The importance of emotional health is equivalent to the important of physical health. This combination produce a healthy body with a healthy mind thus creating the individual that are able to respond and act well to their surroundings. There is many scholar that refer emotional health as mental health because they believe that this two term can be used interchangeably. According to Galderisi et. al (2015), as modified according to the World Health Organization (WHO) definition, they defined mental health as a state of internal equilibrium between body and mind where the individual can realize his or her full abilities and at the same time can cope with the life stressor thus can work effectively and being productive to be able contribute something to the community. They also emphasize on the emotional regulation in order to achieve the harmony in mind by being able to recognize, express and modulate own emotion as well as empathize with other. On the other hand, Extremera and Berrocal (2002), in their paper have defined emotional health as ability to process the emotional information accurately and effectively thus being able to manage own emotion in reaction to surrounding event.

Women as the middle age and having menopause are detected being vulnerable to many emotional related problem such as depression, anger and anxiety (Extremera & Berrocal, 2002). This statement have been supported by many previous research such as Hammar et. al (1984) and Kuh et. al (1997) where they also identified that middle-aged women experience a wide range of physical and psychological symptoms in relation to menopause. Thus the aspect emotional management is important especially among middle age women who experiencing a transition period to allow and help them in identifying their condition and feeling and learn to accept it. When they are able to accept their own condition and feelings, then they will begin to understand why they are experience it and later able to decide on their action in response to those condition and feelings as accordingly. This can be a key indicator of success in leading the middle age women through managing their transition period or menopause. Li et. al (2002) , Dalal et. al (2015) and Baker et. al (2018) identifies emotional disturbances that occur frequently among middle age women is irritation, depressive mood, sleeping problems, fatigue and headache during menopause period either premenopausal or postmenopausal stage. Research done by Soares (2004), reveal that some women, during the peri-menopause and early post-menopausal years’ experience a “window of vulnerability” where they are facing a challenging physical and emotional discomforts that result in significant impairment in functioning and poorer quality of life.

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According to Baker et. al (2018), there is a high level of sleep disturbance in middle-aged women where almost a quarter of them report their disturbance in quality and intensity of sleep during menopausal stage. Specifically Li et al, (2002) and Baker et.al (2018), have found that women during pre-menopause had fewer sleeping problems but more stress than those at post-menopause stage. Sleep disturbances during menopause have been associated with estrogen deficiency (Dalal et. al, 2015). Sleep disturbance can lead to bad mood, higher blood pressure and loss of energy thus affecting the whole daily activity. Study done by Woods ; Mitchell (2010), have identified the linkage between sleep disturbance and mood disorder and vice versa. Rapkin (2007), stated that a number of studies have demonstrated strong relationships between self-reported hot flashes and sleep complaints.

Besides the sleep problem, during this transition period many of the women also complaint of an anxiety and panic attack without an unknown reason (Dalal et. al, 2015). Claudia et. al (2004) in their research found that the fluctuation in estrogen and progesterone can cause anxiety, panic or depression during menopause. However, frequent anxiety or panic attacks are not a normal part of menopause because not all women will develop a panic or anxiety disorder during menopause. The women stated that they were very sensitive and irritable without any apparent reason and this irritability was placing their relationship with their families under stress (Cifcili et.al, 2009). All these symptom can be control using hormonal therapy or prescribed medication for anxiety. Besides that, counselling and divertional therapy also helps treat the psychological symptoms such as this panic and anxiety.
Other than that, loss of confidence is a very common menopause symptom which can affect many areas of women life. Nearly half of women claim they no longer feel attractive, hurt pride, uselessness and lack of self-confidence (Lee at. al, 2011). Erbil (2017), stated the research showed over half of the women questioned said that they had lost their self-confidence especially related to their body image. He also found that there is a correlation between a negative body image and high level of depression. This kind of thought could lead someone to a sense of feeling of less belonging and worsen to the feeling of not worth living. This overall thought and feeling give a big impact in the women quality of life. On the other view, Cifcili et. al (2009), identified some participants in their research associated menopause with getting older and sees it as a stage of experiencing a various complications and possible loss of function. Surprisingly, these concerns seemed to lead them to take better care of their health.

With many physiological and psychological symptoms experiences by women during this transition period, this group of middle age women are at the largest scale for depression especially those with the history of depression. Together with all the changes associated with menopause, many middle-aged women are often occupied with other challenges. According to Erbil (2017), these changes maybe physical disease affecting them or their husband, the death of their spouse or parents, caring for ill family members, marital difficulties, and grown children leaving home. While according to Sloan ; Kornstein (2005), depression seems to be significantly linked to times of hormonal change in women which is during the menopause. They also have a supportive observations and data to establish this theory. However, the results of this study are contrary to the study conducted by Charney and Steward (1997). Various research have identified that women often complaint of feeling miserable and sad during this transition period (Dennerstein ; Soares, 2008). They also complain of losing their interest in the thing they used to feel excited about such as their hobbies and sex activity. Research by Dalal et. all (2015), found that the malaise is the sensation of discomfort that women experience through their mid-life where a women may feel uneasy, slow and passive . During this period of time, they prefer to stay at home and just lay back without doing anything. Result from research done by Elavsky (2009) found that increasing in physical activity improves physical self-worth and positive affect thus lead to improvements in quality of life in menopause women. On the other hand, a study done by Ozpinar ; Cevik (2016) stated that some of the study participants said that over the course of menopause, they had become more competent and gained a greater sense of freedom by gaining a better understanding on their personal development and changes, which in the end allow them express their opinions and elaborate on their emotional thinking. Despite of the some positive finding, it is still put the middle age women during menopause in the vulnerable position toward depression. With the assessment and identification of level of depression experienced by the women, doctors may prescribed antidepressant in combination with hormonal therapy or psychotherapy to control menopause symptom (David et, all). They said that experts prefer type of antidepressant that can effect a brain chemical called serotonin such as fluoxetine and citalopram.
Various opinions and views related to this issue can be found but the way of adaptation and perception is totally different from each individual. Various method available in order to avoid complications. The prompt recognition and early identification of the symptom is necessary to help this women through their transition stage of life positively. It is because many research have proven that despite of high prevalence and obvious effects of symptoms on quality of life, many women with menopausal symptoms do not seek treatment or receive therapy for these symptoms.


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