Menopause around the world: Japan

When I think of Japan, my head is filled with images of Cherry Blossom, a country of unique experiences and cuisine, the beauty of the Geisha and the imposing view of Mount Fuji. I would love to visit but the long flight time & earthquake risk has always prevented me making that all important booking!

Today though, my attention turns to the journey of menopause for Japanese women. How does their experience differ from those of us navigating this stage of life in other countries? Is it shrouded with silence? Is there stigma attached or are women supported with easy access to treatment.

Let’s take a look!

Introducing the concept of Koneki

In the UK, and as I expect is the case throughout Western cultures, menopause (and here I use this as the collective term to cover the entire journey) is commonly framed as a medical ‘problem’ but in Japanese culture the view is quite different.

And that is where the concept of Koneki comes in, a terms that loosley translates to ‘renewal’, ‘season’, or ‘energy’. With this terminology comes a different perspective. Menopause is seen not a the end of something but as a transition, it is not viewed as something that needs to be fixed but as something to move through into a new and natural stage of life.

I don’t necessarily think that menopause is always seen as a medical problem but the way it is treated is certainly similar to how other medical conditions are managed. Equally, the concept of Koneki - at least without further research - introduces a whole heap of questions, not least does this view of menopause mean that women do not have access to treatments like HRT? We’ ll come to that in a little while…

A Luxury Disease

As I looked into the history of menopause in Japan, it is most often spoken about as a quiet, normal part of aging BUT - and this did make me simultaneously laugh & shake my head - it was in fact once described as a luxury disease, being associated with more affluent, urban women rather than the broader population!

But it we want to wrap up the history of menopause in Japan with a neat red bow, it teaches us that Japanese women would be less likely to seek treatment and that this stage of life was (and still is) framed as natural rather than disruptive.

So how does this all feed cultural attitude toward menopause? It is unsurprising that the primary attitude towards menopause is one of acceptance. Not only is this viewed as a natural stage in life, it is also linked to wisdom and maturity (in western culture perhaps that wisdom is being clearer on what we will and won’t tolerate!).

I guess this brings me back to the questions I have on whether this view of menopause makes it harder or less likely for women to seek treatment and support? As I sought out some answers, I uncovered a bit of a mixed bag - something that seems to be quite common in the world of menopause!

It is clear that there is less stigma attached that in some other cultures but with the ‘natural stage of life’ view also comes less open dialogue, with it being treated as a private matter that doesn’t require lots of conversation and debate.

The HRT Picture

So, this brings us to the million dollar question - can women access HRT in Japan? The answer is yes, but that doesn't necessarily mean they do.

It is true that, just like me and many other women, those experiencing symptoms that interfere with daily life can consult a gynaecologist or specialist menopause clinic, and HRT is one of the recognised treatment plans. It is all pretty standard in terms of the types of HRT available - tablets, gel and patches forming the main delivery methods (I've had them all!).

As I continued my research, I discovered - and this was a surprise to me as I know little in terms of Japanese health care systems! - that HRT can also be covered by Japan's national health insurance. The Japan Society for Menopause and Women's Health provides estimates of the cost per month, with the health insurance included, which is roughly £5-£13 (1,000-2,500 yen). So not extortionate but still more than it will cost you in the UK with your menopause pre-payment certificate.

So far so good, but there are still problems. Ant it's not so much about access and the availability of treatment, it is mor about women actually asking for it. Back is 2022 the Japan Health Ministry carried out a menopause survey and, while this data is now a few years old, I did find it helpful in better understanding the gap between availability and women seeking it out. You can read the full survey summary here, but to provide one key statistic, the survey found that among women in their fifties whilst 38.3% thought they might have symptoms, just 9.1% reported having been medically diagnosed - suggesting that a significant number had never sought treatment.

Of course this is only one survey but other research carried out in Japan has also shown relatively low use of hormone therapy. Why? Well I don't think every woman is basing her decisions on one reason - it could be influenced by concerns about HRT (something that is not unique to Japan), limited awareness of treatment, perhaps its a preference for Japanese Kampo medicines (think Chinese herbal medicines) or as a result of that historical view that menopause is something to be quietly endured rather than treated.

And this is where I a torn in my view of Menopause in Japan. On the one hand I think it is a real positive that Menopause is recognised as a natural transition and not of a personal failure, but equally if symptoms are being dismissed as simply part of getting older, it may discourage women from asking for help when they genuinely need it. This is of course an outsiders view - it could feel very different to those living in Japan - if you happen to live or have lived in Japan, I'd love to hear your perspective!

Support, Guidance and free information

Now my Japanese language skills are quite simply non-existent, as are my reading skills so I won't claim to be able to tell you what the material actually says BUT what I can say with a high degree of certainty, is that there is free information available for women.

Japan's Ministry of Health, Labour and Welfare provides online information about symptoms, treatment and the impact menopause can have on work. It also encourages those experiencing persistent symptom to seek help.

Importantly there is also advice for employers, providing guidance on supporting women through menopause at work - now as I said, I have no Japanese language skills but thanks to a little translate button on my laptop I was able to read the site contents, so here's a link to the workplace support info in case of use (it covers a whole range of women's health topics).

The Japan Society for Menopause and Women's Health offers a free downloadable HRT guide, plus an online directory to help women find a qualified professional and there are also a variety of other organisations also trying to improve menopause awareness and support.

A genuine mixed bag

That brings me to the end of this piece on menopause around the world, but how would I summarise what I have discovered?

Well for me it feels like menopause support in Japan is a bit of a mixed bag. HRT is available, government guidance and free information exist, and support organisations are working to improve awareness. Despite all of this, relatively few women are seeking medical help, which suggests that viewing menopause as a natural and private transition, may make it harder to speak up and ask for support.

I love the idea of kōnenki as a season of change rather than an ending. But natural doesn’t always mean easy, and no woman should feel she has to suffer in silence—wherever in the world she lives.

So that is all from me today - I hope you enjoy the read and you never know, if I ever make it to Japan I might discover, in between soaking up the culture and drinking the matcha, that there is greater progress than research suggests and larger numbers of women are now speaking out, seeking treatment and embracing the natural transition with les suffering.

Until next time,

Rachel