Using and Appropriating Technology to Support The Menopause Journey in the UK

The menopause transition has a direct impact on half of the global population, yet it has continued to be a stigmatised topic with limited focus on supporting it with technology. Whilst attention being given to menopause in HCI may be new, people experiencing it is not and people have adopted, adapted and appropriated technologies to support their menopause journey. In this questionnaire and interview study, we examine how people in the UK are using (and not using) existing general and menopause-specific technology to support themselves through the transition. Despite limited menopause-specific technologies available, participants have found novel uses of technologies such as social media and smartwatches for 1) connecting and sharing, 2) information seeking, 3) tracking and reflecting, and 4) self-care. This work contributes design considerations for menopause specific technologies, and design opportunities and challenges for technologies that can be appropriated to support menopause.


INTRODUCTION
The menopause -a transition made up of four stages, premenopause (before symptoms occur), perimenopause (symptoms start to occur because of hormonal changes), menopause (menstruation has stopped), and post-menopause (last period was over 12 months ago) -has a significant and long-lasting impact on half the global population.The number of people in the UK who are currently estimated to be perimenopausal or menopausal is 13 million -a third of the UK female population [57].Menopausal symptoms are estimated to affect 90% of those who go through the transition [58].The Menopause Charity currently lists 33 common menopause symptoms, such as irregular periods, hot flushes/flashes, night sweats and chills [59], however, the prevalence of menopausal symptoms will vary from person to person as well as individually over the years the transition takes place.Symptoms can have considerable impact on people's lives and the economy; a study conducted by a UK insurance company in 2021 found that "almost one million women in the UK had left their jobs because of menopausal symptoms" [60].
Yet, despite the large proportion of the UK population that experiences menopause, and the impact it has on their lives and those around them, there remains little technology commercially available that provides support for those going through it.Generally, technology plays a vital role in most people's lives, for example, in the UK it is predicted that by 2025, 95% of the population will use a smartphone [3].We see technology use in education, in the workplace, for exercise, socialising, and so on, and indeed iterative approaches to design and advancement of these technologies [53].However, can the same be said for technology use to provide support during menopause?
It is expected that FemTech (which includes technology for menopause) is estimated to grow to $50 billion by 2025 [45].Existing technologies for menopause, such as temperature regulating bracelets [61][62][63], handheld cooling devices [64], and tools such as cooling clothing [65] and cooling jewellery [66], have a heavy focus on attempting to alleviate hot flushes (sudden feeling of warmth).Alternatively, apps such as Balance [67] and Stella [68], aim to help combat the lack of knowledge people have about the menopause transition and provide features to support symptom tracking.Nevertheless, these technologies and tools cover a very small part of the menopause experience and only for some people for a portion of their menopause journey.
In the field of Human-Computer Interaction (HCI), there has been a growing number of publications that seek to explore the menopause transition.Often, the menopause experience is studied by the researchers through means such as interviews or workshops [52], or web scraping public menopause groups such as the Reddit group R/Menopause [23].From these initial investigations, researchers then proceed to develop design ideas for technologies or tools to provide support for those going through menopause.However, due to much of the research happening in just the last few years, there has yet to be much opportunity to build upon those design ideas and further refine where technology can provide support in real world settings.In [12], Ciolfi Felice et al. hosted a workshop where participants were encouraged to centre experience, focusing less on developing technology to fix people's problems, and instead, focusing on developing technology to provide support.We hope to build on this experience-based approach to technology design by understanding the lived experiences of people in the menopause journey, with specific attention on their experiences of technology (and related tools) to provide support in their everyday lives.
Although there has been design oriented HCI research focusing on the design of near future technologies, we instead focus on current use and provide a novel qualitative empirical account of what people are actually using and not using to support their menopause journey.Through a survey (n=38) and interview (n=11) study, we present the current gap in technology to support the menopause journey by examining technology use and non-use, the use of analogue tools, daily practices and rituals, and the development of technology for menopause.Our study contributes 1) an empirical account of current technology practices to support the menopause journey, 2) considerations for the design of future technologies to support the menopause journey, and 3) implications for the appropriation of technologies to support the menopause journey.

RELATED WORK 2.1 Digital Women's Health Technologies, Prior to Menopause
Research into technology support for life events such as menstruation, pregnancy and breastfeeding has shown the benefits it can provide.Søndergaard et al. conducted a study that used menstruation as "a trope to discuss the politics and culture of selftracking, sharing, and intimate data" [46].In a study on menstruation in public restrooms and the distribution of menstrual products across Seattle, Fox [18] described wanting to counter the idea of technology development as if it is suited for all, and instead identified the value in creating technology designs that recognise that they are a partial solution.Campo Woytuk et al. sought to create "period-positive technologies" with participants [10].Campo Woytuk et al. noted the importance in approaching participant discussions with this positive direction so that technology designs do not continue to exasperate existing taboo around menstruation.This paper highlighted how the ways in which we, as researchers, present or explore design spaces with participants has a significant effect on the discussions held and design ideas produced.Peyton et al. conducted a study of pregnant women's experiences with the aim of designing a mobile application that helps "prevent excessive gestational weight gain in pregnant lower-income American women" [38].In this study, it becomes clear that when designing for an experience that is incredibly varied -"every pregnancy is different" -the flexibility and individuality that technology can provide to end-users is a valuable asset.Furthermore, the wide reach of mobile applications makes these systems accessible to often marginalised groups such as lower-income women.
In 2015, Balaam et al. conducted a study exploring some of the issues people face with public breastfeeding, and developed a mobile app called FeedFinder [4].The inclusion of participants with breastfeeding lived experiences was "essential in identifying and confirming the design space".In a wider study on womencentered design, Almeida et al. [1], also note the importance of including women in the design process, and describe it as "critical to improving women's experiences in bodily transactions, choices, rights, and access to and in health and care.Yadav et al. [54] explored how breastfeeding experiences differ as the boundary is crossed from personal home settings to professional work settings.Similar to the menstruation research discussed, Yadav et al. argue that an implication of intimate technology design to be ever more "discrete and invisible" is that it perpetuates existing stigma and taboo in society.

