Women's Health

Culture may influence how women experience menopause

Even though hormonal changes after menopause produce similar symptoms in many women, cultural differences can still shape how people experience this stage of life, a study suggests.

Researchers reviewed results from an online survey asking 8,200 older men and women in North America and Europe how menopause impacted their sex lives and relationships and found similar complaints in different countries. But the magnitude of suffering for typical symptoms such as vaginal dryness, hot flashes and weight gain varied by nationality.

“In societies where age is more revered and the older woman is the wiser and better woman, menopausal symptoms are significantly less bothersome,” lead study author Dr. Mary Jane Minkin, a professor in obstetrics, gynecology and reproductive health at Yale Medical School, said by email. “Where older is not better, many women equate menopause with old age, and symptoms can be much more devastating.”

Women go through menopause when they stop menstruating, which typically happens between ages 45 and 55. As the ovaries curb production of the hormones estrogen and progesterone in the years leading up to menopause, women can experience symptoms ranging from irregular periods and vaginal dryness to mood swings and insomnia.

Minkin and colleagues focused their analysis on postmenopausal women aged 55 to 65, and men in relationships with women this age, in the United Kingdom, United States, Canada, Sweden, Denmark, Finland, Norway, France and Italy.

The survey was primarily designed to assess how vaginal atrophy, which may include dryness, irritation, itching or pain, impacted participants’ relationships. But the web-based questionnaire also explored other menopause symptoms and examined whether the severity of these difficulties matched what people had expected to experience.

Perhaps not surprisingly, given the main goal of the study, vaginal dryness was the top complaint both men and women reported, regardless of nationality, the researchers report in the journal Menopause.

Across all of the countries in the study, this symptom was most commonly reported in Canada, where 85 percent of women and 81 percent of men cited this as a concern. Italians were least likely to list this complaint, which was reported by 65 percent of women and 61 percent of men.

Many symptoms were more prevalent among women from the U.S., the U.K. and Canada, and less common among women in Sweden and Italy, the study found. U.S., U.K. and Canadian men, however, were more likely to report symptoms in their female partners.

Overall, men ranked mood swings and vaginal pain during intercourse among their top five complaints related to menopause, while for women, disrupted sleep and weight gain were more important.

Among the women, residents of Denmark, Sweden and Norway were most likely to report that going through menopause turned out better than they expected, while participants living in the U.S., U.K., France and Canada were more prone to find menopause much worse than they had anticipated.

The findings might not reflect the experiences of a broader population because the survey was designed to recruit only women with vaginal pain and men who experienced this with their partners, Melissa Melby, an anthropologist at the University of Delaware, said by email.

Even so, the cultural differences highlighted by the survey responses underscore how regional differences in diet, physical activity, attitudes toward aging and expectations about menopause might influence how people experience symptoms, said Melby, who wasn’t involved in the study.

“If menopause symptoms were due solely to hormonal changes then the menopausal experience would be more homogenous,” Dr. Sandra Thompson, professor in rural health at the University of Western Australia, said by email.

The symptoms directly associated with a decrease in estrogen are hot flashes, night sweats, vaginal dryness and insomnia, said Thompson, who wasn’t involved in the study. So it’s not surprising that these were the top complaints in the study, regardless of nationality.

Culture comes into play, however, when women assess the severity of symptoms, she said.

“The social context in which a woman lives is important to her understanding and experience of the menopausal transition,” Thompson said. “When looking at different countries, variations in symptom reporting can be attributed to language differences, culturally shaped expectations about menopause, culturally influenced gender roles and socioeconomic status.”