A reproducible search strategy was implemented using a combination of Medical Subject Heading (MeSH) terms and natural language in titles and abstracts, focusing on menopause, perceptions, attitudes, and ethnicity (Table 1). Search terms were combined using Boolean operators to align with the study objectives. References were exported to Rayyan Web and duplicates were manually removed (17). The search strategy aimed to identify studies exploring how women from different ethnic or cultural groups perceive and experience menopause, including sociocultural meanings, attitudes toward symptoms, and coping mechanisms.

Articles were retrieved from seven databases: Medline/PubMed, Web of Science and Scopus, using specific search equations developed for each database (Supplementary Table S2). No time or language restrictions were applied in order to include all relevant studies addressing ethnic or cultural perceptions of menopause across different historical and social contexts.

In the first stage, two reviewers (A-TK and OC-J) independently screened titles and abstracts. Discrepancies were resolved through discussion or by a third reviewer (E-MJ) with expertise in qualitative and cross-cultural health research. In the second stage, full texts were reviewed following the same procedure, and a PRISMA-ScR flowchart (Figure 1) summarizes the selection process. The online Rayyan Web software was used for the screening process (17).

Inclusion criteria encompassed studies addressing perceptions, attitudes, beliefs, or experiences of menopause among women who self-identify with specific ethnic or cultural groups (e.g., Indigenous, Afro-descendant, Asian, or others, according to the national context). Studies using qualitative, quantitative, or mixed methods were included. Exclusion criteria comprised reviews, commentaries, editorials, case reports, conference abstracts, governmental documents, animal studies, and articles without full-text access. Studies focusing solely on biological, hormonal, or clinical aspects of menopause without addressing cultural or perceptual dimensions were excluded.

Two reviewers (A-TK and E-MJ) developed a data extraction form refined by the author team. Data were independently extracted by reviewers (C-RL, A-TK, and OC-J), and discrepancies were resolved by a fourth reviewer (E-MJ). Extracted variables included: author(s), publication year, study objective, country, ethnic groups, study design, participant age, analytical approach, and main findings.

Studies were analyzed for their methodological approaches, populations, and key findings regarding cultural understandings of menopause. Emergent themes included symbolic meanings of menopause, sociocultural determinants of attitudes, coping strategies, and the intersection of ethnicity and health beliefs. Results are presented in tables summarizing the characteristics and thematic patterns of the included studies.

The quality of the included studies was assessed using the interpretative synthesis criteria for vulnerable populations proposed by Dixon-Woods, et al. (18) (Supplementary Table S3). Studies failing to meet at least one of the five criteria were excluded. Articles were reviewed by E-MJ and cross-checked by C-RL, with discrepancies resolved through discussion among three reviewers and a third (R-QP) as needed.

Table 2 summarizes the general characteristics of the included studies, categorized by ethnic representation, study design, analytical approach, and key findings related to menopausal experiences. Most studies employed quantitative methodologies—primarily cross-sectional designs—while a smaller number adopted longitudinal or comparative/multinational approaches. Only a few incorporated qualitative or mixed-methods analyses focusing on the interpretive and cultural dimensions of menopause.

The study populations predominantly included middle-aged women between 40 and 60 years of age, although some extended participation up to 90 years or included perimenopausal groups. Ethnic classification was generally broad, encompassing African American, Hispanic/Latina, Asian (Chinese, Japanese, Indian, Korean), Indigenous (Māori, Andean), Arab, and Caucasian women, often for comparative purposes. However, some studies also explored intra-group differences, such as variations between migrant and native Asian women.

Regarding analytical focus, most studies reported descriptive or ethnicity-stratified analyses, identifying variations in the prevalence, intensity, and impact of symptoms on quality of life. Others applied multivariate regression or factor-analytic methods to assess associations between ethnicity and symptom burden, while a few adopted thematic qualitative approaches to interpret subjective experiences, meanings, and cultural beliefs surrounding menopause.

The most frequently reported outcomes across studies were psychological and vasomotor symptoms, followed by sexual, musculoskeletal, and sleep disturbances. Some studies also examined perceived health deterioration, empowerment, or social respect as cultural expressions of menopause. Taken together, these findings underscore the predominance of biomedical symptomatology in the existing literature, with comparatively fewer investigations addressing the cultural and relational meanings of the menopausal transition.

