Navigating Support Dilemma: A Socio-Ecological Analysis of Health Management for Women in China Living with Moderate-to-Severe Menopausal Syndrome

Navigating Support Dilemma: A Socio-Ecological Analysis of Health Management for Women in China Living with Moderate-to-Severe Menopausal Syndrome | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Navigating Support Dilemma: A Socio-Ecological Analysis of Health Management for Women in China Living with Moderate-to-Severe Menopausal Syndrome Qiqi Ye, Zhijia Zhang, Li Song, Kefu Zhong, Xuedan Wu, Qihua Huang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7590310/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Patients with moderate to severe menopausal syndrome often face significant physical and mental health challenges, yet their experiences are frequently overlooked in China. This study aims to explore the illness experiences and health management needs of these patients, focusing on their feelings, coping strategies, and demands for health services to address both physical and psychological symptoms, thereby promoting reforms in management programs. Methods: A phenomenological approach was employed, with an interview guide developed based on socio-ecological systems theory. Twelve patients with moderate to severe menopausal syndrome were selected through purposive sampling for semi-structured interviews. Data were analysed using Colaizzi's seven-step method. Results: Twelve women participated this research. Three primary themes and ten subthemes were emerged: (1) micro- cognitive limitations and reduced coping capacity (aging and confusion, self-regulation and health monitoring, delayed treatment, and divergent expectations); (2) meso- family silence and disappearing workplace care (ambiguous information, feeling of pain, isolation and helplessness, and workplace neglect and gossip); and (3) macro- misaligned healthcare (fleeting communication, absence of health promotion role, and enhancing management plan specificity and systemization). Conclusion: The study found that patients with moderate to severe menopausal syndrome possess strong self-management awareness; however, their coping abilities require enhancement, particularly for atypical symptoms such as palpitations and joint pain. Developing effective and targeted health management plans relies on collaboration among families, communities, media platforms, medical institutions, and healthcare professionals to provide comprehensive support for patients. Menopause syndrome Experience of illness Social-ecological theory Hierarchical health management Women's Health Introduction Menopause Syndrome (MPS) constitutes a cluster of complex symptoms prevalent among perimenopausal women. Statistical data indicate that the incidence of MPS in perimenopausal women in China approximates 61% 1 . As age advances, the symptoms experienced by MPS patients tend to escalate, and the condition becomes more severe 2 . Notably, patients with moderate to severe MPS frequently encounter multiple symptoms concurrently 3 . The likelihood of "physical and mental illness" is elevated compared to those with mild 4 , with the co-occurrence of dual symptoms reaching up to 80% 5–7 . Of greater concern is that MPS not only impairs the quality of life for patients but also heightens the risk of cardiovascular events and mortality, which ranges from approximately 2% to 11% 8 . The risk of patients with moderate to severe MPS developing chronic conditions such as hypertension and diabetes is estimated to be between 22% and 40.1% 9,10 , thereby imposing a significant burden on patients' families, society, and healthcare systems. For an extended period, Menopause Syndrome (MPS) has been heavily stigmatized, often associated with negative and derogatory connotations. This adverse social and cultural public opinion climate has exacerbated the psychological stress experienced by patients, prompting some women to attempt to rationalize their experiences and the discomfort induced by MPS through shame and stigma 11 . Such attitudes have impeded MPS patients' willingness to seek medical assistance. In certain regions of China, Menopause Syndrome (MPS) is viewed as an ill-fated and sinful condition within family culture 12 . Consequently, some afflicted MPS patients have endured prolonged mental humiliation from their spouses and children. This perception, to some extent, distorts the accurate understanding of MPS among perimenopausal women, undermining their sense of self-worth and self-identity. Moreover, it intensifies women's aversion towards MPS and perimenopause, thereby impacting the holistic health management of MPS. Dahlgren's 13 research has indicated that psychosocial stress, genitourinary symptoms, and advanced age are significantly correlated with the level of stigma experienced by MPS patients. This observation underscores the urgent need for comprehensive and targeted intervention strategies to enhance the quality of life for these women who suffer from both physical and psychological symptoms. The Social-Ecological Model (SEM) was proposed by Urie scholars 14 , which delves into the intricate connection between behaviour and cognition with the individual's environment. Within this framework, individuals and their relatives, social networks or workplace colleagues, and social culture or social organizations constitute micro, meso, and macro systems respectively, thereby forming a unique social ecosystem for individuals 15 . Currently, SEM has been extensively applied in various fields such as violence prevention 16 , nutritional support 17 , humanitarian assistance 18 , and chronic disease prevention 19 , yielding positive social impacts. By leveraging this theory, it may facilitate an understanding of the interplay between patients with moderate to severe menopausal syndrome, their families, and society during their illness. It also aids in elevating societal awareness of MPS, rectifying misconceptions and prejudices, and concurrently offers a foundation for medical institutions to devise targeted management plans. However, the empirical evidence supporting this approach remains insufficient. In light of this, the present study investigates the authentic illness experiences and health management needs of MPS patients through the lens of SEM theory, aiming to provide a reference for the subsequent formulation of relevant health management plans. Methods Design The phenomenological research method was used in in-depth semi-structured interviews. Adopting the slogan of "returning to things themselves," this method seeks to unveil the meaning of transcendental experiences and subsequently elucidate the nature of phenomena 20 . It holds significant value in delving into the essence of specific groups or intricate and complex phenomena, as well as the sentiments of individuals within them. Consequently, selecting this approach aids researchers in concentrating on the authentic illness experiences of patients with moderate to severe MPS and in meticulously exploring their needs for health management strategies. Participants Purposive sampling method was used to obtain heterogeneous sample for exploring the experiences of patients with moderate to severe MPS and their needs for health management strategies. From April to June 2024, patients with moderate to severe MPS in gynaecological outpatient clinics of 2 public medical institutions in Guangzhou were selected for semi-structured interviews. Inclusion criteria: (1) Those who were diagnosed as "menopausal syndrome" by medical examination; (2) Those whose medical records complain that contain both physical symptoms and psychological symptoms of MPS; (3) Women aged 45 to 55 years; (4) Modified Kupperman Index (mKI) ≥ 16 points; (5) Those who have clear consciousness and can express and answer questions correctly; (6) Be informed about this study and voluntarily consent to participants. Exclusion criteria: (1) People with severe physical diseases or mental disorders (such as patients with advanced malignant tumours, mania, etc.); (2) People with severe hearing impairment. The mKI was used to evaluate MPS severity: 0-6 scores were normal, 7-15 scores were mild, 16-30 scores were moderate, and ≥ 31 scores were severe 21 . The sample size for the study is determined by the saturation of interview data and content, with no new topics emerging upon the addition of new interviewees or interview materials 22 . Ultimately, 12 patients aged between 45 and 55 years with moderate to severe MPS (5 moderate and 7 severe) were included. The majority of respondents were currently employed (n = 8), and co-residents primarily consisted of husbands and children (n = 6). The KI score results varied from 16 to 52 points (Table 1). In adherence to the principle of study confidentiality, the real names of respondents will be replaced with case numbers H1 to H12. Ethical approval This study received approval from the Ethics Committee of Guangdong Provincial Hospital of Traditional Chinese Medicine (ZE2024-038-01). The ethical protocol ensures the confidentiality of the research design and the interviewee's right to freely decline the interview or halt it at any point. All interviewees included in the scope of text analysis had provided informed consent. Data collection Based on the SEM theory, the interview outline for this study was devised. A nursing professor and a medical professor reviewed the interview outline and provided suggestions for revision. Two patients with menopausal syndrome who met the research criteria were selected for pre-interviews, and the outline was adjusted according to the interview results and the feedback from the interviewees. Ultimately, an interview outline comprising the following questions was established (Supplement file). The study employed semi-structured interviews, conducted by two female graduate nursing students who served as interviewers and recorders, respectively, within a quiet, private consultation room or lounge. Prior to the interview, the interviewer established rapport by inquiring about the interviewee's recent living circumstances, subsequently introducing the research objectives and the necessity for recording. Upon obtaining informed consent and executing the consent form, the interview commenced, with each session lasting between 19 to 38 minutes. To thoroughly explore the content of the interview outline, the researcher adeptly adjusted the questioning method and sequence, providing timely responses and confirmations to the patient's perspectives, and delving into topics of research value. The recorder meticulously documented the interviewee's distinctive intonation, micro-expressions, and bodily movements. Should the respondent exhibit avoidance or aversion towards a particular question, the researcher would either bypass the question or conclude the interview. General data pertaining to the participants (age, educational background, co-occupant, work status, occupation, mKI score, MPS severity, etc.) were collected post-interview to minimize interference with the interview process. Data analysis Following each interview, the researcher responsible for questioning transcribed the recorded materials into textual form within 24 hours and subsequently provided feedback to the interviewees. Utilizing QRS Nvivo 12 pro software, two researchers applied Colaizzi's 7-step analysis method to conduct immersive reading and coding analysis of the transcribed materials: (1) Familiarization with the data; (2) Disjunctive statement; (3) Content coding; (4) Gathering of views; (5) Detailed description; (6) Discrimination and analysis of viewpoints; (7) Verification of the structure. Upon completion of each transcription, the entire study team reviewed the content for fluency and accuracy. Results Through the analysis and synthesis of the interview data, in conjunction with the SEM model, the following three themes and ten sub-themes (Table 2) were extracted. These themes collectively encapsulate the illness experiences of patients with moderate to severe MPS and delineate the genuine and specific requirements for perimenopausal health management strategies. Theme 1: Cognitive L imitations and Reduced C oping Capacity Subtheme 1: aging and confusion The cognition of menopausal syndrome in patients with moderate to severe MPS is relatively shallow. Under the general trouble of menstrual disorders, mood disorders, sleep disorders and other symptoms, its body image is characterized by aging, such as "irritability" and "no longer beautiful", rather than chronic diseases. Some patients think that MPS is a normal change in the perimenopausal stage, but it is customary to use the word "menopause" to obscure menopausal syndrome. "So, the skin starts to dry out and we lose collagen. Plus, our memory goes downhill. Some of my colleagues had a bit of a period in their forties and they said it was better to end it sooner. Because we're so busy with work and we've got kids anyway, there's no point in worrying too much about these things" ( H1 ); "I don't see it as a disease. I think it's just a phase people go through after they hit their forties. You can't stay beautiful forever. Each age has its own charm. The key is to accept it and understand it" (H6) Simultaneously, patients with moderate to severe MPS frequently experience nonspecific symptoms such as bone and joint pain and paroxysmal palpitations, yet they are perplexed and unable to comprehend the manifestation of these