Translate this page into:
Effectiveness of Mind-Body Intervention on Stress, Anxiety, and Quality of Sleep Among Menopausal Women
* Corresponding author: Janet Prima Miranda, Department of OBG Nursing, Yenepoya Nursing College, Yenepoya (Deemed to be University), Mangaluru, Karnataka, India. janetmiranda@yenepoya.edu.in
-
Received: ,
Accepted: ,
How to cite this article: Pavithra, Miranda JP, Amin AS, Banu S. Effectiveness of Mind-Body Intervention on Stress, Anxiety, and Quality of Sleep Among Menopausal Women. J Health Allied Sci NU. doi: 10.25259/JHASNU_300_2025
Abstract
Objectives
Menopause is a natural phase in a woman’s life resulting from reduced ovarian function and declining oestrogen levels. Many women experience stress, anxiety, and sleep disturbances during this period, especially those engaged in physically demanding or low-status occupations. Although mind-body interventions (MBIs) are increasingly explored, evidence on their structured use among Group D working women remains limited. Hence, the present study aims to evaluate the effectiveness of a MBI on stress, anxiety, and sleep among menopausal Group D working women.
Material and Methods
A quasi-experimental pretest-post-test control group design was used to evaluate the effectiveness of a MBI on stress, anxiety, and sleep quality among menopausal women in a selected university. Using non-probability purposive sampling, 84 participants were assigned to intervention and control groups. The intervention group received a mind-body therapy that included yoga asanas, pranayama, meditation, and relaxation techniques. Data were collected using the perceived stress scale, generalized anxiety disorder scale, and Pittsburgh sleep quality index. Analysis was conducted with SPSS version 27, employing descriptive and inferential statistics.
Results
Participants in the intervention group showed a statistically significant decrease in stress and anxiety (p <0.001) and a significant improvement in sleep quality (p <0.001) compared to the control group, which showed no statistically significant changes (p >0.05).
Conclusion
Mind-body interventions are effective in reducing stress and anxiety, while also enhancing sleep quality.
Keywords
Anxiety
Midlife women
Mind-body therapies
Stress
Sleep
INTRODUCTION
Menopause is a natural milestone that women typically experience in their midlife. It is considered clinically after 12 months of amenorrhea.[1] Most women will spend 1/3 of their lives after menopause.[2] As per the WHO, natural menopause occurs in women between 45-55 years of age.[3] Although not all women will undergo natural menopause. Some women may undergo induced menopause as a result of surgery or medical treatment.[4] However, it is estimated that 1.2 billion postmenopausal women will exist globally by 2030.[5]
During the period of menopause, many women go through physical and mental symptoms due to hormonal fluctuation as a result of declining ovarian function.[6] These symptoms and their severity vary from person to person due to the effects of confounding factors.[7] Due to genetic, cultural, lifestyle, socioeconomic, educational, behavioural, and dietary factors, individual responses to menopause vary considerably.[8]
The common symptoms include hot flashes, night sweats, sleep problems, joint and muscle pain, depressive mood, irritability, anxiety, mental exhaustion, sexual dysfunction, bladder problems, vaginal dryness, etc.[9] In addition to these symptoms, women can also experience stressors and increased perceived stress associated with higher levels of cortisol and fibrinogen, which can worsen the severity and frequency of menopausal symptoms.[10]
During menopause, heightened stress and anxiety, along with impaired sleep, emerge as critical factors that compromise women’s well-being and daily functioning.[11] Stress during menopause is a significant and severe problem, as it not only exacerbates physical symptoms such as hot flashes and sleep disturbances but also negatively affects emotional well-being, daily functioning, and overall quality of life (QoL).[12]
Anxiety is a frequent mental health concern during menopause, and its higher occurrence among postmenopausal women can negatively affect both physical and emotional well-being. It often leads to disturbed sleep patterns, diminished QoL, and may increase the likelihood of developing other health-related complications.[13,14]
Sleep disorders are a significant concern for many women during menopause, affecting 39-47% of them. Poor sleep quality can contribute to or worsen other conditions, such as anxiety or depression. Also, these sleep issues can severely impact a woman’s daily functioning and overall QoL.[15] Frequent sleep interruptions characterize the sleep disturbance associated with menopause. Complaints include night-time awakenings, greater wakefulness after sleep onset (WASO), poor quality, insufficient or nonrestorative sleep, and difficulty initiating or waking up early. The most common sleep disturbances include disrupted sleep with nighttime awakenings and increased WASO.[16]
Unmanaged menopausal symptoms can significantly impair women’s QoL and adversely affect daily functioning and work productivity. Psychological distress, fatigue, and sleep disturbances are associated with reduced concentration, work efficiency, and increased absenteeism.[17-19]
Although a wide variety of pharmacological treatments exists, they are not widely incorporated due to their high cost and associated adverse effects.[20] Therefore, specific strategies are essential to cope with the symptoms of menopause and to prevent chronic conditions in the future. However, as it is a natural biological process, no medical treatment is necessary. There are various alternative non-pharmacological therapies available to relieve menopausal symptoms and to promote a better QoL.[21] Hence, managing these noticeable symptoms of menopause is necessary to improve the QoL of menopausal women.
