Sumrin Kalia was 18 when she married. By 25, she had four children. Life moved fast — and so did her body. At 37, without warning, she began experiencing excessive bleeding. A doctor told her she was entering perimenopause — the stage before menopause.
“There were no signs before. It was so sudden,” said Kalia, who is now in her mid-40s and lives outside Pakistan. “I started bleeding heavily and more often than normal.”
At the time, she was using an intrauterine device (IUD) for birth control. After its removal, her periods stopped completely — without clear medical explanation.
Her story is not unique. Many South Asian women report symptoms of early menopause years before the average age seen in the U.S. or Europe. And experts believe a mix of cultural, biological, and health care issues may be behind it.
A Global Gap in Menopause Timing
The World Health Organization states the average age for menopause globally is between 45 and 55. In the U.S., the typical age is 52. But studies show South Asian American women begin menopause around 48 or 49.
In South Asia itself, the average is even lower. In India and Pakistan, menopause typically starts at 46 or 47. Many women begin experiencing perimenopause symptoms well before that.
At the same time, birth rates are shifting. In Pakistan, the average number of children per woman dropped from 3.61 in 2023 to 3.19 in 2024. In India, it fell slightly from 2.14 to 2.12.
It’s not yet clear if these changes in fertility directly relate to menopause trends. But doctors are observing how many factors seem to be accelerating the aging process among South Asian women.
Genetics, Vitamin Deficiency, and Early Ovarian Failure
Dr. Palwasha Khan, a hormone specialist in Pakistan, says menopause often runs in families.
“Women usually start and stop their periods around the same age as their mothers,” she explained. “If you began menstruating early, you may also reach menopause early.”
Dr. Khan also points to low vitamin D levels, a common issue among South Asian women, which can worsen chronic health conditions and speed up aging.
She added that early ovarian failure — where the ovaries stop working before age 40 — is becoming more frequent. Undiagnosed medical problems and limited access to quality health care only add to the issue.
Fertility Pressure Often Overrides Health
In many parts of South Asia, women are expected to have children soon after marriage. Health takes a back seat.
“Women’s health isn’t treated as a separate concern,” said Dr. Khan. “There’s little knowledge about hormones, and treatments like hormone replacement therapy (HRT) are extremely rare.”
In fact, she estimates that for every 10,000 women, maybe two receive HRT. The focus remains on fertility, while conversations around menopause are pushed aside.
Mental and Emotional Toll of Early Menopause
Sabina Qazi, a woman in her mid-40s from Karachi, faced a very different menopause experience — but with equally emotional consequences. After undergoing a radical hysterectomy to lower her cancer risk, she suddenly entered surgical menopause.
She remembers struggling to think clearly or follow conversations. “My husband and kids would speak to me, but I couldn’t follow. I felt like I had to prove I wasn’t stupid,” she told DW.
While the surgery was medically necessary, Qazi said doctors never fully discussed the long-term impact. “They made it seem like menopause would happen soon anyway — so why not now?”
She later began HRT to manage her symptoms, especially brain fog. But the emotional impact lingered. Friends and family brushed off her concerns, suggesting her body had done its job since she already had children.
“The message was: I don’t need these organs anymore,” she said.
Cultural Expectations, Chronic Stress, and Burnout
Many South Asian women carry heavy emotional and social burdens. Dr. Khan believes this contributes directly to faster aging and earlier menopause.
“Chronic illnesses, stress, emotional trauma, lack of support — these all add up,” she said. “Brown women are burned out.”
She blames societal roles, pressure from extended families, and mental health stigma. “The weight of society and expectations often becomes too much.”
One woman living in Saudi Arabia summed it up simply: “I feel angry all the time.”
Conclusion
Early menopause and faster aging are becoming more common among South Asian women. While biology plays a part, cultural pressure, poor health care, and stress appear to be powerful forces accelerating the process. Experts say it’s time to take women’s long-term health more seriously — not just their ability to bear children.
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