Menopause for Māori Women in Aotearoa New Zealand: Cultural Perspectives and Persistent Inequities in Access to Care

Menopause is commonly framed within Western medicine as a biological event characterised by hormonal change, symptom clusters, and long-term health risks. While this biomedical framing can be clinically useful, it does not fully reflect how menopause is understood or experienced by all women.

For many Māori women, menopause is not conceptualised as a medical problem. Instead, it is understood as a natural life transition, embedded within whakapapa, tikanga, and evolving social and spiritual roles. At the same time, Māori women continue to experience persistent inequities in access to healthcare across the life course, and emerging evidence suggests that these inequities extend into menopause information, assessment, and treatment.

This article brings together the current evidence on Māori perspectives of menopause and the structural factors that shape access to menopause care in Aotearoa New Zealand.

Māori understandings of menopause

Menopause as a normal and meaningful transition

Available research consistently suggests that Māori women’s understandings of menopause are holistic, culturally grounded, and often positive, rather than deficit-based or pathological (1–3).

A meta-ethnography translating Indigenous menopause research into a Māori context identified four key metaphors used to describe menopause: natural, cultural protection, freedom, and idiomatic (1). These metaphors align closely with Māori concepts such as mana wahine, ruahinetanga, tikanga, and mātauranga Māori (1,2).

Within this framework, menopause is positioned as a normal stage of life rather than a condition requiring correction.

Mana wahine and ruahinetanga

In contrast to dominant Western narratives that associate menopause with loss of youth or femininity, Māori-centred framings often position menopause as a transition into greater authority and social significance.

Menopause may be associated with mana wahine, reflecting strength, dignity, and leadership, and with ruahinetanga, a life stage in which post-menopausal women are recognised as cultural leaders and knowledge-holders within whānau, hapū, and iwi (1,2).

Rather than decline, menopause may represent consolidation of identity and influence.

Tikanga, sacredness, and cultural protection

Māori understandings of reproductive transitions are often shaped by tikanga and concepts of tapu. Traditional restrictions related to bleeding or reproductive states are frequently framed as forms of protection and respect, rather than stigma or exclusion (4).

This framing supports an understanding of menopause as a sacred and meaningful transition, situated within broader spiritual and genealogical contexts, rather than an isolated biomedical event (1,4).

How Māori perspectives differ from Western biomedical framings

(1–4)

When healthcare systems rely exclusively on Western biomedical frameworks, Māori cultural meanings of menopause may be overlooked, contributing to misalignment between services and women’s lived experience.

What is known about inequities in menopause care for Māori women

Limited menopause-specific research

Despite Māori women experiencing higher morbidity and lower life expectancy than non-Māori, there is a notable lack of research specifically examining Māori women’s menopausal health needs (3,5). This absence of evidence is itself indicative of structural inequity.

However, broader research on Māori women’s sexual, reproductive, and mid-life healthcare demonstrates persistent barriers that are likely to affect menopause care (1,2,8–13).

Lower use of menopause hormone therapy

The most robust quantitative evidence comes from a New Zealand study comparing menopausal symptoms and treatment use among Māori and non-Māori women (7).

While vasomotor symptoms were reported at similar rates, Māori women were substantially less likely to use menopause hormone therapy (MHT):

• Ever used MHT: 24% Māori vs 54% non-Māori

• Current MHT use: 5% Māori vs 30% non-Māori (7)

This six-fold difference in current use is not explained by symptom burden and suggests differences in access, offer of treatment, cultural acceptability, or trust in healthcare systems (2,7).

Access barriers and service availability

Across the life course, Māori women report barriers to healthcare access including cost, limited appointment availability, and poorer referral pathways to specialist services (8–10).

In the context of menopause, these barriers may result in fewer opportunities for:

• Comprehensive mid-life symptom assessment

• Discussion of treatment options, including MHT

• Preventive care such as cardiovascular and bone health screening (8,10)

Cultural safety and trust

Qualitative research consistently shows that Māori women frequently experience sexual and reproductive healthcare as rushed, dismissive, or culturally unsafe (11–13). These experiences undermine trust and can discourage re-engagement with services.

In menopause care, where symptom disclosure, shared decision-making, and longitudinal follow-up are essential, lack of cultural safety is likely to contribute to under-assessment and under-treatment (11,12).

Information gaps and health literacy

Several studies indicate that Māori women are less likely to receive clear, culturally meaningful information about gynaecological health, including red-flag symptoms such as post-menopausal bleeding (12,8).

These gaps affect understanding of:

• What constitutes a normal menopausal transition

• When to seek medical advice

• What treatment options are available (2,8,12)

These are system-level information failures rather than individual deficits in health literacy.

Medicines access and prescribing inequities

Older Māori experience reduced access to essential medicines and higher rates of harm from inappropriate prescribing compared with non-Māori (14,15).

In menopause care, this raises concerns about under-prescribing, less safe prescribing, and reduced access to monitoring and follow-up when treatment is initiated (14,15).

Putting the Pieces Together

Taken together, the evidence suggests that Māori women often conceptualise menopause as a normal, culturally meaningful transition, while simultaneously facing structural barriers to culturally safe and equitable menopause care.

Māori women are significantly less likely to use MHT despite comparable symptom burden, have reduced access to services and medicines, and encounter healthcare environments that may not recognise Māori worldviews or support informed, values-based decision-making.

Importantly, the limited research base means it is not possible to clearly distinguish between culturally informed treatment preferences and unmet healthcare need. This gap highlights the urgent need for menopause research that centres Māori women’s voices and is grounded in Kaupapa Māori approaches.

A Way Forward

Improving menopause care for Māori women does not mean medicalising menopause, nor does it mean withholding treatment. It means offering care differently — in ways that reflect Māori worldviews and honour the meaning menopause holds within women’s lives.

This includes care that:

• Acknowledges Māori understandings of health, identity, and ageing

• Respects menopause as a culturally and spiritually significant transition

• Supports informed choice across a range of treatment and support options

• Is co-designed with Māori women, whānau, and communities

Until Māori women’s perspectives are consistently visible in research, policy, and service design, inequities in menopause care will continue.

Menopause is not only a biological event. It is a social, cultural, and spiritual transition — and equitable care requires a health system capable of holding all of these dimensions.

References

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14. Hikaka J, Jones R, Hughes C, Connolly M, Martini N. Ethnic Variations in the Quality Use of Medicines in Older Adults: Māori and Non-Māori in Aotearoa New Zealand. Drugs & Aging. 2021. https://doi.org/10.1007/s40266-020-00828-0 

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