Mind-body exercises have become increasingly popular in the field of complementary and alternative treatment for menopause.[22] This plays a crucial role in managing the symptoms of menopause due to the lower cost, time, and effort required. Moreover, there are no side effects.[23] With the support of recent evidences mind-body interventions (MBIs) become the most effective therapy for menopausal symptoms.[24] It is a combination of yoga, mindfulness, meditation, and relaxation techniques that integrate mental and physiological processes to enhance emotional balance and reduce stress, anxiety, depression, sleep disturbances, and pain, and also contribute to the overall QoL.[25]
Several studies have demonstrated the beneficial effects of MBIs across diverse population groups. Among individuals with diabetes, these interventions reduce stress, anxiety, depression, and metabolic disturbances while improving sleep quality and overall well-being.[26] They are also effective in managing sleep disturbances and depressive symptoms among older adults.[27] Mindfulness-based stress reduction (MBSR) improves sleep quality and psychological well-being and reduces anxiety among informal caregivers.[28]
Additionally, MBIs enhance sleep quality in women with breast cancer, alleviate physical symptoms in irritable bowel syndrome, reduce menopausal symptoms, improve QoL in perimenopausal women, strengthen mental well-being and hope among patients with multiple sclerosis, and reduce pain intensity and functional limitations in women with chronic pain.[29]
Though studies have been conducted to explore the problems of menopausal women globally, there is still a knowledge gap in managing these symptoms. Many women lack in seeking help for problems associated with menopause. The majority of women do not understand the complications and issues related to menopause.[30] To address this gap, a multifaceted approach is necessary.
Considering the proven benefits of MBIs in reducing stress, anxiety, and improving sleep quality, this study aimed to evaluate their effectiveness among menopausal women at a selected university.
MATERIAL AND METHODS
Study design and setting
A quasi-experimental pretest and post-test control group research design was adopted to conduct the study at the selected University of Mangaluru, Karnataka.
Sample size calculation
The sample size was calculated using G*Power software for an independent samples t-test. The effect size (Cohen’s d) was estimated based on findings from a previous study.[31] Assuming a two-tailed significance level of 5% (α = 0.05) and a power of 90%, a minimum of 38 participants was required in each group. Thus, the total sample size was 76. After accounting for an anticipated attrition rate of 10%, the final required sample size was increased to 84 participants.
Sample selection procedure
The list of women belonging to Group D workers (support staff involved in routine manual and auxiliary services such as housekeeping, sanitation, patient transport, etc.) was obtained from the Human Resource Department of a private medical college hospital. Using a non-probability purposive sampling technique, a total of 84 women were recruited in the study based on the sample selection criteria. The study included women aged 45 years or older who had reached natural or surgical menopause and could read and write Kannada. Women who are contraindicated to yoga and physical exercises, such as those with a hernia or spinal injury, and women with clinically diagnosed life-threatening illnesses, such as asthma and heart problems, were excluded from the study. Participants who met the inclusion and exclusion criteria were randomly assigned to intervention and control groups using a lottery method.
Data collection tools
Demographic proforma: It consists of age, age at menopause, marital status, number of children, level of education, family monthly income in rupees, and type of menopause.
