Australian trans and gender diverse people's understandings of menopause: beyond cisgenderism, heterosexism, and binary-based gender in the current 'menopause moment'.

This study had been designed to explore the perspectives and experiences of trans people who will or have experienced perimenopause, menopause, and/or other acute hormonal fluctuations associated with oestrogen cessation and/or ovulation cessation. A previous article from this study was focused on participants’ views on menopause-related resources and information seeking practices of trans people ( Drysdale et al . 2026b ). Qualitative research of this nature is useful when the goal of research is exploratory and approaches to analysis need to be grounded in participants’ perspectives ( Braun and Clarke 2006 ). Focus groups were selected as they are a highly effective method for gaining information about the variety of experiences and opinions about health issues and enabling cross-fertilisation of ideas within a cohort, allowing for synergistic responses and flow of ideas ( Kitzinger 1994 , Wilkinson 1998 ). In addition, for research involving trans people, focus groups are useful in alleviating risks associated with disclosing personal information or sensitive medical histories, as participants are encouraged to couch responses in terms of hypothesis and conjecture. All members of the research team were recorded female at birth and have various lived experience of menopause and/or intersections with gender affirming healthcare. Collectively, we were interested in menopause given our own departure from many of the assumptions of menopause, and so were highly attuned to exploring nonnormative experiences, such as this study represented. This facilitated the level of reflexivity required of exploratory qualitative research. Data were collected using purposeful sampling, with recruitment taking place through closed email lists and social media maintained by ACON, Australia’s largest LGBTQA+ community health organisation. Recruitment and data collection processes were further supported by the involvement of dedicated ACON staff who work on trans health equity matters. The researchers included a positionality statement on all information for participants, noting the gender, sexuality, pronouns, and expertise of each researcher. The research purposefully used expansive definitions of menopause and eligibility criteria in the recruitment materials to invite as much diversity of lived experiences as possible, noting that experiences and/or expectation may differ from with the dominant narratives attributed to cisgender women. Participants were directed to an online form to express their interest in participating, with implied consent to collect demographic information (though completing all questions was not mandatory and did not bar people from participating in focus groups). Informed consent was collected through a signed copy of the consent form prior to commencement of the focus group via email, or by undertaking a verbal consent process before focus groups commenced. Focus groups were conducted on video conferencing software Zoom (one focus group was conducted online and in person at ACON’s offices simultaneously), lasting between 1 h and 22 min and 1 h and 24 min after consent processes, administration and housekeeping, and introductions were conducted. Focus group discussion was facilitated by both first and second authors and was guided by an interview schedule that posed questions related to: current understandings of menopause and perimenopause; perspectives on menopause-related resources and information available; and current or anticipated menopause-related support and service needs and access. All focus group participants received an AUD $80 gift voucher for reimbursement of their time and in recognition of their lived experience expertise. All data generated were analysed using reflexive thematic analysis ( Braun and Clarke 2021 , Braun et al . 2022 ), and coded both deductively in response to the research questions and inductively to identify other relevant themes—using a hybrid approach to thematic analysis to ensure rigor and triangulation ( Fereday and Muir-Cochrane 2006 ). Specifically, we employed Braun et al. (2022) six phased process for reflexive thematic analysis: familiarisation with data through (re)reading each transcription in full; initial coding into categories; identifying patterns evident through coding; generating cross cutting themes; refining themes; and writing up the results. Throughout, we critically reflected on how our own lived experiences shaped the research design, descriptions of menopause, and decisions around participant eligibility. Thus, we consider our analytic process to be inclusive of both experientially (i.e. facilitating participant-led sense making processes) and critically oriented analysis (i.e. interrogating how participants and researchers interpreted their own and others’ experiences; see Braun et al . 2022 ). For this article, we present data predominately from coding nodes related to definitions, categorisations, and direct experiences of menopause. Ethical approval to undertake this research was received from the UNSW Human Research Ethics Committee (iRECS7219) and the ACON Research Ethics Review Committee (D202408).

