1.2 billion women+ across the globe will be on the menopause journey by 2030.

Source: The Demography of Menopause | Maturitas

Menopause Around the World: Country by Country Guide

Every woman’s menopause journey is unique. While there are symptoms like vasomotor symptoms (hot flashes, night sweats, and palpitations) which 80% of women+ in the U.S. experience, they are not as “common” in some countries. (Vasomotor symptoms are also known as VSMs.)

Symptoms may vary from woman to woman and from country to country.

And a woman’s perspective and mindset about menopause, and both the culture and societal messaging about this natural stage of life to which a woman is exposed may also play a role.

Based on a variety of studies across the globe, additional factors that appear to impact the symptoms a woman may experience include age, socioeconomic status, geographic locale, underlying medical conditions, lifestyle, time of onset of very first period, and race/ethnicity.

women from all over the world

How is menopause experienced around the world?

To some degree, it depends on where you live. In other instances, there may be commonalities across countries, and the differences are related to factors like socioeconomic status or the number of pregnancies a woman has had.

Several examples are described in the Study of Women’s Health Across the Nation (SWAN), which is a study of the various changes which occur in women+ as they pass through mid-life and as they age – physical, emotional/mental, biological, and social. The ongoing study is co-sponsored by the National Institute on Aging (NIA), Office of Research on Women’s Health, the National Institutes of Health (NIH), the National Center for Complementary and Alternative Medicine and the National Institute of Nursing Research (NINR).

Researchers in the study have published a wealth of findings regarding the menopause journey.  For example:

  • Chinese and Japanese participants had a consistently longer menstrual cycle length during perimenopause compared to their white counterparts.
  • An earlier age at onset of menopause increased the risk of bone fractures (due to an increased risk of osteoporosis).
  • Women with an older age at menopause transition onset experienced a longer menstrual cycle length during perimenopause.
Of course, there can be differences within a country too.
 

Menopause ages vary around the world

A 2011 study noted the average age of onset of menopause can vary from country to country as well as location within a given country, including:

  • younger age (by several years) of onset of natural menopause in developing countries including China, Latin America, Pakistan, Indonesia, Singapore, Peru and Chile)
  • younger age in rural settings than in urban areas
  • younger age (up to 1.5 years earlier) of onset in high-altitude locations

1% of women in the U.S. experience menopause at an age < 40 and 5% at age 40 or older but younger than 45.

How age of menopause impacts health

The hormonal changes which occur during the menopause transition increase the risk of conditions like cardiovascular disease, osteoporosis (and therefore fractures), dry mouth, gum disease, and UTIs.

Those who experience premature or early menopause, therefore, carry this increased risk for a longer period over a lifetime. And life expectancy at age 50 has been found to be up to 3.5 years shorter in those who reach menopause at an age younger than 45.

The risk of developing type 2 diabetes at an earlier age is greater, and individuals with premature or early menopause are more likely to experience severe menopause symptoms.

They may also suffer from sadness or depression related to the early loss of fertility or changes to their bodies which occur sooner than expected.

Preparing for menopause

You may wonder why it’s important to consider the factors that influence your menopause journey. Having that knowledge can potentially help you become better prepared for the experience and make the most of this time, which some women actually view as a period of renewal, transformation, and new freedom. 

Practices and approaches can also be learned from other countries to move through the transition with greater ease and to be as proactive, healthy, and empowered as possible, both now and in the future.

So, let’s get started on this trip around the globe. You can jump right to a specific country to view symptoms and the usual timing of their onset in that locale or start by understanding some of the broad range of differences in age of perimenopause onset that can exist based on the factors outlined above, like race/ethnicity.

However, it’s important to note that when an individual moves to another country, the menopause experience may become more like the country to which the move occurred rather than the prior country of residence or origin.

This shift sometimes seems to be related to the degree to which the lifestyle and environment of the new country is adopted by the individual. For example, for those coming to the U.S., it is not uncommon for the risk of breast cancer (e.g., Japanese women moving from Japan) to increase and sometimes even exceed the rate of those born in the U.S.

And a study found a 10% difference in testosterone levels in postmenopausal Asian women born in Asia and those born in the West, with lower levels found in those born in the West. Low testosterone levels can impact libido, weight gain, bone density, mood, heart disease, and memory.

Insert Map here if not at the top highlighting these countries or grid

  • Show scenery or map from each – have to be resized 
  • Africa
  • North America: Canada, US, Mexico
  • Asia: Japan, India, China, Israel
  • Central America
  • Middle East
  • Scandinavia
  • Europe: Switzerland
  • Central and South America
  • Australia??

