Policy Blind-Spots: A Systematic Review of Midlife Health in Global Women’s Care (KATHERINE Project)

Background: Women in perimenopause, menopause, and post-menopause experience significant biological, psychological, and social changes, including vasomotor symptoms, urogenital atrophy, sleep disturbances, and cognitive shifts. Despite the impact on quality of life, productivity, and social participation, these life stages are underrepresented in national and international health policies compared to reproductive years.Methods: A systematic review following PRISMA guidelines was conducted. English-language national and international policy documents published up to March 2025 were retrieved from PubMed, Science Direct, Google Scholar, WHO, UNFPA, and national health ministry websites. Policies were included if they addressed women’s health during perimenopause, menopause, or post-menopause. Data extraction captured policy focus, target populations, chronic disease management, cancer screening, menopause care, equity considerations, and alignment with global standards. Thematic and conceptual analyses synthesized findings into key domains and gaps.Results: Thirty policies from 13 jurisdictions were reviewed, addressing women’s health across the reproductive life course, including peri-menopause, menopause, and post-menopause. Common priorities included chronic disease management, menopause symptom management, cancer prevention and screening, mental health support, and management of reproductive disorders such as PCOS, endometriosis, and infertility. Equity considerations focused on underserved populations, including rural women, socioeconomically disadvantaged groups, Indigenous and ethnic minorities, and other high-risk populations such as sex workers and adolescents. Conclusion: Policies addressing later reproductive years remain heterogeneous, with inconsistent integration of chronic disease management, cancer screening, and reproductive health care. Strengthening equitable, evidence-based policy frameworks is crucial to support women’s health, reduce disparities, and improve quality of life during perimenopause, menopause, and post-menopause.