What are the barriers and facilitators to women with menopausal symptoms participating in physiotherapy intervention?

Introduction

Menopause typically begins in the 40s (perimenopause) with symptoms such as hot flushes, fatigue, and musculoskeletal pain affecting 80% of women. Declining hormones during menopause can reduce bone density, muscle strength, and joint health, contributing to musculoskeletal (MSK) pain, reported in up to 85% of women. Physiotherapists play a key role in the management of MSK pain, however, menopause-related symptoms such as fatigue and low self-efficacy can hinder physiotherapy engagement.

Objectives

To explore the experiences of menopausal women with musculoskeletal (MSK) pain attending physiotherapy and identify barriers and facilitators to engagement.

Design

A qualitative study utilising semi-structured interviews. Reflexive thematic analysis was performed.

Setting

A single NHS elective orthopaedic hospital in the UK.

Participants

12 participants recruited via e-posters and staff support group

Results

Two main themes were identified: uncertainty regarding symptoms and considerations for physiotherapists. Common barriers to physiotherapy were fatigue, cognitive issues, low self-efficacy and negative language used by healthcare professionals. Participants emphasised being asked directly about their menopausal status and feeling listened to were facilitators for engagement. Individualised treatment strategies and education were reported as recommendations to foster rapport and engagement.

Conclusions

Menopausal women with MSK pain experience uncertainty about their symptoms and feel their needs are not fully met by physiotherapists. Direct enquiry, individualised care plans and education may improve engagement and enhance therapeutic relationships. Physiotherapists are well-positioned to support women through this important transition, but specific training may be required to enhance their knowledge and skills in treating menopausal women with MSK pain.

Contribution of paper

• This is the first study to explore barriers and facilitators to physiotherapy for women with menopausal symptoms through their own perceptions and experiences

• Menopausal women with MSK pain often experience high levels of uncertainty regarding their intrusive symptoms

• Physiotherapists should consider direct questioning, education and individualised treatment plans when treating menopausal women with MSK pain

• Training programmes may be required to improve the knowledge and skills of physiotherapists treating menopausal women with MSK pain.