Menopause is a time of significant transition for women, representing the termination of the reproductive phase. Although menopause is thought to be a biological process, it also has sociocultural and socio-sexual meanings and consequences. Biologically, menopause is the permanent cessation of menstruation as a result of decreasing hormones levels. To understand menopause, it is necessary to define it medically and socioculturally, including the symptoms associated with it and the cause of those symptoms. Placing the experiences of menopausal women within the medicalized model facilitates an understanding of the challenges with which women are confronted. Last, a review of the social construction of menopause cross-culturally is necessary, as menopause is an archetype of how societal notions of gender and femininity interconnect to form a valuation system of women.
There is no definitive medical definition of menopause. Menopause is diagnosed retrospectively after 12 full months without menstruation. Despite the fact that there is no clear linkage between chronological and reproductive age, most medical professionals still use age as a marker to identify when menopause occurs. In Western countries, doctors place the age of menopause around 50 years, although hormone levels often decline in women in the preceding 8 to 10 years. In general terms, menopause, or climacteric, as it is characterized in medical terminology, occurs when the ovaries become less sensitive and/or resistant to certain hormones, which, in turn, causes a decrease in the production of estrogen. The reduction in hormone levels is categorized in terms of vasomotor (e.g., hot flashes, fatigue), atrophic (e.g., complaints related to urinary and reproductive systems), and psychological or sexual (e.g., breast tenderness, vaginal dryness) symptoms.
It is generally assumed that age of symptom onset is due to a combination of genetics and maternal activity during pregnancy. It is also assumed that the external environment and the female’s behavior have an impact on eventual menopause experience. For instance, smoking and having multiple births (e.g., twins) are associated with significantly earlier menopause, while women who are married, from higher socioeconomic classes, and taking hormone replacements experience menopause later in life. It is unclear how such variables impact the onset of menopause, but clear associations have been demonstrated, and it has been established that late-stage menopause results in increased health risks, such as endometrial and breast cancers. Current research is unable to distinguish between the effects of the aging process and menopausal symptoms. For instance, the fatigue a woman in her 40s or 50s may experience could also be due to taking care of ailing parents, work-related stress, marital difficulties, or children leaving home for college. Menopause occurs during a normally stressful and challenging time in a woman’s life, and any discussion of symptomology should be placed within such a context. Moreover, minimal research has been conducted on how menopause is experienced by lesbians, women of color, low-income women, and women with mental illness. As such, it is important to study menopause from a life span perspective, noting that symptoms vary according to the interaction between biology and sociocultural and sociosexual factors.
Menopause has been medicalized and pathologized in Western countries, leaving women dependent on the medical establishment and the pharmaceutical industry for treatment and relief of symptoms. It is measured in terms of loss of ability, functioning, and role. When women enter midlife and begin to identify vague symptoms, such as fatigue or depression, the response of the medical establishment is to assume the cause is a result of hormone deficiencies. Women are often placed on hormone replacement therapy, which has its own set of risks associated with use in excess of 6-week intervals (e.g., increased rates of cancer), as opposed to being directed to self-help techniques used in other countries. Medical professionals in Western countries contend that without hormone replacement therapy, women are at increased risk for chronic diseases, such as heart disease, osteoporosis, and Alzheimer’s, and will have a lower quality of life. However, there is no research to support the claims that hormone replacement therapy improves quality of life or decreases the likelihood of chronic disease. Several cultural assumptions regarding menopause have permeated the medical establishment in relation to menopause, including the following:
Health is the result of modern medicine and technology, and as such there is an emphasis on prevention and treatment.
The Unites States regards itself as a leader in the medical field and disregards research from other countries that are antithetical to its own research. For instance, low levels of bone factures are associated with hormone replacement therapy, yet Asian and African women do not use hormone replacement therapy and experience lower levels of bone fractures than American women.
Much of the research on menopause is sponsored by the pharmaceutical industry in America and as such is focused on the benefits of drug intervention.
Several research instruments have been developed to measure the quality of life of menopausal women, the assumption being that quality of life decreases as women age and are no longer capable of reproduction. Eight major scales are used by clinicians, researchers, and health care practitioners to identify the impact of symptoms and the effects of hormone replacement therapy on menopausal women. No one instrument is effective in addressing all of the issues, and so many health care practitioners combine the tools. Contrary to research focusing on the negative aspects of menopause, additional research has demonstrated no significant differences between the quality of life for pre- and postmenopausal women in terms of physicality, psychology, or sexuality. Moreover, qualitative research has illustrated that many women regard menopause positively, with an enhanced awareness and acceptance of themselves. This is especially prevalent among some women of color whose cultural experiences have taught them to regard menopause as a natural aging process in which they can behave in less culturally confined ways.
Despite the biological component, menopause is essentially a socially constructed concept. This is evidenced by the various ways in which menopause is experienced globally. Non-Western cultures characterize menopause through the health perspective, whereby it is regarded as a natural physiological process that actually improves the health of women. According to this perspective, because women are no longer ovulating, their bodies no longer require the high level production of hormones necessary during the reproductive years, and the decrease in hormone levels is analogous to hormone reduction between adolescence and adulthood. Non-Western cultures contend that menopausal women are more confident and energetic, as they have shed the responsibilities associated with menstruation, such as childbearing and child rearing. Moreover, many cultures do not even have a term for menopause, and the women transition at an earlier age and experience no symptoms. This is as a result of the valuation that non-Western societies place on aging women, whereby aging bestows increased status, mobility, and freedom from unwanted pregnancies.
In Western countries, menopause is a time in which women often express an experience of discomforting symptoms. Menopause often involves hot flashes, night sweats, distress, fatigue, insomnia, urogenital complaints, changes in the elasticity and appearance of the skin, aching in the joints and muscles, breast tenderness, painful intercourse, and depressive mood swings. In addition, it has been associated with changing bone density and altered immune response. Western cultural values associated with aging and gender tend to frame menopause as a time of decline for women. From this perspective, menopause means women have entered old age, and society regards older women as less attractive, feminine, and functional. Conversely, aging in men tends to be associated with increased masculinity, competence, autonomy, self-control, and power, and older men are considered highly attractive as a result of these qualities. The stereotypical feminine traits of passivity and noncompetitiveness remain stable, and still unvalued, as women age. Aging women must not only contend with ideal standards of appearance and weight that plagued them in younger years but also the added societal condition that they be asexual and matronly.
There is evidence that symptoms women experience with menopause may be attributable to social, as opposed to biological, factors. For instance, lack of sexual desire may be the result of relationship problems or lack of attraction to one’s partner, as opposed to decreasing hormone levels, as estrogen does not increase sexual activity, desire, or satisfaction without being accompanied by psychosocial and psychosexual factors.
In conclusion, it is extremely difficult to disentangle the natural aging process from the hormonal changes associated with menopause. Consequently, when examining menopause, it must be viewed through a life span perspective that takes into account socio-cultural and sociosexual factors alongside biological elements. Moreover, how society socially constructs aging and women’s experiences with menopause are fundamental in a discussion of symptomology. Despite the fact that Western science links menopause with loss of functioning and ability, many women identify the transition as positive in that they are free from the responsibilities associated with having and raising children.
Biological Determinism; Body Image; Health Disparities; Hormone Therapy; Hysterectomy; Women’s Health Movements
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