The research area for this study is Yongning Township, Ninglang County, Yunnan Province, a region where Mosuo, Yi, and Han ethnic groups traditionally reside together (10). Yongning Township is renowned for its diverse cultural background and unique ethnic traditions. According to data from the local police station, there are a total of 2,038 women aged 40 to 60 in this area, including 1,071 Mosuo women, 316 Yi women, and 651 Han women (24). As the main settlement of the Mosuo people, Yongning Township provides an ideal setting for studying the impact of cultural factors on menopausal symptoms and help-seeking behaviors.

The inclusion criteria for participating in this study were Mosuo, Yi, and Han women aged 40 to 60 who volunteered to participate. The exclusion criteria were women who had undergone unnatural menopause, those using medications that affect endocrine function, those with a history of severe physical or mental illness, and those unable or unwilling to participate in the study. During the research process, a fixed researcher used standardized scales to evaluate all participants, assisted by a young Mosuo woman fluent in both the Mosuo language and Mandarin, with at least a middle school education, who served as a translator. In the end, a total of 210 valid questionnaires were collected, including 81 from Mosuo women, 71 from Yi women, and 58 from Han women.

Data analysis was conducted using SPSS 27.0 statistical software. First, descriptive statistics were performed on the demographic characteristics and various indicators of the sample, including frequency, percentage, mean, and standard deviation calculations. To examine the differences in menopausal symptoms and help-seeking behaviors among women from different ethnic groups, Chi-square tests and one-way analysis of variance (ANOVA) were used. The severity of menopausal symptoms was assessed using the Kupperman Menopause Index, and the total score of the Kupperman Index was used to measure symptom severity. Then, in a multiple linear regression analysis, the KMI was treated as the dependent variable, while cultural and psychological factors, including the subdimensions of SSICHB, DASS-21, and GSES, were included as independent variables. Height and age were treated as control variables. All statistical analyses were two-tailed tests, with a significance level set at p < 0.05.

The results of Harman’s single-factor test showed that 24 factors with eigenvalues greater than 1 were extracted from the included features, collectively explaining 73.054% of the total variance. The variance explained by the first factor was 16.105%, which did not exceed 40%. Therefore, there is no significant common method bias in this study (31).

The average age of the Mosuo, Yi, and Han women (49.543 ± 5.266, 49.686 ± 7.056, 49.483 ± 4.612, respectively) showed no statistically significant difference (F = 0.022, p = 0.979). And there was a significant difference in height (F = 14.211, p < 0.001), the Mosuo women were found to be taller than the Han and Yi women. Almost all surveyed Mosuo women have religious beliefs, such as Daba and Tibetan Buddhism. Yi women primarily follow local traditional beliefs, with Bimo and Suni being important figures in religious and cultural activities, while the proportion of religious adherence among Han women is very low.

According to the statistical analysis results in Table 1 , there were significant differences in several demographic characteristics between the different ethnic groups. Firstly, there was no significant difference in menopause awareness rates among the three ethnic groups. After conducting an ANOVA on education level, the results indicated significant differences among the ethnic groups (F = 6.059, p = 0.003). Post-hoc comparisons revealed that the education level of the Han ethnic group was significantly higher than that of the Yi group (p = 0.029). Similarly, the education level of the Mosuo group was significantly higher than that of the Yi group (p < 0.001). Smoking status also showed significant differences (χ² = 32.614, p < 0.001), with Yi women having a significantly higher smoking rate (31.0%) compared to Mosuo (6.2%) and Han (0.0%) women. And the difference in alcohol consumption habits among the three groups was not statistically significant (χ² = 2.919, p = 0.232). There were significant differences in dysmenorrhea experiences among the different ethnic groups (χ² = 9.196, p = 0.010), with the highest proportion reported by Han (62.1%) women. There were no statistically significant differences in personal income control and family income support among the different ethnic groups (χ² = 3.282, p = 0.194; χ² = 1.625, p = 0.444). These results provide foundational data for further research on the impact of different cultural backgrounds on menopausal symptoms.

Based on the detection rates of various symptoms from the modified KMI, the top three symptoms reported by Mosuo women were paresthesia (72.8%), arthralgia/myalgia (71.6%), and headache (55.6%). For Yi women, the most common symptoms were arthralgia/myalgia (77.5%), paresthesia (71.8%), and headache (66.2%), while Han women reported paresthesia (87.9%), arthralgia, myalgia (75.9%), and headache (70.7%) as the most frequent symptoms. There were significant differences in menopausal symptoms among women of different ethnic groups. Specifically, there were significant differences among Mosuo, Yi, and Han women in the prevalence of insomnia, vertigo, fatigue, and urinary tract infection. Han women had the highest rates of insomnia (67.2%) and vertigo (69.0%), while Mosuo women had the lowest prevalence of these symptoms (35.8%, 44.4%). Yi women had the highest rates of fatigue (69.0%) and urinary tract infection (38.0%), with Mosuo women again showing the lowest prevalence (14.8%).

