The story of perimenopause symptoms around the world
Did you know that perimenopause symptoms are not the same in different cultures?
Anthropologists have found that culture affects:
• our attitude to menopause, midlife and aging
• our physical experience of perimenopause
Status of older women
seems to be a key influence on how we experience menopause. In cultures where older women are valued, menopause is either a positive experience or not even noticed.
But in youth-obsessed cultures of the West, where the emphasis is on "loss" - of fertility, rather than on transition and "gain" - of wisdom and freedom, the medical or "disease" model of menopause is dominant.
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The fact that culture affects climacteric symptoms can be quite a surprise, because we tend to take it for granted that perimenopause symptoms must be the same for all women.
This is probably because we're so used to hearing the biomedical story of menopause which has created the metaphor of menopause as a disease with symptoms that require a doctor's treatment.
But if symptoms vary with culture and
are different around the world,
this implies something rather important about our midlife journey:
The mystery of menopause is more than pure biology.
Menopause seems to have a strong behavioural and mind body connection too.
An intriguing story
The story of how perimenopause symptoms vary with culture is long and involved. Like all good stories, it’s a tale of intrigue and mystery, with lots of red-herrings, false clues and tantalizing evidence.
And it’s a story that is still unfolding.
On this page I give a flavour of some of the research that has been done so far. But there's a massive treasure trove of findings out there and the story is far from over...
Let's take a look at some snippets of what's known about perimenopause symptoms and culture.
It's a fascinating story and it can help us see menopause in a new light altogether:
It all began in India
It was in the 1970s that anthropologist Marcha Flint first raised the question of the effect of culture on perimenopause symptoms. Flint studied 483 women in Rajasthan and Himachel Pradesh in India and found that most women suffered no other problems at menopause other than menstrual changes. She concluded that:
"much of what we call 'menopause symptomatology' may well be culturally defined and engendered."
Marcha Flint, 1975(1)
Flint suggested that the reason women do not suffer so much in India may be because post-menopausal women have a high status in that culture.
Read more about women's status and menopause experience
A classic tale from Japan
Margaret Lock's classic study in Japan in the 1980s showed that hot flushes were very rare in Japanese women.
In fact the most frequent midlife symptom suffered by middle aged Japanese women was shoulder stiffness(2).
There is not even a word in Japanese that means exactly the same as the English words: "hot flushes" or "hot flashes" and the researchers had to use a variety of terms to describe the concept.
The midlife transition in Japan is known as "konenki" and has social rather than biological connotations. The term "konenki" seems to be more similar to the English term "climacteric" than to the more biologically defined "menopause" (3).
Amazingly 85% of the women who replied to Lock's survey said they had no physical perimenopause symptoms at all (apart from their periods stopping of course). Margeret Lock thought that a possible explanation could be that the physical side of menopause is seen as relatively trivial in Japan.
"At the time I did the research, neither Japanese women nor Japanese doctors considered the end of menstruation to be a significant marker of female middle age."
Margaret Lock, 1998.(4)
And notably,in Japan, as in India, middle aged and older women are given a special status and not ignored as if they were ready for the rubbish heap as seems to occur so frequently in Western cultures.
Other studies of Asian women
Some people have argued that because of the nature of Japanese society, women are less likely to complain of perimenopause symptoms. But Margaret Lock was very careful in her interviewing to make sure that her findings were not just a reflection of under-reporting. Since then, other studies have confirmed that hot flushes do seem to be less common in Asian women than in women in other cultures.
For instance, in a study of Canadian and Chinese women, there was a huge difference in the experience of hot flushes and sweats. Whereas 60% of Canadian women reported these perimenopause symptoms, only 18% of Chinese women complained of hot flushes. In contrast the Chinese women complained more of boredom, poor memory, numb hands and feet and changes in appearance(5).
And in a Hong Kong study, the researchers found that Hong Kong women complained more about joint and muscle problems than hot flushes(6).
Another study looked at perimenopause symptoms experienced by women in 7 South East Asian countries. These researchers found that in Hong Kong, Indonesia, Korea, Malaysia and Taiwan, women reported a similar set of symptoms as those in Western Europe and North America, but they seemed to be milder or less frequent(7).
