The “double whammy” : a cooperative inquiry exploring how women navigate the biographical disruption of perimenopause and rheumatoid arthritis : a thesis presented in partial fulfilment of the requirements of the degree of Master of Science in Psychology (endorsement in Health Psychology) at Massey University, Wellington, New Zealand

Abstract

Background: Biographical disruption offers a robust framework for understanding how chronic illness affects people’s lives, yet it often overlooks how gender shapes these experiences. Drawing on a feminist perspective, this study addresses a critical gap in research by exploring how women with rheumatoid arthritis (RA) navigate perimenopause (PM). This intersection is significant, as RA is most commonly diagnosed around the same age as PM onset (40–50 years) and affects women three times more often than men. The dual challenge can profoundly impact physical, emotional, and social wellbeing, disrupting daily life, identity, and future expectations. However, little is known about how women manage these experiences when they occur together. Method: Guided by feminist-informed phenomenology, this study sought to understand women’s lived experiences while acknowledging how intersecting gendered inequities shape health and meaning-making. Data were collected through cooperative inquiry, a participatory action research method that fosters shared reflection and dialogue. It was then analysed using reflexive thematic analysis underpinned by phenomenological epistemology. This iterative process enabled the identification and interpretation of themes that illuminated how women navigate and make sense of the intertwined experiences of RA and PM. Results: Three overarching themes were identified: ‘Biopsychosocial distress of a new reality’, ‘Coping through resilience strategies and accepting change’, and ‘Navigating the health system’. Participants described a “double whammy” of bodily disruption, emotional strain, and social constraint. Despite these challenges, they also developed adaptive, relational forms of coping that fostered new ways of flourishing. Flourishing was not the absence of suffering, but the capacity to find meaning and connection through it. Conclusion: The study extends biographical disruption theory by demonstrating that disruption is a dynamic, ongoing and dialectic process through which women continually reconstruct meaning and identity. Recognising women’s embodied expertise and the centrality of gender is essential for improving healthcare practice and broader understandings of living well within disruption.