Objective This study is to provide evidence from Nigeria on women’s lived experiences of menopause is sparse, necessitating qualitative inquiry to inform contextually appropriate interventions.DesignProspective cross - sectional study SettingUrban and rural regions of NigeriaPopulation or SampleMidlife womenMethods As part of the MARIE project, semi-structured interviews were conducted with midlife women across urban and rural regions of Nigeria. Participants were purposively sampled to capture diverse socioeconomic backgrounds and menopausal stages. Data were analysed using thematic content analysis, with coding informed by health inequality and gender frameworks, and findings were triangulated by multiple researchers to enhance validity.Results Analysis revealed three overarching themes: (1) structural inequalities in healthcare, including delayed recognition of symptoms, inadequate clinician knowledge, and limited access to hormone replacement therapy; (2) sociocultural and gendered barriers, such as stigma, misperceptions of menopause as a “natural end” requiring no care, and silencing within families; and (3) coping and resilience strategies, encompassing reliance on peer networks, faith-based approaches, and lifestyle adaptations in the absence of formal support. Urban participants reported marginally better access to information and services, while rural women described significant neglect, often relying on informal care.Main Outcome MeasuresThemes emerged from the qualitative interviewsConclusionsThis study highlights profound inequalities shaping menopausal experiences in Nigeria, reflecting gaps in healthcare training, policy attention, and community awareness. The findings emphasise the need for integrated, culturally sensitive strategies, including the incorporation of menopause into primary care, universal access to safe affordable treatments, and targeted public health education.