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Abstract

Introduction:

There is limited education provided to women about perimenopause and menopause, consequently many women have little knowledge and/or do not receive appropriate care in this critical life phase. The aim of this study was to explore Australian women’s knowledge of perimenopause and menopause.

Methods:

This concurrent mixed methods study using an online survey and qualitative interviews explored Australian women’s knowledge and experiences of perimenopause and menopause.

Results:

Four hundred eleven women completed the quantitative online survey with 25 participating in the semi-structured interviews. Data specific to women’s knowledge of perimenopause and menopause were analyzed with qualitative data presented.

Discussion:

Most participants in this study had some knowledge of perimenopause and menopause; however, expectations differed greatly from the reality they experienced. Findings highlighted that websites could be beneficial and discussions between women provided emotional and psychological support. There was no meaningful difference in knowledge scores due to education level.

Keywords

menopause perimenopause women’s health knowledge

Introduction

Perimenopause is the transition period during which physiological changes mark progression toward a woman’s final menstrual period (Delamater & Santoro, 2018) and is associated with biological, and psychological changes and challenges (Greer, 2018). As part of the decrease in ovarian hormone secretion, steroid hormone levels fluctuate (Fiacco et al., 2019) resulting in hot flushes, night sweats, and/or sleep disturbances (Süss & Ehlert, 2020). Perimenopause and menopause are associated with physical health issues that contribute to chronic conditions such as cardiovascular disease, osteoporosis, and oral health problems (Lobo & Gompel, 2022; Varlas et al., 2021), as well as increased risk of psychological disorders, including depression and anxiety (O’Reilly et al., 2023). Globally, 1.1 billion women are projected to be in menopause by 2025 (Barati et al., 2021), yet awareness and education remain limited, leaving many unprepared for this life stage (Harper et al., 2022).

Menopause is a complex and deeply personal experience influenced not only by biological changes, but also by cultural beliefs, education, and social support (Cowell et al., 2024; Davis et al., 2023; O’Reilly et al., 2023). Increasingly, there is recognition that the experiences of menopause among women from diverse ethnic, cultural, and linguistic backgrounds remain underresearched and inadequately understood. In the Australian context, the Senate Community Affairs References Committee (2024) has identified significant gaps in menopause education, clinical care, and workplace support, particularly for women from culturally and linguistically diverse (CALD) and Indigenous backgrounds. These findings are reinforced by Davis et al. (2023) who highlights poor access to appropriate menopause care, low awareness of treatment options, and stigma surrounding menopausal symptoms among Australian women. National initiatives such as the Australian Government’s Women’s Health Strategy 2020–2030, explicitly call for inclusive, gender-responsive research that reflects the lived realities of all Australian women, including those from marginalized communities (Australian Government Department of Health, 2019). By centering this population, this study aims to contribute to a more equitable and comprehensive understanding of menopause, grounded in national health priorities and aligned with global efforts to advance diversity and inclusion in women’s health research.

The aim of this article is to present qualitative and quantitative findings about Australian women’s knowledge of perimenopause and menopause. Due to the depth of data collected, findings relating to perimenopause and menopause in relation to mental health and women’s experiences have been reported elsewhere (O’Reilly et al., 2024; Peters et al., 2025). This study follows Good Reporting of a Mixed Methods Study (GRAMMS) checklist (O’Cathain et al., 2008) (Supplemental S1).

Method

Ethical Considerations

Full ethics approval was granted by the relevant University Human Research Ethics Committee (HREC ID Number: H14724). Participants were fully informed about the study, including its purpose, procedures, and their right to withdraw at any time without consequences. Survey completion implied consent, while interview participants provided audio-recorded verbal consent, confirming their voluntary participation. Confidentiality was maintained through de-identification of personal information and the use of pseudonyms. Contact details for counseling services and support groups were provided where needed.

Study Design

An equal weighting concurrent mixed methods design was employed for the study, where both quantitative and qualitative data were collected at the same time via online surveys and qualitative interviews between April and July 2022. This allowed the researchers to compare and contrast quantitative statistical results with qualitative findings (Creswell & Clark, 2017) and use the data collectively to interpret the findings (Mackey & Bryfonski, 2018).

Setting and Participants

Using purposive and snowball sampling, Australian women were recruited due to the intersection of cultural diversity, health care context, and emerging policy focus. Inclusion criteria were women over 18 who self-identified as being in perimenopause or menopause. To ensure consistency, participants were provided with the following definitions: perimenopause was defined as changes in menstrual cycle length by 7 days or more from baseline for at least two consecutive cycles and/or amenorrhea lasting over 60 days; menopause/postmenopause was defined as amenorrhea for at least 12 months (Harlow et al., 2012).

Recruitment and Data Collection

Participants were recruited through advertisements on Facebook™ and Twitter™ (X), inviting Australian women who were perimenopausal or menopausal to complete an online survey. Survey respondents were then invited to participate in semi-structured interviews to discuss their knowledge and experiences of perimenopause and menopause in greater depth. Maximum variation sampling was used to capture a diverse range of perspectives, with particular attention to cultural background.

