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There is a school of thought that believes that menopausal symptoms are a peculiarly 'Western' phenomenon, not experienced by women from other regions and particularly not from Asia where, it has been claimed, dietary, social and cultural factors afforded protection for women living in that region. More recently, studies conducted in multi-ethnic communities living in Western countries as well as in Asian communities have found that the menopause and its consequences are similar world-wide. Ethnic differences within Asia account for small differences in endogenous hormone levels and age at menopause between Asian and Western women, and the type of menopause symptoms and their prevalence also differ between those two communities. However, like in the West and perhaps because of a Western influence, the long-term health problems of postmenopausal women including cardiovascular disease, osteoporosis and breast cancer are of major importance to Asian women and health services in the 21st century.

Background: Latin American women present more severe menopausal symptoms when compared to those from other regions of the world. Since this population is an ethnic blend of Caucasian and indigenous people, we sought to test the hypothesis that severe menopausal symptoms in Latin American women are associated with an indigenous origin., Objective: To assess menopausal symptoms among two specific indigenous Latin American populations., Method: A total of 573 natural postmenopausal indigenous women aged 45-59 years (288 Quechua (Peru) and 285 Zenú (Colombia)) living in isolated communities were surveyed with a general questionnaire and the Menopause Rating Scale (MRS)., Results: The total MRS score was significantly higher among Quechua women as compared to Zenú ones (22.7 ± 5.7 vs. 14.7 ± 2.5, p < 0.0001); both figures were higher than those described for Hispanic or European populations. Quechua women presented more intense somatic and psychological symptoms as compared to Zenú (8.8 ± 2.3 vs. 5.3 ± 1.8; and 7.8 ± 2.4 vs. 3.2 ± 1.7, p < 0.0001); however, both indigenous groups presented similar intense urogenital symptoms (6.1 ± 1.6 vs. 6.2 ± 1.4, not significant). These differences persisted after adjusting for age, years since menopause onset and parity. The percentage of women presenting severe somatic and psychological symptoms significantly increased with aging among Quechua. This was not the case for Zenú women. More than 90% of indigenous women (Quechua and Zenú) at all age intervals presented severe urogenital scores, a percentage that is much higher than that described in the world literature., Conclusion: Severe menopausal symptoms found among Latin American women could be the result of their indigenous ethnic origin; the urogenital domain is the most affected.

Objective: To describe differences in the age of onset of menopause and in the prevalence of climacteric symptoms in different geographical areas., Design: Systematic review of published data on onset of menopause and symptoms in Europe, North America, Latin America and Asia., Methods: We identified publications by searching electronic databases, including MEDLINE (1966-October 2009) and EMBASE (1975-October 2009). Primary search criteria were age of menopause and climacteric symptoms. A sensitive analysis that excluded papers without full data was performed., Results: The median age at menopause in Europe ranges from 50.1 to 52.8 years, in North America from 50.5 to 51.4 years, in Latin America from 43.8 to 53 years, and in Asia from 42.1 to 49.5 years. The frequency of vasomotor symptoms varies widely depending on the geographical region, selection of criteria, and method of symptom identification. The prevalence of such symptoms ranges from 74% of women in Europe, 36-50% in North America, 45-69% in Latin America and 22-63% in Asia, as reported in different, large, epidemiological studies., Conclusion: There are wide geographical differences in the prevalence of menopausal symptomatology and some differences in the age of onset of menopause. Both in Asia and Latin America, women of poorer socioeconomic status have significantly earlier onset of menopause. Within a geographical region, there are ethnic differences in menopause symptoms. Given differences in study methodologies, firm conclusions are not possible. However, regional differences in age at menopause and in climacteric symptoms are important to acknowledge and lay the foundation for an informed approach to the management of menopause and an understanding of its impact on women's health in the different regions of the world.

