Principal Findings
Overview
Our findings show that how menopause is framed on social media can meaningfully influence women’s immediate affective responses to online information. In an online experiment, participants who viewed posts portraying menopause as distressing reported greater levels of worry, confusion, and anxiety and lower levels of reassurance, optimism, and empowerment. Notably, shifts in affect did not extend to behavioral intentions to engage with the content (eg, liking or sharing posts). Below, we discuss these findings in relation to individual differences (such as menopause status and age), comparisons with existing literature, and practical considerations for online communication of menopause information. The discussion is organized around the 4 study objectives: the role of individual characteristics in shaping responses to menopause-related social media narratives, the impact of narrative condition on affective responses, the impact of narrative condition on expected behavioral responses, and participants’ perceptions of the posts and their representativeness of wider menopause narratives.
Individual Characteristics: Menopause Stage and Age Each Independently Influenced Worry and Anxiety
Participants who were postmenopausal reported significantly less worry about menopause, and older participants were less likely to feel worried or anxious even when controlling for menopause status. This finding suggests that age and menopausal stage make separate contributions to affective responses rather than one fully accounting for the other. It aligns with findings of prior research that has shown that postmenopausal women typically hold more positive attitudes toward menopause than premenopausal women [21,33]. Two-thirds of postmenopausal women report feeling better or at least neutral about menopause after the transition compared with before [34]. Perimenopausal women, in contrast, are more active information seekers online, being twice as likely to search on social media than postmenopausal women [21]. With lived experience to draw on, postmenopausal women may be able to reflect on and contextualize existing narratives about menopause, recognizing nuances that speak to the individual nature of “local biologies” [35] through which expectations, knowledge, and psychosocial factors shape experience. Evidence from life span research similarly indicates that older adults typically report less frequent worry, including about health [36]. Together, these findings underscore the value of earlier, credible information to allay anticipatory anxiety and support women who have not yet begun menopause. Although many women delay information seeking until the onset of perimenopausal symptoms [37], providing accessible guidance earlier in the life course, for example, in schools and at routine health checks and appointments [38], and adopting a more inclusive approach to menopause support and education [39] may help younger and perimenopausal women calibrate expectations and feel better equipped to navigate the transition.
Affective Responses: Exposure to Distress-Framed Posts Increased Negative Emotional Responses
A key finding of this study is that framing social media posts about menopause in distressing terms increased negative affect. Compared with participants who viewed posts that described menopause as a normal experience, those exposed to distress-framed posts reported higher worry, confusion, and anxiety and lower reassurance, optimism, and empowerment. These effects remained after controlling for age, educational level, and social media use. This pattern suggests that distress-framed narratives of menopause might shift affect in the moment, potentially narrowing perceived coping resources and elevating negative emotion. In contrast, positioning menopause as a normal life stage appeared to create a more positive affective response to social media posts. This is consistent with work showing that understanding what to expect can shape appraisals of menopausal experiences [40] and that better knowledge is associated with more positive experiences [41]. Digital spaces have been shown to cultivate affective atmospheres that modulate user experience [42]. Related research on emotional contagion shows that the emotional tone circulating in social feeds can shift users’ subsequent emotions and expressions, underscoring how local online climates matter in terms of how health narratives feel in the moment [43]. However, shifts in how content makes people feel do not necessarily translate into transmission behaviors such as liking or sharing, particularly when typical engagement cues are absent.
Behavioral Responses: Experimental Condition Did Not Influence Intended Behavioral Responses
Framing menopause as distressing or transformative had no impact on intended behaviors toward online information compared with framing it as a normal part of life. Despite strong effects on affect, neither distress nor transformative (vs normal) framing significantly changed intentions to like, share, save, comment, search, or discuss a post. Overall, reported behavioral intentions to engage with the social media posts were low across all narrative conditions. Retransmission rates for health content are often modest relative to other content types [44]. Many people obtain what they need from online health sources without visible participation, a pattern of passive use often described as “lurking” [45]. For menopause in particular, information seeking frequently serves as sense making and validation rather than public sharing [23,46]. Source and platform cues also shape willingness to act. Behavioral intentions vary with the identity of the source [47], and trust judgments about the source predict intentions to act on health advice [48-50]. Tweets from health organizations are more likely to be retransmitted than those from non–health organizations [44]. Social signals can function as bandwagon cues, where popularity is read as credibility [51], and these cues interact with message features to influence perceived credibility [52]. Our stimuli intentionally removed source identity and social proof, which likely dampened the reported expected behavioral intentions. Finally, translating online material into conversations with others is not always easy to achieve. For example, people are often reluctant to disclose to health care professionals that relevant health information came from the internet, sometimes attributing it to family or friends [53], and online inputs may be incorporated into health decision-making in more indirect, nuanced ways [54].
