Menopause is a universal biological transition that affects all women and gender-diverse people assigned female at birth as they age, but the experience can vary significantly across different ethnic and cultural groups. In this blog post, we delve into the unique journey of Asian and Asian American women through menopause, highlighting both cultural influences and health-related aspects.
The SWAN Study: Age of Menopause
The SWAN Longitudinal Study -- Study of Women's Health Across the Nation -- has been pivotal in understanding menopause. It revealed that the average age of the final menstrual period varied among ethnic groups: 50.9 years for Latinx women, 52.2 years for Black women, 52.4 years for Chinese women, 52.9 years for White women, and 53.1 years for Japanese women. However, when adjusting for socioeconomic, lifestyle, and health factors, these differences vanished, suggesting that external social factors significantly influence the timing of menopause (1).
Symptom Diversity and Ethnicity
The study also shed light on the prevalence of menopausal symptoms:
Early and Premature Menopause: Chinese and Japanese women were the least likely to report menopause onset before the age of 45. Chinese and Japanese women were also the least likely to experience surgical menopause via removal of the ovaries.
Hot Flashes and Night Sweats (Vasomotor Symptoms): Latinx women (49.4%) and Black women (46.5%) reporting the highest rates. Chinese (36.6%) and Japanese (34.3%) reported more vasomotor symptoms than White (28.9%) women.
Mood Symptoms: Latinx and Black women were more likely to report depressive symptoms, while Chinese and Japanese women were the least likely. Japanese women were also the least likely to report trouble falling asleep.
Attitudes Towards Menopause: Black women reported more positive attitudes towards menopause, contrasting with the less positive attitudes reported by Chinese- and Japanese-American women. As attitudes towards menopause may have affected the participants' responses in the study, we must bear this in mind.
Possible Reporting Bias
Interestingly, the differences found in hot flashes in the SWAN Study (and others) may largely be due to reporting bias. In a 2009 survey, women of Japanese descent in Hawai'i reported significantly fewer hot flashes in the prior two weeks than women of European descent. However, the two groups reported no differenced in hot flashes in real time via diary entries (2). In addition, skin conductance testing showed no difference in the number of objective hot flashes experienced by Japanese American and European American women! This once again reflects the fact that attitudes toward menopause may impact its subjective experience.
Asian Cultural Perspectives and Menopause
A 2019 meta-synthesis reviewed 17 qualitative studies examining the Asian experience of menopause (5 United States studies and 12 Asian studies) (3). The authors found an interaction between Asian women's attitudes regarding menopause and their experiences, both positively and negatively.
Positive Attitudes: In contrast to the SWAN Study, this review found that Asian women generally have neutral or positive attitudes toward menopause. Cultural influences often served as protective factors against menopausal symptoms.
Cultural Barriers: Despite positive attitudes, Asian women may face challenges related to cultural norms. The stigma around discussing menopause openly can hinder seeking appropriate care.
The Western Experience: Asian women in Western cultures tend to retain their traditional practices and remedies around menopause. A diverse set of self-management strategies are used.
Understanding South Asian Immigrant Women’s Menopausal Experience
A 2022 review of South Asian immigrants' experiences with menopause highlighted 11 different studies and discovered the following themes (4):
1. Symptoms
Physical Symptoms: South Asian immigrant women commonly report vasomotor symptoms such as hot flashes and night sweats, joint pain and stiffness, fatigue, headaches, and gastrointestinal issues.
Psychosocial Symptoms: Mental health challenges, including anxiety, depression, and decreased memory/concentration, are prevalent.
2. Facilitators and Barriers:
Education and employment serve as facilitators for a healthy menopausal transition, while barriers include a lack of knowledge and support.
The Impact of COVID-19
In a 2024 comparative study between midlife women from the United States and China, researchers explored factors influencing the willingness to seek help due to menopausal distress. Surprisingly, knowledge about menopause did not directly impact motivation to seek help in either sample. Instead, cultural nuances, perceived severity of symptoms, self-efficacy, and COVID-19–related barriers played significant roles (5).
