title: How do ecological factors shape diversity in menopause experience?
Creators: name: Fraser, Abigail
Publisher: name: University of Glasgow
Year: 2023

description: Background: Menopause is a fundamental aspect of human female ageing which marks the end of reproductive function. Despite its ubiquity in the female ageing process, menopause is seldom studied in a public health capacity. My study seeks to capture the breadth of variation in menopause experience within the UK, and the extent to which ecological factors can explain this variation. In order to do so, I explore how a deficit of knowledge production surrounds menopause in the biomedical paradigm and employ an interdisciplinary and integrative mixed methods approach to alleviate these limitations. Methods: A mixed methods approach was employed, involving secondary quantitative data analysis of the UK Biobank dataset and thematic analysis of an online qualitative survey. An analytical sample was derived from the UK Biobank dataset containing participants who had experienced natural menopause (N= 97797) and tested to explore whether patterns in age at menopause exist across temporal and spatial dimensions of the dataset, and whether variation in age at menopause was associated with wider measures of the ageing process. Thematic analysis was performed on an online qualitative survey dataset (n=377) exploring breadth of variation in menopause experience in both a 'normal’ and Covid-19 lockdown context. The results from both were integrated at the interpretive stage of this thesis. Findings: From the quantitative analysis, patterns in variation of age at menopause were identified across both spatial and temporal dimensions. Furthermore, associations were identified between age at menopause and more general markers of ageing, suggesting that a later age at menopause is associated with a slower rate of overall ageing. However, the dataset itself was a very limiting factor in the quantitative analysis, which calls into question the ability of quantitative data to capture menopause experience. The qualitative analysis identified multiple facets of menopause experience and how menopause experience amongst participants is co-produced by the interaction between physical manifestations of menopause and the wider environment. Participants would situate themselves in the menopause transition based on bleeding status and symptom presence, with range of symptoms extending beyond those typically associated with menopause in the biomedical paradigm. Menopause impacted the wider lived experience of participants in 2 ways – by disrupting everyday life and by producing discomfort in participants. Disruption and discomfort as a result of menopause were identified in home and personal lives, in a workplace context and socially. In the specific ecological context of the 2020 COVID-19 lockdown, changes to menopause experience did not stem from changes in symptoms but rather from the novel environment in which participants were living. When integrated together, my findings suggest that both menopause experience and the impact of ecological factors in shaping variation were better captured through qualitative data production and analysis. While the ecological context was limited to singular measures of location and socioeconomic status within the quantitative data, the qualitative research captured the multiple layers of the ecological context extending from the micro-level to macro-level structures. Conclusions: Variation in menopause experience in the UK was found to be present, both in timing of menopause and wider menopause experiences. This variation can also be linked to interactions between individuals and the ecological context, indicating that determinants of menopause experience extend beyond symptom experience and absence of bleeding. In the context of increasing public demand for menopause support and information, this thesis presents ways in which menopause can be reconceptualised in a public health research context.