HCI Menopause Research
Early exploration of the menopause in HCI followed a similar route to what we see in existing commercial apps.Lee et al. [24] sought to create a mobile application to provide menopausal women with the ability to record their symptoms, track their menstrual cycle to better understand what stage of the transition they are in, and provide tailored information based upon the current transition stage.Trujillo et al. also wanted to provide a personalised app for those both in the pre-menopause and the menopause, using a fuzzy rule-based system [51].Homewood initially sets out to continue this discussion on designing self-tracking technologies for menopause [20].However, over the course of the project their perspective shifts and the study's focus becomes a discussion on the decision to not design as existing self-tracking tools for menopause could "largely be replaced by analogue tools".Furthermore, Homewood explained that the self-tracking technologies were framing menopause as a problem that needed to be fixed with technology.
Lazar et al. conducted an analysis of posts on the subreddit R/Menopause [23] showing the social context of menopause and how this affects those going through it, with implications for technology.With this expanded understanding of the menopause experience, Bardzell et al. [5] built upon this work to develop design ideas for "What-If scenarios".These varied greatly in concept reflecting the diverse experiences of the menopause identified in the subreddit.Tutia et al. [52] also produced a study that explored lived experience to produce a set of design provocations.For each of these design provocations, they also presented questions about the potential negative impacts.The work of Mustafa et al. [28] explored the impact of religion, namely Islam, in participants experiences of menopause, finding that religion shapes participant's attitudes and behaviours and consequently presented a set of "guidelines to the HCI community" for digital health technology design for Muslim women.This paper highlights the importance of considering the menopause in the wider context of people's lives and how different characteristics such as religion, impact people's experiences of the transition.
Ciolfi Felice et al. 's work focuses on bodily experience [12] with participants identifying three key experiences they wished to design for: "bodily anxiety", "introversion" and "sleep is gold".A key theme in this paper was not to frame menopause as a problem to solve, but instead to consider where technology design can be taken to provide support and to stay with the body and its lived experience, which contrasts quite significantly with commercial products currently available.

Commercial Technologies and Tools for Menopause
2.3.1 Hot Flushes.Hot flushes are one of the most well-known symptoms and affect three-quarters of those going through menopause.On the NHS website they are described as "when you have sudden feelings of hot or cold in your face, neck and chest which can make you dizzy" [12].Other descriptions also include this sensation spreading throughout the entire body as well as being accompanied by sweating or heart palpitations [29].A similar symptom to hot flushes is night sweats which have the same experience and variability, but only occur at night and are always accompanied with sweating [29].Consequently, night sweats are often targeted by products that also target hot flushes.
Wearable technology bracelets such as Grace [63], Embr [62] and Thermaband [61], have been developed specifically to target hot flushes.They aim to do this by providing a cooling sensation at the wrist, which in turn helps cool down the whole body.Similarly, the Menopod has been designed as a hand-held device to place on the neck, where a cooling sensation is then provided [64].Of these technologies, only Embr and Menopod are currently available to buy (the others are in development).The unpredictability of hot flushes means that wearable devices like the bracelets or an easily portable hand-held device like the Menopod, seem to be suitable designs to provide relief at different parts of the day.These technologies are also all marketed as being suitable to combat night sweats, however, the Menopod and Embr require action from the user to activate, and in the case of the Menopod also to place and hold it against the neck.This means these technologies would be a lot more intrusive to use at night.Finally, there are a variety of analogue tools currently available on the market, designed to help combat hot flushes.Examples include cooling clothing [65], cooling jewellery [66], menopause magnets [69] and cooling mists [70].

Information and Awareness.
There are many examples where people who have experience with the menopause transition have described a feeling (that can last years) of not understanding what is happening to them, a feeling like they are losing their mind [55].
It is this sharing of information that is a key motivator behind a lot of existing menopause apps.Currently, there are a host of apps available, including Balance [67], Stella [68], Midday [71], Femilog [72] and Caria [73].These apps contain more information about what to expect going through the menopause transition, such as common symptoms as well as guides to help combat common problems, e.g., issues with sleeping.They also offer the ability to track symptoms over time.
Non-technology sources of information include books and podcasts.These books can include detail on the hormonal changes that happen during the menopause transition, providing a scientific context to what people are experiencing.For symptom tracking, some books offer premade symptom tracking sheets (with common symptoms) that people can fill in.These books offer much more detailed discussions compared to information that can be found on the aforementioned apps.

Towards Understanding Current Use of Technologies to Support Menopause
Research on digital women's health and menopause within HCI focuses on the importance of lived experiences and reframing the menopause experience as something that is incredibly varied and context specific.With the advances in menopause commercial technologies, much of this design research combines to show technologies that might help with the transition to menopause in the near future.However, there is a lack of research on what current menopause practices are with technology.There is little understanding of how these commercial devices and technologies are used in the real world, how other technologies are appropriated for supporting the menopause journey, and how near future designs discussed in HCI might be embedded within the ecosystem of technologies currently being used.In this paper, we focus on this current use of technology to inform the design of near future technologies that support the real world lived experience of the menopause journey.

METHOD
This qualitative research used a mixed approach with a questionnaire (n=38) and semi-structured interviews (n=11) run concurrently, providing a combination of depth of experience through the interview and potentially higher candour through the anonymity of the questionnaire [21].A reflexive thematic analysis method was used for the data analysis [8].The work by Bardzell [6] influenced every stage of the project.In this paper, Bardzell explains five feminist interaction design qualities: pluralism, participation, advocacy, ecology and self-disclosure.These were used to shape the design and the ethical approach to this research as explained below in the method.The authors read sensitising academic and non-academic writing on the menopause lived experience to design the study, for instance to prioritise anonymity for the questionnaire given issues with stigma.An ethics application for this project was reviewed and approved by the [redacted] University Research Committee.

Recruitment and Participants
A local community women's group email list and participation at an International Women's day event in Bristol, UK (Figure 1) were the two main sources of recruitment of people living in the UK who have menopause experiences (peri-menopause, menopause or postmenopause).Other two sources were word-of-mouth and social media posts in existing menopause support groups on Facebook and Reddit.The project was also shared on Twitter and Instagram.
For the questionnaire, 55 responses were received, from which 38 passed the inclusion criteria (UK-based people with menopause experiences).Of these 38, 30 described their ethnic background as "White British", "White", "White UK", "White Irish", "White German", "White English" or "White European".Two participants described their ethnic background as "British".For the remaining ethnic background descriptions one participant identified as each  set at International Women's Day event to recruit people with lived experience of menopause of the following, "European", "Mixed", "British Indian", "British Bangladeshi", "English" and "Human".The age range of questionnaire respondents is 30 to 61 years old and 35 out of 38 respondents identified their gender as female with other identities being "non binary AFAB" (Assigned Female At Birth), "female sex.No gender" and "woman".For the descriptions of responsibilities in daily life, half of the respondents described working part-time and other descriptions included responsibilities such as parenting and volunteering.
For the interviews, the age range of participants was 36 to 57 (M=49.9,STD=6.9).Seven participants identified as being in the perimenopause stage and four participants identified as being in the post-menopause stage.Nine of the eleven interviewees also participated in the questionnaire.The participant table for these interviews can be seen in Table 1.All names used are pseudonyms.