symptoms. Additionally, most participants exhibit limitations and misconceptions regarding the normal age of menopause. Some even hold the belief that "the later the menopausal event occurs, the better" and "it is ideal to menstruate until old age." " I really feel that i t doesn't feel normal to me ! I even asked my friend yesterday. She's still having periods at 50 and she also has insomnia, but she doesn't have my palpitations. Some people think it's normal. They say menopause is just like that, but I feel like something's not right, don't you think? How can palpitations be normal? I'm not just flustered, I'm the kind of scared that feels like I'm in danger" ( H5 ); " I’m going crazy , I can't sleep at all, and I've got joint pain. My feet feel weak and my knees hurt, but I don't think these should count, right? It's like I've had this before" ( H2 ) Subtheme 2: self-regulation and health monitoring Self-regulation by most patients with moderate to severe MPS is pivotal in the management of MPS health. As stated, following: "I reckon personal adjustments are key. If you're feeling down, you might start noticing all sorts of niggles. And mentally, you need to give yourself a nudge, face up to it, and tweak things. Realize that even docs can only do so much to help" (H6); "Honestly, I would say that women in their 30s should start getting clued up. Maybe if you prepare early, you won't freak out so much later. Everyone's symptoms are unique, so it's wise to know what's coming" ( H5) MPS patients perceive that participation in a systematic health management program can motivate them to pay greater attention to MPS and other health issues. As in the following narrative: “I'm cool with that. I can keep tabs on it yearly, and I've got it covered in my mind” (H12); Other participant emphasized furtherly: “I'm all for proper health management for menopause. If there's a thorough, tiered approach, it can really help us figure out what's going on and what we need” (H5) Subtheme 3: delayed treatment Participants with moderate to severe MPS often encounter a prolonged waiting and hesitation period during the process of seeking medical treatment, and the delay in seeking medical attention is pronounced, which may be one of the significant factors contributing to the exacerbation of their symptoms. "I'm really snappy. Sometimes, I just don't know what to do. I'm clueless when it comes to picking a doctor. At night, I can't get comfy, my leg's all over the place. Even when I pinch it, I still don't bother seeing a doctor" (H3); "I wanted to get checked out earlier, but work got in the way. I'd been meaning to get help for ages, but my job kept pushing it back. The everyday hassles just kept piling up, so I finally had to head to the hospital for insomnia and others" (H5) Additionally, one patient was readily influenced by the ambiguous and indifferent attitudes of family members during her hesitation period of seeking medical treatment. She tended to default to the belief that MPS is not associated with health threats, thereby neglecting her own discomfort symptoms: "I didn't think about going to the hospital back then. I told my husband about the dryness and bleeding, and he brushed it off. He said I could just pop into the clinic for a quick check, and it wouldn't kill me… After I took the meds and seemed to have nothing wrong, I just let it slide and never went back to the gynaecologist" (H7) Subtheme 4: divergent expectations Due to the unclear risks associated with menopausal hormone therapy and the varying personal expectations of treatment outcomes, participants tended to favour non-hormonal treatments or guidance on healthy lifestyles in their subjective preferences when making treatment decisions. "If I used hormones, I might think more about it. I might think: Why use hormones? What do you want? Because I think what kind of condition do you want me to recover from with hormones? Well...To my mind, I'm not too eager to fully recover." ( H6 ) Theme 2: Family Silence and Disappearing Workplace Care Subtheme 1: ambiguous information dissemination Because menopausal syndrome is closely linked to female reproductive function and organs, the primary sources of health information for participants are female relatives and friends. During the exchange of information, patients and their relatives and friends often harbour feelings of shame and taboo regarding MPS, which casts an ambiguous and vague hue over the dissemination of MPS health information. "My husband's sister was anxious, and this happened to her at that time … I also accompanied her here to see a doctor, but a few years ago, my body didn't have these conditions at all, and I didn't understand (her) situation … I also have a friend who also had these situations. She also told me that she was very serious and even depressed. She said that she actually didn't know how to be anxious. We were all confused why we get it?" ( H5 ); " There is no one to say in my hometown. I quietly asked my sister-in-law two years ago, and asked her what the process of menstruation was like. She said it was gone a little bit, a little bit anyway. Didn't say anything to me." ( H7 ) Subtheme 2: feeling of pain, isolation and helplessness Patients interviewed considered both MPS and perimenopausal changes to be "private" and should not be discussed with others: "It's all about self-adjustment, because I consider these personal issues, and I don't want to or dare to tell others." (H2). One interviewee exhibited significant emotional fluctuations upon hearing questions about family members' care for her. Despite her outward expression of indifference, her suddenly raised tone and faster speech conveyed the anguish of feeling ununderstood and uncared for: "I don't need to talk to others, just adjust it myself. Deal with your own affairs. These problems have nothing to do with your family, so you don't need to increase the burden on others." (H10) Simultaneously, some interviewees felt they greatly lacked the attention and companionship of their partners, and their inner distress sought an outlet, leading to a mix of "demands" and "expectations." One participant sighed helplessly while sharing: "Well, he simply advised me to rest more… If I expect him to be considerate, it might tire him out. It's good to care, but you can't ask for too much…" (H12) Another clearly emphasized that the family care she received was insufficient to compensate for the trauma she experienced in family life, causing her psychological emptiness during the transition period to become more pronounced: "Honestly, not enough… Officially, due to the lack of family support or the influence of my childhood family environment, my slight depression is influenced by my family of origin. Therefore, after entering menopause, this feeling is even stronger. I think no one would deny that coupled with some private and unspeakable secrets, I can't talk to my husband, it just only make me more depressed and anxious." (H4) Subtheme 3: workplace neglect and gossip Currently, within China's workplace environment and social and cultural context, our participants still do not receive sufficient attention, understanding, and empathy. A teacher working at a medical university shared her sentiments with us: " Even though we work in a medical university, where you'd think it would be relatively easy to access this information, menopausal syndrome doesn't seem to be specifically highlighted for public awareness. I feel that the care for women in society now only remains at a relatively broad level. Perimenopause isn't regarded as an important and special period like pregnancy and childbirth, and we don't feel much attention." (H1) Another interviewee's perspective echoes this sentiment: " I would like to point out that the workplace, unless it's a particularly supportive one, otherwise I don't believe it pays much attention to menopausal syndrome, and the workplace might not give much thought to us during this period. Well, that’s true." (H2) Furthermore, the public's prejudice and stigma towards menopausal syndrome have resulted in significant public opinion pressure on patients with moderate to severe MPS in the workplace. " It's less acknowledged. Seriously, society pays less attention and understanding to this stage. Moreover, I feel a kind of pressure, fearing that my colleagues and superiors will think I have something wrong all over, and I'm unsure what others might think of me or gossip about. Then I suppress myself, become very irritable, and worry that others will think I have… a terminal illness." (H5) Theme 3: Misaligned Healthcare Subtheme 1: fleeting communication Due to the scarcity of medical resources and the high volume of patients, the medical atmosphere is characterized by tension and urgency during the diagnosis and treatment process. This environment prevents patients from engaging in in-depth communication with their attending physicians about their condition and personal health concerns, thereby exacerbating negative emotions such as "helplessness" and "hesitation" among patients with moderate to severe MPS. The following voices of several interviewees reflect this reality: "The doctor doesn't pay enough attention to us, yet… They're always in a rush. They just ask what the issue is, then write out a prescription. Oh dear, it feels very assembly-line." (H8) " The community doctor just tells me what to watch out for, and that's it. If there's any treatment (discussion), they don't go into specifics. Yes, the doctor didn't elaborate." (H5) " How can the doctor find the time to listen to you and explain it in detail? Let alone, they've already written out a prescription. Can I even stay in the consulting room? Sometimes I really feel helpless, really." (H3) Subtheme 2: absence of health promotion role Owing to the insufficient transparency and openness of current publicity methods employed by medical institutions, participants reported difficulties in fully accessing professional health information. Among the existing social health service initiatives, perimenopausal women and MPS patients are infrequently targeted for intervention. "The current health lectures in the community mainly target older people, and there are no specific projects for menopausal health or specialist clinics. It feels like no one has the time to support us. Maybe it would be hopeful to focus on this in the future." (H2); " Well, I would say, if the hospital had those promotional materials, I would definitely take them, but I don ’ t know where to find them. Nobody knows, I guess." (H7); " It seems to me that free clinics or consultations on menopausal syndrome are quite rare, and the information provided by hospitals is not clear or complete enough. Often, we don ’ t even know these activities exist." (H12) This lack of focus contributes to the challenges faced by moderate to severe MPS patients who are aware of the need for medical treatment but struggle to obtain primary healthcare services and effective referrals. Consequently, this situation has become a significant contributing factor to the delays in the medical treatment of MPS patients. Subtheme 3: enhancing management plan specificity and systemization Participants in the interviews indicated that the current management measures implemented by medical staff are overly structured and universal, lacking the necessary flexibility and adaptability. These measures do not adequately consider the unique circumstances and individual differences within specific management dimensions, which adversely affects patients' willingness and compliance with health management intervention strategies: "If you ask me, after I realised that her advice was not specific, I lost interest in it. The focus needs to be improved… When seeing a doctor, I expect a professional medical plan that includes exercise, diet recommendations or something else. It would be helpful if the doctor could specify what we can and cannot eat, providing more detailed and targeted guidance" (H1); "The way I see it, doctors ought to take the initiative to offer advice, instead of we ask for it." (H2) Given that the symptoms of Menopause Syndrome (MPS) involve multiple physiological systems, purely structured health education may fail to account for the overall health status of MPS patients. Those with moderate to severe MPS report a need to understand their current disease risk levels. It is essential for medical staff to develop transitional management plans for perimenopause based on risk assessment results, with a greater emphasis on mental health management. "I think it is still necessary to carry out an overall management, breaking down specific symptoms and addressing them based on their severity. Serious and mild symptoms require different management approaches, right?" (H5) Another participant also emphasized that: "Personally, if further improvement is needed, I think it would be beneficial to incorporate psychological assessments, similar to offering psychological counselling. Psychological support and guidance from you are very important for those of us experiencing emotional issues. Thank you." (H6) Discussion Through 12 in-depth conversations with patients suffering from moderate to severe Menopause Syndrome, it has been observed that cultural or value-based constraints, such as "menstrual shame," "menopausal shame," and "age shame," significantly impact their emotional state. The global incidence of MPS has been on the rise in recent years, gradually emerging as a significant public health issue 23–25 . Due to its complex pathogenesis and diverse clinical manifestations, MPS often leads to chronic conditions characterized by "physical and mental comorbidity." From the menopausal transition period, it is necessary to carry out a comprehensive and scientific health risk assessment for menopausal women and timely adjust their chronic disease management strategies 26 . Although the "Chinese Women's Development Program (2021-2030)" 27 published in recent years mentioned that the main goals of women's health construction include: women enjoy good health services throughout their life cycle. However, in reality, the maternal and child policy in China has actually focused on "maternal and child health care" for a long time 28 , and the health needs of perimenopausal health care and people with menopausal syndrome are far from being fully paid attention to and met. Because the symptoms of patients with moderate to severe PMS are relatively prominent and complex, such patients have richer needs for health management and strong demands for health management solutions, so it is particularly urgent to solve their health management needs.. 