Why We Don't Talk About Menopause, And Why That Silence Is Hurting Us
Follow on your favorite platform
My mother never explained menopause to me. Not because she didn't love me, but because no one had explained it to her either. In my family, and in a lot of ours, a woman's body was something you managed quietly, without complaint, without taking up too much space.
So I inherited the silence along with everything else. And it took me years, and a medical degree, to understand how much that silence actually costs us.
I'm continuing the South Asian women's health series on Endocrine Matters with the conversation most of us never had. You can watch or listen on my channel.
The Silence We Inherited
Growing up, certain things were absorbed without being said. Periods were not just private, they were treated as something close to shameful. And if we could not talk about periods, we certainly were not going to talk about perimenopause. There was no framework for it, no preparation, no language.
The overgeneralization is that this silence was modesty or respect. The truth is that it left generations of women unable to name what was happening to them, and unable to ask for help.
South Asian Women Enter This Earlier Than You Think
Here is what most of us were never told: we tend to reach menopause earlier than white women. The average age of menopause in white American women is around 51. For South Asian women, the data points closer to 48, and nearly one in three experience early menopause, before age 45.
This is not just a quality-of-life issue. Earlier menopause is associated with earlier cardiovascular and metabolic risk. So if you are a South Asian woman in your early 40s with irregular periods, poor sleep, and unfamiliar anxiety, you may already be in this transition, and it deserves your attention.
The Symptoms Nobody Named for Us
When we picture menopause, we picture hot flashes. But South Asian women often report them less than other groups. What we report more: sleep disruption, waking at 2 or 3am and not falling back. Joint pain and body aches. Anxiety, low mood, and brain fog. And urinary symptoms, which almost no one talks about.
These get blamed on stress or age. Often, they are perimenopause. Naming that is the first step to treating it.
Vitamin D, Bones, and the Part We Skip
Studies suggest 70 to 90 percent of South Asian women are vitamin D deficient, partly from sun avoidance and partly from skin melanin that reduces vitamin D synthesis. During perimenopause, that deficiency matters more: it is tied to accelerated bone loss, worse sleep, more mood symptoms, and more of the musculoskeletal pain we already report at high rates.
Get your level checked. If it is low, and statistically it probably is, supplementing is one of the simplest evidence-based things you can do. And because sleep is so central to how this transition feels, managing nighttime temperature can help too. Some patients find a cooling mattress setup like Eight Sleep genuinely eases the 3am wake-ups: [Use this link for a discount]
You Are Allowed to Ask for Help
You are allowed to not feel well and say so out loud. You are allowed to walk into your doctor's office and say: I am not sleeping, I am exhausted, my joints hurt, my periods are changing, and I need to understand what is happening. You do not have to white-knuckle a decade of symptoms because the women before you did.
The Bottom Line
The silence that surrounded our mothers' bodies was not wisdom. It was a gap in research, in conversation, and in permission.
We get to close that gap, for ourselves and our daughters. Starting with conversations like this one.
📍 Still have questions?
💬 Contact us and we'll be happy to help!
💌 Or join our newsletter to stay informed: Sign up here
FAQs
When does perimenopause usually start? It is a phase, not a moment, and it can last two to ten years. It typically begins in the 40s, sometimes the late 30s, and for South Asian women it may start earlier than average.
Why do South Asian women go through menopause earlier? Research, including the MASALA study, points to a mean menopause age closer to 48 for South Asian women versus about 51 in white women, with a meaningful share experiencing early menopause before 45. The reasons are still being studied, but the earlier timing carries real cardiovascular and metabolic implications.
Isn't menopause just hot flashes? No. Many South Asian women report sleep disruption, joint pain, mood changes, and urinary symptoms more than hot flashes. These are commonly dismissed as stress or aging.
Why does vitamin D come up so much? Deficiency is very common in South Asian women (studies suggest 70 to 90 percent), and it worsens bone loss, sleep, and mood, all of which are already at play during perimenopause. It is worth checking and correcting.
Should I consider hormone therapy? Maybe. The point is to have an informed conversation. Evidence suggests hormone therapy started within about 10 years of menopause, or before 60, has a more favorable risk profile. Ask your doctor whether you are a candidate.
What if my doctor doesn't seem to know much about perimenopause? That is common, since it is barely covered in medical training. Consider finding a clinician certified through the Menopause Society.
