health is the fundamental rights of every human being and improvement of educational methods is a public duty ( 1 ) . considering the limited research in this field , a programmed approach to learning is evident in various cycles of life including menopause as the most critical period of women s life ( 2 ) . lack of knowledge and access to relevant information is the major challenge faced by menopausal women intensified by contradictory information ( 3 ) . women s awareness of learning styles consistent with social norms and context is the key to solving this problem ( 4 ) . quality of life and menopausal symptoms are closely related concepts ( 5 ) and would affect women s quality of life ( physiological and psychosocial ) ( 6 ) . health education intervention strategy is one of the alternative strategies ( 7 ) for improving women s attitudes and coping with menopause symptoms ( 8) identified as one of the sub - categories of health promotion programs ( 9 ) . this may promote the health behavior of the patients and their families and will change life threatening life styles ( 10 ) . in a group discussion considering post - menopausal women s opinion about application of instructional methods , 83% of participants were demanding information about menopause and strategies to deal with it through educational methods . there was significant relationship between severity of menopausal symptoms and decreasing level of life quality , too ( 11 ) . a group expressed willingness to apply several instructional methods to overcome these symptoms ( 12 ) . one of these methods is  support group  which can be developed in different populations that , with regard to this issue and social and cultural context , is reflected in the focus of health interventions ( 13 ) . this method is an efficient tool in quality of life research due to mutual exchange of experiences , promotion of critical thinking and verbal skills ( 14 ) . rotem examined the effectiveness of an instructional program on support group to cope with physical , sexual , psycho - social menopause symptoms ; the intervention effect was significant ( 8) . rostami performed an educational program using the lecture and the q & a methods that led to improvement of menopausal symptoms including physical , sexual and psycho - social aspects ( 12 ) . the support group of mental and physical health of alzheimer s caregivers had a minor impact on the burden of care and would only increase their knowledge ( 15,16 ) . however , according to some studies using this method on caregivers of patients with psychotic disorders and schizophrenia would lead to increased awareness as well as reducing stress , easing burdens of care and enabling them to better deal with the patient ( 17 ) . considering low number of studies investigating proper instructional methods lack of educational support group programs , disregarding women as emotional or psychological center of family life and especially great effect of improving the quality of life on promoting family and , consequently , community health ( 18 , 19 ) this study examined the effect of structured curriculum by using support group , on quality of life in postmenopausal women . a single - blind trial was conducted in august to december 2010 at saadatmandi health center ( robatkarim , iran ) . the study population included 110 healthy postmenopausal iranian , literate , muslim and married women . with ci of 95% and power of 80% the maximum sample size was obtained by using s=1.01 and quality of life scores on physical dimension ( 8) . the total sample was estimated to be 110 cases . the minimum number of samples in each group was 55 ( predicted 10% drop ) . first the subjects were selected using non probability - convenient sampling and then were randomly divided into two test and control groups . inclusion criteria were as follows : not using hormone replacement and no smoking within 6 months and till the end of the study period , no history of hysterectomy , body mass index ( bmi ) less than 30 ( kg / m ) and not employed in any health systems . criteria for exclusion of the study were subject s unwillingness to continue participation in the trial , not answering the questions , not ongoing participation in the sessions , presence of physical or mental diseases during the intervention period , possible incidence of adverse events during intervention and before collecting the second questionnaire data ( three months after completing the intervention ) . the support group program was developed for 6 groups ( five nine - member and one ten - member groups ) . this program was performed for each of the groups on a particular day of the week ( ten sessions of 120 minutes each ) . to interact and communicate effectively with the participant , the researcher explained the pre - designed research objectives and methods 30 minutes before the program began . then participants discussed the subject for about 70 minutes ; during the last 20 minutes of the session the researcher classified the subjects . due to importance of face - to - face communication , topics of the sessions included : 
