The menopause, characterized by the cessation of menstruation due to declining ovarian function, significantly impacts women's lives. The perimenopause, the transition to menopause, can last up to four years and is marked by irregular periods and various symptoms. A vast majority of women (up to 80%) experience difficulties during this time, with a significant portion (25%) reporting severe challenges. Symptoms range from vasomotor symptoms (hot flashes, night sweats) to physical symptoms (fatigue, bone pain) and sexual symptoms (loss of libido, vaginal dryness). These symptoms are strongly linked to decreased quality of life. Medically induced menopause often leads to more severe symptoms and long-term health consequences, including cardiovascular disease, osteoporosis, and dementia. The menopause transition is also a period of increased vulnerability for mental health issues, particularly depression. Existing research highlights a bidirectional relationship between depressive and vasomotor symptoms, emphasizing the importance of mental health screening. Despite the 2015 NICE guidelines, high-quality menopause care remains inadequate in the UK. This study aimed to understand women's perspectives on the availability and quality of menopause care services in the UK, focusing on mental health concerns and variations in experiences across different menopause stages (early and late perimenopause, post-menopause, medically induced menopause).

The introduction extensively reviews existing literature on menopause symptoms, their impact on quality of life, and the increased risk of mental health issues during this transition. It highlights the bidirectional relationship between depressive and vasomotor symptoms and the need for comprehensive care addressing both physical and psychological challenges. The review also emphasizes the inadequacy of current menopause care provision, even in high-income countries like the UK, despite the existence of NICE guidelines.

A mixed-methods approach was employed using an anonymous online survey distributed through various channels (email, social media, word-of-mouth, support groups). The study included 952 participants (out of 1154 who started) who were UK residents aged 18 years or older, currently experiencing menopause or perimenopause symptoms, and not pregnant or breastfeeding. Participants were categorized into four groups: early perimenopause, late perimenopause, post-menopause, and medically induced menopause. The survey collected sociodemographic data, information on healthcare seeking behavior, treatment received, mental health symptoms, and experiences with healthcare professionals. Quantitative data were analyzed using descriptive statistics, ANOVAs, Kruskal-Wallis H tests, and Chi-square tests. Qualitative data from an optional open-ended question (159 responses from those reporting poor care) underwent thematic analysis following established guidelines. This involved familiarization with the data, code generation, codebook creation, blinded coding, consensus building, and theme development.

The majority of participants (74.47%) sought help for menopausal symptoms, primarily from NHS GPs. Oral and topical medications were the most common treatments. A significant proportion (86.76%) reported negative mental health impacts from menopause symptoms, yet only a small percentage (24.40%) received mental health information from their HCPs. Mental health screening was not consistently integrated into menopausal care. Thematic analysis of open-ended responses from participants reporting poor care revealed six main themes: consequences of poor care (feeling unsupported, dismissed, hopeless); dismissive or negative attitudes from HCPs (trivialisations, dismissal due to age, ignoring symptoms after blood tests); poor treatment management (quick jump to antidepressants, lack of monitoring, lack of patient involvement); lack of symptom information and misattribution (symptoms wrongly attributed to other conditions); poor HCP knowledge; and the need for self-advocacy (women having to research and advocate for themselves). Women with medically induced menopause reported lower satisfaction with care.

The study's findings highlight the significant gaps in menopause care provision in the UK. The lack of consistent mental health screening, dismissive attitudes from HCPs, and inadequate treatment management contribute to poor patient experiences. The need for self-advocacy underscores a system failing to proactively address women's needs. The findings emphasize the importance of improving HCP knowledge, providing empathetic and supportive care, and involving women in decision-making. The lower satisfaction among women with medically induced menopause highlights a specific need for improved care in this population. The study’s limitations include a sample potentially not representative of the wider UK population due to higher education levels and income, and recruitment bias towards those seeking help for mental health symptoms.

This study reveals significant shortcomings in UK menopause care, particularly concerning mental health integration and empathetic, patient-centered approaches. Immediate improvements are needed, including enhanced HCP training, improved communication, and systematic mental health screening. Future research should focus on diverse populations and explore effective strategies for improving care delivery and patient satisfaction.

The study sample over-represents women with higher education levels, household incomes, and a higher proportion of white participants, potentially limiting the generalizability of findings to the broader UK population. Social media recruitment introduced a potential recruitment bias, potentially over-representing those with negative care experiences or those actively seeking support for mental health symptoms related to menopause.