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      <title-group>
        <article-title>Women’s awareness of menopausal symptoms and the measures taken at selected settings in Asmara, in view of preparing self-instructional module</article-title>
      </title-group>
      <contrib-group content-type="author">
        <contrib contrib-type="person">
          <name>
            <given-names>Dr. Kavitha. P, PhD Ob-Gyn Nursing</given-names>
          </name>
          <email>aroun2000@gmail.com</email>
          <xref ref-type="aff" rid="aff-1"/>
        </contrib>
      </contrib-group>
      <aff id="aff-1">
        <institution>Assistant Professor, Fatima College of Health Sciences, Abu Dhabi, UAE.</institution>
        <country>United Arab Emirates</country>
      </aff>
      <history>
        <date date-type="received" iso-8601-date="2020-08-11">
          <day>11</day>
          <month>08</month>
          <year>2020</year>
        </date>
        <date data-type="published" iso-8601-date="2020-08-11">
          <day>11</day>
          <month>08</month>
          <year>2020</year>
        </date>
      </history>
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    <p><bold><italic>Research article</italic></bold><bold><italic>                                                                                               Medical research</italic></bold></p>
    <sec id="sec-1">
      <title>Women’s awareness of menopausal symptoms and the measures taken at selected settings in Asmara, in view of preparing self-instructionalmodule</title>
      <sec id="sec-1_1">
        <title>Dr. Kavitha. P, AsmeromAsgodom, Drar Abe, MebrahtomTekle, RussomGezae, SenaitOgubaslassie</title>
      </sec>
    </sec>
    <sec id="sec-2">
      <title>Assistant Professor, Fatima College of Health Sciences, Abu Dhabi, UAE.</title>
      <p><bold>*Corresponding Author</bold>: <bold>Dr. </bold><bold>Kavitha</bold><bold>. P, PhD</bold><bold>Ob-Gyn Nursing</bold></p>
      <p>
        <bold>Email ID</bold>
        <bold>: </bold>
        <bold>aroun2000@gmail.com</bold>
      </p>
      <sec id="sec-2_1">
        <title>Abstract</title>
        <sec id="sec-2_1_1">
          <title>Background</title>
        </sec>
        <sec id="sec-2_1_2">
          <title>Aim</title>
          <p>The main aim of the study is to assess the women’s Awareness of menopausal symptoms and the measures taken by them i n view of preparing self-instructional module. </p>
        </sec>
        <sec id="sec-2_1_3">
          <title>Methods</title>
          <p>Totally 180 samples were selected for this study from selected settings in Asmara by clustering sample technique. The interview questionnaire was used to collect the data. The data analysis was done by SPSS package.</p>
        </sec>
        <sec id="sec-2_1_4">
          <title>Results</title>
          <p>The result of the study showed the <bold>mean age</bold> of menopause was 45.yearsMost of the participants (97.84%.) were attained menopause naturally . 56.11 %were not aware of menopausal symptoms. The majority of them (72.22%) were not taken any action to relive the menopausal symptoms</p>
          <p><bold>Keywords:</bold> Menopause, Menopausal symptoms, Measures, Mean age of menopause.</p>
        </sec>
        <sec id="sec-2_1_5"/>
      </sec>
      <sec id="sec-2_2">
        <title>Background </title>
        <p>Middle age is one of the turning points in women’s life as it brings along many changes. It is midway between the challenges of adulthood and despair of old age, comes the changes, i.e. menopause in women and which take a compulsory change of direction (Meyer, 2003). As a woman approaches menopause, the number of ovarian follicles declines producing less estrogen causing irregular menstrual period and a host of other physical discomforts. The reduction of estrogen production results in a number of signs and symptoms, which could be observed during menopausal transition (Clarisa, et al., 2007 as cited in Girma, 2014). One third of the age of women spent in menopause. On the other hand, one third of the female population is in menopause suffering with menopausal symptoms [1-5].</p>
      </sec>
      <sec id="sec-2_3">
        <title>AIM</title>
        <p>The main aim of the study is to assess the women’s Awareness of menopausal symptoms and the measures taken by them.</p>
        <sec id="sec-2_3_1">
