Breaking the Silence on Menopause: Insights from Pakistani Women’s Lived Experience - A Qualitative Study

Introduction: Menopause, a biological transition, which marks the permanent cessation of menstruation and is commonly experienced between 45–55 years. In Pakistan, the mean age of menopause is reported as 47 years. While menopause has been extensively studied in Western contexts, psychological well-being, coping strategies, and awareness remain underexplored in Pakistan. Cultural taboos, limited utilisation of healthcare services, and absence of workplace policies compound the challenges women encounter during this transition. This study explores the lived experiences of Pakistani women to inform culturally appropriate interventions and evidence-based policy development. Methods: A qualitative study was conducted as part of the MARIE WP2A project from March to May 2024 in urban and peri-urban Peshawar. Twenty peri-menopausal, surgical menopausal, and post-menopausal women aged 45–68 years participated in semi-structured, in-depth interviews. A pre-designed topic guide explored physical and psychological symptoms, coping strategies, healthcare engagement, social support, and workplace policies. Interviews were conducted in Pashto or Urdu, transcribed, translated into English, and analysed using Braun and Clarke’s six-step thematic analysis framework. Results: Six key themes emerged. Physical symptoms were widespread, with musculoskeletal pain (65%), hot flushes (60%), and urinary complaints (55%) most reported. Psychological symptoms included emotional lability (60%), lack of concentration (60%), and anger issues (35%). Coping strategies were largely informal, including family support (25%) and pacing daily activities (20%). Most participants reported limited social support, with menopause often experienced in isolation. Only 35% sought healthcare, with hesitancy towards hormone replacement therapy due to fear of side effects. Awareness of workplace policies was absent, though participants highlighted the urgent need for structured support. Conclusions: Menopause in Pakistan is shaped by cultural silence, limited healthcare engagement, and systemic neglect. Addressing these gaps through community awareness, culturally appropriate healthcare guidelines, and workplace policies is essential to improve psychological well-being and quality of life for midlife women.