الفهرس 
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Abstract
M
enopause is a period in the life of women who have experienced cessation of menstruation for one year or more. It is also a new phase in women life cycle, characterized by several symptoms brought about by decreased hormonal activity in the body system. Hence, women at this Stage need to make suitable adjustments that will enable them cope with the new challenges successfully. The period is similar to retirement from active service, whereby the retiree feels a sense of loss because job has been taken out of her hands. Thus, it represents limitation in terms of the woman transiting into another phase of life where her pride has been taken away, (Southin, 2012).
During this period women can experience many symptoms such as hot flushes, night sweats, aching in muscles and joints, sleeping problems, short breath, weight gain, increased facial hair, depression, irritability, anxiety, sexual problems, vaginal dryness, and urinary symptoms such as urine leakage while laughing and coughing. These symptoms decrease women’s health and affect their biological, psychological, and social health, (Guldal, 2014).
The prevalence of menopausal symptoms among Egyptian women is 84%. So increase life expectancy from 54 to 71 years lead to women experiencing menopausal health complains for a long time. Healthcare of women during this period requires special care to assess menopausal women health needs in order to provide competent care. Promoting good physical and psychological health during menopausal age is important for individuals in later life. Thus increasing women’s awareness and dealing with their health complains are important to decrease severity of menopausal symptoms, (McKinney et al., 2012).
Quality of life is an important outcome measure of health care, and understanding the impact of menopause on quality of life is a critically important part of the care of symptomatic postmenopausal women. The impact of menopause on QoL is attributed to its symptoms particularly the classic vasomotor disorders& some physical symptoms such as palpitations or dyspareunia. The women consider that physical disorders are one of the main effects of menopause. These menopausal symptoms have a severely impaired QoL. Menopause causes a decrease in quality of life which is independent from age & other socio demographic variables, (Chedraui et al., 2013).
Role of community health nurse menopausal women will be managed in primary care with very few needing onward referral to secondary care. The community health nurse plays an important role in initially identifying those with troublesome symptoms. The community health nurses are key players in motivating women to adopt healthier lifestyles by stopping smoking and introducing weight loss initiatives. Many menopausal women derive comfort from simply talking about their physical and psychological issues the community health nurses are in an ideal position to provide a listening ear, (Rees & Hope 2013).
The community health nurse will assess whether menopausal symptoms are being effectively controlled by the prescribed therapy and if there are any nuisance side effects or bleeding problems. Enquiries should be made about any changes in the woman’s medical history or medication that may potentially contraindicate the use of HRT. Finally all women should be encouraged to attend for routine cervical screening and mammography, (Sood et al., 2014).
Aim of the Study
The aim of this study is to evaluate the effect of the education program on quality of life among menopausal women through assessing knowledge and practice of women related menopausal symptoms to health maintenance. Designing health educational program based on menopausal women health need. Implementing the health education program and evaluating the impact of the health education program on quality of life among menopausal women.
Research Hypothesis
Implementing health educational program will improve quality of life among menopausal women
Study design
The design of this study aquasi- experimental design was used to achieve the objectives of the study.
Setting
The study was conducted at outpatient clinics of the maternity hospitals affiliated to Ain Shams University hospitals.
Sampling type:
Purposive sample was taken from menopausal women attended to gynecological Clinics of the maternity hospitals affiliated to Ain Shams University hospitals.
Sampling criteria:
• Menstruation must be stopped at least from one year.
• Their age from 40 to 60 years.
Tools of data collection:
Two tools were used for data collection; this tool was filled by the researcher
First tool: An interviewing questioner:
It was prepared and designed by the researcher after reviewing of recent related literature it was include the following parts:
Part one:
• Assessing menopausal women socio demographic data such as; age, social status, level of education, occupation, cohabitation and family size, etc…...
Part two:
• Assessing menstrual history as regard the date of the first menstrual cycle, regularity of menstrual (regular or irregular) and the date of last menstrual, etc.
Part three:
• Assessing women’s knowledge about menopausal including; the definition of menopause, previous stages of menopause, stages of menopause, causes of menopause, factors affecting women’s body during menopause and complications associated with menopause and menopause symptoms etc….
