Indian migrant women’s access to health resources about menopause in the UK

INTRODUCTION

BACKGROUND LITERATURE REVIEW (BLR)

Menopause is a universal biological transition significantly shaped by sociocultural contexts
and "local biologies". For Indian migrant women in the UK, this experience is intersectional,
compounded by the social process of "immigrant transition" which involves complex factors
like -migratory, cultural, and social changes.
Structural Barriers within the NHS and UK Healthcare System
Mann et al. (2025) found in this qualitative study, examining barriers and facilitators to
menopause care provision through semi-structured interviews with primary healthcare
professionals across central England, found that cultural and ethnic differences were
perceived as significantly impacting whether women sought menopause care or HRT from
their GP. Healthcare professionals felt they needed more time for in-depth communication
and education with women from minoritised ethnic groups, noting that approximately five
times fewer Black women and four times fewer Asian women were prescribed HRT
compared with white women. Targeted, culturally sensitive outreach and specific HCP
training were identified as essential to reduce health inequalities, with the study concluding
that the current NHS primary care model was structurally inadequate for meeting the
additional needs of ethnic minority menopausal women.
Stanzel, Pham, Hammarberg & Fisher (2025) explained that this cross-sectional study
thematically analysing free-text responses from 76 primary healthcare providers found that
competing migration-related priorities, the healthcare system's limited resources, and
culturally informed beliefs about menopause collectively constituted the primary structural
barriers to midlife care for migrant women. Migrant women speaking a language other than
that of the host country were more likely to have low health literacy skills, resulting in lower
participation in health promotion programmes, preventive healthcare, and higher rates of
emergency care and hospitalisation. Providers concluded that flexible models of primary
healthcare and coordinated engagement with community groups were essential, and that the
current NHS primary care model was fundamentally ill-equipped to address the compound
health needs of migrant menopausal women.
Health Literacy among Indian Migrant Women
Past academic literature indicates that South Asian women may present with symptoms
differently than their White peers, often reporting musculo-skeletal aches and pains rather
than traditional vasomotor symptoms like ‘hot flushes’.
Baghdadi, Singh & Gatuguta (2025) findings showed that immigrant Muslim adult women in
Brighton (UK) research showed using constructivist grounded theory, core theme of
. Misconceptions about HRT, poor health literacy,
and dismissive GPs caused insurmountable barriers to care, with HRT misconceptions
resulting in high rates of hesitancy. This study based on constructivist grounded theory with
twelve in-depth online semi-structured interviews. The results found that cultural stigma and
limited their knowledge compounded negative perceptions and experiences of menopause,
with women reporting, that they experienced including ‘physical and emotional’ difficulties

such as; ‘disruption of sleep’,’ changes in cognitive ability’ and ‘anxiety levels’. The lack of
awareness about HRT resulted in a high level of reluctance to take it, but women who used it
reported a significant reduction in symptoms, which demonstrates that a poor level of health
literacy directly correlates to untreated symptom. The core theme identified by the study was
that of Navigating a Web of Silence and how a deficiency in health literacy, is perpetuated by
intergenerational silence (mostly cultural) a stigma linked shame making mandatory GP
training to spread the menopause education has been suggested as a critical corrective
measure.
Whelan, Dempsey & Voon Yi Chi (2026) explained that this qualitative research
methodology established that women in more collectivist cultures (and especially within
immigrant populations) who have to negotiate around the dimensions of the cultural taboos
around woman ageing, their reproductive health in life-stages. Having to experience about
their menopause in silence, with cultural attitudes around covert approach to their symptom
disclosure having a significant impact on healthcare uptake. Several barriers were identified
that hinder menopausal women from seeking medical assistance, including low health
literacy regarding menopause, low-priority assigned to addressing symptoms, and the
perception of menopause as a natural part of ageing that does not warrant medical attention.
The review concluded that trust in healthcare professionals was a pivotal mediating variable
— where trust was absent, as in many migrant communities, health literacy remained low
and formal help-seeking was actively avoided in favour of community-based informal
remedies.
Language Barriers and Culturally Appropriate Menopause Resources
Even in England, however, primary care practitioners (PCPs) reported a notable so-called
communication gap, in which cultural manifestation of symptoms do not necessarily reflect
well within the environment of Western medicine, potentially leading to misdiagnosis or sub-
optimal care.
According to Briscoe et al. (2022), this study, which is based on pilot work with individuals
with limited English proficiency within the South Asian communities across the UK, found
that the inability to request language support, the concern about overstressing the
healthcare service, and the lack of confidence in discussing health-related issues with an
interpreter were the most common barriers to accessing primary care. This also gave a great
deal of fluctuation in the way in which clinical commissioning groups in England and Wales
have been implementing interpreting services, creating an English post-code lottery, where
access to language-appropriate healthcare became a question of geographical chance,
rather than being the result of deliberate policy. The authors recommended evidence-based
and up-to-date guidance to be given to the decision-makers who commission language
services, as well as digital transformation tools to allow more inclusive and linguistically care
clinical communication.
British Menopause Society (2023) clarified that this evidence synthesizing was produced by
the institution, there might be language barriers and a lack of understanding of the terms
used by ethnic minority women. This is in the context of describing their symptoms with
traditional and conservative cultural orientation of Asian women being an additional barrier to
help-seeking. The report has shown that in several South Asian languages there is not a
direct equivalent word to denote menopause as in English, and that the very articulation of
symptoms during a clinical consultation itself was structurally inhibited. Therefore, a need to
educationally resource in multi languages including leaflets, posters and videos of ethnic
minority women was clearly identified as necessary step, to enable and normalise a
structured approach to ‘informed health’ related decision making in these communities. It