Data Collection
3.2.1 Questionnaire.To provide the opportunity for people who are unable to take part in interviews (for example due to lack of time or concerns over speaking about the topic), we offered an alternative way to share their experiences through a questionnaire.This was influenced by the feminist principle of participation [6].The questionnaire was piloted with four people with menopause experiences and one question's wording was slightly modified.From the feminist design qualities outlined by Bardzell [6], the quality of advocacy warns that when designers are trying to come up with solutions, they run the risk of "imposing their own values on users".This influenced the decision to ask about both positive and negative experiences of technology use as well as the use of tools to account for the fact that not everyone is going to be an avid technology user.After informed consent was obtained, demographics, general technology use and menopause technology use was captured.Open-ended questions with text box answers asking participants about positive and negative experiences of technology use, familiarity and perceptions of menopause, the use of tools (non-technology objects) for menopause support, tools and technologies used at home versus at work, and practices and rituals and how these may have changed during the menopause.Microsoft Forms was used to collect this information and participants could sign up to optional prize draw (£50 voucher) at the end of the questionnaire.

Interviews.
We wanted to get a better understanding for the situations and reasons for which participants would choose to use or not to use technology, inspired by the design research of Tutia et al. and Ciolfi Felice et al. [12,52] focusing on lived experiences.Similar to the questionnaire, the interview design was influenced by Bardzell [6], in particular the principle of advocacy.When asking about participants' practices and rituals, we wanted to understand how technology plays a role in facilitating or hindering these practices, or if it had a role at all in them.This was also influenced by the principle of ecology in Feminist HCI, which refers to how design artefacts have an effect outside of their intended use and intended user.This topic seeks to provide more understanding for technology use and non-use during the menopause transition and how it may be used differently in different contexts.The principle of self-disclosure explains how the assumptions about a user that influence the design of a product results in the product projecting these assumptions onto the user, and this influenced the question order.Questions included "What do you think of these [menopause] technologies or tools?", what they thought of example design ideas from existing body-based/menopause research [5,12,48,52] (see Figure 2), "What part(s) of your menopause experience would you like to see technology being developed to provide support for?" and "Are there any aspects of your menopause experience that you think technology should not be designed for?".
Each interview was audio and video recorded (to aid audio transcription), and participants were compensated with £15 shopping vouchers.Participants were provided with a participant information sheet and consent form prior to the interview.During the interview, participants were asked for their verbal consent before starting the recording.The interviews ranged from 38 to 60 minutes.

Data Analysis
The data analysis was conducted on the combined questionnaire and interview data by the authors, who identify as women but do not have personal lived experience of menopause.Reflexive Thematic Analysis (TA) allows for codes to evolve throughout the coding process [9].In reflexive TA, it is also understood that the codes will inescapably be shaped by the researcher(s) involved [9].This method, therefore, allows the coding process to be shaped by participant responses while recognising the inevitable influence of the researcher in the analysis.This is especially important in this project since it explores experiences of menopause, a transition that is highly individual and that the researchers did not have personal experiences with.Six phases of TA were conducted, starting with familiarization and coding by the first author.The other authors engaged in co-analysis for the phases of generating initial themes, developing and reviewing themes, and refining, defining and naming themes.Producing the report also led to refinement on the themes.Stories Map [52].Stress ball, Meno-Hotel and Paused [5].Cocoon and Spike Mat [12].Soma Mat and Breathing Light [48].

FINDINGS
The findings are presented with themes covering how people are using technologies to support their menopause journey, specifically to connect and share, to find information, to track and reflect, and to perform self-care.Each theme is then broken down into what technologies are being used, how are they being used, and what went wrong with these technologies.In the interview, Samantha stated: "I joined quite a lot of community groups on Instagram as well for like the support".With the menopause experience being so varied, the wide use of social media can allow for people to connect with others having a similar experience: "…because I'm on the younger side, and so I, where I've got a few friends that are going through it they've probably got 10 years or so on me.And so, [my general practitioner family doctor] was saying it's good to join some of the groups that have a wider breadth of people experiencing it so that I would feel there were some more people my age that I could discuss things with if I wanted to" (Oliva).
Technology also plays a role in the 'Menopause Cafés' (in-person or online meet-ups to discuss the experiences of menopause, share information and provide support) that four participants attend at their workplace, as they happen in online spaces: "…the Menopause Cafés are online because they're work based, and that's through a Teams call" (Chloe).The use of social media to gather information from others in a passive format (little to no posting) has become widely referred to as 'lurking' ( [11,30,40]) with 'lurkers' gaining from the information that is posted by others [50], whilst remaining anonymous as a personal preference [49].We have identified this practice among participants, for example, Sarah described: "But for me, even if you don't take part in these groups, you can often see other ladies will ask very similar questions, and I think you can just be very well informed from these groups".In contrast to existing literature that examines the exacerbation of loneliness by social media [31], discussions with interview participants highlighted how sharing of experiences and the community aspect of social media groups, has helped alleviate loneliness: "you're not on your own and you do feel, feel quite solitary […] your friends aren't always going through that at the same time as you.It's not something, and everybody's menopause is different, so listening to other people that might have gone through similar things" (Zoe).Social media communities can also provide a sense of friendship by helping people connect and "build social bonds" [31].In the interview, we see this reflected in Zoe's experience when she pointed out: "And it's that pack mentality of women together supporting one another, and it is through something that's so negative as the menopause, I think it's a beautiful thing".Another motivator for social media use is to find other people with a similar experience to feel validated and 'normal', and participants used words like "mad" (Ava, Zoe), "hypochondriac" (April), and "hysterical" (Zoe) to describe how they were feeling before receiving this validation : "…you do doubt yourself, you do, you feel like you're hysterical, so you do doubt yourself.So it is just having somebody else there to say, 'no, this happens to me, you're not going mad'".This behaviour of seeking out others on social media to feel 'normal' can be seen in the chronic condition literature [32,35], and the idiosyncratic nature of these conditions has similarities to the menopause transition.

