Published in BJOG: An International Journal of Obstetrics & Gynaecology, the systematic review and meta-analysis brought together evidence from 61 studies involving nearly 280,000 participants from around the world. The research examined factors associated with vasomotor symptoms such as hot flushes and night sweats, as well as vaginal dryness and joint symptoms.
Funded by the National Institute for Health and Care Research (NIHR) Research for Patient Benefit programme, the study found that menopause symptoms are not experienced equally across different groups of women.
Symptom burden across ethnic groups
Black women were 65% more likely than White women to experience hot flushes and night sweats, 91% more likely to report severe symptoms, and were also more likely to experience vaginal dryness. In contrast, Asian women were less likely that White women to report hot flushes and night sweats.
The researchers suggest that cultural differences in symptom awareness, perceptions of menopause, and comfort discussing symptoms or seeking support may partly influence how women experience and report symptoms.
Senior author Dr Jennifer Hirst, Associate Professor at the Nuffield Department of Primary Care Health Sciences, said:
“These findings highlight the need to better understand why some groups of women experience a greater burden of menopause symptoms and whether barriers to accessing treatment or support are contributing to these inequalities.”
The study adds to growing evidence that menopause care needs to be more inclusive. The authors note that women from some groups — including Black women and women living with obesity or depression — may face a higher burden of symptoms but are not always equally likely to receive effective treatment or support. Previous work by the team has shown that Black women in the UK are less likely to receive hormone replacement therapy (HRT), despite evidence that they may experience more severe symptoms (Inequalities in hormone replacement therapy prescribing in UK primary care: population based cohort study and Factors Associated With Hormone Replacement Therapy Use: A Systematic Review and Meta-Analysis).
Lifestyle and health factors
The review also identified several lifestyle and health factors associated with more frequent or severe menopause symptoms. Smokers were around 60% more likely to experience symptoms, while women living with obesity were around 40% more likely to report both the presence and severity of symptoms, and depression was linked to greater symptom severity.
Women with higher levels of education and income were more likely to report vasomotor symptoms, a pattern the researchers say may reflect differences in health awareness, access to care, or willingness to seek support rather than any straightforward biological explanation.
Dr Janice Hoang, lead author from the University of Leeds and former researcher at the Nuffield Department of Primary Care Health Sciences, said:
“Our review shows that menopause symptoms are not experienced equally. Factors such as ethnicity, smoking, obesity and mental health can all influence symptom burden, highlighting the importance of more personalised and equitable menopause care.”
The researchers say the findings highlight the need for more personalised and equitable menopause care. They argue that clinicians should consider proactive menopause discussions with women who may be at higher risk of symptom burden, while being mindful that social circumstances and barriers to treatment can affect whether symptoms are recognised and managed.
They also point to the importance of behavioural and lifestyle support as part of menopause care, reinforcing the need for preventative and supportive interventions for smoking and obesity alongside clinical treatment.
Dr Hirst added:
“Menopause care should not take a one-size-fits-all approach. Our findings underline the importance of culturally sensitive, individualised care that recognises the different experiences women may have during the menopause transition.”
Read the full paper, 'Factors Associated With Menopause Symptoms: A Systematic Review and Meta‐Analysis' in BJOG: An International Journal of Obstetrics & Gynaecology.