Abstract
Menopause is experienced differently across cultures. Yet existing literature for cultural comparisons across multiple countries mostly adopts a quantitative approach leaving a gap in qualitative understanding of menopause. This systematic review synthesizes qualitative studies to advance understanding of how women from different cultures perceive and experience menopause. Searches were conducted across CINAHL, PubMed, Scopus, PsycINFO, and Web of Science for qualitative, peer-reviewed studies published in English between January 2000 and June 2025, that compared cultural differences of menopause. Quality assessment was conducted using CASP. Data were analyzed using thematic analysis. Thirteen articles from eight countries, with 17 cultural groups, were included. Three major themes were identified namely Narratives on Menopause centering on perception of menopause, attitudes towards symptoms, and public and private discussion of menopause; The Support Spectrum which focuses on the influence of family, social norms, religious beliefs, and language on menopausal experiences; and Navigating Healthcare: Preferences and Approaches which considers how culture can shape preferences for health systems and treatments. Culturally sensitive healthcare practices and development of assessment tools that reflect diverse cultural contexts are needed to advance appropriate wholistic support during the menopause life transition.
Introduction
Menopause is marked by the permanent cessation of menstruation due to the decreased loss of ovarian follicular activity in the late 30s, and its complete loss usually by the early 50s (Ilankoon et al., 2021). This is a natural event experienced by half of humankind and it is projected to affect 1.3 billion women by 2030 (Afshari et al., 2020). With the current increased life expectancy, women may spend nearly a third of their lives in post-menopausal stage, underscoring the need for research to better understand its impact (Afshari et al., 2020).
Menopause signals various biological changes which lead to symptoms like changes in libido, and mood swings (Taebi et al., 2018). Vasomotor symptoms, such as hot flashes and night sweats, are among the most common symptoms, affecting up to 80% of women (Nappi et al., 2021). These symptoms have been linked to decreased quality of life (QoL), depression, and insomnia, as demonstrated by a cross-sectional study in Iran involving 405 postmenopausal women (Nazarpour et al., 2020). While biological changes are significant, they do not encapsulate the full menopausal experience. As women transition into menopause, they may develop new social identities, which also impact their QoL (Taebi et al., 2018; Ye et al., 2022).
Cultural Variability in Menopausal Experiences
Cultural and social contexts deeply influence how menopausal symptoms are experienced and expressed. While hot flashes/flushes are widely recognized as a hallmark symptom, reported prevalence differs markedly across populations: 62% in Europe and 59% in the United States, compared to only 29% in Japan (Nappi et al., 2021). Lock and Kaufert’s (2001) concept of “local biologies” illustrates how the interplay between sociocultural norms and physical environments shapes the manifestation of menopause. For example, differences between Japanese and North American women can be understood through factors such as the cultural valorization of aging in Japan, high lifelong intake of soy-based phytoestrogens, and traditional expectations that women prioritize family over personal health. These dynamics contribute not only to differences in symptom prevalence but also to patterns of reporting, reflecting how menopause is embedded within specific cultural logics. Further illustrating the influence of culture, a survey by Haines et al. (2005) across nine different Asian ethnicities found notable variations in symptom prevalence. For instance, body and joint pains were the most prevalent symptoms among Vietnamese and Korean women, with 96% of Vietnamese and 76% of Korean women reporting these issues. The high prevalence of these symptoms challenge the idea that menopausal symptoms are uniformly lower in Asian countries compared to Western countries.
This variability highlights the importance of examining cultural differences in menopause. However, existing quantitative studies, such as those by Haines et al. (2005) and Nappi et al. (2021) rarely explore the underlying reasons for these differences in experience and reporting of symptoms. Advancing understanding of menopause through a qualitative lens is warranted to capture the nuanced ways in which cultural, social, and psychological factors intersect to influence women’s experiences of this life stage.
Language and Medicalization of Menopause
Linguistic factors can shape how menopausal symptoms are understood and communicated (Melby et al., 2005). In some cultures, such as Indigenous Australian and Native American Indians, there is no specific word for menopause (Jones et al., 2012; Obermeyer et al., 2007). Similarly, there is no direct Japanese equivalent for the term “hot flush” (Melby et al., 2005). This absence of specific terminology reflects a different cultural engagement with menopause compared to Western societies where menopause is often discussed through focusing on symptoms and reproductive decline (Jones et al., 2012). The medicalization and Western framing of menopause appear to have influenced how symptoms are reported in Japan. After the term “menopause” was introduced into the Japanese language, reports of vasomotor symptoms increased, although prevalence remained significantly lower than among Japanese Americans and Caucasian women (Melby et al., 2005). This suggests that cultural and linguistic contexts play a critical role in shaping the perception and expression of menopausal symptoms.
In Western societies, menopause is frequently medicalized and viewed in terms of symptoms and treatment. This has been linked to more negative attitudes and heightened distress among women during this life stage (Ayers et al., 2010). In contrast, many Asian cultures perceive menopause as a normal part of aging (Ilankoon et al., 2021) and a liberating stage, marking freedom from menstruation and childbearing responsibilities (Krajewski, 2019). This approach can foster a more positive experience. It can be reinforced by societal practices that encourage non-pharmacological approaches to symptom management, such as using local herbs and engaging in Buddhist religious practices, which have been associated with reduced symptoms like insomnia (Ilankoon et al., 2021). These findings suggest that framing menopause as a natural life transition, rather than a medical condition, can offer benefits to women (Ilankoon et al., 2021).