Introduction: Since the designation of people as Hispanic involves the amalgamation of a number of different cultures and languages, we sought to test the hypothesis that menopausal symptoms would differ among Hispanic women, based upon country of origin and degree of acculturation., Methods: A total of 419 women, aged 42-52 years at baseline, were categorized as: Central American (CA, n = 29) or South American (SA, n = 106), Puerto Rican (PR, n = 56), Dominican (D, n = 42), Cuban (Cu, n = 44) and non-Hispanic Caucasian (n = 142). We assessed vasomotor symptoms, vaginal dryness and trouble in sleeping. Hispanics and non-Hispanic Caucasians were compared using the chi(2) test, t test or non-parametric alternatives; ANOVA or Kruskal-Wallis testing examined differences among the five Hispanic sub-groups. Multivariable regression models used PR women as the reference group., Results: Hispanic women were overall less educated, less acculturated (p < 0.001 for both) than non-Hispanic Caucasians and more of them reported vasomotor symptoms (34.1-72.4% vs. 38.3% among non-Hispanic Caucasians; p = 0.0293) and vaginal dryness (17.9-58.6% vs. 21.1% among non-Hispanic Caucasians, p = 0.0287). Among Hispanics, more CA women reported vasomotor symptoms than D, Cu, SA, or PR women (72.4% vs. 45.2%, 34.1%, 50.9%, and 51.8%, respectively). More CA (58.6%) and D women (38.1%) reported vaginal dryness than PR (17.9%), Cu (25.0%) and SA (31.4%) women. More PR and D women reported trouble in sleeping (66.1 and 64.3%, respectively) compared to CA (51.7%), Cu (36.4%), and SA (45.3%) women., Conclusion: Symptoms associated with menopause among Hispanic women differed by country of origin but not acculturation. Central American women appear to be at greatest risk for both vasomotor symptoms and vaginal dryness.

Objectives: To describe menopause symptoms in postmenopausal Maori and non-Maori New Zealand women, and explore relationships between symptoms, sociodemographic profile and hormone replacement therapy (HRT) use., Methods: Cross-sectional analysis of data collected during recruitment of women from 27 primary-care practices into an observational study and the international WISDOM trial of postmenopausal HRT., Results: A total of 3616 women aged 49-70 years (mean 58.9 years) were recruited between 1999 and 2004. Maori and non-Maori participants differed in demographic and clinical characteristics, but few differences were observed in the frequency of menopause-related symptoms. Vasomotor symptoms (hot flushes and/or night sweats) were reported by 34.4% of women, with no statistically significant difference between Maori and non-Maori (controlling for demographic variables, p > 0.05). Compared to non-Maori, Maori were less likely to have ever used HRT (24% vs. 54%), and only 5% of Maori reported current HRT use compared to 30% of non-Maori (p < 0.05)., Conclusions: Maori and non-Maori have the same rate of self-reported vasomotor symptoms despite differences in factors thought to influence the experience of menopause symptoms. Differences in HRT use between Maori and non-Maori need to be further explored to identify contributing factors and whether, in turn, these factors impact on quality of life.

Aim: To investigate the menopausal experience of Arabic women living in Sydney and to explore the relationship between the psychosomatic symptoms and various sociodemographic factors., Method: A cross-sectional survey was conducted among 197 Arabic women aged 45-65 years. The Menopause-specific Quality of Life (MENQOL) questionnaire was used to collect information on sociodemographic characteristics and menopausal symptoms., Results: The median age at menopause in the present study was 49 years (mean+/-standard deviation, 47.9+/-5.0 years). Out of 29 symptoms, the most frequent symptom reported was 'feeling tired or worn out' (86%), followed by 'aching in muscles and joints' (85%). Sixty-three percent of the subjects reported 'hot flushes' and 54% reported 'vaginal dryness during intercourse'. The least prevalent symptom was 'increased facial hair' (35%). Postmenopausal women suffered more vasomotor and sexual symptoms than pre- and perimenopausal women (p<0.05). Women from the sample who were better educated and had a lower body mass index reported fewer and less severe symptoms., Conclusion: Menopause-related symptoms among these Arabic women in Sydney were more prevalent and severe than those reported in many other countries and their quality of life was negatively affected by these symptoms.