          <title>Specific Objectives</title>
          <list list-type="bullet">
            <list-item>
              <p>To assess the demographic variables.</p>
            </list-item>
            <list-item>
              <p>To assess the awareness of menopausal symptoms.</p>
            </list-item>
            <list-item>
              <p>To assess any measures taken by women to relieve the menopausal symptoms. </p>
            </list-item>
            <list-item>
              <p>To assess the mean age of menopause. </p>
            </list-item>
            <list-item>
              <p>To find out the association between demographic variables and awareness.</p>
            </list-item>
          </list>
        </sec>
      </sec>
      <sec id="sec-2_4">
        <title>METHODOLOGY</title>
        <p>Descriptive cross-sectional design was used in this study. The research samples are female workers selected from Asmara College of health sciences and Public Transportation of ZobaMaekel between the ages of 40-60 years. Cluster sampling technique wasused to select 180 samples for the study. The data were collected using interview questionnaire.it was analyzed using descriptive &amp;inferential statistics. SPSS version 20 was the statistical program used for analysis [5-15].</p>
      </sec>
      <sec id="sec-2_5">
        <title>Results</title>
        <list list-type="bullet">
          <list-item>
            <p>Most of them (56.11%.) were between the age group of 40-45 .</p>
          </list-item>
          <list-item>
            <p>Few of them (12.78%.)were between the age group of 51-55  </p>
          </list-item>
          <list-item>
            <p>More than half of them (51.67%.) were attained menopause. </p>
          </list-item>
          <list-item>
            <p>Most of the participants (97.84%.)were attained menopause naturally. </p>
          </list-item>
          <list-item>
            <p>More than half of them (56.11 %) were not aware of menopausal symptoms.</p>
          </list-item>
          <list-item>
            <p>24.79%   mentioned their source of information were from the health care providers.</p>
          </list-item>
          <list-item>
            <p>The majority of them (72.22%) were not taken any action to relive the menopausal symptoms. </p>
          </list-item>
          <list-item>
            <p>The <bold>mean age</bold> of menopause was calculated and it was 45.years.</p>
          </list-item>
        </list>
      </sec>
      <sec id="sec-2_6">
        <title>Section A</title>
        <p>
          <bold>Table –1 Distribution of Menstrual history in frequency&amp; percentage</bold>
        </p>
        <p>N=180</p>
        <table-wrap>
          <table>
            <tr>
              <td>
                <bold>Status of Women</bold>
              </td>
              <td>
                <bold>f</bold>
              </td>
              <td>
                <bold>Percentage</bold>
              </td>
            </tr>
            <tr>
              <td>Menopausal Women</td>
              <td>93</td>
              <td>51.67%</td>
            </tr>
            <tr>
              <td>premenopausal women</td>
              <td>87</td>
              <td>48.33%</td>
            </tr>
          </table>
        </table-wrap>
        <p><bold>Table –2</bold> - <bold>Frequency&amp; percentage</bold><bold>of</bold><bold>Distribution Mode of menopause</bold></p>
        <p>                                                                                     N=93</p>
        <table-wrap>
          <table>
            <tr>
              <td>
                <bold>Mode of menopause</bold>
              </td>
              <td>
                <bold>f</bold>
              </td>
              <td>
                <bold>Percentage </bold>
              </td>
            </tr>
            <tr>
              <td>Natural </td>
              <td>91</td>
              <td>97.84%</td>
            </tr>
            <tr>
              <td>Medical </td>
              <td>0</td>
              <td>0%</td>
            </tr>
            <tr>
              <td>Surgical </td>
              <td>2</td>
              <td>2.16%</td>
            </tr>
          </table>
        </table-wrap>
        <p>Table 2: shows that most of the participants were attained menopause naturally91 (97.84%) and 2 (2.16%) of them had surgical menopause [16]</p>