What Went
Wrong with these Connecting and Sharing Technologies?Despite the information sharing on social media being a positive aspect for many of the participants, misinformation can still be a problem: "…that's certainly not where I would go to for reliable information -that's an issue with social media, why I wouldn't use social media" (Samantha).For many, the menopause can be a very difficult experience, and this was reflected in the in the negativity shared on social media: "So Facebook groups [. ..] you know, more people are feeling the same way, so that is useful… but again, you know, it's just mostly people moaning"(Chloe).This negativity online could foster an environment of 'doom and gloom'.
For some, the 'Menopause Cafée' format being online can make it more accessible, however not all of the participants found the online format conducive to forming personal connections and being comfortable sharing: "I find them useful because it's shared experience, but it's not something that I would feel comfortable speaking up with, especially with people I don't know that well.Definitely a barrier there.[…] it probably would even be easier in a room face to face" (Chloe).Trying to use technology to access these support groups can also be a struggle for some less digitally savvy participants: " I'm just not as sharp as I used to be.I find it really stressful trying to get on calls and Zoom, oh Zoom is the absolute, in fact, no, Teams is the bane of my life because it either works or it doesn't" and Ava described: "…me and technology don't always get on".

Technologies for Menopause Information
4.2.1 What Information Technologies are People Using?Seeking information online was very beneficial to support the menopause transition: "I did a lot of research over the sort of 10 years I was undiagnosed with menopause joint pain [musculoskeletal aches and pains related to menopause], so definitely use my laptop a lot" (Sarah).Other participants found watching the TV documentary online, 'Sex, Myths and the Menopause', useful [43]: "This program really helped me to understand women going through it, and also myself, to understand my symptoms and if I am going through it [the menopause transition]." Other participants were using technology, such as apps, that provided a gateway to information: "I think it was the first page [of Balance app] that I think was particularly mind blowing with the whole list, or the first few pages, the list of symptoms, because […] I wasn't aware of how much stuff I was feeling that could potentially be menopausal".In the questionnaire, 20 out of 38 question responses indicated users had at least heard of the Balance app [67].

What are People Using Information Technologies for?
A Censuswide study found that it takes on average 14 months for women to link their experience of symptoms to perimenopause [74], and another study found that for one in ten women it can take more than nine doctor's appointments to come to a diagnosis of the menopause [29].Participants were motivated to learn about menopause to understand what they were experiencing, but also to support their health advocacy in clinical encounters "it gives me the confidence to ask the right questions at the GP [family doctor]" (Jessica).Olivia regretting not acquiring this understanding earlier: "I think if I'd have realised sooner, I would have got help sooner.And also the fact that it happened to me so much earlier than it happened to a lot of people".Issues with misdiagnosis also prompted information seeking: "They kind of looked at me for Lyme disease, fibromyalgia, arthritis, and after nearly 10 years, you know, it really was a matter of kind of holding myself up and and having to just do my own research really" (Sarah).Zoe described the impact that a lack of information at the doctors caused: ". ..because of the misdiagnosis I went under for years.[. ..]I had such a bad experience because the education wasn't out there.[. ..]I think because when I was told, I had a blood test done and I was told I was perimenopausal [. ..] and that was it.Nobody, I didn't even know what that meant".Due to struggles to get clinical appointments in the UK's National Health System (NHS), even after diagnosis interview participants spoke about sourcing health information themselves: "Definitely search engines to check for information about the [Hormone Replacement Therapy (HRT) medication] that I'm taking, and especially when the dose is changed or I've had any complications, then definitely started Googling those to see if I could get more information because it's so hard to get a doctor's appointment" (Ava).

What Went Wrong with these Information Technologies?
Whilst sourcing information through technologies such as search engines and apps was valuable for many participants, they also spoke of concerns they had of the reliability of the information online: "…search engines obviously take it all with a pinch of salt, and you find yourself sometimes on site where you go, 'wouldn't really know how, how accurate this information is, or how sensible it is to try and stick to"" (Chloe).This wealth of information can also be overwhelming, for example, when researching which apps to try Ava described: ". ..there's so many out there, that's the first thing, there is just an ocean of apps out there, and most of them have a cost associated, and you don't know exactly really what you're paying for".This cost is also a concern for Sarah and why when searching for information she would opt to use search engines instead of apps: "…the apps I think are brilliant -in a cost-of-living crisis, I don't think it's going to be anybody's priority to necessarily, you know, when you can Google things".Whilst there is a wealth of information online that participants relate to their own experience, there are still cases where people cannot find that representative information, and this can have a negative impact: "I think when you're, when you're not the average person that it is happening to, if all you see are average stories, it makes you feel abnormal" (Olivia).When it comes to TV programs raising awareness about menopause, Ava was concerned about some programs being more genuine than others, with some jumping on a menopause trend in the UK: "I guess, having that information out there, but it has to be done sensitively.Now I think we've almost, everybody's trying to do it, and it's, it's a risk, there's a risk of people being saturated and overloaded by it".

Technologies for Tracking and Reflection
During Menopause Very few apps were used for tracking and reflection, but when used they were accessed with various connected technologies: "I've got an iPad, iPhone, and iWatch.
[…] When I used to have periods, I did use an app on my watch to sort of plot things" (Grace).Fitness trackers were popular amongst participants: "I was experiencing quite a lot of palpitations, so the fitness tracker again, I was able to track my, your heartbeat" (Zoe).In the questionnaire, 10 out of 38 respondents indicated the menopause had influenced them to use fitness trackers and 7 out of 38 respondents were influenced to use smartwatches.

What are
People Using these Tracking and Reflection Technologies for?Fitness trackers have been shown to improve physical activity [16] and this was a common use case of fitness trackers for the interview participants: "…to try and keep up my 10,000 steps, obviously connected to weight loss, or weight gain unfortunately" (Sarah).Despite not having used a fitness tracker herself, Jessica described wanting to use one after noticing the benefits it provided to other people in her life, not only around physical activity, but also around reminders to meditate: "…wouldn't that be so nice to have something in your life that reminds you, you know, not, not to kind of annoy you and tell you when you're at your most stressful, but it's nice to have something on your phone, that 'oh have you remembered to breathe today, take five minutes to take five deep breaths"".Other participants use trackers to monitor their periods, which, for example, had helped Samantha recognise the beginning of perimenopause: "…it enabled me to start spotting irregularities that hadn't existed before.So it was that pattern matching that I found really helpful".For Grace, this tracking of her cycle was particularly useful during the perimenopause stage: "…that was quite useful, being perimenopausal, because you might have gaps in your period".