was suggested to provide information in a culturally sensitive manner, based on the level of
understanding of the individual, to further educate healthcare professionals, and to make
systematic access of interpreter services to menopause care pathways.
Cross-Cutting Themes and Intersectional Analysis
Eccles et al. (2025) findings showed that Black and Asian women were much less likely to
take HRT compared to their white counterparts – with the use rate of 6.2% and 5.2%
respectively compared to 23.3% in white women. Minority ethnic women reported a lack of
trust in medical institutions and fear of stereotyping during appointments and the cultural
inability to discuss menopause openly with their communities, which further increases
access barriers.
Hirst et al. (2025) GP records for nearly two million women aged 40–60 over a ten-year
period, this landmark cohort study found that overall HRT uptake was just 19.2%, with stark
ethnic and socioeconomic disparities. 3.9% in Black African women to 22.6% in white
women, and from 10.9% in the most deprived areas to 24.2% in the most affluent —
demonstrating that structural inequalities.
NHS England CPAR Programme (2025) funded by NHS England's School of Public Health,
found that menopause remains deeply stigmatised among migrant women from ethnic
minority backgrounds, leaving many to navigate emotional and medical isolation, cultural
taboos, inconsistent medical advice, and low awareness of available resources. Howlett et
al. (2024) study highlighted that misinformation and language barriers created an
environment in which women felt neither seen nor supported within NHS primary care.
MacLellan, Dixon, Bi, Toye & McNiven (2023) qualitative study of 46 primary care
practitioners across 35 English practices, supplemented by consultations with 14 women
from three ethnic minority groups, found that health literacy constraints, language barriers,
and cultural inhibition significantly impeded ethnic minority women's help-seeking for
menopause symptoms.
Zou et al. (2021) identified individual, familial, and community-level barriers to healthy
menopause among immigrant women aged 45–65 undergoing natural menopausal
transition. Key barriers included acculturation stress, patriarchal household dynamics, and
restricted access to culturally competent healthcare, all of which are acutely relevant to
Indian migrant women in the UK.
Stanzel, Hammarberg & Fisher (2021) women describe menopause as a taboo topic
considered secretive and inappropriate for discussion, compounded by low health literacy
and the absence of government policies adequately funding women's health for migrant
populations. The cohort of the Indian migrant women, is typically shaped by their family
based generational, cultural and religious norms in everyday life, which are frequently found
to normalise symptoms and avoid formal healthcare engagement.
Ussher, Hawkey, & Perz, (2019) study with sample of n=169 found that Indian women
included with Iraq, Somalia,South Sudan, Sri-Lanka (Tamil), Sudan and various South
American females who are in the perimenopause stage has shown diverse belief around the
word menopause. Most of captured showed diverse cultural values, mental concepts from
the social constructions based on beliefs, impacting their personal interpretations.
One of the common themes is the cultural differences between native white adult females
and Indian women. This is an ethinicity gap, that has direct connection to the communication
skills is creating a phenomenon of "web of silence" in context of female reproductive health.

