Abstract
Background Menopause awareness in the UK has increased demand for GP appointments and menopausal hormone therapy. However, inequalities persist in accessing menopause care, particularly among ethnic minorities, individuals with disabilities, and those experiencing domestic abuse (DA). DA can exacerbate menopause symptoms and create additional barriers to care.
Aim To explore the experiences and healthcare needs of women navigating both DA and perimenopause, identifying key barriers and opportunities for primary care support.
Design & setting A qualitative study involving women from a national DA survivors’ group in the UK with experience of perimenopause.
Method Semi-structured interviews and focus groups were conducted online with 15 women experiencing perimenopausal symptoms and a history of DA. Data were analysed thematically using the ‘one sheet of paper’ technique and discursive analysis.
Results The following three key themes emerged: 1) confusion over symptoms, with participants struggling to differentiate menopause symptoms from mental health issues, pre-existing conditions, or DA-related trauma; 2) medical avoidance and barriers to accessing support; and 3) experiences in primary care, with some receiving beneficial treatments while others felt dismissed or misdiagnosed, particularly with antidepressants instead of hormone replacement therapy. Participants highlighted missed opportunities for DA disclosure during GP consultations.
Conclusion The study underscores the need for trauma-informed menopause care in primary care settings. Primary care practitioners should integrate DA screening into menopause consultations and adopt a holistic, patient-centred approach. Further research and training are needed to support tailored interventions for DA survivors experiencing perimenopause.
How this fits in
Menopause symptoms can be challenging to identify, particularly for women with co-existing health conditions or psychosocial stressors, and domestic abuse (DA) is known to impact women’s health and healthcare access. Existing research highlights gaps in GP training for both menopause management and DA support, contributing to missed opportunities for intervention. This study is the first to our knowledge to explore the intersection of DA and menopause, revealing how symptom confusion, low self-advocacy, and access barriers affect survivors' ability to seek care. The findings emphasise the need for trauma-informed, holistic menopause care in primary care, including improved GP training and structured opportunities for DA disclosure.
Introduction
In the UK, growing awareness of menopause has increased demand for primary care appointments and menopausal hormone therapy (MHT) prescriptions.1–3 However, inequalities persist in accessing menopause care. For instance, MHT prescribing is 29% lower in deprived areas than in affluent ones.4 Populations experiencing health inequalities, including ethnic minorities5–8 and individuals with disabilities,9,10 face additional barriers to menopause support.
DA is a significant issue in primary care, particularly post-COVID-19.11–14 In 2022, the Office for National Statistics reported that 6.9% of adult women had experienced DA in the previous year.15 Studies suggest DA acts as a barrier to accessing women’s health services12,15,16 and evidence indicates abuse exacerbates menopause symptoms, worsening physical and mental health outcomes.17–19 Many women struggle to recognise menopause symptoms, often confusing them with medication side effects, stress, or comorbidities,20–22 compounding difficulties for survivors of DA in seeking appropriate care.
Primary care practitioners require better training to deliver quality menopause care21,23–25 and to support patients with DA histories.12,13,26,27 One survey found 52% of GPs felt unsupported in treating menopausal symptoms, and 77.5% called for improved menopause training.26 Similarly, nearly half of UK postgraduate GP programmes lack DA education, with significant variations in content and quality.26
Despite these challenges, little research explores the combined impact of DA and menopause. Our study sought to fill this gap by examining the barriers faced by women navigating both, to inform primary care practices and improve support for affected women and their families. The research question was ‘what are the experiences of women who are survivors of DA as they go through peri and full menopause?’
Method
This study explored the experiences and needs of women who had experienced DA during perimenopause. An interview schedule was co-designed by an academic health researcher (CM) and a community leader for women experiencing DA (SOR). Semi-structured, exploratory questions were developed in plain English (see Table 1 for the topic guide).
Recruitment and data collection
Fifteen women, all members of a national DA survivors' group and experiencing perimenopausal symptoms, were recruited via their community group. The participants either took part in a focus group or an individual interview.
All interviews were conducted online by one researcher (SOR), who was known to participants, between February and April 2024. Participants, all female and aged >40 years, were predominantly White British and from various UK regions. They received study information in advance and were compensated £25 for participation.