        <p>.</p>
        <sec id="sec-2_6_1">
          <title>SECTION – B: To assess the awareness about menopausal symptoms.</title>
          <p>
            <bold>Table – 3- frequency and percentage distribution of women’s awareness</bold>
          </p>
          <p>                                                                                              N =180  </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>State of awareness</bold>
                </td>
                <td>
                  <bold>F</bold>
                </td>
                <td>
                  <bold>Percentage </bold>
                </td>
              </tr>
              <tr>
                <td>Aware</td>
                <td>79</td>
                <td>43.88%</td>
              </tr>
              <tr>
                <td>Not Aware</td>
                <td>101</td>
                <td>56.11%</td>
              </tr>
            </table>
          </table-wrap>
          <p>Table 3: shows that among 180 participants 79(43.88%) of them were aware of menopausal symptoms and the majority of them {101(56.11)} were not aware of menopausal symptoms [17].</p>
          <p>
            <bold>Table -4</bold>
            <bold>:Frequency</bold>
            <bold> and percentage distribution of </bold>
            <bold>Menopausal symptoms stated by participants</bold>
          </p>
          <p>                                                                                                                          N=180</p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>S.No</bold>
                </td>
                <td>
                  <bold>Menopausal  Symptoms</bold>
                </td>
                <td>
                  <bold>f</bold>
                </td>
                <td>
                  <bold>Percentage</bold>
                </td>
              </tr>
              <tr>
                <td>1</td>
                <td>Hot flashes</td>
                <td>50</td>
                <td>27.78%</td>
              </tr>
              <tr>
                <td>2</td>
                <td>Vaginal dryness</td>
                <td>2</td>
                <td>1.11%</td>
              </tr>
              <tr>
                <td>3</td>
                <td>Shorter duration</td>
                <td>0</td>
                <td>0%</td>
              </tr>
              <tr>
                <td>4</td>
                <td>Shorter cycles</td>
                <td>14</td>
                <td>7.78%</td>
              </tr>
              <tr>
                <td>5</td>
                <td>Incontinence</td>
                <td>4</td>
                <td>2.22%</td>
              </tr>
              <tr>
                <td>6</td>
                <td>Longer cycles</td>
                <td>21</td>
                <td>11.66%</td>
              </tr>
              <tr>
                <td>7</td>
                <td>Difficulty sleeping </td>
                <td>10</td>
                <td>5.56%</td>
              </tr>
              <tr>
                <td>8</td>
                <td>Easy tearfulness</td>
                <td>3</td>
                <td>1.67%</td>
              </tr>
              <tr>
                <td>9</td>
                <td>Night sweats</td>
                <td>31</td>
                <td>17.22%</td>
              </tr>
              <tr>
                <td>10</td>
                <td>Irregular periods</td>
                <td>43</td>
                <td>23.88%</td>
              </tr>
              <tr>
                <td>11</td>
                <td>Lighter periods</td>
                <td>8</td>
                <td>4.44%</td>
              </tr>
              <tr>
                <td>12</td>
                <td>Irritability </td>
                <td>59</td>
                <td>32.77%</td>
              </tr>
              <tr>
                <td>13</td>
                <td>Longer cycles</td>
                <td>12</td>
                <td>6.66%</td>
              </tr>
              <tr>
                <td>14</td>
                <td>Low mood or depression</td>
                <td>8</td>
                <td>4.44%</td>
              </tr>
              <tr>
                <td>15</td>
                <td>Decreased ability to concentration </td>
                <td>6</td>
                <td>3.33%</td>
              </tr>
              <tr>