Seventeen participants took part in three focus groups conducted in October 2024. Purposeful sampling resulted in a cohort with representation of diverse demographic characteristics, including age, gender, sexuality, geographical location, and country of origin (see Table 1 ). All participants were recorded female at birth, but equal numbers of trans men and non-binary participants showed relevance to both populations. The higher percentage of younger people aged 18–29 (35% of the sample) reflected younger trans people’s interest in and expectations of menopause that aligned with how they perceived their experiences before midlife. The next greatest percentage were among those thought to experience perimenopause at ages between 40 and 49 (24% of the sample), which highlighted for some participants their immediate and direct experiences that align with normative assumptions around cisgender women’s experiences at midlife. Common among this cohort were experiences of surgically induced menopause (i.e. oophorectomies carried out with hysterectomies) and the sudden cessation of menstruation through the advent of gender affirming hormonal therapies (i.e. commencing testosterone). Almost a third of the participants were born overseas, however, all were from high-income countries comparable to Australia (United Kingdom, United States of America, and Aotearoa New Zealand). While participants provided their preferred terms for their gender, the basic demographic information accompanying each quote is simplified to man or non-binary (as the majority-preferred terminology) to avoid re-identification of participants. Participant demographic data. a All participants were recorded female at birth. In this article, we look to how menopause is understood and made meaningful among trans participants. This is evident in three thematic categories related to menopause: definition, application and resistance. When asked to define menopause, participants frequently drew on definitions closely aligned with clinically oriented diagnoses: [Menopause is a] medical kind of statement, that it's after the cessation [of] your last period […]. And they say that completed menopause [is when] you've had no periods for a year. (Man, aged 30–39) From my understanding, menopause is 12 months after your last menstruation, basically when the body ages out of reproducing, like producing eggs and things like that. (Non-binary, aged 40–49) These two quotes were representative of participants’ familiarity with conventional biomedical framings: menopause as a moment that can only be identified retrospectively and as a chronological transition linked to reduced ovarian function. Perimenopause was similarly defined by participants according to such clinical frameworks—as the period from when changes to menstrual cycles are first observed to one year after the final menstrual period. Phrasing such as ‘medical kind of statement’, ‘they say’, and ‘from my understanding’ indicated that participants were comfortable drawing on these clinically derived narratives, suggesting recourse to standard definitions. [Menopause is a] medical kind of statement, that it's after the cessation [of] your last period […]. And they say that completed menopause [is when] you've had no periods for a year. (Man, aged 30–39) From my understanding, menopause is 12 months after your last menstruation, basically when the body ages out of reproducing, like producing eggs and things like that. (Non-binary, aged 40–49) Under these diagnostic frameworks, however, participants queried whether menopause is applicable to their own experiences over the lifecourse, even when they were at an age conventionally associated with menopause: I have had a hysterectomy recently […]. And so, a lot of these things don't apply to me. Like, I don't have a cervix anymore. I don't have ovaries anymore. (Non-binary, aged 50–59) As such, participants did not necessarily disavow menopause per se but relied on precise clinically derived details to properly determine the criteria for definition. At the same time, many participants identified ambiguity over the definition of menopause when identifying how the terms perimenopause and menopause were used in everyday vernacular. Specifically, participants recognised that these two clinical terms were often conflated, or that menopause was often used as shorthand to refer to the longer transitional period of perimenopause: But everyone kind of describes menopause [to be] what is actually perimenopause, which is when your hormones are shifting as the body is going through that hormonal change, working up to having no periods for a year. (Man, aged 30–39) I didn't come across the word [menopause] compared to perimenopause, but I understand it to be the fluctuation [of] perimenopause. But I don't really think of them as being separate. (Man, aged 18–29) Confounding factors therefore emerged between consensus on the definition of menopause. This was most evident between clinical precision and vernacular conflation, with ‘menopause’ frequently functioning as shorthand for a longer period of hormonal fluctuation rather than referring to a discrete post-menopausal state. This tension was more pronounced when the conversation moved to the implications of these potentially ambiguous or conflated meanings derived from either clinical and/or vernacular descriptions. This tension arose in three ways. I have had a hysterectomy recently […]. And so, a lot of these things don't apply to me. Like, I don't have a cervix anymore. I don't have ovaries anymore. (Non-binary, aged 50–59) But everyone kind of describes menopause [to be] what is actually perimenopause, which is when your hormones are shifting as the body is going through that hormonal change, working up to having no periods for a year. (Man, aged 30–39) I didn't come across the word [menopause] compared to perimenopause, but I understand it to be the fluctuation [of] perimenopause. But I don't really think of them as being separate. (Man, aged 18–29) First, participants broadly resisted the notion that menopause can only ever be the product of biological aging. Instead, menopause was conceptualised as a broader process of hormonal fluctuation or oestrogen cessation that could occur through multiple pathways: Yet, it's something that every AFAB [assigned female at birth] human is going to go through at some point, be it earlier because you go on testosterone, or later because the aging process. (Non-binary, aged 60–69) Second, participants also recognised that menopause was dominantly associated with a particular