Psychosocial Vulnerability and Perceived Support Needs Across the Menopausal Transition: A Cross-Sectional Study of Romanian Women

Background/Objectives: Psychosocial difficulties during the menopausal transition, including impaired self-esteem, perceived isolation, and perceived need for support, remain insufficiently characterized in Eastern European populations. This study estimated their prevalence among Romanian midlife women and examined their associations with demographic factors and symptom burden. Methods: This cross-sectional secondary analysis included 306 women aged 45–65 years (65 perimenopausal, 40 recent menopause, and 201 long-standing menopause), recruited voluntarily through an online questionnaire. Participants completed the 44-item Multidimensional Menopausal Burden Questionnaire and three single-item psychosocial questions. Primary analyses used ordinal and binary logistic regression; symptom clustering, mediation, receiver operating characteristic (ROC) analysis, and multinomial regression were exploratory. Results: Menopause-related self-esteem impairment was reported by 45.9% of women, perceived isolation by 47.1%, and a need for external support by 44.1%; 77.6% of women reporting a need did not report having received support, and 41.0% of them stated that they had not sought it. Psychological symptom burden was consistently associated with all three outcomes (adjusted odds ratios 1.18–1.21 per point). Long-standing menopause was associated with self-esteem impairment (OR 2.18, 95% CI 1.01–4.71), although the confidence interval included the null after multiple imputation (OR 2.10, 95% CI 0.99–4.46). In exploratory analyses, a somatic–oral–psychological symptom-burden cluster (21% of participants) showed the highest frequencies of self-esteem impairment (78%) and of need without support received (58%), and a PSY-9 threshold of ≥11 discriminated perceived support need (AUC 0.82; optimism-corrected sensitivity 0.67 and specificity 0.81). Conclusions: Psychosocial difficulties and perceived support needs were common in this voluntary sample and were closely associated with psychological symptom burden. Because the support item did not record help-seeking or access, the gap between perceived need and support received should not be read as evidence of service barriers. The symptom-burden clusters and the PSY-9 threshold are exploratory and require external validation before any clinical use.