Background Women globally spend a significant portion of their lives experiencing perimenopausal and menopausal symptoms, which can severely affect their quality of life. Hormone Replacement Therapy (HRT) has proven effective in alleviating symptoms such as hot flushes, sleep disturbances, and mood disorders. However, disparities in access to HRT exist, especially in low- and middle-income countries (LMICs), where socioeconomic factors and healthcare availability may limit treatment access.AimWe aimed to explore economic barriers and disparities to access to HRT across Brazil, Ghana, Malaysia, Nepal, Nigeria and Sri Lanka. Methods An exploratory study was conducted using publicly available data from national healthcare databases, pharmacies, and hospital formularies from Brazil, Ghana, Malaysia, Nepal, Nigeria, and Sri Lanka. The availability and cost of common HRT medicines, including oral and transdermal therapies, were analysed alongside of surgical procedures. Affordability was assessed by comparing the cost of a two-month HRT supply to the number of days of minimum wage work required to cover the cost. Additionally, Gross National income (GNI) per capita was also collected to contextualise these findings.Findings The availability of HRT medicines varied widely across the six countries, with Brazil and Nigeria offering a broader range of options compared to Ghana and Nepal. Pricing disparities were significant, with the cost of medicines such as the Mirena Coil requiring over 21 days of minimum wage work in Brazil and more than 260 days in Nigeria for Angeliq. Affordability remained a critical issue across LMICs, with high out-of-pocket costs restricting access to essential menopausal treatments.Conclusion This study reveals substantial economic barriers to accessing HRT in LMICs, driven by high costs and limited availability. Healthcare policy reforms to improve access and affordability of HRT in these regions are urgently needed. These findings can inform strategies to reduce healthcare inequalities and enhance women’s health outcomes globally.

Women globally spend a significant portion of their lives experiencing perimenopausal and menopausal symptoms, which can severely affect their quality of life. Hormone Replacement Therapy (HRT) has proven effective in alleviating symptoms such as hot flushes, sleep disturbances, and mood disorders. However, disparities in access to HRT exist, especially in low- and middle-income countries (LMICs), where socioeconomic factors and healthcare availability may limit treatment access. We aimed to explore economic barriers and disparities to access to HRT across Brazil, Ghana, Malaysia, Nepal, Nigeria and Sri Lanka. A cross-sectional exploratory study was conducted using publicly available data from national healthcare databases, pharmacies, and hospital formularies from Brazil, Ghana, Malaysia, Nepal, Nigeria, and Sri Lanka. The availability and cost of common HRT medicines, including oral and transdermal therapies, were analysed alongside of surgical procedures. Affordability was assessed by comparing the cost of a two-month HRT supply to the number of days of minimum wage work required to cover the cost. Additionally, Gross National income per capita was also collected to contextualise these findings. The availability of HRT medicines varied widely across six countries, with Brazil and Nigeria offering a broader range of options compared to Ghana and Nepal. Pricing disparities were significant, with the cost of medicines such as the Mirena Coil requiring over 21 days of minimum wage work in Brazil and more than 260 days in Nigeria for Angeliq. Affordability remained a critical issue across LMICs, with high out-of-pocket costs restricting access to essential menopausal treatments. This study reveals substantial economic barriers to accessing HRT in LMICs, driven by high costs and limited availability. Healthcare policy reforms to improve access and affordability of HRT in these regions are urgently needed. These findings can inform strategies to reduce healthcare inequalities and enhance women’s health outcomes globally.

Objective This paper explores Ghanaian women’s experiences of menopause, focusing on its occupational, sociocultural, and healthcare dimensions and considering implications for national and diaspora health strategies.Design Qualitative study using semi-structured interviews and thematic analysis.Setting Ghana, within the context of the MARIE project, focuses on women engaged in informal trade, caregiving, and community roles.Population or Sample Eighteen Ghanaian women representing diverse socioeconomic, occupational, and health backgrounds.Methods Semi-structured interviews were conducted to capture symptom experiences, work–life balance, healthcare access, coping strategies, and societal perceptions. Data were analysed using Braun and Clarke’s six-phase thematic approach.Main Outcome Measures Narratives of menopausal experiences, thematic patterns related to occupational, psychological, and healthcare domains.Results Six overarching themes emerged: (1) occupational and economic strain; (2) psychological burden and emotional disruption; (3) physical and somatic disruption; (4) barriers to healthcare access and knowledge; (5) coping, resilience, and withdrawal; and (6) outlook, migration, and intergenerational lessons. Menopause was described as a disruptive and embodied transition, shaped by gendered occupational expectations, sociocultural idioms, and systemic neglect.Conclusions Menopause in Ghana is not only a biomedical event but also a deeply occupational and sociocultural phenomenon. Clinical recognition of colloquial idioms, integration into chronic disease and mental health services, and workplace protections are urgently needed. Findings also inform strategies for Ghanaian diaspora women in high-income countries, where their menopausal needs remain underserved.

Women-led indigenous farming and ethnobotanical systems across Asia, Africa, and South America are vital yet often overlooked foundations for reproductive health, food security, and ecological resilience. This paper draws on diverse case studies—including jamu in Indonesia, ayurveda in India and helawedakama in Sri Lanka, milpa systems in Mexico, Andean potato terraces, and sub-Saharan African agroforestry—to illustrate how women cultivate biodiversity-rich agricultural and medicinal traditions that support menstruation, fertility, childbirth, and postpartum care.As farmers, healers, seed custodians, and knowledge holders, women advance nutritional, therapeutic, and psychosocial outcomes while preserving intergenerational resilience. Yet these systems face mounting threats from land dispossession, extractive industries, commercial seed regimes, and exclusionary policies. Regional examples—from Kenya’s seed banks and Brazil’s feminist agroecology to Venezuela’s survival-based herbal practices—demonstrate both the strength of these traditions and the gendered barriers to their sustainability.Climate change further underscores the urgency of safeguarding these low-input, locally adapted practices. As women increasingly navigate civil society and state frameworks, their knowledge must be formally recognized and resourced. We argue that inclusive health, agricultural, and environmental policies that centre gender equity, biocultural heritage, and climate resilience in low- and middle-income countries. International collaboration is essential to protecting and scaling women-led indigenous systems as pathways toward transformative global health and sustainability.