Perceived stress scale: A Perceived Stress Rating Scale (PSS 10) was a standardised, free-to-use scale. The PSS was a 10-item questionnaire designed to evaluate the self-reported amount of stress in the participants by assessing thoughts and feelings in the previous month. Responses were rated on a 5-point Likert scale, ranging from 0 (never) to 4 (very often). Scores ranged from 0-40. A higher score indicates a high level of stress. The standard reliability of this tool was 0.7-0.9.[32]
General anxiety disorder scale (GAD-7): This standardized tool consists of 7 items to measure the symptoms of worry and anxiety. Items were rated on a 4-point Likert-type scale (0-3). The total score was calculated by assigning scores of 0, 1, 2, and 3 to the response categories. The GAD-7 total score ranges from 0-21, indicating severe anxiety with higher scores. The standard reliability of this tool was 0.89.[33]
Pittsburgh sleep quality index (PSQI): The PSQI was a self-reported questionnaire widely accepted to assess the overall quality of sleep and sleep components based on the past month. It consists of 19 individual items, creating seven components that produce one global score. The scale has several domains, including subjective sleep quality, latency, duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Each item was weighted on a 0-3 interval scale. The global PSQI score was calculated by totalling the seven component scores, providing an overall score ranging from 0-21, with a total score of >5 indicating poor sleep quality. The standard reliability of this tool was 0.83.[34]
Data collection procedure
A trained investigator was administered a MBI consisting of yogaasanas (Vajrasana, Shashankasana, BaddhaKonasana, Bhujangasana, and Shavasana), Pranayama (AnulomVilom and Bhramari Pranayama), and meditation to the intervention group. The duration of each session was 30-40 min, including 10-15 min of yogaasanas, 10 min of Pranayama, and 5-10 min of meditation and relaxation. The total duration of the intervention was 21 days. Pre-test data were collected on day one from both groups at the irrespective workplaces. From day 2-6, the intervention group practiced the intervention during an allotted time within their work hours, under the direct supervision of the researcher, in a designated quiet room within the institution. From day 7-21, participants continued the practice independently, with daily telephone reminders, and adherence was monitored using a daily practice log, which was submitted at the end of each week. The control group continued with routine work without any intervention. Post-test assessment was conducted on day 22 for both groups at the workplace.
Statistical analysis
-
The data was recorded in an Excel sheet and analysed using SPSS version 27.
-
Chi-square test was applied to assess demographic variable homogeneity.
-
Normality was tested using the Shapiro-Wilk test and Q-Q plot, which indicated that the data were approximately normally distributed.
-
Levene’s test was used to check the assumption of homogeneity of variance. Parametric tests were therefore applied for comparison: the paired samples t-test for within-group comparisons and the independent samples t-test for between-group comparisons.
-
The chi-square test was used to find the association of stress, anxiety, and quality of sleep scores with the selected demographic variables.
Ethical consideration
The Institutional Ethics Committee was granted permission (YEC-1/2023/135). Formal written permission was obtained from the administrative authorities of the university. Subjects were informed about the nature and purpose of the study before the data collection, and informed consent was obtained. They were given full autonomy to take part in the research.
RESULTS
A total of 84 menopausal women participated in the study, with 42 assigned to the intervention group and 42 to the control group. Both groups were homogeneous since there was no significant difference across the variables (p >0.05). The majority of participants in both the intervention (20, 47.6%) and the control group (19, 45.2%) belonged to the age group of 50-54 years. Most women had attained menopause between 45 and 49 years, with 25 (59.5%) in the intervention group and 24 (57.1%) in the control group. The majority were married and had two children. More than half of the participants experienced natural menopause, accounting for 34 (81%) in the intervention group and 29 (69%) in the control group [Table 1].