Quantitative Data Collection

The quantitative survey comprised demographic questions and two validated tools with permission from the authors. These tools were the 23-Item Women’s Health Questionnaire (WHQ) (Girod et al., 2006) and nine items from the Menopause Knowledge Scale (MKS) (Appling et al., 2000) which had been adapted by Smail et al. (2020). The 23 item WHQ investigates six domains including depressed mood and anxiety; well-being, memory and concentration; somatic symptoms; sleep problems and vasomotor symptoms. Scoring is on a 4-point Likert-type scale where 1 = yes, definitely, 2 = yes, sometimes, 3 = no, not much and 4 = no, not at all. Cronbach’s alpha coefficient for the 23 item WHQ is >0.88 (Girod et al., 2006). The adapted MKS (Smail et al., 2020) explores knowledge of menopause by asking respondents to indicate their level of agreement with various statements. Items are scored with 1 = Agree and 2 = Disagree. Cronbach’s alpha coefficient for the MKS is 0.858; Smail et al., 2020). To ensure suitability for the target population, the survey was reviewed by 10 women in perimenopause or menopause, leading to minor formatting and wording adjustments. The electronic survey was open from April to July 2022.

Qualitative Data Collection

Semi-structured interviews were conducted using a guide developed by the authors, all registered nurses and PhD qualified researchers (see Table 1). The guide was reviewed and refined based on expert panel feedback. Interviews were held via telephone or online video, audio-recorded, and transcribed verbatim, with a mean duration of 28 min.

Table 1.

Interview Guide.

Question 1. Can you tell me about your experience of perimenopause/menopause?Question 2. Approximately what age were you when you first identified that you were going through perimenopause/menopause?

Question 3. What symptoms did you experience when going through perimenopause/menopause? Did these symptoms change/impact on your life? If so, how?

Question 4. What knowledge did you have of menopause before you started going through perimenopause/menopause?

Question 5. Where did you gain your knowledge of perimenopause/menopause from? Can you tell me about any cultural influences?

Question 6. What involvement with service providers have you had in relation to menopause?

Question 7. What strategies did you use to alleviate symptoms of perimenopause/menopause? Can you tell me about any cultural influences?

Question 8. Can you identify changes to your health and well-being that you have experienced since perimenopause/menopause?

Question 9. Do these changes present any challenges to you as a woman? If so, can you tell me about these challenges?

Question 10. Is there anything else you want to tell us about your experience of perimenopause/menopause?

Data Analysis

Quantitative data were analyzed using SPSS version 25.0. Pairwise deletion addressed missing responses, preserving information (Shi et al., 2020). Descriptive statistics summarized means, medians, ranges, percentages, and standard deviations.

Qualitative data were transcribed verbatim and managed in NVivo 7.0™. Analysis followed Braun and Clarke’s (2019) framework, beginning with repeated reading of transcripts and listening to audio recordings to ensure accurate interpretation. Two authors independently coded the data, grouped similar codes into clusters, and collaboratively refined these into themes until consensus was reached.

After separate analyses, quantitative and qualitative data sets were compared with identify convergence or divergence. Reporting followed a contiguous narrative approach, presenting quantitative results first, followed by qualitative findings.

Rigor

Credibility in the qualitative phase was ensured through active participant engagement. Although offered the chance to review their transcripts, participants did not do so. To validate the interpretation and understanding of participants’ narratives, two researchers independently conducted the data analysis. An audit trail of decision-making was maintained, and the researchers engaged in critical self-reflection to examine how their preconceptions might have influenced the interpretation of findings. Final themes were collaboratively discussed until consensus was reached and supported by participants’ quotes to ensure dependability and confirmability.

Results

Quantitative Results

Four hundred and eighty women commenced the survey; however, 69 of these completed only some sections. Only 411 women completed all questions therefore there are minor differences in some of the percentages and numbers presented.

The participants in this study had a mean age of 51.69 years, with the majority (73.8%) being Australian born. Just over half (54.1%) reported being in perimenopause, while the remainder were in menopause. Education levels varied, with 35.6% holding a bachelor’s degree, 22.7% a master’s, and 14.3% a PhD. Smaller proportions had completed secondary education (5.9%), technical college (12.4%), part of a university degree (6.3%), part of a technical college course (0.7%), or had no formal schooling (2.1%) (see Table 2).

Table 2.

Demographic Characteristics of Survey Participants.

	Characteristic	%	n
Mean age (years)			51.69
Country of Birth	Australia	73.80	301
(n = 412)	United Kingdom	10.00	41
	New Zealand	3.90	16
	Other	12.30	54
Relationship status	Married or de facto	80.05	341
(n = 426)	Divorced/separated	10.56	45
	Single	7.28	31
	Widowed	1.17	5
Employment status	Full-time	58.82	250
(n = 425)	Part-time	23.53	100
	Temporary/Contract	5.41	23
	Retired/Unemployed/Unable to work	7.30	31
	Other	4.94	21

Note. Numbers and percentages differ as not all participants completed all survey items.

