Menopause

Overview

Menopause is a complex biocultural phenomenon. Though a normal part of the human reproductive lifecycle, menopause has become pathologized, or medicalized (see: Medicalization). Biomedicine defines it as an illness, or risk factor for disease, that is universally the same in all female bodies. In fact, menopause is experienced differently worldwide.
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Health Impact

Menopause, or the cessation of ovulation, occurs when a woman’s estrogen level diminishes and is insufficient to induce ovulation. It occurs, on average, at around age 50 though this age varies among women worldwide. Factors related to earlier age at menopause include childhood undernutrition, low menstrual cycles, never having given birth, low socioeconomic status, low education level, rural living, and lifestyle factors such as smoking or alcohol consumption.[1]

Biomedicine has come to view menopause as deficiency in the estrogen hormone due to ovarian failure associated with negative symptoms such as hot flashes, headaches, depression, and chest pains. It is viewed as the end of a woman’s reproductive life and one of the disorders of aging. Biomedicine often treats this “pathology” with hormone replacement therapy, particularly because of the assumption that reduced estrogen levels lead to an increased risk of osteoporosis, heart disease, and more.[2]

Originally, several non-specific symptoms were associated with the aging concept of the “climacteric,” and it wasn’t until the end of the 19th century that the term “menopause” began to refer to the biological female reproductive lifecycle transition and the end of menstruation. The advent of life beyond menopause, it has been argued, is a result of improved health care.[3] There is also a theory, “The Grandmother Hypothesis,” that it is evolutionary advantageous for women of non-reproductive age to care for offspring and grandchildren.[4]

Moreover, there is worldwide variation of menopause. Research has found that social, political, cultural and economic factors play a role in the timing of menopause and symptoms reported [5] [6] Not all postmenopausal women experience an increased risk for CVD and osteoporosis, and hormone replacement therapy may not be right for all women. These diseases are complex and multifactorial, and it has been posited that they vary with diet and other behavioral risk factors. Recent studies have called into question whether HRT in fact decreases the risk of cardiovascular disease, and there is recent epidemiological evidence that it may increase breast cancer rates.[7]

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Medical Anthropology Research

Menopause is a biological process that is experienced differently by women, and is uniquely affected by both biology and culture, making it an ideal topic of study for medical anthropology. Anthropologist Emily Martin has studied the language with which medicine has described the end of menstruation. During menopause, the ovaries cease to respond and fail to produce estrogen, associated with breakdown of the machine-body.[8] Compared to male gametes, which are actively produced, female gametes are all present at birth and degenerate throughout the lifetime. She argues that these medical metaphors fit with stereotypical or traditional roles of the female gender, and the idea that the female body is a defective machine.

Biological and Evolutionary Anthropologist Wenda Trevathan has shown that geographic location, income, education, diet, behavior and marital status have all been associated with the timing of menopause.[9] It has also been discovered that symptoms vary across cultures. Hot flashes are reported among many women in North America, Thailand, Norway, India, Nigeria and Tanzania, but rarely in Japan, among Navajo women, Mayan peasants, and Sikh women.

Anthropologist Margaret Lock has studied menopause in Japan and found that Japanese women are much less likely than North American or European women to report symptoms in general, but especially hot flashes, sweats, and trouble sleeping. Menopause among these women is not seen as distressing, and indeed there is no word in Japanese that refers exactly to menopause.[10] Japanese women were found to have lower risks of heart disease and breast cancer, and though they have lower bone density, they reported fewer occurrences of osteoporosis. Few Japanese women seek out medication when they reach their climacteric, referred to as konenki. For women in Japan, menopause is simply part of the process of aging, which encompasses much more than just the biological cessation of reproduction.

Lock and Nguyen call attention to the dangers of the assumption that there is a standardized body that is everywhere the same. Data on the increase risk of CVD and osteoporosis among postmenopausal women were derived from a sample that included white women only. They write, “the danger is that the white Euro-American body remains the gold standard against which difference is seen either as statistical deviation or as due to cultural difference alone, leaving the medical model of a universal menopause intact”.[11] The concept of local biologies, which refers to the way in which biological and social processes are inseparably entangled, was created by Lock to account for differences in symptom reporting at menopause. Because hormone replacement therapy is touted by biomedicine as the solution to menopausal symptoms and prevention of osteoporosis globally, it is important to recognize the way in which these treatments are intertwined with local biologies.

