Minority ethnic women's experience of menopause: a mixed methods study

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We will investigate, through rich ethnographic research, the medical, social and cultural dimensions of minority ethnic women's experience of menopause in order to provide guidance to aid health care interventions targeted both at menopause and later in the life course. Our starting point is that very little is known about the menopause experience of women from diverse ethnic communities living in the UK, including their perceptions of, and interaction with, health care providers. Health care providers report rarely, if ever, interacting with such women about their menopause and of lacking the confidence and cultural competence to do so. Consequently, opportunities to offer support both in terms of menopause symptoms and in terms of mid-life health and wellbeing may be lost. The white western-focused research on menopause means that the different ways in which menopause may be experienced by minority ethnic women is not something doctors may recognise. From the women's perspective, the emphasis on White women's experiences in research as well as their dominance in patient information literature may discourage them from seeking health care. Those who do attend report dissatisfaction with these encounters. The limited existing research on this subject suggests that barriers and obstacles to health care need exploring both from the perspective of women and from that of their health care providers. Drawing on the insights of previous anthropological/sociological research and informed by the need to reduce the health gap between white and minority ethnic communities which grows wider with age, this research takes a culturally informed approach to the menopause. It recognises that menopause is not 'one' experience that women all around the world will experience but combines a biological and cultural element which influences symptoms and the social meanings given to them. Additionally, women from different minority cultures in the UK will have a range of issues relating to factors such as life course, history of migration and degree of acculturation, as well as intersectional issues around class, sexuality and lifestyle, that will impact on menopause. This complexity necessitates rich qualitative research that is sensitive enough to capture differences between, as well as within, communities. Consequently, we will generate original knowledge through semi-structured interviews with 30 Black and 30 Chinese women adopting a life course and biographical perspective of menopause. Our sample will be accessed through a range of women's and cultural centres located in Liverpool. The semi-structured interviews will explore: a) experience of menopause, psychosocially and physiologically; b) impact of menopause on other areas of life; c) life course narratives contextualising menopause within reproductive history; d) health and well-being in a life-course context; e) interaction with/perceptions of health care providers. We will develop a structured Health and Menopause questionnaire adhering to STROMA guidelines and containing both standard questions and ones unique to these communities using the input of the semi-structured interviews. Additionally, we will carry out focus groups with health care professionals to explore the barriers and facilitators, from their perspective, in terms of offering support and appropriate interventions to these women. We will also invite women to focus groups designed to capture their experience of menopause through creative methods. Insights from the research will inform the development of three tools: a) a 'cultural competence' menopause tool which will support health care professionals in recognising culturally diverse symptoms of menopause and its impacts on health and thereby offering information, advice and support to such women and b) culturally appropriate guidance for women themselves; c) a survey instrument suitable for larger scale research on menopausal experience in similar minority communities.