Menopause in low-resource settings: Challenges and practical solutions with special reference to Sri Lanka

With increasing female life expectancy, a substantial proportion of women in Sri Lanka now live several decades beyond menopause. Despite this demographic transition, menopausal health remains inadequately addressed within routine clinical practice, particularly in low-resource settings. Multiple challenges, including sociocultural perceptions, health system limitations, restricted access to hormone replacement therapy (HRT), and limited clinician training, contribute to suboptimal care. This narrative review examines the burden of menopausal symptoms in Sri Lanka and discusses pragmatic, context-appropriate solutions. Particular emphasis is placed on difficulties in individualising HRT, limitations in available therapeutic options, constraints in investigating abnormal uterine bleeding associated with HRT, health economic considerations, lack of structured postgraduate training, and low acceptance of HRT among eligible women. Strengthening primary care-based services, improving clinician capacity, and adopting evidence-based yet resource-sensitive strategies are essential to improve menopausal care and promote healthy ageing.