moment in the lifecourse, attributable to cisgender women at midlife: I strongly believe that we hold the word menopause to a very direct age group, and I think just reading general things online about it, everyone’s like, ‘yeah, happens right after you're 40’. (Non-binary, aged 18–29) But as this same participant continued to say, by reframing menopause in terms of its physiological effects, rather than as a universal lifecourse event, participants were therefore more likely to attribute their own physiological symptoms to an earlier stage in life: But myself, as soon as I started testosterone. I'm around 18 now, that is when I started going through it. So, I think we need to open up the possibility that a lot of younger people are going through that. (Non-binary, aged 18–29) Third, participants were highly opposed to any distinction between ‘natural’ and biomedically induced menopause: For me, the experience of menopause is just a natural process I've been through as part of my gender affirming journey. (Man, age not provided) Participants resisted distinctions between ‘natural’ menopause and hormonally mediated bodily transition because participants perceived that biomedical interventions brought on or accelerated menopause before midlife. Instead, menopause-like experiences were frequently understood as part of a continuum of hormonal change that included gender-affirming interventions. In the same vein, other participants challenged the notion that any menopausal experiences can ever be considered ‘natural’. Instead, menopause was understood as a physiological process requiring some form of diagnosis (and potentially treatment), which could occur through multiple hormonal pathways: I don't think it's like really a natural thing. I think there's so many things because [menopause] is caused by other things as well. Why should that be natural? (Non-binary, aged 50–59) As this participant continued, the basis of querying the existence of ‘natural menopause’ was the implication that some forms of menopausal experiences are ‘unnatural’. As they had already commenced menopausal hormonal therapies—‘the fact that I would like hormones to replace my previous hormones’—menopause was seen by this participant as just one pathway of a greater diversity of potential biomedical interventions, regardless of age. Yet, it's something that every AFAB [assigned female at birth] human is going to go through at some point, be it earlier because you go on testosterone, or later because the aging process. (Non-binary, aged 60–69) I strongly believe that we hold the word menopause to a very direct age group, and I think just reading general things online about it, everyone’s like, ‘yeah, happens right after you're 40’. (Non-binary, aged 18–29) But myself, as soon as I started testosterone. I'm around 18 now, that is when I started going through it. So, I think we need to open up the possibility that a lot of younger people are going through that. (Non-binary, aged 18–29) For me, the experience of menopause is just a natural process I've been through as part of my gender affirming journey. (Man, age not provided) I don't think it's like really a natural thing. I think there's so many things because [menopause] is caused by other things as well. Why should that be natural? (Non-binary, aged 50–59) Menopause therefore emerged through the focus group discussions not as a singular or universal biomedical event, but as a flexible and contested umbrella term through which participants could interpret diverse forms of hormonal change. Such umbrella terms, compared to clinically precise terminology, encapsulated a diversity of meanings when viewed through the lens of symptomatology and treatment. As such, there was consensus that trans experiences should not be ‘othered’ through definitions of menopause attributed to midlife experiences, reproductive capacity, or ‘natural’ aging. Doing so can result in stigma, discrimination, and exclusion if menopause is only ever spoken about in terms of natural versus unnatural on which many lay interpretations rest: I feel like it further stigmatises [me] and other people who don't experience menopause in the textbook way. (Non-binary, aged 18–29) For many participants, their own menopausal-like symptoms, perceived as physiological effects, were understood as part of the same continuum of hormonal fluctuation that they experience through other biomedical interventions. That is, participants recognised that their own physiological experiences, which occurred for them after undergoing surgical interventions (oophorectomies) or undertaking gender-affirming hormonal therapies (testosterone), were similarly aligned with menopause symptomology: Menopause is also about what can happen after something like a hysterectomy, where you don't know if you're still bleeding or not, but your body has stopped doing that for other reasons. So, whether that's surgical reasons, whether that's some medical treatments as well, [those reasons] can cease [stop] the body producing those hormones. I sort of reached estrogen cessation, but mainly it was the advent of going on T [testosterone]. And there's the people I speak to [who] tend to understand that [gender-affirming hormonal therapeutic intervention] also means that there's sort of a pseudo menopausal effect. (Man, aged 18–29) Conversely, when solely relying on clinical definitions, biomedical interventions that produced similar symptoms meant that it was difficult for participants to distinguish the reason for their sudden onset of menopausal symptoms. In these cases, participants tended to revert to vernacular uses of menopause as an umbrella term as it could accommodate the way that they expressed physiological and psychological ambiguity: It's really hard to tell because I haven't bled for, you know, over a year and a half now. So yeah, and even before that, I was skipping as many periods as I could due to other medical stuff. So, yeah, it is weird to try and pinpoint that. (Non-binary, aged 40–49) This comment also raises the possibility of menopause to be brought on by ‘other medical stuff’ outside of gender affirmation interventions. Participants acknowledged that this could be, for instance, where menopause may be induced through treatments for hormonally sensitive cancers or in response to menstruation-related considerations for people living with other chronic health conditions, such as polyendocrine metabolic ovary syndrome (PMOS) or endometriosis/adenomyosis. At the same time, the specificity of the effects of menopause—that is, its physiological