Adopting strategies with menopausal experiences: A systematic review

Abstract Background and Aims Menopause is one of the most significant stages in women's life. It is accompanied by many complications and a serious challenge. This study aimed to assess the menopause experiences of Iranian women and compatibility strategies. Methods We searched PubMed, Web of Science (ISI), Scopus, Ovid, and the Iranian Clinical Trial Registry and Magiran, SID, from January 1990 to January 2021. Results Psychological effects, sexual disorders, physical problems, bone pain, insomnia, fatigue, and hot flashes are all menopause experiences. Cultural factors, lifestyle, social factors, education level, employment and economic status, marital status, and the number of pregnancies and births can influence this experience. It is important that menopausal women are aware how menopausal compatibility and prepare for this period. Many factors have affected menopausal adopting strategies. Negative emotions, negative attitudes, worry, and anxiety, and their psychological effects exacerbate the annoying experiences of menopause and decelerate menopausal adoption. Conclusions Social support and educational intervention were the practical menopausal adopting strategies. It will guarantee the health of menopausal women in the last third of their lives.

menopause is named a biological, social, cultural, and emotional process. 5vorable socioeconomic conditions are associated with betterincoming jobs and higher education in couples that could accelerate compatibility with menopausal changes and senility.Menopause is close to old age or sometimes with it.It can have a substantial impact on women's health.In addition, some socio-demographic variables and perceived health affect the severity of menopausal experiences. 6is disaster may last for many years.It may be uncomfortable and put pressure on the health system's budget.We live in a world today.Where we need individual and social flexibility and adaptability more than ever.These are due to many changes and challenges caused by technology and modern life.Adaptability and flexibility have played a significant role in health promotion.Adaptability helps to increase the ability to control impulses, emotions, or attitudes.If a person doesn't communicate with others and his social environment or adaptation is disrupted, behavioral disorders will appear.Compatible people can communicate better with their surrounding environment and overcome environmental changes.Adaptable people cope with environmental conditions and changes and exploit them to their advantage.Significantly, people adapt according to the new conditions.The complications of menopause have been explained in various studies, but there have been few solutions for compatibility with these changes.Many studies describe menopausal experiences.Some experimental, semi-experimental, and descriptive studies have assessed women's reactions to these experiences.Women's compatibility is more important than the description of experiences.
Adopting can substantially affect the intensity and quality of the experiences and improve the menopausal quality of life.
Many studies have mentioned menopausal experiences.However, the strategy to adapt to menopause has been explained in few interventional studies.This research made a summary and conclusion of these cases.Compatibility to this period of life, which includes about one third of women's lives, is a fundamental issue. 7,8This systematic review can be practical for expressing the experiences of

| Inclusion and exclusion criteria
The inclusion criteria were as follows: (1) articles published in Persian and English; (2) data from a cross-sectional, case-control, experimental, and semi-experimental phenomenological study of postmenopausal women in Iran between January 1990 and January 2020.The exclusion criteria were as follows: (1) editorials, speeches, comments, and conference abstracts; (2) insufficient characterization; (3) the lack of full text and necessary information; and (4) to avoid multiple publication biases in our study, duplicate publications were removed from the analysis.

| Search strategy
In this research, we manage to investigate annoying menopausal experiences and compatibility strategies of Iranian women.The keywords, as shown in Table 1, are menopause, compatibility, cultural, social support and complication, sign, symptom, and Iran.
We screened the title and abstract to determine the relevant papers.
If there were doubts in the abstract, the full text was evaluated.The protocol of this study was recorded in PROSPERO (record number: 281264).

| Study selection
We imported all the articles searched into the EndNote library.First, we provided titles and abstracts and further evaluated them.
Then, we evaluated the full text of the article according to our inclusion and exclusion criteria.In this study, the eligible were reported, and the other noncompliant reports were deleted for the evidence shown in Figure 1.

