Every woman who lives long enough goes through menopause, yet the experience is far from universal. In Western countries, around three in four women report hot flushes. In Japan, studies have put that figure as low as 20–25%, and many Japanese women report feeling chilly rather than hot. Mayan women in parts of Mexico and Guatemala reach menopause around age 44 and, in some villages, report few symptoms at all.
If the biology is shared, why does the experience differ so much? Researchers point to a mix of diet, lifestyle, language, social status and, increasingly, expectation. A 2005 review in the American Journal of Medicine (Avis et al.) went as far as concluding there is no evidence of a single "universal menopausal syndrome". As Dr Sandra Thompson, Professor of Rural Health at the University of Western Australia, told Reuters Health, "If menopause symptoms were due solely to hormonal changes then the menopausal experience would be more homogenous."
Why do some cultures report more menopausal symptoms?
The short answer is that no single factor explains it. Several overlap, and the evidence for each varies in strength.
Same symptoms, different suffering
Even among Western countries, the experience is not uniform. A survey published in the journal Menopause and reported by Reuters Health asked 8,200 people across nine countries in North America and Europe about menopause and their relationships. The respondents were postmenopausal women aged 55 to 65 and men partnered with women of that age. Women everywhere described similar complaints, but how much those complaints bothered them varied by country.
- Vaginal dryness topped the list everywhere, peaking in Canada (85% of women) and lowest in Italy (65%).
- Many symptoms were more common among women in the US, UK and Canada, and less common in Sweden and Italy.
- Women's priorities were disrupted sleep and weight gain, while men more often cited mood swings and pain during sex.
University of Delaware anthropologist Melissa Melby, who wasn't involved in the study, cautioned that it recruited only women with vaginal pain and their partners, so it may not reflect all women. Even so, she said the differences point to the influence of diet, physical activity, attitudes toward ageing and expectations of menopause.
Thompson argues that the symptoms directly tied to falling oestrogen (hot flushes, night sweats, vaginal dryness and insomnia) are fairly consistent. Culture comes into play when women judge how severe they are. In her words, "The social context in which a woman lives is important to her understanding and experience of the menopausal transition." She attributes the variation between countries to language, culturally shaped expectations, gender roles and socioeconomic status.
Diet and lifestyle
The most cited physical explanation is diet. Soy contains isoflavones, plant compounds that act like weak oestrogens, and may soften the drop in hormone levels. Japanese women also have about half the osteoporosis rate of white North American women and around a third of the US breast cancer rate. Women's Health Network points to Japan's wider mix of diet, exercise, public health education and equal access to care, while noting that the dietary evidence is still unclear.
Language and the permission to speak
Until recently, Japanese had no specific word for a hot flush. In the 1980s, anthropologist Margaret Lock found only about 20% of Japanese women reported them. Writing in The Vajenda, gynaecologist Dr Jen Gunter notes that reporting rose within about 20 years of the term entering everyday language.
A study of women in Hawaii makes the point more sharply. When hot flushes were measured with equipment, Japanese American and European American women had roughly the same number. Yet Japanese American women were about half as likely to report noticing them. The physiology was similar, but the perception was not.
The same applies across generations. A Swedish study following women born between 1918 and 1966 found daily hot flushes at age 50 rose from 25% to 33–38%. Gunter cautions that older women may simply have kept quiet, out of "a mix of shame and stoicism". The researchers also raised endocrine-disrupting chemicals as a possible factor.
Social status after menopause
In many cultures, menopause brings new freedoms rather than losses. In Rajasthan, anthropologist Marcha Flint found in 1975 that women who had been veiled and secluded during their childbearing years could now socialise with men and joke in public. In Qatar, women looked forward to fuller religious participation. Northern Sudanese women see menopause as a stage that brings more social power. Where the change opens doors, symptoms seem to weigh less, even when they are present.
Why doesn't Western culture revere elderhood?
The Groningen researchers note that many women feel more energetic or stable after menopause, yet this rarely features in public discussion.
In many societies, the end of fertility marks the start of a respected new role. Maori, Iroquois, Mayan and Cree women have traditionally become community leaders, healers and spiritual elders after menopause. In Japan, respect for elders is deeply rooted and konenki is understood as a long, gradual transition associated with renewal and energy. A 2010 study of North American First Nations women found that this stage could lift a woman's standing in her community as someone "wise".
The West took a different path. Researchers at the University of Groningen trace this to the 19th and 20th centuries. During that time, European and North American medicine recast menopause from a natural transition into a medical crisis. Doctors linked it to hysteria and mental instability. From the 1950s, hormone treatments framed it as a deficiency to be fixed. By the 1960s, hormone therapy was marketed as a way to stay young and energetic, and that image has endured.
This framing ties into a broader cultural value placed on youth, attractiveness and reproduction. Nerva describes the Western attitude as "youth is best", leaving menopause easy to read as decline. Women's Health Network goes further, arguing that Western culture treats older women as less valuable members of society. The result is what the Groningen team calls a "loss narrative": menopause as the loss of fertility, youth and desirability.