3.1 Empowering management enhances the self-coping ability of patients with moderate to severe PMS The study found that the disease cognition of patients with moderate to severe MPS can be classified into two categories: "natural state" and "disease state." Changes in menstrual rhythm, duration, and characteristics are typical manifestations of MPS; however, individual differences and the association between symptoms and "aging" can easily induce negative emotions in patients 29 . Although these women demonstrated a strong willingness for self-management, their effective coping strategies were limited due to various factors related to their symptoms. This was particularly evident in their disease awareness, access to health information, and efforts to seek medical support. In the present study, patients with moderate-to-severe PMS were primarily concerned about the effects of symptoms on health and work performance. In a guideline recommendation published in recent years by the Equality and Human Rights Commission 30 , employers are poorly reminded that if symptoms of menopausal syndrome in perimenopausal women interfere with daily activities in the workplace, they can be regarded as disabling. This vague and unscientific policy definition may further aggravate the age discrimination and stigma faced by middle-aged women in the future. However, in fact, according to the systematic review study report of Taylor et al. 31 , menopausal status alone is not necessarily related to women's individual work results, and even if there are adverse effects, the effects are likely to be confused by other factors that interfere with middle-aged women's work ability. 3.2 Make full use of family support system and texture social support system for patients with moderate to severe PMS Our study also identified significant shortcomings in family support, work environments, and socio-cultural understanding among patients experiencing moderate to severe Menopause Syndrome (MPS). The finding following is slightly different to Chen's perspective 32 , some respondents in this study delayed seeking medical treatment due to a lack of initiative, while others were influenced by inadequate family support or socio-cultural values, which suppressed their willingness to pursue medical attention. Socio-cultural prejudices against menstruation and perimenopause may, to some extent, restrict patients' ability to openly discuss symptoms and access information support 12 . A similar view has been empirically verified in the project of Borzu et al. [21]. According to research, compared with Portuguese women, Iranian women have a stronger perception of menopause, and it may be closely related to cultural background, social support level and other factors. Notably, patients with MPS continue to shoulder multiple social roles and bear responsibilities during perimenopause, facing pressures from work, childcare, and eldercare 33 . If the cultural constraints that bind perimenopausal women are not dismantled over time, this may further diminish their courage to express their true feelings in family and workplace settings 34 . Emotional support for patients with moderate to severe MPS was primarily obtained from same-sex relatives or close friends, with children and male relatives, excluding husbands, rarely present during interviews. Additionally, discussions seldom addressed sexual dysfunction, genitourinary syndrome, and other symptoms directly related to reproductive health that are indicative of quality of life 35 . Furtherly, it was observed that the interviewees typically attended medical appointments alone, including women who were retired or on long-term leave. This may reflect a lack of adequate family or social support for patients with moderate to severe Menopause Syndrome from another perspective. Because women with menopausal syndrome in perimenopause are at the intersection of "aging" and "feminine" identities that are stigmatized to some extent, whether discussing perimenopause or menopausal syndrome, they will violate these two cultural "taboos" at the same time. At the same time, the above findings also show that perimenopausal health information is cleverly "avoided" in the process of public media dissemination due to the structural bias of gender and internalized narrative framework. This is very similar to the stigma and avoidance mechanisms of another common social prejudice problem among women-menstrual shame 36 . Compared with previous interviews with patients with menopausal syndrome, patients with moderate to severe menopausal syndrome in this study rarely but accurately indicate that in the current working environment, the age of perimenopause is an important factor that affects their access to adequate workplace support. In addition, at present, China, like some other countries in the world, has no national-level "menopausal vacation" legislation as a form of care for patients with menopausal syndrome, and related discussions still mostly stay on the introduction and proposal of foreign experience 37 . In contrast, in Japan, which is also a cultural and economic circle in East Asia, its Ministry of Health, Labour and Welfare requires enterprises to provide necessary care and support conditions for female employees facing health problems such as menstruation and perimenopause at the legislative level 38 , which provides a possible legal basis for women to enjoy menopausal vacation, and helps to guide social enterprises to implement a specific system of providing specific vacation for female employees 39 . In addition, jumping out of the medical field, Cao 40 and his team, when China is facing the transformation of market economy, cut in from the perspective of the vigorous development of new media industry, revealing that the new media, driven by capital power, constructed the definition of perimenopause and the crisis of middle-aged women needed for the transformation of China's market economy with the help of the strategy of "medical authority", thus strengthening the gender order that belittles and discriminates against middle-aged women. This negative impact continues to this day, and it also exists in other countries or regions 41 . In view of this, we must admit that improving the social support system for patients with moderate to severe Menopause Syndrome relies on the collaborative efforts of medical and health institutions, media, and social organisations. These entities should provide relevant, accessible, and effective information while break the stereotypes of menopause and PMS in society. concept and long-standing gender bias.. The intergenerational family relationship is closely linked to the severity of MPS and the quality of life of affected individuals 42 . Clinical doctors, particularly community general practitioners and working in perimenopausal specialties, should actively engage family support for patients with moderate to severe MPS and fulfil their professional roles in effectively disseminating accurate information about the condition. Furthermore, workplaces should foster a cultural atmosphere that values and respects women, recognising the significance of their contributions, jointly set up a multi-level workplace strategy 43 , and establish comprehensive care systems for perimenopausal women to enhance their professional satisfaction and success. In addition, social organizations and institutions should strengthen the overall level of social support for patients with menopausal syndrome from the legislative level, which will play an important role in promoting the well-being of menopausal women. 3.3 Promote the improvement of health management plans for patients with moderate to severe PMS and improve the pertinence of management measures A key factor contributing to the stigma associated with menopausal syndrome is the inadequate information support provided by medical staff, which results in the neglect of symptoms in patients with moderate to severe Menopause Syndrome and their inability to access sufficient health management measures 44 . This, in turn, exacerbates patients' misconceptions regarding menopausal hormone therapy and fosters negative attitudes towards menopausal syndrome 41 . In this study, patients with moderate to severe MPS generally reported that current health management protocols lacked relevance and had limited practical significance. In a survey of perimenopausal management knowledge of residents in the United States led by Kling et al. 45 , it was reported that about one fifth of doctors had zero exposure to menopause-related lectures during the study stage, and even more regrettably, less than 7% of residents believed that they could adequately manage perimenopausal women. This may indicate that globally, the medical education environment pays insufficient attention to patients with menopausal syndrome. In order to help patients successfully survive perimenopause and improve their quality of life, general practitioners and specialist medical staff should guide patients to understand the timing and necessity of PMS intervention, and pay attention to patients' willingness and expectation for treatment. In psychological counseling, medical staff can reduce the burden of patients' "menopausal shame" from the perspective of empowerment, promote the development of their correct self-image, enhance their self-management ability, and make informed and personalized health decisions. In addition, the promotion of the establishment of perimenopausal or menopausal specialist outpatient clinics is proposed, alongside the enhancement of training for general practitioners at the grassroots level and the facilitation of referral linkages and health management interactions between community health institutions and higher-level medical facilities 46 . These measures aim to ensure continuous care and long-term health management for patients. In the information age, digital interventions can effectively address deficiencies in time, space, and interactive experiences inherent in real-life settings 47 . Leaders of medical and health institutions may consider utilising digital information technology to construct a health forum or management applet specifically for menopausal syndrome, or to develop management programmes suitable for wearable devices, serving as auxiliary tools for the linkage between community hospitals and superior medical institutions. Simultaneously, this approach can integrate health management models such as "triangle hierarchical management" 48 , taking into account the supply capacity and needs of both managers and patients, thereby enriching and improving the structure of MPS health management schemes and enhancing patients' quality of life and self-management abilities. Additionally, scientific researchers should consider developing and implementing MPS screening and risk assessment guidelines, utilising risk stratification results to provide a foundation for formulating targeted management plans for patients with moderate to severe MPS. Conclusion To sum up, the health management for patients with moderate to severe Menopause Syndrome in China currently faces several challenges, including limited self-awareness, inadequate family support, socio-cultural prejudices, and insufficient professional medical assistance. This study pointed out that in order to avoid further stigma of perimenopause and menopausal syndrome, and solve the current support dilemma of this group, it is necessary to promote estrogen medication through popular science, improve the two-way referral system and develop health management plans to support personalized decision-making, etc. Measures to improve patients' quality of life and service quality. Strengthen, limitations and perspectives This study conducted in-depth interviews with patients with moderate to severe menopausal syndrome who were obviously troubled, and analysed the difficulties faced by patients with moderate to severe menopausal syndrome in different life scenarios from the level of self, family, social and professional resources from shallow to deep with the help of the social ecosystem framework, and highlighted the prominent needs of this group for workplace support and personalized medical decision-making. In addition, this study also crosses the