Navigating menopause in Singapore: Sociocultural, clinical and policy implications from a qualitative study (MARIE-Singapore)

Introduction: Menopause is a universal life transition with lived experiences shaped by biological, psychological, sociocultural and systemic factors. In Singapore, where diverse cultural norms intersect with a high-pressure professional environment, little is known about how these influences converge to shape symptom recognition, coping and care.

Methods: This qualitative study formed part of the multi-country MARIE project on menopause and midlife health. Eighteen participants with different menopausal stages were purposively sampled ensuring variation in age, ethnicity, socio-economic status and health status. Semi-structured interviews explored symptom profiles, psychosocial well-being, family and workplace dynamics, and healthcare experiences. Data were analysed using the Delanerolle and Phiri framework, integrating biological, psychological, sociocultural and health system domains.

Results: Participants described heterogeneous symptom trajectories, with vasomotor, genitourinary and cognitive symptoms as most prominent. Multimorbidity and surgical menopause intensified symptom burden and narrowed treatment options. Anxiety, low mood and brain fog impaired work, particularly without workplace support. Sociocultural silences and misinformation reinforced self-management and delayed care-seeking. Resilience rooted in peer and family support, and culturally familiar coping strategies buffered distress for some. Health system gaps included inconsistent general practitioner's knowledge, reluctance to prescribe hormone therapy and private care costs. Study participation itself triggered symptom recognition and help-seeking in some, underscoring menopause invisibility in routine care.

Conclusion: Findings highlight that menopause in Singapore is navigated through intersecting clinical, cultural and structural determinants. Addressing inequities requires embedding women’s voices into clinical pathways, training clinicians in culturally competent care, and implementing workplace and public health policies that legitimise menopause as a health and occupational issue.