Total 42 56,0 33 44,0 75 100
According to the table 5.5. obtained data on the duration of use based
on the type of contraception in postmenopausal women at Posyandu Lansia,
Group Monalisa in Siti Rejo district III, sub district of Medan Amplas, that the
use of contraception oldest is 8 years and type of contraception is hormonal, ie as
many as one person (1.3 %) and the fastest is 1 year and type of contraception is
hormonal with the number of respondents 3 (4.0%).
c. Menopause age
Table 5.6. Frequency Distribution of Age of Menopause in Posyandu Lansia,
Group Monalisa in Siti Rejo district III, sub district of Medan Amplas.
 NO Age n Percentage(%)
1. 43 1 1,3
2. 44 1 1,3
3. 45 8 10,7
4. 46 10 13,3
5. 47 5 6,7
6. 48 2 2,7
7. 49 2 2,7
8. 50 5 6,7
1. 51 9 12,0
2. 52 11 14,7
3. 53 7 9,3
4. 54 8 10,7
5. 55 4 5,3
6. 56 2 2,7
Total 75 100
According to the table 5.6. it can be seen that the age of menopause
fastest In women in Posyandu Lansia, Group Monalisa in Siti Rejo district III,
sub district of Medan Amplas, namely the age of 43 years as many as 1 (1.3%),
the oldest is 56 years of age by 2 people (2.7%).
2. Analysis Bivariat
The bivariate analysis in this study was conducted to assess the relationship of
independent variables and the dependent variable using the chi square test. In this
research there are independent variables, (contraception) and the dependent
variable (age at menopause). The calculation result between contraceptive use by
age of menopause in Posyandu Lansia, Group Monalisa in Siti Rejo district III,
sub district of Medan Amplas can be seen in the following table:
Table 5.7. The relationship between a history of contraceptive use by
age Menopause
Contraception Menopause Age
Normal Terlambat Total p value
% % %
Hormonal 29 38,7 13 17,3 42 56,0
Non-hormonal 32 42,7 1 1,3 33 44,0 0,000
Total 61 81,4 14 18,6 75 100
From Table 5.7 shows that the percentage of normal menopause age of
the respondents who use hormonal contraceptives, 38.7% less compared with the
use of non-hormonal contraception 42,7%. As for women who experience a late
menopause that women using hormonal contraception that is 17.3%, while
women using non-hormonal contraception which is 1.3%. From the analysis to
look at the relationship between a history of contraceptive use by age at
menopause using chi-square statistical test at 95% confidence level and margin of
error () 5% p values obtained Value 0,000, for a value of p <0.05 means there is
a relationship between history of contraceptive use with menopause.

DISCUSSIONS
Menopause is the permanent cessation of menstruation due to the
cessation of ovarian function, starting with no vaginal bleeding for at least 12
months. Menopause is a time when a woman's life poduksinya stopping ability.
Ovary (female reproductive glands) ceased to function and produce fewer
hormones6.
There are several factors that influence the age of menopause women,
the age at first menstrual period (menarche), employment status, parity, smoking,
use of hormonal contraception, diseases.
This study is in line with research conducted by Larasati with
qualitative methods which states that there is a relationship between the use of
contraception by age menopause7. Use of hormonal contraception but can
prolong the arrival of menopause of course, also can suppress the symptoms
commonly occur in postmenopausal women, such as the risk of osteoporosis,
reducing vasomotor fatigue, boost immunity and reduce the rate of bone other
symptoms that are common in menopausal women up to 10% year8.
Results of analysis using Chi-Square test in this study showed an
association between a history of the use of contraceptives, especially hormonal
birth to the age of menopause. It is assumed that the use of hormonal
contraception plays a role in suppressing ovarian function to perform ovulation
so as to slow down the age of menopause. This study found an association
between the use of hormonal contraception with menopausal age (p = 0.000).
In this research, collecting data obtained directly from the respondents
by conducting interviews and distributed questionnaires that had been prepared
beforehand to the respondent, to obtain data on the age of menopause, a history
of the type of contraception used, and the duration of use of contraception to
determine the influence of a history of contraceptive use the age of menopause.
Characteristics of respondents in this study has the distinction is between age,
education level and occupation. Age of the respondents in this study was
determined to be from 45-60 years, while the respondent's educational level also
vary from the level of primary school education to Bachelor level, as well as the
work of each respondent is also quite varied.

CONCLUSION
The results of this study concluded that there is an association between a history
of contraceptive use hormonal contraceptives specifically to the age of
menopause.

SUGGESTIONS
For people, especially for students to know that the relationship between the
history of the use of contraceptives, especially hormonal birth to the age of
menopause, which means the use of hormonal contraception may be a risk factor
for slowing the age of menopause, so therefore it is necessary to educate the
public, especially students on the matter ,

ACKNOWLEDGEMENTS
1. Dr. dr. AldySafruddinRambe, Sp.S (K), as Dean of the Faculty of Medicine,
University of North Sumatra.
2. dr.Mohd.RhizaZ.Tala, Mked (OG), Sp.OG (K) and dr.IrinaKemalaNst, Sp.S,
as the supervisor of writers who have provided guidance, ideas, correction and
input so that this thesis can be resolved.
3. dr.Andre Pasha Ketaren, Sp.JP and dr.SariHarahap, Sp.PD as examiner who
has given various suggestions and criticisms to the perfection of this thesis.
4. Jamaluddin, SP, as Head of Sub Siti rejo III district of Medan Amplas who has
given permission to conduct research at the site, along with the mother spacecraft
as Head Posyandu Lansia, Group Monalisa in Siti Rejo district III, sub district of
Medan Amplas who helped in the implementation of this study.
5. The author of beloved family, especially parents, who gave me all his support
and love since childhood
6. Fellow compatriots FK USU who have helped and supported in this research.

REFERENCES
1. Fitriyani. Relations contraceptive pill to the age of menopause in Depok
2012. Indonesia.2013 University; h.11-47
2. Sinclair C. Handbook of Midwifery. First Print Add. Book Medical
Publishers EGC. 2009; h. 704-723
3. When Northrup C. Wisdom of Menopause. First Edition, Publisher Q-Press,
Bandung. 2006; h. 13
4. Kasdu D. Tips Healthy and Happy at the age of menopause. First Edition,
Publisher Reader Governmental Development Nusantara, Jakarta. 2002
5. Orphans F. Irregular Menstruation and Menopause. First Edition. Publisher
Popular Library Torch, Jakarta. 2001
6. Baziad, Ali. Menopause and Andropause. Jakarta: Yayasan Bina Library
Sarwono Prawihardjo 2003
7. Larasati, Tika. Quality of Life in Women who had entered menopause.
Journal of Psychology Faculty Gunadarma University, 2009; vol 1 1: 15-17
8. Eka Chandra Herlina. relationship hormonal contraceptives with less bone
mineral density in menopausal and post-menopausal women. Diponegoro
University, Semarang, 2000. 6