'They can induce and exacerbate each other' - the complex interplay between domestic abuse and the perimenopause: a qualitative study with female survivors.

BACKGROUND: Domestic abuse (DA) and perimenopause are each known to profoundly impact women's health, yet their intersection remains largely unexplored. This study reveals how these experiences collide to create unique vulnerabilities and unexpected opportunities for transformation. This qualitative study explores how DA survivors experience perimenopause, examining the complexity and support needs that emerge when these experiences overlap.

METHODS: Fifteen DA survivors participated in focus groups (and one individual interview) facilitated by a community leader of a DA survivors group exploring their perimenopause experiences. Data were analysed thematically using the one sheet of paper (OSAP) technique, with a DA survivor community leader (third author) involved throughout to support ethical engagement and participant well-being. Analysis revealed how trauma and hormonal changes interweave to shape help-seeking and survival.

RESULTS: Three interconnected themes emerged: (1) symptom confusion and overlapping conditions - participants struggled to distinguish between trauma responses, hormonal changes, and pre-existing conditions; (2) weaponisation and empowerment - perpetrators exploited perimenopausal symptoms for coercive control, yet paradoxically, hormonal changes sometimes catalysed women's decisions to leave; (3) barriers and facilitators - system failures drove survivors toward peer support networks that provided validation unavailable from professional services. Participants described heightened anxiety, mood changes, and sleep disturbances intensified by current or past abuse. The weaponisation of perimenopausal symptoms represents a previously unreported form of coercive control. Conversely, some participants described perimenopause as a moment of emotional clarity, contributing to decisions to leave relationships with an abusive partner.

CONCLUSIONS: The intersection of DA and perimenopause creates unique vulnerabilities that current UK support systems fail to address. Healthcare providers require training to recognise how trauma and hormonal symptoms can mask or mimic each other. The finding that perimenopause can serve as both a tool of abuse and a catalyst for liberation challenges deficit-focused narratives around both DA and perimenopause. Integrated, trauma-informed approaches are urgently needed across healthcare and support services.