INTRODUCTION

This study addresses t= he concept of climacteric an= d the use of medicinal plants as natural therapy by <= span class=3DSpellE>women who experience it and who attend a cervical cancer prevention= service in a unit of the = Family Health Strategy (ESF).

<= span style=3D'font-family:"Times New Roman",serif'>Climacteric is a te= rm commonly used as a = synonym for menopause, but the latter is a retroactively defined phenomenon, representing = the permanent cessation of menstruation for a period= of 12 months (1). The term climacteric comes from the Greek= origin (klimakter), when = referring to the top of a ladder= , when referring to ascent to a different stage o= f life (2). The World Health Organization (WHO) define= s climacteric as a biological and non-pathological phase of a woman's life, in addition<= /span> to understanding this proc= ess as a transition from the r= eproductive to the non-reproductive ph= ase (2-3).

The term menopause, on the other hand, = also comes from the Greek= and refers to mens =3D month = and pausis =3D pause, however= it comprises the interruption of menstruation (2). Menopause is characterized as the final part<= /span> of the reproductive phase<= /span> that corresponds to the last menstrual cycle and usually happens between 48 and 50 years<= /span> of age (1).

<= span style=3D'font-family:"Times New Roman",serif'>However, by und= erstanding that climacteric is not a disease, but a natural phase of a = woman's life, and that many of them can go through th= is phase without complaints or need for medicalization= , others can present changes in their organism that vary in the= ir diversity and intensity (= 1), and this will depend on= how each woman will face this aging body process.

From this perspective, aging<= /span> with quality appears as a hope, even in a society marked by a culture of rejection of <= span class=3DSpellE>old age. The understanding that maturity also includes se= lf-knowledge and acceptance = and that in old age there is a grea= ter process of investment in self-knowledge, generating= more positive ways of appreciating life, which can result in a transformation of negative stere= otypes about aging at the = point of social view (2-4).

The taboos related<= /span> to menopause are due to the way in which this process<= /span> is approached, which is very widespread with nega= tive connotations, using terms= such as bankruptcy, atrophy, loss, among other denominations that characterize somethin= g bad. In this sense,= women choose to undergo hormone therapy <= span class=3DSpellE>because they believe that= menopause is a disease, however<= /span> they need to realize that = menopause is a stage of life and that it is possible to overcome it through com= plementary integrative practices and therapies , in addition t= o phytoestrogens and selective estrogen receptor modulators, with no need to introduce<= /span> “medicalization” as a therapy (1-5)= .

From this perspective, medicalization involves broader processe= s that are not limited only to the drug product, in addition to having a more subtle and = perverse logic of controlling the lives of = people and society (5-6). Thus, the term medicalization has been used as the process of transfor= ming aspects of everyday= life into objects of medicine,= schematizing conformity a= nd social norms.

Thus, medicalization permeates the logic of so= cial norms established by traditional medicine, as a proce= ss of change in people's lives. And thinking of breaking with this paradigm, in 2006, after several nation= al health conferences = and the recommendations of the World Health Organization (WHO), the National Policy= on Integrative and Complem= entary Practices (PNPIC) was institutionalized in Brazil as an element of the System = Health Service (SUS) (7).

Considering that mo= st health services are= attended by women, and th= at this woman can be seen in its = global dimension, without losing sight of its uniqueness, its processes of living at any stage of life. In this context, the PNPIC contemplates the integrality of health care for women in the climacteric phase. This phase, which also requires the interaction of other actions existing in= the SUS. This interaction cont= ributes to the expansion of women'= s co-responsibility and auto= nomy for their health in a deme= dicalized perspective, during this p= eriod, thus increasing the= exercise of their citizenship and consequently their quality= of life (7) Furthermore, it is necessary to break with the paradigm that climacteric it has to be treated with hormone therapy and promote actions against hegemony and medicalization and pla= ce women as protagonists and autonomous in self-care.

In the field of health, the National Policy on Integrative and Complementary Practices contemplates th= e guidelines and institutional responsibilities for the provisi= on of various services= and products, as well as the = use of medicinal plants as therap= eutic possibilities (6) to face the intrinsic changes of the climacteric, thus ensuring greater comprehensiveness and resolutene= ss in women's health c= are during this phase.

