Healthcare Inequalities in a Diverse Menopausal Population: Insights from the UK (MARIE WP2a Study)

Objective Health inequalities during the menopausal transition remain under-explored in UK health services research. Through in-depth qualitative analysis across 50 diverse participant narratives including cis-women and transgender, surgical menopause, minoritised ethnic groups, and rural communities we sought to illuminate the structural, clinical, and sociocultural barriers to equitable menopause care.DesignProspective cross sectional study SettingUrban and rural regions of UKPopulation or SampleMidlife womenMethods We conducted reflexive thematic and content analysis of qualitative interviews from individuals experiencing perimenopause, menopause, and post-menopause across the UK. Participants (n=50) were purposively sampled to maximise diversity in geography, ethnicity, identity, and reproductive history. Data were analysed inductively to identify overarching themes and sub-themes relating to health inequality in menopause, with particular attention to previously underrepresented populations.Results Four intersecting domains of inequity emerged; (1) Clinical care gaps, including delayed diagnosis, misattributed symptoms, lack of surgical menopause protocols, and clinician hesitance around non-HRT pathways; (2) Structural barriers, such as postcode-based access (postcode lottery), service fragmentation, digital exclusion, and reliance on costly private care; (3) Psychosocial and identity-based inequities, including compounded distress among minoritised and transgender participants, cultural silence, reproductive trauma, and under-recognition of intersectional stigma; and (4) Workplace inequalities, marked by absent policies, performance stigma, and premature exit from employment. These findings highlight inequities not previously detailed in UK menopause landscape. Main Outcome MeasuresThemes emerged from the qualitative interviewsConclusions This study uniquely foregrounds lived experiences of menopause-related inequality through an intersectional lens, revealing how clinical, systemic, and occupational structures compound marginalisation. Our insights call for urgent policy and practice reform specifically integrated multidisciplinary pathways, culturally responsive training, standardised HRT access, and menopause-aware workplace policies to advance equitable care across all UK nations.