The Asian Menopause Experience

By Maria C. Hunt

If a woman in her early 50s tells her doctor she’s having hot flashes, most clinicians will talk about “menopause.” But when midlife East Asian and Southeast Asian women go to their doctors with their typical menopause symptoms— severe body aches, joint pain and weight gain — their clinician is likely to think of arthritis, or lecture them about eating less and moving more.

For many Asian women, menopause can be a very private and isolating experience. Doctors miss their symptoms and it’s not part of conversation with friends or family. “In Asian cultures, you know it’s not cancer, it’s not a heart attack, it’s something you’re supposed to just quietly manage,” says Karen Tang, MD, a board-certified gynecologist at Thrive Gynecology in Bryn Mawr, PA, and author of It's Not Hysteria: Everything You Need to Know About Your Reproductive Health (but Were Never Told).

Culturally, menopause is seen as a natural transition, so why would it need any medical treatment? But that doesn’t mean women aren’t seeking relief. When researchers in Taiwan interviewed 1,000 pan-Asian women in 2010, they learned nearly 40 percent used natural remedies⁽¹⁾ for their symptoms including body aches and disturbed sleep. And while more than half knew of HRT, close to 40 percent didn’t know how it worked. A decade later, a National University of Singapore study found that no matter how women felt about their menopause transition, conservative societal norms discouraged many of them from seeking help⁽²⁾.

Many South Asian women are equally reluctant, says Sameena Rahman, MD, a board certified OB/GYN who practices in Chicago. A 2022 study from Nipissing University School of Nursing confirmed that South Asian women in Toronto were likely to self manage⁽³⁾ symptoms.

Across many South Asian cultures, a woman on her period is considered unclean, so most women don’t talk about. In Nepal, the ancient Hindu practice of banishing women to outdoor menstrual huts called chhaupadi was outlawed in 2005, but it still happens. In 2019, a woman died in one, and researchers found 8 in 10 girls were still barred from their homes during their cycles⁽⁴⁾.

Women in the Islamic faith also cope with restrictions. “I’m Muslim so we don’t go to mosques or pray or fast when you’re menstruating,” Rahman says. So many Muslim women see menopause as a gift, and hot flashes, belly fat gain or painful sex may seem like an acceptable trade off.

But untreated hot flashes and visceral fat around the organs are like pouring gasoline on preexisting inflammatory conditions like diabetes and heart disease. Cardiovascular disease is an epidemic in Pakistan and among immigrants, and women tend to have greater risk than men⁽⁵⁾ because of higher rates of obesity, high blood pressure, diabetes and elevated blood fat. “Of course [they’re] the ones that are going to die quicker and [they’re] not going to get the cardiac catheterization⁽⁶⁾,” Rahman says. “It’s like an uphill battle for women for some women of color.”

It's Time to Break the Silence

But that’s slowly starting to change. Rahman says Gen X and Millennial women aren’t about to suffer silently through menopause; they’re talking about it and sharing information. And for the first time in 2022, the Japanese government funded menopause research, Tang shares. According to a Nikkei Asia article, the move came after the workforce shrank by 10 percent as menopausal women dropped out to deal with their health. “It was like a menopause expert saying that it had not been thought of as a real medical issue worth research,” Tang says. It “made an impact that women were dropping out of the workforce just at the time they’re supposed to be taking on leadership positions.”

Tang recalls that when her mother started having serious back and joint pain, she worried something was seriously wrong. But tests her doctor ran were “normal,” so her mother went home, wondered if she was overreacting, and coped as best as she could. “She was left at the point of, well I guess I’ll just deal with this on my own and get numbing medicine patches and put them all over the place,” Tang says.

She wrote her book to empower women to ask educated questions and advocate for care. She also wants them to shift their mindset away from suffering quietly; every woman deserves to feel good. “That’s important for an Asian woman who is more reluctant to press an issue,” she says.

As a baseline, midlife women need to make sure they’re getting eight hours of restful sleep, eating foods that support wellness and making time for regular strength training and cardio. Rahman and Tang shared these other strategies for Asian women:

Focus on lowering cardiovascular risk

The 2023 MASALA study⁽⁷⁾ says midlife is the time for women to redouble efforts to make sure they’re heart healthy. Menopause increases risk for more subcutaneous fat, hypertension, higher BMI and abnormal blood lipids. The study says BMI and blood pressure screenings can help women determine their level of risk. Know your numbers.

Ask your doctor about a calcium scan

The coronary artery calcium (CAC) test is a specialized scan that allows clinicians to see if calcium deposits are starting to form in the heart’s walls and arteries. A rating from 0 to 300 predicts your heart disease risk; the lower the number the lower your risk of a heart attack in the next 10 years. Depending on your risk factors including family history and your age, your insurance company may pay for the test.

Manage pain in a comprehensive way

Estrogen hormone replacement therapy can be one of the most effective ways to manage body aches and joint paint⁽⁸⁾. But even for women who aren’t interested in HRT Tang often refers patients for physical therapy, and/or evaluation by a physical medicine and rehabilitation (PMR) physician, who can look for other causes of joint, muscle and nerve pain. Acupuncture can also help some women, she says.

Get support with mood

It’s hard to take care of yourself or others if you’re feeling down or depressed. Tang suggests seeing a licensed mental health professional, because counseling and cognitive behavioral therapy can help not only with mood symptoms, but also with managing other menopausal issues like vasomotor symptoms.

Educate yourself about HRT

Even though many Asian women are on long term medications for blood pressure, Tang says many are still scared of taking menopausal hormones for years. Since replacing missing estrogen can resolve many symptoms, she urges them to learn about modern bio identical hormones, and have a discussion with a menopause-trained doctor to determine if the health benefits outweigh the risks.

Some Instagram accounts to follow:

• Dr. Karen Tang @karentangmd
• Dr. Sameena Rahman @gynogirl
• Dr. Nighat Arif@drnighatarif
• Meera Boghal@meeraboghal

Background reading:

• It's Not Hysteria: Everything You Need to Know About Your Reproductive Health (but Were Never Told) by Karen Tang, MD
• Relation of Menopause with Cardiovascular Risk Factors in South Asian American Women (From the MASALA Study)
• Sub-Ethnic Differences in the Menopausal Symptom Experience: Asian American Midlife Women - The Economic Case for Better Female Health in Nikkei Asia.com

Author Bio

Maria C. Hunt is a California-based journalist and author specializing in cultural stories around cuisine, beverages, travel, and wellness, particularly menopause and ethnic health disparities.