by Professor Lynn Basford
Different Menopause – Different Culture?
Some more variants explained
In part one we looked at the fact that menopause is a universal phenomena. Thats right, if you live long enough it is every woman’s experience.
The simple truth is that there is no doubt that menopause is a female biological event. But, it is also true that not every woman has the same experience and other factors are influential.
Menopause, as indicated through numerous cross cultural studies, is also shaped by a woman’s social, environmental and cultural exposure, notwithstanding her own personal attitude.
Recap: Cultural Variants
- More often a woman living in the west explains and experiences menopausal symptoms from the perception of biology associated with hormonal imbalance. The concept is fuelled by the media, the medical and pharmaceutical fraternity.
- Her symptoms have a preponderance towards hormonal imbalances, which include hot flushes, night sweats, menstrual irregularities, vaginal dryness and alteration of vaginal ph levels. In addition, she may suffer from depression, insomnia, memory loss, fatigue, weight gain/weight loss, decreased libido, and mood swings.
- Conversely, a woman living in the east often explains menopausal symptoms from her cultural expectations and understanding, coupled together with dietary factors and the environment in which she works and lives.
- Through the lens of cultural diversity and differences it has become clear that a woman’s menopausal experience defies a simple explanation and more attention needs to be given to her biology , psychology, genetics, culture, diet, life style and living conditions.
Menopausal Symptoms: Recorded Differences as illustrated by studies.
- Japanese menopausal women experience more headaches and shoulder stiffness .
- Indian women in the Rajput caste suffered minimal symptoms except period cessation as did Mayan women.
- Lebanese women report increase in fatigue and irritability,
- British women report more and diverse unpleasant symptoms associated with the menopause.
Vaso Motor Symptoms
Western ideology assumes that the most identified menopausal symptom are vaso-motor related, i.e. HOT FLUSH & NIGHT SWEATS.
Several cross cultural studies have shown that this is not universal.
While on the surface it appears to be a prevalent symptom that is common in North America and Europe, it is relatively non existent or marginalised within the Asian and Indian communities.
A fact endorsed by the SWAN study ( the multiethnic/racial Study of Women’s Health Across the Nation) in that hot flushes and night sweats was the lowest in women of Japanese and Chinese ethnicity and higher among Hispanic and African-American women.
Based on this perspective there has been a focus of attention that suggests Vaso motor symptoms are directly related to diet, physical activity and the environment. This seems to miss out on the concepts of personal attitude, acculturation, genetic disposition and social class.
The latter has been highlighted in recent US and European studies that have shown women with higher levels of menopausal symptoms are often from the lower -socio- economic class. Conversely, it is totally opposite in Asian communities whereby women from the higher social classes report more menopausal symptoms.
The above results illustrate cultural differences and it raises other questions that seem worthy of further investigation such as:
1. The issue of fertility and childbearing?
2. Individual internalisation of stress and the use of coping strategies?
3. Medical treatment for symptoms such as Hormone Replacement Therapy.
4. Dietary factors such as high consumption of photo oestrogen’s (Soya).
5. Consumption of traditional remedies (Herbs & teas) etc.
6 Obesity – Ie. body weight and lean body mass -factors known to effect hormone levels.
7 Cultural freedom and access to the higher echelons of community life.
1.0 The issue of fertility and childbearing
In some traditional cultures women marry early, commence childbearing followed by long periods of amenorrhea lactation (breast feeding, which includes temporary cessation of periods).
In these instances women have few, or no periods for almost all of their reproductive life span that may last for 15-20 years. This process is often followed by early onset menopause. Menopause is therefore compressed into a few short years . Because there is a different experience regarding the fertile and monthly cycles it is not surprising that their reporting of menopause symptoms /experience is different.
2.0 Internalisation of stress and coping strategies
The ways in which individual women internalise stressors affects their overall health and well being.
This is no different in a women’s reproductive biology. Some women will experience heavy bleeds leading up to menopause and welcome menopause as a positive element in her life.
In other traditional communities there is an inherent understanding that heavy bleeds clean the uterus from residual debris and toxins that have been accumulated in the uterus throughout the fertile years. Intervention with this process is positively discouraged. (Indeed this was my own experience as advised by my grandmothers).
By contrast, in western medicine, there is an over reliance of medical (hormonal) intervention from start of a women’s menses and beyond menopause. This illustrates that a women’s natural biology is seen as an abnormality that must be controlled.
3.0 Medical Treatments/Interventions
In western societies some girls, at the point of their menses, are given hormonal therapy to remove any period discomfort or irregularities they may have.
This is followed by hormonal treatment for pregnancy prevention (the hormonal intervention may differ, but a current method is to use hormonal patches that prevents monthly bleeding cycles).
HRT is actively encouraged during the pre, peri and post menopausal periods.
All of the above is evidently beneficial to some women; contraceptive needs obviously, those experiencing severe menstrual pain and women with excessive vast motor symptoms. But should there be more discernment on individual needs?