Part four:
• Assessment women’s practices toward menopausal symptoms including, practices towards the symptoms of menopause related hot flashes, towards the symptoms of menopause related to psychological and social complaints, practices towards the symptoms of menopause physical complaints etc……
Second tools:
Menopause specific quality of life questionnaire (MENQOL); It is a self-report measure assessing the presence and severity of menopause symptoms and the degree to which they adversely affect women’s life. It consists of four domains (vasomotor, psychosocial, physical, and sexual).the vasomotor domain assesses hot flushes, night sweats, and sweating. The psychosocial domain evaluates the psychological wellbeing of the individual by including items regarding anxiousness, memory, and feeling “blue”. The physical domain assesses items such as flatulence, bloating, pain, tiredness, sleeping, energy and weight gain. The sexual domain inquires about changes in sexual desire, vaginal dryness, and intimacy
Preparatory phase:
It includes reviewing current and past local and international related literature and theoretical knowledge of various aspects of the study using books, articles, internet, periodicals and magazines to develop tools for data collection related to educational strategies. The developed tools were examined by experts to test their reliability to the study. Researcher made needed modification on tools of data collection after their revising by experts.
Validity:
It included reviewing of the current local and international related literature using books, articles and scientific magazines to develop tools for data collection.
Reliability:
By using cronbach’s Alpha coefficient test and no modification was done.
Pilot Study:
It was conducted out on ten menopausal women to evaluate clarity, reliability and applicability and content validity, as well as the time required to fulfill the developed tool according to the obtained results, modifications such as omission, addition and rewording were done according to the available resources.
Filed work
Data collection for this study was carried out throughout, (6) months in the period from the beginning of January 2018 till the end of May 2018, attending 3 days per week (Saturday, Monday and Thursday) from 10.00 am to 1.00 pm to interview attended menopausal women under inclusion criteria, after introducing oneself and explain the purpose of the study to the subjects and consent from every by participates to share in the study were done, listed tool assessed and interview the menopausal women in outpatient clinic which offer medical services and all tools lasted 25-30 minutes for each subject included in study, the health educational program was developed and implemented by researcher in the form of health education use different teaching methodology such as discussion, session and demonstration, education sessions; two sessions per week/ three weeks with a total of 6 sessions (2 practical and 4 for theoretical), every session take one hour, total program duration was 6 hours, booklet include information about menopause was designed by researcher and distributed to the menopausal women, post\test was done after the program implementation, assessment of menopausal women’s knowledge, reported practice and quality life.
The results of this study revealed that:
• The mean age of menopausal women is 53.83±7.48 years.
• The finding of this study proved that the effect of the health educational program on improving of quality of life among menopausal women through:
- Highly statistical significant relation was found between pre and post health educational program regarding knowledge of menopausal women about menopause with (p < 0.001).
- There were high statistical significant relation was detected between pre and post health educational program regarding knowledge of menopausal women about symptoms of menopause with (p < 0.001).
- Highly statistical significant relation was noticed between pre and post health educational program regarding to practices of menopausal women towards the symptoms of menopause related hot flashes with (p < 0.001).
- Highly statistical significant relation was found between pre and post health educational program regarding practices of menopausal women towards the symptoms of menopause sexual complaints with (p <0.001).
- Highly statistical significant relation was noticed between quality of life among menopausal women pre and post educational program regarding vasomotor and psychological symptoms in the menopause measure with (p < 0.001).
Recommendation:
According to the finding of the present study the researcher suggest the following recommendations:
• Increase women awareness about pre -menopausal period so reduce the severity of menopausal symptoms.
• Individual and group counseling should be planned for menopausal women aimed at helping them to share their concerns with other women who experience similar problems in order to find solution to such problems.
• Psychological counseling enables women to adjust better to the situation and grants them the assurance that menopause is a natural phenomenon.
• The medical experts should help to dispel fears, anxieties and worries in menopausal women provide them with information on how to cope with it in addition to administering treatment for severe cases.
• Hand out should distributed to create awareness among women who are in need of knowledge to overcome the menopausal symptoms.
• Health educational programs directed to menopausal women through mass media, (television, radio, journals, newspaper, medical doctors, and medical team) to increase their awareness about this period and thereby for increasing their quality of life.
• Health care must counsel the menopausal woman to cope up with the condition to achieve high level functioning.
• Further research addressing women’s health needs is also essential for improving the quality of life of menopausal women.