The participants in this qualitative study were 16 women with a mean age of 47.5 ± 2.28 years. Besides, 43.75% of the participants had more than diploma education and most of them (81.25%) were unemployed. Moreover, 81.25% of the participants lived with their husband, and 68.75% of them reported a moderate-income level (Table 2):
Codes, sub- subcategories, subcategories, and categories identified in the study
The data analysis revealed 388 primary codes, 24 sub-subcategories, 11 subcategories, and 5 categories as displayed in Table 3.
Category 1: Mixing menopause and aging
The results of the study indicated that the participants’ experiences of premenopause were characterized by gradual exposure to new changes that were taking place with unknown causes.
Feeling changes: All participants pointed to physical, psychological, and sexual changes including menopausal changes, skin changes, sweating and hot flashes, body aches, lack of energy, sleep disorders, impatience, forgetfulness, depression, decreased libido, and decreased sexual intercourse:
My menopausal cycle has become irregular. My body gets somehow hot. I sweat a lot. Then my skin dries up a bit … I feel very tired. My energy has decreased a lot compared to the last few years. I feel old and I feel pain in my knees (Participant 16, 48 years old).
The ambiguity of the cause of changes: Some participants attributed these changes to the onset of menopause and some to aging and the onset of aging:
I’m feeling changes in my body that are new to me. For example, now I feel hot and very tired. I always like to be alone. … My husband is complaining about it. He says my temperament has changed. I don’t know whether it’s due to menstruation or aging (Participant 11, 51 years old).
Some of the participants mostly considered aging as the cause of changes in themselves. These were the people who experienced the most physical symptoms such as body aches and dryness:
My lack of energy has made me think I’m not young anymore. I consider my impatience to be due to my age. I think I’m old enough to feel old. When I wake up in the morning and have to massage myself a little to relax my body. I have not been feeling like this before. This feeling started about five or six months ago. At first, it was not intense, but it got gradually worse (Participant 3, 48 years old).
Category 2: Life change
The analysis of the participants’ experiences indicated negative behavioral and mood reactions that were caused by the changes in them, affecting their relationships with their husbands and children.
Negative mood/behavioral reactions: Most participants reported behavioral changes, including bad-temperedness, most of which were due to physical changes in themselves. They stated that they experienced changes such as irritability, anger, aggression, low mood, discomfort, mental conflict, and apathy:
I cannot sleep comfortably at night. When I wake up in the morning, I feel tired and upset. When I look at other women, I feel that I’m missing something compared to them. It makes me feel bad and inefficient. I’m feeling old, less energetic, lazy, and unmotivated (Participant 2, 45 years old).
The negative effect of changes on social life: These problems have had negative and adverse effects on the participants’ life, so that the person’s family relationships, i.e. relationships with spouse and children have also been negatively affected:
My husband is unhappy and says I don’t behave like before … he gets cold little by little and comes home late, he mostly entertains himself with the housework, he thinks I don’t like him (Participant 1, 49 years old).
I feel bored and tired. I feel depressed, aggressive and restless at home. The children also complain a little about the way I behave (Participant 16, 50 years old).
Category 3: Confrontation of fear and hope
Given the changes that have taken place and the consequences and impact on the participants’ life, they stated that they were facing an internal conflict, which was the confrontation of fear and hope.
Fear of persistence and aggravation of symptoms: Following the changes, the women stated that they were struggling with disturbing thoughts about their disabilities and getting old quickly. The cause was not important to them, but the consequence, that is, old age and disability, was highlighted by them. Furthermore, they were afraid that these changes would remain stable and get worse.
These changes have had a profound effect on my psyche and mental health. The problems I did not have before but now have got worse. I am afraid they will continue getting worse. I don’t know what I should do (Participant 4, 41 years old).
Self-consolation: In addition to the fear of aggravation of symptoms and disabilities, the participants reported that they also experienced a sense of hope. In fact, there is still hope that the situation is temporary and may end after a while:
I feel inadequate and less energetic. I give hope to myself that these will be temporary and over and I will feel well again. This situation will end for better or worse (Participant 5, 47 years old).
Category 4: Life adjustment
The participants stated that in the face of these recent changes, they were trying to overcome the problems, and the efforts made by them were somewhat effective.
Trying to overcome problems: Most of the participants stated that they were trying to overcome the problems faced by them:
I have to talk with someone to help me control myself so that I do not worry my husband and children. I want them to know that I can cope with this stage as I did with many other events (Participant 7, 47 years old).
Effective efforts: Most of the participants stated that they were trying to reduce the problems by engaging in activities and hobbies such as exercising, going out with friends, shopping, etc., or reduce the problems by seeing a consultant and doctor and following the recommendations provided by them. Accordingly, they succeeded in reducing the problems to some extent by doing such activities.
Category 5: Needs to facilitate the transition time
Women undergoing menopausal changes have needs including receiving more attention and support from their husbands and being understood by them. Besides, they need friends to share experiences and also spend time with them, and they also need awareness and advice to have a better lifestyle and find answers to their questions.
The need to be understood the husband: Some participants were concerned that because of these changes and the lack of awareness and understanding of their husband, their husband may pay less attention to them and consider them as a woman who is in the process of aging:
I need my husband to understand me. Sometimes I think he is looking at other women and when I look closely, I see that they are almost a few years younger than me and I envy them. I would like my husband to know what happened is a part of every woman’s life and it will happen to them sooner or later (Participant 4, 41 years old).
The need for empathetic peers: The participants reported that they need to have peer friends who are in a similar situation so that in addition to sharing their experiences and ideas, they can spend time and empathize with them.
I would like to have a few friends like myself to consult and sympathize with them. I like to spend time with them and talk to them easily about the problems and this common pain; think and sympathize about it together (Participant 14, 48 years old).
Need for expert advice: Women at this age need to be aware of menopausal changes and how to adapt to them. In fact, they need to make sure whether these problems are permanent or just typical of the current period:
I need more information and must see a doctor who can answer all my questions and help me not grow old or these things happen later. I need advice and information so that I can undergo this period more easily and without further injury to my body (Participant 9, 43 years old).