However, the experience of menopause varies significantly across different ethnic and cultural groups.
For South Asian women in the UK (me included), this phase of life is shaped by bio-psychosocial factors (such as genetics and culture) that can affect symptom perception, access to care and health outcomes.
Missing from the data
While the biological process of menopause doesn’t discriminate, the research and subsequent clinical care often do. While studies have highlighted significant variations (ie psychological, cultural and biological) in how women from different ethnic backgrounds experience menopause to their White counterparts, South Asian women remain disproportionality underrepresented in major research.
A striking example of this oversight is the Study of Women’s Health Across the Nation (SWAN). The long-term US study, which serves as a cornerstone for midlife women’s health research notably omitted South Asian women from its research entirely, further indicating lack of representation on how the unique symptoms of menopause impact this population.
This lack of inclusion in research isn’t just an academic issue; the direct consequences demonstrate the South Asian women are not offered the intervention required. This omission directly contributes to a broader pattern of invisibility that extends into clinical care and the development of public health policies.
Recently, the NHS published waiting list data from Asian or British Asian backgrounds showing that women from these communities face significantly longer waiting times – 18+ weeks for a gynaecology appointment – than any other ethnic group. This disparity highlights a systemic issue that extends beyond women’s health.
It demands urgent attention and action.
To genuinely commit to equitable health outcomes for all women, it is essential that South Asian women are acknowledged, heard and accurately represented in both research studies and in clinical practice.
Onset and symptom experience
Menopause typically occurs between the age of 45 and 55, with the average age in the UK being 51 years. However, research suggests that South Asian women potentially reach menopause earlier than their White British counterparts.
Several studies have shown that the average age of natural menopause in South Asian women is around 47 years. This is noteworthy because earlier menopause is associated with increased risk for cardiovascular disease and osteoporosis.
South Asian women also report different symptom profiles. Research from global studies suggest they may experience higher rates of physical symptoms like joint pain, fatigue, palpitations and low mood compared to the classic vasomotor symptoms of hot flushes and night sweats that are often cited as common peri/menopausal symptoms.
A study of women from the Indian subcontinent living in Birmingham found that reports of vaginal dryness were notably higher, compared to White counterparts, with 38% of women affected.
Cultural norms may influence symptom reporting
In many South Asian cultures, menopause is viewed as a natural part of ageing and less as a medical condition requiring intervention. While this can offer psychological resilience, it may also lead to underreporting or under-treatment of distressing symptoms.
During my consultations with South Asian women, their symptoms are described using non-Western idioms such as ‘heat in the tummy,’ ‘everywhere pain,’ or ‘no energy.’ As a women’s health GP, I’m on high alert when managing such patients and better able to understand the unique way in which they describe their symptoms.
However, for other healthcare providers, the language barrier and non-conventional way of reporting symptoms can lead to under-recognition or misattribution by medical staff who are not familiar with the cultural specifics of this subgroup.
Barriers to care
Despite the increasing awareness of menopause in the UK, South Asian women often face unique barriers to care.
Language and communication challenges
Especially for first-generation migrants, limited English proficiency can hinder effective communication with healthcare professionals and women may rely on translation by a family member, whose translation may well be affected by their own opinions and health literacy level.
Stigma and silence
Talking about menopause, particularly its impact on sexual and emotional health, is often considered taboo in South Asian communities, leading to delays in seeking help
Limited representation in healthcare materials
Menopause campaigns often lack cultural tailoring, reducing engagement among South Asian women.
The NHS Long Term Plan (2019) and NICE guidelines (2023) recognise the importance of culturally competent care, but implementation remains inconsistent. Only 14% of women from ethnic minority groups in the UK reported receiving adequate information about menopause before experiencing symptoms, compared to 32% of White women.
Health implications
South Asian women in the UK are already at higher risk of developing conditions like type 2 diabetes and cardiovascular disease. Menopause can exacerbate these risks by the associated weight gain and decline in oestrogen levels, yet tailored prevention strategies are lacking.
A 2024 study by Samuel, highlighted the need for more targeted menopause services for ethnic minority women, recommending culturally sensitive educational interventions and training for GPs in diverse communities.
Moving forward
Efforts to improve menopause care for South Asian women in the UK must go beyond clinical settings. Community-based education, better representation in national campaigns and culturally inclusive training for healthcare providers are essential.
More research is also needed on menopause timing, symptom patterns and effective interventions specific to South Asian populations particularly intergenerational patterns and epigenetic changes, that introduce complexities that differ notably from White counterparts
By recognising and addressing these unique needs, the UK healthcare system can ensure equitable support for all women as they navigate menopause.
