Navigating Menopause in Rwanda: Insights into Women’s Health, Ageing, and Systemic Gaps

Menopause is a universal stage of life for women, yet in Rwanda it remains poorly understood and largely absent from public health strategies. Many women experience vasomotor, psychological, musculoskeletal, and urogenital symptoms that impact quality of life, productivity, and social participation. Cultural expectations of silence and endurance mean that symptoms are often managed privately, without formal support. With Rwanda’s ageing population and increasing life expectancy, the burden of menopause will grow, highlighting the urgent need for evidence to inform health services and policy. This qualitative study was part of the MARIE Rwanda Work Package 2a (WP2a) and explored the lived experiences of perimenopausal, menopausal, and post-menopausal women across rural and urban settings. Semi-structured interviews were conducted with 28 women aged 40–75 years who had experienced natural, surgical, or medical menopause. Data were analysed thematically using Braun and Clarke’s approach, guided by the Delanerolle and Phiri framework to examine biological, psychological, socio-cultural, health-system, and structural determinants. Five interconnected themes were identified: biological symptom burden; psychological distress and coping; cultural silence and stigma; health-system neglect; and structural barriers. Rural women faced compounded challenges, including transport difficulties, financial strain, and heavy labour, while urban women reported subtle neglect despite proximity to services. Surgical and medical menopause were associated with abrupt and severe transitions, particularly in the absence of anticipatory counselling and follow-up care. These findings highlight the invisibility of menopause within Rwanda’s health system and communities. Addressing this requires integrated, culturally sensitive interventions, policy inclusion, and improved access to care to reduce stigma and promote equity for midlife and older women.