Perimenopause signs and culture –
why are we all so different?

It’s all in our life baggage

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Ask almost anyone about perimenopause signs and many will say “Hot Flushes". These strange and unexplained feelings of heat, causing sweating and sometimes a chill afterwards are the famous sign that everyone associates with middle aged women.

But like many things in life, hot flushes don’t come to everyone equally. And it’s notable how much they vary by culture and ethnic group.


No-one’s the same

A review of how hot flushes vary around the world showed some big differences: In North America they have been reported as affecting between 30% and 75% of women, and in Europe around 20 - 30%, whereas in Asia the range was from 5 – 20% (1). In some groups in India nobody reported hot flushes and in Mayan women in Mexico, nobody reported any perimenopause signs at all, other than menstrual changes!(2)


So what on earth is going on?

Understanding variations in perimenopause signs is very complicated and it is extremely tricky to research. There are so many things that can vary and some of these are very difficult to either measure accurately or assess objectively.

Once you start to think about it, there are lots of factors that might affect the way our bodies behave when we reach midlife. And most of these are influenced by our culture. Because of this, some experts believe that a lifespan approach to understanding menopause is essential(3).


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Life baggage that can influence our perimenopause signs:

  • Our genetic makeup which may alter the fine-tuning of how our bodies make and use oestrogen and other hormones.
  • Our mother’s health and lifestyle when she was pregnant with us – because that’s when our eggs were being made.

  • Our nutrition and environment when we were growing up.
  • Our sexual and reproductive stories – whether we've been pregnant, our age at first pregnancy, how many pregnancies we’ve had, how long the gaps were between pregnancies, whether we’ve had our tubes tied, or had a hysterectomy etc.
  • Our own general health and our lifestyles – how much exercise we take, whether we drink alcohol, smoke and whether we are thin, fat or about right.

Many of us would have trouble answering some of these things in detail even if we tried. Some, like pregnancies, we usually remember but others, such as the diet we had when we were teenagers, or the amount we smoked and drank in our twenties, may be a bit more hazy.

Research has shown, that in addition to all these factors, which we think of as being biological (or biology influenced by behaviour), there are other influences on our perimenopause symptoms. These include our level of education, our jobs, our financial and social status, and whether we are under stress or not.


Then into the cauldron just add…

…the issue of culture, ethnicity and language.


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Not only may all that biological and other baggage that I’ve just mentioned depend on culture, but the way the research is done opens another Pandora’s box:

Because the language the researchers use affects how their questions are interpreted. Plus the expectations women have of perimenopause symptoms and how menopause is discussed and perceived, all vary with culture.

Anthropologists argue about the best method to get this kind of knowledge: some feel that giving women from non-Western cultures questionnaires about so-called perimenopause signs is a bit like forcing square pegs into round holes. They argue that the only way to understand how women really experience menopause is to live in a culture for a long time and listen to their stories in depth(4).


Language and culture affect meaning

A study from the University of Massachussetts Medical School used data from the SWAN study (Study of Women’s Health Across the Nation) to show how important it is to take culture into account when trying to understand perimenopause symptoms (5).

The SWAN study, involved over 3000 women from seven sites in the USA, and looked at differences in reporting of hot flushes – or vasomotor symptoms (VMS) - by non-Hispanic and Hispanic white, African American, Chinese and Japanese women.

This study showed that it is all too easy to think (wrongly), that women understand a term in the same way as the researchers:

"Questions that are assumed to be universal but are really understood differently or not understood by particular groups lead to possible misinterpretation." (5)

And depending on the terms used, the research found that reporting varied – for instance the frequency of hot flushes in Japanese women varied by as much as 3% to 17% depending on the words used.

A positive or negative attitude to menopause also influences symptom reporting:

"The experience of menopause, including VMS, is seen as more positive and natural, less bothersome, and less likely to require medical intervention in non-European and non-European American women, consequently, VMS may be less remarkable or memorable for them." (5)

Some of the questions were also answered differently depending on how much women had adopted mainstream American lifestyle. For instance Chinese women pointed out that menopause was not normally discussed in traditional Chinese culture in the same way that it is in the West.

Finally it’s important to remember that the differences between women occur within the same culture as well as between different cultures.


No standard women...

It seems that in most cultures, at least some women experience hot flushes around the time of their periods stopping. In some cultures women are very bothered by them, in others less so. Whether the flushes are physiologically and objectively worse in the cultures where the women complain the most, is a matter of much speculation and debate.

But at the end of the day, just as there is no such thing as a standard woman, there is no standard experience of perimenopause signs either.


Bibliography

  1. Obermeyer CM. Menopause across cultures: a review of the evidence. Menopause. 2000 Jun;7(3):184-192.
  2. Beyene Y. Cultural significance and physiological manifestations of menopause. A biocultural analysis. Cult Med Psychiatry. 1986 Mar;10(1):47-71.
  3. Lynnette Leidy Sievert, Menopause. A Biocultural Perspective. Rutgers University Press, New Brunswick 2006.
  4. Obermeyer CM, Sievert LL. Cross-cultural comparisons: midlife, aging, and menopause. Menopause. 2007 Aug;14(4):663-667.
  5. Crawford SL. The roles of biologic and nonbiologic factors in cultural differences in vasomotor symptoms measured by surveys. Menopause. 2007 Aug;14(4):725-733.


Published July 2010. Updated 3/7/2010

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