The Menopause Exchange Blog

MENOPAUSE IN DIFFERENT CULTURES

There is wide variation across different cultures on how each group experiences the menopause. This article looks at what research tells us about different ethnic groups.

This article was included in issue 81 (summer 2019) of The Menopause Exchange newsletter.

There may be no understanding of the term ‘menopause’ or women not reaching menopausal age in some cultures (e.g. in underdeveloped countries where poverty, low socioeconomic status, poor health and lack of healthcare facilities may result in lower life expectancy). Women may not have classic menopausal symptoms such as hot flushes and night sweats (e.g. Japanese women have a diet rich in isoflavone-containing foods throughout their lifetime, which is thought to explain why they don’t have symptoms).

At the other end of the spectrum are women who experience symptoms and think about whether or not to come forward for treatment. This may be the case with the westernised population, with a woman (whatever her ethnicity) finding out about the risks and benefits of treatment and then deciding to just cope with her symptoms, especially if she feels that these will be time limited.

The menopause experience

Many factors influence whether a woman has a positive or negative view of the menopause. These include biological, psychological, social and cultural factors, with culture having a strong effect on how the menopause is experienced. Different cultural groups of women may have different understanding of, and needs during, the menopausal transition.

Korean women regard the menopause as a disease and prefer to use lifestyle interventions to manage this phase. A 2012 Australian study found that psychological or emotional symptoms, sexual dysfunction and vasomotor symptoms such as hot flushes and night sweats were more commonly reported by Australian women compared to the indigenous Laotian women population. A Southern Europe study asked around 1500 women aged between 40 and 65 from Serbia and Portugal to complete quality of life questionnaires and found that women with higher scores were more highly educated, employed, non-smokers and physically active and were more likely to see their doctors for help with menopausal symptoms compared with women with lower scores. Researchers who spoke with Palestinian women to understand their views on the menopause found that most women in their study had a positive view about mid-life years, seeing this and ageing as a natural process.

In Japan, women don’t generally experience vasomotor symptoms at the menopause, and don’t understand what the term ‘hot flushes’ means. Asian-Indian women actually see this phase as a positive time, with improved social status and the ability to participate in religious activity without having to worry about periods. Asian women generally report lower rates of psychological menopause symptoms compared to women in western countries.

The SWAN study

The Study of Women’s Health Across the Nation (SWAN) study is a multi-ethnic study of women living in the US, including Caucasian (White), African-American, Chinese, Japanese and Hispanic women. The researchers looked at various factors, such as education, psychological wellbeing, financial strain and other biological and physical measures, when analysing data about when menopause symptoms started and how frequent and severe they were. Across all five racial/ethnic groups, there were two consistent presentations – women either complained of classic menopausal symptoms such as hot flushes and night sweats or they had psychological and psychosomatic symptoms. Most symptoms varied by ethnicity. Caucasian women reported significantly more psychosomatic, more emotional symptoms than other racial/ethnic groups. Vasomotor symptoms were more common in African-American and Hispanic women and also seen more in women with higher BMI (body mass index), which suggests that obesity isn’t protective against vasomotor symptoms. Vaginal dryness was present in three or four out of every ten SWAN participants at the start of the study, and was found more commonly in Hispanic women. Among Hispanic women, symptoms varied by country of origin. The fact that a woman had moved from her country to the US, and possibly adopted some of the US culture, was thought to play a part in her presentation of menopausal symptoms. Looking at biological factors, SWAN found that peri-menopausal women (women going through the menopause but not stopped natural bleeding), hormone users, and women after a surgical menopause (hysterectomy and removal of ovaries in some cases) reported higher rates of vasomotor symptoms. All groups, plus postmenopausal women (women naturally bleed free for a year or more), reported significantly more vasomotor symptoms than premenopausal women.

The PAM study

The Pan-Asia Menopause (PAM) study looked at different menopausal symptoms in over a thousand Asian women from nine ethnic groups. Vietnamese and Pakistani women reported the highest rates. Within each ethnic group, the prevalence of individual symptoms also varied considerably. Only 5% of Indonesian women, for example, had hot flushes but 93% complained of body or joint aches/pains. Overall, body or joint aches/pains was the most prevalent symptom, ranging from 76% in Korean women to 96% in Vietnamese women.

In this study, women took hormone therapy with good overall symptom control, but more research is needed to understand how to help each ethnic group. A 2010 US study found that the most severe symptom experienced by Chinese and Korean women was forgetfulness; for Asian-Indian women it was exhaustion or fatigue; for other Asian women it was a loss of sexual interest. These were women in the US as opposed to women recruited for the PAM study which was undertaken in Asia. 

About the author

Dr Nuttan Tanna is a pharmacist consultant in women’s health. She runs weekly menopause and osteoporosis medication management clinics at Northwick Park Hospital, in Harrow, Middlesex, and is also actively involved in education and research.

References:

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Nomura SJO, Hwang YT, Gomez SL et al. Dietary intake of soy and cruciferous vegetables and treatment-related symptoms in Chinese-American and non-Hispanic White breast cancer survivors. Breast Cancer Res Treat. 2018;168(2):467-479

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Created Summer 2019

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