Data processing and analysis
Interviews were audio-recorded, transcribed verbatim, and anonymised. Two researchers (CM and SOR) identified key themes independently and summarised using the ‘one sheet of paper’ technique,27 which involved reading through each interview and identifying key themes, with underpinning data summarised across a single sheet of paper. Three researchers (CM, SOR, and KHS) then met to compare the independent analyses and ensure intercoder reliability, and to iteratively refine emergent themes and combine to a final set of themes. The final set of themes were used to code the data using NVivo (version 14) by one researcher (CM).
Informed consent
All participants provided recorded consent before starting the online interview. A total of 15 women attended with a member of the study team. The focus group was conducted at a preferred time suitable to all participants; with responders’ consent, the interviews were recorded. Owing to the sensitivities of the topic, some groups conducted focus groups using an online platform (Microsoft Teams). This enabled recruitment and participation across the UK. Interviews were considered the most appropriate method of data collection as it would enable a richness of data and provide the participant’s voice to the phenomena of interest. Participants were provided with written and verbal information about the study. Those participating in focus groups were assured of the confidentiality of their identities and informed before joining that this was a focus group interview and they could withdraw at any point.
Results
Our thematic analysis identified the following three categories answering our research question: 1) confusion over symptoms; 2) medical avoidance and barriers to accessing support; and 3) experiences in primary care. Since our overall study aim was not to develop theoretical categories or themes in the process of analysis, we did not focus on data saturation but instead focused on the individual perspectives about the topic during the interview.28
Confusion over symptoms
Many participants expressed difficulty in identifying perimenopause symptoms:
‘I think I've had some odd symptoms I had no idea menopausal … I thought I was having a heart attack one day and ended up at the walk-in centre.’ (Participant [P]8)
Some struggled to differentiate symptoms from other health conditions such as mental health issues, attention deficit hyperactivity disorder (ADHD), COVID-19, and fibromyalgia:
‘Some symptoms mimic bipolar, so I wasn't sure and didn't think I was perimenopausal.’ (P14)
Others found it difficult to separate menopause symptoms from the impact of their DA relationship:
‘I don’t know whether I would have experienced the same symptoms if I hadn't been in that relationship. I had my own business for a lot of years, I was a lively, vibrant human being and I turned into a complete and utter shell and I don't know whether that was the menopause or whether that was him that did that.’ (P12)
Gaslighting compounded confusion, especially regarding brain fog:
‘I was feeling anxious, but my relationship was all over the place. On reflection, I now realise the gaslighting had started.’ (P2)
One participant initially mistook her stress-induced night sweats for menopause symptoms:
‘I thought I was going through menopause, but after leaving the relationship, the symptoms disappeared overnight.’ (P9)
Medical avoidance and barriers to accessing support
Uncertainty over symptoms prevented many of the participants from seeking help:
‘Is it my health or is it the way that I'm feeling? Because all of those things are so interlinked and it’s really like, your symptoms overlap.’ (P13)
A sense of going into survival mode owing to their abuse experience prevented many from prioritising health:
‘I got low mood swings and fatigue, but I’ve not been to the GP. I just deal with whatever comes.’ (P4)
It was evident that low self-esteem for some of the participants made it difficult for them to self-advocate:
‘[The doctor] said to me, “You need to do a three-month trial and then come back to me, we'll reassess you”. But because of my lack of self-esteem and self-worth, I didn't feel like I could chime up, so I waited the three months. And I said to her, “Look, I'm not happy with them” … And it was blistering my skin and scarring me, but I put up with it and put up and shut up.’ (P15)
Other participants lacked the knowledge to advocate for themselves:
‘I didn’t know what questions to ask. I was completely unprepared.’ (P6)
Barriers also included difficulty accessing timely appointments:
‘I hardly ever go to my GP — it’s never easy to get an appointment.’ (P4)
One participant had been on an NHS waiting list for 3 years for a hysterectomy but ultimately had to pay privately. Demand for NHS services impacted perceptions of access to care.