What went
Wrong with these Tracking and Reflection Technologies?For Ava there was an element of distrust with using the Balance app [67] for symptom tracking, given the cost and data implications: "they want you to log your symptoms to further their research, so they want something from you, but you have to pay to use the app".The cost on its own was also a deterrent for Ava: "but it's £8 a month, I think, and and that's a lot".Other participants had trouble consistently using the apps for tracking, influencing the insights that could be obtained from it, for example Chloe describing her problem with the Balance app [67]: "I do find that you can't really track patterns very well.So if you're trying to kind of understand what's happening, obviously, you have to be a bit more, a bit more sensible than me, and not only use it when your symptoms are bad".Fluctuations in symptoms and previous experiences of infrequent use of apps meant that Jessica would be apprehensive about using menopause apps for symptom tracking because she was not motivated to track when her symptoms disappeared: ". ..for me, I'll be like, 'oh I'm fine I'm fine I'm fine' and then my symptoms will spike and I'll be like not okay, and then I'll go back to making notes and doing these kind of things, apps, and then I'll forget about it again".After not being able to consistently use online trackers, Olivia found that switching to a paper version was much more suitable: "…there's a lot of online trackers, but I actually did better, I was finding I wasn't necessarily filling them in online, so my doctor suggested that I printed it out and did it that way, and that was more successful for me".

Technologies for Self-Care During Menopause
4.4.1 What Self-Care Technologies are People Using?Beyond the digital, physical devices were used by interview participants and in the questionnaire, 3 out of 38 respondents indicated the menopause had influenced them to use electronic massage tools.Grace described using mindfulness apps: "I think that mindfulness is selfhelp […] I think all of that is really supportive in menopause, I think being able to be in the moment is, is really helpful".Exercise can also fall under self-care, and has been shown to improve mental health [44] and help with menopause symptoms [75].Samantha has also made use of online exercise classes alongside in-person classes: "I do online via YouTube, and when they are available, I will do online classes which we did […] during lockdown, aren't currently available now, but they are something I have found very beneficial".The design ideas from research were discussed with interview participants (see Figure 2) had a heavy focus on self-care.Whilst these are not currently used, discussing them with participants elicited feedback on near future technologies.For example, for Sarah, it was the Stressball [5] that caught her attention.The Cocoon and Spike Mat [12] caught Chloe's attention, and it was the Cocoon in particular that Ava liked: "The Cocoon just sounds lovely, that air flow".The Meno-Hotel [5] was popular with Jessica: "when you said the hotel I was like, 'no way that's such a good idea"'.
Prompting interview participants with these design ideas fostered a discussion of analogue self-care tools where the sensory experience is an important part of the use.For example, Grace described using a cooling mat to help alleviate her hot flushes at night.The Spike Mat design idea [12] reminded Melody "of a mat that I actually got bought myself, the Shakti [acupressure] mat".Sarah also mentioned having heard of other people who are in the menopause transition having used weighted blankets: "I know women with anxiety have tried sort of weighted blankets and things like that".

What are
People Using these Self-Care Technologies for?Managing aches and pains was a motivator for some participants to use self-care tools, such as electronic massage tools: "…just for shoulder strain and aches and pains and stuff in my back" (Ava).Samantha described her use of exercise for pain relief and also peace of mind: "Firstly, helps immediately with, you know, whatever is causing the pain, but it also means that I don't need to worry about it as much, because I know more what I'm dealing with and that, that not worrying reduces the stress and anxiety".Self-care was also enacted through relaxation practices, with the discussion of the design ideas prompting reflection on how they achieved relaxation: "I know that [acupuncture mat] is a weird sensation, but it's lovely if you can kind of go through it" (Melody).When talking about the Cocoon [12] Chloe was intrigued by the audio sensory experience: "…the whole audio guidance breathing.I'm like, okay this sounds lovely, this sounds like I can just go and wrap myself up and then just drift off ".Alternatively, for Ava it was the airflow feature of the Cocoon that stood out: "I always liked sleeping under a ceiling fan [. ..] a soft breeze that just brushes the skin, is very relaxing and does keep you cool without being intrusive".
Using apps for meditation to support different aspects of mental health was particularly useful for Jessica who described: "I really liked how they spoke about a meditation, how it helps you, and you can put in there like, if you want a specific one like anxiety or low mood or grief, and they have specific ones for that topic".For Sarah it was the Stressball [5] design idea that she explained would be useful for a calming effect: "I just wonder, it's got that calming, it takes your mind off, you know, we all know when you're having a panic attack and anxiety, you've got to find somewhere square and breathe in".The notification of family and friends feature of the Stressball was another noteworthy aspect for Sarah: "I think, if you're really struggling with anxiety, and your family and your loved ones are concerned about you.I think that's absolutely brilliant […] but I think so many of us, and I'm just talking personally for me, I didn't tell anybody".
Sleep is a vital part of taking care of oneself, supporting healthy brain function and general well-being [76].For Grace, supporting her sleep with an app "would have been quite useful".For Sarah, it was sleep deprivation that was a particularly difficult part of her menopause experience: "I think sleep deprivation is hell on Earth" and so she was interested in the Cocoon and Spike mat [12] design ideas in supporting people in getting to sleep: "I'd watch those with interest".The Meno-Hotel [5] was a design idea that stood out for some participants as a place that would almost act as an intervention for self-care: "…being somewhere physically away, and being in a place where you could have some like, some downtime and be in a spa, or do whatever activity that serves you in that moment that day" (Jessica).

What Went
Wrong with these Technologies for Self-Care?Similar to an issue identified with self-tracking tools, inconsistent use was another problem participants identified with using technologies for self-care because they lost interest: "I find with apps like I get bored after a while.So I probably wouldn't pay for it, but I'll probably join it, do it for a few weeks, or a few months, and then just get bored of it" (Jessica).For April, the problem with inconsistent use stems from having to remember to have the self-care technology with her: "I guess that Stressball has to be near you, in your vicinity, you know, and sort of take with you wherever you are going.Whereas, you know, I can barely remember my phone when I leave the house let alone have a stress ball".The unpredictability of menopause symptoms could also lead to inconsistent use of self-care technology: "…when you have a hot flush, is not something you can predict.I don't know how other people are, but they just come all of a sudden, and you may not have the Cocoon handy to, and and they also go as quick so it is a bit hit and miss in a way" (Lauren).
The cost and the cost-benefit of self-care technologies are a deterrent for many participants: "Probably like not […] the electronic massage tools.Only because they require like money and stuff and I don't really want to spend on technology like that" (Jessica).Lauren had similar concerns about the Meno-Hotel [5]: "Usually these things are more expensive and, you know, you you need to pause and think is this worth?".Sarah was concerned about the cost of the Meno-Hotel as well as the motivations behind it: "…lots of people are jumping on the old menopause retreats, and doing lots of yoga.Again, I think if you can afford it.I was a single mum, and, and again the hotel, is it people cashing in? ".
Another design idea that was discussed with interview participants was Paused [5], described as a lifestyle brand that celebrates the menopause.Considering the Meno-Hotel [5] and the lifestyle brand, Chloe described her discomfort with the viewpoint of celebrating the menopause: "I am so far off embracing it as a 'oh let's go and celebrate our menopause by going to the menopause hotel and sit with some other women who are also anxious, brain foggy and, you know, just generally sometimes a bit sad.Then, no, that's not for me".
A study of unpaid care work (e.g.cooking, cleaning, caring for children) found that "around the world, women spend two to ten times more time on unpaid care work than men" [17], and these additional responsibilities affect when people can take time for themselves.Many participants described finding the time to do self-care after they have catered to everyone else's needs: "…when the kids have gone to bed, and you have, you know, half an hour to yourself after you've cleared away dinner and washed up and, you know, done all those bits and bobs" (April).Balancing new self-care practices with existing routines is something a few participants discussed struggling with: "…we have other commitments, we have work, families.So that is a struggle to, to actually become routine" (Lauren).The suitability of a self-care technology fitting into daily life was also a concern for Grace who described how the commercial technology, Menopod [64], would not have been something she could integrate into her work environment: "…there's no way I could have picked up a pod and and pop that on my neck, it would never, never worked".The importance of being able to find flexibility with self-care technologies and fit it in throughout the day is highlighted by Jessica: "I'm not trying to get through my day, and rush my day to feel calm, but I'm trying to incorporate it into my life so that I don't have to do it when I'm stressed, I can do it if I feel like anxiety is coming up".

