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۱٫ Introduction

The menopause can now be considered to be a mid-life event as the lifespan of women continues to increase in developed countries [1]. By the year 2025, the number of postmenopausal women is expected to rise to 1.1 billion worldwide. Although not all women will experience short- or long-term problems of menopause, the high prevalence of hot flushes [2,3] and vaginal atrophy [2,4], which can lastfor many years, as well as osteoporosis (1 in 3 women are at risk of an osteoporotic fracture)[5], makes caring for ageing women a key issue for health professionals. The European Menopause and Andropause Society (EMAS) aims to provide holistic consensus advice on the management of menopausal women through its position statements and clinical guides [6]. This position statement intends to provide a model of care for (healthy) ageing menopausal women.

2. Concept of healthy ageing and healthy menopause

Health and disease can be conceptualized as a continuum, reflected by a dynamic balance between faced demands and an individual’s capacity to adapt physiologically, psychologically and socially. That concept incorporates physical, mental and social functioning, which differs between individuals and changes due to ageing [7]. Healthy ageing includes survival to old age, delay in the onset of non-communicable diseases (NCDs) and optimal functioning for a maximal period at individual levels of body systems and cells. The conceptual framework of Active and Healthy Ageing (AHA) [8] incorporates items such as functioning (individ ual capability and underlying body systems), wellbeing, activities and participation, and diseases, including NCDs. Signs of impaired function may act as markers of failure to reach developmental potential (“health resources”), accelerated ageing or underlying disease processes, and offer opportunities for early intervention [9]. Furthermore, markers of function and wellbeing above average (“health strengths”) may act as guidance for successful and sustainable interventions to reach best age- and lifestyle-related health status in an individual or epidemiological approach. The conceptual framework of the Healthy Menopause (HM) [7] breaks the AHA concept down to menopause regardless of when and why menopause occurs. Herein, HM is defined as a dynamic state, following the permanent loss of ovarian function, characterized by self-perceived satisfactory physical, psychological and social functioning, incorporating disease and disability as well as a woman’s desired ability to adapt and capacity to self-manage. Thus,HMincorporates bothobtainedanddevelopedresources aiming to maintain, revisit, adjust, recover and improve that dynamic balance. Most importantly, the conceptual HM framework encompasses women as a whole, beyond their hormonal, reproductive and physiological health.

3. Evidence of what women want

Women’s conceptions of the menopausal transition are individual and incorporate both physical and psychological symptoms. However, the menopausal transition has also been described, in a more holistic view, as a natural process affected by endocrine and lifestyle factors, the psychological situation and ageing per se [10]. Ethnic and sociodemographic differences in menopausal symptom management have been observed. A US study [11] found that white women tended to focus on specific symptoms by seeking help through formal healthcare systems, but ethnic minorities approached their symptoms more holistically, by seeking help through their family members and friends. Thus, medication for menopausal symptom relief was a first step for white women and a final step for ethnic minorities. Moreover, attitudes towards the menopausaltransition may differ between women and their physicians [12]. Thus, awareness and identification of women’s different perspectives are crucial for healthcare professionals, as consultations regarding menopause-related matters constitute a significant part of the workload [13]. Despite the omnipresence of all kinds of media, there is a lack of knowledge among women regarding menopause, treatment options and possible risks associated with menopausal hormone therapy (MHT) [14–16], making informed decisions difficult for individual women. Furthermore, some women may feel completely ignored by their healthcare providers [17]. Thus, first of all, women want their healthcare providers to start listening to what they report [17]. Secondly, women want clear, evidence-based information about the various hormonal and non-hormonal treatment options [16,18–21]. In addition, they want to discuss and seek help for non-vasomotor menopause-related symptoms, such as weight gain, sleep disturbance,tiredness,moodiness, low sexual desire and dyspareunia [22].

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