'Nobody talks about it': Menopause stigma silences Asian women

Health advocates have warned that cultural stigma is making it harder for some Asian women to recognise menopause symptoms and seek medical help.

New Zealand marked World Menopause Day on Sunday.

When Annu Sharma began experiencing anxiety, low mood and brain fog in her mid-40s, she struggled to understand what was happening to her.

Growing up in an Indian family where menopause was rarely discussed, Sharma, now an integrative health and menopause coach and founder of MenoBoss Global, had little understanding of the symptoms.

"Nobody talks about it," Sharma said.

"I've never heard my mum talk about it, and I'm sure her mum never talked about it."

"Looking back, I think my mum just went through it quietly.

"So when it happened to me, I had no idea. I thought I had a terminal illness."

Sharma said her experience was not uncommon.

In some segments of the Indian community, she said stigma surrounding menopause discouraged women from seeking help until their symptoms became more severe.

For Xuan Zhang, 44, who grew up in China, the stigma was equally familiar.

Zhang began experiencing fatigue and mood changes about a year ago.

When her sleep deteriorated late last year, leaving her waking several times a night, she sought advice from her GP.

After two rounds of blood tests, her GP suspected she might have premature ovarian insufficiency, a condition that can cause symptoms similar to those of perimenopause.

Zhang began menopause hormone therapy (MHT), which she said significantly relieved her symptoms.

But while Zhang sought medical help, she said many women still struggled to talk openly about menopause.

"In a Chinese-language context, the term 'menopausal woman' is often used as an insult," she said.

"It implies that a woman is irritable, emotionally unstable or incapable of thinking rationally. That's why many women are reluctant to talk about it."

Zhang said gender inequalities in parts of China meant women were often valued for their youth, appearance and fertility, adding to the shame surrounding menopause.

Since moving to New Zealand in 2019, she said she had encountered similar attitudes within the Chinese community.

She hoped sharing her experience would help raise awareness among women from ethnic communities.

The Ministry for Women acknowledges that stigma surrounding women's health can make some women from ethnic communities reluctant to discuss menopause or seek medical help.

They may also face barriers to accessing healthcare, the ministry says.

Its Understanding Menopause publication also noted that research into the experiences of Māori, Pacific, ethnic community and disabled women remained limited.

Sharma called for more research into Asian and Pacific women's experiences, better menopause training for healthcare professionals to understand the needs of different ethnic groups, and culturally tailored education in local communities.

She said these measures could help women recognise symptoms earlier and feel more confident seeking medical advice.

In Auckland, some community organisations are already working to encourage more open conversations.

Lily Xu, a health promotion coordinator and women's wellbeing coach at The Asian Network Incorporated (TANI), recently held a menopause awareness talk at Highland Park Library in East Auckland, covering common symptoms, treatment options and ways to maintain wellbeing.

Xu said the discussion encouraged women to speak openly about menopause, helping to challenge the stigma surrounding the subject in Asian communities.

"By sharing what you've been through and exchanging perspectives on how you've dealt with those experiences, you can learn a lot from one another," she said.

"That kind of sharing can be incredibly helpful."

Xu said attitudes towards menopause varied among women in the Chinese community.

Some ignored the symptoms.

Some felt anxious, while others were reluctant to discuss the subject.

She suggested setting up a multilingual helpline for Asian women, staffed by health professionals who could answer questions and address concerns about menopause.

Such a service, alongside community education, could help women better understand their symptoms and feel more confident seeking medical advice, she said.

According to Health New Zealand, menopause is a natural biological process that typically occurs between the ages of 45 and 55.

Perimenopause, the transition leading up to menopause, can begin in a woman's early 40s and last four to eight years, during which periods may become irregular or heavier before stopping altogether.

Menopause is generally confirmed after 12 consecutive months without a period, while postmenopause refers to the years that follow.

Symptoms vary widely and can include hot flushes, night sweats, fatigue, sleep disturbances, joint pain, anxiety, mood changes, memory problems and difficulty concentrating, sometimes known as "brain fog".

Hormonal changes associated with menopause can also increase the risk of osteoporosis and cardiovascular disease.

Sarah Clarke, Health New Zealand's national clinical director of primary and community care, said menopause was a normal stage of life, but its symptoms and their effects varied significantly among women.

She encouraged women to seek medical advice if symptoms affected their quality of life, sleep, work, relationships or daily activities.

"General practitioners and other primary care clinicians are usually the first point of contact for assessment, advice and treatment," Clarke said.

Treatment options included lifestyle changes, non-hormonal treatments and hormone replacement therapy, depending on individual symptoms and circumstances, she said.

Clarke said health professionals were expected to provide culturally appropriate care under professional and regulatory standards.

Health New Zealand also funded free Culturally and Linguistically Diverse (eCALD) training for healthcare professionals, including a strong focus on working with Asian communities.

Menopause information was available in several languages, including simplified Chinese and Hindi through Healthify and Diversity Counselling New Zealand, she said.

"Women are also encouraged to let their healthcare team know if they would benefit from language support or interpreter services during appointments," Clarke said.

She said Health New Zealand was continuing to work to improve access to health information and services for all communities.

According to Pharmac, a range of hormone treatments for perimenopause and menopause symptoms are publicly funded in New Zealand, including oestradiol patches, tablets and gels, vaginal oestrogen, progesterone capsules, tablets and intrauterine device, conjugated oestrogen tablets, combined oestrogen and progestogen tablets.

Funded brands include Estradiol TDP Mylan, Estradot, Progynova, Estrogel, Ovestin, Utrogestan, Provera, Primolut N and Mirena.

Several other hormone treatments are partially funded, including Estrofem, Premarin, Kliovance, Kliogest and Trisequens.

Adrienne Martin, Pharmac's chief adviser, said the Estradot brand of oestradiol patches remained subject to dispensing restrictions because of global supply constraints.

Patients can collect only one month's supply at a time, with a limit of two patches of each strength per week.

Martin said the Estradiol TDP Mylan brand was not subject to those restrictions.