Of the 63 full-text studies assessed for methodological quality and cultural sensitivity, 20 met all inclusion criteria—including the five interpretive criteria proposed by Dixon-Woods et al.—and were included in the final synthesis. The remaining 43 studies failed to meet at least one inclusion criterion; among these, 14 were excluded from the main analysis due to a high risk of bias, specifically for not fulfilling the Dixon-Woods interpretive criteria. The most common reasons for exclusion were the absence of a clearly defined focus on ethnic or cultural variation in the menopausal experience (Criterion 1) and insufficient methodological transparency to support interpretive validity (Criterion 4) (Supplementary Table S3).

The final synthesis included 20 studies published between 1977 and 2022, representing research conducted across six world regions: North America, South America, Europe, Asia, Africa, and Oceania. North America accounted for the largest representation (11 studies), reflecting the predominance of U.S.-based data in the literature. Asian countries such as China, India, and Singapore contributed five studies, while Africa was represented by three studies conducted in Nigeria and Egypt. Europe contributed two studies, and single studies were identified from South America (Bolivia) and Oceania (New Zealand). Several investigations included participants from multiple countries, underscoring the transnational scope of the evidence base.

Across the 20 studies, more than 20,000 women aged between 35 and 90 years were included, with sample sizes ranging from small qualitative cohorts (n = 14) to large multicenter surveys (n > 16,000). Most investigations employed cross-sectional designs (70%), followed by longitudinal (15%) and comparative or multinational studies (15%). Collectively, the studies revealed considerable ethnic and cultural variability in menopausal experiences, with frequent comparisons among African American, Hispanic, Asian, Indigenous, Arab, and Caucasian women.

Vasomotor manifestations such as hot flushes, night sweats, and palpitations were the most frequently reported symptoms across ethnic groups, though their prevalence and perceived severity varied considerably. Studies in African American and Hispanic women consistently described a higher frequency and intensity of vasomotor symptoms compared with White or Asian women (19–21). Similarly, Indigenous women from Bolivia identified hot flushes and genital discomfort as their most distressing experiences, often linked to anxiety and fatigue (22).

Somatic symptoms, including joint and muscular pain, fatigue, and physical exhaustion, were also highly prevalent among Arab women in Egypt (23) and among Chinese and migrant Asian women in Germany, where musculoskeletal discomfort was often attributed to both aging and cultural stressors associated with migration (24). In India, menopausal fatigue and joint pain were found to co-occur with psychological symptoms such as irritability and anxiety, forming an interconnected somatic–emotional cluster (25).

Psychological dimensions of menopause—particularly mood changes, irritability, depression, and anxiety—emerged as universal across studies. African American and Hispanic women tended to report more emotional instability than their White counterparts (21, 26). The Study of Women's Health Across the Nation (SWAN) demonstrated that Caucasian women were more likely to report psychosomatic symptoms, while African American women described more vasomotor and stress-related complaints (19, 27).

In Asian populations, fatigue, irritability, and loss of concentration were common, but emotional disturbances were often normalized or considered a temporary imbalance rather than illness (25, 28). Among Arab and African women, feelings of anxiety, sadness, and diminished vitality were associated with the physical discomfort of menopause and social expectations regarding aging and femininity (23, 29). Conversely, some Indigenous and rural groups interpreted emotional calmness post-menopause as a sign of maturity or relief from reproductive obligations (22, 30).

Sexual and relational changes emerged as a consistent theme across the included studies, although with substantial variation depending on cultural norms, the symbolic meanings attributed to menopause, and the social positioning of women within each ethnic group. Physical symptoms affecting sexual functioning—particularly loss of libido, vaginal dryness, and dyspareunia—were recurrent across several populations, including Indigenous Bolivian and Arab/Egyptian women, where urogenital discomfort and genital pruritus were common and directly linked to reduced sexual activity and avoidance of intercourse (22, 23). Among the Yoruba population in Nigeria, sexual withdrawal was even more pronounced: more than half of postmenopausal women reported discontinuing sexual activity, explaining this decision primarily through deeply rooted cultural beliefs that associate postmenopausal intercourse with illness, weakness, or spiritual harm (29).

In contrast, relational concerns were more prominent among Hispanic women, who reported that mood changes, reduced energy, and emotional exhaustion significantly interfered with intimacy, communication, and marital dynamics, beyond the impact of physical symptoms alone (21). These findings are consistent with multiethnic analyses in the United States, where Hispanic and African American women reported greater emotional distress, psychological symptoms, and diminished vitality—factors that indirectly affected partner relationships—compared with White, Chinese, or Japanese women (26, 31). The interplay between vasomotor symptoms, somatic discomfort, and emotional instability was also reflected in studies from India, where irritability, anxiety, poor concentration, and fatigue clustered with loss of sexual desire, suggesting that sexual and emotional domains during menopause tend to deteriorate concurrently rather than independently (25).

