Perimenopausal Healthcare Services Utilization Among Women Aged 40 to 60 Years in Guangzhou, China: Status, Determinants, and Insights from a Mixed-Methods Study

Background: In China, the vast majority of perimenopausal healthcare (PMH) services are performed in a diversity of outpatient clinics, the implication is that women encounter more obstacles towards acquiring appropriate management of perimenopause, resulting in misdiagnosis or missed diagnosis and subsequent repeated visits. The initiation of PMH clinic in public hospitals is a new concept. This study aimed to assess PMH services utilization among women aged 40-60 years, and identify factors influencing it’s uptake in Guangzhou, China. Methods: A convergent parallel mixed-method study was conducted combining quantitative and qualitative methods from February to October 2024. A total of 1136 women from Tianhe District, Guangzhou were included in the quantitative survey. Barriers and facilitators for PMH services utilization were analyzed based on Andersen’s Behavioral Model of Health Services Use. Individual in-depth interviews with 16 stakeholders including perimenopausal women, their husbands, health providers, etc., were conducted to gain further insight into the services utilization behaviors. Results: The magnitude of PMH services utilization was 31.0% among women aged 40 to 60 year in Guangzhou, China. Factors associated with services utilization included registered residence (OR=3.158, 95%CI:2.014～3.957), distance (OR=2.841, 95%CI:1.784～3.259), decision-making autonomy (OR=0.361, 95%CI:0.128～0.813), stigma (OR=0.284, 95%CI:0.079～0.560), social support (OR=3.015,95%CI: 1.809～3.217) and severity of menopausal symptoms (OR=2.045, 95%CI:1.610～2.967 and OR=1.836, 95%CI:0.739～2.318, respectively). The qualitative study identified an overall low awareness of perimenopausal symptoms, perimenopause-related stigma in the public, and flawed health systems as significant barriers to services utilization. Conclusions: The utilization of PMH services among women aged 40 to 60 years remained suboptimal. Efforts should be made to raise public concerns about perimenopause. Improving services access and enhancing its uptake among disadvantaged sub-groups of women are critical for increasing the utilization of PMH services.