Navigating menopause: a qualitative exploration of the mental health implications for women with congenital heart disease

Background: As survival from congenital heart disease (CHD) improves, there is a rapidly growing population of adults with congenital heart disease. Women with CHD experience unique reproductive health challenges throughout their lifespan and these challenges are characterised by complex medical risks alongside significant psychological burden. Reproductive health amongst women living with CHD has mostly focused on menstrual irregularities and pregnancy. There are currently no studies which explore menopause and its impact on mental health. Aims: The aim of this study was to explore the mental health impact of menopause on women living with CHD by: 1) identifying the facilitators and barriers to accessing support; 2) to explore the psychological and social resources available for them. Methodology: A qualitative design was used. Semi-structured interviews were conducted with 15 women living with CHD who were transitioning or had transitioned through the menopause. Participants were recruited via the National Health Service (NHS) in a hospital which has a specialist adult CHD department. Reflexive thematic analysis (RTA) was used to analyse the data. Results: Six themes were identified ‘The Cumulative Impact of Health Factors’, ‘Physical Change as an Emotional Reminder’, ‘Gaps in Knowledge and Holistic Understanding’, ‘Seeking Safe Choices’, ‘Personal Coping Resources’ and ‘Social Connectedness as Support’. Conclusion: Women living with CHD and transitioning through the menopause are navigating several new and existing mental and physical health symptoms, often overlapping with their CHD condition. However, this transition is not just about managing symptoms but the uncertainty within healthcare systems not yet set to address their needs. Implications: This study offered new insights into the experiences of transitioning through menopause for women living with CHD. Increasing knowledge among both CHD teams and patients is crucial, to develop CHD-specific materials, strengthen collaboration with GPs in order to improve the care of women living with CHD as they enter a new life stage.