Women rated their knowledge about menopause as good (43.13%; n = 190); fair (31.35; n = 132); very good (18.76; n = 79) or admitted to having little knowledge (4.75%; n = 20). Participants’ perceptions of their own knowledge were mostly accurate when participants scored themselves as having little or fair knowledge. Participants who rated their knowledge as good or very good were less accurate. The majority (85.7%; n = 306) of participants were aware of treatment options and recognized Hormone Replacement Therapy (HRT) as the most suggested treatment for menopause.

The overall mean score for the MKS was 6.73 out of a possible 9 marks. The higher the score the greater the knowledge about menopause. Notably, there was no significant difference in MKS scores due to education level. Most participants in this study (79.29%; n = 333), considered menopause to be a natural transition in a woman’s life. 9.76% (n = 41) stated menopause was a medical problem and should be treated as such, 9.76% (n = 41) of women thought it was a natural transition that required medical intervention and 1.19% (n = 5) of women did not know whether menopause was a natural transition or a medical problem. Knowledge regarding hot flushes and weight gain was highlighted in the quantitative data and identified by the participants as common symptoms they expected in perimenopause and menopause.

88.19% (n = 366) of participants agreed that menopause was due to a decrease in female hormones compared with 5.54% (n = 23) who disagreed. 6.27% (n = 26) of participants indicated they did not know about the relationship with hormones. Most participants agreed that menopause occurred when menstruation stops (77.59%; n = 322), with 20.48% (n = 85) disagreeing and 1.93% (n = 8) indicating they did not know. Most participants (79.95%; n = 331) agreed with the statement that pregnancy cannot occur after menopause compared with 11.84% (n = 49) who disagreed. A further 8.21% (n = 34) indicated they did not know. Most participants (60.24%; n = 250) also agreed that menopause occurs when ovaries stop functioning compared with 21.69% (n = 90) who disagreed. The remaining 18.07% (n = 75) reported they did not know. 88.14% (n = 364) of participants agreed that menopause was accompanied by hot flushes compared with 10.17% (n = 42) who disagreed. Again, a small percentage (1.69%, n = 7) of women reported not knowing.

Interestingly, most participants had a better understanding of the increased risk of osteoporosis during menopause than the increased risk of cardiovascular disease. 92.29% (n = 383) of participants agreed that risk of osteoporosis increases with menopause with a notable decrease to 66.75% (n = 277) of participants agreeing that risk of cardiovascular disease increases with menopause.

The majority of participants agreed that risk of depression increases during the menopause period. Only 2.17% (n = 9) disagreed and 14.22% (n = 59) said they did not know. Less than half of the participants (37.20%; n = 154) agreed that menopause can have harmful consequences if not treated compared with 39.61% (n = 164) who disagreed with a further 23.19% (n = 96) indicating they did not know.

In relation to seeking out knowledge, over half (52.9%, n = 221) of the women responded that they gained knowledge of menopause from the internet or social media compared with 30.1% (n = 126) who reported gaining knowledge from a health care professional. The remaining participants gained knowledge about menopause from relatives or friends (15.3%; n = 64) with the remaining 1.7% (n = 7) sourcing information from magazines.

Qualitative Results

Twenty-five women participated in the semi-structured interviews. The mean age was 51.8 years with the majority (n = 15) Australian born. Other countries of birth included New Zealand (2), Chile (1), Serbia (1), Pakistan (1), Bahamas (1), Vietnam (1), Spain (1), United Kingdom (1), and Germany (1) which reflected the diversity of the multicultural nature of Australia (see Table 3). All participants spoke fluent English. Most participants were married or in a de facto relationship (n = 16). Twenty-one women described themselves as heterosexual, with four identifying as bisexual. Their employment ranged from working in health (13), teaching (3), advertising and marketing (3), events management (1), science (1), corporate (1), psychology (1), accounting (1), and mediation (1).

Table 3.

Demographic Characteristics for Interview Participants (n = 25).

Pseudonym	Country of origin	Education level	Relationship status	Employment status
Ally	Australia	Master’s degree	Divorced	Full-time
Jill	Australia	Certificate	Married	Part-time
Olivia	Chile	PhD	Divorced	Full-time
Bella	Serbia	Bachelor’s degree	Single	Student
Ann	Australia	Diploma	Married	Part-time
Flora	Australia	Bachelor’s degree	Married	Part-time
Sophie	Australia	Diploma	Married	Full-time
Betty	Australia	Master’s degree	Separated	Full-time
Elsbeth	Australia	Bachelor’s degree	Married	Full-time
Marissa	Spain	Master’s degree	Married	Full-time
Claire	Australia	Master’s degree	Married	Full-time
Jodie	United Kingdom	Bachelor’s degree	Single	Full-time
Gayle	Australia	Secondary school	Married	Full-time
Myat	Australia	Bachelor’s degree	De facto	Full-time
Avril	Australia	Diploma	Married	Part-time
Hannah	Australia	Master’s degree	Divorced	Full-time
Penny	Pakistan	PhD	De facto	Full-time
Debbie	Australia	Master’s degree	Single	Part-time
Lisa	New Zealand	Some secondary school	Divorced	Full-time
Ashley	Bahamas	Master’s degree	Divorced	Full-time
Mary	Vietnam	Bachelor’s degree	Married	Part-time
Monica	New Zealand	Diploma	Married	Part-time
Naomi	Australia	PhD	Married	Unable to work
Vanessa	Australia	Bachelor’s degree	Married	Part-time
Janet	Germany	Master’s degree	Married	Part-time