                <td>16</td>
                <td>Weight gain </td>
                <td>39</td>
                <td>21.66%</td>
              </tr>
              <tr>
                <td>17</td>
                <td>Absence of periods</td>
                <td>62</td>
                <td>34.44%</td>
              </tr>
              <tr>
                <td>18</td>
                <td>Heavier periods or flooding </td>
                <td>17</td>
                <td>9.44%</td>
              </tr>
              <tr>
                <td>19</td>
                <td>Loss of interest in sex </td>
                <td>15</td>
                <td>8.33%</td>
              </tr>
              <tr>
                <td>20</td>
                <td>Changes in hair growth </td>
                <td>0</td>
                <td>0%</td>
              </tr>
              <tr>
                <td>21</td>
                <td>Memory problems</td>
                <td>5</td>
                <td>2.77%</td>
              </tr>
              <tr>
                <td>22</td>
                <td>Others </td>
                <td>33</td>
                <td>18.33%</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table-5-Distribution of frequency and percentage for number of symptoms mentioned by the participants who have awareness</bold>
          </p>
          <p>N=79</p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>No: of symptoms mentioned</bold>
                  <bold> by the participants</bold>
                </td>
                <td>
                  <bold>F</bold>
                </td>
                <td>
                  <bold>Percentage </bold>
                </td>
              </tr>
              <tr>
                <td>2</td>
                <td>12</td>
                <td>15.2</td>
              </tr>
              <tr>
                <td>3</td>
                <td>29</td>
                <td>36.7</td>
              </tr>
              <tr>
                <td>4</td>
                <td>15</td>
                <td>19.0</td>
              </tr>
              <tr>
                <td>5</td>
                <td>10</td>
                <td>12.7</td>
              </tr>
              <tr>
                <td>6</td>
                <td>8</td>
                <td>10.1</td>
              </tr>
              <tr>
                <td>7</td>
                <td>3</td>
                <td>3.8</td>
              </tr>
              <tr>
                <td>9</td>
                <td>1</td>
                <td>1.3</td>
              </tr>
              <tr>
                <td>10</td>
                <td>1</td>
                <td>1.3</td>
              </tr>
              <tr>
                <td>Total</td>
                <td>79</td>
                <td>100.0</td>
              </tr>
            </table>
          </table-wrap>
          <p>Table -5: shows that many of them mentioned 3 symptoms {29(36.7%)} and only one mentioned 9(1.3%) and another one mentioned 10(1.3%) symptoms</p>
          <p>
            <bold>FIG:1 Number of symptoms mentioned by the aware participants</bold>
          </p>
          <p>
            <bold>Table: 6: Frequency and percentage distribution of participants who state their Source of information (from women who aware)</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Source of information  </bold>
                </td>
                <td>
                  <bold>f</bold>
                </td>
                <td>
                  <bold>Percentage</bold>
                </td>
              </tr>
              <tr>
                <td>Health provider</td>
                <td>30</td>
                <td>24.79%</td>
              </tr>
              <tr>
                <td>Books, magazines, journals</td>
                <td>4</td>
                <td>3.30%</td>
              </tr>
              <tr>
                <td>Mass media </td>
                <td>9</td>
                <td>7.43%</td>
              </tr>
              <tr>
                <td>Friend</td>
                <td>23</td>
                <td>19%</td>
              </tr>
              <tr>
                <td>Relatives</td>
                <td>6</td>
                <td>4.96%</td>
              </tr>
              <tr>
                <td>Educational session</td>
                <td>13</td>
                <td>10.74%</td>
              </tr>
              <tr>