Dr Mary Jane Minkin, Professor of Obstetrics and Gynecology at Yale and lead author of the nine-country survey, sees this effect in her data: "In societies where age is more revered and the older woman is the wiser and better woman, menopausal symptoms are significantly less bothersome." She adds, "Where older is not better, many women equate menopause with old age, and symptoms can be much more devastating."
What this narrative leaves out is just as telling. The Groningen researchers note that many women feel more energetic or stable after menopause, yet this rarely features in public discussion. They also challenge the idea that menopause is taboo. Professor Rina Knoeff says, "It is often said that menopause is not talked about, but that is simply not true." In their view, the problem is less silence than the way menopause is talked about: mostly as symptoms and treatments.
The nocebo effect: can expectation shape symptoms?
Same symptom, different meaning. A Bengali woman and a Californian woman may describe the same symptom, but only one sees it as a problem.
Most people know the placebo effect, where a positive expectation improves how we feel. The nocebo effect is its mirror image: expecting something to be unpleasant makes a negative experience more likely and more intense. Symptoms that arise this way are not imagined. Expectation shapes how the brain attends to and interprets signals from the body, so a sensation that might pass unnoticed can be felt as distressing.
The Groningen team is now testing whether this applies to menopause. Professor Tineke Oldehinkel, who studies mental health across the life course, says: "When menopause is constantly portrayed as a difficult or problematic phase, it can colour expectations." She links this directly to the nocebo effect. The team stresses that this work is still at an early stage, and how much of a role expectation plays is not yet known.
Several findings fit the idea:
- Measured vs. felt. In the Hawaii study, Japanese American and European American women had similar numbers of measured hot flushes, but Japanese American women reported about half as many. Gunter also notes that some women report hot flushes with no measurable physical sign, raising the question of how the brain generates or interprets the sensation.
- Expecting symptoms. Women's Health Network describes Greek rural women who expect hot flushes as part of menopause, and report them.
- Same symptom, different meaning. A Bengali woman and a Californian woman may describe the same symptom, but only one sees it as a problem.
- The patient frame. Treating menopause purely as a medical condition casts women as patients waiting to recover, which may itself shape how symptoms are felt.
The nine-country survey also asked women whether menopause matched what they had expected. Women in Denmark, Sweden and Norway were the most likely to say it turned out better than they anticipated. Women in the US, UK, France and Canada were more likely to find it much worse. The survey wasn't designed to test the nocebo effect, but countries with a more negative story about menopause tended to report a harder experience.
The Groningen researchers are careful not to dismiss real suffering. As PhD researcher Hanneke de Boer puts it, "We want to start a conversation, not to trivialise medical complaints." The point is not that symptoms are "all in the head". It is that the story a culture tells about menopause may influence how strongly its women feel them.
The environmental factor: endocrine disruptors
Culture may shape how symptoms are felt, but the chemical environment may shape the symptoms themselves. The Swedish researchers' hunch about endocrine-disrupting chemicals (EDCs) is backed by a recent review of human and animal studies. It links phthalates, bisphenols, parabens, PFAS ("forever chemicals"), PCBs, dioxins and some pesticides to faster reproductive ageing and earlier menopause.
The figures are striking. In US national survey data, women with the highest urinary phthalate levels reached menopause 3.2–3.8 years earlier than those with the lowest. In the SWAN cohort, women in the top quarter of PFAS exposure reached menopause about two years earlier. EDCs may also affect how menopause feels. In the US Midlife Women's Health Study, phthalate exposure was linked to more frequent hot flushes and disrupted sleep, and paraben exposure to higher odds of hot flushes.
The authors note that the evidence is not uniform. Some studies of pesticides and PCBs found no link, or even a later menopause, and the evidence on symptoms is still limited. Most findings are associations rather than proof of cause, and the mechanisms remain unclear. Still, because these chemicals are found in food packaging, personal care products and household goods, exposure differs from place to place. That is one more possible reason menopause looks different around the world.
A meta review considers the chemical build up of EDCs to be an issue of concern and that needs more attention.
Perception is key
Menopause is a biological event, but how it is felt is shaped by much more than hormones. Diet, lifestyle, language, social status and expectation all appear to play a part, and many of the studies behind these ideas are small or decades old. Still, the pattern is consistent. Where menopause marks the start of a valued new stage, women tend to find it less troubling. As Gunter puts it, "studying hot flashes is complicated both from a biological and a cultural perspective." The next question is whether changing the Western story about menopause could change the experience itself.
Sources
- Menopause around the world, Nerva
- Menopause in different cultures, Women's Health Network
- Perceptions of menopause and symptoms, Reuters Health, June 2015 (reporting Minkin et al. in Menopause)
- What was menopause like for our mothers and grandmothers?, Dr Jen Gunter, The Vajenda, October 2022
- Menopause in perspective, University of Groningen, November 2025
- Endocrine disrupting chemicals, reproductive aging and menopause, review article, PubMed Central
