The Middle Eastern Menopause Experience

By Maria C. Hunt

No matter who you are, menopause can catch you by surprise. Noor Al-Humaidhi, MD, a lifestyle medicine doctor, is the daughter of a white American mother and a Kuwaiti father. “My mother's experience was very much hot flashes,” she says.

But when Al-Humaidhi, whose practice is in Exeter, New Hampshire, went through her own menopause transition, it was very different. “My own experience was debilitating fatigue and mental health brain fog that was a big feature of my perimenopause symptoms,” she recalls. “I think it took me so long to figure out what was wrong with me …because I was like, well, I’m not having hot flashes, so surely I’m not in menopause.”

Her experience is typical of other women across the Middle East. Studies on menopausal Middle Eastern women paint a picture of women who are dealing with varied symptoms, and very high rates of serious bone health and metabolic issues, coupled with a lack of education on how to resolve them.

Generations of women across Kuwait, Saudi Arabia, Syria and Egypt have known menopause by an Arabic phrase that means “the age of despair”. But that narrative is starting to change. TENA, the world’s largest maker of incontinence products, launched a competition for women to suggest a new phrase for menopause. The menopause transition was rebranded in 2021 as the Age of Renewal in a joint campaign with the United Nations Population Fund. When people look up menopause in the popular Al Maany dictionary, they’ll find the age of renewal. The larger campaign included Egyptian actress Shereen Reda, Jordanian/Palestinian TV journalist Fadia Al-Taweel, and Tunisian singer Ghalia Benali, who recorded a song called Despair No More.

And Al-Humaidhi was excited that she just attended a 2024 menopause summit in Doha, Qatar, as women are coming together to mastermind providing needed care and education to women across the region.

Still, there’s much work to do. When Al-Humaidhi established her Lifestyles by Noor Practice, women across the Middle East sent her messages via Instagram seeking online consultations. Many countries, including affluent ones such as Kuwait, lack menopause-trained doctors and the full range of modern bioidentical hormone medications. The Kuwaiti government determines the formulary, and she says that right now, there’s just one oral estradiol pill for menopausal women. “You cannot get any transdermal or oral micronized progesterone in Kuwait. The availability is not there,” she says.

She’s also been swamped by interest from women in her local area who want to make sure they age gracefully with all their faculties and strength. “This generation… we've seen our mothers fall and break things, you know, we've … had to bear witness,” Al-Humaidhi says. “Lots of women come and see me and they're like, ‘I'm not going to turn out like my mother.’”

For women who want to thrive during menopause, Al-Humaidhi says it’s essential to develop daily habits built around science based self-care. Those include movement, sleep, stress management and nutrition. For some patients, adding hormone replacement therapy makes sense, for others it doesn’t. But they’re not a magic pill.

“We need to really aggressively address your nutrition,” she says. “We need to aggressively address your bone density, your body composition, your stress management.” Starting these practices early — even in your 30s — is essential; since menopause comes to Middle Eastern women early.

Here are some of Dr. Al-Humaidhi’s recommendations:

Follow a Mediterranean style of eating

Middle Eastern culture is built around sharing food for everything from welcoming visitors to celebrating milestones to religious observances. She urges women to avoid ultra processed foods(anything with more than 10 ingredients, high fructose corn syrup, seed oils or dyes) and enjoy the classic Mediterranean way of eating. Eating lots of vegetables and fruits, legumes, olive oil, fatty fish, lean meats, beans, and fermented foods has been shown to support cardiovascular health.⁽¹⁾

Concentrate on bone health

Keep your bones and muscles healthy by doing weight-bearing exercise three times a week. Explore whole body vibration⁽²⁾, which studies found is an effective way to maintain bone density. Bone density scans usually don’t happen until age 65, but by that time you could already have osteopenia. Request a bone density scan as early as possible; some experts believe Saudi women should be scanned at age 55⁽³⁾ since low bone density is so common. Even habits like eating prunes⁽⁴⁾, which have been shown to maintain bone density in postmenopausal women, can help. As women age it’s important to eat enough protein⁽⁵⁾ (aim for 30 grams per meal) to maintain bone density. muscle mass. Your body will pull magnesium from your spine and hip bones if you’re deficient, so make sure you’re taking enough magnesium, vitamin D3, and calcium.

Work out regularly

Muscles do more than make us look good, they help burn up carbs and sugars, and building muscle keeps our bones strong⁽⁶⁾ and our brains active⁽⁷⁾. Do a combination of weight-bearing exercise and cardio like pickleball, swimming, dancing or running on the elliptical machine. Just find something you love and stick to it - invite a friend or join a women only gym makes it easier for some to stick to their schedule.

Keep blood sugar stable

Managing blood sugar is one of the keys to preventing the development of belly fat during the menopausal transition. Eating foods with proteins, healthy fat and fiber before simple carbohydrates and sweets is a key way to help stabilize blood sugar. Studies show garbanzo beans or chickpeas can help prevent blood sugar spikes(8) after meals and reduce appetite at later meals.

Some accounts to follow on social media:

• Dr. Noor Al-Humaidhi @lifestylesbynoor
• Tamsen Fadal @tamsenfadal
• @yourgoldenhour_eg

Related reading:

• How to Menopause: Take Charge of Your Health, Reclaim Your Life, and Feel Even Better than Before by Tamsen Fadal
• Bloody Hell!: Adventures in Menopause from Around the World edited by Mona Eltahawy