Two themes captured participants’ knowledge of menopause: Having limited knowledge and Acquiring knowledge. The theme Having limited knowledge highlights participants’ lack of prior awareness and understanding of what they would experience when transitioning to perimenopause and menopause, and the second theme, Acquiring knowledge, describes how the women independently sourced information about perimenopause and menopause:

Having limited knowledge: My knowledge of menopause was a few hot flushes and a bit of dry skin.

From the qualitative data, it was evident that some participants had the preconceived idea that the transition to perimenopause and menopause would consist only of the cessation of their period and that they may experience hot flushes and weight gain:

Well, I knew about menopause, that you had hot flushes and sweat a lot, and you put on weight, and you stop your period. That’s pretty much it. (Janet)

All interview participants had the knowledge that the cessation of menstruation was part of perimenopause and menopause. Some women described the inconsistencies in their cycle as their first indication that they may have been in perimenopause:

My first sign was my period started going a bit crazy. I can be [menstruating] anywhere from 13 days and my longest at the moment is 64 days. Very irregular periods. (Vanessa)

Regardless of their prior knowledge, all interview participants were surprised by the intensity and variety of symptoms, with one participant stating:

I could never have anticipated that perimenopause would have been like this. I guess I didn’t understand—I didn’t expect how all-consuming perimenopause is. It’s not just a shift of your cycle or your hormones, it’s every part of your wellbeing, like the difficult-to-manage weight gain, the identity shift, the mental health implications, the way my skin has changed. It affects every part of your body and mind, and I don’t think—yeah, I didn’t know about that. (Naomi)

Regardless of educational or cultural background, the women in this study demonstrated limited knowledge regarding the severity of symptoms they may experience. Even participants that self-identified as health professionals had an inadequate understanding of what to expect. Ally conveyed that she felt she should have been aware and conveyed a sense of annoyance at not recognizing her symptoms:

I had very limited knowledge, even though I’m a nurse and a woman . . . . . . my knowledge of menopause was a few hot flushes and a bit of dry skin, that’s all I knew. Then I had these light periods in my early 40s, and I went to the doctor about it, and he suggested I might be perimenopausal. (Ally)

Most of the women in this study had some expectation they would experience hot flushes, sweating and some mood swings as part of the transition process and believed they would last for a definitive amount of time and then stop. The reality of their experiences differed from what they expected:

Just like always the hot flushes thing. I knew that was something and maybe mood swings. I never kind of knew, but I had in my head that it was more like very definite you knew exactly when it was going to happen. When it started you knew this was it, and it would go for X time, and you knew when it stopped. When it stopped you knew that was it. It was all—I think my experience was different to what I imagined in my head it would be. (Elsbeth)

Acquiring knowledge: “Knowledge is power”

Acquiring knowledge about menopause was difficult for most participants. Despite the cultural diversity of Australian women, most participants regardless of their ethnic background, identified that discussions around menopause were avoided. This avoidance led to their lack of knowledge about this life transition. Olivia conveyed, “For me, from my culture, like South American, I think for my mum it’s just something that happens, and you just live through it and move on. My mum never talked about it” (Olivia). Jodie and Ann were both from Caucasian backgrounds and reported that menopause was “swept under the carpet” (Jodie) and that mothers were “from a time where you don’t talk about that. So, I didn’t get a lot of information out of out of her” (Ann). Similarly, Bella conveyed her knowledge about menopause was poor “because in my culture [Serbian] we don’t really talk about it much” (Bella) and Penny revealed “I was born in Pakistan . . . women’s health, over there it would just not even feature.”

The women in this study described being desperate for information which led them to seek their own knowledge via friendship groups, the internet and listening to podcasts:

I would say I have a lot more knowledge now than at the beginning. But due to only me personally seeking that information . . . not so much from what I’ve received from the GP but from just researching and talking to friends. Yes, I would say that my knowledge is probably more so. (Avril)

Doing their own research not only provided them with insights into the symptoms they were experiencing so they could take control of their own health but it also equipped them with knowledge that gave them a sense of relief and mitigated feelings of not being “normal.”