In Hispanic and African cultures menopause is commonly perceived as a normal aspect of aging, leading women to downplay the severity of their symptoms (Zou et al., 2021). However, for immigrant women, cultural taboos surrounding menopause can create barriers to open discussion, causing them to endure symptoms in silence. This silence exacerbates emotional and mental health challenges, as the lack of dialogue limits access to support networks (Zou et al., 2021). The absence of open conversations can leave women feeling isolated, making it difficult for them to seek help and address the psychological challenges of menopause (Bell et al., 2022; Li et al., 2023; Zou et al., 2021).
The role of trust in healthcare providers is important in shaping how women manage menopause. For instance, research in the United Kingdom demonstrated that trust in healthcare providers encourages women to seek treatment, underlining the importance of a strong patient-provider relationship (Barber & Charles, 2023). Huston et al. (2009) found that trust in healthcare professionals influenced women’s adherence to hormone therapy, highlighting the role of medical expertise in shaping menopausal care.
Mohamad Ishak et al. (2021) identified several barriers that hinder menopausal women from seeking medical assistance, including low health literacy regarding menopause, low priority for addressing symptoms, and the perception of menopause as a natural part of aging that does not require medical intervention. As a result, many women turn to family and friends for support instead of consulting healthcare professionals (Mohamad Ishak et al., 2021). This reliance on informal support systems reflects how cultural norms can shape and limit the ways women manage their health.
Rationale for Study
While many quantitative cross-cultural comparison studies of menopause have been undertaken qualitative research is more limited (Gopalakrishnan & Ganeshkumar, 2013). A systematic review by Hoga et al. (2015) provided a broad overview of global menopausal experiences however, to our knowledge, no systematic review has specifically examined the cultural dimensions of menopause through qualitative research. This systematic review seeks to bridge that gap by synthesizing findings from qualitative studies across cultures. The research questions for this study are: (a) How do women across different cultures perceive and experience menopause? (b) What are the variations in the levels of support available to menopausal women, and how do these differences impact women? (c) How does access to healthcare for menopausal women vary across cultures, and what are the implications of these disparities?
Methods
Search Strategy
The protocol for this systematic review was registered on PROSPERO [Reference CRD42024516150] to ensure transparency and avoid duplication. A systematic search was performed using CINAHL, PubMed, Scopus, PsycINFO and Web of Science databases. As there are no gold standard methodological filters for qualitative research for systematic reviews (Shaw et al., 2004), the search strategy was developed in consultation with existing literature and systematic review experts within the institute. The search strategy combined Boolean operators and truncation with Medical Subject Headings (MeSH) keywords. The search was limited to studies published between January 2000 and June 2025 as Obermeyer (2000) only included studies up until 2000. Search terms were formulated collaboratively by the authors to comprehensively capture qualitative studies focusing on menopause and cultural differences (Appendix Table A3).
Eligibility Criteria
Inclusion criteria were established using the SPIDER framework (Appendix Table A1). Studies had to be published in a peer reviewed journal and written in English. No restrictions were placed on the geographic region or country of origin. Only studies that explicitly compared menopausal experiences across different cultures were included to ensure that all included studies adopted a cultural lens.
Exclusion criteria were studies on surgically induced menopause, as experiences associated with surgical menopause differed from natural menopause (Secoșan et al., 2019) and studies without an explicit cultural comparison. Additionally, quantitative and mixed-method studies, studies on societal perceptions of menopause (as opposed to women’s own experiences), and grey literature (e.g., theses, annual reports) were excluded.
Data Screening
Data screening was conducted using Rayyan. All articles were title and abstract screened by a member of the research team, and a second member independently screened 15% of the studies. There were no disagreements. During the full-text screening, all articles were reviewed by at least two of the team. Discrepancies were resolved through discussion. A total of 13 studies were included in the final review, as depicted in the PRISMA flowchart (Figure 1). The most common reason an article was excluded was lack of explicit cultural comparison.

Prisma flow diagram.
Data Extraction
Data was extracted under the following headings: author(s), publication year, country of origin, sample size, participants’ ethnic backgrounds, menopausal stage, number of participants who are mothers, study objective, data analysis methods, cultural contexts compared, and main findings. Additional study characterisitcs can be seen in Appendix Table A4.
Data Synthesis
Data were analyzed using thematic synthesis, following the framework by Thomas and Harden (2008). This approach was adopted as it enabled uncovering patterns across included studies, allowing for in-depth immersion in the data and interpretation of findings within broader cultural contexts (Purssell & Gould, 2021). Considering the study focus on cross-cultural experiences, this approach allowed for a culturally sensitive analysis by situating the data within the unique cultural settings in which menopause was experienced.
The synthesis process was conducted in three stages. The first stage involved line-by-line coding of the results of each study, employing an inductive approach to identify themes organically within the dataset (Thomas & Harden, 2008). In the second stage, recurring themes were noted and grouped, leading to the development of descriptive themes closely tied to the original studies (Thomas & Harden, 2008). This step maintained the integrity of each study while providing a comprehensive overview of commonalities across the data. The final stage involved generating analytical themes that extended beyond description (Thomas & Harden, 2008) enabling the production of broader insights and conclusions that transcend the scope of individual studies.
Quality Appraisal
The quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) for qualitative research (Critical Appraisal Skills Programme, 2024). Although CASP does not prescribe a scoring system, the method by Chatfield et al. (2017) was adopted to quantify the appraisal. Each CASP criterion was evaluated for compliance, with a score of 0 for non-compliance, 1 for partial compliance, and 2 for full compliance. Studies scoring ≤10 were categorized as lower quality, 11 to 15 as moderate quality, and 16 to 20 as higher quality. The outcomes of this assessment are summarized in Appendix Table A2, with 11 studies categorized as high quality and two as moderate quality. The most common unmet criterion was item seven, where ethical considerations were not mentioned. No studies were excluded based on their CASP scores.
