Physical and mental health impact of perimenopause, menopause and post menopause in a diverse global population (MARIE Project- Global Chapter WP 2a): cross-sectional quantitative data from a mixed-methods study.
Menopause is a major global health issue affecting cisgender women, transgender people, and gender-diverse populations, yet it remains under-recognised in research and policy, particularly in low-income and middle-income countries. Rising life expectancy means that an increasing proportion of the world's population spends many years in peri-, menopausal or post-menopausal stages, often with significant physical and psychological symptoms. Despite this burden, evidence from diverse global settings is limited.
The MARIE WP2a project is a mixed-methods study that aimed to explore menopausal health across 13 countries. Study conducted from January 2024 to September 2025. Eligible participants (cis and transgender women) experiencing perimenopause, menopause, or post-menopause were recruited digitally from clinical and community settings from UK, Rwanda, Nigeria, Ghana, Tanzania, Sri Lanka, India, Pakistan, Nepal, Malaysia, Singapore, Oman and Brazil. Here, we report the quantitative component of the broader mixed-methods study within MARIE WP2a. The present analysis focuses exclusively on cross-sectional quantitative data to characterise symptom burden and associated health domains across participating countries. The primary aim of MARIE WP2a was to explore and document the physical and mental health impacts of perimenopause, menopause, and post-menopause among women. Secondary aims included exploratory assessment of symptom patterns in a subset of participants with repeated observations in the change in symptoms, lower-back pain, and quality of life. Symptom burden was assessed using validated scales covering psychological, somatic, pain, sleep, disability, and quality-of-life domains. Analyses included multivariable linear models; analyses involving repeated observations were conducted as sensitivity analyses only and, country-grouped heterogeneity models, and Gaussian Graphical Modelling to examine symptom interconnections.
A total of 5228 participants from 13 countries were included. The median age was 55 years (IQR 50-61). The distribution of menopausal stages was 18.6% (n = 972) perimenopause, 32.2% (n = 1684) menopause, and 49.2% (n = 2572) post-menopause. Symptom burden varied substantially across countries and menopausal stages. The UK and Rwanda exhibited the highest levels of anxiety, depression, somatic burden, vasomotor symptoms, and overall MRS scores, while Nepal, Sri Lanka, Malaysia, and Singapore consistently showed lower burden. Clinical complexity including endometriosis, disability, long-term conditions, premature ovarian insufficiency, and GnRH analogue use was strongly associated with worse outcomes. Burnout emerged as the most central symptom connecting psychological and somatic domains.
Menopause is a complex biopsychosocial transition shaped by geography, social determinants, and multimorbidity. Rather than testing causal hypotheses, this analysis is descriptive and hypothesis-generating, aiming to characterise patterns across diverse populations. Our findings highlight the need for holistic, multidisciplinary, equity-focused menopause care and policy approaches beyond narrowly symptom-based models. Future research should prioritise longitudinal designs and culturally grounded approaches to better understand trajectories and inform integrated models of care.
NIHR Research Capability Fund.
The MARIE WP2a project is a mixed-methods study that aimed to explore menopausal health across 13 countries. Study conducted from January 2024 to September 2025. Eligible participants (cis and transgender women) experiencing perimenopause, menopause, or post-menopause were recruited digitally from clinical and community settings from UK, Rwanda, Nigeria, Ghana, Tanzania, Sri Lanka, India, Pakistan, Nepal, Malaysia, Singapore, Oman and Brazil. Here, we report the quantitative component of the broader mixed-methods study within MARIE WP2a. The present analysis focuses exclusively on cross-sectional quantitative data to characterise symptom burden and associated health domains across participating countries. The primary aim of MARIE WP2a was to explore and document the physical and mental health impacts of perimenopause, menopause, and post-menopause among women. Secondary aims included exploratory assessment of symptom patterns in a subset of participants with repeated observations in the change in symptoms, lower-back pain, and quality of life. Symptom burden was assessed using validated scales covering psychological, somatic, pain, sleep, disability, and quality-of-life domains. Analyses included multivariable linear models; analyses involving repeated observations were conducted as sensitivity analyses only and, country-grouped heterogeneity models, and Gaussian Graphical Modelling to examine symptom interconnections.
A total of 5228 participants from 13 countries were included. The median age was 55 years (IQR 50-61). The distribution of menopausal stages was 18.6% (n = 972) perimenopause, 32.2% (n = 1684) menopause, and 49.2% (n = 2572) post-menopause. Symptom burden varied substantially across countries and menopausal stages. The UK and Rwanda exhibited the highest levels of anxiety, depression, somatic burden, vasomotor symptoms, and overall MRS scores, while Nepal, Sri Lanka, Malaysia, and Singapore consistently showed lower burden. Clinical complexity including endometriosis, disability, long-term conditions, premature ovarian insufficiency, and GnRH analogue use was strongly associated with worse outcomes. Burnout emerged as the most central symptom connecting psychological and somatic domains.
Menopause is a complex biopsychosocial transition shaped by geography, social determinants, and multimorbidity. Rather than testing causal hypotheses, this analysis is descriptive and hypothesis-generating, aiming to characterise patterns across diverse populations. Our findings highlight the need for holistic, multidisciplinary, equity-focused menopause care and policy approaches beyond narrowly symptom-based models. Future research should prioritise longitudinal designs and culturally grounded approaches to better understand trajectories and inform integrated models of care.
