الفهرس 
ACKNOWLEDGEMENTOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Menopause, which literally means the cessation of menses, represents the stage in a woman’s life when her reproductive capacity has been brought to an end. There are many hormonal changes that lead to the cessation of menses. The main cause is the DROP in estrogen. Estrogen, which is linked to depression, explains why there are higher depression rates in women than in men. However, as the estrogen level decreases before menopause, the risk of depression should also decrease.
The increased depression rate encountered during menopause suggests that it is not actually the hormonal changes, but the psychological impact associated with this stage that causes the problems. For most women, the changes in status and fertility associated with menopause affect a wide range of other aspects, such as the way they view themselves and their sexuality. Psychologists state that women who have a positive attitude on the changes that happen in their body look healthier and are likely to have an increased interest in sex. In contrast, those who believe in the myth that menopause is the end of their womanhood, they start to lose their attractiveness and vitality and look older. Also, negative attitudes on menopause may increase the unpleasant symptoms associated with it, such as hot flushes, fatigue, night sweats, sleeping disorders and aches (Taylor, 2006).
Aim of the Study:
To assess the relation between psychological changes and quality of life among menopausal women at Benha City through :
1- Monitoring of changes across the domains of physical, behavioral, cognitive and emotional functioning.
2- Measurement of changes across the domains of physical, behavioral, cognitive and emotional functioning.
Subject and Methods:
The study was conducted at the three woman’s health centers in Benha City, the study subjects encompassed 100 menopausal women within age 40 – 60 years and free from physical and psychological disorders who attended for check up in the woman’s health centers.
To collect data of the study the following tools were used:
Tool I:
An interview schedule was used for data collection. It was developed by the researcher after a thorough review of literature and included:
1- Personal data: Age, level of education, occupation, marital status.
2- Obstetric and menstrual data, age at menarche, age at marriage, number of pregnancies, number of deliveries, number of lived children and date of last menses.
Tool II:
The Menopause Assessment Scale: Adopted by (Jones, 2000) it was translated into Arabic by the researcher under the guidance of supervisors, this scale is issued to measure the severity of symptoms that may be experienced by menopausal women. These symptoms may be physical, psychological or sexual or mixture of all three. This tool consists of 20 items.
Tool III:
Self. Rating Depression Scale (SDS): Adopted by (Zung, 1965). This scale has 20 items, it was translated into Arabic to assess depression in menopausal women.
Tool IV:
This tool included the Utian Quality of Life (UQL), adopted by (Utian, et al. 2002) and translated by the researcher under guidance of supervisors and modified according the Egyptian culture. This tool includeds, 23 item questionnaires, demonstrating four separate, intercorrelated domains.
Occupational quality of life, which contains 7 items.
Health quality of life, which contains 7 items.
Sexual quality of life, which contains 3 items.
Emotional quality of life, which contains 6 items.
- These tools were distributed to 10 experts in the psychiatric, obstetric and community nursing fields to verify their validity and reliability.
- A pilot study was carried out on a sample of 10 menopausal women within age range from 40 to 60 years. According to the results of the pilot study, four questions were modified, the tools then were then revised, redesigned and rewritten.
- Each interview lasted from 60 to 90 minutes, starting from the beginning of August 2007 to the end of December 2007.
The socidemographic data reveled that the total number of the sample was 100 menopausal women; the highest percentage of them was in the age group 46–50 years old, but the lowest percentage was in the age group 56–60 years old. Concerning with the level of education, the present study showed that more than one third of the sample (36%) were secondary education level, but 13% were university education level. Regarding to occupational state, more than half of the study sample were working, while more than two fifths were not working. Concerning marital status, the majority of the sample were married but the minority were divorced. As for nature of husband presence with family, more than three quarters of the husbands are continuously present with their families, while the minority of them were incontinuously present with their families.
Regarding to the obstetric and menstrual history of the menopausal women, for more than two thirds, age at menarche for menopausal women of the sample ranged between 12–15 years old, but for the minority, it started before 12 years old. As for age at marriage, of the menopausal women under study, for more than one third, marriage was at age from 24 <28 years old. Regarding to the number of pregnancies, near half of the menopausal women were pregnant 4 – 6 times, and half of the menopausal women deliveries 0-3 times, and also, are having 4–6 children. Concerning the nature of menses in the last year, less than half of menopausal women were not having menses during last year. Menopausal stage among the studied subjects, was for less than half of them post menopause and for almost two fifths under study symptoms need for more action related to the severity of menopausal symptoms among the studied subject, however 9% of menopausal women of the sample were having symptoms no need for any action.
Regarding to the relations in this study, there was a statistically significant relation between depression levels and menopausal stages, where 53.19% of normal level of depression were during post menopausal stage, while 34.61% of severe depression were during pre-menopause stage.
There was a statistically significant relation between quality of life and menopausal stages among studied subjects, where 38.28% and 21.27% during post menopause stage were having high and higher respectively, while 30.76% and 34.61% during pre-menopausal stage were having low and lower quality of life respectively.
A significant relation was found between quality of life and depression levels, where 20.9% with higher quality of life were within normal level of depression. An equal percentage of 36.4% of low and lower quality of life menopausal women were within severe depression levels. This may be inadequate psychological preparation for women about this phase of life.
There was no significant relation between menopausal symptoms and menopausal stages, where 38.46% of symptoms probably need treatment during pre-menopausal stage, while 10.63% of symptoms no need for any action were during post-menopausal stage. This may be due to insufficient knowledge to menopausal women about menopausal symptoms during the stages of menopause.
A highly significant association was detected between menopausal symptoms and QOL, where menopausal women under study had symptoms no need for any action have higher quality of life. Meanwhile menopausal women having symptoms probably need treatment have lower QOL. This refer to when increase symptoms of menopause lead to decrease Q.O.L related to insufficient information to menopausal women about this period of life.
A significant association was found between menopausal women of the studied subjects and symptoms probably need treatment having sever depression, related to inadequate preparation about his normal phase of life to menopausal women.
Based on the results of this study, the following recommendations were formulated:
• Advice for menopausal women and their caregivers.
• Teaching tips reducing the discomfort of menopause.
• Beating stress.
• Providing adequate nutrients and vitamins for most women through the stages of menopause.
• Nurses should develop strategies and nursing intervention to make menopausal women with positive perception of menopausal experience to enhance their quality of life.