Results
Thirteen studies were analyzed following full text screening and included for data extraction. Studies sample size ranged from seven to 90, with a collective sample of 418 menopausal women. All but study six (n = 21) recorded motherhood status. Of the 397 remaining participants, 87% were mothers. Using thematic analysis the following themes were identified: Narratives on Menopause, The Support Spectrum, and Navigating Healthcare: Preferences and Approaches. Subthemes are illustrated in Figure 2. Findings are referenced according to the study numbers in Table 1.

Diagram illustrating themes and subthemes.
Data Extraction.
Note. 1n per groups was not specified in this study
To support cross-cultural comparison, we organized our findings using Hofstede’s individualism–collectivism dimension as a guiding framework. National groups (e.g., China, Korea, Iran, Greece, Australia, United States) were mapped to their corresponding indices, while diaspora and racial/ethnic minority groups (e.g., Asian American, African American, Hispanic American, Korean Canadian, Singaporean Indian, Greek Australian) were treated as bicultural. These groups draw on both heritage cultural values, which are often more collectivist, and the individualist norms of their host societies, alongside structural experiences that shape health behaviors. While Hofstede’s indices do not determine individual values, they provide a consistent framework for organizing cultural patterns across the diverse contexts represented in this review (Hofstede & Bond, 1984). The thematic findings below are therefore interpreted through this integrative cultural lens. All but study 10 (n = 41) recorded demographic data in a manner which allowed us to note percentage of national culture participants (7%) and bicultural participants (93%).
Narratives on Menopause
Menopause is experienced, and interpreted, through diverse cultural lenses which shape how women perceive, discuss, and manage their symptoms. The cultural framework surrounding menopause influences whether it is predominantly seen as a challenging phase, a period of personal growth, or a natural transition that is either publicly discussed or privately endured.
Menopausal Symptoms: A Challenge, Growth, or Unimportant?
The diverse cultural lens is reflected as some women emphasize the challenges of menopause while others approach it with acceptance or even positivity. For example, an African American participant noted that: “White women are more negative about menopause. Black people just seem to make more jokes about it (1).
This tendency toward negativity is also observed among cultures characterized by more traditional gender roles (e.g., Greek Australian women, Chinese Singaporean women, Iranian women), who frequently expressed dissatisfaction with their menopausal symptoms (7, 8, 12). The cultural emphasis on the difficulties of menopause may amplify the perception of symptoms as burdensome or disruptive or resulting in a woman becoming “deficient” (12). Despite these differences, there are also commonalities within women from, or residing in predominantly individualist cultures (e.g., White, African American, and Asian women in the US), who view menopause as a period of transition that brings opportunities for personal growth and maturity (4). For example, an Asian woman in the US noted that “menopausal symptoms aren’t exactly enjoyable but everything in life is about growth and learning” (4). This shared attitude of embracing menopause as a new chapter suggests that within these largely individualist cultures, there are also positive perspectives on this life stage.
In collectivist cultures, particularly among women of color, there is a tendency to prioritize the needs of the family over personal discomfort during menopause. Filipino women, for example, often place their family’s needs above their own, even during challenging times such as menopause (5). This can be heard in the following quotation: “Considering the needs of the whole family as more important than her personal needs” (5). This sentiment is also echoed among women influenced by collectivist cultural backgrounds but residing in individualist countries and can reflect a tension between heritage and host cultural values. For example, Korean American women, who, while dealing with the stresses of immigration, tend to overlook their menopausal symptoms in favor of family responsibilities (6). This cultural expectation to care for others first often leads to these women overlooking their own symptoms, resulting in fewer reports of menopausal issues compared to individualist cultures that medicalize and emphasize individual experiences of menopause (1).
A Natural Transition
Cultural attitudes toward menopause vary in terms of how the transition is perceived. Many Hispanic American woman again are influenced by host country values and embrace menopause as a liberating phase, “I see menopause as almost liberating. I no longer have the heavy period” (3). This sentiment is also echoed among other hybrid cultures (e.g., African American, Chinese Singaporean, and Korean Canadian women), who generally accept menopause as a natural and expected part of life. These women believe that resisting this change could disrupt the natural order of life (1, 2, 8). Similarly, Asian American women are influenced by hybrid cultures and view menopause as a relief from concerns related to unexpected pregnancies and the discomforts of menstruation, seeing it as a welcome transition rather than a loss (4). These attitudes reflect an optimistic framing of menopause, highlighting it as a period of relief from the burdens associated with fertility and menstruation.
For some women who hold largely collectivist cultural values, menopause is accompanied by feelings of loss, regret, and grief as it signals the end of their childbearing years (6). For example, Iranian and Taiwanese women perceive this natural transition through a lens of loss and decreased libido (12, 13) and Vietnamese participants positioned menopause as an “unstable” time of life when various symptoms had to be juggled simultaneously resulting in multiple parts of their lives being impacted negatively (11). This perspective underscores the emotional complexity of menopause for those who mourn the end of their childbearing years and who view menopause as a natural yet challenging life change.