symptoms—was seen a more precise way of describing menopause rather than relying on broader meanings and associations seen through the cessation of menstruation. Participants whose menstruation had already been altered through gender-affirming hormonal therapies or other interventions described difficulty locating themselves within existing definitions of menopause if it is only ever aligned or concomitant with menstruation. This is because participants identified that, used in this way, menopause in both clinical and vernacular uses often served as a proxy for menstruation cessation. Menopause is also about what can happen after something like a hysterectomy, where you don't know if you're still bleeding or not, but your body has stopped doing that for other reasons. So, whether that's surgical reasons, whether that's some medical treatments as well, [those reasons] can cease [stop] the body producing those hormones. I sort of reached estrogen cessation, but mainly it was the advent of going on T [testosterone]. And there's the people I speak to [who] tend to understand that [gender-affirming hormonal therapeutic intervention] also means that there's sort of a pseudo menopausal effect. (Man, aged 18–29) It's really hard to tell because I haven't bled for, you know, over a year and a half now. So yeah, and even before that, I was skipping as many periods as I could due to other medical stuff. So, yeah, it is weird to try and pinpoint that. (Non-binary, aged 40–49) Much more relevant to participants was how menopause could be potentially interpreted through the lens of gender affirmation, particularly where hormonal fluctuation, menstrual cessation, and bodily changes intersected with experiences of gender-affirming care. For many participants, menopausal experiences were integral to understanding the impact of their own gender-affirming interventions. This perception is evident in one participant’s equation of menopause as part of the process of affirming their gender: [Perimenopause and menopause] are largely part of the same experience, [and] it was an accelerated experience made because of testosterone. […] I only really started thinking about it because I started having atrophy symptoms on testosterone recently and so started being treated [with] topical estrogen. And so that was when I started to conceptualise that it [menopause] is a way of thinking about a process that my body has gone through, and it's an umbrella term that a lot of atrophy and topical estrogen treatment is kind of filed under. (Non-binary, aged 18–29) This ambiguity complicated conventional biomedical definitions of menopause that rely on menstrual cessation as a retrospective diagnostic marker. Instead, many participants interpreted these experiences through clinically oriented framings of hormonal fluctuation and oestrogen withdrawal. Importantly, however, was the way that participants often described their experiences of hormonal fluctuation and oestrogen withdrawal positively, particularly where menstrual cessation affirmed their gender: I can't wait for my periods to stop. You know what I mean? I don't I can't wait for that all to be over. So, in my mind, it [menopause] is a really positive thing. (Non-binary, aged 40–49) For such participants, bodily changes associated with menopause or hormonal fluctuation could be experienced as positive when interpreted through the framework of gender affirmation. [Perimenopause and menopause] are largely part of the same experience, [and] it was an accelerated experience made because of testosterone. […] I only really started thinking about it because I started having atrophy symptoms on testosterone recently and so started being treated [with] topical estrogen. And so that was when I started to conceptualise that it [menopause] is a way of thinking about a process that my body has gone through, and it's an umbrella term that a lot of atrophy and topical estrogen treatment is kind of filed under. (Non-binary, aged 18–29) I can't wait for my periods to stop. You know what I mean? I don't I can't wait for that all to be over. So, in my mind, it [menopause] is a really positive thing. (Non-binary, aged 40–49) However, these experiences were not universal. Some participants distinguished sharply between gender-affirming hormonal care and menopausal-related care, particularly where menopausal interventions did not align with their gender: I find it I completely distinguishable between taking testosterone as being part of my gender affirming care, and I consider that entirely separate to the topical estrogen that I'm taking as being part of the additional care that I'm receiving, because it doesn't feel gender affirming to me. (Man, aged 18–29) This distinction demonstrates that participants did not uniformly adopt menopause as an explanatory framework that defined what their bodies were going through. Rather, menopause was only ever applicable through participants’ perspectives on whether a particular intervention that resulted in, and their embodied experiences of symptoms of, menopause aligned with participants’ understandings of gender affirmation. For those participants who firmly perceive menopause, as either a clinical term or in its vernacular use, as an experience associated with biological aging and reproductive decline, they were forced to distinguish between interventions designed to affirm their gender from interventions designed to alleviate the negative symptoms of menopause. This created an impossible binary, one in which one is received positively while the other is pathologised. Such distinctions then work to allocate one form of hormonal therapy to gender affirming treatments, while others are relegated to menopausal treatments; in effect, separating the function of treatments, regardless of their underlying similarities to treat particular physiological effects. This siloing of the treatment regimens was also a source of frustration in ways that trouble recourse to easy distinctions: all participants expressed frustration that healthcare systems and resources frequently separated menopause care from gender-affirming care, thereby reinforcing experiences of marginalisation: I think that every single GP who deals with me should be able to deal with the fact that when I want to balance my hormones that comes into my gender identity and that I can do what the fuck I want. They should stop telling me it's not HRT [hormone replacement therapy], it's MHT [menopause hormonal therapy]. All of them should do that. (Non-binary, aged 50–59) In this sense, participants