Sumrin Kalia, a Pakistani woman living abroad, married at 18 and had four children by the time she was 25. She experienced no sign, no overt symptoms of menopause until she did, suddenly and early, at the age of 37.
“I began experiencing excessive bleeding. I went to a doctor, who told me I might be perimenopausal,” Kalia, who is now in her mid-40s, told DW.
The World Health Organization puts the global average age for menopause at between 45 and 55 years.
“No one explained it to me. It was very sudden. I started bleeding heavily and more frequently than usual,” Kalia said.
Kalia had been using an intrauterine device (IUD) for birth control. She had it removed, and her periods stopped altogether without explanation.
Her experience was shared by other South Asian women who spoke to DW. They had their own stories to tell of how they had experienced perimenopause symptoms sooner than their global peers.
Menopause on a faster clock: The big picture
A US-based study found South Asian American women reported an average menopause age of 48 or 49 years. For the general US population, the average age at which menopause begins is 52 years.
In South Asia itself, the average is lower than in the US. In India and Pakistan, women enter menopause at around 46 to 47, and they encounter perimenopausal symptoms before that, as is common for menopause.
Meanwhile, Pakistan’s average number of children per woman has dropped sharply from 3.61 in 2023 to 3.19 in 2024, reflecting shifting fertility patterns. By comparison, India’s rate declined more modestly from 2.14 to 2.12.
Whether or how the two sets of data are connected is unclear, but there are indications that a number of factors may be coming together to affect the aging process of South Asian women.
Genetics, biology, and vitamin D deficiency
Hormonal health expert Palwasha Khan, a consultant physician based in Pakistan, explained that menopause timing is partly genetic.
“There’s no exact rule, but studies show women tend to start and end their periods around the same age as their mothers,” Khan told DW. “The earlier you start menstruating, the earlier menopause is likely to occur.”
Khan also highlighted a lesser-known factor: a rapid depletion of vitamin D levels among South Asian women, which can worsen chronic health issues linked to aging.
Furthermore, Khan said that many women experience ovarian failure in their late 30s or 40s, often compounded by “undiagnosed medical issues” and a lack of quality health care earlier in life.
A cultural pressure cooker: Fertility over health
In South Asia, and particularly in Pakistan, societal expectations push women to have children soon after marriage, often at the cost of their long-term health.
“Women’s health as a distinct concern is largely ignored,” Khan said. Awareness around hormonal health is minimal, and treatments like hormone replacement therapy (HRT) are rare. “You’d have to pick 10,000 women to find two who’ve gone on [HRT].”
This intense focus on fertility often sidelines conversations about menopause and women’s well-being.
Another story: The emotional cost of menopause
Sabina Qazi, a Pakistani woman in her mid-40s, based in Karachi, told DW about the emotional and cognitive challenges she faced as a cost of menopause.
“My husband and children would talk to me, but the words would just fall off in between… I had the constant need to prove that I wasn’t stupid,” she Qazi, describing the cognitive difficulties she experienced after undergoing a radical hysterectomy, a procedure in which her uterus, fallopian tubes, and both ovaries were removed due to cancer risk.
Qazi said her biggest frustration with the medical process — a form of surgical menopause — was how little thought was given to the long-term consequences. Although the surgery was preventive, she felt the emotional weight of the decision was never fully acknowledged.
In fact, the procedure was framed as inevitable, a foregone conclusion: She would reach menopause regardless, in a few years time, so, why not get it over with now?
Qazi later began hormone replacement therapy (HRT) to manage her menopause symptoms. She said one of the most persistent challenges was dealing with brain fog.
While her menopause followed a medically required hysterectomy, the overlap between surgical menopause and broader health risks reflects a pattern that medical consultant Khan has observed: Ovarian failure occurring in the late 30s or 40s among South Asian women, often alongside a range of chronic health conditions that appear interconnected.
The emotional toll of the surgery lingered long after Qazi’s physical recovery. She received little support from her community, and peers in her close circle downplayed her experience, suggesting she needn’t be concerned since she had already had three children.
The cultural implication, said Qazi, was that her reproductive organs had fulfilled their purpose, and her losing her uterus and ovaries was significant.
‘Brown women are burned out’
Khan said various factors appeared to be coming together to accelerate aging in South Asian women: chronic illnesses, stress and other mental health issues, and social pressures. And each individual factor seems to be reinforcing the other.
“Brown women are too burned out,” said Khan. “The weight of society. The weight of mothers-in-law. Brown women end up taking on too much stress, and this makes them age faster.”
Many women face relentless social expectations and little support, which intensifies both physical and emotional health challenges.
One woman of South Asian descent, living in Saudi Arabia, shared: “I feel angry all the time.”
Edited by: Zulfikar Abbany