                <td>Community elders</td>
                <td>5</td>
                <td>4.13%</td>
              </tr>
              <tr>
                <td>Parents</td>
                <td>4</td>
                <td>3.30%</td>
              </tr>
              <tr>
                <td>Personal experience</td>
                <td>27</td>
                <td>22.31%</td>
              </tr>
            </table>
          </table-wrap>
          <p>Table-6: shows that most of them 30(24.79%) they mentioned their source of information were from the health care providers and the least of them {4 (3.30%)} were mentioned books, magazines, journals and 4 (3.30%) of them got information from their parents [18-23].</p>
          <p>
            <bold>FIG 2:</bold>
            <bold>Percentage Distribution </bold>
            <bold>Of</bold>
            <bold> Source Of Information</bold>
          </p>
        </sec>
        <sec id="sec-2_6_2">
          <title>Section - C: To find out measures taken to relieve the menopausal symptoms</title>
          <p>
            <bold>Table-7- Distribution of frequ</bold>
            <bold>ency and percentage of measures </bold>
            <bold>taken to relive the Menopausal symptoms</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td rowspan="2">
                  <bold>Measures taken to relive the </bold>
                  <bold>Menopausal symptoms</bold>
                </td>
                <td colspan="2">
                  <bold>By aware (N=79 )                             </bold>
                </td>
                <td colspan="2">
                  <bold>Non aware (N= 101)</bold>
                </td>
                <td colspan="2">
                  <bold>Total(N=180)</bold>
                </td>
              </tr>
              <tr>
                <td/>
                <td>
                  <bold>f</bold>
                </td>
                <td>
                  <bold>Percentage </bold>
                </td>
                <td>
                  <bold>f</bold>
                </td>
                <td>
                  <bold>Percentage </bold>
                </td>
                <td>
                  <bold>f</bold>
                </td>
                <td>
                  <bold>Percentage    </bold>
                </td>
              </tr>
              <tr>
                <td>Health center</td>
                <td>4</td>
                <td>5.06%</td>
                <td>2</td>
                <td>1.98%</td>
                <td>6</td>
                <td>3.33%</td>
              </tr>
              <tr>
                <td>Hospital</td>
                <td>18</td>
                <td>22.78%</td>
                <td>10</td>
                <td>9.90%</td>
                <td>28</td>
                <td>15.55%</td>
              </tr>
              <tr>
                <td>Private hospital</td>
                <td>6</td>
                <td>7.59%</td>
                <td>3</td>
                <td>2.97%</td>
                <td>9</td>
                <td>5%</td>
              </tr>
              <tr>
                <td>Traditional healer</td>
                <td>0</td>
                <td>0%</td>
                <td>2</td>
                <td>1.98%</td>
                <td>2</td>
                <td>1.11%</td>
              </tr>
              <tr>
                <td>Holly water</td>
                <td>6</td>
                <td>7.59%</td>
                <td>6</td>
                <td>5.94%</td>
                <td>12</td>
                <td>6.67%</td>
              </tr>
              <tr>
                <td>Dietary modification</td>
                <td>0</td>
                <td>0%</td>
                <td>0</td>
                <td>0%</td>
                <td>0</td>
                <td>0%</td>
              </tr>
              <tr>
                <td>Action not taken </td>
                <td>45</td>
                <td>56.96%</td>
                <td>78</td>
                <td>77.22%</td>
                <td>123</td>
                <td>68.%</td>
              </tr>
            </table>
          </table-wrap>
        </sec>
        <sec id="sec-2_6_3">
          <title>Section– E: To find out the association between demographic variables and awareness </title>
          <p>
            <bold>Table – 8 Association of demographic variables with awareness</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Association of  demographic variables</bold>
