Menopause Around the World

In an interview with Reuters Health, Dr Mary Jane Minkin, said, “In societies where age is more revered and the older woman is the wiser and better woman, menopausal symptoms are significantly less bothersome.” In contrast, “Where older is not better, many women equate menopause with old age, and symptoms can be much more devastating.”

In many countries and cultures, menopause is considered a new start—the chance for greater freedoms and a time to embrace your life’s experience.

Could it be that in the West, our ‘youth is best’ attitude is actually making our menopause experiences harder?

Menopause in the West

In the US, UK, Canada and Australia, menopause can be seen as a time to dread and navigate in silence.

Work, home life, and everyday activities that we once took for granted can feel like minefields. We become concerned that we’ll have a hot flash in a meeting, cry over a commercial, or not fit into clothes that were once comfortable.

About 75% of women experience hot flashes and many others experience sleeplessness, vaginal dryness, weight gain, and mood swings. Despite this, women aren’t willing to discuss their symptoms and it’s clear that there is a stigma to menopause.

Vodafone, in research into the effect of menopause for working women, found that 50% of women don’t feel they can talk about their symptoms, even though 62% of them felt it was affecting their work.

Another study into the State of Menopause by Bonafide showed that while only 9% of women talk to their mothers about their experiences, 31% will talk to their healthcare practitioner. It seems that culturally, in the West, menopause is viewed as a medical event, more so than many other countries and cultures.

Menopause management tools

In the US alone, 6 million women use hormone replacement therapy (HRT) every year to help manage their menopause symptoms. But as HRT isn’t appropriate for everyone, many women turn to supplements, and increasingly to hypnotherapy for hot flashes.

Menopause in Asia

Japan

Japan is quite possibly the poster-child (or poster-woman) for how to ‘do’ menopause.

So few Japanese women report experiencing hot flashes (only 25%-50%) that local media reportedly had to create a word for it, ‘hotto furasshur’.

Japanese women also have lower rates of other health conditions that typically worsen postmenopause, including heart disease, osteoporosis, and breast cancer.

One school of thought is that the Japanese diet is high in soy, which contains isoflavones that mimic estrogen. This is important, because many menopause symptoms (such as hot flashes) occur due to a lowering of estrogen levels.

Interestingly, many Japanese women are more likely to report more feelings of chilliness than heat, possibly because of their high intake of soy isoflavone as part of their daily diet.

While it’s possible this is one reason Japanese women experience less hot flashes than Western women, research suggests there are both benefits and risks in consuming high amounts of soy or isoflavones.

Another factor that may influence Japanese women’s experiences of menopause is collective cultural attitude. In Japan, menopause is looked upon as a natural life-stage, and the very word for menopause, konenki, means renewal, season and energy.

India

In India, menopause is also approached as a natural stage of life that comes with many benefits.

Back in the 70s and 80s a surprising amount of research was conducted into cultural attitudes towards menopause, with a particular focus on India. In 1975, Marcha Flint found that women in Rajasthan, who had spent their child bearing years veiled and secluded, could now socialise with men, share home brew where the men talked, and publicly joke with them.

And while Marcha Flint’s study may be dated, her findings point to how an ingrained cultural attitude can have a positive impact on women’s menopause experience.

Menopause doesn’t come symptom free in India⸺with women reporting heavy bleeding in the perimenopause stage as well as joint aches and fatigue⸺but there appears to be an overwhelming attitude that this is a time of liberation.

China

In China, menopause is also seen as a ‘rebirth’; a time when energy that was used for child-bearing and fertility can be saved.

Chinese women generally experience less hot flashes than Western women and rarely experience embarrassment of their symptoms. However it is interesting to note that women’s experiences differ, depending on whether they live rurally or in the city, with city professionals experiencing more symptoms than farming women.

Menopause management tools

HRT use remains fairly low in Asia. In a 2010 study of women across several Asian countries, only 19% of women took HRT to manage their menopause symptoms, while 37% used herbal or natural remedies. In China it’s thought HRT use could be as low as 2.1%.

Menopause in the Middle East

In a region that spans 20 countries and many ethnic groups, there are no doubt a wide variety of menopause experiences in the Middle East. In the few studies that have been conducted into women’s menopause experiences in the Middle East, there are some interesting common themes.

