Clinical Epidemiological Profile of Perimenopausal, Menopausal, and Post-Menopausal Women in Sri Lanka

Background: Menopause is a critical life stage for women’s health, yet it remains under-recognised in Sri Lanka despite an ageing female population. Previous studies have reported symptom prevalence and mean age at menopause but lacked an integrated, population-level approach to understanding biological, sociocultural, and health system determinants. Methods: We conducted a cross-sectional analysis of baseline data from 720 women enrolled in the Sri Lanka arm of the Menopause and Ageing Research in International Environments (MARIE) study. Menopause type was classified as natural, medical, or surgical using direct self-reports supplemented by rule-based derivation from hysterectomy, premature ovarian insufficiency (POI), and gonadotrophin-releasing hormone (GnRH) analogue use. Descriptive statistics, Wilson confidence intervals, and multivariable logistic regression with cluster-robust standard errors were used to examine associations with age, ethnicity, education, employment, and urban versus non-urban residence. A burden index was developed to assess cumulative disadvantage across clinical, treatment, and sociocultural domains. Results: The mean age at menopause was 49.7 years (SD±4.1). Natural menopause predominated (83.5%), with 7.4% experiencing surgical and 2.2% medical menopause. The use of traditional remedies was 6.9%, and HRT was 3.4%.The composite burden score (range 0–8) quantified cumulative disadvantage across clinical, treatment, and sociocultural domains. The overall mean burden score was 1·1 (SD 0·7), with a median of 1 (range 0–4). Burden scores were broadly similar across stages: 1·05 in pre-menopausal, 1·10 in perimenopausal, 1·12 in menopause, and 1·11 in post-menopausal women. Conclusion: These findings highlight substantial ethnic and contextual disparities in menopause pathways and treatment access. Addressing inequities through improved access to conservative care, culturally sensitive services, and integrated women’s health policies is urgently needed.