NIHR Research Capability Fund.
Authors
Delanerolle Delanerolle, Pathiraja Pathiraja, Eleje Eleje, Toh Toh, Rathnayake Rathnayake, Tweneboah-Koduah Tweneboah-Koduah, Afful-Minta Afful-Minta, Mudalige Mudalige, Sun Sun, Dhanarisi Dhanarisi, Al-Kharusi Al-Kharusi, Al-Riyami Al-Riyami, Mbwele Mbwele, Madan-Aggarwal Madan-Aggarwal, Ikwuka Ikwuka, Wang Wang, Mitra Mitra, Irfan Irfan, Kareem Kareem, Benetti-Pinto Benetti-Pinto, Dangal Dangal, Taylor Taylor, Briggs Briggs, Saraswat Saraswat, Hinchliff Hinchliff, Potocnik Potocnik, Elliot Elliot, Panay Panay, Atkinson Atkinson, Talaulikar Talaulikar, Umeoranefo Umeoranefo, Fontana Fontana, Kemp Kemp, Corkhill Corkhill, Majumder Majumder, Egwuatu Egwuatu, Njoku Njoku, Rabiu Rabiu, Chimbo Chimbo, Ezenkwele Ezenkwele, Malachy Malachy, Eleje Eleje, Ndukwe Ndukwe, Oriji Oriji, Chikezie Chikezie, Enweani-Nwokelo Enweani-Nwokelo, Ezeora Ezeora, Ikpeze Ikpeze, Nweze Nweze, Osunkwo Osunkwo, Edeh Edeh, John John, Obi Obi, Ekwuazi Ekwuazi, Egbonnaji Egbonnaji, Ogbonna Ogbonna, Muhammad Muhammad, Agu Agu, Chidozie Chidozie, Okoye Okoye, Okoro Okoro, Mbachu Mbachu, Ikechebelu Ikechebelu, Onubogu Onubogu, Nwaogu Nwaogu, Obiegbu Obiegbu, Nnabuchi Nnabuchi, Nweje Nweje, Adedayo Adedayo, Kumuyi Kumuyi, Akanni Akanni, Enyinna Enyinna, Alfa Alfa, Otis Otis, Otis Otis, Agbo Agbo, Anigwe Anigwe, Anyaeche Anyaeche, Okonkwo Okonkwo, Okemeziem Okemeziem, Uwakwe Uwakwe, Igboabuchi Igboabuchi, Ndubuisi Ndubuisi, Nkemdirim Nkemdirim, Sundarapperuma Sundarapperuma, Herath Herath, Dassanayake Dassanayake, Herath Herath, Wijamuni Wijamuni, Palihawattha Palihawattha, Illesinghe Illesinghe, Ambepitiya Ambepitiya, Peris Peris, Sitheja Sitheja, Kannangara Kannangara, Thavalingum Thavalingum, Dulanjala Dulanjala, Gayani Gayani, Madushika Madushika, Sivakumar Sivakumar, Madhushani Madhushani, Keerthisinghe Keerthisinghe, Hathurusinghe Hathurusinghe, Mudalige Mudalige, Lee Lee, Aiman Ali Madinah Aiman Ali Madinah, Jaafar Jaafar, Wong Wong, Yen-Sing Lee Yen-Sing Lee, Lau Lau, Mohsin Mohsin, Mohd Nasir Mohd Nasir, Suk-Chin Law Suk-Chin Law, Zamri Zamri, Abidin Abidin, Azmi Azmi, Kahar Kahar, Adnan Adnan, Wong Wong, Lim Lim, Yien-Mei Sim Yien-Mei Sim, Cristelle Cristelle, Haslan Haslan, Patah Patah, Nalathambi Nalathambi, Jaafar Jaafar, Wong Wong, Ibrahim Ibrahim, Ting Ting, Chen-Ling Lo Chen-Ling Lo, Hamdan Hamdan, Ngu Ngu, Dahian Dahian, Leong-Hoe Ngu Leong-Hoe Ngu, Khoo Khoo, Mathur Mathur, Puvanendran Puvanendran, Safdar Safdar, Kathirvel Kathirvel, Aiyappan Aiyappan, Yela Yela, Rezende Rezende, Nakamura Nakamura, Prasad Prasad, Noor Noor, Shilpa Shilpa, Singh Singh, Chatterjee Chatterjee, Mahinyila Mahinyila, Shemdoe Shemdoe, Mpangala Mpangala, Mwahi Mwahi, Pembe Pembe, Kaminyoge Kaminyoge, Alon Alon, Mwabenga Mwabenga, Pierre Pierre, Clementine Clementine, Chinwe Chinwe, Olubiyi Olubiyi, Sani Sani, Amalimeh Amalimeh, Nwanna Nwanna, Usman Usman, Isingizwe Isingizwe, Hanyurwimfura Hanyurwimfura, Marie Vianney Marie Vianney, Uwimpuhwe Uwimpuhwe, Melanie Melanie, Kantarama Kantarama, Tuyisenge Tuyisenge, Habimana Habimana, Vaidyanathan Vaidyanathan, Al Maqrashi Al Maqrashi, Bouchareb Bouchareb, Shi Shi, Elneil Elneil, Phiri Phiri
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