DISCUSSION
We constructed four themes about technology use for menopause support in the UK: technologies to connect and share, technologies for information, technologies for tracking and reflection, and technologies for self-care.Within each of these themes, we identified existing technologies that participants use (both general and menopause-specific technology), why they use those technologies, and the issues they experience with them.Below, we discuss four topics where HCI can further address menopause: tension between aging and using technology, personal choice for personal experiences of the body, personal choice for varied lives, and opportunities for the appropriation of other technologies.Within each topic, we set out design considerations for future menopause technologies.

Tension Between Aging and Using Technology
5.1.1Stigma with the Menopause and Getting Older.In The Menopause Manifesto, Dr. Jen Gunter describes the "culture of silence about the menopause in our patriarchal society is something to behold" [19].This 'culture of silence' is fuelled by stigma surrounding the menopause and getting older as Gunter goes on to describe how "the concerns of women as they age are often so unimportant that they aren't even worth the minimal effort… they're simply ignored".The ripple effect of this stigma means that for so long the menopause has not been spoken about, at home or in the workplace.A UK government study found that employees experiencing the menopause did not speak out at work to ask for support out of fear of how others will react [56] and Tutia et al. described the menopause as an unspoken topic for generations [52]; our participants also described anxiety.However, much like in Tutia et al.'s study, our participants decided to share their experiences and found benefits such as "relief through acknowledgement, a sense of legitimacy, and information exchange" [52].'Menopause Cafés' and social media allowed for this sharing of knowledge, with positive impacts of understanding that they are not alone in their experiences being described, which is very different from some of the negative (and sometime gendered) words people used to describe their feelings prior to this, such as hysteria.This highlights distrust in understanding what their body is experiencing, which can be linked to "women having their symptoms and health concerns related to the menopause dismissed as being fabricated, unimportant or just 'part of being a woman"' [19].Both Zoe and Sarah spoke about their struggles with misdiagnosis, and for Sarah, this was over a period of 10 years.Without information technologies, health advocacy could not have happened in either case, despite some issues with reliability, negativity, or trouble finding specific information.
The role of technology in reducing stigma is significant, and therefore should be a significant design consideration for future menopause technologies.Participants use of social media helped break the silence surrounding the menopause.Uses of search engines and the Balance app [67] are also helping people better understand their own experiences.However, when designing nearfuture technologies for the menopause, such as the Meno-Hotel [5], it becomes important to consider how technology is being used to help combat the stigma, and if it fits with people's values and views of menopause, with Chloe thinking a positive celebration of menopause went too far.There are also possibilities with other technologies not mentioned in this study to provide opportunities to reduce stigma, such as video games and virtual reality [42].Recent work has shown that these technologies are used as informal mental health tools and provide community to those who might benefit from anonymity [15], which may be beneficial with regard to the stigma associated with menopause, for instance supporting those who were more prone to lurking on social media than participating.
Design Consideration: More available technologies, such as menopause apps, have the opportunity to leverage existing or new non-digital menopause programmes, such as workplace Menopause Cafés, to make them more universally visible, potentially reducing the stigma around menopause, but also making them more accessible to people who might be not want to meet in person because of the stigma attached.Much like menstruation tracking apps that have reduced internal stigma [41], more available menopause specific technologies could also impact menopause stigma through visibility and accessibility.
5.1.2Ageism and Technology.Feeling represented by the technology and comfortable using technology is an important factor in determining whether or not people will use it, such as Sarah and Ava who felt uncomfortable using online video calls for support groups.In a study of Ageism and Digital Technology, Köttl et al. found that "ageism is a key barrier that affects the design, adoption and use of digital technology" [22].They also determined that ageism in digital technology occurs on three levels, macro which covers design and policy, meso which covers social and organisational environment, and micro which covers the individual level.These levels are not independent and affect each other.We can identify with Sarah that there is a strong element of the individual level of ageism and technology in her confidence in her own abilities to use technology.However, there is also an element of the macro level because technology should be designed in a way that makes it easy to pick up and use.This interplay between individual level and macro level is also reflected in Ava's description of how her and technology "…don't always get on".There is an understanding from Ava that it is partly her having trouble using the technology as well as the technology itself being difficult to use.There is the risk to menopause technology designers that they might fall into the trap of considering these technologies are just for older adults, or that older adults are a homogenous group [37].Petrie discusses the misunderstanding of older adults influencing the design of technologies [37], and this is particularly an issue for technologies to support older adults with genders that are underrepresented at the design table [25].
This barrier of ageism in digital technology use will have a significant effect on the usefulness of approaching technology design for support in the menopause transition.Researching and developing an understanding of existing technology use for menopause support will provide a better context for what is currently working with existing technologies.It will also provide an understanding of the contexts for which people consider technology use.Is technology thought to be something that can be used for self-care?Or do people see it as more of a practical 'solution', a mechanism to access something else such as information?Having a better understanding of this will provide researchers with a grounding for developing future technologies that can utilise what is working well and improve upon what is not.
Design Consideration: The menopause journey is long, and advances in available technologies means that a variety of people will need to be able to readily access and use them, but the platforms in which they might be available might shift within someone's journey.Designers of menopause specific technologies should be aware of the variety of different digital skills of the variety of people potentially using these technologies, and design for longer term use and accessibility in order to not exacerbate experiences of ageism.