Applied Work

The applied aspect of anthropology research on menopause involves investigating the link between menopause, symptoms, and risk for disease as it is related to culture, socioeconomics, environment and local biologies. Biological Anthropologist Melissa Melby, following up on the work done by Margaret Lock, has done hormonal analyses, interviews and dietary surveys on menopause in Japan. She has found that reporting of symptoms such as hot flashes has doubled in 20 years, which may be attributable to changes in diet and a decrease in the overall health of Japanese women.[12] She has also found that the consumption of phytoestrogens (primarily soy beans) may have a protective factor for some women during menopause. Few women use HRT, and those that seek out medication prefer herbal medication.

Recent research has found that “some menopausal symptoms may be side effects of modernizing lifestyle changes,” and that “local biologies may have contributed through epigenetic effects”.[13] This is evidence that biomedical concepts of menopause may be limited and may not accurately reflect actual variability.

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Figure: Schematic depicting biocultural life course factors influencing, and varying with, ovarian steroid concentration and ovarian reserve, which in turn influence the timing and experience of menopause (Melby & Lampi 2011)


By researching what behavioral, dietary, and socioeconomic factors affect the onset and symptoms of menopause, and how bodies vary cross-culturally, anthropologists contribute to improved understanding of possible ways to improve the menopausal experience and reduce the need for biomedical treatment. Applied anthropologists can also advocate for a decrease in the assumption that there is a standardized body and that hormone replacement therapy is beneficial for all women. Examining the use of hormonal replacement therapy globally is an important applied contribution of medical anthropology.

Online Resources

The Origin of Menopause: Why Do Women Outlive Fertility? By Tabitha M. Powledge | April 3, 2008, Scientific American http://www.scientificamerican.com/article.cfm?id=the-origin-of-menopause

Further Reading

  • Melby, Melissa and Michelle Lampi (2011) Menopause, a Biocultural Perspective, Annual Review of Anthropology, Vol. 40: 53-70
  • Lock, Margaret (1995) Encounters with Aging. Berkeley: University of California Press
  • Shea, Jeanne (2006) Women’s Midlife Symptom-Reporting in China: A Cross-Cultural Analysis. American Journal of Human Biology 18: 219-222
  • Gold, E. et al (2001) Factors Associated with Age at Natural Menopause in a Multiethnic Sample of Midlife Women, American Journal of Epidemiology 153(9): 865-874

References


  1. ^ Trevathan, Wenda (2010) Ancient Bodies, Modern Lives: How Evolution has Shaped Women’s Health
  2. ^ Wiley Andrea S. and John S. Allen (2009) Medical Anthropology: A Biocultural Approach. New York, NY: Oxford University Press
  3. ^ Lock, Margaret and V. K. Nguyen (2010) Local Biologies and Human Difference, in An Anthropology in Biomedicine
  4. ^ Trevathan, Wenda (2010) Ancient Bodies, Modern Lives: How Evolution has Shaped Women’s Health
  5. ^ Trevathan, Wenda (2010) Ancient Bodies, Modern Lives: How Evolution has Shaped Women’s Health.
  6. ^ Lock, Margaret. (1998) Menopause: Lessons from Anthropology. Psychosomatic Medicine. 60(4) 410-419
  7. ^ Lock, Margaret and V. K. Nguyen (2010) Local Biologies and Human Difference, in An Anthropology in Biomedicine.
  8. ^ Emily Martin, (1987) Medical Metaphors of Women’s Bodies: Menstruation and Menopause, in The Woman in the Body
  9. ^ Trevathan, Wenda (2010) Ancient Bodies, Modern Lives: How Evolution has Shaped Women’s Health
  10. ^ Lock, Margaret. (1998) Menopause: Lessons from Anthropology. Psychosomatic Medicine. 60(4) 410-419
  11. ^ Lock, Margaret and V. K. Nguyen (2010) Local Biologies and Human Difference, in An Anthropology in Biomedicine.
  12. ^ Lock, Margaret and V. K. Nguyen (2010) Local Biologies and Human Difference, in An Anthropology in Biomedicine.
  13. ^ Melby, Melissa and Michelle Lampi (2011) Menopause, a Biocultural Perspective, Annual Review of Anthropology, Vol. 40: 53-70