It is noteworthy that the PNPIC includes in its structure cross-cutting <= span class=3DSpellE>themes that can be present in all points of the Health Care Network, primarily in= Primary Care, with ample = potential for action in t= he actions determined by the SUS. The main approaches in this field permeate the expanded view of prevention and gl= obal promotion of human care, = especially self-care and autonom= y. And when it comes to the woman who experiences the climacteri= c, this care is based on its = multiple biopsychosocial, cultural and spiritual aspects.

The use of medici= nal plants in the art of heal= ing is a form of therapy with a ver= y ancient origin, related to the beginnings= of medicine and based on the = accumulation of information over genera= tions. Over the centuries, produc= ts of plant origin formed the basis for the = treatment of different alterations in the organism (7).

In this contex= t, the use of teas with medicinal plants influences the improvement= of various bodily c= hanges presented by many women <= span class=3DSpellE>during the climacteric phase. And it was shown in this study that the par= ticipants sought this therapeutic alternative in complementary integrative practices. Me= dicinal plants are those capable of alleviating or= curing illnesses and/or <= span class=3DSpellE>characteristics peculiar to a gi= ven situation and have a tradi= tion of use as a medicine in a population or community (8) While the W= HO defines a medicinal plant as being any and all plants that it has, in one or more organs, sub= stances that can be used for thera= peutic purposes (2).

Brazil has great potential for the de= velopment of this therapy, with the greatest plant diversity in the wo= rld, wide socio-diversity in t= he use of medicinal plants linked= to traditional knowledge and technology to scientif= ically validate this knowledge.

Therefore, this study is justified by the need to disclose the use of medicinal plants by women experiencing menopause, in addition to bringing significant social relevance and contributing not only to health<= /span> professionals and academics, but also with women who are experiencing the climacteric phase. Considering that there is a shor= tage of studies on the subject, this can contribute to changes in habits<= /span> and lifestyles of several<= /span> women in the climacteric = process by adding part of the complementary= integrative practices in = health, such as medicinal= plants.

From this perspec= tive, the guiding question was elaborated as a concern that refers to a = significant understanding= of answers through the objective of the study. What is the con= ception of climacteric for women who experience it and which medicinal plants do= they use as a natural therapy for this process?=

Such questioning led to the construct= ion of the following objective= : To identify the conception= of climacteric by women who experience it and which medicinal plants us= e as natural therapeutics for this process.

METHOD =

This is a qualitative, descript= ive and exploratory study whos= e sample was randomly= composed of 17 women who attended the cervical= cancer prevention service of a Family Health Strat= egy (ESF) unit located = in the interior of Bahia. Participants met the following inclusion criteria: being over 40 <= span class=3DSpellE>years old and attending the unit assiduously. And as exclusion criteria, presenting cognitive deficit that implied the = collection of information= and hearing impairment that <= span class=3DSpellE>impeded or hindered verbal communication. Data collection was interrupted when informati= on was repeated, which was characterized as a data saturation proce= ss.

The study setting was the ESF = unit. The collection of informat= ion took place after approval by the Research Ethics<= /span> Committee (CEP) of the State University of Southwest Bahia, according to opinion number 2,440,117 = in 2019. A semi-structured interview script, previously elaborated wit= h questions, was used as an instrument. objective and subjective containing sociodemographic data and leaving the participants = free to answer the questions.

The interviews lasted an average of 30 minutes and were carried out individually = in the waiting room of the (USF)= , after clarification about the <= span class=3DSpellE>objective and procedures of the study, according to the availability of the participants and signing the Informed Consent Form (TCLE). As t= his is a study involving human beings, the guidelines an= d regulatory standards established= by Resolution No. 466/12 of the National Health= Council (CNS) were respected (9).