I think it’s reassuring to know that you’re not going mad, that these problems are real, they do exist, they’re not a figment of my imagination. Yeah, so I think it’s important that women do research a little bit for themselves, because the more knowledge is power. . . and the more you know, the better chance you’ve got of trying to stay on top of things . . . I think just to be aware, self-aware. (Ann)

Taking “the power back” by doing their own research was frequently mentioned by participants. This often gave them the confidence to go to their general practitioner and tell them what that wanted and how they wanted to manage their symptoms:

The GP didn’t want to give me hormonal therapy, and I requested, because that’s it, I was out of options, I just want this to go away. You know at least minimise it a little bit. So, he refused, so I demanded it next time. I said look, that’s it, I can’t take this no more. I need to have this . . . so he was just like all right, all right . . . . (Bella)

At times, however, participants felt that the internet led them down an information rabbit hole which made the process of making informed decisions about effective and appropriate treatment more confusing:

. . . but it was really just more things coming in up in my feed, and then, of course, you click on a couple of those, and then the media get very suggestive so then you see more accounts coming up that might be relevant. (Flora)

Participants expressed having positive experiences however with online support groups where they felt the taboo of talking about menopause was diminished. The support groups gave them the opportunity to participate in discussions with other women with similar experiences and improve their knowledge of perimenopause and menopause:

Probably from certain social media accounts and online. I obviously follow women and groups of women of a certain age. I feel like in the last 12 months, there seems to be a bit of an increase in the discussions in online groups. (Flora)

While the women felt they had taken control of their knowledge by researching on the internet, they also sought emotional support and knowledge from their friends who were going through similar experiences:

I do find trying to catch up with the friends that I—you know, my close sort of group, my tribe I guess, to try and catch up with them, have a coffee with them, give them a hug, I do find that in my little safe haven, seeing them does help. (Avril)

The women talked about how being with their friends and talking about menopause provided them with valuable support, resulting in them being able to reframe the way they dealt with their symptoms and their transition:

Whereas I go out with girlfriends, and someone has a hot flush, and they laugh about it. I think it’s becoming more and more accepted that there are changes, but why would you not talk about them and help each other through them. (Flora)

Supporting friends and generally supporting women was a prominent feature of all interview participants’ stories. The women felt this was important in initiating conversations and thus increasing their knowledge around menopause:

I suppose it opens up some conversations with close girlfriends. Like yeah, oh my gosh, me too and chatting more about things. About how you were feeling and that sort of thing . . . we’re all sort of talking about it because we are sort of thinking well, it is menopause . . . which I guess is a positive thing . . . that we’re acknowledging that we’re there for each other. (Avril)

Discussion

The concurrent, equally weighted mixed-methods design allowed both quantitative and qualitative data to contribute to new knowledge in this study. Integration of the findings highlighted areas of convergence and expansion between quantitative and qualitative data (Fetters & Tajima, 2022). While quantitative results provided a broad overview, they lacked contextual depth, which was addressed by qualitative insights into women’s lived experiences of perimenopause and menopause. Both data sets indicated that women were relatively knowledgeable about common menopause symptoms; however, qualitative data revealed that many were unprepared for the intensity and impact of these symptoms. Similarly, both methods showed that women primarily accessed information independently via the internet, followed by consultations with health professionals, friends, and family. Qualitative findings added nuance, revealing that the internet’s anonymity was particularly valued by women from cultural backgrounds where menopause is a taboo topic.

Cultural background, beliefs, and values shaped women’s knowledge, experiences, and help-seeking behaviors. Women from South American, South Asian, and Eastern European backgrounds described menopause as a private or taboo topic, rarely discussed within families, limiting intergenerational knowledge transfer and contributing to confusion and isolation during symptom onset (Williams, 2024). Beliefs about aging and femininity also influenced emotional responses: in some contexts, menopause was linked to loss of youth and fertility, while in others it was seen as a natural or empowering life stage (Güçlü, 2021; Pickard, 2024). Participants who viewed menopause positively showed greater acceptance and psychological resilience, highlighting the role of cultural narratives in adjustment and help-seeking.

Menopause is an unavoidable life stage for women (World Health Organization [WHO], 2023), and knowledge about it can improve attitudes, health behaviors, and quality of life (Gebretatyos et al., 2020). Despite this, studies show many women have inadequate understanding of menopause (Batool et al., 2017). In this study, participants largely directed their own learning, consistent with research showing women proactively seek information online (Munn et al., 2022). Menopause-specific websites and forums provide knowledge and peer interaction, while multilingual resources increase accessibility (Cooper, 2018; de Arruda Amaral et al., 2019). Tao et al. (2011) found women often consider online information comparable to that from health professionals, though reliability can be difficult to assess (Lycke & Brorsson, 2023). Participants reported that online knowledge supported informed decisions and discussions with health care providers.

Social networks, including friends, family, and female colleagues, also play a key role in knowledge acquisition, normalizing menopause experiences (Koyuncu et al., 2018; Munn et al., 2022). Effective education is linked to more positive attitudes, while negative attitudes correlate with increased symptom reporting. Overall, preparedness and knowledge contribute to better experiences and quality of life (Lycke & Brorsson, 2023). In this study, only one participant described menopause as potentially enriching, influenced by close relationships with other women undergoing similar experiences.

