Physician HRT Training:
Cultural Differences in the Presentation of Menopause
Menopause eventually occurs for all women with ovaries – meaning that up to 50% pf the population will suffer from some, most, or all of the symptoms and health risks associated with menopause at the end of their reproductive years. As a result, many physicians simply take a one-size-fits-all approach to treating menopause.
But the experience of menopause is actually far from universal. Recent studies have shown that culture, location, and biological ethnicity all play a part in how women experience perimenopause and menopause. Understanding of – and sensitivity – to these cultural and ethnic differences is essential for any physician who is treating menopausal patients.
Menopause Symptoms Vary by Culture
In the United States, “hot flashes” and “menopause” are almost synonymous to doctors and their patients. But many physicians who are undergoing HRT training are surprised to learn when they start their hormone practice that this is not the case across all cultures.
According to a 2007 article by Nancy Avis and Sybil Crawford, it is primarily only Western cultures that associate menopause with hot flashes. While other cultures often associate menopause with entirely different symptoms.
That article reported that Japanese women most often report experiencing headaches, shoulder stiffness and chilliness during menopause. And Nigerian women list joint pain as the most common symptom of menopause.
The implications of this for physicians are far-reaching. If a Japanese patient over forty shows up at her physician’s office complaining of shoulder stiffness, or a woman of Nigerian heritage comes in with joint pain, most American doctors would likely consider the onset of arthritis rather than the onset of menopause – when if fact the hormone decline of menopause is the underlying problem.
Menopause Attitudes Vary by Culture
In addition to a variation of menopause symptoms from culture-to-culture, there is also a wide divergence of attitudes about menopause from one culture to another.
Dr. Mary Jane Minkin, a clinical professor at Yale University School of Medicine’s Department of Obstetrics, Gynecology, and Reproductive Sciences reports that menopause can be less traumatic in cultures where multigenerational families live together or very near each other. She explains that living with multiple generations allows younger women to learn from their elders – knowing what to expect when menopause rolls around.
In the United States, however, the general culture is much less family-centric. Women without a multigenerational connection can be more isolated, and therefore less informed as to what to expect when they become older and their hormone production begins to decline.
Women from multi-generational cultures in the US may also be more comfortable discussing or seeking help for menopause because it has been a “fact of life” in their household. While more isolated American women may not realize that their symptoms are the start of menopause – and/or they may be uncomfortable seeking help for what they feel is a taboo subject.
Menopause in Indian Culture
Author Nandita Godbole, has explained that the subject of menopause for Indian women is typically not part of the larger cultural conversation. “The Indian cultural construct of womanhood is heavily tied to a woman’s ability to bear children,” Godbole explained. So, menopause can be seen as becoming “less than” in Indian culture – resulting in silence on the topic, as well as a reticence to seek menopausal treatment.
Menopause in Black Culture
There are also genetic differences between women of different ethnicities. For example, in recent studies, Black women experienced more frequent and intense hot flashes and night sweats than White women during menopause.
Some of this may be attributable to certain lifestyle factors such as financial strain, overall health, access to medical care, weight/BMI, smoking, etc. But there also appears to be physiological differences between Blacks and Whites that may account for a disparity in menopause symptoms.
A recent revealing article in the Washington Post is definitely worth reading for any physician treating Black women of perimenopausal and menopausal age. The author stated that “Throughout history, Black women weren’t allowed to talk about what we were feeling about anything… We were taught and trained to be silent, to suffer and just deal with it. I think that mindset extended across generations and that’s why we don’t have those conversations, which means a lot of us aren’t educated about menopause.”
Geraldine Ekpo, a specialist in reproductive endocrinology, has stated that said menopause has historically been viewed as a natural process, so many Black women may not feel the need to see a physician about it. She also stated that there is some mistrust of the medical system in general among certain members of the Black community.
Age and Perceptions of Menopause
It’s also believed that cultural perceptions about age may play a significant role in how a woman views and experiences menopause. A 2011 study by the British Psychological Society suggested that menopause is often viewed more positively in non-Western cultures that revere age and are not ‘youth obsessed’ like American Society.
For example, in African and Asian countries – where elders are respected for wisdom and experience – menopause is viewed more positively. But in Western societies – where women tend to be valued for attractiveness, reproductive capacity, and youthfulness – aging and menopause tend to be viewed more negatively by female patients and by society at large.
Physician HRT Training for Menopause
It’s clear that one thing physicians can do to improve their patients’ experience of menopause is to be aware of cultural, lifestyle, and biological differences in order to maintain an open and respectful dialogue about menopause and aging.
Asking about the patient’s experience in a way that resonates with them and takes into consideration their cultural preconceptions will not only make them feel more comfortable – but also helps avoid the pitfalls associated with assuming that menopause is a culturally universal experience.
At SottoPelle® we are passionate about training physicians on how the problems related to menopausal hormone deficiency can be treated. Hormonal well-being affects more than just a menopausal a woman’s libido, energy levels, and weight. Hormones support the body’s primary cardiovascular and metabolic function. Restoring balance and improving hormone deficiency helps get a patient back on track to a longer, healthier life.
The SottoPelle Method Physician Hormone Therapy Training program helps physicians nationwide treat their menopausal patients, and restore their quality of life. With hormone replacement therapy on a physician’s list of clinical offerings, patients can experience optimal wellness. Call us today to sign up!
Physician HRT Training: 323.986.5100 (press 1)
IMPORTANT DISCLAIMER: This article is provided as general information only and is not intended to be used as medical advice. While the benefits of hormone replacement are well documented through clinical research, we are not representing that hormone therapy is a “cure” for any disease. Only your treating physician can determine if hormone replacement may be a beneficial part of your healthcare regimen, based on your age, overall health, risk factors, and lifestyle.