advocated for more integrated and affirming approaches to menopause care that recognised hormonal fluctuation and menopause-like symptomology as potentially intersecting with gender-affirming healthcare. This challenges both clinical and lay divisions of two healthcare pathways as separate in ways that hold that trans experiences of similar experiences of menopause are either nonsensical, peripheral, or exceptional. I find it I completely distinguishable between taking testosterone as being part of my gender affirming care, and I consider that entirely separate to the topical estrogen that I'm taking as being part of the additional care that I'm receiving, because it doesn't feel gender affirming to me. (Man, aged 18–29) I think that every single GP who deals with me should be able to deal with the fact that when I want to balance my hormones that comes into my gender identity and that I can do what the fuck I want. They should stop telling me it's not HRT [hormone replacement therapy], it's MHT [menopause hormonal therapy]. All of them should do that. (Non-binary, aged 50–59) Alongside applying menopause through frameworks of gender affirmation, participants resisted dominant social scripts that positioned menopause as a universally negative experience. In this latter sense, participants frequently described mainstream menopause discourse as not relevant to their own experiences. For many participants, the term menopause itself carried social meanings associated with aging and reproductive failure that did not resonate with them: I would prefer not to call it menopause. It makes me really shitty. Like it is a hormonal deficit in the same way that a thyroid hormone deficit can occur as you get older? And yes, it happens to half of the people in the world, which is fine, but defining it as anything as anything other than a hormone change really bothers me. (Non-binary, aged 50–59) The basis of this resistance lay in the medical pathologisation of menopause: I think that the whole concept of menopause is so pathologised. I mean the way it's called symptoms. So, I can't think of a better word, but it implies that it's an ailment. (Non-binary, aged 60–69) This quote, and the one below, challenges dominant heteronormative framings that reduce menopause to a byproduct of reproductive decline, couched in terms of hormonal deficiency. Participants perceived this framing to be reductive and a patriarchal-induced interpretation of women’s social, political and economic roles: I'm extremely shitty with the idea that menopause is what marks the end of a woman's reproductive life. Like, no, it's a hormonal fluctuation. (Non-binary, aged 50–59) As this participant made clear, clinical definitions are based on changes to ovarian function but that this function should not stand in as proxy for a decline in reproductive capacity. Indeed, for some trans people, reducing or ceasing testosterone-based hormonal therapies can reintroduce ovarian function and potentially reverse their menopausal experiences, which disrupts any familiar or singular narrative of menopause as disrupting womanhood, fertility, and femininity. Participants astutely identified culturally oriented definitions of, or discourses around, menopause, especially where those applications were correlated to women’s reduced social, political, and economic roles in society where any cultural benefit that can be derived was tied to the value of reproduction. I would prefer not to call it menopause. It makes me really shitty. Like it is a hormonal deficit in the same way that a thyroid hormone deficit can occur as you get older? And yes, it happens to half of the people in the world, which is fine, but defining it as anything as anything other than a hormone change really bothers me. (Non-binary, aged 50–59) I think that the whole concept of menopause is so pathologised. I mean the way it's called symptoms. So, I can't think of a better word, but it implies that it's an ailment. (Non-binary, aged 60–69) I'm extremely shitty with the idea that menopause is what marks the end of a woman's reproductive life. Like, no, it's a hormonal fluctuation. (Non-binary, aged 50–59) As such, participants were already drawing on social and cultural scripts that aligned with—yet exceeded—clinical definitions of menopause, refusing to constrain any and all experiences of menopause to those predominately associated with heterosexual reproduction. Rather, participants reframe menopause as a physiological phenomenon that is not inherently tied to womanhood or fertility. These accounts suggest that participants resisted dominant menopause discourse not necessarily by rejecting bodily change caused by ovarian hormonal shifts, but by challenging the social meanings attached to menopause. Notably, participants also challenged deficit-oriented framings of menopausal symptoms, preferring language that conceptualised bodily experiences as changes over time: They [symptoms] may not apply. They indicate presence and absence versus change, which is really important for people who have had other experiences around these. (Man, aged 18–29) Instead, some participants preferred the language of ‘hormonal fluctuation’ because it was perceived to be more neutral and less socially ladened: It's about the hormonal fluctuations. […] That's a really important distinction. It's not a decline. (Non-binary, aged 50–59) Referring to menopause as hormonal fluctuation was seen to be a safer, more accurate conversation to have for trans people. They [symptoms] may not apply. They indicate presence and absence versus change, which is really important for people who have had other experiences around these. (Man, aged 18–29) It's about the hormonal fluctuations. […] That's a really important distinction. It's not a decline. (Non-binary, aged 50–59) Participants therefore resisted assumptions that menopause was a singular or universal experience. Instead, they emphasised diversity and individual variability in symptomology and embodiment: I think they need to very much reword what is menopause is and maybe acknowledge that not everyone experiences menopause the same way and has the same symptoms. (Man, aged 18–29) This reframing was perceived as more reflective of the fluctuating nature of hormonal change in which they similarly saw their own experiences. Accordingly, participants’ accounts suggest that resisting dominant social scripts of menopause involved both rejecting narrow social narratives of menopausal decline and advocating for more inclusive, affirming, and flexible understandings of hormonal fluctuation and embodied change. The way that participants recounted these experiences and perceptions suggest the need to destigmatise menopause—and if warranted, the preference for medical intervention—in line with a patient-centred approach that prioritises agency: I think they need to very much reword what is menopause is and maybe acknowledge that not everyone experiences menopause the same way and has the same symptoms. (Man, aged 18–29) Like, this is a major hormonal change that we're going through, and we can address in our own way. (Man, aged 18–29)

