Cultural Differences in Women’s Experience of Menopause: A Qualitative Review

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.

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.

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.