Africa

China

Relaxation

Listen to Your Body

Arts

Lifestyle Choices

Africa

How symptoms vary within Africa

The onset of menopause occurs at an earlier age in African women than in their European or American counterparts. The main cause is believed to be multiple parity over a short period of time. [Parity is the number of births (including live births and stillbirths) in which pregnancies reached a viable gestational age.]

Across the continent of Africa and sometimes within a given country, there is variability in the symptoms which women+ report and societal attitudes.

Nigeria

  • Nigeria
  • eastern Nigeria: hot flashes, bone/joint pain, and brain fog
  • southwestern Nigeria: changes to sexual and marital relationships
  • Benin-City, Edo State, Nigeria: hot flashes, night sweats, joint pain; cessation of menses viewed positively and menopause considered normal; close to 65% no longer sexually active

Let’s take a look:

  • Ghana – sleeplessness, irritability, and general aches and pains
  • Rural Limpopo Province in South Africa – associate the cessation of periods with aging and not menopause per se; menopause viewed as a taboo topic, including sex at menopause
Nigeria Map

West Africa

West African Map

Sub-Saharan Africa ????? (some of this is above and some is not?)

 

These include bone and joint pain, hot flushes and forgetfulness among women in Eastern Nigeria (Anolue et al. 2012) and bodily pains, irritability and sleeplessness in Ghana (Odiari and Chambers 2012). Women in the Limpopo Province in South Africa have described multiple impacts on their lives (Ramakuela et al. 2014) and Yoruba men and women in Nigeria have highlighted changes to their sexual and marital relationships (Agunbiade and Gilbert 2020). Women in South Africa described how discussion around the menopause is often viewed as taboo and as such, there is limited information and support available (Ramakuela et al. 2014; Makuwa et al. 2015). Researchers have highlighted the need for further information and advice about the menopause for sub-Saharan African women (Makuwa et al. 2015; Ibraheem et al. 2015; Ikeme et al. 2011). Work to date includes only a small number of contexts in sub-Saharan Africa, but together, the body of work highlights the diversity of experiences alongside a need for information, such that any information must account for context. Existing information about the menopause is designed to address the circumstance

China

Family and female status impacts menopause 

A 2022 Chinese study looked at the characteristics of menopause-related symptoms and factors which influenced them among Mosuo, Yi, and Han women in the Yongning area of Yunnan province, China (the most ethnically diverse region in China) using the Menopause Rating Scale (MRS). There were variations among ethnicities.

Family and female status factored heavily in the experiences.

The study found:

  • Women+ living in “female-dominated” and “co-deliberated” households had significantly lower scores of menopause-related symptoms than those in a “male-dominated” situation.
  • A higher level of female status in the family and family support had a positive impact on the experience.
China map

Mosuo women had the highest family status. (Mosuo women’s status increases with age. The “grandmother” is the most respected person in the family and is in charge of daily life.)

Yi women typically are in a subordinate position.

Han women fall somewhere in between. 

Among the three groups:

  • Bladder problems were the least severe symptom in all 3 groups.
  • Muscle and joint pain were reported as the most severe symptom. In the Yi, actual joint deformity was sometimes observed.
  • Yi women had the most cardiac symptoms.
  • Han women had higher scores than the Mosuo relative to fatigue and perimenopausal depression.

Menopause attitudes in China

A prior study showed attitudes about menopause were related to the symptoms experienced.

It reported Mosuo women often used the words “clean, convenient, and peaceful” to describe the end of  menses and “often have positive attitudes toward life changes, such as ‘let it be’ and ‘do not think too much,’ to help them relax and maintain family unity and harmony.”

And Mosuo women had the fewest issues with menopause symptoms, including sleep dysfunction.

Japan

Japanese menopause journey

The experience of menopause for many Japanese women has been noted to be dramatically different than in the U.S. 

Findings include:

  • Nearly a third have no symptoms.
  • Fewer than 15% report hot flashes.
  • Report symptoms of dizziness and stiff shoulders, which U.S. women+ rarely mention.

Why Japanese women have fewer symptoms

Some of the reasons attributed to fewer symptoms and much less dread by Japanese women living in Japan include:

  • Mindset
  • The cultural view of aging
  • Lifestyle
Map of Japan

Mindset: menopause is normal 

First, mindset. Their mindset is that menopause is a normal, natural stage of life. In fact, the word for menopause in Japanese, “konenki,” means a time of renewal and energy. 
 
At pausitive health, we’re trying to change the narrative in the U.S. and help women realize menopause is a normal stage of life.
 
For many, there is a sense of greater freedom and a view that it is an opportunity to pursue personal interests. For some, it signals a rise in status and respect.