                </td>
                <td>
                  <bold>P-value</bold>
                </td>
              </tr>
              <tr>
                <td>Age </td>
                <td>0.87(NS)</td>
              </tr>
              <tr>
                <td>Education </td>
                <td>0.044(S)</td>
              </tr>
              <tr>
                <td>Occupation </td>
                <td>0.128(NS)</td>
              </tr>
              <tr>
                <td>Religion </td>
                <td>0.011(S)</td>
              </tr>
              <tr>
                <td>Family type </td>
                <td>0.05(S)</td>
              </tr>
              <tr>
                <td>Residence-Urban &amp;Rural    </td>
                <td>0.633(NS)</td>
              </tr>
            </table>
          </table-wrap>
          <p><bold>N.B</bold>   S – significant NS – non significant. P-value&lt;0.05 </p>
          <p>Table: 8 shows that the associations were found with education (P- 0.044), religion (P- 0.011) and type of family (P- 0.05). The other demographic variables were not having significant association. Hence H<sub>1</sub> was rejected.</p>
        </sec>
      </sec>
      <sec id="sec-2_7">
        <title>Conclusion </title>
        <p> According to the results, most of the women were not aware of the menopausal symptoms and the measures that should be taken. From this it can be concluded that even though the mothers were experiencing   the symptoms they were not able to relate it with menopausal symptoms which may be because of lack of awareness.</p>
        <p>Women needed to enhance awareness towards menopausal symptoms and measure taken to relive menopausal symptoms. It is important to emphasize on educating them about menopause how much it influences their health and how to adopt healthy lifestyle behavior to relive their menopausal symptoms. So further studies needed in Eritrea</p>
      </sec>
      <sec id="sec-2_8">
        <title>References</title>
        <list list-type="bullet">
          <list-item>
            <p>Achar, D. A., Wanga, D.O. and Olubandwa, A.A. Knowledge of Perimenopausal Phase and Symptoms Women Experienced in Njoro District, Kenya. <italic>International Journal of Humanities and Social Science</italic>. 4(3), 2014, 316-321.</p>
          </list-item>
          <list-item>
            <p>Alakananda1, Das, N. and Das, B.P.Age of Menopause and Menopausal Symptoms among women attending Gauhati Medical College and Hospital, Guwahati, Assam: A cross-sectional study. <italic>Scholars Journal of Applied Medical Sciences3</italic>(7C), 2015, 2621-2629 </p>
          </list-item>
          <list-item>
            <p>Al-Taweel, A., Al-Harthy, K. and Al-Nwaiser, A. (2012). Measuring The Awareness Of Menopausal Symptoms In Pre-Menopause Women. King Saud University</p>
          </list-item>
          <list-item>
            <p>Batool, S.F.; Saggu, Y. and Ghani, M. Perception of Menopausal Symptoms among Educated versus Non Educated Women by Using Menopausal Rating Scale (MRS). <italic>Open Journal of Nursing.</italic> 4, 2014, 602-607</p>
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          <list-item>
            <p>Chae, H.D.; Choi, S.Y.; Cho, E.J.; Cho, Y.M.; Lee, S.R.; Lee, E.S.; and Park, H.M. Awareness and Experience of Menopausal Symptom and Hormone Therapy in Korean Postmenopausal Women. Journal of Menopausal Medicine 20, 2014, 7-13</p>
          </list-item>
          <list-item>
            <p>Elkazeh, E.A. and El-Zeftawy, A.M. Knowledge of Women in Reproductive Age about Menopausal Problems and Preventive Health Behaviors in Tanta City, Al -Gharbyia Governorate, Egypt. <italic> IOSR Journal of Nursing and Health Science (IOSR-JNHS) 4</italic> (3), 2015, 51-63</p>
          </list-item>
          <list-item>
            <p>Girma, Y. Attitudes of Middle Adult Women Towards Menopause in Addis Ababa Bahir-Dar and Hawassa Towns: Cross-Cultural Comparative Study. Addis Ababa University: Ethiopia2014.</p>
          </list-item>
          <list-item>
            <p>Ibraheem O.M., Oyewole O.E., and Olaseha I.O. Experiences and Perceptions of Menopause among women in Ibadan South East Local Government area, Nigeria. <italic>African Journal of Biomedical Research</italic>. 18, 2015, 81-94</p>
          </list-item>
          <list-item>