The Over-Reliance on hormonal therapeutic replacement for all areas of a women’s fertility has embedded in the psyche of women that somehow her normal reproductive biology is always malfunctioning and intervention must be pursued at all costs. Such an approach, which is also emphasised in the media, develops negative coping strategies and overshadows any development of positive attitudes towards her menopausal journey.
4.0 Dietary influences.
Because Japanese/Chinese/ women have reported lower vasomotor symptoms than their western counterparts, it is assumed that eating large amounts of soya and similar photo-oestrogens would reduce the Hot Flush and associated symptoms.
Whilst Soya may be one food source that Japanese and Chinese traditional diets embrace, it should be also acknowledged that their traditional diet is different in many respects and making assumptions towards one dietary element may be misleading.
However, we cannot ignore the fact that dietary habits have an association with many modern ailments and diseases therefore it is a high probability that diets may have a causal link with menopausal symptoms.
5.0 Intervention with herbs and teas
Traditional cultures use herbs/teas to promote fertility, ease menstrual pain and blood flow, act as a pregnancy prevention, use during the peri-menopausal phase and into old age. Such an approach is also linked to a positive attitude and is viewed as part of the cycle of life.
6.0 Obesity and Lean Body Mass
In western communities there has been an explosion of obesity to the point that large amounts of people, including children are morbidly obese.
It often relates to the type and amount of food consumption coupled together with lack of exercise, which is known to affect the lean body mass and hormone balance.
Obesity is known to affect a women’s reproduction so it would follow this could also be an influence through her menopausal period.
7.0 Cultural freedom.
In some cultures, such as Greece, women are allowed to have more personal freedom and participate more widely in community life when they reach menopause.
This is contrasted strongly within western communities where women are valued for their sexual attractiveness and not the wisdom that ageing (including menopause) brings.
It is clear the menopause is not just a biological phenomena, but shaped by attitudes, perceptions, expectations and cultural norms.
Far from promoting negative connotations in the media and elsewhere, a framework for promoting positive coping strategies should be encouraged and developed to the point that the whole concept of menopause is viewed by all women in a positive light and not one to be feared.
Menopause – part of the cycle of life,
lets embrace it!
celebrate its passing
a new phase of our lives.
Bring on the WISDOM!!!
Barclay L. (2013) HRT Use: New Guidelines From the British Menopause Society : Consensus Statement on Menopausal Hormone Therapy
J. de Villiers, M. L. S. Gass*, C. J. Haines†, J. E. Hall‡, R. A. Lobo**, D. D. Pierroz†† and M. Rees, (2013), Consensus Statement On Menopausal Hormonal Therapy. CLIMACTERIC 2013;16:203–204Flint. M.
( 1975) The menopause: reward or punishment? Psychosomatics. 16(4):161-163.
Patient Information UK (2014), http://www.patient.co.uk/health/menopause-and-hrt-leaflet
Lock M. (1993) Encounters with Aging: Mythologies of Menopause in Japan and North America. Berkeley: University of California Press.
Melby MK, Lock M, Kaufert P. (2005) Culture and symptom reporting at menopause. Hum. Reprod. Oct;11:495-512.
Avis, N. & Crawford S. ( 2007), Cultural Differences in Symptoms and Attitudes toward Menopause, Menopause Mangement.
Lock M. ( 2001) Menopause, local biologies, and cultures of aging. JournL HUM. BIO. 13:495-504
Anderson D. & Yoshizawa (2007) ,Cross-cultural comparisons of health-related quality of life in Australian and Japanese midlife women: the Australian and Japanese Midlife Women’s Health Study. J MENOPAUSE VOL 14- 4 PP 697-707.
Lock M. ( 1998) Menopause: Lessons from Anthropology. 60: 410-19
Hilditch JR et al. ( 1999), Experience of menopausal symptoms by Chinese and Canadian women. Climacteric 1999;2:164-73.
Ho SC, et al. ( 1999), Menopausal symptoms and symptom clustering in Chinese women. Maturitas 1999; 33:219-27
Boulet MJ et al. ( 1993), Climacteric and menopause in seven south-east Asian countries. Maturitas 1993; 19: 157-176.
Beyene Y. ( 1986), Cultural significance and physiological manifestations of menopause; a bicultural analysis. Culture, Medicine & Psychiatry 10:47-71.
Avis N. et al (2001) Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups. Social Science & Medicine. 52:345-356.
Collins A. (2002), Sociocultural Issues in Menopause. in NIH: International Position on Women’s Health and Menopause. NIoH, US Dept Health and Human Services,
The National Institute Ageing (2011)The Study of Women’s Health Across the Nation (SWAN) Repository.
Avis, NE. and Crawford S. (2007), Cultural Differences in Symptoms and Attitudes toward Menopause, in , Menopause Management, Primary care for midlife health..
Obermeyer( M. & Makhlouf C. ( 2005), Menopause across cultures: A review of the evidence. Menopause Journal ; Vol. 12 -3 pp 250-257