It is seen as entrenched in cultural taboos of bringing the issues out into the open in Indian
female in society creates a stigma that make the menopausal a self-deprecating and
personal issue. This is one of the factors that lead to poor health literacy where Indian
migrant women only understand menopause as the end of periods. There is lack of
knowledge and stop in awareness creation, without knowing about peri-menopausal
changes or medical treatments, such as the use of Hormone Replacement Therapy (HRT).
Besides, there are structural barriers which exist; the immigrants women face systemic
discrimination in foreign nations mostly due to language proficiency barriers and socio-
economic disadvantages that do not allow navigating healthcare practices successfully.
Research gaps in knowledge remain significant, particularly the lack of UK-specific
qualitative research focusing on Indian adult female migrants for menopause in their
lifestages, as current evidence is "limited" and often unrepresentative. There is a critical
shortage of data regarding the effectiveness of non-English health resources and how
structural factors, such as short consultation times, specifically disadvantage women from
collectivist backgrounds who may require more holistic approaches to "join the dots" of their
embodied experiences.

RESEARCH QUESTION AIM AND OBJECTIVES OF THE STUDY.

Research Aim:
To critically examine Indian migrant women’s access to health resources about menopause
in the UK
Research objectives:
RO 1: To examine structural barriers Indian migrant women’s access to health resources
about menopause in the UK
RO 2: To find out ⁠health literacy in Indian migrant women’s access to health resources about
menopause in the UK
RO 3: To evaluate dimensions of ⁠language and culturally appropriate resources for access
to health resources about menopause in the UK
The research aim to examine Indian migrant women's access to health resources is directly
linked to the documented "limited evidence" regarding ethnic minority experiences in the UK.
Research Objective 1 addresses the health sector structural barriers, such as discrimination
and system constraints identified as major hurdles to healthy transitions. Research Objective
2 targets the gap in relation to gap to women menopause health literacy, specifically
awareness preventing Indian adult women in advocating their health issues. Finally,
Research Objective 3 evaluates the need for understand the culturally appropriate
resources, responding to the identified lack of non-English educational materials and the
linguistic "wall" faced by many immigrant populations.

METHODOLOGY, METHODS AND DATA ANALYSIS

 

Databases
MEDLINE, PsycINFO, CINAHL, APA, was used in this study. The multidisciplinary character
of this research theme, which cuts across the fields of psychology, medicine, nursing, and
public health has led the researcher to use databases for selection – PsycINFO, MEDLINE,
APA PsycArticles, and CINAHL. MEDLINE was crucial as the leading biomedical database,
which would contain peer-reviewed clinical evidence on the symptomatology of menopause,
the prescribing of HRT inequalities, and the NHS provision of healthcare services towards
ethnic minority women. The CINAHL (Cumulative Index to Nursing and Allied Health
Literature) was invaluable in capturing nursing-focused, community health and health literacy
studies that have a direct bearing on the experiences of migrant women in the primary care
setting. A search in PsychcINFO and APA PsycArticles was conducted to access
psychological, behavioural and sociocultural aspects of menopause such as stigma,
acculturation stress, cultural identity, and help-seeking behaviour which are core to
understanding the engagement of Indian migrant women in health resource utilisation.
Inclusion/exclusion criteria:

Inclusion Criteria Exclusion Criteria

Studies related to female gender of Asian
Indian origin

Non Asian

Studies set for female of Asian Indian in UK Studies on males Asian Indian in UK

excluded

Studies related to menopause Non menopause articles rejected
Studies that has involved only above 18 yrs
aged respondents

Only for Asian Indian females over 18 yrs of
age
Peer reviewed English language research
journals only

Non English research journals were rejected
Studies for which full text was available Only abstract articles were rejected
Research publication between the years
(2025-2021)
Data Analysis:
To analyse literature about access to health resources regarding menopause in the UK
among Indian migrant women, thematic analysis (TA) is the most suitable approach. TA
being a flexible, theoretically independent methodology that identifies, analyses, and reports
patterns across heterogeneous qualitative data makes TA ideal to synthesise a
heterogeneous literature. Since this study cuts across health disparities, migration, female

gender and cultural identity, as the TA allows the researcher to go beyond surface
descriptions into understandings of interpretative depth of the research journals chosen.
It will use a reflexive thematic analysis model (Braun and Clarke, 2019), where the data will
be inductively analyzed to reveal themes, as opposed to forcing the use of a pre-determined
set of research themes. This is especially suitable in the case of the existing literature being
divided across different fields of study health sociology, postcolonial studies, and feminist
health research. Such themes like the case of the cultural stigmatisation of menopause,
language and communication barriers, intersectional discrimination within the NHS, and
informal health-seeking behaviours are major themes. This goes in line with inter-sectionality
theory (Crenshaw, 1989), which are critical in explaining how race, gender, and migrant
status are intersecting in increasing healthcare marginalisation.