medical theoretical framework, tries to analyse the key potential factors of the current predicament faced by patients with moderate to severe menopausal syndrome from the aspects of media communication and legislation, and puts forward corresponding intervention and improvement suggestions, in order to seek long-term well-being for patients with moderate to severe menopausal syndrome. Limitations of this study include the focus on urban samples; future research should expand the scope to include diverse populations and incorporate cross-sectional studies to better explore the quality of life and health management of patients with moderate to severe MPS, thereby providing a more comprehensive understanding of their circumstances and underlying causes. Declarations Acknowledgements We extend our heartfelt gratitude to the 12 patients with moderate to severe menopausal syndrome who participated in the interviews, sharing their experiences, challenges, and aspirations for a healthy life. We also thank the clinical nurses who assisted in collecting patient information and recruiting participants for the study. This research reflects the collective efforts of all involved, and we sincerely appreciate everyone’ s contributions. Author’s contributions YQQ and HQH were responsible for the conception and design of the article. YQQ, ZZJ, and HQH conducted the feasibility analysis. YQQ, SL, and ZKF contributed to the writing and revision of the paper. Data collection, collation, and result analysis were carried out by YQQ, ZZJ, and WXD. HQH oversaw quality control and proofreading of the article and was responsible for the overall integrity of the manuscript. All authors read and approved the final manuscript. Availability of data and materials Due to the principle of scientific research confidentiality, we promised to keep participant’s information and data confidential, and the data used for this study will not be public, but available from the corresponding author on reasonable request. Competing interests All authors declare that they have no competing interests. Funding This study was financially supported by Research Grant from the Guangdong Nurses Association (Grant No. gdshsxh2023ms20) Consent for publication Not applicable. Ethics approval and consent to participate Participants assured that they were voluntary in the interview. After informing the perimenopause patients about the study and obtaining their informed consent, the researchers began the interview. The study protocol was in accordance with the ethical guidelines of the Declaration of Helsinki and was approved by the Institutional research board of Guangdong Provincial Hospital of Traditional Chinese Medicine (No. ZE2024-038-01). References Jia J, Zhou ZT, Cao XH, et al. Incidence of perimenopausal syndrome in Chinese women aged 40 to 65 years: a meta-analysis. Chin Gen Pract. 2023;26(32):4080–8. Zhao D, Feng XJ, Hou YF, et al. Menopausal syndrome associated with menopausal transition, neuroticism and mindfulness in rural middle-aged women in Shandong Province. J Shandong Univ (Health Sciences). 2019;57(12):92–6. Liu J, Wang XY. Analysis of difficulties and countermeasures when treating menopausal syndrome. 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Food Nutr China. 2023;29(6):5–9. Liu LL, Ruan XY, Ju R, et al. Correlation analysis of lumbar bone mineral density with reproductive characteristics and sex hormone levels in perimenopausal and postmenopausal women. J Capital Med Univ. 2023;44(4):530–4. Cui XJ, Wang K, Xi AP, Xu YL. The relationship between serum bone metabolism biomarker levels and the severity of carotid atherosclerosis in perimenopausal women. Chin J Gerontol. 2022;42(24):5993–6. Menopause Group of the Obstetrics and Gynecology Branch of the Chinese Medical Association. Guidelines for menopause management and hormone therapy in China (2023 Edition). Chin J Obstet Gynecol. 2023;58(1):4–21. State Council of the People Republic of China. Outline of Chinese Women's Development (2021–2030). September 21. 2021. Accessed September 10, 2025. https://www.cnwomen.com.cn/2021/09/27/99232622.html National Health Commission of the People's Republic of China. Guiding Opinions of the National Health and Family Planning Commission on Providing Maternal and Child Health Services under the New Situation. June 19. 2014. Accessed September 10, 2025. http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=fb7b841983a2460e92b350bef532a6a1 Drew S, Khutsoane K, Buwu N, et al. Improving Experiences of the Menopause for Women in Zimbabwe and South Africa: Co-Producing an Information Resource. Soc Sci. 2022;11(4):143. the Equality and Human Rights Commissiong. Menopause in the workplace: Guidance for employers | EHRC. February 22, 2024. Accessed September 11. 2025. https://www.equalityhumanrights.com/guidance/menopause-workplace-guidance-employers Taylor S, Callahan B, Grant J, Islam RM, Davis SR. Menopause and work performance: a systematic review of observational studies. Menopause N Y N. 2025;32(8):769–78. Chen Q. Cognition, help-Seeking, and adherence behaviors in patients with perimenopausal syndrome: a latent profile analysis. 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Labour and Welfare Guidelines on measures that employers should take to properly handle information regarding the mental and physical condition of workers will be published. September 07, 2018. Accessed September 10, 2025. https://www.mhlw.go.jp/stf/newpage_01170.html Otsuka Pharmaceutical. Women's Health Promotion Project. September 30. 2022. Accessed September 10, 2025. https://www.otsuka.co.jp/woman_healthcare_project/ Cao J, Xu L, Xu YF. Menopausal Discourse in Web Media and Market Economy of the Transforming China. J Shaanxi Normal Univ (Philosophy Social Sci Edition). 2015;(3):144–52. The Lancet. Time for a balanced conversation about menopause. Lancet. 2024;403(10430):877. Zhao D, Liu C, Feng X, Hou F, Xu X, Li P. Menopausal symptoms in different substages of perimenopause and their relationships with social support and resilience. Menopause (New York). 2019;26(3):233–9. Ryan S, Charter R, Ussher J, Perich T, Power R, Sperring S. Navigating Menopause at Work: A Rapid Review and Narrative Synthesis of Psycho-Educational and Behavioral Interventions to Support Menopausal Women in the Workplace. Womens Reprod Health . Published online May. 2025;6:1–19. Adelekan-Kamara Y, Asunramu MH, Bhullar K, et al. Factors underpinning an improved menopausal experience in the workplace for doctors: a UK-based qualitative study. BMJ Open. 2023;13(3):e060265. Kling JM, MacLaughlin KL, Schnatz PF et al. Menopause Management Knowledge in Postgraduate Family Medicine, Internal Medicine, and Obstetrics and Gynecology Residents: A Cross-Sectional Survey. Mayo Clin Proc . 2019;94(2):242–253. Mao ZS, Zong ZH, Shu XY et al. Comparative study on perimenopausal statuses of rural women in the east, central, and west areas of China. Maternal Child Health Care China. 2015;(17 vo 30):2799–801. Cronin C, Bidwell G, Carey J, et al. Exploring digital interventions to facilitate coping and discomfort for nurses experiencing the menopause in the workplace: An international qualitative study. J Adv Nurs. 2023;79(10):3760–75. Zeng ML, Ding W, Zhang ZY, et al. Research progress of Triangle model in transitional care. Nurs Pract Res. 2023;20(17):2604–9. Tables Table 1 Demographic information and mKI scores of participants (n=12) Serial number Age Level of education Living conditions Working status Occupation mKI score Severity H1 45 Master's degree Spouse Be on the job University teacher 16 Moderate H2 45 Junior college Spouse Be on the job Customer Service Staff 22 Moderate H3 55 Primary school Spouse, second-generation children Retirement Without 47 severe H4 50 junior high Spouse Retirement Without 48 severe H5 47 Junior college Spouse, generation of children Be on the job Finance staff 31 severe H6 45 Regular college course Spouse, generation of children Be on the job Administrative clerk 33 severe H7 50 Primary school Spouse Long-term leave Cleaning staff 52 severe H8 50 Regular college course Spouse Be on the job Finance staff 33 severe H9 47 Junior college Spouse, generation of children Be on the job Property Manager 20 Moderate H10 46 Regular college course Spouse, generation of children Be on the job Freelancing 18 Moderate H11 50 Junior college Spouse, generation of children Retirement Without 39 severe H12 49 Junior college Spouse, generation of children Be on the job Government workers 16 Moderate Table 2 Themes and subthemes of illness experience and health management needs of patients with moderate to severe PMS in China SEM system Systematic implications Subject matter Subtheme microscopic system Seemingly separate individuals and their activities in a specific socio-ecological environment Cognitive Limitations and Reduced Coping Capacity Aging and confusion Self-regulation and health monitoring Delayed treatment Divergent expectations mesoscopic system Interrelationships between individuals and the various small-scale environments in which they participate, such as families, occupational groups, or other social groups Family Silence and Disappearing Workplace Care Ambiguous information dissemination Feeling of pain, isolation and helplessness Workplace neglect and gossip macroscopic system Large-scale environments that affect both micro-and meso-systems, including sociocultures, beliefs or values, social organizations or institutions Misaligned Healthcare Fleeting communication Absence of health promotion role Enhancing management plan specificity and systemization Additional Declarations No competing interests reported. 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Syndrome","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMenopause Syndrome (MPS) constitutes a cluster of complex symptoms prevalent among perimenopausal women. Statistical data indicate that the incidence of MPS in perimenopausal women in China approximates 61%\u003csup\u003e1\u003c/sup\u003e. As age advances, the symptoms experienced by MPS patients tend to escalate, and the condition becomes more severe\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Notably, patients with moderate to severe MPS frequently encounter multiple symptoms concurrently\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. The likelihood of \"physical and mental illness\" is elevated compared to those with mild\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, with the co-occurrence of dual symptoms reaching up to 80%\u003csup\u003e5\u0026ndash;7\u003c/sup\u003e. Of greater concern is that MPS not only impairs the quality of life for patients but also heightens the risk of cardiovascular events and mortality, which ranges from approximately 2% to 11%\u003csup\u003e8\u003c/sup\u003e. The risk of patients with moderate to severe MPS developing chronic conditions such as hypertension and diabetes is estimated to be between 22% and 40.1%\u003csup\u003e9,10\u003c/sup\u003e, thereby imposing a significant burden on patients' families, society, and healthcare systems.\u003c/p\u003e\u003cp\u003eFor an extended period, Menopause Syndrome (MPS) has been heavily stigmatized, often associated with negative and derogatory connotations. This adverse social and cultural public opinion climate has exacerbated the psychological stress experienced by patients, prompting some women to attempt to rationalize their experiences and the discomfort induced by MPS through shame and stigma\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Such attitudes have impeded MPS patients' willingness to seek medical assistance.\u003c/p\u003e\u003cp\u003eIn certain regions of China, Menopause Syndrome (MPS) is viewed as an ill-fated and sinful condition within family culture\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Consequently, some afflicted MPS patients have endured prolonged mental humiliation from their spouses and children. This perception, to some extent, distorts the accurate understanding of MPS among perimenopausal women, undermining their sense of self-worth and self-identity. Moreover, it intensifies women's aversion towards MPS and perimenopause, thereby impacting the holistic health management of MPS. Dahlgren's\u003csup\u003e13\u003c/sup\u003e research has indicated that psychosocial stress, genitourinary symptoms, and advanced age are significantly correlated with the level of stigma experienced by MPS patients. This observation underscores the urgent need for comprehensive and targeted intervention strategies to enhance the quality of life for these women who suffer from both physical and psychological symptoms.\u003c/p\u003e\u003cp\u003eThe Social-Ecological Model (SEM) was proposed by Urie scholars\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, which delves into the intricate connection between behaviour and cognition with the individual's environment. Within this framework, individuals and their relatives, social networks or workplace colleagues, and social culture or social organizations constitute micro, meso, and macro systems respectively, thereby forming a unique social ecosystem for individuals\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Currently, SEM has been extensively applied in various fields such as violence prevention\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e, nutritional support\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, humanitarian assistance\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, and chronic disease prevention\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e, yielding positive social impacts.