Data processing and analysis were carried out us= ing Bardin's thematic content analysis technique (10). In view o= f the diversification and also = the terminological approximation, it was decided to list the steps in three phases: 1) Pre-analysis; 2) Exploitation of the material; and 3) Treatment of results, inference and interpretati= on. Thus, this study culminate= d with the phases recommende= d by Bardin (10). The first phase began with pre-analysis, in whic= h all the material analyzed = was organized with the aim of making it operational, sys= tematizing the initial ideas. = Later, there was the exploration<= /span> of the material that constituted the second phase, the analysis of th= e data, seeking to identify the <= span class=3DSpellE>registration units and, <= span class=3DSpellE>consequently, the definition of categories. In the third = phase, there was the treatment of results, inference and interpretation. In this stage, the informatio= n was condensed and <= span class=3DSpellE>highlighted for analysis,= culminating in inferential interpretations, in addition to being the moment of intuition, reflective and= critical analysis for theoretical and programmatic purposes.

RESULTS

<= /p>
        =     Initially, the soci= odemographic characteristics of the par= ticipants will be presented a= nd then the categories.=

        =      As for the sociodemographic characteristics, it was <= span class=3DSpellE>observed that of the 17 particip= ants, the age ranged between 40 and an average of 50 years= , eight considered themselves black, and six declared themselves brown. With regard = to marital status, ten report= ed being married.         =           As for the pro= fession, twelve were home secretaries. As for religion, nine reported being Protestant and eight Catholic. The level of education, eleven mentioned incomplete primary education.

        = From the application of the method of analysis, in accordance with the objective of this study, two thematic c= ategories that follow were originate= d.

Category 1- Confusing climacteric with menopause and conside= ring it as a disease

The category above originated fr= om the questioning of the participants<= /span> about their conception of= menopause. However, several of the participants in this study reported not kn= owing or not knowing anything about this phase of a woman's life. Look at your testi= monials.

Ah! Climacteric is. I do not k= now. I don't understand that (l= aughs). I don't know much about it. (P3)

That's what I told you, I don't unders= tand any of that [laughs]. (P4)

Never heard of it. (P6

Boy, I [laughs]... the climacte= ric? I've heard it, but I'm wandering now. (P= 11)

Climacteric? No. (P13)

Probably nothing, right [laughs]. I have no knowledge. (P15)

I want to learn now because<= /span> I don't know [laughs]= . Good thing I learn right? (P16)

However, although they report that they do not know or do not know what climacteric is= , they recognize and describe in= detail the peculiar characterist= ics of this phase they are exp= eriencing, but they still see it as s= ymptoms, and report that they have<= /span> sweating, heat, cold hot = flushes, insomnia, nervousness, forgetfulness, among other characteristics and= /or confused with menopause, = highlighting the difficulties in understanding the phenomenon.

=

But there is the symptom of me= nopause that speaks, right? I just know, that myself, I say = about myself, I felt very hot, my period went away when I was 47 years= old, then I went to the doctor, he <= span class=3DSpellE>said it was normal because it was menopause, then I started the treatment and= I got well. (P1)=

The climacteric is when you determine that menstruation no longer exists, that you also sometimes feel some complaints, such as heat, insomnia, sweating a lot at <= span class=3DSpellE>night as sometimes, I felt nervous myself, I felt insomnia, worry, forgetfulness. (P9= )

I know little, right,= but during this period the woman starts t= o have those hot flashes, r= ight, I'm already starting to fe= el it, I already feel = a strange heat. And that th= is menopause has women who are later, there are w= omen who are earlier. (P= 14)

        =

I also know how menstruation decreases, but in my case= it was different that it increased. And so, I don't know<= /span> if it's because of the blood loss or if it's because of the menopa= use that I'm feeling so weak, I don't know if it's the hormone= I'm losing, I don't know, what I know is that I'm l= ike this. And what I understan= d about this climacteric is this, is that women lose hormones, right, they say= they lose a lot of hormones. There are some who need to take hormones, right? I kn= ow very little about it there. (P14)

I knew about menopause, but that's what you said now, I didn't know. (P16)

And heat, cold, heat...= If I took the cover off i= t was cold, then it's covered, it's a blouse. o= h I remember. (P17)

Category 2- Identifying medicinal p= lants as natural therapeutics for changes inherent to the climacteric

=

Category 2 indic= ates which medicinal plants the participants sought as a = natural therapy to help cope with the changes inherent = to the climacteric. In their stat= ements, it is clear the use of var= ious teas such as blackberry tea, coriander, parsley, mint, lemon balm, capim santo, espinheira santa and other herbs that are included i= n the Complementary Integrative= Practices in Health. were= used with the purpose of = alleviating and/or minimizing the changes inherent to this s= tage of life.