Additionally, cultural contrasts emerged in how menopause is perceived and discussed, as different cultural values can coexist within the same society. For instance, some Asian American women who hold heritage cultural values drew comparisons between their culturally ingrained acceptance of menopause and the individualist tendency of their host country to medicalize and pathologize natural life events (4). This contrast highlights a cultural tension s in how menopause is perceived, with collectivist cultures often prioritizing acceptance and resilience, while individualist cultures may be more inclined to medicalize life transitions and see them as conditions requiring treatment: “We are used to just getting along and not complaining a lot about natural things like menopause. . ..in the Western world there are terms like postpartum depression etc., these terms are unheard of in my culture” (Asian participant) (4)
From Private Pain to Public Discourse
Discourse on menopause across cultures, shapes whether it is treated as a private or public matter. Among groups embedded in predominantly individualist societies (e.g., European American, Asian American, African American, Korean Canadian, and Hispanic American), a common pattern is to avoid discussing menopause with men (1,2,4). However, the degree of openness differs depending on cultural and racial influences each community negotiates. For example, an African American participant noted that “Caucasian women. . ..talk about it a little more openly, where women of colour will talk about it more in an intimate setting” (1). This quotation highlights a broader tendency among African American and Latina women to confine conversations about menopause to close circles, emphasizing privacy over public discussion (1). In bicultural contexts where collectivist heritage norms intersect with individualist host cultures, similar patterns arise. Korean Canadian women noted that while Canadian culture is more open, their Korean heritage discourages discussing menopause, which is often seen as a taboo subject (2). This cultural reticence also affects Korean immigrants in the U.S., many of whom report a lack of dialogue within their families and communities, contributing to a lack of knowledge about menopause (6). For Hispanic Americans, there is a cultural tendency to avoid discussing menopause, resulting in many Hispanic American women normalizing their experiences and enduring menopausal changes without seeking emotional support, for example, “Suffer in silence. . ..silence is the golden rule in menopause” (3). For many of these participants, online forums represented their first opportunity to discuss menopausal experiences openly (3).
Asian American women also face cultural expectations to remain quiet about menopause publicly, and even privately within their families, which again reflects a bicultural group navigating both heritage norms and individualist U.S. cultural expectations. As noted by one participant: “Personally, I live in a different type of society here, times have changed. But bleeding, hot flushes, etc. is not considered ideal for discussion within the family” (5). This expectation is also reflected in collectivist cultures (e.g., Chinese and Korean cultures), whereby women are expected to handle menopause quietly and away from public or familial discussions to avoid being a disturbance (5). Whereas Chinese Singaporean women’s growing openness to discussing menopause was linked to health concerns and understanding symptoms, reflecting adaptation to a society increasingly influenced by individualist cultural norms (8). As heard in the following quotation, Chinese Singaporean women actively seek information and support from others, reflecting a cultural change toward greater transparency about menopause: “Greater awareness and public discussion about the issue here in the U.S. encourage women like us, who are from another culture, to be more open” (5).
Assimilation into more individualist culture may influence how some women approach discussions about menopause. For instance, American cultural norms, which support transparency and open dialogue about health, including menopause, have led some Asian American women to adopt a more open stance (5). This highlights an impact of living in a society that values open dialogue, as it encourages a supportive environment for women to communicate and understand their menopausal experience.
The Support Spectrum
Menopausal experiences are deeply intertwined with the support systems, cultural values, and communication frameworks that surround women. The role of family, social norms, spiritual beliefs and information available shape how women manage, and understand, menopause.
Family: Pillars of Strength, Sources of Stress
Family support plays a role in shaping woman’s menopausal experience, with the level and type of support provided influencing how menopause is perceived. For example, some cultures value emotional support in the form of open dialogue and communication, whereas others value practical support in the form of tangible advice and guidance. Among Hispanic American women influenced by their heritage cultural values, receiving practical support from their family is deeply rooted in this collectivist culture (3). As can be heard in the following quotation practical support from the family can increase a woman’s comfort during this life stage: “My family stresses that I get some extra sleep. [Our]culture views menopause as a serious time” (3). This woman’s reference to “culture” highlights that although residing in the US, she is still largely influenced by her collectivist heritage culture. In contrast, Korean Canadian, Asian American, and Greek migrants often face challenges due to physical separation from their families and may therefore be more likely to assimilate to the dominant, individualist culture in their host society (2, 5, 7). This exemplifies the emotional hardship due to the absence of close family support (2), challenges posed by different time zones (5), and diminished contact with family creating an emotional toll and sense of isolation (7).
Spousal support, particularly in patriarchal cultures, is another factor that can impact a woman’s menopausal experience. For instance, Chinese Singaporean and Vietnamese women emphasized the importance of their husbands’ understanding, especially regarding changes in sexual interest during menopause (8, 11). Similarly, both Iranian and Qatari women noted that the quality of spousal support is vital, as it can ease the menopausal transition “The most important thing is the husband and how does he react to this” (Qatari woman, 10). When this support is lacking, it often results in heightened fears of aging and anxieties about their husbands’ fidelity (10, 12).
The internal conflict faced by women in patriarchal cultures is poignantly illustrated through this Taiwanese woman’s quote: “Sometimes I feel my life with my husband is not really at stake, but sometimes I still feel sorry for him that he has the [sex] need” (13). This statement suggests the pressure to maintain marital harmony in a culture where sex is viewed as a man’s right and a woman’s obligation (13). For many Iranian and Taiwanese participants, this cultural expectation led them to suppress their discomfort and fulfil their husbands’ sexual needs, even if their own interest wanes. These findings suggest that menopausal changes in sexuality can be culturally embedded, reflecting the interplay between biological processes, gendered marital expectations and power dynamics.
Social Expectations, Spiritual Strengths
The social and environmental conditions surrounding menopause shape women’s experiences and coping strategies, with cultural values and religious beliefs influencing them. Cultures dominated by collectivist values, tend towards encouraging women to prioritize maintaining composure and suppressing complaints about discomfort during menopause (5). This emphasis on stoicism often leads to a diminished focus on personal well-being, creating a cycle where women’s health is sacrificed for the sake of perceived emotional strength (5).
