Menopause is often described as "the change", but for millions of women worldwide it is more than a biological milestone. It is a cultural, social and medical turning point. While most women experience menopause, their journeys are not the same. Ethnicity, culture and access to healthcare shape how symptoms are felt, understood and treated. These differences are rarely acknowledged, leaving many women invisible in public conversations about midlife health.
Author
- Dipa Kamdar
Senior Lecturer in Pharmacy Practice, Kingston University
Menopause marks the end of reproductive years and is defined clinically as 12 months after the final menstrual period. Natural menopause usually occurs between the ages of 45 and 55, with the average age in the UK being 51. The transition that leads up to it, known as perimenopause, can last several years and is characterised by fluctuating hormone levels, particularly oestrogen.
Up to 80 percent of women develop symptoms linked to falling levels of oestrogen, progesterone and testosterone. Researchers have identified more than 40 possible symptoms. Because oestrogen acts on receptors throughout the body, its loss is associated with increased risks of long-term health issues such as osteoporosis, heart disease, diabetes and mood disorders.
Symptoms vary widely. Hot flushes, night sweats and sleep disturbances are common, as are mood changes, joint pain, vaginal dryness and reduced libido. Symptoms can last an average of seven years. Although these effects are widespread, their intensity and meaning differ across cultures. Research including the The Study of Women's Health Across the Nation and further work by the British Menopause Society highlights notable variations in how menopause is experienced. There appear to be some differences in hormonal patterns across ethnic groups, although more research is needed to understand why symptoms differ.
Women of African and Caribbean descent tend to experience more severe and longer-lasting vasomotor symptoms, including hot flushes and night sweats. Sleep problems, mental health issues and weight gain are also reported more often. Cultural expectations and stigma can make open discussion difficult, leaving many women without appropriate support.
Women of South Asian descent (India, Pakistan and neighbouring regions) tend to reach menopause earlier, with average ages around 46 to 47 years compared with 51 in western populations. Earlier menopause increases the risk of long-term health conditions such as heart disease. South Asian women also report more urogenital symptoms, such as vaginal dryness, urinary issues and reduced libido. However, conversation about sexual health is often limited due to cultural norms.
Women of East Asian descent (China, Japan and others) often report fewer hot flushes but more musculoskeletal pain, forgetfulness and low libido. In many East Asian cultures, menopause is viewed as a natural stage of ageing, which reduces the likelihood of seeking medical support.
Women of White European heritage report vasomotor symptoms more frequently than East Asian women, but often with less intensity than those experienced by African and Caribbean women. Although access to healthcare is generally greater, inequalities still affect diagnosis and treatment.
Across many minority communities, social stigma and cultural silence remain significant barriers. In some cultures, menopause is associated with loss of femininity or fertility, discouraging women from discussing symptoms. In others it is viewed as a natural process that does not require medical input. Some women prefer natural approaches to symptom management, often due to cultural beliefs or limited trust in medical interventions.
Practical barriers make access to care even more difficult. Language barriers can prevent effective communication with clinicians. Health literacy gaps mean many women are unaware of options such as hormone replacement therapy (HRT). Educational materials often lack representation, with leaflets failing to depict women from diverse backgrounds. Many women report feeling dismissed when seeking help . Socioeconomic inequalities including lower income and limited access to healthcare further widen gaps in symptom management and long-term health outcomes. These issues are compounded by mistrust of the healthcare system , often rooted in historical and ongoing inequities.
For the first time, women aged 40 to 74 attending NHS health checks will now be asked about menopausal symptoms. By embedding menopause into routine checks, policymakers hope to normalise discussion, improve diagnosis and ensure that all women receive appropriate support. However, the benefits may not be evenly distributed. Evidence shows that some women from ethnically minoritised communities are less likely to access these health checks, particularly those who already face barriers to recognition and treatment. If uptake remains unequal, the policy may unintentionally reinforce disparities rather than address them. The challenge for the NHS will be to adapt outreach and service delivery so that menopause support reaches the women who need it most.
Addressing these inequalities requires culturally sensitive healthcare. Information needs to be available in multiple languages and formats, including clear explanations of symptoms, consequences and treatment options, both hormonal and non hormonal. Healthcare professionals must be trained to recognise cultural differences in how symptoms are described and interpreted. Women also need safe spaces to discuss their experiences without judgement.
Menopause is not only a phase of symptom management. It is a critical stage for long-term health. Menopause is universal, but its experience is not. Biological variation, cultural norms and systemic inequalities shape how women navigate this transition. Recognising these differences is essential for building equitable healthcare that supports all women, regardless of ethnicity or culture, through one of life's most significant milestones.
Dipa Kamdar does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
