An exploration of the physical and mental health impact among a diverse population in the United Kingdom experiencing perimenopause and menopause (MARIE UK-WP2a)

OBJECTIVE: Menopause is associated with diverse physical, psychological, and cognitive symptoms, yet variation across menopausal stages and modes of onset remains poorly characterized in the United Kingdom-based populations. This study aimed to evaluate symptom burden and quality of life across perimenopausal, menopausal, and postmenopausal individuals, including those with natural and surgical menopause. METHODS: A mixed-methods, prospective cohort study was conducted to explore perimenopausal, menopausal, and postmenopausal experience in cis-trans gender and LGBTQ+ populations in England, Wales, Scotland and Northern Ireland using the digital XM Qualtrics platform, using psychometric and clinical scales including the Hospital Anxiety and Depression Scale (HADS), Greene Climacteric Scale (GCS), Insomnia Severity Index (ISI), Burnout Assessment Tool (BAT), Numeric Pain Rating Scale (NPRS), Menopause Rating Scale (MRS), and Health-related Quality of Life (HrQoL) assessments. Quantitative data were gathered following informed consent at two time points, and qualitative interviews were conducted in a selected sub-cohort. RESULTS: Among 845 baseline and 538 follow-up participants (median age 52), anxiety severity was significantly higher in perimenopause compared with post-menopause (baseline: P=0.013; follow-up: P=0.013), while depressive symptoms were markedly greater in those with surgical menopause, as shown by both HADS (baseline: P=0.001; follow-up: P<0.001) and GCS scores (baseline: P=0.004; follow-up: P=0.003). People experiencing surgical menopause displayed increased insomnia, back pain, vasomotor symptoms, and reduced quality of life. Cognitive symptoms, including forgetfulness and difficulty concentrating, were most pronounced among the perimenopausal cohort. Insomnia and burnout were moderately prevalent among employed people, especially when coexisting with conditions such as endometriosis. Regional differences were minimal, though participants from Scotland reported higher pain scores. CONCLUSION: Symptom severity and variability are dependent on menopausal stage and vary with the mode of onset. The study findings highlight the need for targeted, stage-specific clinical pathways and workplace adaptations, particularly for those with complex medical histories such as endometriosis. A stratified, inclusive approach to menopause care is urgently required across policy and practice settings.