الفهرس 
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Abstract
Menopause is a normal physiological process which is characterized by thepermanent cessation of menses in women as a result of reduced ovarian hormonesecretion. Thus, menopause is accompanied by many biological and psychosocial changes that reduce women’s quality of life and put them at high risk of developing various health conditions. During menopausal period women experience many symptoms including hot flashes, night sweats, sleep and mood disorders, impaired memory, lack of concentration, nervousness, depression, insomnia, bone and joint complaints, and reduction of muscle mass(Soliman& El-Zeftawy, 2021).
Despite the effectiveness of HRT to alleviate menopausal symptoms, many women refused it because of its side effects and otherwise resorted to traditional practices that reflect their values and beliefs. However, some traditional cultural practices and beliefs may be beneficial, while others may be harmful. Although traditional practices for menopausal symptoms continue to be widely used, unpredictable effects may result such as prolonged recovery period. Therefore, it is important for menopausal women to receive the necessary information about menopause and how to deal with its related symptoms to enhance their overall quality of life.
Aim of the study
The present study aimed toidentify traditional practices used to control menopausal symptoms among women in EL Amreya region.
Materials and method
Setting:
The study was conducted at the gynecological out-patient clinic affiliated to EL Amreya General Hospital, Alexandria Governorate,Egypt.
Subjects:
A convenient sample of 200 menopausal women who selected from the above-mentioned setting. They were chosen according to the following criteria:over 45 years, having cessation of menstruation for at least one year, having at least two or more menopausal symptoms such as (hot flashes, night sweating, irritability, vaginal dryness, dyspareunia, and joint pain), absence or presence of controlled chronic diseases, no HRT and residence of women in rural area.
Data collection tools:
Three tools were developed and used by researcher to collect the necessary data: Tool one: Socio demographic and clinical data structured interview schedule, which assessed menopausal women’s socio-demographic characteristics, medical, menstrual and reproductive as well as menopausal history. Tool two: Greene Climacteric Scale (GCS). This scale was developed by Greene (1990) to assess menopausal symptoms. It is composed of 21 items in three main Sections: psychological (11 items from 1-11), physiological (7 items from 12-18), vasomotor (2 items 19 & 20) and Sexual function (1 item).
Tool three: Traditional practices used to overcome menopausal symptoms structured interview schedule. It was developed and used by researcher to identify traditional practices that are used by menopausal women.
The tools were tested for content validity by 5 juries who were expert in the field.A pilot study was carried out on 20 menopausal women (excluded from the study subjects), to test the feasibility of the study. Relevance, validity and clarity of tool as well as the time needed to complete it. Collection of data consumed 4 months (starting from the beginning of October 2021 till the end of January 2022), 3days/week; 3-4 menopausal women/day. The average time needed to complete the interview schedule ranged between 10-15 minutes. The collected data were categorized, coded, tabulated and analyzed using Statistical Package for Social Sciences (SPSS) version 26 program.
The main findings of the study were:
Socio - demographic data:
- The mean age of menopausal women was 54.02±4.635 years.
- Illiterate or just read & write was mentioned by three-quarters (75%) of menopausal women, while one-quarter (25%) of them had primary & preparatory level.
- A sizeable proportion of menopausal women (78%) were housewives.
- More than three-fifths (65.5%) of menopausal women were married, while less than two-fifths (34.5%) of them were widowed, separated and divorced.
- The vastmajority (89%) of menopausal women had just enough family income /month.
- Almost all (97%) of menopausal women were Moslems.
Medical history:
- Medical diseases were reported by almost two-fifths (41%) of menopausal women, while hypertension and DM were reported by a sizeable proportion (69.5% & 53.7%) of menopausal women respectively.
Reproductive history:
- The majority of menopausal women (82%) had 4-17 pregnancies. While 1-7 abortions were reported by more than one-third (35.5%) of them.
- A sizeable proportion of menopausal women (73.5%) had 4-14 deliveries.
