We need to talk about menopause. But with whom and how?

Menopause is defined as the cessation of menstrual periods. It has traditionally been conceived of as an ending - the end of menstruation and fertility - and as a series of medical problems that require medical solutions. Symptoms of menopause can last for up to 15 years for some women and can pose challenges to identity, how they experience work and relationships, how they experience their social roles, and how they are perceived by others.

In spite of the ubiquitous nature of menopause, women still feel uninformed about it. Only 9% of respondents in the Women’s Health Strategy said they had enough information about menopause and only about two thirds felt comfortable talking to healthcare professionals about it.

There is no doubt that the experience of menopause varies for individual women, but given the significant impact it can have on women’s lives, it is imperative that we understand it not only on a physiological level,  but on experiential and cultural levels too. This is particularly important as women across different cultures, countries and ethnicities report variation in their experiences of menopausal symptoms,¹ leading to calls to consider psychosocial and cultural mechanisms in addition to biological and lifestyle explanations.^2-4

Our new research on improving communication about menopause for women from South Asian backgrounds aims to foreground the experiences of South Asian women living in England. This qualitative study will involve the views of multiple women across the country. The research has been designed with South Asian women after we worked with them to identify this as a priority topic for them.

When researching with minoritised communities, it is important to recognise that traditional models of research may be exclusionary, so it is important to take an inclusive approach. The first stage in designing inclusive research is to ensure it is grounded in what is important to the people the research affects. In 2019, we met with women from South Asian backgrounds to ask them what is important to them and what questions research could answer for them. The main themes of the discussion were illustrated by an artist, who created the evocative painting accompanying this piece.

The women discussed a culture of silence around menopause and menstruation. They explained that they don’t really talk about menopause to each other and worried that this culture of silence allowed misinformed to prevail. They also described a reluctance to talk to health professionals about it too. Previous research has shown that this could be down to fears their doctor may not be female^5-7 or that their doctor’s perceptions about their culture and the way they dress may influence how they are treated.⁷

Thinking about how to take what we’d learned forward; we enlisted the help of some South Asian women as PPI contributors to design and refine the study. Based on their advice, we are doing several things. Information about the study will be translated into multiple South Asian languages. Participants will be able to give verbal instead of written consent. They will have a choice about whether to take part in an interview or focus group. Data will be collected in the language the participant prefers (we will hire consultant researchers to broaden our capacity to do this). We will disseminate the findings in an inclusive and accessible animation. Most importantly, we will continue to work with our PPI co-applicants and contributors throughout to ensure we stay close to what is important to South Asian women.

The Department of Health and Social Care's Women’s Health Strategy will likely define the landscape of research on the health of women in the coming years. But it is worth noting that 91% of the respondents to the survey on which it is based were White. Only 2% were from an Asian background and 3% identified as Black. We need to do more to include the voices of racially minoritised women in research. Our research on improving communication about menopause for South Asian women will go some way towards doing this.

Dr Anne-Marie Boylan is a Departmental Lecturer and Senior Researcher in the Centre for Evidence Based Medicine. She is the Director of the Postgraduate Certificate in Qualitative Health Research Methods.

The study team are Dr Shoba Dawson, Dr Yumna Masood, Neeta Kachhela, Hina Sharma, Dr Stephanie Tierney, Dr Opeyemi Babatunde and Prof Kamal Mahtani.

This study is funded by the NIHR School for Primary Care Research (Grant Reference Number: 681). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

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