Menopause refers to a condition in which menstrual cycles have stopped for one year due to the end of ovarian follicular reserve.1 The mean age of onset of menopause is 51 years (47 to 53 years), but in Iranian women, it occurs at a lower age of 47.8 years. The number of menopausal women is increasing worldwide. The World Health Organization (WHO) has reported that in 2030, the total number of menopausal women in the world will reach one billion, with a total of 47 million women going through menopause every year.2

It is estimated that menopausal women comprise 24 and 76 percent of the female population in industrialized and developing countries, respectively.3 In line with global trends, the Iranian menopausal women population is profoundly increasing. WHO data has reported that about 13.1 million Iranian women were above 45 years old in 2023, while it will be two-fold and reach 25.2 million menopausal women by 2050.4

Menopause affects mental health, physical health, social functioning, and family relationships due to its symptoms and complications. All these effects can be put in a single concept under the quality of life.5 There are controversial reports on the quality of life during menopause. While most studies show a decline in the quality of life during menopause 6, 7, 8, 9, no difference in the quality of life of women between pre-postmenopausal and postmenopausal women has been previously reported.10

However, these contradictions may be due to cultural differences, research methods, study populations, or quality-of-life measurement tools. The existing evidence has shown that the quality of life during the transition to menopause is affected by age, marital status, level of education, number of children, sexual activity, menopausal symptoms, and attitude toward menopause.11

Another critical factor affecting the quality of life during menopause is women's empowerment. Women's empowerment is defined as the ability to overcome unnecessary shame, correct self-awareness, know one's talents and limitations, and have the strength to face hardships, as well as obtaining accurate knowledge of the goals and ability to reach the goals by increasing one's capabilities.12 Empowerment can be economic, social, and political. Previous studies have found a relationship between these types of empowerment and the quality of life of women, among which economic empowerment is of greater importance.13, 14, 15 Women's economic empowerment can increase their income and improve their nutrition, health, and decision-making power in the family.15

Furthermore, women's economic empowerment promotes gender equality and reduces gender-based discrimination, thus positively impacting society.15 These effects can also improve the quality of life in women.13 A study on a sample of female victims of intimate partner violence reported a positive relationship between Women's resources and mental health-related quality of life.16

Another factor affecting the quality of life of women in menopause is their attitude towards this phenomenon. Menopause is a multi-dimensional phenomenon that includes biological, psychological, social, and cultural aspects.11 Differences in the reported experiences of women regarding menopause indicate the existence of factors other than hormones, including attitude toward menopause.17 For example, in one study, European women described menopause as an uncomfortable and health-threatening process.18 Still, in North Indian culture, women welcome menopause, and for these women, menopause is considered a natural phenomenon. It brings them respect, freedom, and broader social interactions.17 The attitude towards menopause is formed by women's feelings and is influenced by socio-cultural factors.19 Previous studies have reported a direct relation between attitude toward menopause and quality of life. A study conducted in South Korea on 139 women survivors of breast cancer showed that the attitude towards menopause was related to quality of life.19 In another study conducted in China, women with a positive attitude toward menopause were found to have a better quality of life.20

The literature review generally showed a relation between quality of life, attitude towards menopause, and women's empowerment in other populations. However, these concepts are context-based and differ in various societies. To the best of our knowledge, no study has focused on the relationship between these variables among Iranian women at the time of the current study. Given this gap in the literature, the present study aimed to investigate the relationship of quality of life with attitudes toward menopause and women's empowerment among menopausal women in Gonabad, Iran.

1- There is a relationship between quality of life and attitude towards menopause in women in the age of transition to menopause.

2- There is a relationship between quality of life and women's empowerment in the age of transition to menopause