Experiences among Asian populations add further cultural nuance. Chinese and Singaporean Chinese women frequently described menstrual changes—especially irregular or heavy bleeding—as shame-inducing, disruptive, and anxiety-provoking events that affected body image, sexual confidence, and openness with partners (28, 32). For many, concerns about “abnormal” bleeding, fear of cancer, or the perception of premature aging promoted secrecy and sexual avoidance. Similarly, migrant Chinese women in Germany reported higher rates of sexual problems, exhaustion, and musculoskeletal discomfort compared with German women, suggesting that migration-related factors and cultural expectations intersect with menopausal changes to shape sexual experiences (24).

While menopause was interpreted as a loss—of youth, fertility, attractiveness, or desirability—in some cultures, other groups articulated more ambivalent or even positive narratives. Studies among Persian, Turkish, and North African women revealed mixed emotions regarding the cessation of fertility: some welcomed relief from reproductive responsibilities or the disappearance of menstrual discomfort, whereas others expressed concern that their husbands might regret the loss of reproductive capacity (33). Women from Lebanon, Morocco, Spain, and the United States similarly highlighted fatigue, physical strain, and diminished energy as major barriers to maintaining intimacy and everyday functioning, underscoring the universal—yet culturally filtered—nature of these midlife challenges (34).

In China, 17% of women explicitly reported a compromised sexual life and 13.8% noted relational difficulties with their husbands due to menopausal symptoms (28). Among Māori and non-Māori women in New Zealand, vaginal dryness and urogenital symptoms were frequently reported, although relational interpretations differed across ethnic groups (30). In nationally representative U.S. surveys, sexual disruption was more prevalent among African American and Caucasian women, who reported higher frequencies of palpitations, chest discomfort, and psychological distress—factors known to indirectly undermine intimacy (27).

Marked cross-ethnic variations were observed in both the perception and reporting of menopausal symptoms. In large multiethnic cohorts, such as those conducted in the United States, African American and Hispanic women consistently reported a higher symptom burden, including vasomotor and psychological symptoms, than White women (20, 31, 35). By contrast, Asian women (Chinese and Japanese) demonstrated the lowest prevalence of distress, frequently interpreting menopause as a natural and expected life transition rather than a medical condition (19, 26). Otras investigaciones asociaron diferencias conductuales y de autocuidado entre grupos étnicos (36).

Studies among Indigenous and Māori women highlighted culturally specific experiences that diverged from Western medical narratives. Māori participants from New Zealand often framed menopause as a continuation of the life cycle rather than pathology, though somatic discomforts such as leg cramps or urinary pain were frequent (30). Similarly, Indigenous Bolivian women associated menopause with “loss of blood” and diminished energy but also acknowledged it as a release from reproductive constraints (22).

Comparative studies revealed how migration and cultural adaptation shape menopausal experiences. Chinese migrant women living in Germany reported greater symptom severity than Chinese women in Beijing, suggesting the influence of acculturation and psychosocial stress (24). Likewise, in transnational analyses involving Lebanon, Morocco, Spain, and the United States, differences in fatigue and perceived health reflected both cultural norms and socioeconomic conditions (34).

The studies collectively illustrate that the meaning of menopause is culturally constructed, embedded in local belief systems, gender norms, and social expectations. In many African and Middle Eastern contexts, menopause was described as a stage of social withdrawal and loss of desirability, intertwined with religious and moral codes emphasizing modesty and purity (23, 29, 33). Conversely, in Indigenous and Asian cultures, cessation of menstruation was sometimes linked to wisdom, spiritual strength, and freedom from reproductive constraints, reflecting positive redefinitions of womanhood (22, 30).

Migration, modernization, and exposure to Western health models appeared to modify traditional interpretations. For instance, Chinese migrant women in Europe and Hispanic women in the United States increasingly adopted biomedical explanations for menopausal symptoms, associating them with stress, hormonal imbalance, or aging (21, 24). Meanwhile, North American women tended to frame menopause as a medicalized process requiring management, often seeking clinical validation for symptoms (20, 31).

On the other hand, the age at menopause onset demonstrates notable variation across ethnic groups. A comparative study reported a higher prevalence of early menopause among Korean women compared with women in the United States. Moreover, Korean women exhibited both a higher and consistently declining prevalence over time, indicating a lower risk of early menopause in younger cohorts relative to older generations within this population (45).

