Beyond Biology: Sociocultural and Systemic Determinants of Menopause Experiences in India

BackgroundMenopause is a significant life stage for women, marking the permanent cessation of menstruation and the end of reproductive function. It may occur naturally or be induced surgically or medically through treatments such as hysterectomy, chemotherapy, or hormone suppression. While natural menopause is often gradual, surgical and medical menopause are associated with abrupt hormonal changes and more severe symptoms. India is experiencing a rapid demographic transition with a growing ageing female population. Despite this, menopause remains under-recognised in public health discourse, with limited research on women’s experiences and a lack of integrated care pathways. This study explored the lived experiences of perimenopause, menopause, and post-menopause among Indian women, focusing on how biological, psychological, sociocultural, and health system factors shape these experiences.MethodsA qualitative study was conducted as part of the MARIE India chapter (work package WP2a) using semi-structured in-depth interviews. Nineteen participants aged 35–70 years, including those with natural, surgical, and medical menopause, were purposively sampled to represent diverse geographical and socioeconomic contexts. Interviews were conducted in local languages, transcribed verbatim, and translated into English. Analysis was guided by the Delanerolle and Phiri framework, supported by thematic, comparative, and contextual approaches. Themes were identified iteratively through team discussions and validated through member checking.ResultsWomen described menopause as a complex transition influenced by intersecting biological, psychological, cultural, and structural determinants. Surgical menopause was associated with sudden, intense symptoms, while natural menopause presented more gradual variability. Cultural silence and stigma limited open discussion, leaving many to manage symptoms alone. Fragmented healthcare systems and lack of coordinated follow-up care exacerbated challenges, especially for women with multimorbidity or living in rural areas.ConclusionMenopause care in India requires urgent attention. These findings highlight the need for culturally sensitive, integrated services and policies to support women through this transition and reduce systemic inequities.