The study showed the severity of the menopausal symptom and all of its dimensions have a negative correlation with body image. Also, regression analysis showed the severity of menopausal syndrome is an associated factor with women’s body image. By this finding, Włodarczyk & Dolińska-Zygmunt (2017) showed women with severe vasomotor and psychosomatic symptoms experience low self-confidence and body function . Perimenopausal physical and psychological changes such as gaining weight, insomnia, flushing, and night sweats as well as elderly symptoms like changes in skin and hair, sexual dysfunction, and osteoporosis can change women’s attitudes and feelings about their body image [24, 39]. Ginsberg et al. (2016) found a negative correlation between high body mass index with positive body image which means obese postmenopausal women have usually dissatisfied body image .
There is evidence to suggest that women’s interpretation of their menopausal experiences relates to their attitude towards menopause and body image. For example, women with a negative attitude towards menopausal physical changes, like weight gain, think that makes them less sexually desirable . A negative attitude towards menopause is associated with body dissatisfaction, self-objectification, appearance-related aging anxiety, and lower perceived attractiveness during the menopausal transition [40,41,42]. A study on 350 women in menopause showed that 74.4% of them feel losing attractiveness after menopause . Therefore, menopausal symptoms are associated with a negative attitude about attractiveness, low self-esteem, and body image . Negative perception about menopausal changes associated with low scores for self-efficacy . Also, changes in the appearance of postmenopausal women are associated with body image concerns which in turn may influence their quality of life . Also, appearance-related aging concerns and body comparison are two sociocultural factors that moderated the association between menopausal status and disordered body image concerns .
We showed a significantly strong negative correlation between urogenital symptoms as a dimension of menopausal symptoms with women’s body image and all of its dimensions. It is consistent with the results of other studies showing that women with urogenital symptoms such as urinary incontinence or dyspareunia are unsatisfied with their body image [20, 47]. In this accordance, another study also showed urogenital symptoms especially stress incontinence can have negative impacts on menopausal women’s body image  as well as on their psychological health [48, 49]. A comparative study showed women with positive body image had less vaginal moistures and so less orgasmic problem and dyspareunia and then more sexual satisfaction (Zamankhani, 2005).
The results also demonstrated a significant correlation between women’s body image with some socio-demographic factors such as the educational level of the women and their husband; their number of children, marital status, income, employment, and housing status in menopause. Although there were no similar studies to show these associations in menopausal women, some studies showing these correlations in other groups of people. For example, a study on 1200 men and women showed a negative correlation between the participants’ education with their body dissatisfaction . Another study on 126 women with breast cancer also showed a positive correlation between educational levels with their body image . Also, a study on 1841 women demonstrated a relationship between individual characteristics such as women’s education level with women’s attitude towards body image and management . It seems high-level educated women manage their menopausal symptoms better than low-level educated women.
There was a positive correlation between monthly household incomes with the women’s body image. Also, the regression analysis showed that monthly household income is an associated factor with body image. Similar results were shown in other studies on women affected by breast cancer  or among other women . It may be because monthly household incomes are more common among empowered educated, employed, and homeowner women who manage their menopausal symptoms and so have appropriate body image.
The results showed body image of employed women was also significantly higher than unemployed ones. A similar result was shown in women with breast cancer . It was shown that employment impacts women’s attitude towards body management . Also, Housing ownership has a positive impact on the body image of women in menopause. A similar finding was also demonstrated in another study among women in all age groups . Therefore, the present study showed the positive relationships between body image with education, employment, income, and housing ownership in menopause. These factors are the indexes of women’s empowerment  and so the study shows the relationship between women’s empowerment with the body image of women during menopause. Therefore, it can be postulated that women’s empowerment could be related to women’s body image and self-esteem.
This study showed a negative correlation between the numbers of children with lower limbs body image. It seems that the high number of children associate with a high number of vaginal deliveries may lead to a negative lower body image. Besides, the finding of the present study showed that married women have lower scores of body image comparing to single/widow/separated women. It was reported that married women are more unsatisfied with their bodies comparing to single women . So, marital status is an influencing factor on women’s attitude towards body management .
This was a cross-sectional study that is not able to assess the cause and effect relationship; however, we used regression analysis to find out factors associated with the body image of postmenopausal women as the dependent variable. The regression model demonstrated the two factors including the severity of menopausal symptoms and monthly household income, can be the factors associated with the women’s body image. Therefore, further analytical studies are necessary to assess the cause and effect relationship between the severity of menopausal symptoms with the women’s body image. This study was the first study showing the relationship between all dimensions of menopausal symptoms with all dimensions of body image in menopausal women. This study could be a base for analytical design studies and interventional studies to improve postmenopausal women’s health.
Strengths and limitations
The strength of the study was that women were not using hormone replacement therapy or phytoestrogenic medicines and so the severity of menopausal symptoms was not affected by these treatments. Also, studies about the effective factors on the body image of menopausal women are rare and this study can be a base for future researches.
A limitation of the study was that the participants were from Tehran, and since sociocultural and economic factors may be effective on postmenopausal women’s body image, perhaps further studies are necessary to be conducted in other communities with different conditions. Another limitation of the present study could be that the cross-sectional study did not permit the assessment of cause and effect relationships between severity of menopausal symptoms and also other socio-demographic characteristics with body image. We also recruited the samples from the public primary health care services that rich women are rarely using these services. Some factors were not measured; for example, BMI was not measured as many postmenopausal women are not aware of the meaning of BMI, and also, we could not measure their weight and height in the health centers because of corona-raised limitations. However, the study might have gained by having actual measurements of body size and proportions correlative with subjective image perception.
These factors such as BMI, habits like smoking, and alcohol use dietary and physical activities are suggested to be considered in future studies. It should be also mentioned that in our previous studies that alcohol use and smoking are rare among this group of women. Also, they are sensitive questions in the country, that responses may not be reliable.