            <p>Jack, G.; Pitts, M.; Riach, K.; Bariola, E., Schapper, J. and Sarrel, P. Women, Work and the Menopause: Releasing the Potential of Older Professional Women. Australian Research Center in Sex, Health and Society. Monash University.2014.</p>
          </list-item>
          <list-item>
            <p>John, M. “A Comparative Study To Assess The Psychosocial Wellbeing Among Menopausal Women In Selected Rural And Urban Areas Of Bengaluru with a view to organize a program on relaxation strategies. Rajiv Gandhi University of Health Science. Bengaluru, Karnataka.2011.</p>
          </list-item>
          <list-item>
            <p>Khan, C.G. and Hallad, J.S. Age at Menopause and Menopausal Transition: Perspectives of Indian Rural Women.2006.</p>
          </list-item>
          <list-item>
            <p>Mandenhall, J. About Menopause, Overview, Identification, Age and Symptoms. [Online] Available: http://www.livestrong.com. 2009.</p>
          </list-item>
          <list-item>
            <p>Mugenda&amp;Mugenda, Research Methods Quantitative and Qualitative Approaches. Acts Press, Nairobi, Kenya.2003.</p>
          </list-item>
          <list-item>
            <p>Mujahid, S.; Siddiqui, A.A.; and Hussain, R. Awareness of Menopausal Symptoms among Young Pakistani Women of Different Educational Backgrounds. <italic>Journal of South Asian </italic><italic>Feder</italic><italic> Menopause Soc. </italic>1(1), 2013, 18-20.</p>
          </list-item>
          <list-item>
            <p>Ojeda, L. Menopause without Medicine. Thorsone Publishers Limited, Wellingborough, Northamptonshire England NN82RQ.1990.</p>
          </list-item>
          <list-item>
            <p>Oyediji, E.F.; Amosu, A. M.; Atulomah, N.O.; Thomas, M.A. and Ojo, E.F. Impact of knowledge and awareness on the ability to cope with menopause among bodija market women in Ibadan Oyo State, Nigeria. <italic>Archives of Applied Science Research</italic>. 3(5), 2011, 179-190</p>
          </list-item>
          <list-item>
            <p>Remennick, L. (2008). Subjective Health, Aging, and Menopause among Native and Immigrant Jewish Women in Israel <italic>Women and Health</italic> 47(1), 2008, 65-82</p>
          </list-item>
          <list-item>
            <p>Sagdeo, M.M. and Arora, D. Menopausal Symptoms: A Comparative Study in Rural and Urban Women. <italic>JK Science</italic>. <italic>13</italic> (1), 2011, 23-26.</p>
          </list-item>
          <list-item>
            <p>Satpathy, M. A Study on Age at Menopause, Menopausal Symptoms and Problems among Urban Women from Western Odisha, India. International Journal of Scientific and Research Publications, 6 (3), 2016, 422-427.</p>
          </list-item>
          <list-item>
            <p>Satpathy, M. A Study on the Knowledge and Awareness about Menopause among Middle Aged Women from Western Odisha.<italic> International Journal of Science and Research</italic>. <italic>5</italic>(7), 2016, 1759-1761. </p>
          </list-item>
          <list-item>
            <p>Shaheen, S.; Mahmood, A. and Kadri, F. Menopause and HRT: Clinical Pattern and awareness. <italic>Professional Medical Journal. 22</italic>(7), 2015, 904-909.</p>
          </list-item>
          <list-item>
            <p>Shakila, P.; Sridharan, P. and Thiyagarajan, S. An Assessment of Women’s Awareness and Symptoms in Menopause (A Study with Reference to Academic Women’s at Sri Lanka. <italic>Journal of Business &amp; Economic Policy</italic>.  <italic>1</italic>(2), 2014, 115-124</p>
          </list-item>
          <list-item>
            <p>Tsehay, D.S. Mulatie, M.M., and Sellakumar, G.K. Determinants of Menopausal Symptoms and Attitude among Middle Aged Women: The Case of Dangila Town, North West Ethiopia. <italic>Innovare</italic><italic> Journal of Social Sciences</italic>. 2(1), 2014, 15-20</p>
          </list-item>
        </list>
      </sec>
      <sec id="sec-2_9"/>
      <sec id="sec-2_10">
        <title>Websites</title>
        <p>www.webmd.com/menopause/ss/slideshow-menopause-overview.htm.</p>
        <list list-type="bullet">
          <list-item>
            <p>Current obstetrics</p>
          </list-item>
          <list-item>
            <p>Medical dictionary </p>
          </list-item>
          <list-item>
            <p>Word dictionary</p>
          </list-item>
        </list>
      </sec>
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