Ethnic and Contextual Inequities in Menopause Pathways and Treatment Access: A Cross-Sectional Analysis of MARIE WP2a-Malaysia
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Background Menopause is a critical life stage for women’s health, yet it remains under-recognised in Malaysia despite an ageing female population and documented ethnic and regional diversity. 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 632 women enrolled in the Malaysian 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 50.1 years (SD 4.5). Natural menopause predominated (72.7%), with 16.0% experiencing surgical and 11.3% medical menopause. Surgical menopause was markedly higher among Bumiputera Sarawak women (35.5%) compared to Chinese (12.5%) and Malay (13.9%) groups. Urban residence was associated with higher odds of both surgical (OR 2.47, 95% CI 1.25–4.86) and medical menopause (OR 1.87, 1.07–3.26). Women with surgical menopause had the highest cumulative burden scores. 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.