Self-Management Box on Hot Flash in Postmenopausal Women

Introduction Menopause is a natural biological transition that marks the end of a woman's reproductive years and results from the loss of ovarian follicular function and a decline in circulating estrogen levels. Natural menopause is clinically recognized after 12 consecutive months of amenorrhea in the absence of another physiological, pathological, or medical cause (World Health Organization [WHO], 2024). Although menopause most commonly occurs between the ages of 45 and 55 years, the timing and experience of the menopausal transition vary considerably among women. The transition may extend over several years and may affect women's physical, psychological, emotional, and social well-being (Gombert-Labedens, Vesterdorf, Fuller, Maloney \& Baker, 2025).

Vasomotor symptoms (VMS), particularly hot flashes and night sweats, are one of the most common symptoms of the menopausal transition. Hot flashes are generally described as sudden sensations of intense heat, commonly involving the face, neck, and chest, and may be accompanied by sweating, palpitations, chills, and anxiety. It has been estimated that approximately 50% to 80% of women experience vasomotor symptoms during the menopausal transition, although their frequency, severity, duration, and associated distress differ substantially among women and across cultural and demographic groups (Crandall, Mehta \& Manson, 2023; Khan, Kapoor, Faubion \& Kling, 2023).

Hot flashes are among the most bothersome menopausal symptoms and are a common reason for seeking menopause-related healthcare. The frequency and severity of hot flashes vary, but they can interfere with sleep, daily activities, concentration, emotional stability, social interactions, and work productivity. They may also contribute to fatigue and psychological distress, thereby reducing women's overall quality of life. Evidence indicates that vasomotor symptoms may persist for a median duration of approximately seven years, while women who begin experiencing them during perimenopause may continue to experience them for a longer period (Crandall et al., 2023; Khan et al., 2023). Effective management of VMS is crucial for improving the quality of life during menopause (Fasero et al., 2025).

Menopausal hormone therapy is considered the most effective treatment for bothersome vasomotor symptoms. Nevertheless, it may not be suitable for every woman because of medical contraindications, concerns about potential risks, personal preferences, or limited access to specialized menopause services. Therefore, evidence-based nonhormonal interventions are particularly important for women who are unable or unwilling to use hormone therapy. Recommended nonhormonal approaches include menopause-specific cognitive behavioral therapy, clinical hypnosis, certain pharmacological therapies, and weight reduction for some women. Treatment decisions should be individualized according to symptom severity, health status, contraindications, and women's preferences (Shufelt et al., 2023).

Self-management is particularly relevant to menopause care because it encourages women to take an active role in understanding, monitoring, and managing their symptoms. Menopause education can improve women's understanding of the menopausal transition, facilitate the adoption of symptom-management strategies, and contribute to improved symptom control and quality of life (Keye, Varley, \& Patton, 2023; McFeeters, Pedlow, McGinn, \& McConnell, 2024). A systematic review and meta-analysis found that menopause education was associated with statistically significant improvements in quality of life and symptom control. However, the authors identified variations in intervention content, follow-up periods, and methodological quality, indicating the need for further well-designed intervention studies (Keye et al., 2023).

More recent evidence supports the use of healthcare professional-led menopause education. A randomized controlled longitudinal study demonstrated that a structured, four-week, midwife-led education program significantly reduced menopausal symptom severity and improved menopause-specific quality of life compared with routine follow-up. The beneficial effects were sustained at the six-month follow-up. This finding supports the potential value of structured professional guidance, continued follow-up, and individualized support during the menopausal transition (Benli et al., 2026).

Nurses play a vital role in delivering these interventions through health education, symptom assessment, behavioral support, follow-up, and referral. Previous nurse-led programs have demonstrated improvements in women's knowledge and self-reported menopause-management practices (Sunny \& Raman, 2019), while other evidence suggests that education and support delivered within nurse-led menopause services may improve menopausal symptoms and quality of life (Keye, 2025). However, some available studies have used small samples or interventions that combined education with medical treatment, limiting the ability to isolate the independent effect of the nurse-led educational component (Keye, 2025; Sunny \& Raman, 2019).

Despite growing evidence supporting menopause education and professionally guided behavioral interventions, evidence remains limited regarding structured, nurse-led, home-based self-management interventions that integrate symptom monitoring, individualized behavioral support, and continued follow-up. In particular, the effectiveness of delivering these components through a standardized self-management box has not been adequately examined among community-dwelling postmenopausal women in Egypt. Therefore, the present study aims to evaluate the effect of a nurse-led menopause self-management box on hot flash frequency and menopause-specific quality of life among postmenopausal women experiencing hot flashes.

Aim of the study This study aims to evaluate the effect of a nurse-led menopause self-management box on hot flash frequency and menopause-specific quality of life among postmenopausal women.