Effect of Lifestyle Intervention on Menopausal Symptoms, Sleep Quality, and Anxiety in Peri- and Postmenopausal Women

Inclusion Criteria: Female patients aged 40 to 55 years presenting to the Educational Family Health Center Categorized into one of the defined reproductive stages: late perimenopause, early postmenopause (0-5 years), or late postmenopause (\>5 years) Reporting clinically significant complaints in at least one key menopausal domain: hot flashes/night sweats, sleep problems, or mood changes (anxiety, irritability, depressive mood) Baseline Menopause Rating Scale (MRS) total score between 9 and 31 (inclusive) Literate and capable of comprehending and completing study questionnaires Accessible for the 24-week follow-up evaluation History of compensated chronic disease (e.g., controlled diabetes mellitus, hypertension, atherosclerotic cardiovascular disease, hyperlipidemia) Provision of written informed consent Exclusion Criteria: Age younger than 40 or older than 55 years History of hysterectomy or bilateral oophorectomy Severe cognitive impairment or inability to complete questionnaires Inability or refusal to provide written informed consent Previously diagnosed severe psychiatric illness (e.g., psychotic disorders, bipolar disorder) Baseline Menopause Rating Scale (MRS) total score \<9 or ≥32 History of decompensated chronic disease (e.g., uncontrolled hypertension, unstable cardiovascular disease, decompensated diabetes mellitus)