Concomitant with the rise in its visibility, attention is increasingly paid to menopauses’ various effects and impacts, which has in part led to increased dissemination of information on menopausal symptomatology and its management. Recent analyses have shown that such heightened visibility intensifies pharmaceutical, wellness, and productivity-oriented discourses ( Rowson et al . 2023 , Orgad and Rottenberg 2024a , 2024b ). That menopause, as a product of biological aging, can potentially be delayed or reversed by pharmaceutical intervention is often reinforced in health consumer information ( Lyons and Griffin 2003 , Amini and McCormack 2019 , Krajewski 2019 , Rowson et al . 2023 , May 2024 , Randle et al . 2024 , McCartan 2025 , Schneider Dallolio et al . 2025 , Takhar et al . 2025a , 2025b ). Not surprisingly, menopause has also captured the attention of the commercial wellness industry seeking to capitalise on menopausal treatment regimens. These commercial drivers adopt neoliberal models of responsible health citizenry, which drive market demand for its products - effective or otherwise ( Padamsee 2011 , Rowson et al . 2023 , Corus et al . 2025 , Schneider Dallolio et al . 2025 ). Along with considerable potential for misinformation around menopause ( Herbert et al . 2020 , Van Poucke 2025 ), commercial interest is making menopause somewhat ubiquitous, with algorithmically determined advertisement targeting women at midlife. This could have a paradoxical effect of unduly influencing purchase decisions at the same time as expecting people to function as market-savvy consumers ( Corus et al . 2025 , Onculer and Onculer Yayalar 2025 , Schneider Dallolio et al . 2025 , Takhar et al . 2025b , Thomas et al . 2025 ). Conversely, health policy analysts and economists draw attention to menopause as not only as an individual health event, but as an issue linked to labour participation and economic productivity ( Vicki Kafanelis et al . 2009 , Riach and Jack 2021 , Riach and Rees 2022 , Whiley et al . 2023 , Thomas et al . 2024 , Goswami and Cherrier 2025 , McCartan 2025 , Taylor et al . 2025 , Walker-Bone and Davis 2025 , Wood et al . 2025 ). In some high-income countries, especially, discourses on the economic impacts of menopause identify the collective toll of the decline in individual productivity, of which responses pivot on removing or reducing barriers in the workplace ( Riach and Jack 2021 , Rowson et al . 2023 , Whiley et al . 2023 , Vincent et al . 2024 , Taylor et al . 2025 , Walker-Bone and Davis 2025 , Wood et al . 2025 ). For example, the Australian Senate Community Affairs References Committee’s 2024 inquiry into menopause and perimenopause debated whether paid reproductive leave should be mandated, which the federal government noted in their response to its recommendation ( Community Affairs References Committee 2024 , Australian Government 2025 ). The Australian Public Service Commission has issued national guidance for Australian Government agencies to support employees experiencing symptoms of menopause in the workplace ( Australian Public Service Commission 2025 ). While Australian unions are campaigning for reproductive health leave, including paid leave for menopause for all workplaces, public sector agreements now enshrine these entitlements in standard awards in some state jurisdictions ( Molloy 2025 ). Menopause can also mark the moment in the lifecourse where systemic inequities can be activated, including disparities in diagnosis and treatment access. Menopause is thus increasingly viewed through a health equity lens. In 2023, Davis and Magraith reported a startling figure: over 85% of Australians with moderate to severe negative symptomatology associated with menopause were not receiving effective, approved, and evidence-based therapies ( Davis and Magraith 2023 , see also Worsley et al . 2016 ). Menopause Societies (specialist authorities for menopause and post-menstrual health) have now been established in various international jurisdictions, such as Australia, to advocate and amplify calls for improved clinical literacy and community awareness ‘for women through midlife, menopause, and beyond’ ( Australasian Menopause Society 2025 ). In efforts towards increasing access to quality healthcare related to menopause, on 1 July 2025, the Australian government introduced new Medicare Benefits Schedule item numbers for menopause-related health assessments to facilitate subsidised access to menopausal health provision in general practice ( Australian Government 2025 ). Yet, all of these discourses that identify the individual and collective impacts of menopause often rest on assumptions about what menopause is and who it will impact—and these assumptions can even carry over to research that evidences these impacts (see, e.g. Drysdale et al . 2026a ). This article is guided by concerns that trans people may be left out of the current menopause moment if we continue to use the term menopause uncritically, which often operates on and consolidates axes of aging, gender, and sexuality. In doing so, there is a risk conflating the diversity of experience into a singular notion of menopause that will continue to exclude outlier or nonnormative experiences. This conflation does a disservice to cisgender heterosexual women who may have experiences that do not conform to dominant assumptions about menopause (see, e.g. Boughton and Halliday 2008 ), let alone how such assumptions can serve to entrench ongoing and systemic inequities in healthcare among trans people (see, e.g. Drysdale et al . 2026b ). The contemporary discourses around menopause may be at a tipping point. This study was designed to address the following questions: What are the experiences and/or expectations of perimenopause and menopause among trans people? What changes are required to menopause resources to better align with these experiences and/or expectations? In this article, we ask: can the ‘menopause moment’ move beyond cisgenderism, heterosexism, and binary-based gender?