| Demographic variables | Intervention group f (%) | Control group f (%) | p value* |
|---|---|---|---|
| Age in years | |||
| a) 45-49 | 11 (26.2) | 10 (23.8) |
0.95 |
| b) 50-54 | 20 (47.6) | 19 (45.2) | |
| c) 55-59 | 9 (21.4) | 10 (23.8) | |
| d) ≥60 | 2 (4.8) | 3 (7.2) | |
| Age at menopause | |||
| a) 45-49 | 25 (59.5) | 24 (57.1) | 0.82 |
| b) 50-54 | 17 (40.5) | 18 (42.9) | |
| Marital status | |||
| a) Married | 35 (83.3) | 33 (78.6) | 0.57 |
| b) Widow | 7 (16.7) | 9 (21.4) | |
| Number of children | |||
| a) No children | 2 (4.8) | 2 (4.8) |
0.90 |
| b) 1 | 9 (21.4) | 6 (14.3) | |
| c) 2 | 20 (47.6) | 21 (50) | |
| d) 3 | 8 (19) | 8 (19) | |
| e) ≥4 | 3 (7.2) | 5 (11.9) | |
| Level of education | |||
| a) Primary school | 34 (81) | 28 (66.7) | 0.13 |
| b) High school | 8 (19) | 14 (33.3) | |
| Type of menopause | |||
| 1. Natural | 34 (81) | 29 (69) | 0.20 |
| 2. Surgical | 8 (19) | 13 (31) | |
*p > 0.05 is not statistically significant, statistics used is the chi-square test.
In the intervention group, most participants (41, 97.6%) reported moderate stress at the pretest. By the post-test, 11 (26.2%) of participants reported low stress, while 31 (73.8%) experienced moderate stress. In contrast, all participants (42, 100%) in the control group reported moderate stress in both the pretest and post-test [Figure 1].
Regarding anxiety levels, during the pretest, most participants in the intervention group (30, 71.5%) experienced moderate anxiety. However, at the post-test, the majority (27, 64.3%) reported mild anxiety. In the control group, the pretest showed that most participants (27, 64.3%) had moderate anxiety, and this trend continued in the post-test, where 33 (78.6%) of participants still had moderate anxiety [Figure 2].
Concerning sleep quality, all participants in the intervention group (42, 100%) experienced poor sleep quality in the pretest. By the post-test, 14 (33.3%) reported good sleep quality, while 28 (66.7%) still had poor sleep quality. In the control group, all participants (42, 100%) experienced poor sleep quality at both the pretest and post-test [Figure 3].
The comparison of pretest and post-test scores of stress, anxiety, and sleep quality within the intervention and control groups was carried out using a paired sample t-test, which shows a significant reduction in the level of stress in the intervention group (p <0.001) after the MBI. There was a decrease in mean anxiety score in the intervention group from pretest to post-test (p <0.001). Similarly, marked improvement was also noticed in the sleep quality among the participants of the intervention group (p <0.001). Whereas no statistical difference was found within the control group (p >0.05) [Table 2].
| Variables | Group | Pretest | Post test | t value | p value |
|---|---|---|---|---|---|
| Mean± SD | |||||
| Stress | Intervention | 19.69±2.56 | 15.69±2.70 | 9.52 | <0.001* |
| Control | 19.62±2.28 | 19.1±2.41 | 1.42 | 0.163 | |
| Anxiety | Intervention | 12.26±2.14 | 8.88±2.53 | 14.03 | <0.001* |
| Control | 11.95± 2.47 | 12.55± 1.90 | -1.581 | 0.122 | |
| Sleep quality | Intervention | 8.4±1.17 | 6.38±1.49 | 12.52 | <0.001* |
| Control | 7.93± 1.42 | 8.17± 1.52 | -0.961 | 0.342 | |
Test statistics used: Paired sample t-test, *p <0.05 significant, SD: Standard deviation.
An independent t-test was computed to compare pre- and post-test scores of stress, anxiety, and quality of sleep between the intervention and control groups. During the pretest, there were no significant differences between the intervention and control groups in terms of stress, anxiety, or sleep quality (p >0.05). However, following the intervention, a statistically significant reduction was observed in stress (p <0.001), anxiety (p <0.001), along with marked improvement in sleep quality (p <0.001) in the intervention group compared to the control group. The overall results suggest that the MBI was effective in reducing stress, anxiety, and improving sleep quality [Table 3].
