It was way back, sometime in the 1970s, anthropologist Marcha Flint was struck by a curious question: was it possible that women from different countries experienced menopause differently? Her survey of 483 women from Rajasthan and Himachal Pradesh showed that when they hit middle age, most women suffered no symptoms of menopause, other than the stoppage of menstruation. It was a revelation–that perhaps culture had as much of a role in the way menopause impacted women as biology.
Research globally shows that women from different countries experience this natural transition differently, with differing physical and psychological symptoms. Importantly, this depends as much on the cultures and societies they belong to as on biology.
The biological perspective:
Menopause is defined as occurring 12 months after the last menstrual period, when the ovaries no longer secrete the hormone estradiol. It usually occurs between the ages of 45 and 55 years, and is preceded by ‘perimenopausal years.’ During this transition, estrogen levels decline, accompanied by several physical and psychological changes. While some women may make a smooth transition with few and mild symptoms, others experience intense, troublesome symptoms, including sleep difficulties, mood swings, clinical depression, hot flashes, sexual problems, muscle and joint pains. The mood changes are attributed to unstable and decreased estrogen levels, which in turn impact serotonin levels. Women who have experienced clinical depression earlier in life are vulnerable to greater mood symptoms, including perimenopausal depression.
In 1980s, anthropologist Margaret Lock found 85 per cent of Japanese women who participated in her survey reported no physical symptoms of menopause. The transition from one natural state into another was referred as ‘konenki’ (a season of renewal and regeneration!).
Culture, societal attitudes and lifestyle play a major role in the way women experience menopause, which is far from homogenous. An intercontinental research review (2014) found that in the US, women
mostly reported muscle and joint pains, with lesser sexual dysfunction, compared to women in other countries. It was almost exactly the opposite in Australia, with lesser complaints about muscle and joint pains and higher prevalence of hot flashes and sexual dysfunction. Closer home, in Asia, number of women with depressive disorders registered an alarming increase, while hot flashes and excessive sweating were the lowest.
The Indian woman’s experience varies widely, based on culture, subculture, lifestyle, diet, educational levels, prior physical health. A study conducted in eastern India (2009) found a marked difference in rural and urban Indian women experiencing menopause. Rural women had a significantly higher severity of hot flashes, night sweats and fatigue.
Cultures that view menopause as a dreaded “loss of youth” negatively impact women’s attitudes to it. Interestingly, according to Traditional Chinese Medicine (TCM), menopause actually slows down the ageing process. Losing blood through menstruation beyond the age of 49 could lead to loss of what the Chinese call ‘chi’ or the essential vitality of life. Once menstruation stops, this loss is contained, allowing women to lead healthy lives for longer periods.
Power of positive thinking:
Studies show that thinking positively can make a remarkable difference in the way a woman perceives this phase of life. Because these are in fact the most wonderful years of your life. Anthropologist Margaret Mead referred to it as ‘menopausal zest,’ when the mind is free of concerns and burden of responsibility.
And truly, women in their middle ages are spectacularly challenging the status quo. Hillary Clinton is running for president; Meryl Streep continues to shock and awe. In India too, women CEOs are on the rise and rise, becoming an important beacon of hope and source of strength for others. The onset of middle age should be celebrated,because it is a transition into a more self-assured role, an opportunity give your life a fresh lease.
(Shamsah Sonawalla is a consultant psychiatrist at Jaslok Hospital)