| Data analysis
The database search results were 2759 articles.Titles and abstracts were evaluated after removing duplicate articles (N = 1698).In the next step, 537 articles had not been explained data correctly.
Subsequently, the full text was evaluated.Twenty-nine articles had uncompleted data.Twenty-three articles had unclear methods.One of the articles had Poor quality.Finally, 23 articles were assessed by two authors.The disagreement on the evaluation results was resolved through a conversation with the third author.As shown in Figure 1, the flowchart is the description of the article selection process, based on the PRISMA checklist.

| RESULTS
In total, 2759 articles were obtained through database research.

| Attitude
According to this review, attitudes toward menopause are influenced by the beliefs and culture of society. 4,11Attitudes may include satisfaction or dissatisfaction. 4If menopause is a sign of aging, loss of youth, and loss of sexual attractiveness, this will lead to a negative attitude toward menopause. 1,4,12,26In cultures where having children is the most important role for a woman, menopause creates a negative attitude in women. 4,13In some societies and cultures, menopause gives women the freedom to have more opportunities to communicate with God and perform religious ceremonies, thus leading to a positive attitude among post-menopausal women. 4[13]

| Somatic experiences
According to this review, most menopausal women had somatic experiences, the most common symptom of which was hot flashes. 24Hot flashes had been aggravated by stress and anxiety.As the age of postmenopausal women increased, the severity of physical and psychological symptoms decreased. 10,25Increasing the level of education increases selfconfidence and better perception of health, thus improving the health of postmenopausal women and decreasing annoying Somatic experiences. 24,26,27

| Psychological experiences
According to this review, depression, anxiety and feeling lonely, irritability, impatience, and feelings of failure were psychological experiences during menopause. 13Psychological support from the husband, the most important person, decreased anxiety and depression and improved compatibility with menopause. 4,6Marital satisfaction has reduced the psychological effects of menopause. 1,4,6,13Various changes in the lives of post-menopausal women, such as variations in the roles and responsibilities, have resulted in increased demands and expectations from myself and others.The changes in this had induced psychological dysfunctions. 13,21

| Sexual experiences
According to this review, sexual capacity diminishes in the menopause. 134][15][16] Menopause had caused a great reduction or termination of sexual activity, but most women had considered themselves obligated to satisfy the sexual needs of their husbands. 13,14

| Quality of life
According to this review, menopausal Changes had a significant impact on the quality of life and daily activities. 7,18,25,28Quality of life decreases with aging. 7Educational interventions have reduced the complications of menopause, and these have improved the quality of life. 4,18,28

| Social support
According to the articles, social support was the level of love, help, and attention, from family members, friends, and others associated with the individual.Stress aggravated women's dependence on the family during menopause.Social and personality variables impacted the complications of menopause and health. 11,12Social support has increased the ability of individuals to compatibility with stress and has reduced physical and psychological symptoms. 6

| Life style
According to this review, Exercise, physical activity, nonsmoking, and proper nutrition had been factored in menopausal health promotion, 11,24,28 but aging has made it difficult to do physical activity and other things.Education has been one of the important factors in increased knowledge and improved performance of postmenopausal women for achieving health promotion. 7