Mayan and Greek women
Another comparative study done in the 1980s also had some surprising findings. Yewoubdar Beyene, worked with Mayan women in a village in the Yucatan, Mexico (8). She found that no Mayan women reported either hot flushes or cold sweats at menopause. As in the Japanese case, Beyene also found that there was no local term for "hot flush or flash" in Mayan culture.
In contrast when she then did a similar study with women living in a mountain village on the island of Evia in Greece, she found similar reporting of perimenopause symptoms as in the rest of Europe and North America.
Menopause variation across the USA
A massive study in the United States, known as the SWAN study, looked at over 3000 women across the country(9). The study found big differences in perimenopause symptoms depending on the ethnic group women belonged to. The differences observed between African Americans, Hispanic and non-Hispanic Whites and Chinese Americans applied to both types of symptoms and the degree of bother that they caused.
Culture versus biology – the battle of the experts
I've summarised here just a few findings from loads of studies that have now been done around the world and with women from different cultural and ethnic backgrounds.
But what does it all mean and how can we make sense of it all?
Is there really a "menopause syndrome" that all women on the planet get? Or could it be that menopause shifts depending on your culture?(10)
During the last 2 decades or so there has been a bit of a stand-off between the medics on the one hand, who have argued that menopause is purely physical, and the anthropologists and social scientists on the other hand, who have argued that culture and social conditions have a big influence on each individual woman's experience.
Questions at the heart of the debate include:
Is the biomedical approach correct in saying that there is a universal physical "syndrome" of menopause?
Or is the socio-cultural approach more accurate and only the end of menstruation is universal and everything else depends on your culture?
Can thinking positively change your experience of perimenopause symptoms?
Does the status of middle aged and older women have an influence on the way you go through menopause?
Or are all the findings from cultural studies just red herrings because women tend to report symptoms differently depending on their cultural background and language or because studies have been done in different ways - so effectively they compare apples with pears ....?
Mind body connection, culture and menopause
Many experts are now suggesting that the socio-cultural and the biomedical ways of understanding menopause should be integrated into an "interactive psycho-bio-cultural model"(10). Some argue that it's all our life experience that adds up to give us our menopause experience.
Read more about the Life Span approach to menopause.
This is an exciting new avenue for interdisciplinary research that is strongly needed. It's also an approach which women all around the world will probably find both interesting and relevant.
Because when we understand the menopausal process as a biocultural event mediated through a mind body connection, we realise that what we are going through is a process of transformation and not a disease.
The studies of culture and menopause weave into a complex tale of how our minds, bodies, cultures and environments collide and create our own individual menopause.
It's a story that's only just being uncovered and it's a tale of an exciting journey of development and not of a decline into a depressed and diseased oblivion.
Flint M. The menopause: reward or punishment? Psychosomatics. 1975;16(4):161-163.
- Lock M. Encounters with Aging: Mythologies of Menopause in Japan and North America. Berkeley: University of California Press; 1993.
- Melby MK, Lock M, Kaufert P. Culture and symptom reporting at menopause. Hum. Reprod. Update. 2005 Oct;11:495-512.
- Lock M. Menopause: Lessons from Anthropology. 1998; 60: 410-19
- Hilditch JR et al. Experience of menopausal symptoms by Chinese and Canadian women. Climacteric 1999;2:164-73.
- Ho SC, et al. Menopausal symptoms and symptom clustering in Chinese women. Maturitas 1999; 33:219-27
- Boulet MJ et al. Climacteric and menopause in seven south-east Asian countries. Maturitas 1993; 19: 157-176.
- Beyene Y. Cultural signficance and physiological manifestations of menopause; a biocultural analysis. Culture, Medicine & Psychiatry 1986;10:47-71.
- Avis N. et al Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups. Social Science & Medicine. 2001; 52:345-356.
- Collins A. Sociocultural Issues in Menopause. in NIH: International Position on Women's Health and Menopause. NIoH, US Dept Health and Human Services, 2002.
Published June 2010. Updated 11/7/2011
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