Beyond Reproductive Years: Addressing Menopause and Health-System Gaps in Rwanda
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Menopause is a universal stage in women’s lives, yet it remains largely invisible in Rwanda’s health policies and services. Symptoms such as hot flushes, fatigue, sleep disturbance, musculoskeletal pain, and mood changes can profoundly affect quality of life and productivity, especially among women engaged in physically demanding work. Despite Rwanda’s achievements in maternal and child health, menopause is overlooked, leaving midlife and older women unsupported. This qualitative study explored health-system readiness and responsiveness to menopause in Rwanda. Semi-structured, in-depth interviews were conducted with 28 women aged 40–75 years from rural and urban areas, representing natural, surgical, and medical menopause. Interviews were carried out in Kinyarwanda, transcribed verbatim, translated into English, and analysed thematically using Braun and Clarke’s six-phase approach. The Delanerolle and Phiri framework guided analysis, exploring biological, psychological, socio-cultural, health-system, and structural determinants. Five interconnected themes were identified: absence of menopause in clinical protocols and conversations; fragmented care pathways and missed opportunities; rural–urban disparities in access and service quality; lack of anticipatory guidance for surgical and medical menopause; and limited community outreach and education. Rural women faced geographical and financial barriers, while urban women encountered systemic neglect despite proximity to services. Across settings, women described cultural silence, lack of information, and health workers unprepared to provide care. Menopause remains invisible within Rwanda’s health system, resulting in unmet needs and inequities. Integrating menopause into policies, expanding community outreach, and training clinicians are essential to improve access, reduce stigma, and promote equity for midlife and older women.