Navigating Uncharted Waters: A Meta-Ethnography Exploring General Practitioners and Women’s Experience of Perimenopause Consultations in General Practice

Background: Perimenopause precedes menopause and can cause a wide range of symptoms for women. General Practitioners (GPs) are often the first point of contact for symptom management. Shifting societal attitudes to perimenopause have prompted more women to seek care within general practice, yet many report suboptimal support. Despite the increasing body of research on menopause care, the experiences of perimenopause consultations in general practice have yet to be conceptually synthesised. This qualitative evidence synthesis, therefore, aimed to explore the experiences and perceptions of women and General Practitioners regarding perimenopause consultations in general practice. Methods: We followed the methods of meta-ethnography as developed by Noblit and Hare and our reporting follows the eMERGE reporting guidance. Seven databases were systematically searched to identify studies detailing the experiences of women and GPs during perimenopause consultations. To evaluate confidence in the review findings, we employed the GRADE-CERQual approach. Results: was established as an overarching metaphor in a line of argument encompassing four main themes: (1) Adrift in the sea of perimenopause uncertainty, (2) Taking the helm: women's advocacy, agency, and negotiated power in perimenopause care, (3) Gendered dynamics: women's experiences and GP perspectives, (4) Navigating structural obstacles and fragmented care. Findings illustrate how pervasive both uncertainty and the ways in which power is negotiated within clinical encounters shape the quality, depth, and direction of perimenopause consultations. Findings highlight how imbalances in perceptions of knowledge and authority shape perimenopause consultations. Conclusion: This qualitative evidence synthesis highlights the tensions and challenges encountered by women and GPs as they navigate the uncertainties inherent in perimenopause care. The results underscore the importance of sensitive and empathetic communication, where normalisation is delivered with compassion, and uncertainty is acknowledged and conveyed transparently. Openly recognising these uncertainties helps manage expectations.