However, in more individualistic cultures, menopause represents a pivotal moment to shift from caring for others to focusing on themselves. In this cultural context, menopause is seen as a time when women are finally prioritized, allowing them to reclaim their identity and well-being (2). Some women reported experiencing menopause as a time when they gained greater social status and respect within their extended families (7). As they age, these women ascend to more authoritative positions, enhancing their influence and reinforcing a positive perspective on menopause as a time of personal growth and emotional liberation (7). This contrasts sharply with perspectives where menopause is often viewed through a lens of loss, including loss of fertility, sexuality, and youth, contributing to a more negative perception of this life stage (2, 7, 12).
Religion can play a role in shaping menopausal experiences across cultures. For women influenced by largely collectivist cultures, faith provides a source of strength and comfort during this transition. For instance, Singaporean Indian women rely heavily on prayer as a coping mechanism “Whenever I got problem I just breathe in and just think of God” (9). This spiritual practice offers not only solace but also a framework for understanding, and managing, the physical and emotional challenges of menopause (9).
Similarly, many Arab participants viewed menopause as an opportunity to deepen their religious engagement (10). Freed from the restrictions of menstruation, they can participate more fully in religious practices such as prayer and pilgrimage, for example, “Like you have free time to perform the prayer and reading Quran, and perform Omra” (10). This newfound freedom allowed these Arab participants to see menopause as a period of spiritual growth, where religious values redefine the experience as one of enrichment rather than decline in life.
Language: A Pathway or a Wall?
The availability of information and the language used to describe menopause significantly shape women’s experiences, and perceptions, across different cultural contexts. For many immigrant women, who navigate more than one set of cultural values, language barriers can pose a considerable challenge, limiting their access to accurate and relevant information about menopause. For example, the disparity felt due to these linguistic hurdles can be heard in this quotation from a Korean Canadian participant: “We didn’t have any information before. . .. but Canadian women maybe they got information they can manage better than us” (2). The lack of accessible information due to language barriers reinforces Korean women’s perception that Canadian women, with their better access to knowledge, are better equipped to manage menopause (2). Furthermore, these participants expressed dissatisfaction with the explanations provided by healthcare professionals, preferring to consult with Korean doctors who share their language and cultural values (2). Korean participants noted that this gap not only affects their understanding but also their ability to effectively navigate this life stage (2).
Language also influenced how menopausal symptoms were perceived and described. For instance, Chinese Singaporean and Chinese American women frequently use the term “temper” rather than “mood swings” to articulate their emotional experiences during menopause (8). Differences in terminology could suggest that standardized medical terms may not fully capture nuances within experiences of menopause and could potentially lead to misunderstandings or miscommunications about symptoms.
The Arabic term for menopause translates as The Hopeless Age, which reflects a traditional cultural perception of menopause as negative and undesirable. However, in recent times many Qatari women are beginning to challenge this negative framing and see menopause as a time of wisdom and freedom rather than hopelessness (10). This evolving perspective signifies a cultural shift, whereby the traditional Arabic view of menopause as a decline is being influenced by more individualist perspectives and reinterpreted as a period of personal growth and self-reflection.
Navigating Healthcare: Preferences and Approaches
Menopausal experiences are deeply influenced by the intersection of cultural traditions and modern medical practices. However, the journey through menopause is also shaped by the level of trust women have in healthcare systems and the barriers they face in accessing appropriate care.
Crossing Paths: Traditional and Modern Medicine
Many cultural groups integrate traditional and Western medical practices, blending ancestral knowledge with modern healthcare to manage menopausal symptoms. For instance, Chicana women often rely on herbal remedies and familial wisdom while also utilizing medical services during menopause (1). This reflects a balanced approach that values both traditional knowledge and contemporary medical solutions (1). Similarly, Korean Canadian and Vietnamese women blend traditional home remedies with Western medical practices, demonstrating an acceptance of integrating diverse methods to address menopausal symptoms (2, 11). However, a clear preference for natural remedies and lifestyle modifications over medical interventions is evident in Asian American women, who often prioritize natural remedies due to cultural values that emphasize holistic approaches over individualized, medical approaches (5). Greek women in Australia also remain committed to their heritage values and turn to alternative therapies, such as herbs and tea therapy, as their primary approach (7).
Cultural expectations further influence whether women seek medical treatment for menopausal symptoms. For instance, African American women are influenced by their heritage collectivist culture and often endure menopausal symptoms without seeking medical help: “You’re expected to be strong women. I don’t think that my culture believes that menopausal symptoms are something that you would have to run to the doctor” (4). This cultural expectation contrasts with narratives reported by women in predominantly individualist cultural contexts, where early engagement with healthcare is considered a normative response. The following quotation illustrates this perspective: “I went running to my GP when my symptoms first started” (4). These differing narratives reflect culturally shaped healthcare practices rather than the appropriateness of any one approach. Women’s openness to hormone replacement therapy (HRT), commonly understood as estrogen–progestin–based treatments, also varied across cultural contexts, reflecting varying degrees of acceptance of the medicalization of menopause. For Korean Americans, who are also influenced by collectivist cultural values, menopause is generally not perceived as a condition that necessitates medical intervention however, there is an openness to considering HRT if necessary (6). Once again reflecting how women face a dilemma in balancing their heritage cultural identity with more contemporary healthcare expectations (2) and may struggle to harmonize traditional beliefs with modern medical interventions.
Across other collectivist cultures, women were also initially skeptical of HRT but have come to recognize its benefits after personal experiences (7, 8). This indicates a cautious yet evolving acceptance of modern medical interventions. However, this is not the case across all collectivist cultures as women still report deep reluctance towards HRT, largely due to cultural fear of cancer, which leads them to avoid prescribed medications altogether (9). This resistance to HRT underscores the powerful role that personal and cultural beliefs play in shaping treatment preferences, with some women choosing to forego medical interventions that conflict with their values or fears.