Social class, education, and marital status further influenced interpretations: women with lower socioeconomic status or limited access to healthcare were more likely to normalize discomfort and rely on cultural explanations, while those with higher education more frequently described menopause through a health literacy or empowerment discourse (25, 34), aunque la mayoría evidenció variaciones étnicas en la experiencia de la menopausia, algunos trabajos no reportaron diferencias significativas en actitudes según grupo étnico o nivel educativo (37). Detailed characteristics of each study, including country, population, design, analytical approach, and main outcomes, are presented in Table 3.

Menopause is not only a time of loss but also a period of growth, self-realization, and transformation for women. Cultural analysis of menopause indicates that women's empowerment depends on their ability to make decisions within the context of inequalities, cultural barriers, and limited access to healthcare services. In the populations studied, the greatest psychosomatic and emotional burden is associated with persistent inequities and culturally insensitive healthcare services, which in many cases restrict women's autonomy in managing their symptoms and health appropriately.

However, in cultures where menopause is viewed as a natural stage of life, strategies adapted to their environment are adopted. This approach fosters a space to redefine women's roles and seize the opportunity to change traditional expectations, incorporating cultural practices and improving the understanding of health information. Moving toward empowerment requires reducing inequalities, providing culturally appropriate care, and creating spaces for participation. From this perspective, menopause can be reconfigured as a stage that allows for autonomy, physical well-being and growth, and not just as a period of loss.

Future research on menopausal experiences across ethnic groups should expand in several strategic directions to address the structural gaps identified in this review. First, there is a critical need for studies focusing on Indigenous, Afro-descendant, and rural women from Latin America, Africa, and other underrepresented regions. The limited evidence available for these groups restricts the understanding of how cosmological beliefs, collective practices, and intergenerational knowledge shape the menopausal transition. Future investigations should therefore prioritize culturally grounded methodologies and community-engaged approaches that capture local explanatory models and epistemologies surrounding menopause.

Research designs must move beyond the dominance of cross-sectional quantitative surveys to include longitudinal, mixed-methods, and qualitative frameworks capable of tracing symptom trajectories, cultural transformations, and temporal changes in women's perceptions. Longitudinal designs would help clarify how structural determinants—such as socioeconomic mobility, migration, acculturation, gender norms, and exposure to biomedical models—influence symptom expression over time. Mixed-methods studies may also enhance interpretive depth by integrating experiential narratives with clinical or epidemiological indicators.

There is a need to systematically explore the role of structural inequities—such as racism, discrimination in healthcare, economic precarity, and limited access to gynecological services—in shaping symptom burden and health-seeking behavior among minority ethnic groups. Future studies should incorporate intersectional analyses capable of capturing how ethnicity interacts with social class, education, sexuality, disability, and geographic isolation to produce differentiated menopausal trajectories. Future reviews and primary studies should incorporate information retrieved through manual searches or community-generated evidence, provided that methodological rigor is preserved. This complementary inclusion would allow a more comprehensive understanding of underrepresented cultural contexts that are seldom present in mainstream academic databases.

Culturally adapted clinical tools and intercultural models of menopausal care should be developed and validated specifically for minority and rural populations. Research evaluating the acceptability, feasibility, and effectiveness of these models—particularly those integrating community health workers, traditional knowledge systems, or non-pharmacological practices—would support the creation of more equitable, context-sensitive health interventions.

Differences in the intensity and meaning of menopausal symptoms across ethnic groups reflect the intersection of cultural, religious, socioeconomic, and gender-related factors. African American and Hispanic women experience greater vasomotor and psychological symptom burdens, whereas Asian and Indigenous women tend to reframe menopause as a natural transition, illustrating the influence of cultural context on bodily perception and distress.

This review reveals a marked lack of research on menopause among Indigenous women in Latin America and Africa, limiting the understanding of the phenomenon from an intercultural perspective. This absence reproduces inequalities in scientific production and perpetuates a hegemonic approach centered on urban White women from industrialized countries, thereby obscuring the cultural and community-based determinants that shape menopausal experience.

It should also be noted that during the literature search, a few potentially relevant studies were identified through manual exploration but were not incorporated into the final synthesis to preserve the methodological rigor and reproducibility of the systematic process. Although this decision ensured adherence to the Joanna Briggs Institute's scoping review framework, it may have excluded additional evidence of contextual value. Future reviews are encouraged to include such manually retrieved studies through a complementary or sensitivity analysis, to capture all relevant perspectives and enhance the comprehensiveness of the evidence base.