ETHICS

This research project has serious ethical implications that must be given serious
consideration. To begin with, the core issue of ‘confidentiality and anonymity’ in research
ethics, must be given first priority, especially in case primary data, which is not applicable for
this research. Second, vulnerable group of Indian women migrants, they may fear being
subject to institutional scrutiny, researchers should be mindful not to strengthen existing
power relations (British Sociological Association, 2017).
Third, the ethical considerations of the positionality of the researcher are ethically significant:
a researcher who belongs to the outside of this community must reflexively question
assumptions based on cultural privilege. Fourth, the aspect of the cultural sensitivity is a
critical gap that no one is addressing. In female biology, the menopause stage is inevitable,
and irrespective of ethnicity it has devastating impact on female psychology and physiology.
The issue in adult females is related to stigma as issues of research show the need to avoid
the outcomes of self-inflicting psychological distress or shame which is family upbringing and
culture induced phenomenon. Lastly, GDPR (2018) and the principles of the Declaration of
Helsinki on research with human participants, data collection must be preceded with
institutional ethical approval by a recognised university ethics board.

RESULTS :

Table which summarises the articles
Author & Year Study Type Population/Setting Key Focus
MacLellan et al.
(2023)

Qualitative
(Interviews & PPI)

UK primary care
practitioners and ethnic
minority women

Communication gaps
and barriers to help-
seeking in primary care

Baghdadi et al.
(2025)

Grounded Theory
(Qualitative)

Immigrant Muslim
women in the UK

Experiences of
menopause, HRT, and
healthcare navigation.

Ussher, J. M.,
Hawkey, A. J.,
& Perz, J.
(2019).

Qualitative N=169 Indian women
along with Iraq, Somalia,
South Sudan, Sri-Lanka
(Tamil), Sudan and
various South American
(Latina) background

Subjects were in onset of
premenopausal stage,
reflected cultural values
diverse in social
constructions and
personal interpretations.

MacLellan et al.
(2023)

Qualitative primary
research
(interviews) of GP,
nurse, pharmacist,

14 women with peri-
menopause/menopause
stage, 35 care
practitioners

Women from ethnic
minority show
menopause to be
different

Page | 8

Female respondent

Results of your analysis – how you have grouped/analysed your articles
Theme 1: Resource Inaccessibility with invisible linguistic wall
The first conclusion to be made throughout the literature is that the current health resources
can often be linguistically and culturally inaccessible. In England, primary care practitioners
(PCPs) specifically mentioned a "specific limitation" on the absence of educational resources
in non-European Asian languages including Urdu, Punjabi and Bengali to be hailed as south
Asian. Moreover, where English resources exist and are being used, we may often find that
they are not resonating. Particularly the Asian or Indian women who do not see themselves
reflected in the messaging and thus perceive that menopause is not their issue, but a White
people issue instead. The lack of particular terms in some heritage (mother tongue)
languages to denote such concepts as a hot flush also makes the internalisation of Western
health information communication any more challenging.
Theme 2: ‘’Ache" as a Symptom with communication gap
The findings present an important incongruence between symptom descriptions as given by
the Indian and South Asian women and the way Western medical systems interpret these
symptoms. While Western resources focus on vasomotor symptoms (hot flushes), Indian
and South Asian women frequently present with musculoskeletal pain and "aching".
Practitioners reported that these as differences in their respective cultural
expressions—such as describing "heat coming from my tummy"—often do not make
"medical sense" to providers. This is causing and leading to missed opportunities for "joining
the dots" providing holistic menopause care in UK to Asian Indian women with limited
English communication vocabulary.
Theme 3: Health care structural access barrier
Access is further restricted by systemic issues within the UK’s primary care system. A "good
menopause consult" is reported to require at least 20 minutes, yet most women are limited
to 10-minute slots, which is insufficient for unpicking complex presentations or expressions
in patients with English as a second language. Additionally, Asian (Indian) women in UK,
expressed a strong preference for female GP clinicians, but reported that accessing a
female practitioner in UK, is often challenging in all the cases/hospitals, leading to repressed
feelings about a female problem, of not being "listened to" by male doctors.
Theme 4: Sociocultural "Web of Silence"
Health resources are often not sought due to a pervasive "web of silence" and cultural
stigma surrounding reproductive health decline. Indians are from collectivist cultures,
menopause is framed as a "taboo" subject, with women feelings-emotions mostly repressed
in Indian society, it is expected to "just get on with it" in silence in British society as well. This
is cultural stoicism linked to Indian females, is due to their upbringing in Indian patriarchal
society (parental child relationship) to behave in certain manner, where family needs are
prioritised over personal health, acts as a self-imposed barrier to accessing formal medical
resource.