Although most participants held qualifications above secondary school level, education did not significantly correlate with increased knowledge about menopause. This aligns with findings from the United Kingdom, where de Salis et al. (2018) found no relationship between educational attainment and menopause knowledge. Cultural context and geographic location also influence knowledge and experiences, as illustrated by Begum et al. (2019), who reported that access to education significantly improved women’s awareness and attitudes toward menopause in Bangladesh.

Participants showed higher awareness of some menopause-related comorbidities. In this study, 92.3% (n = 383) recognized the increased risk of osteoporosis, contrasting with Goh et al. (2019), which reported gaps in bone health knowledge. Awareness of cardiovascular disease was lower, with 66.8% (n = 277) acknowledging its association with menopause. This may reflect greater media focus on bone health, while information on other comorbidities remains limited (Hoga et al., 2015). Limited access to accurate information has important implications for women’s long-term health and highlights the need for culturally responsive educational resources.

Limitations of the Study

The study sample was largely heteronormative and limited to Australian women, though it included participants from diverse cultural and educational backgrounds. Approximately 14% of participants did not complete all survey items, which may limit the Generalizability of the findings. Future research with gender-diverse individuals and women from specific ethnic backgrounds could offer deeper insights into menopause knowledge and experiences. The mixed methods design also posed challenges: concurrent data collection limited the number of interviews and prevented refinement of survey or interview questions based on emerging findings.

Implications for Nursing

Empowering women and achieving gender equality are central Sustainable Development Goals, making discussion of menstrual health, from menarche through to post-menopause, essential. The WHO (2023) has emphasized that menstrual health should be recognized as both a health and human rights issue, encompassing access to education and information, competent and empathetic health care, and the right to live, study, and work without shame. Specific content on menopause should be integrated into nursing curricula to ensure that nurses are knowledgeable about menopause and its symptoms and can deliver culturally responsive care. Nurses are well-positioned to opportunistically assess women for menopause-related symptoms and provide information that can enhance health outcomes during this significant life transition.

Conclusion

This study highlights a persistent gap in women’s knowledge and preparedness regarding perimenopause and menopause, with many participants underestimating the complexity, severity, and duration of associated symptoms. Despite relatively high educational attainment, participants demonstrated limited understanding of menopause-related health risks, indicating that formal education alone is insufficient to ensure awareness. Women often relied on self-directed learning, through online resources, peer networks, and informal discussions, to gain both knowledge and psychosocial support, particularly in cultural contexts that limit open dialogue about menopause. These findings emphasize the need for accessible, culturally responsive, and evidence-based educational interventions to improve women’s understanding of menopause and its health implications.

Supplemental Material

sj-docx-1-tcn-10.1177_10436596251404017 – Supplemental material for Australian Women’s Knowledge of Perimenopause and Menopause

Supplemental material, sj-docx-1-tcn-10.1177_10436596251404017 for Australian Women’s Knowledge of Perimenopause and Menopause by Fiona McDermid, Kate O’Reilly, Sue McInnes, Joanne Perks and Kath Peters in Journal of Transcultural Nursing

Footnotes

Acknowledgements

We wish to thank the participants in this study for allowing their voices to be heard.

Author Contributions

FM contributed to the design of the work, data analysis, wrote the main manuscript text.

KP contributed to the design of the work, data analysis, revised the main manuscript text.

KO contributed to the design of the work and data analysis.

SM contributed to the design of the work and data collection.

JP contributed to the data analysis.

All authors reviewed the manuscript.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Fiona McDermid

Supplemental Material

Supplemental material for this article is available online.

References

Appling

S. E.

Allen

J. K.

Zandt

S. V.

Olsen

Brager

Hallerdin

(2000). Knowledge of menopause and hormone replacement therapy use in low-income urban women. Journal of Women’s Health & Gender-based Medicine, 9(1), 57–64. https://www.liebertpub.com/doi/abs/10.1089/152460900318975

Australian Government Department of Health. (2019). National women’s health strategy 2020-2030. https://www.health.gov.au/resources/publications/national-womens-health-strategy-2020-2030?language=en

Barati

Akbari-Heidari

Samadi-Yaghin

Jenabi

Jormand

Kamyari

(2021). The factors associated with the quality of life among postmenopausal women. BMC Women’s Health, 21(1), 1–8. https://link.springer.com/article/10.1186/s12905-021-01361-x

Batool

Kausar

Naqvi

Javed

Tufail

(2017). Menopausal attitude and symptoms in peri and post-menopausal working women. Pakistan Journal of Psychological Research, 32(1). https://research.ebsco.com/c/4js4w5/search/details/eh75z7ptqj?db=a9h