In addition to studying engagement behaviors such as sharing and commenting, future research should investigate how narrative framings of social media messages influence health-related behavioral responses to menopause information. Meta-analytic work on fear appeals shows that effective behavior change is more likely when messages that elicit fear or alarm are accompanied by clear information about how best to respond [55,56]. Messages signaling “what to do” in response to information about menopause often include high-agency tasks such as seeking HRT, booking general practitioner appointments, or purchasing recommended services and products. In the United Kingdom, recommended actions have also been amplified by celebrity-led menopause narratives, alongside reported increases in demand for HRT and ongoing debate about medicalization [57,58]. However, these routes are structurally constrained: access to general practice remains difficult and uneven, with persistent dissatisfaction about obtaining appointments despite record numbers of appointments being delivered in general practice overall [59]. The time, effort, and costs of navigating care constitute a burden on individuals that can lead to intervention-generated inequalities when solutions rely heavily on individual agency [60,61]. It is important that researchers and public health communicators closely consider the “agentic demands” placed on recipients of health information [62] and foreground feasible options alongside broader structural support so that widening online discourse about menopause does not center on solutions that many cannot enact.
Perceptions of Posts: Distress-Framed Posts Increased Perceived Knowledge but Reduced Post Likability
Although participants were less likely to report liking distress-framed posts about menopause, they reported feeling more knowledgeable about menopause after viewing them compared to posts conveying menopause as a normal stage of life. A possible explanation for this is that it is consistent with established negativity effects, where negative or threatening information is treated as more informative even if it is viewed as undesirable or unpleasant [63]. People preferentially attend to and remember threat-related material. In response to a given stimulus, negative emotions can enhance memory and be judged as more informative in certain circumstances compared to stimuli eliciting a more positive emotive response [64]. Emotional arousal accounts suggest that arousal sharpens competition for attention and memory, giving negative, high-priority cues an advantage for memory and processing of information. This can boost a sense of learning despite producing negative affect associated with the stimuli [64,65].
Perceived Representativeness: Distress- and Transformative-Framed Posts Were Viewed as Less Representative of Health Professionals
Compared to the normal condition, both distress and transformative posts were seen as less representative of health professionals, and transformative posts were also seen as less representative of newspapers or television. The fact that distress narratives were seen as less representative of health care professionals resonates with recent studies suggesting that women are not always taken seriously by health professionals when presenting with severe menopause symptoms [66]. Recent media attention regarding celebrities’ menopause experiences has opened up discussions on menopause, particularly regarding symptoms and HRT, although there have been suggestions that these well-publicized negative accounts contribute to the medicalization of what is usually a natural process [67]. Empowerment-based narratives emphasize the importance of incorporating both medical and psychological dimensions into menopause management [7], with some arguing that menopause should also be seen as an opportunity for growth, self-realization, and transformation [68]. However, many women report feeling overlooked or invisible during menopause [69], and the absence of relatable experiences can foster a sense of isolation and invisibility [67]. That transformative posts were seen as less representative of television or media more broadly perhaps reflects a cultural expectation in which Western cultures have tended to align menopause with aging and fertility, whereas in other cultures where menopause is viewed more positively, symptoms are expressed less frequently [70] and messages on transformation and growth are more prominent [71].
Encouraging a diverse expression of menopause narratives online can better reflect the highly individual nature of the transition, resonate with a wider range of lived experiences, and help reduce stigma and open discussion [22,72]. However, our findings also suggest a need to be mindful of the affective costs of distress framings. This is not an argument for curating or suppressing accounts of menopause distress but for acknowledging well-documented negativity effects, where people often treat negative information as more informative and remember it more strongly [63,64]. In convoluted online environments, negatively framed content can also be privileged by diffusion dynamics: moral-emotional and negative language tends to travel further and faster on social platforms, increasing visibility relative to neutral or positive narratives [73,74]. Recent qualitative research on perimenopause and menopause messages received as anticipatory education found that participants tended to judge memorable messages as negative or ambivalent, suggesting cognitive biases favoring negative menopause information [75]. Additionally, participation inequality on social media means that many users consume but rarely post, potentially skewing what appears to be representative of “ordinary” experiences [76]. Foregrounding distress-framed narratives of menopause may increase overall concerns, but only framing the transition as “normal” or “natural” risks dismissing women with severe and debilitating symptoms or who experience premature or surgically induced menopause [77]. The uniqueness of menopause and the fact that women may adopt multiple normal, transformative, or distressing narratives to describe their experiences [22] suggests a need for more nuanced menopause narratives across both online and traditional media.
Conclusions
This study shows that how menopause is framed on social media influences perceptions and immediate affective responses to online health content. In an online experiment, distress-framed posts increased worry, confusion, and anxiety and reduced reassurance, optimism, and empowerment. Crucially, neither distress nor transformative narratives altered behavioral intentions to like, share, save, comment on, search for, or discuss menopause posts. Overall, narrative tone shaped affective responses without shifting intended behaviors. Encouraging diverse menopause narratives can better reflect the breadth of women’s experiences, reduce stigma, and promote open conversation. At the same time, negative framings may become disproportionately salient on social media, potentially distorting perceptions and beliefs. Future work should examine whether such framing effects endure, how they interact with source and platform cues, and whether more balanced narratives improve women’s everyday experiences of menopause.