Contextualising Menopause in Nigeria: A Qualitative Analysis From the MARiE Project

Abstract

OBJECTIVE: To explore Nigerian women's lived experiences of menopause and identify sociocultural, structural, and health-system factors shaping symptom recognition, care-seeking, and wellbeing, using in-depth qualitative inquiry. DESIGN: Qualitative interview study. SETTING: Urban, peri-urban, and rural communities across Nigeria. PARTICIPANTS: Post-menopausal women aged 40-66 years experiencing natural, surgical, or medical menopause. METHODS: As part of the Nigerian arm of the MARIE project, semi-structured qualitative interviews were conducted with purposively sampled post-menopausal women to capture diverse menopausal stages, socioeconomic positions, and geographic contexts. Interviews were analysed using thematic analysis informed by an equity-centred, intersectional framework. Multiple researchers independently coded transcripts, with iterative discussion and triangulation to enhance analytic rigour and validity. RESULTS: Three interrelated themes characterised menopausal experiences in Nigeria. First, structural health-system inequalities were evident, including limited anticipatory information, inadequate clinician training, fragmented care pathways, and restricted access to hormone replacement therapy and non-hormonal treatments. Second, sociocultural and gendered norms shaped symptom interpretation and disclosure, with menopause often framed as a natural or inevitable life stage requiring endurance rather than care, compounded by stigma and silencing within families and communities. Third, women demonstrated adaptive coping and resilience, relying on peer networks, faith-based practices, and self-management strategies in the absence of formal support. Urban participants reported comparatively better access to information and services, while rural women described pronounced neglect and dependence on informal care. CONCLUSIONS: This qualitative study provides the first in-depth, context-specific account of menopausal experiences among Nigerian women, revealing substantial inequities driven by sociocultural beliefs, economic constraints, and systemic gaps in healthcare provision. The findings underline the urgent need for culturally sensitive, equity-oriented menopause care in Nigeria, including integration into primary healthcare, improved professional training, affordable access to evidence-based treatments, and public health education to reduce stigma and unmet need.