Healthcare utilization patterns reveal variations across cultural groups. White women in the USA, influenced by individualist culture, tend to frequently consult doctors for menopausal symptoms (4). In contrast, women influenced by more collectivist cultural practices often rely on over-the-counter remedies or choose to endure symptoms without seeking professional help (4). The differing approaches to healthcare reflect varying levels of trust in medical systems and institutions as well as highlighting the influence of cultural and societal factors on health-seeking behaviors. The two Singaporean studies provide contrasting insights: women in one study actively use Western medicine and are more open to HRT due to greater exposure to Western medication (8). Conversely, participants in the other study rarely seek medical help, avoid medicines due to negative past experiences, and did not perceive menopause as a condition requiring medical attention (9). These differences demonstrate that although there are dominant cultural values at play, they interact with societal influences and personal experiences and contribute to the layered complexity of cultural influences on healthcare choices.
Trust in Care, Barriers, or Bridges?
Cultural differences significantly influence how women navigate menopause, particularly in terms of their trust in and access to, healthcare. In individualist societies, where healthcare is more accessible, menopause is often medicalized. European American women, for example, generally demonstrate greater reliance on healthcare systems, readily expressing their concerns and engaging with medical interventions (1). This allows for more opportunities to discuss and manage menopausal symptoms through medical avenues, supporting a medicalized approach to menopause. In contrast, women influenced by collectivist cultures may rely more on non-medical remedies, an approach intertwined with a deep-seated fear of visiting the doctor, which is often rooted in past experiences of racial discrimination within the healthcare system (1). The fear and distrust in medical institutions can distance African American women from seeking medicalized treatments for menopause, leading them to explore alternative methods: “We’ve always been afraid, and we try to find other [nonmedical] ways, to curb it.” (1). Similarly, Asian American women often view menopause through a cultural lens that emphasizes acceptance and natural remedies over medical intervention: “Here, you go to the doctor for menopausal problems but in my native culture, it is NOT a sickness you get on with life. No talk” (5). This quote reveals the cultural divergence between seeing menopause as a medical condition versus a natural life event. When menopause is perceived as a normal biological process, there is less inclination to seek medical help, and a stronger preference for natural methods (5).
Greek women in Australia face their own set of challenges related to communication and trust in healthcare. Many report dissatisfaction with the clarity of information provided by doctors, especially regarding the effects of menopause medication. This dissatisfaction reflects a broader issue of trust, as Greek participants often felt their concerns were not adequately addressed, leading to a strained relationship with healthcare providers (7).
The experiences of Chinese Singaporean women reflect care-seeking within a hybrid cultural context, where collectivist heritage values support the use of traditional Chinese medicine while increasing individualist influences normalize engagement with Western biomedical care. “I took Chinese traditional medicine, but I didn’t stop my Western medication. I didn’t tell the Western doctor I just told Chinese physician to adjust medication” (8). Many women engaged in a cautious balancing act, integrating Traditional Chinese Medicine (TCM) to support their health while simultaneously harboring skepticism about its scientific validity. This approach reflects a deeper internal conflict, as these women find themselves caught between the cultural traditions they value and the growing influence of Western medical paradigms. The reluctance to fully embrace either method underscores the tension between adhering to long-standing cultural practices and placing trust in modern medical interventions.
Discussion
This study systematically considers how menopause is perceived, experienced, and managed across various cultural contexts. Although menopause is a universal biological event, its experience is shaped by cultural, socio-economic, and gender dynamics, influencing how it is understood, communicated, and addressed within different societies.
Influence of Cultural Attitudes
Cultural attitudes around symptom disclosure can greatly influence access to healthcare. Previous studies have shown that women from predominantly collectivist cultures, particularly immigrant groups navigating cultural taboos around ageing and reproductive health, often endure menopausal symptoms in silence (Li et al., 2023; Zou et al., 2021). This review expands on these findings by noting differences in how women from various cultural backgrounds talk about menopause within their communities. Women from more individualist cultural contexts, are often perceived, especially by women of color from collectivist or hybrid cultural backgrounds, as more comfortable discussing menopausal experiences openly (Elliott et al., 2002; Im et al., 2009). Whereas women from collectivist cultures tend to be driven by cultural norms that promote handling menopause more privately with less discussion (Im et al., 2009, 2011).
This raises the question: Does the cultural expectation of silence protect women from social stigma, or does it inhibit them from accessing support systems? Within collectivist culture, cultural norms may contribute to delayed recognition and treatment of menopausal symptoms, and a reluctance for women to seek help to manage their symptoms (Elliott et al., 2002; Im et al., 2009). These patterns align with earlier cross-cultural research, for example, Obermeyer’s (2000) observation that menopause was frequently conceptualized as a private life transition rather than a condition warranting medical attention. In contrast, women who reside within more individualist cultural contexts often report increasing comfort with openly discussing menopause and seeking information. However, this review highlights a growing trend toward greater openness among women from collectivist or hybrid cultural backgrounds, influenced by assimilation into Western cultures, increased health awareness, and the use of online platforms (Im et al., 2011; Lim & Mackey, 2012). This trend indicates a shift in cultural norms, suggesting that while traditional expectations persist, there is potential for new avenues of support that respect cultural sensitivities while encouraging more open engagement. Online platforms for instance, offer a space where women can discuss menopause more accessibly.