| Variables | Test | Intervention group | Control group | t value | p value |
|---|---|---|---|---|---|
| Mean± SD | |||||
| Stress | Pre | 19.69 ± 2.56 | 19.62 ± 2.28 | -0.13 | 0.89 |
| Post | 15.69 ± 2.71 | 19.1 ± 2.42 | 6.08 | <0.001* | |
| Anxiety | Pre | 12.26 ± 2.14 | 11.95 ± 2.48 | -0.62 | 0.54 |
| Post | 8.88 ± 2.53 | 12.55 ± 1.9 | 7.51 | <0.001* | |
| Sleep quality | Pre | 8.4 ± 1.17 | 7.93 ± 1.42 | -1.67 | 0.09 |
| Post | 6.38 ± 1.5 | 8.17 ± 1.53 | 5.41 | <0.001* | |
Test statistics used: Independent sample t-test, *p <0.05 significant, SD: Standard deviation.
Table 4 presents the association between the study variables and selected demographic factors. No significant association between pretest stress scores and the selected demographic variables was found (p >0.05). However, a significant association was observed between the place of work at the university and the type of menopause with pretest anxiety scores among postmenopausal women (p <0.001 and p = 0.053, respectively). Additionally, pretest sleep quality scores were significantly associated with several demographic variables, including age (p = 0.02), marital status (p = 0.01), number of children (p = 0.008), and level of education (p <0.001).
| Sr. No. | Demographic variables | Stress | Anxiety | Quality of sleep | |||
|---|---|---|---|---|---|---|---|
| χ 2 | p | χ 2 | p | χ 2 | p | ||
| 1. | Age in years | 0.75 | 0.860 | 2.77 | 0.428 | 9.78 | 0.02* |
| 2. | Age at menopause | 1.32 | 0.249 | 0.62 | 0.428 | 0.006 | 0.936 |
| 3. | Marital status | 1.31 | 0.252 | 1.31 | 0.252 | 5.64 | 0.01* |
| 4. | Number of children | 5.00 | 0.287 | 7.87 | 0.096 | 13.85 | 0.008* |
| 5. | Level of education | 0.119 | 0.730 | 3.42 | 0.064 | 11.04 | <0.001* |
| 6. | Type of menopause | 0.78 | 0.374 | 3.743 | 0.053* | 0.66 | 0.414 |
Test statistics used: Chi-square(χ 2) test, *p <0.05 significant.
DISCUSSION
The present study highlights the effectiveness of a combined MBI in improving stress, anxiety, and sleep quality among menopausal women. The majority of women in both groups had attained menopause between 45-49 years. Similar age distributions have been reported in earlier studies, where most menopausal women were in their early fifties, suggesting that this age group represents a critical period for targeted interventions.[12]
In the present study, a considerable proportion of women reported moderate levels of stress, anxiety, and sleep disturbances, findings that are consistent with earlier studies by Satpathy and Lenka,[35] Jaydeepa et al.,[36] and Wiranda and Dewi.[37] These results highlight the substantial psychological and sleep-related burden experienced by menopausal women and underscore the need for structured, non-pharmacological interventions.
Although studies examining integrated interventions comprising yoga asanas, pranayama, and meditation are limited, the observed outcomes are supported by evidence from studies evaluating the individual components of the intervention. The MBI in this study led to significant reductions in stress and anxiety and improvement in sleep quality among menopausal women. A randomised control trial using yoga by Susanti et al.[38] demonstrated improvements in menopausal symptoms and sleep quality. A 12-week Hatha Yoga program was shown to enhance psychological well-being and QoL among perimenopausal women.[39] Fadlilah et al.[40] further supported the beneficial effects of yoga on both mental health and sleep outcomes. Similarly, few studies have explored the impact of meditation on menopausal symptoms and sleep problems among working women. The practice of meditation has been shown to improve sleep quality[41] and alleviate the symptoms of anxiety, depression, and sleep quality in perimenopausal symptoms.[42] In addition, Bhramari Pranayama demonstrated a significant reduction in anxiety after 10 days of intervention, along with improvements in selected physiological parameters.[43]
While previous studies on yoga and MBIs among menopausal women have largely employed long-duration, supervised, and comprehensive programs, the present study uniquely demonstrates the effectiveness of a brief, component-based intervention consisting of selected yoga asanas, deep breathing, and meditation. Despite its limited and minimally supervised format, significant improvements were observed in stress, anxiety, and sleep quality. The home-based, self-paced approach enhanced feasibility for working women, particularly Group D workers with demanding schedules, thereby strengthening the real-world applicability of the intervention. These findings highlight the potential of low-cost, scalable mind-body practices as practical strategies for managing menopausal symptoms in occupational settings. Overall, the findings of the present study support the inculcation of MBI in managing the stress, anxiety, and sleep-related issues among menopausal women by its effective and safe practical applications.
