الفهرس 
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Abstract
Summary Menopause means the age of permanent cessation of spontaneous menstruation. Natural menopause is menopause sets in at the normal age between 45 and 60 years and not associated with pathologic or psychological causes. It is currently receiving global attention due to the progressive increase in life expectancy world wide. Menopause is a life transition that affects women of varying cultures, nationalities and backgrounds. In Egypt the mean age of the menopause is 46.7 years but this age has been rising recently. This means that women will suffer from menopausal symptoms for longer period of time and causing psychosocial and economic problems for women, which causes burden in our community. Perception of women toward menopause is influences in adaptation of positive or negative attitude toward menopause because the majority of menopausal women may suffer in silence without ever knowing that to do or seek help The physiological changes associated with menopause include vasomotor instability, urogenital atrophy, gastrointestinal problems and psychological trouble. The common signs and symptoms of menopause are hot flush, night sweating, headache, insomnia, constipation, fatigue stress incontinence, vaginal dryness, and loss of libido, poor memory, low concentration, and anxiety Community health nurses in both out patient departments and primary care menopause clinics should provide advice on how menopausal women can deal with their symptoms. Most of community health nurses are play important role in educator and counseling regarding an overall healthy life style. Nurses can help Menopausal women to recognize and cope with stressful psychological or social problems and help Menopausal women to develop an improve interpersonal relationships and to promote personal growth during home visit The nurse also should help the menopausal women who decide to use complementary therapy by providing knowledge about HRT to support this decision The study was conducted at the Out –Patient clinics, and homes at Tanta city and shebein Elkome. A Purposive sample of 200 menopausal women were selected during home visit and the out –Patients And 50 health care professional (physician) were also included in the study according to the following criteria: age of women 40 -65 years, had amenorrhea for at least 1 year The content validity of developed was tested by faculty member from faculty of medicine, and faculty of nursing of menofia. A pilot study was carried out on 20 menopausal women and 5 physicians who were excluded from the study. The aim of pilot study to test the relevance applicability of tool, to detect any further problems peculiar to it and estimate the time needed to apply it The interview was conducted individually and in total privacy Collected of data was carried out over period of eight months, starting from the beginning of January 2011 until august 2011. The collect data
was then feed to computer, tabulated, analyzed and presented in descriptive and associated form The main finding yield by the present study is as the follows 1- General characteristics of study subjects The mean age of women was 55.1+_ 6.95 and equal half of women of women ( 51%) had secondary level of education, the majority of the studded woman are house wife and the family income is not enough for more the half of the woman (54.5% • The main age of women at menarche was 13.23 ± 3.48and the main age of women at menopause was 44.95 ±5.4< 2- Encountered menopausal symptoms of studied women The majority of women reported vasomotor symptoms such as hot flushes, night sweating, headache, and insomnia, palpitation (62.5%,< 90%, 56.5%, 79.5% and 59% respectively). The majority of women suffer from urinary incontinence, vaginal dryness, and vaginal pain, 58.5%, 82.5% and 65% respectively Gastrointestinal problems represent a major part since 51.5% The majority of women had psychological changes such as 74.5% had
depression, 94% noticed difficult in concentration, 95% reported
nervousness, 70.5% had leak of confidence, 94.5% suffered from mood change The majority of women had social changes had 90%over load toward children, 97% reported unable to work, 77% noticed change with>husband relations, 36% reported not neglecting from other The majority of women had sexual changes 87% had vaginal dryness 81.5% said loss in living in intercourse, 79.5% had loss of desire during intercourse, 79% said not reach to the top of desire, 82.5 had pain during intercourse, and 43% reported not present of blood during or after intercourse 3- Encountered women knowledge about hormone replacement therapy was higher among post intervention group than pre intervention group of women 4- Encountered women awareness about menopause was higher among post intervention group than pre intervention group of women 5- Encountered women perception about hormone replacement therapy was higher percentage among post intervention group than pre intervention group of women 6- Encountered women quality of life was higher prevalence in post intervention group than pre intervention group 7- General characteristics of study subjects (physician Mean age of physician was 40.38±9.16 and the mean duration of experience was 16.0±8.59, and more than half 58% work in clinic 8- Encountered physician knowledge about hormone replacement therapy was all physician was know HRT, two third of physician 86% is prescript the therapy, 96% of physician giving information to the menopausal women about HRT, 86% of women accepted to taking HRT, and 94% of physician said that the benefit of HRT is better than its side effect if used in suitable patient Conclusion 1- Moderate to sever menopausal symptoms, physical, social and sexual problems related to menopause 2-Menopausal women had negative perception toward menopause and hormone replacement therapy in the pre test which significantly improved at the post test3-Menopausal women had incorrect knowledge regarding menopauseespecially when the majority of them got their knowledge about menopause hormone replacement therapy from relatives and friends This lack of knowledge improved significantly at the post test 4 -Gynecologist has positive perception about the benefits of HRT, so that the gynecologist prescribed it to women andencouraged using itRecommendationThe following recommendation is suggested Provide simplified guide about menopause to menopausal woman. Whish contain simplified information related to physiology of menopause, its signs and symptoms and how to alleviate such symptoms Provide well training to Health care providers including nurses to give accurate and specialize information about menopause and hormone replacement therapy to help and enable them to manage menopausal consequence and to prevent its