As shown in Table 2 , in terms of the modified KMI total score (excluding the item on sexual intercourse difficulty), Mosuo women scored lower than Yi and Han women (10.580 ± 8.329, 13.873 ± 8.657, 16.224 ± 9.306, F = 7.355, p < 0.021, p < 0.001), with no significant difference between Yi and Han women (p = 0.129). Overall, the differences in menopausal symptoms and experiences among women from different ethnic backgrounds highlight the significant role that ethnicity plays, providing a basis for offering more culturally tailored health management and support to women.

As shown in Table 3 , based on the data from the SSICHSB scale, there were significant differences in illness conception and help-seeking behavior across different stages among Mosuo, Yi, and Han women. The overall score did not show a significant difference among the three ethnic groups (p = 0.259). However, analysis of specific dimensions revealed significant differences in the DIIC among the three groups (p = 0.001), with Yi women scoring the highest, significantly higher than Han and Mosuo women. There were also significant differences in HSMB among the three groups (p = 0.049), with Han women scoring the highest, significantly higher than Yi and Mosuo women.

To further explore the key factors influencing Kupperman scores, a linear regression analysis was conducted on the entire sample of women. In the regression analysis of the entire sample, we included multiple potential influencing factors such as age, education level, religious belief, lifestyle factors (e.g., smoking, drinking), psychosocial factors (e.g., DASS, GSES), and cultural background. The analysis results showed that stress, the presence of dysmenorrhea, anxiety, religious belief, and self-efficacy had significant impacts on the Kupperman score in the overall sample, providing a basis for further subgroup analysis.

Through regression analysis, we can gain a clearer understanding of the factors influencing menopausal symptoms. These results also provide scientific evidence for formulating targeted health intervention strategies.

The regression model was established by including all samples and using the stepwise method to select relevant key factors (R² = 0.568, adjusted R² = 0.552, R² change = 0.486).

As shown in Table 4 , after controlling for age and height, five key predictors of KMI were identified for Mosuo, Yi, and Han women: stress, dysmenorrhea, anxiety, religious belief, and self-efficacy.

Among the independent variables, stress levels (DASS_Stress) and the experience of dysmenorrhea both had significant effects on the Kupperman score—higher stress levels and the presence of dysmenorrhea were associated with more severe menopausal symptoms. Additionally, anxiety levels (DASS_Anxiety) also had a significant effect on the Kupperman score. The presence of religious belief and self-efficacy also significantly influenced menopausal symptoms. Specifically, women without religious beliefs and those with lower self-efficacy experienced more severe menopausal symptoms. These findings suggest that psychological factors and physiological experiences play important roles in the severity of menopausal symptoms.

To explore the changes in menopausal symptoms, health perceptions, and help-seeking behaviors among Mosuo women, this study compared data collected in 2012 and 2020. By longitudinally comparing the data from these two time points, we analyzed the dynamic changes in these aspects among Mosuo women over time.

As shown in Table 5 , by comparing the data collected in 2012 and 2020, it was found that Mosuo women had significantly lower menopausal symptoms (Kupperman score) in 2020 compared to 2012 (p = 0.040), indicating a reduction in their menopausal symptoms. Additionally, Mosuo women had significantly lower scores in the dimension of CDHA in 2020 compared to 2012 (p = 0.010), suggesting a decrease in their concern and worry about illness. There were no significant changes in the dimensions of DIIC and HSMB.

For Han women, there were no significant changes in KMI, CDHA and DIIC. However, their scores in the dimension of HSMB were significantly lower in 2020 than in 2012 (p = 0.028).

The descriptive analysis revealed significant differences across various factors among Mosuo, Yi, and Han women. Notably, Han women had significantly lower rates of smoking and drinking compared to the other two groups, with smoking rates particularly high among Yi women. This finding aligns with previous research (32), which indicated that participants from ethnic minorities and those with lower education levels were more likely to smoke. Similarly, in this study, Yi women had the highest illiteracy rate, surpassing both Han and Mosuo women, highlighting significant educational disparities between the ethnic groups.

The significant differences in menopausal symptoms among Mosuo, Yi, and Han women indicate that ethnic factors play an important role in the prevalence of these symptoms. Mosuo women had the lowest scores in menopausal symptoms, indicating milder symptoms. Similar studies have suggested that the matrilineal social structure and “walking marriage” system of the Mosuo may play a positive role in reducing psychological stress among women (33). Han women had the highest rates of insomnia and vertigo, which could be attributed to the fact that many of them migrated from various parts of the country. Despite living there for some time, they may not have fully adapted to the local environment, climate, or atmospheric pressure (34). This ongoing process of cultural and environmental adaptation may lead to additional psychological and physiological stress (35), contributing to the higher rates of insomnia and vertigo. Yi women exhibited the highest prevalence of fatigue and urinary tract infection, in contrast, Mosuo women had the lowest rates of several menopausal symptoms, such as insomnia, vertigo, fatigue, and urinary tract infections. This could be linked to the unique cultural and social structure of the Mosuo community, where women may receive greater family support (7) and experience less stress (24), thus reducing the severity of menopausal symptoms.