Cultural Lenses: Shaping the Menopausal Journey
Cultural differences shape the reporting, and perception of, menopausal symptoms. Previous research has consistently shown women in predominantly individualist cultures, such as many European and American contexts, tend to report more menopausal symptoms and perceive them more negatively (Melby et al., 2005). In contrast, previous cross-cultural studies indicate that in many collectivist cultural contexts, menopause was historically viewed as less significant compared to other life concerns. This cultural prioritization contributes to women from collectivist backgrounds frequently report fewer symptoms or attribute them less significance (Im & Meleis, 2000; Im et al., 2011). Among groups that emphasize strong communal roles, such as among Filipino and Korean American communities, women may overlook menopausal symptoms because these women prioritize familial responsibilities over personal health concerns (Im & Meleis, 2000; Im et al., 2011). This contrasts with the experiences of women situated within individualist or hybrid cultures that place greater emphasis on personal autonomy, and who are more likely to view menopause as a challenge due to the severity of its symptoms. These women typically live in cultural contexts where individual well-being is more highly valued, leading to greater reporting of menopausal discomforts (Dillaway et al., 2008; Komesaroff et al., 2002; Lim & Mackey, 2012).
Findings from this review build upon Lock and Kaufert’s (2001) research, which demonstrated that in Japan, a predominantly collectivist cultural context, cultural norms surrounding aging and menopause lead to a reduced emphasis on menopausal symptoms. The extension of this pattern to Filipino and Korean American women suggests that the cultural minimization of menopause is not unique to Japan but is a broader phenomenon in cultures that emphasize communal obligations over individual health concerns. This raises concerns about the effectiveness of a one-size-fits-all approach to menopausal care. Such an approach may overlook the needs of women from cultures where menopause is downplayed, potentially leading to delayed diagnosis and inadequate support.
Facilitators and Barriers to Positive Menopausal Experiences
The influence of family support, particularly from spouses plays an important role in shaping women’s experiences during menopause. While prior research has acknowledged the significance of family in seeking support (Mohamad Ishak et al., 2021), this review offers further exploration of how spousal attitudes affect women’s menopausal experiences. In patriarchal societies, where a woman’s self-worth is often closely linked to her husband’s perceptions, negative responses from spouses can heighten anxieties and fears about sexual desirability and the stability of the partnership (Murphy et al., 2013; Yang et al., 2016). On the other hand, positive spousal support can provide assurance and comfort, mitigating the psychological and emotional challenges associated with menopause (Im et al., 2009; Murphy et al., 2013). These differences highlight the importance of culturally sensitive interventions that involve not just women but their partners as well, to promote a supportive environment.
In addition to family support, the review highlights that social factors can also positively influence menopausal experiences. In many collectivist or hybrid cultural contexts, menopause is seen positively as liberation that marks a transition to a higher social status, bringing increased respect and opportunities for self-reflection (Elliott et al., 2002; Komesaroff et al., 2002). This contrasts with women in more individualist cultural settings who often report negative perceptions of menopause, where menopause is frequently associated with loss of fertility, youth, and desirability (Komesaroff et al., 2002). Religion is often drawn on as a coping mechanism, offering strength and support during menopause, across various collectivist and hybrid cultures. For women in Indian, Singaporean and Arab communities, religious practices provide new avenues for participation and identity post-menopause (Komesaroff et al., 2002; Lim & Mackey, 2012).
The review considers previous claims regarding the absence of terminology for menopausal symptoms in non-Western languages (Jones et al., 2012; Melby et al., 2005; Obermeyer et al., 2007). This difference may have been influenced by previous studies’ narrow focus on specific cultural contexts, such as Japanese and Mayan cultures, which were not included in the current review. This review instead highlights that women from collectivist and hybrid cultural backgrounds frequently use culturally embedded expressions to describe menopausal experiences. To echo a point noted by Lim and Mackey (2012) it may be useful to include culturally specific terminology into research questionnaires to enhance understanding and reporting of menopausal symptoms across cultures.
Healthcare Decisions and Preferences
Trust in healthcare systems influences symptom reporting and treatment choices, shaped by cultural beliefs and past experiences. While in predominantly individualist cultures women with high trust tend to prefer medical interventions (Dillaway et al., 2008), women from collectivist or hybrid cultures often favor natural or combined traditional and modern approaches (Dillaway et al., 2008; Im et al., 2011; Komesaroff et al., 2002). This aligns with the idea that culturally positioning menopause as a natural progression can enhance the overall experience (Dillaway et al., 2008; Mackey et al., 2014). Importantly, trust in Western medicine does not replace traditional practices. Instead, many women in hybrid cultural settings, such as Chinese Singaporean women, commonly combine biomedical treatments with culturally rooted approaches (Lim & Mackey, 2012). This nuanced interplay highlights the need for healthcare systems to accommodate cultural preferences rather than expecting modern treatments to fully replace traditional ones.
Strengths and Limitations
The strength of this work lies in its broad scope and inclusive approach, integrating a diverse array of cultural perspectives on menopause. By encompassing studies from various individualist, collectivist, and hybrid cultural contexts, it provides a nuanced understanding of how cultural factors shape menopausal experiences. The qualitative approach adds further depth to our understanding of these experiences and provides supplementary knowledge to previous quantitative studies.
Another key strength is the review’s methodological rigor. The decision to include only studies that explicitly compare cultures ensures a more focused and robust analysis by emphasizing comparative cultural perspectives. The inclusion of research from eight countries and 17 cultures further broadens the scope and depth of the analysis, contributing to a more comprehensive understanding of menopause across diverse contexts.
However, the review is not without its limitations. Despite its cultural and global perspective, the review does not fully represent all regions. Notably, South America and South Africa are underrepresented, which means the review might not fully capture the cultural diversity of these continents. Although studies from the United States include Hispanic and African groups (Dillaway et al., 2008; Im et al., 2009, 2010), they may not fully reflect the cultural nuances of these populations in their countries of origin. Moreover, many studies predominantly examined cultural differences through the lens of women of color, often comparing them to European and American women which may limit the generalizability of findings.