\u003c/p\u003e\u003cp\u003eBy leveraging this theory, it may facilitate an understanding of the interplay between patients with moderate to severe menopausal syndrome, their families, and society during their illness. It also aids in elevating societal awareness of MPS, rectifying misconceptions and prejudices, and concurrently offers a foundation for medical institutions to devise targeted management plans. However, the empirical evidence supporting this approach remains insufficient. In light of this, the present study investigates the authentic illness experiences and health management needs of MPS patients through the lens of SEM theory, aiming to provide a reference for the subsequent formulation of relevant health management plans.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe phenomenological research method was used in in-depth semi-structured interviews. Adopting the slogan of \"returning to things themselves,\" this method seeks to unveil the meaning of transcendental experiences and subsequently elucidate the nature of phenomena\u003csup\u003e20\u003c/sup\u003e. It holds significant value in delving into the essence of specific groups or intricate and complex phenomena, as well as the sentiments of individuals within them. Consequently, selecting this approach aids researchers in concentrating on the authentic illness experiences of patients with moderate to severe MPS and in meticulously exploring their needs for health management strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePurposive sampling method was used to obtain heterogeneous sample for exploring the experiences of patients with moderate to severe MPS and their needs for health management strategies. From April to June 2024, patients with moderate to severe MPS in gynaecological outpatient clinics of 2 public medical institutions in Guangzhou were selected for semi-structured interviews. Inclusion criteria: (1) Those who were diagnosed as \"menopausal syndrome\" by medical examination; (2) Those whose medical records complain that contain both physical symptoms and psychological symptoms of MPS; (3) Women aged 45 to 55 years; (4) Modified Kupperman Index (mKI) ≥ 16 points; (5) Those who have clear consciousness and can express and answer questions correctly; (6) Be informed about this study and voluntarily consent to participants. Exclusion criteria: (1) People with severe physical diseases or mental disorders (such as patients with advanced malignant tumours, mania, etc.); (2) People with severe hearing impairment. The mKI was used to evaluate MPS severity: 0-6 scores were normal, 7-15 scores were mild, 16-30 scores were moderate, and ≥ 31 scores were severe\u0026nbsp;\u003csup\u003e21\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe sample size for the study is determined by the saturation of interview data and content, with no new topics emerging upon the addition of new interviewees or interview materials\u003csup\u003e22\u003c/sup\u003e. Ultimately, 12 patients aged between 45 and 55 years with moderate to severe MPS (5 moderate and 7 severe) were included. The majority of respondents were currently employed (n = 8), and co-residents primarily consisted of husbands and children (n = 6). The KI score results varied from 16 to 52 points (Table 1). In adherence to the principle of study confidentiality, the real names of respondents will be replaced with case numbers H1 to H12.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received approval from the Ethics Committee of Guangdong Provincial Hospital of Traditional Chinese Medicine (ZE2024-038-01). The ethical protocol ensures the confidentiality of the research design and the interviewee's right to freely decline the interview or halt it at any point. All interviewees included in the scope of text analysis had provided informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the SEM theory, the interview outline for this study was devised. A nursing professor and a medical professor reviewed the interview outline and provided suggestions for revision. Two patients with menopausal syndrome who met the research criteria were selected for pre-interviews, and the outline was adjusted according to the interview results and the feedback from the interviewees. Ultimately, an interview outline comprising the following questions was established (Supplement file).\u003c/p\u003e\n\u003cp\u003eThe study employed semi-structured interviews, conducted by two female graduate nursing students who served as interviewers and recorders, respectively, within a quiet, private consultation room or lounge. Prior to the interview, the interviewer established rapport by inquiring about the interviewee's recent living circumstances, subsequently introducing the research objectives and the necessity for recording. Upon obtaining informed consent and executing the consent form, the interview commenced, with each session lasting between 19 to 38 minutes. To thoroughly explore the content of the interview outline, the researcher adeptly adjusted the questioning method and sequence, providing timely responses and confirmations to the patient's perspectives, and delving into topics of research value. The recorder meticulously documented the interviewee's distinctive intonation, micro-expressions, and bodily movements. Should the respondent exhibit avoidance or aversion towards a particular question, the researcher would either bypass the question or conclude the interview.\u003c/p\u003e\n\u003cp\u003eGeneral data pertaining to the participants (age, educational background, co-occupant, work status, occupation, mKI score, MPS severity, etc.) were collected post-interview to minimize interference with the interview process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing each interview, the researcher responsible for questioning transcribed the recorded materials into textual form within 24 hours and subsequently provided feedback to the interviewees. Utilizing QRS Nvivo 12 pro software, two researchers applied Colaizzi's 7-step analysis method to conduct immersive reading and coding analysis of the transcribed materials: (1) Familiarization with the data; (2) Disjunctive statement; (3) Content coding; (4) Gathering of views; (5) Detailed description; (6) Discrimination and analysis of viewpoints; (7) Verification of the structure. Upon completion of each transcription, the entire study team reviewed the content for fluency and accuracy.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThrough the analysis and synthesis of the interview data, in conjunction with the SEM model, the following three themes and ten sub-themes (Table 2) were extracted. These themes collectively encapsulate the illness experiences of patients with moderate to severe MPS and delineate the genuine and specific requirements for perimenopausal health management strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCognitive\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eL\u003c/strong\u003e\u003cstrong\u003eimitations and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eReduced\u003c/strong\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003cstrong\u003eoping\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCapacity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 1: aging and confusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe cognition of menopausal syndrome in patients with moderate to severe MPS is relatively shallow. Under the general trouble of menstrual disorders, mood disorders, sleep disorders and other symptoms, its body image is characterized by aging, such as \"irritability\" and \"no longer beautiful\", rather than chronic diseases. Some patients think that MPS is a normal change in the perimenopausal stage, but it is customary to use the word \"menopause\" to obscure menopausal syndrome. \u003cem\u003e\"So, the skin starts to dry out and we lose collagen. Plus, our memory goes downhill. Some of my colleagues had a bit of a period in their forties and they said it was better to end it sooner. Because we're so busy with work and we've got kids anyway, there's no point in worrying too much about these things\"\u003c/em\u003e\u003cem\u003e\u0026nbsp;(\u003c/em\u003e\u003cem\u003eH1\u003c/em\u003e\u003cem\u003e);\u0026nbsp;\u003c/em\u003e\u003cem\u003e\"I don't see it as a disease. I think it's just a phase people go through after they hit their forties. You can't stay beautiful forever. Each age has its own charm. The key is to accept it and understand it\"\u003c/em\u003e\u003cem\u003e(H6)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSimultaneously, patients with moderate to severe MPS frequently experience nonspecific symptoms such as bone and joint pain and paroxysmal palpitations, yet they are perplexed and unable to comprehend the manifestation of these symptoms. Additionally, most\u0026nbsp;participants\u0026nbsp;exhibit limitations and misconceptions regarding the normal age of menopause. Some even hold the belief that \"the later the menopausal event occurs, the better\" and \"it is ideal to menstruate until old age.\" \u003cem\u003e\"\u003c/em\u003e\u003cem\u003eI really feel that i\u003c/em\u003e\u003cem\u003et doesn't feel normal to me\u003c/em\u003e\u003cem\u003e!\u003c/em\u003e\u003cem\u003e\u0026nbsp;I even asked my friend yesterday. She's still having periods at 50 and she also has insomnia, but she doesn't have my palpitations. Some people think it's normal. They say menopause is just like that, but I feel like something's not right, don't you think? How can palpitations be normal? I'm not just flustered, I'm the kind of scared that feels like I'm in danger\"\u0026nbsp;\u003c/em\u003e\u003cem\u003e(\u003c/em\u003e\u003cem\u003eH5\u003c/em\u003e\u003cem\u003e);\u0026nbsp;\u003c/em\u003e\u003cem\u003e\"\u003c/em\u003e\u003cem\u003eI’m going crazy\u003c/em\u003e\u003cem\u003e, I can't sleep at all, and I've got joint pain. My feet feel weak and my knees hurt, but I don't think these should count, right? It's like I've had this before\"\u003c/em\u003e\u003cem\u003e\u0026nbsp;(\u003c/em\u003e\u003cem\u003eH2\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 2: self-regulation and health monitoring\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSelf-regulation by most patients with moderate to severe MPS is pivotal in the management of MPS health. As stated, following:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"I reckon personal adjustments are key. If you're feeling down, you might start noticing all sorts of niggles. And mentally, you need to give yourself a nudge, face up to it, and tweak things. Realize that even docs can only do so much to help\" (H6); \"Honestly, I would say that women in their 30s should start getting clued up. Maybe if you prepare early, you won't freak out so much later. Everyone's symptoms are unique, so it's wise to know what's coming\"\u003c/em\u003e (\u003cem\u003eH5)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMPS patients perceive that participation in a systematic health management program can motivate them to pay greater attention to MPS and other health issues. As in the following narrative: \u003cem\u003e“I'm cool with that. I can keep tabs on it yearly, and I've got it covered in my mind” (H12);\u0026nbsp;\u003c/em\u003eOther participant emphasized furtherly: \u003cem\u003e“I'm all for proper health management for menopause. If there's a thorough, tiered approach, it can really help us figure out what's going on and what we need” (H5)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 3: delayed treatment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants with moderate to severe MPS often encounter a prolonged waiting and hesitation period during the process of seeking medical treatment, and the delay in seeking medical attention is pronounced, which may be one of the significant factors contributing to the exacerbation of their symptoms. \u003cem\u003e\"I'm really snappy. Sometimes, I just don't know what to do. I'm clueless when it comes to picking a doctor. At night, I can't get comfy, my leg's all over the place. Even when I pinch it, I still don't bother seeing a doctor\" (H3); \"I wanted to get checked out earlier, but work got in the way. I'd been meaning to get help for ages, but my job kept pushing it back. The everyday hassles just kept piling up, so I finally had to head to the hospital for insomnia and others\" (H5)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAdditionally, one patient was readily influenced by the ambiguous and indifferent attitudes of family members during her hesitation period of seeking medical treatment. She tended to default to the belief that MPS is not associated with health threats, thereby neglecting her own discomfort symptoms: \u003cem\u003e\"I didn't think about going to the hospital back then. I told my husband about the dryness and bleeding, and he brushed it off. He said I could just pop into the clinic for a quick check, and it wouldn't kill me… After I took the meds and seemed to have nothing wrong, I just let it slide and never went back to the gynaecologist\" (H7)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 4: divergent expectations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the unclear risks associated with menopausal hormone therapy and the varying personal expectations of treatment outcomes, participants tended to favour non-hormonal treatments or guidance on healthy lifestyles in their subjective preferences when making treatment decisions. \u003cem\u003e\"If I used hormones, I might think more about it. I might think: Why use hormones? What do you want? Because I think what kind of condition do you want me to recover from with hormones?