Menopause Apps, Empowerment and Epistemic Injustice

In women’s healthcare the problem of epistemic injustice may be compounded by women’s structural marginalisation. Fricker argues that healthcare professionals (HCPs) rarely adopt these negative positions on purpose, nevertheless they present a substantial barrier to women seeking to access support and treatment for a range of health issues including menopause. 

Mobile health applications (mHealth apps) provide a resource across a range of health topics including women’s health and menopause but there is debate in the literature as to whether these apps are empowering for women or whether, at least in terms of their promotional narratives, they reinforce sexist stereotypes and diminish women’s credibility as people who can ‘trust their own experiences and gather reliable knowledge about their own bodies’ (Hendl & Jansky, 2022). 

Picking up on this debate we wanted to understand more from the perspective of women using menopause apps and to find out what if any role they played in their experiences of empowerment and epistemic injustice. In our study we spoke to peri and post-menopausal women about their experiences of using menopause apps. Women told us they used the apps to find out more about menopause, to read other people’s experiences and in many cases, they tracked their menopausal symptoms, symptom triggers and menstrual information. 

This tracking data was often used to 'evidence' women’s symptoms and their changing menstrual cycle as part of their discussions with HCPs. Women felt more confident in talking about their menopause with their HCP if they had a visualisation or record of their symptoms whilst others simply used the tracking data to bolster their confidence in explaining their concerns and their treatment preferences. For these women, many of whom had previously had an unsatisfactory encounter with a HCP in which they felt they hadn't been believed or listened to about their menopause, using the apps was empowering. 

Whilst the idea of turning personal experience into knowledge and evidence seems to fit with a healthcare context that often priorities objective scientific decision-making, the app played a role in a number of ways. It certainly didn’t seem to ‘reveal’ knowledge of the body but allowed women to capture and document what they were already aware of in a format that made it easier for them to collate and present to HCPs. 

Many didn’t feel the need to share the data with HCPs; consulting the app before the appointment provided a confidence boost to their discussions. The data had other meanings for women beyond sharing and evidencing. These related to ongoing self-reflection, self-care and positive decision-making around their health and wellbeing and for many it complimented or was a natural progression from paper-based journaling.

Importantly, experiences with HCPs varied with some women discussing positive conversations with empathetic and understanding HCPs and using the apps led to positive acceptance of menopause and increased discussion with friends, family and work colleagues. Technology like this does not solve the problem of epistemic injustice and the marketing narratives around ‘taking control’ are often misleading. But for our women, the apps supplemented rather than undermined their belief and understanding of their own experiences of menopause. They felt confident to express their personal testimonies with a backup plan in their pocket if needed. Menopause apps might be a resource that supports productive and supportive encounters with HCPs and one that some women will find helpful even if only for a short period of time.

Elizabeth Sillence is an Associate Professor in the PaCT Lab at Northumbria University. Her work focuses on the role of digital technology in health and wellbeing with a particular focus on trust and decision-making. 

Alison Osborne is a senior researcher engaged in research focusing on health, well-being, technology, inclusion, and social justice. Her work has involved working closely with a variety of populations including women, veterans, bereaved families, LGBT+ communities and military children as well as stakeholders including local authorities, the NHS, charities, local and national government. Alison’s research aims not only to understand experiences and needs but to support meaningful change.