The review also faces challenges with broad racial categorization. While general categories like Asian, African American, and White help identify group-specific trends, they can oversimplify the diversity within these groups and perpetuate stereotypes. These findings highlight the need for more nuanced categorizations that consider individual and subcultural variations to avoid biases in both research and clinical practice. Finally, while a number of studies included in this work, for example, Im and Meleis (2000) and Im et al. (2011), reported the qualitative data of a larger mixed methods study, it may have strengthened this review further had the search inclusion criteria explicitly included mixed methods studies in which the qualitative data was reported separately.
Implications
This work enhances the theoretical understanding of menopause by expanding its conceptualization across individualist, collectivist, and hybrid cultural contexts, it challenges the view of menopause as merely a negative event. Instead, it highlights cultures in which menopause is understood as a natural or even positive life transition, associated with increased autonomy, social respect, or spiritual growth (Dillaway et al., 2008; Elliott et al., 2002; Mackey et al., 2014). However, this recognition of menopause as a culturally positive experience should not inadvertently normalize or silence the suffering experienced during this time of life or obscure the very real physical and emotional difficulties many women face.
The increasing openness in discussing menopause, especially among women navigating hybrid cultures and engaging in online platforms (Im et al., 2009, 2010; Lim & Mackey, 2012) is a promising development. Healthcare providers and policymakers should leverage this trend by creating environments that encourage open discussions about menopause and support women in accessing timely care, particularly within minority and immigrant communities. The growing use of online platforms by women to discuss menopausal symptoms, despite cultural stigmas (Im et al., 2009, 2010), also highlights the potential for these platforms to bridge cultural barriers and facilitate early symptom recognition and treatment.
In addition, findings from this review highlight the need to develop culturally sensitive assessment tools that accommodate diverse linguistic and cultural contexts, thereby enabling more accurate symptom reporting and treatment.
Future Research
Current studies are concentrated on North America, Europe, and parts of Asia, leaving gaps in the understanding of menopausal experiences in underrepresented regions like South America and Africa. The existing research mostly reflects the experiences of women of color and their views on Western women’s experiences, which may oversimplify and reinforce stereotypes about menopause (Dillaway et al., 2008). To address this, future research should investigate the diverse experiences of women in various individualist, collectivist, and hybrid cultural contexts. Such research should also ensure that clarity is provided regarding identification of participant race, and ethnicity and the source of classifications used (Flanagin et al, 2021). Moreover, as online platforms increasingly shape menopausal discussions (Im et al., 2009, 2010), it is relevant to study how these spaces influence women’s perceptions and management of menopause. Future research should also focus on how factors such as socio-economic factors influence menopausal experiences across different ethnic groups.
Conclusion
This study examines how cultural and social factors shape women’s experience of menopause. Notably, the increasing openness among women from collectivist or hybrid cultural backgrounds in Western societies to discuss menopause marks a significant shift from traditional norms of silence. This change, driven by assimilation, heightened health awareness, and digital connectivity, signals a redefinition of menopause in communities where it has historically been stigmatized. Moreover, this study advocates for the development of more equitable healthcare systems that recognize and respect the diverse ways in which women navigate menopause across different cultural landscapes. The findings underscore the importance of culturally sensitive healthcare practices tailored to each woman’s unique needs.
Footnotes
Appendices
Additional Study Characteristics.
| Author(s), year, | Sample size | Study objective | Data analysis method |
|---|---|---|---|
| Dillaway et al. (2008) | 61 | Comparing different groups’ experiences, acknowledging intersecting social locations, and conducting in-depth analyses of the complexities of privilege and oppression that we can deepen our understanding of why and how race/ethnicity, class, gender, and other social locations might matter in women’s menopause experiences. | Inductive analysis |
| Elliott et al. (2002) | 7 | Examine how menopause is experienced by a sample of Korean–Canadian women. | Narrative reduction |
| Im et al. (2009) | 27 | Examined the menopausal symptom experience of Hispanic midlife women in the United States. | Descriptive content and thematic analysis |
| Im et al. (2010) | 90 | The purpose of this study was to explore commonalities and differences in menopausal symptom experience among four major ethnic groups in the United States (Whites, Hispanics, African Americans, and Asians). | Thematic analysis |
| Im et al. (2011) | 13 | To explore the menopausal symptom experiences of Asian American midlife women within the contexts of their daily lives using a feminist approach. | Thematic analysis |
| Im and Meleis (2000) | 21 | Explore the meanings of menopause among a vulnerable group of women low-income Korean immigrant women. | Thematic analysis |
| Komesaroff et al. (2002) | 40 | To demonstrate how qualitative methodologies can assist with the development of clinical services by employing them to elucidate the role of cultural variables in the ways in which Greek women view menopause, aging, illness and medicine. | Thematic analysis |
| Lim and Mackey (2012) | 14 | Explores the menopause transition experiences of ethnic Chinese women in Singapore. | Thematic analysis |
| Mackey et al. (2014) | 58 | Explored knowledge, attitudes, and practices associated with the menopause transition particular to women in the multi-ethnic cultural context of Singapore. | Thematic analysis |
| Murphy et al. (2013) | 41 | The aim of this study was qualitatively to describe and examine the expectations and experiences of the midlife transition in Arab women living in Qatar. | Thematic analysis |
| Nguyen et al. (2024) | 13 | This study aimed to explore Vietnamese women’s experiences during the menopausal transition. | Grounded theory analysis |
| Shamsalizadeh et al. (2025) | 15 | The purpose of this study was to explore the meanings of menopause through women’s lived experiences to identify how the meanings of menopause were infused by women’s socio-cultural context. | Thematic analysis |
| Yang et al. (2016) | 18 | To examine Taiwanese women’s perspectives on the way menopause affected their sexual behavior to gain an in-depth understanding of their experiences during this transition. | Thematic analysis |
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, or authorship of this article.
