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Recently Syed Alwi et al [1] reported data of 324 mid-aged indigenous women (40-65 years) from Sarawak, a state of Malaysia. They performed a face to face survey in order to explore their perceptions of the menopause. Approximately 30% of surveyed women were pre-, peri- and postmenopausal. A 22.5% agreed that problems occurring during the menopause should be treated, with 32.3% arguing that natural options were better than hormonal treatments. A 75% of them agreed that having no more menses after the menopause was a relief; in parallel 61.2% indicated that the menopause causes bothersome symptoms. More than half were unsure if the menopause would affect their sexual attractiveness or make them feel less woman. There was also a high level (> 70%) of uncertainty among participants regarding enjoying sex or being stressed after the menopause. Education was correlated positively to a more positive perception of the menopause. The authors conclude that their data correlate with that from other Asian studies, that being more educated or premenopausal related to a more positive opinion of the menopause and that although women express a negative attitude towards the bothersome symptoms, having no more menses is a relief.


It is known that the perception that women have of the menopause may vary in relation to menopausal status, educational and social background, culture, and physical and emotional health [2,3]. These factors have also correlated with their attitudes toward the menopause and the knowledge that they have of this natural phenomena. The present study confirms what is already known, that women with a lower education (possibly in relation to the fact that the majority were indigenous), have a more negative perception of the menopause. Contrary to this, higher educational level correlates with a more positive perception. Author indicate that this correlates well with other Asian studies. This is similar to an Ecuadorian study in which Leon et al [4] reported data related to mid-aged women from Ecuador who were nursing staff. They perceived the menopause as a positive event as they agreed that it is a normal (93.7%) and important event (73.6%), that it gives more confidence and maturity (78.8%), and that they may fully enjoy sexual relations (74.8%). They also indicated that there is a relief after menopause onset because the risk of becoming pregnant is null. The authors concluded that despite the fact that women perceived the menopause as a positive event, and displaying a concerned attitude toward it, their related knowledge was low. Improving education and the understanding of this crucial female life stage will change women’s negative attitudes towards the menopause, eliminating their apprehension and adverse emotional states. The authors state that if one changes female’s view of the menopause, through empowering them with knowledge this will cause less emotional distress.

The study has the limitation related to the design (cross-sectional) which is not being able to determine causal relationship and the results cannot be generalized to the whole Malaysian population. Despite this, data coming from this population has been lacking, which can be viewed a relative strength of the research. There is a need to improve education related to the menopause, because this will have a positive impact over female’s perception and attitudes toward the menopause, allowing them to become aware and seek prompt treatment and counseling. Women who transit the menopausal transition should be encouraged to engage in educational programs that will increase knowledge and awareness aiming to have a better comprehension of the problem, as a cost effective way to counter act negative emotional feeling linked to less education.

Peter Chedraui, MD, PhD
Instituto de Investigación e Innovación en Salud Integral
Universidad Católica de Santiago de Guayaquil, Guayaquil Ecuador


  1. Syed Alwi SAR, Brohi IB, Awi I. Perception of menopause among women of Sarawak, Malaysia. BMC Womens Health. 2021;21(1):77.
  2. Ibraheem OM, Oyewole OE, Olaseha IO. Experiences and Perceptions of Menopause among women in Ibadan South East Local Government area, Nigeria. Afr J Biomed Res. 2015;18:81-94.
  3. Jurgenson JR, Jones EK, Haynes E, et al. Exploring Australian Aboriginal Women’s experiences of menopause: a descriptive study. BMC Women’s Health. 2014;14:47.
  4. Leon P, Chedraui P, Hidalgo L, Ortiz F. Perceptions and attitudes toward the menopause among middle aged women from Guayaquil, Ecuador. Maturitas. 2007;57(3):233-8.

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