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I cured more with tea= . (P1)

I use blackberry leaf= , then I cook and drink. (P= 3)

I drink cilantro with parsle= y, thick mint, lemon balm, lemongrass. I mix it all together and take it... There's also one that my mother <= span class=3DSpellE>always taught me, it's a = kind of seed, “mulungu” seems to be. (P5)

Oh my daughter, it was= so much tea. Blackberry tea, tea from espinheira = santa, so much tea that I drink that you can't even imagine. (P8)

I drank= a lot of tea, you know, blackberry tea, espinheira santa, capim santo, so, we always drank tea, there in the countryside we drank a lot of tea, and <= span class=3DSpellE>then I always drink it, <= span class=3DSpellE>until today. (P9)

Just tea. Blackberry tea, these teas like that= . Homeopathic stuff, herbal= more natural things, you know? (= P11)

I drink a lot of blackberry<= /span> tea, such as oats, soy, then I started researching, I found this blackberry tea and several other teas that have, right, chamomile, <= span class=3DSpellE>but what I really drink i= s blackberry tea (P14)=

Yes, I used a lot of tea like this, lemongrass= , capim santo, lemongrass. (P17).=

DISCUSSION

The first catego= ry leads us to the understanding that the participants in this study still have a wrong conception of meno= pause. However, more than = half of users who attend Primary Care= are women (1-3). This makes us refle= ct that there may be a lack of knowledge and practices, especially on the part of= professionals who work in= different health services. In this sense, = to meet their felt needs, women seek the care of health profess= ionals inserted in this context. Thus, the women's health policy offers them the right to see themselves in their entirety as an autonomous and participative subject in the decision-m= aking process for self-care. Thus, as they are included in this = process, there is a guarantee of meeting their needs and the quality of = care, especially in health services (11).

In this perspective, the need for health professionals who work in= these spaces, such as nurses, d= octors, social workers, psychologi= sts and the Community Health Agent-ACS and other professionals, to be open to wel= come and assist the felt= needs of women experiencing menopause, <= span class=3DSpellE>thus aiming to provide them with knowledge of their own body in relation= to the changes inherent in this phase: insomnia, sweating,= hot flashes, loss of libido, h= air loss, dryness of th= e skin, among others , in order t= o show that these changes are part of this process and that each woman can experience this= in the most natural way possible= , thus contributing to a better quality of life (1= 2).

Thus, it is essential that women in <= span class=3DSpellE>menopause have expanded and global assistance to this process, paying attention to the specificities of this phase. This assistanc= e must take ownership of hea= lth professionals and make them able to work the subjectivity of women at this stage of life, in = addition to using appropriate and more attractive tools for the moment, in w= hich the health professional assumes the role of facilitator and contemplate integrative and complementary practices in health in order to broaden the view of care in this process and the global promotion of hu= man care,(13-14) especially with an emphasis on the autonomy of self-care, based on natura= lness.

In this sense, the units of analysis in category 1 of= this study represent their conc= eptions and reveal the scarcity of information about this phase of women's lives. Perhaps, the fact that many participants have a low level of education may have contributed to the <= span class=3DSpellE>lack of knowledge of the = term climacteric. Although most users regularly attend health services, it still= seems that menopause is rarely addressed by professionals during consultations. Therefore, the term menopause is more common among them, being confused with the climacteric.

In line with what was described in a study according to which women showed difficulty in discerning the meaning of= menopause, referring to t= his as being the same as menopause. The distinction of terms has its importance in the sense of identifyin= g characteristics inherent to the phases of the human life cycle (3).

