Menopause Experience Across Borders: Sub-Saharan African Women in LMICs and HICs

Abstract

Objectives: To identify menopause age, prevalence and severity of symptoms, knowledge and treatment-gap specific to the residence of the Sub-Saharan African (SSA) women. Methods: An electronic mixed-methods cross-sectional community survey was administered in June 2024, of Sub-Saharan African women > 40 years who had reached menopause across the world. Qualitative data provided contextual themes on the experience of menopausal care. Data analysis was via Microsoft Excel©. Results: Demographics: 87 of the 124 responses met the inclusion criteria. Average menopause age of 47.59 yrs ± 4.56 (HIC cohort) vs 49.78yrs ±3.26 (LMIC cohort) P= 0.013 95%CI (0.479 -3.9). There were no statistical differences in demographics. However, a small cohort of HIC women with early menopause occurrence after 5-8 yrs of emigration with a mean ± SD of 6.8 ± 3.4 yrs) was observed. Symptom-prevalence: was high and similar between cohorts (93.5% HIC vs 92.7% LMIC), with 17% of women globally reporting significant severity. Genitourinary symptoms (GUS) were most common in the LMIC at 58% prevalence, followed by vasomotor symptoms (42%) and insomnia (21%). Vasomotor symptoms were as common as GUS in the HIC cohort (58%). Hypertension prevalence was 21.4% in the LMIC and 15.2% in the HIC cohort. Knowledge deficit: Symptom-recognition was poorer in the LMIC cohort (46.3%) than the HIC cohort (26.1%), though most provided an appropriate definition (>78%). HIC women reflected a better understanding of Menopause symptoms. There was associated harm from disease -severity from poor recognition in the LMIC cohort. Treatment: Global MHT use was 8%, concentrated in the HIC cohort (15.2%), with none reported by the LMIC cohort, P=0.009. Use was also higher among the well-educated (67%) as compared to those with high income (37%) P=0.004.13% of women with significant symptoms were on Menopause Hormone Treatment Conclusions: In this small study, a HIC-resident woman undergoes menopause nearly 2.5 years ahead of her LMIC-resident counterpart. The LMIC cohort demonstrates poorer symptom-awareness and increased treatment-deficit, with associated disease morbidity. These findings imply a need for clinical guidelines and public health awareness campaigns, specifically tailored to the socioeconomic and educational contexts of LMIC populations. This study uniquely quantifies the disparity in menopause experience and management between HIC and LMIC residents of Sub-Saharan origin, highlighting a critical intervention point for reducing morbidity; future research should investigate causal mechanisms and evaluate targeted intervention programs.