The regression analysis further identified key factors influencing menopausal symptoms. Higher levels of stress and anxiety were associated with more severe menopausal symptoms (p < 0.001), demonstrating that psychological factors play an important role in symptom severity. This is consistent with previous research that found a close relationship between psychological stress, anxiety levels, and the severity of menopausal symptoms (36, 37). However, depression scores were not included, as there is currently no direct evidence linking depression to menopausal symptoms (18). Significant increases in depression during menopause are primarily observed in women with a history of depressive episodes (38). Stress and anxiety are significant risk factors for menopausal symptoms. Women experiencing anxiety symptoms face an increased risk of developing moderate to severe vasomotor symptoms during the menopausal transition (39). These findings support the hypothesis that psychosocial factors influence menopausal symptoms (18). Additionally, the presence of dysmenorrhea was identified as a risk factor for menopausal symptoms. Experiencing pain and discomfort may increase the risk of developing psychosomatic symptoms. Additionally, the presence or absence of religious beliefs is significantly associated with menopausal symptoms. However, as shown in Table 1 , the differences in religious beliefs closely align with ethnic differences. Due to the small sample size, whether these variations are related to religious beliefs requires further investigation in future research. These findings highlight the importance of physiological and psychological factors in managing menopausal health, suggesting that multiple factors should be considered when developing interventions. The results indicate that self-efficacy is a protective factor against menopausal symptoms. Previous studies have found that self-efficacy moderates the relationship between symptoms and menopausal life satisfaction (19), highlighting that self-efficacy is an important psychological factor that plays a crucial role in maintaining women’s physical and mental health.

In the comparison of SSICHSB, Yi women scored significantly higher than both Han and Mosuo women in their conception of disease and health in adulthood, suggests that Yi women exhibit a higher level of concern and fear regarding illness compared to Mosuo and Han women. The lack of difference between Mosuo and Han women is consistent with previous findings (14), while the higher scores among Yi women support earlier research on the health-related quality of life in the Yi population (40). The high prevalence of infections among Yi women may be related to their more negative illness perceptions. Health beliefs shaped by ethnicity and culture can greatly influence related health behaviors (41).

In terms of help-seeking methods and behaviors, Han women, having received higher levels of modern education and possessing greater knowledge of modern medicine, tend to have a more optimistic and proactive attitude towards illness. They tend to believe that recovery from illness is largely dependent on their own efforts. In contrast, Mosuo and Yi women were less likely than Han women to believe that recovery from illness is significantly related to their personal efforts, which may be linked to their ethnic religious beliefs. The Mosuo people, who practice Daba or Tibetan Buddhism, often seek herbal remedies for minor illnesses, while major or unexplained ailments are treated with a combination of Western medicine and religious rituals (42). The Yi people in the Xiao-liangshan region of southwest China have a unique practice of combining ritual healing and traditional medicine for patient care, often avoiding hospitals and other modern medical facilities (43).

Comparing data from 2012 and 2020, it was found that Mosuo women experienced significantly reduced menopausal symptoms in 2020 (p = 0.040), likely due to changes in their social and cultural environment. Over the years, Mosuo women have undergone natural adaptation and physiological adjustment, gradually becoming more accustomed to the changes associated with menopause, which has naturally led to a reduction in symptoms. A decrease in the use of their traditional language (44), along with improvements in the built environment and the growth of tourism (45), has significantly altered their lifestyle. With the development of modern medicine, Mosuo women in 2012 may have confused some disease symptoms with menopausal symptoms in the survey, but now they are better able to distinguish symptom attribution and receive appropriate treatment for underlying conditions, further reducing the reported incidence of menopausal symptoms. Compared to eight years ago, Mosuo women have developed a more positive outlook on illness, reflecting the profound impact of social and cultural changes on women’s health behaviors. This also highlights the integration of traditional culture with modern health concepts during the process of modernization (46, 47). Han women, while showing a significant decrease in help-seeking methods and behaviors in 2020 compared to 2012 (p = 0.028), still maintained higher scores than Mosuo women, demonstrating a relatively proactive approach. With the advancement of basic healthcare, even in impoverished areas, effective treatments for common diseases are now available (48).

These findings reveal changes in menopausal symptoms and health behaviors among women from different cultural backgrounds, providing important references for further research. The first step is to identify modifiable risk factors (18), such as the introduction of CBT therapy and the adoption of its treatment principles, as well as implementing stress management and anxiety clarification strategies (49). By providing better medical knowledge and healthcare services to women, particularly in medically underserved minority communities, their menstrual experience can be improved and discomfort reduced (50), Mitigation of risk factors. Additionally, improving women’s education levels and encouraging regular physical exercise can enhance their self-efficacy in leveraging protective factors, empowering them to better manage their menstrual health and overall well-being (18, 51). Future research should further explore the impact of cultural and social changes on women’s health to provide more targeted health support and interventions for women from different cultural backgrounds. These interventions may include culturally sensitive health education, psychological support, and personalized medical services for different ethnic groups. By comprehensively considering cultural, psychological, and social factors, we can more effectively support women through menopause and improve their quality of life.