The aim of this clinical study is to determine the effect of mandala coloring on menopausal symptoms, sexual quality of life, and self-esteem in women during menopause period. The main questions the study aims to answer are as follows:

1. Does mandala coloring reduce the severity of menopausal symptoms in women?
2. Is there an increase in self-esteem levels among women who participate in mandala coloring after the intervention?
3. Is there an increase in the quality of sexual life among women who participate in mandala coloring after the intervention? Researchers will compare the intervention group (those who participated in mandala coloring) with the control group (those who did not participate in any intervention) to evaluate the effectiveness of mandala coloring.

Participants

• Participants in the intervention group will attend 30-minute mandala coloring sessions once a week for 4 weeks.
• Participants in the control group will not receive any intervention during the same period.
• Both groups will be assessed using a questionnaire at the beginning of the study and at the end of the 4th week (pre-test/post-test).

Menopause is a natural, biological process that marks the end of a woman's fertile years. Every woman's menopause is unique. The experience, severity, duration, and physical and psychological effects of menopause are all unique. During this period, women must contend with both the processes of aging and the hormonal changes that occur during menopause. These changes can sometimes negatively impact an individual's life, reducing their quality of life. Menopausal symptoms can often appear one to two years before their last menstrual period and up to 15 years afterward. These symptoms, such as decreased sexual desire, decreased estrogen levels, mood disorders, illnesses associated with menstruation, decreased genital sensation, vaginal dryness, physical discomfort, and bone loss, can lead to a loss of sexual desire and alienate a person from their partner. This, in turn, leads to a decrease in self-esteem, a feeling of unease about one's own characteristics and ongoing physical and psychological changes. Consequently, individuals' anxiety levels increase, and their ability to cope with symptoms decreases. Studies have highlighted the benefits of alternative methods for coping with anxiety in women undergoing menopause. Music therapy and art therapy are examples. Studies have also demonstrated the therapeutic effects of mandala coloring, an art therapy activity. This study aims to examine the effects of mandala coloring on menopausal symptoms, quality of sexual life, and self-esteem in menopausal women.

Inclusion Criteria:

• Being between the ages of 40 and 65,
• Not having experienced menstruation for at least one year,
• Having a score of 15 or higher on the MSDS (meaning having experienced at least moderate menopause),
• Not having received hormone replacement therapy for menopausal symptoms,
• Not having undergone surgical menopause,
• Experiencing at least one vasomotor symptom of menopause (hot flashes, night sweats, sudden sweating attacks, palpitations, chills and shivering attacks, etc.).
• Being able to read, write, speak, and understand Turkish,
• Not having previously received mandala art therapy training or regularly practicing mandala coloring,
• Not having an allergy to mandala coloring materials,
• Not practicing spiritual practices such as yoga or meditation,
• Agreeing to participate in the study.

Exclusion Criteria:

• Having a physical symptom that may prevent mandala coloring,
• Having communication and perception problems,
• Having difficulty understanding or speaking Turkish,
• Having a psychiatric illness or taking psychiatric medication,
• Having experienced a loss in the last 6 months.

Female gender is suitable as the study is on menopausal symptoms.