Begum

S. A.

Mahmud

Rahman

Zannat

Khatun

Nahar

. . .Sharmin

(2019). Knowledge, attitude and practice of Bangladeshi women towards breast cancer: A cross-sectional study. Mymensingh Medical Journal, 28(1), 96–104. https://pubmed.ncbi.nlm.nih.gov/30755557/

Braun

Clarke

(2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597. https://www.tandfonline.com/doi/full/10.1080/2159676X.2019.1628806

Cooper

(2018). Examining factors that influence a woman’s search for information about menopause using the socio-ecological model of health promotion. Maturitas, 116, 73–78. https://www.sciencedirect.com/science/article/pii/S0378512218301026

Cowell

A. C.

Gilmour

Atkinson

(2024). Support mechanisms for women during menopause: Perspectives from social and professional structures. Women, 4(1), 53–72. https://www.mdpi.com/2673-4184/4/1/5

Creswell

J. W.

Clark

V. L. P.

(2017). Designing and conducting mixed methods research. Sage.

10.

Davis

S. R.

Pinkerton

Santoro

Simoncini

(2023). Menopause—Biology, consequences, supportive care, and therapeutic options. Cell, 186(19), 4038–4058. https://pubmed.ncbi.nlm.nih.gov/37678251/

11.

de Arruda Amaral

I. C. G.

Baccaro

L. F.

Lui-Filho

J. F.

Osis

M. J. D.

Pedro

A. O.

Costa-Paiva

. (2019). Opinions and main sources of information about menopause among middle-aged Brazilian women. Menopause, 26(10), 1154–1159. https://journals.lww.com/menopausejournal/abstract/2019/10000/opinions_and_main_sources_of_information_about.12.aspx

12.

Delamater

Santoro

(2018). Management of the perimenopause. Clinical Obstetrics and Gynaecology, 61(3), 419. https://journals.lww.com/clinicalobgyn/fulltext/2018/09000/management_of_the_perimenopause.3.aspx

13.

de Salis

Owen-Smith

Donovan

J. L.

Lawlor

D. A

. (2018). Experiencing menopause in the UK: The interrelated narratives of normality, distress, and transformation. Journal of Women & Aging, 30(6), 520–540. https://www.tandfonline.com/doi/full/10.1080/08952841.2018.1396783

14.

Fetters

M. D.

Tajima

(2022). Joint displays of integrated data collection in mixed methods research. International Journal of Qualitative Methods, 21, 1–13. https://journals.sagepub.com/doi/full/10.1177/16094069221104564

15.

Fiacco

Walther

Ehlert

(2019). Steroid secretion in healthy aging. Psychoneuroendocrinology, 105, 64–78. https://www.sciencedirect.com/science/article/pii/S0306453018305791

16.

Gebretatyos

Ghirmai

Amanuel

Gebreyohannes

Tsighe

Tesfamariam

E. H.

(2020). Effect of health education on knowledge and attitude of menopause among middle-age teachers. BMC Women’s Health, 20, 1–10. https://www.proquest.com/docview/2451721080?pq-origsite=gscholar&fromopenview=true&sourcetype=Scholarly%20Journals

17.

Girod

de La Loge

Keininger

Hunter

M. S.

(2006). Development of a revised version of the Women’s Health Questionnaire. Climacteric, 9(1), 4–12. https://www.tandfonline.com/doi/full/10.1080/13697130500487372?casa_token=JV4z5H9vKUMAAAAA%3ArnrW4q3FWfEoSA9TY4x1QUmiDgbSigV8ghpXtSRSylNDt6BVaAUsft-A6Uy8wv_AvBy6DV1HsA

18.

Goh

Nguyen

H. H.

Khan

N. N.

Milat

Boyle

J. A.

Vincent

A. J.

(2019). Identifying and addressing osteoporosis knowledge gaps in women with premature ovarian insufficiency and early menopause: A mixed-methods study. Clinical Endocrinology (Oxford), 91(4), 498–507. https://onlinelibrary.wiley.com/doi/full/10.1111/cen.14049

19.

Greer

(2018). The change: Women, ageing and the menopause. Bloomsbury Publishing, London.

20.

Güçlü

(2021). The intersectionality of age, gender, and body: A case study on educated women’s menopause experiences [Master’s thesis]. Middle East Technical University. https://www.proquest.com/docview/3122677348?pq-origsite=gscholar&fromopenview=true&sourcetype=Dissertations%20&%20Theses

21.

Harlow

S. D.

Gass

Hall

J. E.

Lobo

Maki

Rebar

Sherman

Sluss

P. M.

de Villiers

T. J.

, & SRAW 10 Collaborative Group. (2012). Executive summary of the Stages of Reproductive Aging Workshop + 10: Addressing the unfinished agenda of staging reproductive aging. Menopause, 19(4), 387–395. https://doi.org/10.1097/gme.0b013e31824d8f40

22.

Harper

J. C.

Phillips

Biswakarma

Yasmin

Saridogan

Radhakrishnan

. . .Talaulikar

(2022). An online survey of perimenopausal women to determine their attitudes and knowledge of the menopause. Women’s Health, 18, 17455057221106890. https://journals.sagepub.com/doi/full/10.1177/17455057221106890

23.