DISCUSSION & CONCLUSION :

There is evidence of an emerging convergent pattern of ‘triple marginalisation’ facing Indian
migrant women in menopause care: ‘cultural’ (stigma, silence, normalisation of suffering);

‘structural’ (NHS underprepared for cultural competence, HRT prescribing disparities); and
‘epistemic’ (absence of culturally tailored information resources). As the reasons for such
inequalities in menopause care remain poorly understood, this body of evidence
compellingly justifies further intersectional, community-centred qualitative inquiry specifically
focused on the Indian migrant women demographic — a group whose distinct cultural
identity has been sidelined, which is an outcome of the migration and lifestyle experience,
and language context has been examined in sufficient with scholarly depth.
CONCLUSION
The synthesis of these findings illustrates that for Indian migrant women in the UK, "access"
to health resources is not merely a matter of physical availability but is an intersectional
challenge involving linguistic, structural, and sociocultural hurdles. This research
demonstrates that Indian migrant women in the UK face a multi-layered exclusion from
menopause health resources. While menopause is a universal biological transition for any
adult female irrespective of race, ethnicity, its manifestation in Indian women migrants living
in UK is often presented as musculoskeletal pain rather than the terminology used by while
females living in UK expressing 'hot flushes' symptoms. This is frequently misinterpreted or
dismissed within the UK’s time-constrained primary care healthcare framework exposing
structural inadequacy, as healthcare system design for migrant females and is overlooked. It
is mostly a communication gap, as individual Indian migrant adult females are not proficient
in English communication to express their body indicators that pertains to menopause
symptoms. This medical narrative with specific terminology is culture specific which reflects
their respective experiences in them. There is also a cultural dimension as most of it is
considered a taboo for discussion, rather ignore, and suffer in silence. The research also
highlights that when targeted, culturally sensitive education is provided, women feel
empowered to regain agency over their bodies. All these are limiting chances and probability
for the Indian migrant women to achieve "healthy menopause,". The UK healthcare system
must move beyond "universal" English-centric resources toward a holistic, intersectional
model. Therefore, while the gap remains, healthcare system needs values cultural
dimension, Indian women symptoms of menopause, capture their expressions through
interpreters, and address to remove the structural barriers such as consultation length,
language barriers and clinician training.

LIMITATIONS:

The main weakness of this study is the limited scope of a specific qualitative data of the
Indian sub-groups in the UK context, since many studies merge their results under the
umbrella term of South Asian or Immigrant along with Indian adult females. The scoping and
systematic reviews involved are also largely performed by a Western mindset and restricted
only to English-language articles, which may be missing subtle aspects of heritage-language
thinking. The interviewed clinicians sample was dominated by females, which might have
skewed the data toward the more empathetic interpretations of patient experiences as
compared to the general primary care workforce.

CONCLUSION

This study shows that Indian migrant women in the UK experience a multi-layered non-
access to menopause health resources. Although menopause is a universal biological
transition, how it manifests amongst the Indian women who tend to show symptoms most
often as musculoskeletal pain, rather than as hot flushes, is often misunderstood or
disregarded within the time-constrained primary care system in the UK. A lack of health
resources in heritage languages and a medicalised narrative (specific terminology), that does not take into consideration the collectivist and the local biology facts of these women,
contributes to the "communication gap. Moreover, the culture of silence instigated by culture
taboos does not allow most women to attribute their symptoms to menopause and as such
many women endure in silence as opposed to seeking help.

 

 

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