title: Women's experience of menopause: a systematic review of qualitative evidence.
abstract: BACKGROUND
  Evidence shows than an estimated one billion women have experienced menopause worldwide. The experience of menopause is influenced by beliefs and values prevalent in the sociocultural setting, the background of the women, and the ways in which the women approach changes in this phase of life. Independently of the circumstances involved, women experiencing menopause need to have their care needs and corresponding support identified based on their personal and contextual perspectives. Although it is essential to provide appropriate support to women experiencing menopause, no systematic reviews have so far been conducted that focus on menopause experienced by women worldwide.
  
  
  OBJECTIVE
  The objective of this review is to identify the best available evidence related to how women experience menopause worldwide.
  
  
  METHODS
  
  
  
  METHODS
  This review considered studies that included menopausal women aged between 40 and 65 years, who have lived the transition from reproductive years through menopause and beyond. This review included only studies whose participants have lived the experience of natural menopause. Women who have had induced menopause, or with premature menopause were excluded from this review. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: This review considered studies that investigate women's experiences of natural menopause under the scope of different social and cultural settings. TYPES OF STUDIES: This review considered studies that have a descriptive and interpretive approach, conducted using qualitative methodology. Qualitative studies that focus on program evaluation were excluded from this review. Qualitative data including, but not limited to, study designs such as phenomenology, grounded theory, ethnography, action research and feminist research were considered for inclusion in this review. TYPES OF OUTCOMES: This review considered studies that include the following outcome measures: all aspects related both directly and indirectly to the experience of menopause, as concretely lived by women and according to their own point of view.
  
  
  METHODS
  The search strategy aimed to find both published and unpublished studies. Studies published in English, French, Portuguese and Spanish were considered for inclusion in this review, without any restriction in terms of year of publication. This decision was made to permit the inclusion of all of research related to women's lived experiences of menopause worldwide since the inception of this type of research. The databases searched included CINAHL, Medline and Pubmed, PsycINFO, Lilacs, Scielo, Scopus, Dissertation Abstracts International and the University of São Paulo Dissertations and Thesis.
  
  
  METHODS
  Each primary study was assessed by two independent reviewers for methodological quality. The Joanna Briggs Institute Qualitative Appraisal and Review Instrument Data Extraction Form for Interpretive and Critical Research was used to appraise the methodological quality of all papers.
  
  
  METHODS
  Qualitative data was extracted from papers included in the review using standardized data extraction tools developed by the Joanna Briggs Institute.
  
  
  RESULTS
  Qualitative research findings were synthesized using The Joanna Briggs Institute Qualitative Appraisal and Review Instrument.
  
  
  RESULTS
  From the 24 included studies, 108 findings were extracted. These findings were aggregated into 17 categories, and then into six synthesized findings. The six synthesized findings are: (i) Menopause is a natural event in a woman’s life that is closely associated with psychosocial events of midlife and the aging process; (ii) The physical and emotional changes of menopause strongly affect the women; (iii) The women perceive menopause as a time characterized by gains and losses; (iv) Resilience is improved at the time of menopause and coping strategies are adopted to enhance physical and emotional wellbeing; (v) Health issues, family and marital relations, sociocultural background and meaning attributed to the women’s sex life determine if the sexual experiences during menopause are pleasant or not; and (vi) The women should be prepared and have their needs supported according to their perspectives.
  
  
  CONCLUSIONS
  The systematic review shows that menopause is a stage of life experienced in different ways. The experience of menopause is characterized by personal challenges and changes in personal roles within the family and society. Hot flushes and night sweats are the strongest symptoms of those reported by women affected by the changes experienced during menopause. The positive or negative ways in which each woman approaches the changes during menopause are influenced by their personal, family and sociocultural background. Health care providers pay little attention to women´s perceptions regarding menopause. Considering menopause is a time when women feel vulnerable, personal and tailored healthcare according to individual needs, preferences and expectations should be provided. Coping strategies regarding the effects of menopause should be determined in creative and dynamic ways through the identification and consideration of the complex issues involved. These measures are essential to ensuring effective support for menopausal women.
authors.affiliation: University of São Paulo.|The Brazilian Centre for Evidence-based Healthcare: a Collaborating centre of The Joanna Briggs Institute.
authors.forename: Luiza
authors.initials: L
authors.lastname: Hoga
authors.affiliation: University of São Paulo.|The Brazilian Centre for Evidence-based Healthcare: a Collaborating centre of The Joanna Briggs Institute.
authors.forename: Juliana
authors.initials: J
authors.lastname: Rodolpho
authors.affiliation: University of São Paulo.|The Brazilian Centre for Evidence-based Healthcare: a Collaborating centre of The Joanna Briggs Institute.
authors.forename: Bruna
authors.initials: B
authors.lastname: Gonçalves
authors.affiliation: University of São Paulo.
authors.forename: Bruna
authors.initials: B
authors.lastname: Quirino
mesh_terms: D000328:Adult; D000368:Aged; D000884:Anthropology, Cultural; D003466:Cultural Characteristics; D005260:Female; D014943:Global Health; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008593:Menopause / Q000502:physiology / Q000523:psychology*; D008875:Middle Aged; D017698:Postmenopause / Q000502:physiology / Q000523:psychology; D036301:Qualitative Research
keywords: Menopause; change events; life experiences