by Professor Lynn Basford
The proceeding article on menopause could seem to be a depressing read. As if by magic you have to traverse a series of twists and twirls that you have no real control over. Your hormones are in control of you, affecting your physical, psychological and emotional health and well being. Like King Canute, the tide of menopause is coming with no real chance of stopping it!
Depressing as it may seem, there are some significant difference between women who are culturally and genetically different, eat different foods types, have different familial and social pressures, and who are exposed to different environmental factors. Exploring these differences can offer insights into how you as, a mature woman can off set some of the maladies associated with peri-menopause.
So our story of the menopause has indicated not all women have the same experience. The inference here is within the modern western communities whose reproductive life is medicalised at all stages. However, there is evidence from scientific studies that there are significant differences between cultures. 1,2,3
In essence, it’s about attitudes towards menopause and the unfolding experience.
If we consider the physiological changes that occur during the peri-menopausal transition it would seem implausible that there are significant differences, but differences there are. This implies that one’s attitude and responsive behaviour towards the menopausal process is a significant factor.
Choosing your story
If you are told from a young age that all elements of your reproductive life is a biological story that requires treatment or medical intervention of some kind, then the story will be played out by those individuals who buy in to the story. Eventually, the story spreads out as fact promoted by the media, endorsed by doctors until a critical mass of women totally buy into the medicalisation of the menopause. (Consider just a few years ago, it was promoted that all peri-menopausal women should take HRT).
On the other hand, if you belong to a culture that views, and celebrates all reproductive transitional stages as a natural phenomena to be embraced with a positive attitude. The prevailing outcome of menopausal symptoms will be different, mediating the biological response. In this instance, menopause is not purely a biological interlude, but a passage of time through which you become a senior respected stateswoman within your community; admired for your wisdom and valued for who you have become.
Like all aspects of human life, the differences presented above implies a simple explanation, but studies reveal there are compounding issues that need to have a fuller understanding.
It was the work of anthropologist Flint (1970) who first proposed there was a cultural difference. Her study examined Indian women in the Rajasthan and Pradesh regions and found that the majority of women had very little symptoms during the menopausal phase until they reached period cessation. One conclusion was because post menopausal women had high status within their communities.
In Japan, studies concluded that hot flushes were a rarity for women and they were largely asymptomatic 2. Indeed, if you examine the Japanese language there is not a word for, “hot flush”, and the peri-menopausal transition has a social influence rather than a biological one.
Similar, conclusions were made between women of (i) Canadian and Chinese ethnicity 5 , (ii) Australian and Taiwanese, 7, ( iii) Greek and Mayan 12 .
You can be forgiven in thinking these difference are with women who live in traditional communities, but larger studies, such as the American SWAN study 11 found that there were peri-menopausal differences between African Americans, Hispanic and Chinese Americans 10 Suggesting that culture strongly influenced the attitudes of women regarding their lived experience of the menopause.
The Medical profession are central to the debates surrounding the medicalisation of the menopause. Can they ignore that there are a range of symptoms that women have during the peri-menopausal period? Or, should the views of anthropologists and sociologists continue to proclaim that social and cultural conditions greatly influence the degree a woman experiences peri-menopausal symptoms.
So what does all this mean for you?
The key issues are that women of certain ethnicity embrace the tradition phase with a positive attitude. This is one aspect you can do regardless of your cultural background!
OK you might say How do I do it?
In our PRAM Menopause model series of articles we will provide you with tools to enable you to have a positive attitude and positive coping strategies to enable you to take control of your menopause!!
Just remember, menopause is a natural process, NOT A DISEASE
1. Flint M. The menopause: reward or punishment? Psychosomatics. 1975;16(4):161-163.
2. Lock M. Encounters with Aging: Mythologies of Menopause in Japan and North America. Berkeley: University of California Press; 1993.
3. Melby MK, Lock M, Kaufert P. Culture and symptom reporting at menopause. Hum. Reprod. Update. 2005 Oct;11:495-512.
4. Lock M. Menopause: Lessons from Anthropology. 1998; 60: 410-19
5. Hilditch JR et al. Experience of menopausal symptoms by Chinese and Canadian women. Climacteric 1999;2:164-73.
6. Ho SC, et al. Menopausal symptoms and symptom clustering in Chinese women. Maturitas 1999; 33:219-27
7. Boulet MJ et al. Climacteric and menopause in seven south-east Asian countries. Maturitas 1993; 19: 157-176.
8. Beyene Y. Cultural signficance and physiological manifestations of menopause; a biocultural analysis. Culture, Medicine & Psychiatry 1986;10:47-71.
9. Avis N. et al Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups. Social Science & Medicine. 2001; 52:345-356.
10. Collins A. Sociocultural Issues in Menopause. in NIH: International Position on Women’s Health and Menopause. NIoH, US Dept Health and Human Services, 2002.
11 The National Institute Ageing (2011)The Study of Women’s Health Across the Nation (SWAN) Repository.
12 Avis, NE. and Crawford S. (2007), Cultural Differences in Symptoms and Attitudes toward Menopause, in , Menopause Management, Primary care for midlife health.