Menopause in low and middle-income countries: a scoping review of knowledge, symptoms and management

Objective: This study aimed to systematically map available evidence on menopause-related knowledge, symptoms and management in low and middle-income countries (LMICs) and identify critical gaps to inform research and policy. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidelines, the MEDLINE, EMBASE, CINAHL and Scopus databases were searched for studies published between 2000 and 2024. Eligible studies were those that reported on menopause-related knowledge, symptom prevalence or management in LMICs. Data were extracted and synthesised descriptively and thematically. Results: From 10,758 records, 252 studies from 41 LMICs were included. Most were cross-sectional (85%) and relied on non-probability sampling (62%), with only 4% being nationally representative. Menopause classification methods were often inconsistent, with only 17.5% of studies using the Stages of Reproductive Aging Workshop (STRAW) +10 or World Health Organization (WHO) criteria. National-level data on age at menopause are lacking across all LMICs. The prevalences of vasomotor symptoms, joint pain and sexual concerns were comparable with high-income countries. However, data on the severity and burden of symptoms were scarce. Knowledge about menopause and menopausal hormone therapy (MHT) was poor, especially in low-income and rural settings. Cultural stigma, misconceptions and healthcare provider knowledge gaps contributed to low uptake of evidence-based menopause care. MHT use was consistently low, with women predominantly using traditional remedies. Provider hesitancy, lack of training and structural health system barriers were key limitations in service delivery. Conclusions: Despite a growing population of postmenopausal women, menopause remains a neglected health issue across LMICs. There is an urgent need to integrate menopause into reproductive and non-communicable disease policies, invest in provider education and ensure equitable access to evidence-based menopause care, including MHT, for women in LMICs.