Perceptions of healthcare provision throughout the menopause in the UK: a mixed-methods study

The study investigates women’s perceptions of menopause care in the UK, addressing a recognized shortfall in comprehensive, high-quality services despite guidance such as the 2015 NICE menopause guidelines. Menopause and the transition period (perimenopause) involve diverse vasomotor, physical, and sexual symptoms that can significantly reduce quality of life; medically induced menopause may present with more severe symptoms and long-term health risks. The transition is also a period of heightened vulnerability to mental health problems, particularly depression, with evidence of bidirectional links between vasomotor and depressive symptoms. Prior research indicates inadequate care provision, even in high-income settings, and limited patient-centered understanding of experiences across different menopause stages and among those with medically induced menopause. This study aims to characterize healthcare access, treatment, and mental health support across menopause stages and in medically induced menopause, and to identify areas for service improvement.

The paper situates its work within literature showing: (1) high prevalence of menopausal symptoms and substantial impacts on quality of life, with symptom burden correlating with lower QoL; (2) women with medically induced menopause experiencing more severe symptoms, worse QoL, and greater long-term health risks (e.g., cardiovascular disease, osteoporosis, dementia, mortality); (3) increased vulnerability to mental health issues—especially depression—during the transition, with perimenopausal symptom profiles including irritability, sleep disturbance, fatigue, and somatic complaints; (4) bidirectional associations between vasomotor and depressive symptoms; and (5) persistent inadequacies in menopause care provision, including after the introduction of UK NICE guidelines. The literature underscores the need for HCP awareness, routine mental health screening, and patient-centered, evidence-based management across menopause stages, including medically induced cases.

Design: Mixed-methods, cross-sectional online survey with quantitative descriptive and comparative analyses and qualitative thematic analysis of open-ended responses. Participants: Recruited January–March 2023 via email, paid Facebook/Instagram ads, Cambridge Centre for Psychosexual Research social media (Facebook, Twitter), Reddit, word-of-mouth, and relevant foundations/support groups. Inclusion: ≥18 years; UK resident; currently experiencing menopausal or transition symptoms; classified as (i) early perimenopause (significant change in bleed length or cycle not due to pregnancy/breastfeeding, stress, or medical condition), (ii) late perimenopause (3–11 months amenorrhea), (iii) post-menopause (≥12 months amenorrhea), or (iv) medically induced menopause (amenorrhea due to hysterectomy with one/both ovaries retained or other medical procedure). Exclusions: current pregnancy/breastfeeding. No mental health diagnosis required. Incentive: entry to win one of three £50 vouchers. Sample: 1154 commenced; 952 (82.50%) completed ≥97% of the survey. Stage distribution: early perimenopause 48.21% (n=459), late perimenopause 17.54% (n=167), post-menopause 26.05% (n=248), medically induced 8.19% (n=78). Mean age 50.01 (SD=5.27, range 24–69). Majority identified as female (98%), white (97.27%), had ≥undergraduate degree (59.98%), were married/in civil partnership (61.97%), employed (85.19%), and had household income ≥£35,001 (61.76%). Materials/Procedure: Anonymous Qualtrics survey (15–20 min), eight sections: information sheet; consent; sociodemographics; menopause-specific QoL symptoms; mental health symptoms and care provision; menopause-specific QoL (duplicate section in instrument); experiences/interest in digital technology for menopause-related mental health; debrief. Adaptive branching used. Included an optional open-ended question about unusual/inappropriate HCP comments and their impact. Quantitative Analyses: SPSS v28.0.1.1. Descriptive statistics overall and by menopause stage. Group differences in continuous variables: one-way ANOVA (eta-squared effect sizes). Non-parametric: Kruskal–Wallis with post hoc Mann–Whitney U (r effect sizes). Binary variables: Chi-square or Fisher’s Exact Test (Cramer’s V effect sizes). Figures created in Microsoft Excel/PowerPoint (version 2206). Qualitative Analyses: Thematic analysis of optional open-ended responses from women who rated HCP menopause care as poor/very poor. Steps: familiarization; initial coding/codebook; blinded coding by two authors; resolution of discrepancies; theme development by two authors and consensus. Themes and sub-themes summarized graphically.

