Menopause in Brazil: lived experiences, inequities, and opportunities for inclusive care (MARIE-Brazil WP2a).

Abstract

Despite global prevalence of Menopause, evidence on lived experiences across diverse populations remains limited, particularly in Brazil. Addressing these gaps is essential for designing equitable health policies. MARIE-Brazil conducted a qualitative study to explore menopausal experiences. Twenty women were selected from a cohort of 262 women in the MARIE-Brazil quantitative study who consented to the qualitative phase. Semi-structured interviews were conducted using a topic guide with participants self-identifying as experiencing perimenopause, menopause, or post-menopause. Sampling captured heterogeneity across age, menopausal stage, socio-economic position, ethnicity, and healthcare access. The findings indicate intersecting biological, psychological, socio-cultural, and health system determinants shaping experiences. Participants reported vasomotor symptoms, sleep, cognitive, and urogenital changes that influenced quality of life and occupational participation. Barriers to care included limited clinical knowledge, "front-desk gatekeeping," and financial inaccessibility of treatments. Cultural stigma and gender norms exacerbated inequities, while peer networks and supportive clinicians improved coping. Menopause is not solely a biological milestone but a multifaceted transition shaped by structural and cultural determinants. Findings highlight urgent needs to adapt robust clinical protocols (e.g. Brazilian Federation of Gynecology and Obstetrics Associations-FEBRASGO, Brazilian Society of Climacteric-SOBRAC) for the public sector (SUS) and provide training for non-clinical staff, and accessible treatment pathways. Incorporating lived experiences into service design and policy frameworks is critical to promoting equity in menopause care across diverse Brazilian population.