Intersecting Burdens: Comorbidity, Symptom Severity, and Structural Gaps in Menopausal Care (MARIE WP2a Study)
Authored by Gayathri Delanerolle, Jie Sun,
Julie Taylor, Paula Briggs, Lucky Saraswat, Sharron Hinchliff, Kristina Potocnik, Kathryn Elliot, Nick Panay, Carol Atkinson, Vikram Talaulikar,
George Uchenna Eleje, Nirmala Rathnayake, Tharanga Mudalige, Vindya Pathiraja, Jeevan Dhanarisi, Donatella Fontana, Lamiya Al-Kharusi, Nihal Al-Riyami,
Toh Teck Hock, Ieera Madan-Aggarwal,
Irfan Muhammad, Rabia Kareem,
Helen Felecity Kemp, Victoria Corkhill, Kingshuk Majumder, Ramiya Palanisamy, Jian Shi,
Sohier Elneil, and
Peter Phiri
- Posted
- Server
- Preprints.org
Abstract Objective Menopause, whether natural, medical, or surgical, is a universal yet heterogeneous health transition shaped by biological, psychological, socio-cultural, and systemic factors. Despite growing awareness in the UK, the experiences of those with multimorbidity, neurodivergence, reproductive trauma, or abrupt menopause remain under-represented in research and underserved in policy. This study aims to provide a critical lens to examine how social positioning, structural inequalities, and clinical marginalisation converge to influence symptom burden, care access, and health outcomes.DesignProspective cross sectional study SettingUrban and rural regions of UKPopulation or SampleMidlife womenMethods We conducted a qualitative analysis using the Delanerolle and Phiri Framework, which integrates four interdependent domains, Biological, Psychological, Socio-cultural, and Health System to capture the complexity of menopausal experiences. Data from in-depth interviews were coded both deductively, using framework-aligned a priori codes, and inductively to identify emergent themes. Intersectional analysis mapped the interplay between comorbidities, symptom severity, structural barriers, and care pathways across natural, medical, and surgical menopause.Results Participants reported high symptom burden beyond vasomotor complaints, including cognitive impairment, mood disturbance, musculoskeletal pain, and urogenital dysfunction, often exacerbated by co-existing health conditions. Systemic barriers included delayed diagnosis, inadequate menopause-specific training for general practitioners, fragmented mental and physical health services, and limited non-pharmacological care options. Marginalised groups particularly those who were neurodivergent, from racially minoritised backgrounds, or living in socioeconomically deprived or rural areas faced compounded disadvantage. The framework enabled disaggregation of experiences into system-specific deficits, such as lack of trauma-informed primary care, absence of neurodiversity awareness in mental health services, and culturally non-adapted communication in community outreach.Main Outcome MeasuresThemes emerged from the qualitative interviewsConclusion Menopause care in the UK requires redesign to reflect its intersectional and multisystem nature. Findings support the need for integrated, trauma-informed, and equity-driven models that address biological, psychological, socio-cultural, and systemic determinants in tandem. The Delanerolle and Phiri Framework provides a practical tool for translating lived experiences into targeted clinical, policy, and workplace interventions, with relevance for health systems globally.