Women’s experiences with diagnosis and management of vaginal symptoms of menopause: a mixed-methods study

Vaginal symptoms associated with menopause affect around 50% of women. Although the multi-factorial impact of vaginal symptoms has been well explored, experience of management and treatment preferences are poorly understood. A mixed-methods study was conducted in Australia to explore patient attitudes and experience related to the recognition and management of vaginal symptoms associated with menopause. In part 1, symptomatic post-menopausal women were recruited from hospital clinics and by word-of-mouth. Semi-structured interviews were conducted, transcribed, and coded by two researchers independently using a reflexive thematic analysis guided by interpretative phenomenological approach. In part 2, a quantitative online survey investigating attitudes towards care-seeking and management of vaginal symptoms associated with menopause in symptomatic or previously symptomatic, peri- or post-menopausal women was conducted. This study provides the context for a separate DCE investigating patient treatment preferences for this condition. Data were collected from 7 semi-structured interview participants (February-September 2023) and 578 survey respondents (April-May 2024). We identified considerable variation in experience of vaginal symptoms between interview participants. Core themes were extracted from the semi-structured interviews: recognition and attitudes towards vaginal symptoms, impact of symptoms, healthcare experience, and treatment of vaginal symptoms. Although bothersome vaginal symptoms were reported by 194/349 (56%) respondents, they were less frequently reported as a respondent’s most bothersome symptom compared to other menopausal symptoms, ranked by respondents in their top three most bothersome symptoms by 83/349 (24%). Whilst 320/349 (92%) of symptomatic respondents were aware of treatments for vaginal symptoms associated with menopause, only 182/349 (52%) had tried any treatment, and 159/349 (46%) had presented to a health practitioner for this indication. There was no significant difference in rates of previous treatment or consultation with healthcare practitioner, whether vaginal symptoms were ranked in a respondent’s top three most bothersome symptoms or not. Impact and experience of vaginal symptoms associated with menopause is variable between individuals, necessitating personalised care. Relative bother of vaginal symptoms is not associated with rates of treatment or presentation to a healthcare practitioner for this condition and suggests other factors may influence engagement with care. Understanding patient preferences in management and treatment of vaginal symptoms associated with menopause is essential to guiding clinical practice and health funding in improving delivery of menopause care.