Thus, "= health professionals need = to take ownership of the multiple= issues that encompass the= climacteric to identify, = listen to and welcome the= se women in a comprehensive = way (3)". It is noteworthy that the non-distinguishment of the terms climacteric/menopause lea= ds us to think that there is= a lack of information, especially in relation to= scientific terminology an= d its characteristics on the part of health professionals when= assisting women in this <= span class=3DSpellE>stage of life. Thus, health professionals should promote with greater involvement a focus on women in menopause/menopause knowing that these actions are r= ecommended by the National Policy for Comprehensive Care for Women's Health (PNAISM) (14). This fact becomes worrying in most Br= azilian cities where health services are not yet prepared to contemplate t= his policy in its entirety. <= span class=3DSpellE>Likewise, there seem to b= e few health professionals engaged and committed to valuing this phase of women's lives.=

In this context, the World Health Organi= zation shows us that menopause is not a disease, but a physi= ological phase of women's lives and that many of them go through this phase without complaints and without the need for drug therapy (1-2) . This condit= ion leads us to the reflection= that the medicalization of the female body in the name of scienc= e and an improbable <= span class=3DSpellE>well-being has always been a practice in the field of medicine and that it will only be transformed = when women empower themselves and create strategies for autonomy and freedom as <= span class=3DSpellE>protagonists of self-care. Thus<= /span>, they will be able t= o define and recognize their rights= , preventive possibilities and implementation of natural practices, as well as the consequence= s of different medical pract= ices imposed on their own body.

Thus, we live in a society where consumption a= nd beauty standards are marked by the media, while the enhan= cement of image and appearance transforms the female bod= y into the most beautiful and desirable of objects. It can even be said= that we live in the paradigm of co= rporeality and that there are many aspects that are illustrated and, with the evolut= ion of new technologies, new h= orizons emerge that highlight the = dimension of the female body (13). After all, the body is= not just an evidence, <= span class=3DSpellE>but the essence of existence in our era is focused<= /span> on it. In it is all the beauty, which seems to make itself avail= able to those who lust after it, transforming or disfiguring the original and cre= ating another “product”, an ideal model that oversh= adows human incompetence = (15).

In the process of appropriation = of the female body throughout history, it is necessary = to highlight the movement of= autonomous and defiant women who made the subordinate position a= ssigned to the female world in rel= ation to medicine to be rethought (16). From this perspective, our society still sees the female body exposed in a context of medicalizatio= n, in addition to understandi= ng a body that was built in its multiple forms of expression. Thus, due to the scope of the phenom= enon of medicalization, it is u= nderstood as indispensable and neces= sary to broaden the discussions= around this theme, given that there is still a shor= tage of studies dealing with this phenomenon and regarding a condition<= /span> that must be confronted and modified (16).

It is assumed that medicalization also produces different consequences for women who experience menopause, a fact that has been little explored. In this sense, it is understood as important= to enter this theme= in order to contribute to th= e construction of new research, as well as new critical reflections on the condition of these women who also permeate the aging process (17).<= /o:p>

Identifying that the women in this study did not diff= erentiate between menopause and meno= pause, it is extremely relevant that health professionals<= /span> are aware of these aspects= and place women as = protagonists of their own= care and empower themselves with autonomy to live this phas= e of life, considering it as a natural process of female aging and which can be based on integrative practices for a healthier= and more natural life.

The second category leads us to think t= hat medicinal plants as a ther= apeutic option for the intrinsic changes of the climacteric were elements that the particip= ants of this study used, and that the Ministry of Health points out that the expansion of therapeutic options offered to users of the <= span class=3DSpellE>Unified Health System Health (SUS), involves a guarantee of access to various medicinal plants = and services related to phytotherapy, with safety, efficacy and quality, from the perspective of <= span class=3DSpellE>comprehensive health care= (18). This is important with a v= iew to improving health= care for the female population<= /span>, especially at this stage = of life. Thus, the use of medicinal plants by the participants in this study proved to be an important = option of choice to impro= ve or minimize the bodily changes associated with thi= s stage of women's life, an= d certainly those that were more accessible and = supported by sources cite= d for the changes inherent to the climacteric.

Therefor= e, the use of medicinal plants as complementary <= span class=3DSpellE>integrative practices in = health during the climacteric phase has become a widely accepted practice, = in addition to involving man= y health professionals (17)= . There is a growing interest, both popular and institutional, regarding the use of these pract= ices in the SUS. In addition to the existence of several documents emphasizing the introduction of medicinal and herbal plants in the Unified Health System (18). Amon= g the main documents = of primary care in SUS, Ciplan Resolution No. 8/88 stands out, = which regulates the implementati= on of herbal medicine in health services and creates procedures and routines related to its implementat= ion (16).