Experiences in primary care
Some of the participants shared positive experiences when seeking help:
‘I have a wonderful female GP who’s really quite forward thinking and not dismissive of the menopause or perimenopausal symptoms.’ (P2)
Many stated they preferred seeing a female practitioner:
‘Speaking with a female GP makes a difference. Male GPs often just say, “You need to lose weight.”’ (P4)
However, some participants stated they lacked trust in primary care practitioners:
‘GP was never my first port of call and never would be.’ (P8)
Some had appointments multiple times before considering perimenopause:
‘I went three times — once I thought I’d got Alzheimer’s, once because he [abusive partner] told me I had mental health problems, and finally about menopause, and then I finally went and said, “Oh, I think I'm starting on the menopause”. And they did some blood tests and said, “Oh, no, you know, your hormone levels aren't postmenopausal yet.” And now I can look back at it and it was him gaslighting me.’ (P3)
Several women were offered antidepressants at their appointments:
‘What’s interesting is that concurrently I was also in a domestic abuse relationship and when I went to the GP, I was basically just put on antidepressants … I had to really fight with the doctor to get any kind of HRT [hormone replacement therapy].’ (P6)
Some women had accessed hormone replacement therapy (HRT) as a treatment and found it useful. By contrast, others found it difficult to get information about or access to HRT, feeling practitioners pushed generic treatments such as intrauterine devices:
‘My doctor was trying to encourage me, not force, encourage me to have a coil fitted, which is something I didn’t want, and I just felt like I was sort of railroaded.’ (P13)
Participants suggested that women needed confidence to self-advocate for the care they needed:
‘If the one size fits all doesn't fit you come a bit unstuck and you really have to fight your own corner.’ (P15)
Some women believed interactions could have provided an opportunity for DA disclosure:
‘I guess when I was seeing my GP, I wished, now looking back in retrospect, I wish they'd delved a bit further and given a bit more time to it. You know, because I think now looking back, I can see that some of those times I was going, like, to disclose [but] that I wouldn't have disclosed unless they'd have just probed a bit further.’ (P9)
This was agreed by participants in multiple groups as a missed opportunity:
‘The fact that, you know, I went to my GP three times and nobody ever picked up on it.’ (P3)
Participants emphasised a need to upskill GPs about DA and the impact on perimenopause in counselling women as they are the primary healthcare professional consulted:
‘There’s a link between DA and menopause, but not enough support. My doctor just said, “I’m not a gynaecologist.” But surely, they must know something?’ (P13)
The study participants recognised further research and funding was needed to inform greater understanding of how to best support women:
‘I just think GPs need to be better informed, don't they? That’s from my perspective, you know, and not make assumptions and ask delving questions. But it’s about them having the funding to be able to give people more time.’ (P4)
Discussion
Summary
Our research is unique in focusing on the experiences of older women (aged >40 years) and navigating both DA and perimenopause.
Our findings show that women struggle to distinguish between symptoms of existing conditions, perimenopause, and the impact of DA. This confusion, along with low self-esteem and difficulty prioritising health, can create barriers to accessing help. While some participants had positive experiences from primary care with support from selective serotonin reuptake inhibitors (SSRIs) and HRT, others felt they were offered generic rather than personalised treatments and lacked the confidence to self-advocate.
Our study suggests an opportunity for all primary care practitioners to consider DA during menopause consultations, facilitating conversations that might help women access needed support. The challenges of limited practitioner time, lack of clinical resources, and missed opportunities for discussing DA are well-documented.8,11–13,16,17 This study highlights the added complexity of menopause for DA survivors, particularly for older women survivors,18,19,29,30 an under-researched area that requires prioritisation to ensure quality equitable care for female patients.
Strengths and limitations
Our study demonstrates several strengths. By employing a community-based co-production approach and involving DA survivors in study design, we ensured a participant-centred methodology that captured nuanced, lived experiences. The qualitative focus group methodology enabled rich discussions on sensitive topics, allowing participants to validate each other’s experiences. Collaboration with community leaders enhanced the study’s credibility and accessibility.
