Quality of life among Tunisian women across different menopausal stages.

Introduction: Menopause represents an important transition in women's lives, often accompanied by physiological, psychological, and lifestyle changes that can affect overall quality of life (QoL). Understanding how individual characteristics, body composition, and daily habits influence QoL during this stage is essential. This study aimed to assess the prevalence of menopausal symptoms and to examine how anthropometric measurements, sociodemographic factors, and lifestyle variables-particularly physical activity levels-independently influence the QoL of Tunisian women during mid-life. Methods: A cross-sectional study was conducted among 375 women recruited from different regions of Tunisia and classified according to the World Health Organization's definitions of menopausal stages. Data were collected using the Menopause-Specific Quality of Life Questionnaire (MENQOL) and the Physical Activity Self-Assessment Questionnaire (J. Ricci ' L. Gagnon). Anthropometric measurements were performed by the research team. The Mann-Whitney and Kruskal-Wallis tests were applied to compare MENQOL scores across menopausal stages. Results: Among premenopausal women, the most reported symptom was feeling tired or worn out (76%), with the psychosocial domain showing the greatest QoL impact (score: 2.05), followed by physical (2.03), sexual (1.64), and vasomotor (1.36) domains. In perimenopausal women, fatigue was reported by 81%, with the physical domain most affected (2.03), followed by psychosocial (1.87), vasomotor (1.77), and sexual (1.28) domains. In postmenopausal women, flatulence or gas-related colic was the most frequent symptom (86%), and the psychosocial domain had the highest impact (2.36), followed by physical, vasomotor, and sexual domains. Overall, 68% of participants had a moderate level of physical activity. Higher physical activity was associated with better QoL in the total sample but remained significant only among premenopausal women. Overweight (42%) and obesity (28%) were common, and higher BMI was consistently linked to poorer QoL, particularly during premenopause. Discussion/Conclusion: Physical and psychosocial symptoms were the most prevalent across menopausal stages. While higher physical activity and lower BMI were associated with better QoL in premenopausal women, these associations weakened during menopause, suggesting that other factors, such as income and BMI, may play a stronger role in postmenopausal QoL. Promoting physical activity and healthy weight management could therefore improve QoL outcomes for women throughout the menopausal transition.