- Help-seeking and providers: 74.47% (n=709) discussed menopausal symptoms with an HCP. Among these, most consulted an NHS GP (90.41%, n=641), then NHS gynecologists (13.68%, n=97) and other HCPs (12.13%, n=86). 78.56% (n=557) knew symptoms were menopause-related before the appointment. - Treatments/support: Among those who saw an HCP, common options were oral medical treatments (68.83%, n=488), topical treatments (17.21%, n=122), and lifestyle changes (17.21%, n=122); 55.29% (n=392) received a prescription from the HCP. 18.76% (n=133) reported receiving no treatment/support. - Mental health impacts and care: 86.76% (n=826) reported negative effects of menopause symptoms on mental health. Of these, 61.62% (n=506) visited an HCP to discuss mental health since noticing the transition. Only 28.49% (n=202) felt HCPs managing their menopause care were aware of menopause’s effects on mental health; 24.40% (n=173) received mental health information from HCPs; 33.99% (n=241) were asked about mental health; 7.85% (n=58) were asked to complete a mental health assessment. 36.36% (n=184) felt their menopause-related mental health symptoms were not taken at all seriously; 63.64% (n=532) felt they were taken at least slightly seriously. Preferred information timing/methods: 43.70% (n=416) at first HCP contact for any menopausal symptom; 42.68% (n=408) via text/post to those nearing the average menopause age. - Group differences: Overall satisfaction with menopause care differed (Kruskal–Wallis H(3)=11.44, p=0.010); medically induced menopause reported lower satisfaction than late perimenopause (Mann–Whitney U=3182, p<0.001, r=0.24). Early perimenopause women were less likely to receive treatment/support than post-menopausal women (as discussed). - Qualitative themes (n=159 open-ended responses from those reporting poor/very poor care): (1) Consequences of poor care (feeling unsupported, dismissed, hopeless; deterred help-seeking); (2) HCP dismissive/negative attitudes (age-based dismissal, trivialization, over-reliance on blood tests to negate symptoms); (3) Poor treatment management (antidepressants over HRT for some; poor monitoring; limited shared decision-making; lack of signposting); (4) Lack of symptom information and misattribution (attributing to other conditions/lifestyle); (5) Poor HCP knowledge; (6) Need for self-advocacy (patients researching, requesting HRT, bringing information to HCPs). - Overall satisfaction: Approximately one-third reported good/very good care and a similar proportion reported poor/very poor care; women with medically induced menopause were less satisfied than those in late perimenopause.

Findings indicate that most women disclose menopausal symptoms to HCPs—primarily NHS GPs—and many already recognize the menopausal origin of their symptoms, reflecting relatively high awareness in this sample. Treatment most often involved oral medications, topical estrogen, and lifestyle modifications; however, early perimenopausal women appeared less likely to receive treatment/support than post-menopausal women, suggesting missed opportunities for early intervention when hormone-based therapies may be particularly effective and have broader health benefits. Mental health needs were substantial but insufficiently addressed: although most women reported negative mental health impacts and many sought help, relatively few were asked about mental health, provided information, or assessed with standardized tools. Over a third felt their mental health symptoms were not taken seriously, indicating poor integration of mental health screening and management within menopause care. Satisfaction with care was mixed, with lower satisfaction among women with medically induced menopause relative to those in late perimenopause, underscoring gaps in acknowledging and addressing symptoms after surgical or medical interventions. Thematic analysis highlighted consequences of poor care (e.g., feeling dismissed, deterred from help-seeking), dismissive attitudes, suboptimal treatment management and shared decision-making, misattribution of symptoms, and perceived deficiencies in HCP knowledge. Collectively, results emphasize the need for empathetic, supportive, and evidence-based care, improved HCP education, routine mental health screening, and collaborative decision-making to better align services with women’s needs across menopause stages and in medically induced menopause.

The study demonstrates urgent needs to improve menopause care in the UK by: (1) enhancing HCP understanding of physiological and psychological changes beyond stereotypical symptoms; (2) integrating empathetic, supportive communication and validation of women’s experiences; (3) involving women in shared decision-making with clear, evidence-based information on treatment options, including referrals to specialized women’s health services where appropriate; and (4) recognizing and addressing the distinct needs of women with medically induced menopause. Future work should extend to more diverse and representative populations and evaluate strategies to embed routine mental health screening and patient-centered care pathways within menopause services.

The sample over-represented highly educated, higher-income, and white participants relative to the UK population, limiting generalizability, particularly to ethnic minorities and disadvantaged groups who may face additional barriers. Social media-based recruitment and online delivery likely introduced selection bias (e.g., over-representation of those seeking help for mental health symptoms or those with negative care experiences). These factors should be considered when interpreting and extrapolating findings.