 _ the first session : the menopause and its symptoms , stress , memory problems during menopause_the second session : the meaning of happiness and social relationships and the effect of menopause on them_the third session : purpose of the menopausal vasomotor symptoms and causes of them_the forth session : the importance of sex with spouse in islam , sexual signs in menopause period including abstain from sexual relations and pain during sexual intercourse_the fifth session : vaginal dryness , consistency and appearance of the skin after menopause_the sixth session : incontinence of urine while coughing or sneezing and frequent urination in postmenopausal women_the seventh session : sleep disorders and their causes after menopause_the eighth session : reduced physical strength and joint problems associated with menopause_the ninth session : relaxation techniques , importance of relaxation training_the tenth session : the importance of aerobic exercises and training _ the first session : the menopause and its symptoms , stress , memory problems during menopause _ the second session : the meaning of happiness and social relationships and the effect of menopause on them _ the third session : purpose of the menopausal vasomotor symptoms and causes of them _ the forth session : the importance of sex with spouse in islam , sexual signs in menopause period including abstain from sexual relations and pain during sexual intercourse _ the fifth session : vaginal dryness , consistency and appearance of the skin after menopause _ the sixth session : incontinence of urine while coughing or sneezing and frequent urination in postmenopausal women _ the seventh session : sleep disorders and their causes after menopause _ the eighth session : reduced physical strength and joint problems associated with menopause _ the ninth session : relaxation techniques , importance of relaxation training _ the tenth session : the importance of aerobic exercises and training three of the sample in support group ( 2 cases due to lack of attending the sessions and 1 due to moving to the other city ) and 2 cases in control group ( 1 participant due to divorce and 1 due to use of hormone therapy during intervention ) were lost ; the number of participants in test and control group decreased to , respectively , 52 and 53 . data gathering tool was  menopause specific quality of life ( menqol ) questionnaire  ; demographic information was added to it , too . demographic questions were closed questions and short answers about demographic variables including age and menopausal age of the case , height and weight , bmi , number of children ( living or dead ) , education level , employment and economic status . this is a reliable and standardized questionnaire for assessing quality of life post - menopausal women , designed and standardized by hiditch et al . in toronto , canada menqol consisted of 99 closed questions ( ratings rate from zero to six ) in likert scale which included 4 dimensions ( 3 questions on vasomotor , 7 questions on psychosocial dimension , 16 questions on physical dimension , 3 questions on sexual dimension ) . content validity was used to assess validity and the test - retest analysis was used to assess reliabilities of the questionnaire ( r=0.084 ) . according to scoring and points and number of questions ( 29 questions ) , minimum and maximum scores for vasomotor , psychosocial , physical and sexual dimensions were , respectively , ( 3 to 24 ) , ( 7 to 56 ) , ( 16 to 128 ) , ( 3 to 24 ) ; the total for life quality was ( 29 to 232 ) . scores close to maximum criterion indicated severity of the menopause symptoms and low quality of life . demographic data and the questionnaire were prepared before the training started and three months after the last training session by going to participants houses . qualitative variables were analyzed using chi - square tests and quantitative variables were analyzed using mann - whitney and wilcoxon test , paired t - test and independent t - test the wilcoxon test and paired t - test were respectively used to compare  before  and  after  scores of ( respectively ) vasomotor and psychosocial , physical and sexual dimensions . the first was used to kolmogorov - smirnov test ( ks ) for testing normality , based on scores before & after vasomotor dimension had abnormal distribution , so was used non parametric tests ( mann - whitney and wilcoxon test ) . psychosocial , physical and sexual scores had normal distribution , so was used parametric tests ( paired t - test and independent t - test ) . the ethical issues in this study included introducing the researcher to the subjects , giving necessary explanation on content , getting written consent from the participants , informing them of the voluntary nature of participation in or withdrawal from the study and ensuring the confidentiality and privacy of information . the two test and control groups were matched in age , menopause age , bmi , education , employment and economic status , number of children ( live or dead ) before intervention and there were no significant differences ( table 1 ) . but after intervention there were great differences in scores of vasomotor ( p=0.001 , z=1.58 ) , psychosocial ( p=0.007 , t=0.743 ) , physical ( p= 0.001 , t= 3.797 ) , sexual ( p=0.001 , t=0.383 ) , and qol score ( p= 0.001 , t= 4.422 ) . regarding support group participations , there was significant difference between the scores of