Personal Choice for Personal Experiences of the Body
5.2.1 Varied Choice.Varied technology use for menopause was captured.Social media apps and video conferencing apps were being used to connect with others also experiencing menopause; apps were being used to access tracking features of smartwatches and to log symptoms; apps were providing a space to get information on the menopause from more trusted sources; meditation apps and yoga apps were being used to support mental health as well as physical health; and a variety of self-care technologies were being used from electronic massage tools to online exercise classes.However, there wasn't consistency of technology use between any participants.The motivations for using technology to support menopause varied individually and between participants, including support for diagnosis, aches and pains, information seeking, relaxation, and sleep.The varied choice available means that many can provide at least one accessible option that can cater to different daily lives as "…everybody's menopause is different" (Zoe).For instance, Olivia and Jessica provided a unique perspective on menopause technologies as they were managing primary ovarian insufficiency, which made their experiences very different from participants who experienced the start of the menopause journey after the age of 40.Information seeking research has shown that these individual experiences can lead people to put in much effort to find out what is 'normal', particularly turning towards their peers to seek out information on a large variety of symptoms and treatments [32].However, existing commercial technology is very focussed on just two aspects, hot flushes and information and awareness, showing opportunities for industry to expand what aspects of the experience are catered to, but also explaining why so many different technologies were appropriated in different ways.Despite the diverse experiences captured, Almeida et al. warned that technology can provide a tool for social change, but it can also be a tool for oppression [1].Therefore, if we are going to create technology for menopause it is important that we remain conscious of the wide impact menopause has.It includes people of all income groups, ethnic backgrounds and gender identities.It includes people in different regions that might not have access to digital technologies, or where there are risks of privacy or security related to health information.In this study, the interview participant group was mainly formed of people who identify as White (7 out of 11) and all participants identified their gender as female or woman; our questionnaire respondents followed a similar ethnicity composition, and for gender identity there was only two exceptions, with one respondent identifying as non-binary and one with "No gender".Mustafa et al. highlight the importance of including religion as a characteristic to pay attention to, in order to "fully understand the landscape of women's health" [28].In this study, we did not discuss religious beliefs with participants, however future studies could take their community outreach to different religious communities to expand on understanding the role religion plays in the menopause experience, and to also include how technology plays a role in this context.Bennett et al. also emphasises the importance of including people with disabilities in technology development [7].
Design Consideration: In striving to make research inclusive and varied, we can then develop a diverse array of design ideas that reflect the idiosyncratic experiences of the menopause as well as the individual lives to which these technologies may be integrated.These variety of experiences should also be captured in the design of commercial menopause technologies to capture idiosyncratic needs, potentially through participatory design approaches, which has been shown to be useful for personal health needs [2].

5.2.2
Value of Free Trials and Trial and Error.A shortcoming of having a variety of technologies available is that participants described becoming overwhelmed with the amount of choice, having concerns about consistent use and also cost.In addition, misinformation and trust are concerns for people around technology, particularly information and misinformation around issues related to women's health (e.g.[26,36,39]).A possible way around these issues of trust and utility of unfamiliar technologies is through trialling them and testing them out.As technology for other parts of our lives such as listening to music or watching TV has become ever more popular and more competitive between providers, free trials have become a staple of many subscription-based services.For example, research has highlighted that free trials were a large contributor to the success of Spotify [13].This is due to people being able to try the features for free, then getting used to having those features and consequently going on to pay to keep access to them.With menopause experiences being so varied, different approaches will work for different people.Similar to research on activity trackers that showed large individual heterogeneity [27], there can be a variety of reasons why some technologies work for some people and a wide variety of reasons why they might be abandoned.
Design Consideration: Providing people with the opportunity to be able to trial menopause support technologies could reduce the risk of them spending money and it not being worthwhile, thus perhaps reducing anxiety around the number of options and choosing the 'right one'.It would also allow for people to develop usage habits before having to be concerned about the cost.

Individual
Choice.Almeida et al. cover three main approaches for a feminist-oriented design of technology that seeks to improve the conditions of all women [1].One of these approaches is the humanistic approach, which encourages consideration of how a technology design fits in people's lives from the beginning to the end of its life cycle.In the context of the menopause, this can be considered as how a technology fits in throughout the different stages of the transition, perimenopause, menopause and post-menopause.For example, we saw Grace and Samantha mention that period tracking was particularly useful during their perimenopause stages, which would not be useful for some and might also invoke negative feelings for others in the midst of menopause.
There is also the possibility of considering the stage before menopause symptoms occur, pre-menopause.In HCI there is already a growing body of research on menstruation [10,18,46].Creating technology that is useful and used before the menopause transition begins and then continues to provide support throughout the transition, would for example, perhaps improve people's consistent use of symptom tracking tools.It was explained by participants such as Chloe that she tends to only remember to use the symptom tracking tools when her symptoms are bad, but if people had already developed a habit of using a technology during pre-menopause and there was that sense of trust and comfort previously described, then it may make it easier to integrate a new habit of symptom tracking.It may also improve awareness of the menopause so that people do not have to start learning about the transition only after they have grown concerned about their health.Similar to Ciolfi Felice et al. [12], it is therefore worth considering how we can create technology that respects the changing body and seeks to evolve in response, reflecting the individual needs of each user throughout the menopause transition.
Design Consideration: There is benefit to long-term use of menopause technologies given the long-term nature of the journey.For designers of these technologies, there is potential to engage people earlier in the pre-menopause stage or leverage existing technologies related to health, such as menstruation apps, to support the menopause journey before symptoms can start to cause potential issues.

Personal Choice For Varied Lives
5.3.1 Life Gets in the Way of the Menopause and Vice Versa.Considering the context of menopause in everyday life is an important part of understanding the role that technology can play in providing support.Many of the participants spoke of practices they used to combat anxiety, such as Samantha's yoga practice and Jessica's meditation apps.Anxiety has a knock-on effect to other parts of everyday life because it can cause restlessness, dizziness and heart palpitations [77].The experience of heart palpitations was mentioned by Zoe, restlessness or trouble sleeping was mentioned by Sarah, and Grace described her use of apps to help her sleep.Lack of sleep is linked to many chronic health conditions such as heart disease and can also impact work, driving and social functioning [33].We can start to see, therefore, that there is not a clearcut divide between providing support for menopause and providing support for different aspects of everyday life and everyday health.
Participants have described how their busy lives affect the time they have to use technologies for menopause support.Finding small moments of time for self-care throughout the day was important, but related to issues of gendered responsibilities.Ciolfi Felice et al. also highlighted that participants found it difficult to make time for self-care practices in their busy lives [12].Minimal and flexible time-commitment requirements of technology are therefore important factors in making it accessible for people to use for menopause support.
To understand these bright pockets of time and opportunity, it is important to understand the contexts in which they are used.Are different technologies used at home versus at work? Alone versus in social situations?Do people see the role of technology differently at home versus at work?In an exploration of the use of breast pumps in the workplace, Yadav et al. found that all "participants had unique pumping stories" and workplace socio-cultural dynamics such as professional standing, played a role in shaping these experiences [54].
Design Consideration: It may be the case that having different formats for a menopause support tool can make it accessible for more people to integrate it into their daily lives.For instance, for use at home/work, for use alone/socially, for use online/offline, for use discreetly/to share, for use on-the-go/room-based, or for use daily/sporadically.However more research is required to better understand the differences for menopause support in these contexts and use cases.

