First Voices: Documenting Menopause in Indigenous “Vedda” Community of Sri Lanka (MARIE- Sri Lanka WP2a)

Background: Menopause is a significant transitional phase in a woman’s life, yet among marginalised populations such as indigenous communities in Sri Lanka, it remains under-explored and under-supported. Objectives: This study aimed to explore the lived experiences of menopause among indigenous women, focusing on their symptomatology, coping strategies, socio-cultural challenges and access to healthcare services.Methods: As part of Work Package 2a (WP2a) within the MARIE Global Project, a worldwide women's health initiative, a qualitative study was conducted to explore the lived experiences of menopause among indigenous women in Sri Lanka. This study contributes to the project's broader effort to examine the physical and mental health impacts of menopause across diverse populations, emphasising culturally embedded perspectives and healthcare challenges in low-resource settings. In-depth interviews were carried out with five indigenous women aged between 45 and 64 years. The sample size was determined using the conceptual model, taking into account the specific characteristics of the study sample, until data saturation was reached. A thematic analysis was then conducted to identify recurring patterns and insights within the data.Results: The findings revealed that last menstrual periods were typically occurred around 45 years of age. Six major themes were identified. The most distressing reported symptoms were bodily aches and pains, which significantly affecting daily functioning. None of the participants had received any formal information or health education regarding menopause, and none had attended a Well-Woman Clinic. There was no outreach or engagement from healthcare professionals regarding menopausal care. As a result, participants relied heavily on traditional herbal remedies, including the use of Bin Kohomba (Munronia pinnata), to manage symptoms and maintain health. Geographical distance, financial constraints, limited access to relevant information, and the absence of formal education have been identified as significant challenges to accessing healthcare services.Conclusion: Indigenous Vedda women in Sri Lanka experience menopause in near-total isolation from formal healthcare due to cultural silence, limited education, geographic barriers, and systemic neglect. Addressing these challenges requires integrating menopause care into community health services, training healthcare workers in cultural competence, ensuring culturally responsive care, and incorporating traditional health practices beyond reproductive years. These steps are essential for bridging systemic gaps and fostering equitable, inclusive healthcare for Indigenous women.