In Australia and other high-income countries, a ‘menopause moment’ has been unfolding amid rising political, social, and commercial visibility that position menopause as a health issue. Yet, this continues to be a moment indexed by aging, gender and sexuality which centre cisgender women at midlife signalling an end to their reproductive capacity. Some trans people with ovaries may experience menopause but this experience often occurs across a range of physiological pathways than those typically described in cisgender populations. While there is no universal experience of menopause, this current menopause moment risk obscuring the diversity of experiences, including those among trans people. Critically interrogating lay understandings of the limited diversity referenced by the shorthand or suppositional function of menopause is essential to prevent this contemporary moment from inadvertently reinforcing exclusion. Now is the time to move menopause beyond cisgenderism, heterosexism and binary-based gender so that trans people can be included in this contemporary ‘menopause moment’.

Trans participants in our study revealed how they defined, applied, and potentially resisted a combination of terms, associations, and proxies broadly aligned with ‘menopause’. Generally, participants within focus groups identified a variety of ways that the term was used. Finely grained delineations, often determined by the age associated with the onset of symptoms (premature, early, perimenopause, and post-menopause), were useful for participants in this study to identify biological changes in their bodies, often enabling self-diagnosis that can trigger information seeking practices and encourage engagement with healthcare services (see also Drysdale et al . 2026b ). Used interchangeably or simultaneously in the same conversation, participants also identified vernacular uses of menopause that function as a broad umbrella term, which allowed participants to refer to their own experiences as menopause. However, opposition was voiced in respect to how menopause was often used as a proxy for a range of other socially mediated discourses. Participants firmly resisted the sociocultural meanings that coupled menopause to reproductive capacity and cisgender womanhood, as they imply socially sanctioned understandings of gender, age, and sexuality (see also similar findings across literature in Brown et al . 2015 ). Attention to sociocultural dimensions of menopause is crucial as research has shown that the expectations associated with menopause in turn influence the embodied experience of it ( Lyons and Griffin 2003 , Ayers et al . 2010 , Hunter and Chilcot 2013 , Hickey et al . 2022 ). It is not surprising, then, the term ‘menopause’ may be ambiguously or uneasily received by trans people (see also Toze and Westwood 2025 , Drysdale et al . 2026a , 2026b ). This ambiguity reveals how understandings of menopause among trans people were mediated both by their and others’ gender, and by the different contexts in which people experience hormonal change, including trans people’s experiences of gender affirmation. This could also mean that the cessation of menstruation and the onset of menopause could be experienced as positive among trans people, as they decouple menopause from reproductive function and associated sentiments of decline and dysfunction. While menopause is subject to widespread social discourses that position it as characterised by a decline in reproductive capacity due to hormonal decay, feminist scholarship has long critiqued this tendency to frame menopause primarily through narratives of decline, dysfunction, or reproductive failure ( Bell 1987 , Martin 2001 , Greer 2018 ). Yet, these findings also support other literature that reveal how trans people may experience uncertainty in recognising and interpreting symptoms as menopausal, particularly when vasomotor or cognitive changes overlap with or are attributed to GAHT or other experiences of (ill)health ( Mohamed and Hunter 2019 , Cheung et al . 2023 , Toze and Westwood 2025 ). Crucially, these findings from this study contrast with the way that emerging and circulating discourses on menopause tend to rely on a universal experience, which can impact cis and trans people alike. Media, popular, and commercial attention to health issues has a significant impact on health policy and practice, which renders menopause vulnerable to shifting influences that can enable or constrain individual healthcare seeking practices and healthcare service provision. For example, literature has documented the ways in which women and people with ovaries are being targeted by the wellness industrial complex, which, combined with a lack of investment in women’s healthcare more generally, can either leave people vulnerable to misinformation and commercially driven pseudo-medical products while simultaneously demanding their responsibilisation as market-savvy agents and consumers ( Corus et al . 2025 , Onculer and Onculer Yayalar 2025 , Schneider Dallolio et al . 2025 , Takhar et al . 2025b , Thomas et al . 