Cultural views

culture with an often different view of aging (wisdom, involvement in the upbringing of younger generations, reverence) and a much lower rate of medicalization of growing older has a positive impact on menopause symptoms. This difference is being translated into action with more development of infrastructure that supports the changing needs of an aging population.

Lifestyle

Lifestyle – higher intake of soy, smaller portions of food, more plant-based diet, longer work life, intergenerational households, and a greater focus on being as healthy as possible for as long as possible to avoid being a burden to family and society as a whole (“meiwaku” or “being a nuisance”)

Asian women in family smiling

Japan and China comparison

A study published in Menopause in 2022 of Japanese and Chinese women in urban areas of their respective countries found differences in their symptoms and a correlation between symptoms and their degree of self-efficacy.

The following was found in Japanese women:

  • Fatigue was the most common symptom.
  • They experienced greater severity of a range of symptoms compared to their Chinese counterparts – sexual function, anxiety and other mental health conditions, and autonomic imbalance. (The autonomic nervous system regulates involuntary physiologic processes like blood pressure and heart rate, respiration, digestion, and sexual arousal.)
  • The greater the degree of a feeling of self-efficacy, the less the severity of the symptoms was. (“Self-efficacy is confidence in the ability to exert control over one’s behavior, motivation, and social environment. It reflects an individual’s belief in her/his capacity to execute behaviors necessary to produce specific performance attainments.”)

The following was found in Chinese women:

  • Memory loss was the most common symptom.
  • Peri- and post- menopausal women showed significantly higher severity scores on sexual function.
  • Perimenopausal women scored higher on mental health conditions and autonomic balance factors.
  • The greater the degree of a feeling of self-efficacy, the less the severity of the symptoms was.

United States

NEED MORE ON SYMPTOMS AND LINK TO SYMPTOMS PAGE ***

Lifestyle and education matter

A University of Pittsburgh study found women+ with less education were more likely to experience symptoms and the risk of symptoms was also greater if you:

  • drink alcohol moderately or heavily
  • suffer from depression or anxiety
  • are obese
  • are in poor health
  • smoke

Societal views of aging matter

In another study, the Yale doctor who led the research found menopausal symptoms were less of an issue in countries where older women are considered wiser and are more highly regarded in general. In countries where phrases like “old age” are attached to the life cycle of women, symptoms are often more pronounced.

 

Think about how American society typically views menopause and the stigma and taboo which surround it.

That type of outlook can be internalized by women, and menopause becomes something to be dreaded and “the curse” to be suffered in silence. (LINKS TO ARTICLES ON THIS)

Canada

Caribbean

Menopause happens earlier than the U.S.

Women in the Caribbean have been reported to experience the onset of menopause at an earlier age than those in the U.S. 

Factors which were believed to impact age of onset in the study included:

  • lower level of education
  • manual labor
  • smoking
  • having 5 or more children
  • socioeconomic adversity

 

Mexico and Central America

Map of Central AmericaMexico and Central America

Why do women+ in Mexico and Central America typically experience menopause up to a decade earlier than their U.S. counterparts? 

Some factors that have been considered potentially causative include:

  • multiple pregnancies
  • longer periods of breastfeeding
  • heavy Mayan workloads
  • poor nutrition
  • an environment which can be more extreme

This is according to study published in Current Women’s Health Reviews.

n a study of 543 women in urban and rural locales in the state of Campeche, Mexico published in December 2021, socioeconomic factors and reproductive history rather than ethnicity (Mayan vs. non-Mayan) were factors found to impact age of menopause onset.

A later age of onset was found in those with a later age at the time of the first period, higher socioeconomic status, and a history of a greater number of pregnancies.

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Menopause is a welcome experience 

Unlike Western culture, there is no stigma associated with aging and the menopausal period in the Mayan culture. In fact, menopause is considered to be a welcome natural phenomenon in Central America that all Mayan women, who come of age, will experience.

Anxiety, negative attitudes, health concerns, and stress for the Mayan woman are all events that are commonly associated with pregnancy and childbearing, not with menopause. 

Maya women perceive the menopausal period very positively, as they are no longer burdened with menstrual bleeding and childbearing, and are more relaxed about sexual activities.

Thus, compared with their U.S. counterparts, Maya women have a better overall perceptions and attitudes toward the menopausal transition, have symptoms that appear to be short-lived, do not generally use HRT and appear to have a lower prevalence of osteoporosis. 

In Mexico, another study of 395 Mexican women and men found:

  • The most negative attitudes regarding menopause were found in women who experienced menopause as a result of surgery. However, there was no correlation in the symptoms experienced by women who experienced surgical menopause.???? (what does that mean?0
  • Younger study participants had a more negative attitude than those in middle age.
  • A negative attitude was found to correlate with symptoms in peri-menopausal and naturally postmenopausal women.