\u003c/em\u003e\u003cem\u003e\u0026nbsp;Well...To my mind,\u003c/em\u003e\u003cem\u003e\u0026nbsp;I'm not too eager to fully recover.\"\u003c/em\u003e\u003cem\u003e\u0026nbsp;(\u003c/em\u003e\u003cem\u003eH6\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2: Family Silence and Disappearing Workplace Care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 1: ambiguous information dissemination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBecause menopausal syndrome is closely linked to female reproductive function and organs, the primary sources of health information for participants are female relatives and friends. During the exchange of information, patients and their relatives and friends often harbour feelings of shame and taboo regarding MPS, which casts an ambiguous and vague hue over the dissemination of MPS health information.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"My husband's sister\u003c/em\u003e\u003cem\u003e\u0026nbsp;was\u003c/em\u003e\u003cem\u003e\u0026nbsp;anxious, and this happened to her at that time\u003c/em\u003e\u003cem\u003e…\u0026nbsp;\u003c/em\u003e\u003cem\u003eI also accompanied her here to see a doctor, but a few years ago, my body didn't have these conditions at all, and I didn't understand (her) situation\u003c/em\u003e\u003cem\u003e…\u003c/em\u003e\u003cem\u003e\u0026nbsp;I also have a friend who also had these situations. She also told me that she was very serious and even depressed. She said that she actually didn't know how to be anxious. We were all confused\u0026nbsp;\u003c/em\u003e\u003cem\u003ewhy we\u003c/em\u003e\u003cem\u003e\u0026nbsp;get it?\"\u003c/em\u003e\u003cem\u003e\u0026nbsp;(\u003c/em\u003e\u003cem\u003eH5\u003c/em\u003e\u003cem\u003e);\u003c/em\u003e\u003cem\u003e\u0026nbsp;\"\u0026nbsp;\u003c/em\u003e\u003cem\u003eThere is no one to say in my hometown. I quietly asked my sister-in-law two years ago, and asked her what the process of menstruation was like. She said it was gone a little bit, a little bit anyway. Didn't say anything to me.\"\u003c/em\u003e\u003cem\u003e\u0026nbsp;(\u003c/em\u003e\u003cem\u003eH7\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 2: feeling of pain, isolation and helplessness\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients interviewed considered both MPS and perimenopausal changes to be \"private\" and should not be discussed with others: \u003cem\u003e\"It's all about self-adjustment, because I consider these personal issues, and I don't want to or dare to tell others.\" (H2).\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne interviewee exhibited significant emotional fluctuations upon hearing questions about family members' care for her. Despite her outward expression of indifference, her suddenly raised tone and faster speech conveyed the anguish of feeling ununderstood and uncared for: \u003cem\u003e\"I don't need to talk to others, just adjust it myself. Deal with your own affairs. These problems have nothing to do with your family, so you don't need to increase the burden on others.\" (H10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSimultaneously, some interviewees felt they greatly lacked the attention and companionship of their partners, and their inner distress sought an outlet, leading to a mix of \"demands\" and \"expectations.\" One participant sighed helplessly while sharing: \u003cem\u003e\"Well, he simply advised me to rest more… If I expect him to be considerate, it might tire him out. It's good to care, but you can't ask for too much…\" (H12)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother clearly emphasized that the family care she received was insufficient to compensate for the trauma she experienced in family life, causing her psychological emptiness during the transition period to become more pronounced: \u003cem\u003e\"Honestly, not enough… Officially, due to the lack of family support or the influence of my childhood family environment, my slight depression is influenced by my family of origin. Therefore, after entering menopause, this feeling is even stronger. I think no one would deny that coupled with some private and unspeakable secrets, I can't talk to my husband, it just only make me more depressed and anxious.\" (H4)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 3: workplace neglect and gossip\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCurrently, within China's workplace environment and social and cultural context, our participants still do not receive sufficient attention, understanding, and empathy. A teacher working at a medical university shared her sentiments with us: \u003cem\u003e\"\u003c/em\u003e \u003cem\u003eEven though we work in a medical university, where you'd think it would be relatively easy to access this information, menopausal syndrome doesn't seem to be specifically highlighted for public awareness. I feel that the care for women in society now only remains at a relatively broad level. Perimenopause isn't regarded as an important and special period like pregnancy and childbirth, and we don't feel much attention.\" (H1)\u003c/em\u003e Another interviewee's perspective echoes this sentiment: \u003cem\u003e\"\u003c/em\u003e \u003cem\u003eI would like to point out that the workplace, unless it's a particularly supportive one, otherwise I don't believe it pays much attention to menopausal syndrome, and the workplace might not give much thought to us during this period. Well, that’s true.\" (H2)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFurthermore, the public's prejudice and stigma towards menopausal syndrome have resulted in significant public opinion pressure on patients with moderate to severe MPS in the workplace. \u003cem\u003e\"\u003c/em\u003e \u003cem\u003eIt's less acknowledged. Seriously, society pays less attention and understanding to this stage. Moreover, I feel a kind of pressure, fearing that my colleagues and superiors will think I have something wrong all over, and I'm unsure what others might think of me or gossip about. Then I suppress myself, become very irritable, and worry that others will think I have… a terminal illness.\" (H5)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3: Misaligned Healthcare\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 1: fleeting communication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the scarcity of medical resources and the high volume of patients, the medical atmosphere is characterized by tension and urgency during the diagnosis and treatment process. This environment prevents patients from engaging in in-depth communication with their attending physicians about their condition and personal health concerns, thereby exacerbating negative emotions such as \"helplessness\" and \"hesitation\" among patients with moderate to severe MPS. The following voices of several interviewees reflect this reality:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"The doctor doesn't pay enough attention to us, yet… They're always in a rush. They just ask what the issue is, then write out a prescription. Oh dear, it feels very assembly-line.\" (H8)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"\u003c/em\u003e \u003cem\u003eThe community doctor just tells me what to watch out for, and that's it. If there's any treatment (discussion), they don't go into specifics. Yes, the doctor didn't elaborate.\" (H5)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"\u003c/em\u003e \u003cem\u003eHow can the doctor find the time to listen to you and explain it in detail? Let alone, they've already written out a prescription. Can I even stay in the consulting room? Sometimes I really feel helpless, really.\" (H3)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 2: absence of health promotion role\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOwing to the insufficient transparency and openness of current publicity methods employed by medical institutions, participants reported difficulties in fully accessing professional health information. Among the existing social health service initiatives, perimenopausal women and MPS patients are infrequently targeted for intervention.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"The current health lectures in the community mainly target older people, and there are no specific projects for menopausal health or specialist clinics. It feels like no one has the time to support us. Maybe it would be hopeful to focus on this in the future.\" (H2);\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"\u003c/em\u003e\u003cem\u003eWell, I would say,\u0026nbsp;\u003c/em\u003e\u003cem\u003eif the hospital had those promotional materials, I would definitely take them, but I don\u003c/em\u003e\u003cem\u003e’\u003c/em\u003e\u003cem\u003et know where to find them. Nobody knows, I guess.\" (H7);\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"\u003c/em\u003e \u003cem\u003eIt seems to me that free clinics or consultations on menopausal syndrome are quite rare, and the information provided by hospitals is not clear or complete enough. Often, we don\u003c/em\u003e\u003cem\u003e’\u003c/em\u003e\u003cem\u003et even know these activities exist.\" (H12)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis lack of focus contributes to the challenges faced by moderate to severe MPS patients who are aware of the need for medical treatment but struggle to obtain primary healthcare services and effective referrals. Consequently, this situation has become a significant contributing factor to the delays in the medical treatment of MPS patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 3: enhancing management plan specificity and systemization\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants in the interviews indicated that the current management measures implemented by medical staff are overly structured and universal, lacking the necessary flexibility and adaptability. These measures do not adequately consider the unique circumstances and individual differences within specific management dimensions, which adversely affects patients' willingness and compliance with health management intervention strategies: \u003cem\u003e\"If you ask me, after I realised that her advice was not specific, I lost interest in it. The focus needs to be improved… When seeing a doctor, I expect a professional medical plan that includes exercise, diet recommendations or something else. It would be helpful if the doctor could specify what we can and cannot eat, providing more detailed and targeted guidance\" (H1); \"The way I see it, doctors ought to take the initiative to offer advice, instead of we ask for it.\" (H2)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eGiven that the symptoms of Menopause Syndrome (MPS) involve multiple physiological systems, purely structured health education may fail to account for the overall health status of MPS patients. Those with moderate to severe MPS report a need to understand their current disease risk levels. It is essential for medical staff to develop transitional management plans for perimenopause based on risk assessment results, with a greater emphasis on mental health management.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"I think it is still necessary to carry out an overall management, breaking down specific symptoms and addressing them based on their severity. Serious and mild symptoms require different management approaches, right?\" (H5)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant also emphasized that: \u003cem\u003e\"Personally, if further improvement is needed, I think it would be beneficial to incorporate psychological assessments, similar to offering psychological counselling. Psychological support and guidance from you are very important for those of us experiencing emotional issues. Thank you.\" (H6)\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThrough 12 in-depth conversations with patients suffering from moderate to severe Menopause Syndrome, it has been observed that cultural or value-based constraints, such as \"menstrual shame,\" \"menopausal shame,\" and \"age shame,\" significantly impact their emotional state.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe global incidence of MPS has been on the rise in recent years, gradually emerging as a significant public health issue\u003csup\u003e23–25\u003c/sup\u003e. Due to its complex pathogenesis and diverse clinical manifestations, MPS often leads to chronic conditions characterized by \"physical and mental comorbidity.\" From the menopausal transition period, it is necessary to carry out a comprehensive and scientific health risk assessment for menopausal women and timely adjust their chronic disease management strategies\u003csup\u003e26\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAlthough the \"Chinese Women's Development Program (2021-2030)\"\u003csup\u003e27\u003c/sup\u003e published in recent years mentioned that the main goals of women's health construction include: women enjoy good health services throughout their life cycle. However, in reality, the maternal and child policy in China has actually focused on \"maternal and child health care\" for a long time\u003csup\u003e28\u003c/sup\u003e, and the health needs of perimenopausal health care and people with menopausal syndrome are far from being fully paid attention to and met. Because the symptoms of patients with moderate to severe PMS are relatively prominent and complex, such patients have richer needs for health management and strong demands for health management solutions, so it is particularly urgent to solve their health management needs..