these dimensions before and after comparison and qol score after three months , but no significant difference was found in control group ( table 2 ) . this survey demonstrated the positive impact of 10-week consecutive structural program by using support group on quality of life and symptoms of menopause ( vasomotor and psychosocial , physical , sexual dimensions ) . a positive effect of using support group method on promoting women s attitudes towards menopause and its physical and psychosocial signs is reported . the current research evaluated the effect of support group intervention on vasomotor , psychosocial , physical , sexual dimensions ; the effect of educational intervention on these 4 dimensions was positive . although evaluating the effect of the intervention on women s attitude was not primary goal of the recent intervention . the effectiveness of this method was studied in postpartum distress physical and mental health of alzheimer and psychotic patients caregivers ( 8,15 ) . hey - chung investigated the impact of support group program of postpartum distress of 60 women within 23 days of delivery ( 15 ) , where implementation of this kind of intervention ( similar to hey - chung s study in intervention method ) has led to significant differences in vasomotor ( hot flashes and night sweats ) and sexual symptoms ( vaginal dryness , abstain from sexual relations and changes in sexual desire ) , psychosocial and physical dimensions and quality of life . so it can be said that support group intervention not only has a positive effect on women on reproductive age but is effective in promoting qol of postmenopausal ones and can help improve its signs . the problems of the research by hey - chung included lack of control group , difficulty of the content presented in the sessions ; besides , as the authors acknowledged , content of the study was not proportionate to maternal educational level . while in current study appropriateness of the content with educational level has been taken into account , it was written in a clear manner with no medical terms . herbert s study on physical and mental health of alzheimer s caregivers indicated that , despite the 8-week intervention program , the participants showed a slight increase in knowledge and the intervention did not affect the other variables including behavioral indicators optimization ( 16 ) . tong chen conducted a systematic review of researches on the effect of using support group method on psychotic patients caregivers ( caregivers of patients with schizophrenia and other psychotic disorders ) and reported that instructional support group design had significant effect in mean score of stress , knowledge increase and better deal with these patients ( 20 ) . rostami made a semi - empirical study of direct education effect on the quality of life of postmenopausal women ; the results indicated positive effect of lecture on promoting scores of sexual , physical and psychosocial dimensions but had no significant impact on vasomotor score ( 12 ) . measured variables were similar to current research although the method used by rostami was direct learning method . the difference between rostami s study and ours included lack of control group , using direct method of teaching , impossibility of active participation of the samples in the issues , low education level of participants for implementation of educational program . rostami used menqol questionnaire with 26 components . in most societies specific attention is focused on the problems of women during pregnancy but not on menopause problems in middle - aged and elderly women . regarding constantly increasing number of this group of women ( 18,21 ) and lack of studies on proper learning styles ( based on cultural and social context ) it will be necessary to address the personal and social aspects of menopause problems which then helps to relieve its signs . life style differences among participants , effectiveness of mass media educational programs , lack of knowledge about family structure such as marital life , nuclear and extended families as well as family conflicts . considering the lack of research in this area and , also , increasing number of postmenopausal women , it is recommended to use available low - cost training methods including booklets and pamphlets . life style differences among participants , effectiveness of mass media educational programs , lack of knowledge about family structure such as marital life , nuclear and extended families as well as family conflicts . considering the lack of research in this area and , also , increasing number of postmenopausal women , it is recommended to use available low - cost training methods including booklets and pamphlets . using the support group method will help to reduce the bothersome signs of menopause as well as vasomotor , physical , psychosocial and sexual symptoms . this will subsequently improve the quality of life . considering the growing population of postmenopausal women , as the most vulnerable groups in society , it is recommended to uses ethical issues ( including plagiarism , informed consent , misconduct , data fabrication and/or falsification , double publication and/or submission , redundancy , etc ) have been completely observed by the authors .