Navigating power and silence: Communicative disenfranchisement in menopause healthcare communication

This study explores the communication patterns between women in various stages of menopause and their healthcare providers through the lens of the theory of communicative disenfranchisement (TCD). Drawing from in-depth interviews (n = 32), using a thematic analysis and adopting an interpretive approach, three themes were identified relating to healthcare provider communication. Findings suggest that provider and patient communication involves (1) validating talk, (2) disenfranchising communication and disconfirming talk, and (3) patient self-advocacy. Although power imbalances are endemic to patient-provider relationships, our analysis demonstrates how these dynamics are exacerbated and acutely felt in the context of menopause from the perspective of the patient, due to the convergence of medical uncertainty, societal stigma, and the subjective nature of symptoms. Participants' narratives advocate for reforms that prioritize validation, comprehensive information, and access to more specialized and responsive care. The study argues that the TCD provides a critical framework for understanding how systemic healthcare disparities become communicatively enacted in specific, stigmatized health contexts like menopause. Implications and directions for future research are discussed.