Hoga

Rodolpho

Gonçalves

Quirino

(2015). Women’s experience of menopause: A systematic review of qualitative evidence. JBI Evidence Synthesis, 13(8), 250–337. https://journals.lww.com/jbisrir/fulltext/2015/13080/women_s_experience_of_menopause__a_systematic.18.aspx

24.

Koyuncu

Unsal

Arslantas

(2018). Evaluation of the effectiveness of health education on menopause symptoms and knowledge and attitude in terms of menopause. Journal of Epidemiology and Global Health, 8(1), 8–12. https://link.springer.com/article/10.2991/j.jegh.2018.08.103

25.

Lobo

R. A.

Gompel

(2022). Management of menopause: A view towards prevention. The Lancet Diabetes & Endocrinology, 10(6), 457–470. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00269-2/fulltext

26.

Lycke

Brorsson

(2023). Swedish women’s experiences of menopausal transition: A focus group study. Sexual & Reproductive Healthcare, 35, 100807–100807. https://www.sciencedirect.com/science/article/pii/S1877575622001136

27.

Mackey

Bryfonski

(2018). Mixed methodology. In Phakiti

De Costa

Plonsky

Starfield

(Eds.), The Palgrave handbook of applied linguistics research methodology (pp. 103–121). Palgrave Macmillan.

28.

Munn

Vaughan

Talaulikar

Davies

M. C.

Harper

J. C.

(2022). Menopause knowledge and education in women under 40: Results from an online survey. Women’s Health, 18, 17455057221139660. https://journals.sagepub.com/doi/full/10.1177/17455057221139660

29.

O’Cathain

Murphy

Nicholl

(2008). The quality of mixed methods studies in health services research. Journal of Health Services Research Policy, 13(2), 92–98. https://doi.org/10.1258/jhsrp.2007.007074

30.

O’Reilly

McDermid

McInnes

Peters

(2023). An exploration of women’s knowledge and experience of perimenopause and menopause: An integrative literature review. Journal of Clinical Nursing, 32(15–16), 4528–4540. https://pubmed.ncbi.nlm.nih.gov/36336832/

31.

O’Reilly

McDermid

McInnes

Peters

(2024). “I was just a shell”: Mental health concerns for women in perimenopause and menopause. International Journal of Mental Health Nursing, 33(3), 693–702. https://onlinelibrary.wiley.com/doi/full/10.1111/inm.13271

32.

Peters

O’Reilly

McInnes

Perks

McDermid

(2025). ‘Just Put Up With It’: Women’s Experiences of Perimenopause and Menopause. Journal of Advanced Nursing. https://onlinelibrary.wiley.com/doi/full/10.1111/jan.70312?casa_token=Q9OUVIG4IjsAAAAA%3AEBuxBzLqfvo7jOvR_Fwrb3wQmguLLpjjxB50-IgzfhBRKKERjkQXu-px5HLkY-y1ZNxmKgFW7i5H

33.

Pickard

(2024). Persephone at mid-life: Revisiting feminist archetypal theory in a personal journey through menopause. Feminist Theology, 32(2), 132–146. https://journals.sagepub.com/doi/full/10.1177/09667350231208137

34.

Shi

Lee

Fairchild

Maydeu-Olivares

(2020). Fitting ordinal factor analysis models with missing data: A comparison between pairwise deletion and multiple imputation. Educational and Psychological Measurement, 80(1), 41–66. https://doi.org/10.1177/0013164419845039

35.

Smail

Jassim

G. A.

Sharaf

K. I.

(2020). Emirati women’s knowledge about the menopause and menopausal hormone therapy. International journal of environmental research and public health, 17(13), 4875. https://www.mdpi.com/1660-4601/17/13/4875

36.

Süss

Ehlert

(2020). Psychological resilience during the perimenopause. Maturitas, 131, 48–56. https://www.sciencedirect.com/science/article/pii/S0378512219305043

37.

Tao

Teng

Shao

Mills

E. J.

(2011). Knowledge, perceptions and information about hormone therapy (HT) among menopausal women: A systematic review and meta-synthesis. PLOS ONE, 6(9), Article e24661. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0024661

38.

Varlas

Parlatescu

Epistatu

Dima

Bors

R. G.

Bohiltea

R. E.

Perlea

(2021). Menopause and oral health. Romanian Journal of Stomatology, 67(4), 216–220. https://doi.org/10.37897/RJS.2021.4.2

39.

Williams

(2024). Culturally responsive care for menopausal women. Maturitas, 185, 107995. https://www.sciencedirect.com/science/article/pii/S0378512224000902

40.

World Health Organization. (2023). WHO statement on menstrual health and rights. https://www.unwater.org/news/who-statement-menstrual-health-and-rights#:~:text=The%20statement%20emphasized%20three%20major,rather%20than%20a%20hygiene%20issue

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