Opportunities for the Appropriation of Other Technologies
Of all the technologies the participants have discussed using, the only one that had been designed specifically for menopause was the Balance app [67].Instead, all participants found use for existing technologies: social media to find connections with others sharing the same experiences; smartwatches and fitness trackers to monitor cycle changes; meditation apps for managing anxiety and stress that can often be exasperated by the transition, etc. Existing research projects for menopause support in HCI have looked to the use of recommender systems for encouraging healthy behaviours [24], tangible objects such as the Stressball [5] and soma design-inspired objects such as the Cocoon and the Spike Mat [12].However, there is still the possibility for other technologies that are not associated with the menopause to be appropriated for it.Soubutts et al. conducted a study with a group of older adults to get a better understanding of how the Amazon Echo Show voice assistant can be used to support "social, care and information needs in the home" [47].The results showed that the voice assistant provided benefits for these needs.We can also identify these needs in our work: social (technologies to connect and share), care (technologies for self-care), and information (technologies for information).It is, therefore, possible that using voice assistants may be useful in providing support for the menopause, particularly around activities such as information seeking and meditation.
We discussed above the value technology could provide if it were designed with the changing body and the individual user's needs in mind.Artificial intelligence (AI) is used to provide personalised experiences in different parts of our lives already (e.g.music [78] and product recommendations [79]).Recommendation systems have the potential to be of great value to people in the menopause transition, considering the wide variety of experiences and options available.If there is a wide variety of technologies being created to provide support, recommendation systems could aid in sifting through all the potential options.In healthcare, Machine Learning (ML) is being used for personalised diagnosis and treatment recommendations based on a specific patient's attributes (e.g.[14]).This provides greater opportunities for the personalisation of technology so that it better suits each individual user's needs.In the interviews, participants have both directly noted how every menopause journey is different, and shown this through their different technology uses, motivations and experiences.Therefore, it would be infeasible to create bespoke technologies so that everyone's menopause experience is catered for.Instead, personalisation could be used to tailor technology applications for each user, thus allowing the technology to cater for a wider audience.
Smartwatches and fitness trackers are already used by many of the participants.It is, therefore, worth considering how technology development can be built on top of these existing products.For instance, the warming and cooling sensations provided by the commercial temperature regulating bracelets could be incorporated, or tracking symptoms such as hot flushes could be incorporated into the existing tools that already track users' movement, speed, oxygen level and the amount of electrical current flowing through the users' body [80].This would reduce some of the requirements of people having to manually track their menopause symptoms which has been described by some participants as difficult to maintain.However, this is not without controversy as our participants have already described issues with inconsistent motivation to track, distrust of how their data is being used, and the cost to engage with the functionality, echoing recent work on contraception showing uncertainties on long-term availability, personal data use, and subscription fees of apps [34].This has also been noted in Homewood's work, where a conscious decision was made to not engage in the design of a self-tracking menopause tool that treated menopause as something that needed a solution [20].
Design Consideration: Looking beyond designing apps might have the potential to support people going through the menopause journey, such as with tangible objects, voice assistants, virtual/augmented reality, AI/machine learning and wearables.However, more research will be needed to explore the design possibilities of nearfuture menopause technologies that might be adopted into real world use, but also into how existing technologies can be appropriated to support a life transition that half the world goes through.There are bright spots for design based on the positive uses of technology presented in this work, but also some of the barriers and the risks to some of these technologies that HCI researchers, healthcare providers and industry should take account of when engaging with the design, implementation and dissemination of menopause technologies, or technologies appropriated for menopause.

Limitations
Menopause is an understudied area of research in many fields, and human-computer interaction is just one of them.More research needs to be conducted to better understand the relationships between the menopause journey and the use of technologies.This study was a focused qualitative empirical account, however a larger and wider study might provide insights beyond the UK context, involve a more diverse group of participants (such as non-binary and trans participants who we were unable to recruit for the interview portion of the study), and delve into cultural differences more significantly (such as the impact of religion on technology use).A quantitative or mixed method study might provide some differentiations between the use of technologies for different stages of the journey or how different demographics might adopt and use technologies in different ways.Moreover as this was a retrospective qualitive approach, intervention studies may be useful to delve deeper into how people's lived experiences of the menopause journey change with the introduction of menopause technologies.

CONCLUSION
Investigating technology use for menopause support in the UK through an interview and questionnaire study has shown how people use technologies 1) for connecting and sharing, 2) for information seeking, 3) for tracking and reflection, and 4) for self-care.Building on innovative design research in HCI, this study instead focused on current use of technology.This has highlighted the value of appropriating existing technologies and also shows where menopause specific technologies can make an impact.Considering half the global population will go through the menopause transition, there are huge opportunities to explore what other existing technologies may be successful for providing support, but also where existing technologies that are already popular and adopted by people going through the transition might be leveraged to support menopause.Although this study was limited in its context and the recruitment of diverse participants, there was a huge diversity of approaches to menopause technology use.Through future work, this diversity could be explored, with the caveat that there are some negative potential consequences to the use of technology if it is not contextually appropriate or does not engage with the ethical risks of health and care technology design.

Figure 1 :
Figure 1:Table set at International Women's Day event to recruit people with lived experience of menopause

Figure 2 :
Figure 2: The PowerPoint slide prop used for the research design ideas discussion in the interviews.Smart Bra and Interactive Stories Map[52].Stress ball, Meno-Hotel and Paused[5].Cocoon and Spike Mat[12].Soma Mat and Breathing Light[48].

4. 1
Technologies to Connect and Share the Menopause Experience 4.1.1What Technologies are People Using for Connecting and Sharing?In the questionnaire, 32 out of 38 respondents indicated their menopause experience influenced them to use social networks.

4. 3 . 1
What Tracking and Reflection Technologies are People Using?

Table 1 :
Interview Participant Table