\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eEmpowering management enhances the self-coping ability of patients with moderate to severe PMS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study found that the disease cognition of patients with moderate to severe MPS can be classified into two categories: \"natural state\" and \"disease state.\" Changes in menstrual rhythm, duration, and characteristics are typical manifestations of MPS; however, individual differences and the association between symptoms and \"aging\" can easily induce negative emotions in patients\u003csup\u003e29\u003c/sup\u003e. Although these women demonstrated a strong willingness for self-management, their effective coping strategies were limited due to various factors related to their symptoms. This was particularly evident in their disease awareness, access to health information, and efforts to seek medical support.\u003c/p\u003e\n\u003cp\u003eIn the present study, patients with moderate-to-severe PMS were primarily concerned about the effects of symptoms on health and work performance. In a guideline recommendation published in recent years by the Equality and Human Rights Commission\u003csup\u003e30\u003c/sup\u003e, employers are poorly reminded that if symptoms of menopausal syndrome in perimenopausal women interfere with daily activities in the workplace, they can be regarded as disabling. This vague and unscientific policy definition may further aggravate the age discrimination and stigma faced by middle-aged women in the future. However, in fact, according to the systematic review study report of Taylor et al.\u003csup\u003e31\u003c/sup\u003e, menopausal status alone is not necessarily related to women's individual work results, and even if there are adverse effects, the effects are likely to be confused by other factors that interfere with middle-aged women's work ability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eMake full use of family support system and texture social support system for patients with moderate to severe PMS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study also identified significant shortcomings in family support, work environments, and socio-cultural understanding among patients experiencing moderate to severe Menopause Syndrome (MPS). The finding following is slightly different to Chen's perspective\u003csup\u003e32\u003c/sup\u003e, some respondents in this study delayed seeking medical treatment due to a lack of initiative, while others were influenced by inadequate family support or socio-cultural values, which suppressed their willingness to pursue medical attention. Socio-cultural prejudices against menstruation and perimenopause may, to some extent, restrict patients' ability to openly discuss symptoms and access information support\u003csup\u003e12\u003c/sup\u003e. A similar view has been empirically verified in the project of Borzu et al. [21]. According to research, compared with Portuguese women, Iranian women have a stronger perception of menopause, and it may be closely related to cultural background, social support level and other factors.\u003c/p\u003e\n\u003cp\u003eNotably, patients with MPS continue to shoulder multiple social roles and bear responsibilities during perimenopause, facing pressures from work, childcare, and eldercare\u003csup\u003e33\u003c/sup\u003e. If the cultural constraints that bind perimenopausal women are not dismantled over time, this may further diminish their courage to express their true feelings in family and workplace settings\u003csup\u003e34\u003c/sup\u003e. Emotional support for patients with moderate to severe MPS was primarily obtained from same-sex relatives or close friends, with children and male relatives, excluding husbands, rarely present during interviews. Additionally, discussions seldom addressed sexual dysfunction, genitourinary syndrome, and other symptoms directly related to reproductive health that are indicative of quality of life\u003csup\u003e35\u003c/sup\u003e. Furtherly, it was observed that the interviewees typically attended medical appointments alone, including women who were retired or on long-term leave. This may reflect a lack of adequate family or social support for patients with moderate to severe Menopause Syndrome from another perspective.\u003c/p\u003e\n\u003cp\u003eBecause women with menopausal syndrome in perimenopause are at the intersection of \"aging\" and \"feminine\" identities that are stigmatized to some extent, whether discussing perimenopause or menopausal syndrome, they will violate these two cultural \"taboos\" at the same time. At the same time, the above findings also show that perimenopausal health information is cleverly \"avoided\" in the process of public media dissemination due to the structural bias of gender and internalized narrative framework. This is very similar to the stigma and avoidance mechanisms of another common social prejudice problem among women-menstrual shame\u003csup\u003e36\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eCompared with previous interviews with patients with menopausal syndrome, patients with moderate to severe menopausal syndrome in this study rarely but accurately indicate that in the current working environment, the age of perimenopause is an important factor that affects their access to adequate workplace support. In addition, at present, China, like some other countries in the world, has no national-level \"menopausal vacation\" legislation as a form of care for patients with menopausal syndrome, and related discussions still mostly stay on the introduction and proposal of foreign experience\u003csup\u003e37\u003c/sup\u003e. In contrast, in Japan, which is also a cultural and economic circle in East Asia, its Ministry of Health, Labour and Welfare requires enterprises to provide necessary care and support conditions for female employees facing health problems such as menstruation and perimenopause at the legislative level\u003csup\u003e38\u003c/sup\u003e, which provides a possible legal basis for women to enjoy menopausal vacation, and helps to guide social enterprises to implement a specific system of providing specific vacation for female employees\u003csup\u003e39\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIn addition, jumping out of the medical field, Cao\u003csup\u003e40\u003c/sup\u003e and his team, when China is facing the transformation of market economy, cut in from the perspective of the vigorous development of new media industry, revealing that the new media, driven by capital power, constructed the definition of perimenopause and the crisis of middle-aged women needed for the transformation of China's market economy with the help of the strategy of \"medical authority\", thus strengthening the gender order that belittles and discriminates against middle-aged women. This negative impact continues to this day, and it also exists in other countries or regions\u003csup\u003e41\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIn view of this, we must admit that improving the social support system for patients with moderate to severe Menopause Syndrome relies on the collaborative efforts of medical and health institutions, media, and social organisations. These entities should provide relevant, accessible, and effective information while break the stereotypes of menopause and PMS in society. concept and long-standing gender bias..\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe intergenerational family relationship is closely linked to the severity of MPS and the quality of life of affected individuals\u003csup\u003e42\u003c/sup\u003e. Clinical doctors, particularly community general practitioners and working in perimenopausal specialties, should actively engage family support for patients with moderate to severe MPS and fulfil their professional roles in effectively disseminating accurate information about the condition. Furthermore, workplaces should foster a cultural atmosphere that values and respects women, recognising the significance of their contributions, jointly set up a multi-level workplace strategy\u003csup\u003e43\u003c/sup\u003e,\u0026nbsp;and establish comprehensive care systems for perimenopausal women to enhance their professional satisfaction and success. In addition, social organizations and institutions should strengthen the overall level of social support for patients with menopausal syndrome from the legislative level, which will play an important role in promoting the well-being of menopausal women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Promote the improvement of health management plans for patients with moderate to severe PMS and improve the pertinence of management measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA key factor contributing to the stigma associated with menopausal syndrome is the inadequate information support provided by medical staff, which results in the neglect of symptoms in patients with moderate to severe Menopause Syndrome and their inability to access sufficient health management measures\u003csup\u003e44\u003c/sup\u003e. This, in turn, exacerbates patients' misconceptions regarding menopausal hormone therapy and fosters negative attitudes towards menopausal syndrome\u003csup\u003e41\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, patients with moderate to severe MPS generally reported that current health management protocols lacked relevance and had limited practical significance. In a survey of perimenopausal management knowledge of residents in the United States led by Kling et al.\u003csup\u003e45\u003c/sup\u003e, it was reported that about one fifth of doctors had zero exposure to menopause-related lectures during the study stage, and even more regrettably, less than 7% of residents believed that they could adequately manage perimenopausal women. This may indicate that globally, the medical education environment pays insufficient attention to patients with menopausal syndrome.\u003c/p\u003e\n\u003cp\u003eIn order to help patients successfully survive perimenopause and improve their quality of life, general practitioners and specialist medical staff should guide patients to understand the timing and necessity of PMS intervention, and pay attention to patients' willingness and expectation for treatment. In psychological counseling, medical staff can reduce the burden of patients' \"menopausal shame\" from the perspective of empowerment, promote the development of their correct self-image, enhance their self-management ability, and make informed and personalized health decisions.\u003c/p\u003e\n\u003cp\u003eIn addition, the promotion of the establishment of perimenopausal or menopausal specialist outpatient clinics is proposed, alongside the enhancement of training for general practitioners at the grassroots level and the facilitation of referral linkages and health management interactions between community health institutions and higher-level medical facilities\u003csup\u003e46\u003c/sup\u003e. These measures aim to ensure continuous care and long-term health management for patients.\u003c/p\u003e\n\u003cp\u003eIn the information age, digital interventions can effectively address deficiencies in time, space, and interactive experiences inherent in real-life settings\u003csup\u003e47\u003c/sup\u003e. Leaders of medical and health institutions may consider utilising digital information technology to construct a health forum or management applet specifically for menopausal syndrome, or to develop management programmes suitable for wearable devices, serving as auxiliary tools for the linkage between community hospitals and superior medical institutions. Simultaneously, this approach can integrate health management models such as \"triangle hierarchical management\"\u003csup\u003e48\u003c/sup\u003e, taking into account the supply capacity and needs of both managers and patients, thereby enriching and improving the structure of MPS health management schemes and enhancing patients' quality of life and self-management abilities. Additionally, scientific researchers should consider developing and implementing MPS screening and risk assessment guidelines, utilising risk stratification results to provide a foundation for formulating targeted management plans for patients with moderate to severe MPS.