In this perspective, the Mini= stry of Health, on March 21, 2018, amends Consolidation Ordinance N= o. 2/GM/MS, of September 28, 2017, to include new = practices in the National= Policy on Integrative and= Complementary Practices (= PNPIC) with the intention to stan= dardize its use in the SUS and expand the possibilities to guarantee comprehensive= ness in health care. Complement= ary integrative practices in the SUS are resources, inv= olving approaches that seek to st= imulate the natural mechanisms of = health recovery through effective= technologies, with an emphasis on qualified and= welcoming listening, developing the therapeutic bond and the integration = of the human being with the environment and their social rel= ationships (16). In this sense, the e= xpansion of the global view of the = health-disease process generates t= he appreciation of self-care (19-20).<= /p>
It is observed that th= e population uses medicinal plant<= /span> therapy due to the popular idea that the natural does not bring harm, further reinforcing= the issue of the rise in the = use of medicinal plants as a ther= apeutic in the climacteric (17-20). This fact is evident in the results<= /span> of this study, when it is noticed that of the 1= 7 participants, 10 used med= icinal plants as a natural therapeutic<= /span> practice aiming to alleviate or improve the alterat= ions inherent to this stage of life.

The Ministry of Health points out that many of the complementary integrative practices are= covered by an interdisciplinary approach to care, and in the different therapeutic resources offered, which involve substances such as medicinal teas, <= span class=3DSpellE>plant emulsions, metal or= vegetable ointments, essential oils and plant roots , medicinal bath, poultice, compress, bandaging, footbath, among others (18).

<= span style=3D'font-family:"Times New Roman",serif'>Climacteric women do not suffer from a disease that requires hormone deficiency or treatment. Hormone therap= y should be understood as a= therapeutic option only f= or cases where there are specific indications. Thus, the medicalization of the female body, with the continuous use of hormones during menopause, <= span class=3DSpellE>has been a common practice in medicine (1). Thus, it is essential that healt= h professionals are scientif= ic and updated to proceed with an approach in the field of integrative practices, where they are recognized= as one of the approaches that have an expanded view of the natural process, since the medicalized practice, in = the future, may generate other health problems for women.

The expression “medicalization” has been used to designate the process of = transforming aspects of <= span class=3DSpellE>daily life into objects of medicine, in order to ensure compliance with so= cial norms (3). Medicalization= can also be defined as the ability of medical knowledge to appropriate everyday problems, thus covering medicine's meanings and explanations= (3).

Therefore, the PICS expand the vision of this process= and the global promotion of human care, especially self-care and the autonomy of women who experience menopause, considering it= in its various biopsychosocial <= span class=3DSpellE>aspects in the search for= a change of paradigm, of logic from intervention <= span class=3DSpellE>focused on symptoms to ca= re based on complementary integrative practices. Th= ese practices contribute to t= he expansion of the health c= are model, as they serve women in their entirety, uniqueness and = complexity, sociocultural streng= thening the relationship between u= ser/professional for the humanization of he= alth care.

=

FINAL CONSIDERATIONS

The study shows that the part= icipants have a misconception about the climacteric, but they know how to identify the changes in= herent to the phase and use strat= egies of integrative practices as therapeutics to cope with this phase of life.

The contribution and <= span class=3DSpellE>suggestions of this study are ba= sed on the dissemination of the use of medicinal plants by women who are experiencing the = climacteric as they contribute to alleviate the changes inhe= rent in this phase. In addition= to encouraging the impleme= ntation/implementation of PIC protocols<= /span> in the health care network, considering that integrative practices= contribute to the specifics and particularities of this stage of life, and that health serv= ices have professionals = prepared and sensitized t= o promote care for women during the climacteric.

As a limitation of the study, most of the times the difficulty of collecting information<= /span> was highlighted, considering the place of = collection and the time between the interview and the= consultation with the nurse of the health unit, in addition t= o the difficulty of these participants= to understand the meaning<= /span> of the climacteric term.

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        &= nbsp;           &nbs= p;

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