Menopausal history:
- Age at menarchewas 11-16 years among almost all (97%) of menopausal women.
- Age at menopausewas 45-<55 years among more than three-fifths (64.5%) of menopausal women, meanwhile the most of them (96%) had natural menopause.
Menopausal symptoms intensity using GCS:
- Psychological symptoms were mainly reported by menopausal women as mild in relation to irritability (53.5%), loss of interest in most things (51.5%). They were also mostly described by them as moderate in terms of excitability (67.5%). In addition, psychological symptoms were substantially mild and moderate in respect of feeling tired or lacking in energy (47% & 47.5%) respectively.
- Physiological symptoms, mild symptoms were reported by almost one-half and more of them regarding pressure or tightness in head (48.5%), feeling dizzy or faint (50.5%) and parts of body feel numb (55%). Moderate symptoms in the form of muscle and joint pains were also mentioned by more than one-half (55%) of menopausal women. However, three-fifths (60%) of them had mild and moderate breathing difficulties (33.5% & 26.5%) respectively.
- Vasomotor & sexual symptoms demonstrated that mild loss of interest in sex was experienced by more than two-fifths (41%) of menopausal women. Whereas a considerable proportion of them (61% & 55.5%) had moderate hot flushes and sweating at night respectively.
Traditional practices used to control feeling tense or nervous:
- The practice main usedby the women was religious rituals (55.3%) followed by herbs (35.3%).
- Types of herbswere mainlymint (52.8%).
Traditional practices used to control difficulty in sleeping:
- Type of practices used was herbs as reported by all (100%) of these women.
- The main herbs used were anise (60.1%).
Traditional practices used to control excitability:
- Religious rituals were the main practice used by a sizeable proportion of these women (71.9%), compared to herbs, which used by only 28.1% of them.
- Herbs used were anise (56%).
Traditional practices used to control muscle and joint pains:
- Types of practices used were herbs and cupping as reported by almost two-fifths and more (45.2%& 39.5%) of menopausal women.
- Herbs used in the form of local application of oils by 55% of their users.
- On the other hand, wet cuppingwas used by almost three-quarters (75.7%) of users.
Traditional practices used to control breathing difficulties:
- Herbswere the mainpractice usedby all (100%) of menopausal women, who had breathing difficulties symptom.
- Herbs such as fennel, anise, cumin, fenugreek, nigella sativa, flax, artemisia and cloves seeds were used by most of their users (96.5%).
Traditional practices used to control hot flashes:
- Herbswere the main practice used by more than three-quarters (77.5%) of menopausal women who had this symptom.
- Herbs like fenugreek, fennel, soya bean, sage, flax, cloves, anise, cress, nigella sativa, cumin and sesame seeds were used by the majority of their users (84.1%).
- Menopausal symptoms were decreased by the most traditional practices used by women. Also, Family and relatives were the main sources of information about the traditional practices that used by menopausal women as well as sources of getting the practice were mainly holy Quran for religious rituals, spice dealer for herbs andequipment ofcupping got from medical store.
Recommendations:
Based on the findings, the following recommendations are suggested:
• Develop specific health educationalprograms for women at health care settings aimed to improving thequality of life of menopausalwomen and promoting their life styles.
• Workshops and conferences should be held to obstetric and gynecological nurses to ensure that they are aware of safe and harmful traditional practices used during menopause.
• Evidence- based information and researches about traditional practices should be encouraged amongobstetric and gynecologic nurses to evaluate its effectiveness and risks.
Recommendations related to further studies:
1. Replication of the current study on a lager sample size and different settings for the purpose of better generalization.
2. Factors associated with use of traditional practices among menopausal women.
3. Future studies by the appropriate specialists are needed to evaluate the actions, effectiveness, and side effects of certain herbs which were most used among subjects of the present study such as: fennel, ginger, fenugreek and anise as well as nigella sativa, flax.