Does one size fit all? The usefulness of menopause education across low and middle income countries

Approximately six million women, globally, will become menopausal annually, with 76% of these living in developing countries. Western studies show that the menopause transition is associated with an increased risk of cardiometabolic disease (CMD), cognitive decline and related risk factors. Longitudinal research found CMD risk factors are increasing, leading to the majority of deaths worldwide, particularly in low- and middle-income countries (LMICs). Data show that CMDs are associated with cognitive decline and subsequent dementia. A laterage at menopause is associated with increased longevity and low morbidity, but women in LMICs, where poor socio-economic conditions are the norm, have been shown to become menopausal earlier than their Western counterparts. A series of socioeconomic challenges, including a lack of adequate human and financial resources to collect robust, accurate data have hindered longitudinal research in LMICs, resulting in a paucity of data on the perimenopause and the increased health risks. Additional challenges includevery limited or no access to gynecological consultations or annual health checkupsfrom under resourced and stressed public health systems, lack of education, and scarcity of information on menopause. Menopause education focussing on modifiable life style risk factors is urgently needed to inform LMIC public healthcare systems and the population, particularly since menopausal hormone therapy is not readily available. However, several challenges suggest that information from Western studies may not be easily generalizable to LMIC women. Cultural and ethnic differencesmay determine a different experience of the MT between LMIC women and their Western counterparts. Socioeconomic status, education level and lifestyle may vary widely. There are limited appropriate screening tools and resources to measure various aspects of the menopause, including accurate staging, CMD risk factors and cognition, meaning menopause research in LMICs focusses primarily on age at menopause, menopausal symptoms and perception of menopause. In order to ensure that women in LMICs receive effective menopause education, there is an urgent need for LMIC menopause research focusing on biological and cultural factors affecting midlife women, using culturally appropriate and validated measures, and carefully designed methodology encompassing the broad range of confounding factors found in LMICs.