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTo sum up, the health management for patients with moderate to severe Menopause Syndrome in China currently faces several challenges, including limited self-awareness, inadequate family support, socio-cultural prejudices, and insufficient professional medical assistance. This study pointed out that in order to avoid further stigma of perimenopause and menopausal syndrome, and solve the current support dilemma of this group, it is necessary to promote estrogen medication through popular science, improve the two-way referral system and develop health management plans to support personalized decision-making, etc. Measures to improve patients' quality of life and service quality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengthen, limitations and perspectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study conducted in-depth interviews with patients with moderate to severe menopausal syndrome who were obviously troubled, and analysed the difficulties faced by patients with moderate to severe menopausal syndrome in different life scenarios from the level of self, family, social and professional resources from shallow to deep with the help of the social ecosystem framework, and highlighted the prominent needs of this group for workplace support and personalized medical decision-making. In addition, this study also crosses the medical theoretical framework, tries to analyse the key potential factors of the current predicament faced by patients with moderate to severe menopausal syndrome from the aspects of media communication and legislation, and puts forward corresponding intervention and improvement suggestions, in order to seek long-term well-being for patients with moderate to severe menopausal syndrome.\u003c/p\u003e\n\u003cp\u003eLimitations of this study include the focus on urban samples; future research should expand the scope to include diverse populations and incorporate cross-sectional studies to better explore the quality of life and health management of patients with moderate to severe MPS, thereby providing a more comprehensive understanding of their circumstances and underlying causes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our heartfelt gratitude to the 12 patients with moderate to severe menopausal syndrome who participated in the interviews, sharing their experiences, challenges, and aspirations for a healthy life. We also thank the clinical nurses who assisted in collecting patient information and recruiting participants for the study. This research reflects the collective efforts of all involved, and we sincerely appreciate everyone’ s contributions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor’s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYQQ and HQH were responsible for the conception and design of the article. YQQ, ZZJ, and HQH conducted the feasibility analysis. YQQ, SL, and ZKF contributed to the writing and revision of the paper. Data collection, collation, and result analysis were carried out by YQQ, ZZJ, and WXD. HQH oversaw quality control and proofreading of the article and was responsible for the overall integrity of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the principle of scientific research confidentiality, we promised to keep participant’s information and data confidential, and the data used for this study will not be public, but available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was financially supported by Research Grant from the Guangdong Nurses Association (Grant No. gdshsxh2023ms20)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants assured that they were voluntary in the interview. After informing the perimenopause patients about the study and obtaining their informed consent, the researchers began the interview. The study protocol was in accordance with the ethical guidelines of the Declaration of Helsinki and was approved by the Institutional research board of Guangdong Provincial Hospital of Traditional Chinese Medicine (No. ZE2024-038-01).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJia J, Zhou ZT, Cao XH, et al. Incidence of perimenopausal syndrome in Chinese women aged 40 to 65 years: a meta-analysis. Chin Gen Pract. 2023;26(32):4080\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhao D, Feng XJ, Hou YF, et al. Menopausal syndrome associated with menopausal transition, neuroticism and mindfulness in rural middle-aged women in Shandong Province. 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Nurs Pract Res. 2023;20(17):2604\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 Demographic information and mKI scores of participants (n=12)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"111%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003eSerial number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eLevel of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eLiving conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eWorking status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003emKI score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eSeverity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eH1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eMaster\u0026apos;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eSpouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eBe on the job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eUniversity teacher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eH2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eSpouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eBe on the job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eCustomer Service Staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eH3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eSpouse, second-generation children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eRetirement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003esevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eH4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003ejunior high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eSpouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eRetirement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003esevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eH5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eSpouse, generation of children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eBe on the job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eFinance staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003esevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eH6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eRegular college course\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eSpouse, generation of children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eBe on the job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eAdministrative clerk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003esevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eH7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eSpouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eLong-term leave\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eCleaning staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003esevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eH8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eRegular college course\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eSpouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eBe on the job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eFinance staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003esevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eH9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eSpouse, generation of children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eBe on the job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eProperty Manager\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eH10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eRegular college course\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eSpouse, generation of children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eBe on the job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eFreelancing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eH11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eSpouse, generation of children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eRetirement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eWithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003esevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eH12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eSpouse, generation of children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eBe on the job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eGovernment workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 Themes and subthemes of illness experience and health management needs of patients with moderate to severe PMS in China\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"112%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eSEM system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003eSystematic implications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eSubject matter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eSubtheme\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003emicroscopic system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eSeemingly separate individuals and their activities in a specific socio-ecological environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eCognitive Limitations and Reduced Coping Capacity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eAging and confusion\u003c/p\u003e\n \u003cp\u003eSelf-regulation and health monitoring\u003c/p\u003e\n \u003cp\u003eDelayed treatment\u003c/p\u003e\n \u003cp\u003eDivergent expectations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003emesoscopic system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eInterrelationships between individuals and the various small-scale environments in which they participate, such as families, occupational groups, or other social groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eFamily Silence and Disappearing Workplace Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eAmbiguous information dissemination\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFeeling of pain, isolation and helplessness\u003c/p\u003e\n \u003cp\u003eWorkplace neglect and gossip\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003emacroscopic system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eLarge-scale environments that affect both micro-and meso-systems, including sociocultures, beliefs or values, social organizations or institutions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eMisaligned Healthcare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eFleeting communication Absence of health promotion role\u003c/p\u003e\n \u003cp\u003eEnhancing management plan specificity and systemization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Menopause syndrome, Experience of illness, Social-ecological theory, Hierarchical health management, Women's Health","lastPublishedDoi":"10.21203/rs.3.rs-7590310/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7590310/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePatients with moderate to severe menopausal syndrome often face significant physical and mental health challenges, yet their experiences are frequently overlooked in China. This study aims to explore the illness experiences and health management needs of these patients, focusing on their feelings, coping strategies, and demands for health services to address both physical and psychological symptoms, thereby promoting reforms in management programs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA phenomenological approach was employed, with an interview guide developed based on socio-ecological systems theory. Twelve patients with moderate to severe menopausal syndrome were selected through purposive sampling for semi-structured interviews. Data were analysed using Colaizzi's seven-step method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Twelve women participated this research. Three primary themes and ten subthemes were emerged: (1) micro- cognitive limitations and reduced coping capacity (aging and confusion, self-regulation and health monitoring, delayed treatment, and divergent expectations); (2) meso- family silence and disappearing workplace care (ambiguous information, feeling of pain, isolation and helplessness, and workplace neglect and gossip); and (3) macro- misaligned healthcare (fleeting communication, absence of health promotion role, and enhancing management plan specificity and systemization).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe study found that patients with moderate to severe menopausal syndrome possess strong self-management awareness; however, their coping abilities require enhancement, particularly for atypical symptoms such as palpitations and joint pain. Developing effective and targeted health management plans relies on collaboration among families, communities, media platforms, medical institutions, and healthcare professionals to provide comprehensive support for patients.\u003c/p\u003e","manuscriptTitle":"Navigating Support Dilemma: A Socio-Ecological Analysis of Health Management for Women in China Living with Moderate-to-Severe Menopausal Syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-22 14:38:40","doi":"10.21203/rs.3.rs-7590310/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"590c4b7b-ff6a-4b8f-afe9-8da0febcb8c3","owner":[],"postedDate":"October 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T08:24:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-22 14:38:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7590310","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7590310","identity":"rs-7590310","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}