Women's perception about hydrotherapy in postmenopause: a qualitative study

Introduction: The transition from reproductive to post-reproductive life is part of the female life cycle that impacts well-being, with menopause as a significant milestone. Regular physical activity should be encouraged to mitigate the symptoms of menopause and prevent age-related problems. Hydrotherapy is one such alternative, since immersion in heated water facilitates exercises that would be difficult to perform on land. Objective: Assess women’s perception about the effect of hydrotherapy on the signs and symptoms of postmenopause. Methods: A qualitative study in which participants underwent 48 hydrotherapy sessions and answered a semistructured interview. Results: The participants were eight women, aged 55.75 ± 8.55 years, menopausal for 8.5 ± 7.98 years, with vasomotor symptoms (100%), mood swings (87.5%), sleep disorders (87.5%), vaginal dryness (62.5%), low sex drive (62.5%) and chronic pain (100%). Conclusion: Women’s perception about the effects of hydrotherapy on the signs and symptoms of postmenopause include less pain and muscle tension, a decline in the signs and symptoms, better quality of life and sexual pleasure, and an improvement in biopsychosocial factors such as anxiety and stress through better social interaction.


Introduction
There are specific periods in the female life cycle that warrant special attention due to their impact on health and well-being. 1,2 One such cycle is the transition from reproductive to post-reproductive life, with menopause as a significant milestone. Characterized as the natural cessation of the menstrual cycle, menopause is diagnosed after 12 consecutive months of amenorrhea and typically occurs between the ages of 45 and 52 years. 3,4 Although menopause is directly related to ovarian aging, it also influences the hypothalamic-pituitaryovarian-uterine axis, triggering signs and symptoms that characterize the onset of menopause (climacteric) 5 and can persist for up to 10 years after the cessation of menstrual cycles. 3 Irregular menstrual cycles, vasomotor symptoms such as night sweats and a sudden feeling of heat (hot flashes), difficulty sleeping or insomnia, vaginal dryness, low sex drive and mood swings are the most commonly reported signs and symptoms. 3,6 Muscle and joint pain are also typical during this time; however, it is important to consider the influence of lifestyle and aging-related factors in these body changes and complaints, making it difficult to pinpoint a single factor. 4,7 Thus, measures aimed at controlling weight, engaging in physical exercise and improving sleep quality are considered first-line strategies for pain management in these cases. 7 Regular physical activity should be encouraged to mitigate the signs and symptoms of menopause and prevent and treat age-related problems. 3 Previous studies have highlighted the importance of regular physical activity, reporting that worse physical performance is related to more intense climacteric symptoms and low physical activity levels. 1,8 Nguyen et al. 9 observed improvements in the psychological, sexual and vasomotor aspects of menopausal yoga practitioners and highlighted the need for quality studies that assess other exercise modalities.
Hydrotherapy is one such modality and has gained ground, since immersion in heated water facilitates exercises that would be difficult or impossible to perform on land. 10 The mechanical and thermal properties of water allow the body to relax and improve joint mobility, motor coordination, pain and blood flow. 9,11 Additionally, aquatic activities in a group setting contribute to improving the self-esteem and social interaction of the participants, positively affecting their physical and psychological aspects 12 and thus helping them to cope with stages of life that require specific strategies, such as postmenopause.
Given the association between the physiological changes of aging and the chronological process of menopause and postmenopause, there is an urgent need for research on nonpharmacological therapies to help manage these issues. In this respect, the present study aimed to assess women's perception regarding the effect of hydrotherapy on the signs and symptoms of postmenopause, provide support for health professionals and promote future research by expanding scientific discussion.  For the purpose of greater accuracy, all the interviews were recorded. Next, they were transcribed, eliminating grammar mistakes, linguistic errors and semantic weight.
Codes were used to identify the participants in order to protect their identities, as follows: P1, P2, P3, P4, P5 and so on. The interviews were validated by email, requesting that participants confirm the information within 15 days.
Data from the empirical material were analyzed by the researchers in three stages, using content analysis:

Discussion
The first category related to perceptions about the effect of hydrotherapy on postmenopausal signs and symptoms was reduced pain and muscle tension, as indicated in the statements below:

Results
Participants were 8 women aged between 43 and 69 years. Of these, four were married and four divorced; one was on sick leave, two worked in general services and five were retired (   Reduced pain is a therapeutic effect achieved by hydrotherapy even in chronic cases.

Authors' contributions
RB and APMG were responsible for the study design, methodology, data collection, analysis and interpretation, and writing the article. VJBA and ELJ contributed to the methodology, data analysis and interpretation and critical review of the article. All the authors contributed substantially to the conception of the manuscript and approved the final version.