Menopause is inevitable for people with ovaries. Still, the experience is far from universal. Culture, geographic location, and biology play a role in the development of women in perimenopause and menopause.
For writer Laurie Ulster, 54, entering perimenopause a few years ago came as a shock – mostly because she didn’t know much about perimenopause until she started experiencing symptoms.
“The way we hear about menopause as a kid is basically that you stopped getting your periods and stopped having babies. And there are hot flashes,” Ulster said. “”[There’s] No talk of there could be an entire decade of unpredictable symptoms. ”
Ulster is a Canadian who now lives in New York. He belongs to a white Jewish family who openly discussed periods and bodies. “With all of this, it was super weird to be so in the dark during perimenopause,” she said. “I’m an adult who doesn’t live with older generations. My mother died in 2013 … she’s the person I would have gone to.”
For writer Nandita Godbole, connecting with her mother as an Indian woman who had hysterectomies was complicated, since neither menopause nor hysterectomies are typically part of the larger cultural conversation. In 2019, Godbole entered menopause after undergoing a hysterectomy. She told her mother about the procedure, but kept the conversation short and simple.
“The Indian cultural construct of femininity is strongly tied to a woman’s ability to bear children,” Godbole wrote via email. “Triggering menopause with a hysterectomy is often viewed as an act of weakness or ‘less than’.”
Menopause remained an intense topic of conversation between Godbole and her mother – even after they shared the experience. Godbole tries to change that by openly sharing her experiences with her teenage daughter.
Symptoms and attitudes vary by culture
Menopause can be less shocking in cultures where multi-generational family environments are paramount, according to Dr. Mary Jane Minkin, clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale University School of Medicine and a member of the HealthyWomen’s Women’s Health Advisory Council. Minkin explained that multi-generation living allows younger people to learn from their elders.
“In the US, we’re much less family-oriented,” Minkin said. For example, age of menopause tends to be hereditary – if a woman goes through menopause at a younger age, her daughter is likely to have a similar experience. “When you see a couple of aunts going through menopause early, it becomes ‘that’s what we do in our family,'” Minkin continued. “It’s more acceptable and you can talk to your aunts because they’re there and they can share their experiences.” Those without this multi-generation connection may be more isolated.
Numerous studies published over the last 15 years show how women all over the world experience the physical aspects of menopause differently.
A 2015 study of the prevalence of postmenopausal symptoms in North America and Europe, co-authored by Minkin, found that certain symptoms – particularly vaginal dryness, hot flashes, night sweats, trouble sleeping, and weight gain – were more common in women from the US, Canada, and the UK. Women from these countries also said the effects were “worse than expected”. Conversely, the study found that these symptoms were less common in women from Sweden and Italy. In addition, women from Sweden, Norway and Denmark reported that their experience with menopause was “better than expected”.
According to a 2007 article by Nancy Avis and Sybil Crawford, Western cultures associate menopause with hot flashes, but other cultures often associate it with other symptoms. The article found that Japanese women reportedly have headaches, stiff shoulder, and chills, while Nigerian women cite joint pain as the most common symptom.
Through an email exchange with HealthyWomen, Crawford, a professor at the University of Massachusetts Medical School, confirmed that research continues to confirm 2007 results, that symptoms vary widely between cultural groups, and that more recent studies have expanded to include groups that have not previously been investigated.
She explained that differences likely reflect biology (including health-related behaviors that can affect biology, such as diet and smoking), as well as attitudes toward menopause. “Biological factors influence whether symptoms such as hot flashes occur,” wrote Crawford, “Attitudes influence the meaning and perception of symptoms.”
She added that because of different terminology, surveys may not capture symptoms in different cultures. “We need to ask about experiences that will resonate with the study participants,” Crawford said.
What does aging have to do with it?
The perception of age is also believed to play an important role in how women experience transitions in middle age. In countries that adore old age, like African and Asian societies, menopause is viewed differently, Minkin said. Crawford’s 2007 study also found that menopause is often viewed more positively in non-Western cultures.
“When you’re older, you are smarter – that’s good, so it’s good to be older, and maybe the hot flashes aren’t that bad,” Minkin explained. “But if you’re in a society that adores the youth, it may not be so good that you get hot flashes.”
A 2011 article by the British Psychological Society argued that women in Western societies tend to be valued for attractiveness, fertility, and youthfulness. Therefore, aging tends to be viewed negatively by women and society as a whole.
Speaking of menopause
Minkin said one thing Americans can do to improve the experience of menopause in the United States is to maintain a dialogue about menopause, aging, and sex.
“If women can communicate with each other about what they’re going through, then they’re not alone – they’re not crazy,” Minkin said.
Ulster said her perimenopausal experience would have been easier if she had known what was causing her symptoms. “I would have felt less like a freak,” she concluded. Ulster and her older sister eventually bonded. The more they talked about menopause, the more easily she asked her friends about their experiences.
Nationally, Minkin hopes first lady-elect Jill Biden and Vice-President-elect Kamala Harris will deepen the conversations about menopause and include the issue on their health agendas.
She also applauded former first lady Michelle Obama for publicly discussing hot flashes.
“I have a feeling people will think if it’s good enough for Michelle Obama to talk about it, it’s okay for me to discuss it.”