2025 ). The (over)medicalization of menopause also can affect patients’ agency and autonomy in determining that best course of action that responds to their own healthcare preferences ( Murtagh and Hepworth 2003 , Padamsee 2011 ). Other literature has highlighted the psychosocial and cultural aspects of menopause, extending focus from the ‘silent biological changes’ ( Davis and Magraith 2023 ) to a range of intersectional sociocultural processes and as occurring within highly variable sociopolitical contexts ( Flint and Samil 1990 , Hunter and Rendall 2007 , Hyde et al . 2010 ). In high-income countries, especially, attention is paid to the experiences of menopause in workplaces where it is framed by declines in individual productivity and the economic impacts of people prematurely leaving or taking time away from the workforce ( Riach and Jack 2021 , Rowson et al . 2023 , Whiley et al . 2023 , Vincent et al . 2024 , Taylor et al . 2025 , Walker-Bone and Davis 2025 , Wood et al . 2025 ). While the current ‘menopause moment’ has raised important awareness across a range of social, political, and economic domains, there is also the risk of the amplification and normalisation of only one type of menopause. While identifying important distinctions between trans experiences and/or expectation of menopause and the normative assumptions associated with heterosexual cisgender womanhood, more research is needed to carefully disentangle intersectional experiences of ethnicity and culturally mediated experiences, as well as unpacking these experiences from other chronic health conditions which may be distinct from or impact menopause. Equally, there may be important distinctions in understandings of, and service access needs related to, permanent menopause (i.e. no possibility of returning to a state of ovarian function) or temporary menopause (i.e. where menstruation may return if certain biomedical interventions are ceased), not explored here. The absence of clear clinical guidance ( Cheung et al . 2019 , 2023 ) and limited inclusion of trans bodies in menopause research ( Drysdale et al . 2026a ) contribute to difficulties in distinguishing menopause-related changes from other health, hormonal, or biomedical interventions. Recognising menopause as part of a broader life-course approach to gender-affirming healthcare ensures that emerging menopause discourses do not exclude trans people but may instead contribute to more equitable and inclusive healthcare. Equity in health promotion is often centred on inclusiveness ( Drysdale et al . 2024 , 2025 ). This requires a crucial reorientation to be more critical of how we talk about menopause. Understanding menopause as socially and culturally situated, shaped not only by hormonal change but also by broader relations of gender, aging, class, race, sexuality, and embodiment are also critical for trans inclusiveness in understanding menopause ( Mohamed and Hunter 2019 , Glyde 2022 , Cheung et al . 2023 , Mehta et al . 2024 , Sobel et al . 2024 , Toze and Westwood 2025 , Westwood 2025 , Drysdale et al . 2026b ). This is because outside of clinical interventions, menopause is also experienced as a sociocultural phenomenon, in which menopause is often the target of other drivers, or can stand in for a range of other proxies. Rather than dismissing these tensions as inevitable via the comparison of clinical versus vernacular uses, we find that menopause can—in its popular evocation—become a meaningful term that invokes a range of social forms, cultural meanings, and hierarchically ordered experiences. This then narrows conversations around menopause to those experiences are most visible, which in turn, becomes those most salient and in need of response. This menopause moment generates an increasingly lay understanding of ‘natural’ ( World Health Organization 2024 ) menopause; that is, the range of menopausal experiences that take place at a result of biological aging. This in turn implies that some experiences are unnatural; for example, those resulting from a range of biomedical interventions. But by making a distinction between natural and unnatural menopause, this necessarily prompts debates over ‘medicalised menopause’ ( Hickey et al . 2022 ). This in turn leads to disagreements over whether menopause is being either over- or under-treated, and then indeed, what counts as a symptom of menopause. This divide then invites a separation between menopausal healthcare provision targeting people who may experience hormonal fluctuations at midlife (i.e. cisgender women and people with ovaries) and those who experience the very same experiences of hormonal fluctuation related to biomedical interventions (i.e. trans people and other people who, for a variety of reasons, have undergone biomedically induced menopause). Along with binary-based gender that sees menopause as something that only ‘women’ may experience, current menopausal diagnostic, referral, and treatment pathways may have limited resonance with the complex hormonal changes through which trans people may experience menopause ( Toze and Westwood 2025 , Westwood 2025 , Drysdale et al . 2026b ). Paradoxically, in the wake of the heightened visibility of menopause there is a risk of the increasing narrowness of the conversation.