From a symptom point of view, it appears that women in Saudi Arabia experience similar frequency and severity of hot flashes to women in the West. But cultural attitudes to menopause are quite different.

The word for menopause in Arabic translates to ‘the hopeless age’ or ‘the age of desperation’ but this is thought to have more to do with the end of child bearing years, than the actual experience of menopause or ageing.

Postmenopausal life for women in the Middle East can be a time of renewed life, greater inclusion, and higher position in society.

Qatari women look forward to menopause as a time of liberation. In one study, many women talked about being more socially active after menopause. Postmenopause they could take part in religious activities that were previously off limits while they were menstruating.

Interestingly, the same study showed some women’s experiences largely depended on how supportive their husbands were. When women in the study were asked of their perceptions of menopause in the West, many believed that western women would not have the same support from husbands and families and therefore have a more negative experience.

A review of social impacts on menopause experiences showed that in Iran, prayer played a major role for women. While participating in prayer may provide an element of social support, there is also a level of comfort from the perception that menopause is a natural happening, and part of God’s predetermination.

Menopause management tools

Currently there is very little data on menopause treatments used by women in the Middle East to manage their symptoms, but it’s thought there is a preference for natural remedies over HRT.

Menopause among First Nation peoples

First Nations women may have quite different experiences than their caucasian counterparts.  

For some North American First Nations groups there isn’t even a word for menopause, it’s just a time known as ‘when the period stops.’ This doesn’t mean symptoms are experienced to any lesser degree, but hot flashes, mood changes, and sleep issues just aren’t as well associated with the menopause process.

In a 2010 study into First Nations experiences of menopause, some participants spoke about how entering this stage of life changed their status within their communities. They were now seen as ‘wise’, because of their lived experiences.

Many Mayan women experience menopause at a significantly earlier age (44 compared to 51 in the West) but their transition comes almost symptom free. Even those who do experience symptoms, approached menopause with optimism and a positive attitude about their change in social status.

For Maori women, hot flashes and other menopause symptoms happen at a similar frequency to non-Maori New Zealanders, but they are less likely to seek healthcare support for their symptoms.

Less is known about the experiences of Australian Aboriginal women. In a study of Indigenous women from Queensland, there seemed to be little understanding of menopause, or even recognition of the word.

This may be because ‘women’s business’ within Australian Indigenous cultures is very private. The study found that around 59% of women surveyed weren’t aware that their periods would eventually stop. In another small study, Aboriginal women who participated mentioned fear of the changes they were experiencing, but also talked of gaining respect in their community as they aged.

Menopause management tools

Maori, North American Indian and Indigenous Australian women may experience menopause symptoms to the same degree as their caucasian counterparts, but studies suggest they are less likely to use management tools such as HRT. Whether this is because of cultural influences, or a lack of health literacy and access to healthcare needs to be studied further.

Reclaiming menopause

It’s clear that the way we approach menopause can have an impact on our experiences.

As Dr. Sandra Thompson explained to Reuters Health, “If menopause symptoms were due solely to hormonal changes then the menopausal experience would be more homogenous.”

In an article for the British Psychological Society, the authors said, “In Western societies women tend to be valued for their physical and sexual attractiveness, reproductive capacity and youthfulness. Ageing is often viewed negatively among women and wider society.”

And while our individual experiences of menopause may be unique, perhaps our collective experience can be improved if we work towards a culture that celebrates the wisdom that comes with ageing, and the benefits of moving to this next stage of life.

A natural first step is to normalize menopause through open conversation with friends, mothers, family and work mates.

A second step is to educate ourselves on our physical symptoms and understand the menopause management tools available to us.

A final step is to be kind to ourselves. Appreciate all that our bodies have been through to this point and all that they are capable of now.

The Wrap Up

Millions of women experience perimenopause and menopause every year, but the extent that it is a positive or negative experience may reflect cultural influences. In the West, menopause can be seen as a time to dread, while in the Middle East, Asia and for some First Nations people it is a time of renewal, rebirth and improved social status. By normalizing the menopause experience and educating ourselves on management tools, we can reclaim this time of our life and create our own positive experience.