Lifestyle

Besides genetics, diet and lifestyle may play a significant role in the overall impact of menopause in these women, as their diet is primarily plant-based, they get plenty of exercise over a lifetime, and they use primarily plant-based medicines and massage to control menopausal symptoms. 

Thus, the impact of culture and attitude on the menopausal transition in Mexico and Central America appears to be a positive one. 

Future research should focus on why the prevalence of osteoporosis is low in Maya women and how women in the U.S. might benefit from this.

In addition, collections of data on cognition, as well as cardiovascular and cancer risk between these groups would be of benefit, considering that Maya women do not generally use HRT.

Hot flashes

While hot weather can raise body temperature and be a factor for American women having hot flashes, it wasn’t an issue in at least one Mexican state, which obviously has warmer weather than the U.S.

In a study of 155 women also conducted in the state of Campeche did not appear to differentiate between a report of hot flashes and the experience of living in a hot and humid climate.

Scandinavia

Denmark

A 2015 study of 1,339,829 women in Denmark between the ages of 40 and 79 found urogenital atrophy-related symptoms (LINK) e.g., vaginal dryness, painful intercourse, and pelvic floor disorders were under-diagnosed and undertreated.

Finland

A study of 1427 women in Finland published in 2010 in the journal Maturitas provided insights into the prevalence and severity of menopausal symptoms and the impact of lifestyle and weight. 

Findings included:

  • 38% of the premenopausal, 50% of the perimenopausal, and 54% of both postmenopausal and hysterectomized women who had under-gone a hysterectomy reported bothersome symptoms.
  • Fewer symptoms were experienced by those who were physically active compared to those with a sedentary lifestyle.
  • Smoking did not have a correlation with to vasomotor symptoms (VSM), e.g., hot flashes and night sweats.
Scandinavian countries

Norway

The Norwegian Hordaland Women’s Cohort study……

Sweden

Approximately 70% of women in a study published in 2015 by researchers at Linköping University reported issues with hot flashes. Yet, very few took hormone therapy.

For those not using hormone therapy, the prevalence was greatest in those who were post-menopausal, with approximately one-third reporting mild symptoms, 50% moderate symptoms, and about twenty percent with severe hot flashes.

Switzerland

Map of Switzerland

Europe

Map of Europe

Israel

Map of IsaraelWomen and Their Bodies (WTB), an organization that “works to promote awareness of the health and sexuality of women and girls in Israel,” conducted a study in 2020 of 2200 women in Israel. 

The findings included:

  • The most common symptoms were mood swings, chronic fatigue, sleep issues, “heat waves,” weight gain, low libido, and difficulty concentrating.
  • Women indicated symptoms were moderate or severe.

Russia

Women and Their Bodies (WTB), an organization that “works to promote awareness of the health and sexuality of women and girls in Israel,” conducted a study in 2020 of 2200 women in Israel. 

The findings included:

  • The most common symptoms were mood swings, chronic fatigue, sleep issues, “heat waves,” weight gain, low libido, and difficulty concentrating.
  • Women indicated symptoms were moderate or severe.
Russia Federation Map

https://www.shutterstock.com/image-photo/handsome-girl-posing-on-ramparts-walk-612624956o.

India

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A study of 2108 patients conducted by the members of the Indian Meno-pause Society was published in the Journal of Midlife Health. It included women who had natural menopause as well as those who went into meno-pause related to surgery.

  • The average age of menopause was 46.2 (5 years younger than in the U.S.).
  • There was an increased risk of heart disease and osteoporosis, which the researchers believed was related to an earlier age of menopause onset.

They identified 5 factors that were correlated with menopausal age:

  1. marital status – earlier age of menopause in single women than in those who were married or widowed
  2. education level – later age of menopause in those with more education
  3. socioeconomic status – later age of menopause in those with better economic circumstances.
  4. BMI – earlier age of menopause in those with a lower BMI
  5. parity – earlier age of menopause in those who had been pregnant and had had multiple pregnancies than in those who had never been pregnant.

Middle East

Map of the Middle EastJordan

A study showed close to 70% of women+ have moderate symptoms, with VSMs being the most severe symptoms. 

Also, perimenopausal women complained of menopause symptoms more frequently than women in other stages, except for vasomotor and sexuality symptoms. Postmenopausal women reported more concerns with those.

The study also found a significant association between the severity and occurrence of these symptoms and an individual’s:

  • age
  • family income
  • level of education
  • number of children
  • perceived health status
  • menopause status
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