Supporting engagement, behavior change, and equitable self-management in menstrual and menopausal health: A multi-agent digital-health framework

Menstrual-cycle–related conditions and, later, menopausal symptoms are highly prevalent across the female life course and impose a large, under-recognized burden on quality of life and work, yet digital tools to support self-management are fragmented, hard to sustain, and unevenly reached. We propose HERA (Health Engagement and Reflective Agent architecture), a conceptual, hypothesis-generating framework for supporting engagement, behavior change, and equitable self-management in menstrual and menopausal health across the life course. Under human governance, HERA combines two adaptive agents (interpretation and orchestration) with three rule-based modules (self-monitoring and data integration, guidance and content governance, and equity and engagement monitoring) that integrate self-monitoring, deliver personalized feedback, surface governed guidance, monitor equity, and coordinate hand-offs to clinicians and occupational-health services. Distinct from clinician-facing diagnostic agents, HERA is patient-facing and treats equity and engagement as first-class. We distinguish technically feasible from aspirational elements and set out a staged, threshold-gated evaluation plan. HERA is a design reference, not a validated system.