In both groups, perceived benefits and self-efficacy predicted motivation to seek help.
Interestingly, those who were more concerned over COVID-19 infection were also more motivated to seek help in menopause.
Interventions and Recommendations
Culturally Sensitive Care: Healthcare providers should offer culturally sensitive care, addressing women’s unique needs. Providers should be aware that Asian women often prefer self-management and traditional remedies to cope with menopausal symptoms.
Support Networks: Building strong support networks within the community can enhance well-being.
Reducing Socioeconomic Barriers: Addressing socioeconomic challenges is crucial for optimal health outcomes.
Easy Access to Telehealth: Concern over COVID-19 infection during the pandemic highlighted the need for culturally sensitive telehealth solutions to support menopausal health (5).
Exercise and Mind-Body Interventions: Exercise and mind-body therapies have been found to improve quality of life, menopausal symptoms, and depression among Asian perimenopausal women. However, hot flashes were not improved with these interventions (6).
Offer Trustworthy Information: Asian woman report that they seek trustworthy sources of information during the menopause transition (3). Therefore, providers should strive to offer unbiased, accurate, and up-to-date information regarding the standards of care for menopause. According to The Menopause Society, symptomatic menopausal women within 10 years of menopause onset and without contraindications should be offered menopausal hormone therapy as a first-line treatment (7).
Conclusion: Bridging Cultural Understanding
The Asian American experience with menopause is multifaceted. While cultural influences serve as protective factors against menopausal symptoms, they can also hinder open discussions and access to care. Healthcare providers must recognize these nuances and provide culturally sensitive support. By bridging cultural understanding and addressing unmet needs, we can empower Asian and Asian American women to navigate menopause with resilience and knowledge.
Remember that individual experiences vary, and personalized care remains essential. Let’s continue to explore and celebrate the diversity of menopause experiences across cultures.
References:
Green R, Santoro N. Menopausal symptoms and ethnicity: the Study of Women's Health Across the Nation. Womens Health (Lond). 2009 Mar;5(2):127-33. doi: 10.2217/17455057.5.2.127. PMID: 19245351; PMCID: PMC3270699.
Brown DE, Sievert LL, Morrison LA, Reza AM, Mills PS. Do Japanese American women really have fewer hot flashes than European Americans? The Hilo Women's Health Study. Menopause. 2009 Sep-Oct;16(5):870-6. doi: 10.1097/gme.0b013e31819d88da. PMID: 19367185; PMCID: PMC2746710.
Shorey S, Ng ED. The experiences and needs of Asian women experiencing menopausal symptoms: a meta-synthesis. Menopause. 2019 May;26(5):557-569. doi: 10.1097/GME.0000000000001269. PMID: 30562319.
Zou P, Luo Y, Wyslobicky M, Shaikh H, Alam A, Wang W, Zhang H. Menopausal experiences of South Asian immigrant women: a scoping review. Menopause. 2022 Feb 14;29(3):360-371. doi: 10.1097/GME.0000000000001919. PMID: 35213522.
Lau BHP, Tang CSK, Holroyd E, Wong WCW. Challenges and Implications for Menopausal Health and Help-Seeking Behaviors in Midlife Women From the United States and China in Light of the COVID-19 Pandemic: Web-Based Panel Surveys. JMIR Public Health Surveill. 2024 Jan 26;10:e46538. doi: 10.2196/46538. PMID: 38277194; PMCID: PMC10858418.
Shorey S, Ang L, Lau Y. Efficacy of mind-body therapies and exercise-based interventions on menopausal-related outcomes among Asian perimenopause women: A systematic review, meta-analysis, and synthesis without a meta-analysis. J Adv Nurs. 2020 May;76(5):1098-1110. doi: 10.1111/jan.14304. Epub 2020 Feb 17. PMID: 31950541.
“The 2022 Hormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022 Jul 1;29(7):767-794. doi: 10.1097/GME.0000000000002028. PMID: 35797481.
Comentários