| Adopting
According to this review, compatibility had been created by increasing the ability to control impulses and emotions. 4men's view had determined their personal needs in menopausal compatibility.Useful entertainment also made women compatible with menopause.Many women mentioned entering the community as a useful factor and a way to prevent depression.Thus, they had been better compatible with menopause. 11Sometimes, the lack of knowledge about menopause could cause nonacceptance and the emergence of psychoemotional symptoms in post-menopause. 7The educational intervention had accelerated compatibility with menopausal changes. 7The results of the research showed that behavioral intervention had reduced vasomotor symptoms in postmenopausal women. 4,7,14,15,24,29| DISCUSSION This study showed that social support and educational intervention were the best compatibility strategies and improvement attitudes.
Social support affects the experiences of menopause and has a significant role in reducing menopausal problems. 30Social activity compensates for the loss of fertility and decreases menopausal complications.As a result, working women experience fewer annoying experiences, complications, and problems.Communities can increase their social support by creating compatibilities for menopausal women to do charity work.
However, achieving optimal menopausal health requires considering many factors.Many factors affect postmenopausal psychological status, including psychological disorders, anxiety and depression, insomnia, and sexual dysfunction. 28 course, some of these symptoms usually appear with aging; these symptoms are not related to menopause. 8Still, all of the factors would affect menopausal health.The review of these studies showed that psychological factors are one of the experiences affecting menopausal quality of life.
In one study, anxiety and depression did not correlate with the severity of menopausal Signs and symptoms in Iran, 10 despite the research of other countries that have reported this correlation. 21,23,30,31These differences are caused by differentiation in women's culture and attitudes.This attitude influences the experiences, signs, and symptoms or complications of menopause.
In some societies and cultures, such as Iran, menopause gives women liberate to have more opportunities to communicate with God and perform religious ceremonies, thus leading to a positive attitude in postmenopausal women. 4e thought that menopause is the end of sexual life leads to a negative attitude toward menopause. 15Still, "rescue feeling" or "liberation" from unwanted pregnancies, annoying dysmenorrhea, extensive bleeding, the negative reaction of sexual partners, and the health requirements of menstrual cycles lead to a positive attitude toward menopause. 4,20A negative attitude toward menopause has a negative impact on menopausal adoption. 32nopause can cause or increase sexual dysfunction.The prevalence of sexual disorders is 38% in the reproductive period and 72.4% in the postmenopausal period. 31Sexual disorders cause widespread family disputes and sometimes lead to family breakdowns.Using Royal jelly could be beneficial for vaginal dryness, and could be decreased sexual disorders, and improves menopausal health.Honey bee products Royal jelly, contains proteins, amino acids, sugars, fats, minerals, vitamins, gamma globulin, and elements. 33It influences the collagen production process and activates fibroblasts in the skin.Using it improves menopausal skin changes and sagging skin.It improves menopausal experiences and mental image in postmenopausal women.
Negative attitudes and aging feelings decrease if women prepare themselves for this phenomenon before menopause. 20e study of women's menopausal compatibility in England showed that 68% of women of psychological adjustment techniques, 66% of direct action, 63% of seeking social support, 58% of relaxation, 55% of redefining the situation, 48% of acceptance, and 36% of religion used to compatible menopause. 17According to research conducted in America, women who used task-based coping strategies had better physical and mental health, compared to women who used emotional coping strategies. 6Similar results in 31 premenopausal and 36 post-menopausal studies in Spain also revealed that individuals who used coping strategies instead of avoidance strategies compatible better with life changes caused by menopause. 18cording to this review, education has a huge impact on menopausal compatibility and decreases annoying experiences, 6,7,20,22,24,25,32 and improves menopausal health. 4,10Rotem et al. demonstrated that giving efficient and updated information to postmenopausal women may improve their compatibility and ability to adapt menopause. 34They suggested that support group training programs have important effects on accepting physical, social, and psychological changes of menopause. 34rther studies should be performed on compatibility with menopause to identify healthy ways to deal with these problems.
Education about these strategies can improve menopause compatibility.In this research, tried to increase the knowledge of compatibility with menopause so that women can adapt to menopause more easily and have less annoying experiences.

| Conclusion
The findings of this study show the importance of various factors in adapting to menopause.A positive attitude, increasing the support of husband, children, and peers, improving lifestyle, increasing awareness in this field, and participating in social interactions can help to adapt to menopause.These findings can be used in the formulation of a treatment-care policy for menopausal women.It is suggested that future studies focus on how to create a positive attitude toward menopause, increase women's capabilities, and increase social support for menopausal women to maximize their adaptation to new conditions.

| Limitations
One of the limitations is the small number of menopause compatibility studies and the unpublished results of other studies.
menopause and how compatibility with it.It could help manage menopausal experiences.So, this study was conducted to investigate strategies for adopting menopausal experiences.The research question is "What strategy do menopausal women use for coping with menopausal experiences?" 2 | METHODS 2.1 | Study design We searched and assessed International electronic bibliographic databases from January 1990 to January 2020, including PubMed, Web of Science (ISI), Scopus and Ovid, and English and Persian languages that were done in Iran.This review was performed by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol.The research question was: What are the menopause experiences and adaptation strategies of Iranian women?

1 Combination of words used to search articles.
outcomes are written in Table2.