Limitations of the present study include that outcomes were based on self-reported measures, which may be subject to response bias. Although long-term follow-up was not undertaken, the study provides valuable evidence on the short-term effectiveness of the intervention and lays the foundation for future research to examine the sustainability of its effects.
CONCLUSION
The present study demonstrates that a brief, component-based MBI consisting of selected yogaasanas, Pranayama (structured breathing techniques), and meditation is effective in reducing stress, anxiety, and sleep disturbances among menopausal working women. Despite minimal supervision and home-based practice, significant improvements were observed, highlighting the feasibility of such interventions for women engaged in physically demanding and time-constrained occupations. These findings support the integration of low-cost, non-pharmacological mind-body practices into workplace and community-based health programs to promote the well-being of menopausal women.
Acknowledgment
The authors thank all the participants for their active participation and interest in the study. We also appreciate the University for granting permission to conduct our research.
Ethical approval
The research/study was approved by the Institutional Review Board and Yenepoya Ethics Committee-I, number YEC-1/2023/135, dated 30th June 2023.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.
References
- A study on women’s health information needs in menopausal age. BMC Women’s Health. 2021;21:434.
- [PubMed] [Google Scholar]
- The effect of menopause on women’s health: A Systematic review. In Review. 2024;17:e1968.
- [Google Scholar]
- Effectiveness of structured teaching programme and yoga therapy on menopausal symptoms among menopausal women residing in selected villages at Namakkal district. JETIR. 2021;8:1071-7.
- [Google Scholar]
- A study to assess the menopausal problems among postmenopausal women residing in selected rural and urban areas of Jagadhri, Yamuna Nagar, Haryana. IJANM 2022:397-400.
- [CrossRef] [Google Scholar]
- Menopause uncertainty: The impact of two educational interventions among women during menopausal transition and beyond. Prz Menopauzalny. 2020;19:18-24.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Prevalence of menopausal symptoms and attitudes towards menopausal hormone therapy in women aged 40–60 years: A cross-sectional study. BMC Womens Health. 2023;23:472.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Prevalence and severity of menopausal symptoms and the quality of life in middle-aged women: A study from Sri Lanka. Nurs Res Pract. 2019;2019:2081507.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Prevalence of menopausal symptoms and its effect on quality of life among rural middle aged women (40–60 Years) of Haryana, India. Int J App Basic Med Res. 2020;10:183.
- [Google Scholar]
- Prevalence of menopausal symptoms among peri-menopausal women in Suburban area of Chandigarh, India. Int J Nurs Educ Res. 2021;9:69-73.
- [Google Scholar]
- The relationship between social support, stressful events, and menopause symptoms. PLoS One. 2021;16:e0245444.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- A cross-sectional survey to assess the level of stress among postmenopausal women in rural Valparai, at Coimbatore district, Tamilnadu, India. Int J Sci Res. 2020;9:56-9.
- [Google Scholar]
- A cross-sectional study to determine stress level among postmenopausal women in rural area of Bhagalpur (Bihar) Indian J Appl Res. 2023;13:55-7.
- [CrossRef] [Google Scholar]
- Factors affecting the development of anxiety in postmenopausal women: A cross sectional study in coastal areas. Indones J Obstet Gynecol 2018:6. https://doi.org/10.32771/inajog.v6i3.775
- [Google Scholar]
- Managing anxiety among postmenopausal women through yoga. Int J Indian Psychol. 2021;9:31-5.
- [Google Scholar]
- Sleep quality and its association with menopausal and climacteric symptoms. Rev Bras Enferm. 2021;74:e20201150.
- [Google Scholar]
- Sleep disturbance associated with the menopause. Menopause. 2024;31:724-33.