However, there are limitations. Recruitment through a single national DA survivor group may introduce selection bias and limit demographic representation. The predominantly online group interview format may have influenced participant comfort and disclosure, potentially limiting depth. Additionally, reliance on self-reported, retrospective experiences could be subject to recall bias.
We note the value of engaging with community practitioners, who for this study was also a DA survivor. This assisted with addressing areas of potential sensitivity when directly working with survivors for this study in addition to providing any necessary support mechanisms. Consideration was made of any bias when theming the data.
While not representative of the broader DA survivor population, our findings offer transferable insights into the experiences of a vulnerable and often overlooked group in primary care. Despite these limitations, our study provides valuable groundwork for future, more comprehensive research.
Comparison with existing literature
Our findings align with research indicating that many women struggle to recognise menopause symptoms, often confusing them with medication effects, stress, or comorbidities.21–23 Similarly, previous studies highlight that medical avoidance24 and biopsychosocial factors contribute to women deprioritising their health,16,31,32 leading to inadequate menopause support.4,5,21,25
Our study emphasises the need for public education initiatives on both menopause and DA. While there is extensive research on public awareness efforts around menopause (for example, ‘the Davina effect’)1–3 and DA,12,14,33 little work has explored the intersection of both. Our findings align with recent research on the impact of trauma on women’s health,31 reinforcing calls for improved training and research.
Participants reported mixed experiences with GPs and other primary care practitioners they may have discussed their symptoms with. Some received beneficial medications, supporting evidence on the efficacy of these treatments, as is noted in the literature,1,7,16,20,25,34 while others felt their care lacked personalisation. This suggests that despite clear guidelines for patient-centred care, primary care practitioners may lack the tools to deliver individualised support and the funding to train and offer extended appointments. Our findings reinforce calls for expanded women’s health training for primary care practitioners, both in education and practice, and additional funding for GPs to improve women’s health.25,26,31,35
Implications for research and practice
Our findings highlight the need to better understand DA survivors’ experiences of perimenopause. The complexity of overlapping symptoms underscores the importance of further research into the biological and psychological interactions at play and the most effective treatment approaches for women with multiple co-existing health factors.
Our study also emphasises the need for comprehensive training for care. Healthcare professionals must be equipped to recognise the symptom complexities DA survivors experience. Primary care practitioners should integrate DA screening into menopause consultations, adopting a holistic, biopsychosocial approach. Further research could support the development of trauma-informed menopause care protocols and screening tools. Given resource constraints in primary care, centralised support services — including digital peer networks and culturally sensitive information hubs such as women’s health hubs — could improve accessibility. These interventions should focus on survivors’ mental health, self-advocacy, and healthy ageing.
Our findings further support the need for menopause policies prioritising individualised care, backed by adequate funding for quality consultations. Public health campaigns should enhance awareness of menopause symptoms and DA and the impact of stress on menopause, as well as communicate effective self-care strategies.
Finally, our research underscores the urgent need for survivor-led support networks and comprehensive education initiatives for healthcare professionals, support workers, and the broader community. Implementing these recommendations would help healthcare systems better address the complex needs of DA survivors navigating perimenopause.
Notes
Funding
The project was funded by UK Research and Innovation/'Innovate UK Unlocking Potential Award: Build 2024 (reference: 10091484) and by De Montfort University Impact funding.
Ethical approval
The project was given ethical approval by Nottingham University Business School Research Ethics Committee (reference: 202324023).
Provenance
Freely submitted; externally peer reviewed.
Data
Due to the ethically sensitive nature of the research, supporting data cannot be made openly available. Anonymised interview transcripts from participants who consented to data sharing are available on request from the corresponding author.
Acknowledgements
We would like to thank all participants for bravely sharing their experiences with us.
Competing interests
Claire Mann is the CEO of ChangeXtra, a digital menopause support company and creator of the Pausetrack app. Sally Olewe-Richards is the CEO of Women of Wisdom and Courage (WOWC), a group for survivors of domestic abuse, and is the creator of the WOWC app. Kathryn Hinsliff-Smith has declared no competing interests.
- Received February 25, 2025.
- Revision received June 24, 2025.
- Accepted August 31, 2025.
- Copyright © 2026, The Authors
This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)
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