Indigenous, integrative, and biomedical perimenopause and postmenopause healthcare for Indigenous midlife people residing in the United States and Canada: A scoping review

BackgroundLittle is known about the menopause-related healthcare of Indigenous people of the United States and Canada. This scoping review mapped the existing literature on Indigenous, integrative, and biomedical healthcare for U.S.- and Canada-based perimenopausal Indigenous populations. MethodsWe followed the JBI Manual for Evidence Synthesis. The protocol was registered on Open Science Framework. Eligibility criteria included records focused on Indigenous people of the U.S. and Canada perimenopause/postmenopause healthcare. Medline and eight other data bases were searched on June 1, 2023, and updated November 21, 2024. Covidence was used for selecting and extracting data. FindingsAfter screening 6,684 records, 45 met inclusion criteria. These focused on Indigenous peoples experiences, care barriers, symptom reporting, and treatment preferences. Traditionality, community roles, and cultural beliefs influenced symptom experience and healthcare-seeking. Many participants preferred Indigenous or integrative interventions, sometimes in combination with biomedical care. Barriers included rushed encounters, language and cultural disconnects, and systemic inequities. InterpretationFindings highlight the need for culturally responsive, patient-centered care during the menopausal transition with an emphasis on evidence-based interventions including Indigenous and integrative health approaches. Additional research, stronger community engagement, and healthcare-provider training will help improve perimenopause health outcomes for Indigenous populations in the United States and Canada FundingThe authors disclose receipt of the following financial support for the research, authorship, and/or publication of this article. The first author received support from the National Clinician Scholars Program (NCSP) as a postdoctoral fellow at the University of Pennsylvania. Additionally, she was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number F31NR020431. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Indian Health Service. The authors were supported by a grant from the University of Utah office of the Vice President for Research. Panel: Research in ContextO_ST_ABSEvidence before this studyC_ST_ABSBefore undertaking this scoping review, the review team identified several sentinel articles. No prior evidence reviews nor protocols on our topic were identified in searches conducted on February 22, 2023 in PROSPERO, Open Science Framework, PubMed, Cochrane Library, Campbell Systematic Reviews, CINAHL, and Sociological Abstracts. We then conducted comprehensive searches across nine databases--Medline (Ovid) 1946-2024, Embase (Elsevier) 1974-2024, CINAHL Complete (EBSCOhost) 1937-2024, Ageline (EBSCOhost) 1966-2024, Alt HealthWatch (EBSCOhost) 1984-2024, APA PsycInfo (EBSCOhost) 1872-2024, Scopus (Elsevier) 1977-2024, Web of Science Core Collection (Clarivate) 1900-2024, and the Native Health Database (1900-2024). Searches were initially conducted on June 1, 2023, and repeated on November 21, 2024. We also reviewed reference lists of included studies. Search strategies combined keywords and subject headings related to menopause, healthcare, and Indigenous populations. Only English-language records were included due to funding constraints. We excluded books and cancer-related studies to focus on natural or surgical menopause not induced by chemotherapy. No quality assessment of included studies was conducted in accordance with scoping-review methodology. Added value of this studyThis is the first known scoping review to synthesize literature on perimenopause and postmenopause healthcare among Indigenous peoples in the United States and Canada. It maps Indigenous, integrative, and biomedical treatment practices; highlights structural and cultural barriers to care; and identifies the influence of traditional knowledge, community roles, and colonization on symptom interpretation and treatment-seeking. It also summarizes patient-centered recommendations for improving perimenopause healthcare delivery, and outlines key research gaps. Implications of all the available evidenceFindings from this review, combined with existing literature, emphasize the urgent need for culturally responsive, community-informed healthcare for Indigenous midlife populations. Interventions should consider traditional knowledge systems, language and literacy needs, and preferences for Indigenous and integrative treatments. Healthcare providers must engage in shared decision-making and address systemic barriers to care. Future research should center Indigenous perspectives, investigate disparities in symptom experiences, and help to improve access to perimenopause healthcare for Indigenous peoples.