- [CrossRef] [PubMed] [Google Scholar]
- Impact of menopausal symptoms on work and careers: A cross-sectional study. Occup Med (Lond). 2023;73:332-8.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Influence of menopause-related issues in the working environment of college teachers In Kerala. Afr J Biomed Res. 2024;27:3427-31.
- [CrossRef] [Google Scholar]
- Severity of menopausal symptoms on quality of life among working women. J Educ Health Promot. 2024;13:35.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Effectiveness of deep breathing and walking exercise in reducing menopausal symptoms among post-menopausal women of Tripura, India. Int J Community Med Public Health. 2021;8:2881.
- [CrossRef] [Google Scholar]
- Evaluation of stress and its influence on quality of life in postmenopausal women. Asian J Pharm Clin Res. 2016;9:199-201.
- [CrossRef] [Google Scholar]
- Effects of mind-body exercise on perimenopausal and postmenopausal women: A systematic review and meta-analysis. Menopause. 2024;31:457-6.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Effect of mind-body approaches on menopausal symptoms among women: A community-based pilot study. J Health Allied Sci NU. 2021;11:061-5.
- [Google Scholar]
- Mind–body therapies for sleep disturbances, depression, and anxiety in menopausal women: A systematic review and meta-analysis of randomized controlled trials. Front Public Health. 2025;13:1686981.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Effects of physical and mind-body exercise on sleep quality in individuals with diabetes mellitus: A systematic review and meta‐analysis. J Prev Med Public Health. 2025;58:1-10.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Efficacy of mind-body exercise to reduce sleep disturbance and depression among older adults: A systematic review and meta-analysis. Asian Nurs Res (Korean Soc Nurs Sci). 2024;18:408-19.
- [CrossRef] [PubMed] [Google Scholar]
- The effect of mindfulness-based stress reduction on anxiety and sleep quality in informal family caregivers of cancer patients: A randomized controlled trial. BMC Nurs. 2025;24:1375.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Mindfulness-based stress reduction group training improves of sleep quality in postmenopausal women. BMC Psychiatry. 2022;22:254.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- A study of assessment menopausal symptoms and coping strategies among middle age women of North Central India. Int J Community Med Public Health. 2018;5:4470.
- [CrossRef] [Google Scholar]
- Yoga increases the quality of sleep in menopause women. Indones J Med. 2019;4:278-84.
- [CrossRef] [Google Scholar]
- Psychometric analysis of the perceived stress scale among healthy university students. Neuropsychiatr Dis Treat. 2020;16:2389-96.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Psychometric properties of the general anxiety disorder 7-item (GAD-7) scale in a heterogeneous psychiatric sample. Front Psychol. 2019;10:1713.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Evaluation of sleep quality among nursing faculty: Application of the Pittsburgh sleep quality index—A descriptive correlational study. Nursing Open. 2022;9:339-48.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Stress a hidden problem in the life of menopausal women. Int J Indian Psychol. 2020;8:938-47.
- [Google Scholar]
- Effect of yoga therapy on level of anxiety among menopausal women. IJED. 2018;1:54-9.
- [Google Scholar]
- Effects of yoga on menopausal symptoms and sleep quality across menopause statuses: A randomized controlled trial. Nurs Health Sci. 2022;24:368-79.
- [CrossRef] [PubMed] [Google Scholar]
- Considering the impact of yoga on psychological well-being and quality of life in perimenopausal women: A randomized controlled trial. Teor Metod Fiz Vihov. 2025;25:331-9.
- [CrossRef] [Google Scholar]
- Promoting mental and sleep health in menopausal women: The effectiveness of yoga and brain gymnastics interventions. Healthc Low-resour S. 2025;13:14128.
- [CrossRef] [Google Scholar]
- Meditation as an approach to lessen menopausal symptoms and insomnia in working women undergoing the menopausal transition period: A randomized controlled trial. Advances in Integrative Medicine. 2021;8:278-84.
- [Google Scholar]
- Effect of mindfulness meditation training on anxiety, depression and sleep quality in perimenopausal women. Nan Fang yike da xuexue bao= J South Med Univ. 2019;39:998-1002.
- [Google Scholar]
- Effect of Bhramari pranayama on menopausal women. SBV J Basic, Clin Appl Health Sci. 2023;6:73-8.
- [CrossRef] [Google Scholar]