In this study, the predominance of poor quality of life in the SF-36 was evidenced in the domains referring to pain, general health status and the domain referring to vitality. In this sense, it is important to highlight that studies have identified a compromise in the vitality dimension, which can be explained by the double working hours that women perform inside and outside their homes 18 .
For the most part, when asked about the level of satisfaction with their health, women responded that they were classified as good and very good, so that only a small portion referred to their health as poor. However, this finding can be justified, in part, by the economic classification and levels of education they belong to, which, being more favorable, provide opportunities for better dietary practices, awareness for the practice of physical activities and other measures that promote the performance of physical activities. healthy habits 19. On this issue, a study carried out in Brazil that showed that schooling was one of the predominant factors for better coping with the climacteric period, since it provides greater knowledge about its difficulties, symptoms and, mainly, forms of treatment and treatment. alleviation of symptoms 20 .
In addition, the economic level is another fundamental factor for the improvement of the quality of life of these women, because, given the social and health situation in the country, it provides access to specialized services for the care of their climacteric complaints, with a more professional service. qualified and multi-professional. Thus, having a humanized, prepared and informative service has a greater positive effect on the perception of these women's quality of life 6 .
Furthermore, studies carried out with climacteric women have shown that regular physical activity is another factor that positively contributes to a lower manifestation of climacteric symptoms and improved quality of life 21. Practices are responsible, for example, for improving mood and relieving hot flashes and, therefore, contributing to a better perception of quality of life 22. Predominant factor in this study, in which the large portion of women who participated in this research perform physical activities regularly, representing a value of 60.32%.
Pain was one of the domains that also changed from the SF-36, which may be associated with the work performed, physical exertion and issues related to non-ergonomics in the work environment 23. In addition, other studies relate pain to hormonal changes, especially hypoestrogenism, which is associated with bone cartilage wear 24. Furthermore, musculoskeletal pain was characterized as one of the most frequent complaints, affecting approximately 93% of the population studied, among them, most of them classified the pain as intense 25 .
In the WHQ, the dimensions that showed the greatest impairments are the dimensions focused on depressed mood, anxiety, sexual functioning, vasomotor symptoms and menstrual problems. About 50 to 70% of women who go through the climacteric period can trigger emotional problems, loss of libido, anxiety and even depression. Furthermore, this author also points to the relationship between depression, mainly associated with the fear of aging and the feeling of uselessness and affective lack 26 .
In addition, studies indicate that between 25% and 35% of women between 35 and 59 years old tend to have sexual dysfunctions, which can reach up to 75% among women aged 60 to 65 years. This dysfunction can be evidenced by the urogenital atrophy mechanism, but above all, by the physical changes that occur with aging, which impact on self-esteem and influence libido 20. In line with these findings, studies carried out in Sweden showed that most women reported sexual dysfunctions, such as decreased libido, sexual activity, satisfaction, and especially symptoms associated with vaginal dryness 27 .
Still in the WHQ, another problem that compromises the quality of life of the analyzed women was in the dimension of somatic symptoms, characterized by hot flashes (hot flashes) and sweating. Hot flashes are felt in approximately 75% of menopausal women 28. Such symptoms tend to compromise the quality of life of these women. In studies developed, they showed a small incidence of hot flashes in pre - menopause, with an increase in these symptoms in early perimenopause and a higher incidence in late perimenopause, however, after menopause, especially in older women, there is a decline in the intensity of these symptoms. 29 .
As mentioned through the Kruskal -Wallis test, there is evidence of a statistical difference in the number of pregnancies with the SF-36 pain dimension, sleep problems and WHQ somatic symptoms. This finding was mentioned in studies in which the association of a greater number of pregnancies with the intensity of climacteric symptoms, which shows that women with three children or more, had greater menopausal symptoms 30 .
In this study, no statistical differences were found in relation to quality of life with smoking, which can be explained by the low number of female smokers. However, studies show an association between a poor quality of life and the habit of smoking 31 .
However, there is evidence of statistical difference between marital status and the vitality dimension of the SF-36, and the dimensions of somatic symptoms and sexual and global functioning of the WHQ. Where married professionals or those in a stable relationship had a higher WHQ score on somatic symptoms, sexual and global functioning on the WHQ, in addition to a lower SF-36 score on vitality. This corroborates with other studies, which point to a correlation between a better quality of life in women who had a partner to the detriment of those who declare themselves single or divorced 32 .
Furthermore, for this study, there was evidence of statistical difference of the existence of concomitant disease with the dimension of anxiety in the WHQ and in the Kupperman Menopause Index, where professionals with a concomitant disease had higher scores in the respective dimensions mentioned. The chance of professionals with a concomitant disease to present moderate or severe Kupperman classification increases 5.20 times, compared to professionals without concomitant disease 33 .
Finally, the chance of professionals using regular medication, presenting moderate or severe Kupperman classification, increases 4.35 times, compared to professionals without regular medication use. This corroborates the studies carried out in the city of Ouro Preto, where approximately 113 climacteric women were analyzed and the results indicate that the presence of chronic diseases and the use of medications concomitantly with the climacteric was associated with a worse quality of life 33 .
The intensity of symptoms related to estrogen deficiency, established by the Kupperman menopause index, was classified as: Mild 55.56% ( n° =35), moderate 41.27% ( n° =26) and severe 3.17% ( No. =2). Insomnia symptoms were perceived as the most marked change, while symptoms related to arthralgia/myalgia and headache were classified as moderate.
Insomnia problems are common in the climacteric period, however, there are no studies that correlate insomnia with estrogenic drop, being, therefore, more associated with the occurrence of hot flashes and emotional difficulties 26. Furthermore, studies show a positive relationship between the scores on the sleep scale and the score related to menopause, which highlights a worse quality of sleep in women who were experiencing this period 34. Thus, insomnia, along with hot flashes, are the main complaints of women during menopause 28. Furthermore, studies show that the use of sleeping pills increases from 5.8–11.22% in the female population who are going through menopause 35 .
Therefore, the results found in this research corroborate with several authors who work on the climacteric theme and who mention that the arrival of this period in a woman's life is marked by several changes, whether physical, hormonal or emotional. The occurrence of symptoms and perception of these symptoms differs from woman to woman, to a greater or lesser extent. This highlights the need for qualified and individualized listening to the needs of these women in health services.