Why Menopause is a Diversity Issue

Women from different ethnicities will have different menopausal and perimenopausal symptoms. We speak to a doctor who is determined to start a more inclusive conversation.

One of the reasons the menopause is so hard to diagnose is that each of us has a variety of different symptoms. Evidence suggests your ethnicity, culture and background may play a part in this, according to Dr Shahzadi Harper, a GP who specialises in the menopause. The trouble is, there’s only a limited amount of research to show what these variations might be.

So how can we make sure every woman gets the information and advice she deserves?

Let’s broaden the conversation

‘‘There’s such a lot of good work being done, making the conversation around menopause more open and public,” says Dr Harper, who describes herself as having a working class Pakistani heritage. She trained as a GP in Oxford, and opened her own clinic last year in London, theharperclinic.com.

“Now it’s time to open up that conversation, to inject some diversity, to encompass women of different ethnicities, cultures and backgrounds.”

Of the approximately 66 million people in the UK, nearly 14 per cent are of Afro Caribbean origin. Just over eight per cent are Asian. Half are women. That’s roughly 15 million women.

“All of those women will go through the menopause at some point or another,” says Dr Harper. “While we are starting to talk about menopause much more openly, what’s not being addressed is the fact there are ethnic variations and differences in the way women experience it. We need to make this conversation around menopause accessible to all cultures and social backgrounds.”

“Some different cultures aren’t too open about talking about the menopause,” says Dr Harper. There can be a lot of stigma attached to it.

There are a few reasons for the skew, says Dr Harper. “A lot of the faces talking about menopause in the media and on social media tend to be more middle class and often tend to be white, too,” she says. The same goes for most of the doctors.

“Another reason is the lack of NHS awareness, meaning menopause care has become more of a payable service – which makes it unaffordable for a lot of women,” says Dr Harper.

Change the face of menopause

The issue at the root, is that most studies on the menopause have been done on white women. The result of this bias? “In some cultures and social demographics, there may be a lack of knowledge and education about what services and treatments are available,” says Dr Harper. This is important, when you know that how other ethnicities experience the menopause can vary widely.

Take the average age of menopause, for example. In subcontinent India, it is 46.5, according to the PAN India survey. There are differences in the way women present to their doctor, says Dr Harper. Women from the Indian subcontinent, for example, tend to present with vaginal dryness, body pain and fatigue, while Japanese and Chinese women tend to present with shoulder stiffness and chills rather than hot flashes. A 2018 study in the US, showed that compared with non-Hispanic white women, black and Hispanic women are more likely and Asian women are less likely to report vasomotor symptoms – ie hot flushes.

A sensitive subject

There is huge cultural variation in attitudes to menopause. “Some different cultures aren’t too open about talking about the menopause,” says Dr Harper. There can be a lot of stigma attached to it. “For example, for women who come from subcontinent India and for those from Japan and China, it’s a much more sensitive subject; they don’t tend to talk about their periods.”

Stigma and silence, says Dr Harper, are huge barriers to getting treatment. “If women aren’t talking, they won’t find out or realise how much other women are going through the same symptoms, so they will suffer in silence.”

There can be different attitudes to managing symptoms in other cultures too, which often depend less on medicine. “In India in particular because healthcare is limited, women tend to manage the symptoms with yoga, meditation and natural methods rather than going down the HRT route.”

“I want to tell women of all different backgrounds that they don’t have to put up with debilitating symptoms.”

While ethnic and cultural differences are important, there’s an interplay with socio economic reasons, too. “For example, someone who smokes will have the menopause 2.8 years earlier,” says Dr Harper. “Women who are single or who haven’t had children and poorer women tend to go through it earlier.”

Let’s make it better for everyone

So what does Dr Harper think needs to happen? More studies on the existence of and nature of ethnic and cultural differences, as well as socio economic variations. “There is a huge lack of research into this,” she says. Right now, the best information on symptoms and treatment needs to be disseminated more widely, she says.

“A good start would be to see best practice advice being translated into lots of different languages,” says Dr Harper. “I find it upsetting that people don’t know about treatment, or come in to clinic, having suffered for a long time. It’s damaging when women don’t know there are options available to them.

“I want to tell women of all different backgrounds that they don’t have to put up with debilitating symptoms.”

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