Menopause: What's Culture Got to Do With It?

11/02/2017 05:12 pm ET

Patricia Whelehan, Contributor

Patricia Whelehan, PhD, CST/CAC, is an emerita professor in the SUNY system and a certified sex therapist with AASECT, a certified sex therapist, mentor and clinical supervisor with the ABS and a certified HIV test counselor in CA and NY

Anne Bolin, Contributor

Emerita Professor of Anthropology, Dept of Sociology and Anthropology, Elon University

Introduction

Menopause is more than a physiological phenomenon. It is steeped in cultural meaning and articulated with our evolutionary past. This entry and future entries are shaped by your authors’ training as anthropologists. As we have stated in our first blog” Sexuality and Women over 50: Women and Aging “ sexuality-and-women-over-50-women-and-aging_us_594c3d6ce4b0f078efd9801b-o4l, we believe we bring a unique lens to this topic not shared by other disciplines and one not known more widely outside of academia. We are both “Boomer” women, retired university professors of anthropology. We devoted our careers to sexuality issues especially as those impacting women. We will use cross-cultural, comparative, and evolutionary data to show how many societies, in contrast to ours, embrace sexuality in women over 50. We will apply this perspective to specific topics concerning women over 50 in the US. Here we are concerned with menopause as a bio-cultural phenomenon. Humans are unique in that our biological evolution is closely tied to interaction with culture, and thus has huge implications for understanding menopause.

Why Menopause?: “Why do human females, and even higher primate females, live for an extended period of time after their reproductive lives are over?¹

As with much anthropological research, there are controversies and multiple explanations as to why human and higher primate females experience menopause and live for an extended period of time after it occurs. While there are numerous explanations including the argument that menopause is a “by-product of the longer life span in general for humans, we feel the most compelling evidence supports the Grandmother hypothesis which we explained in our entry on Aging (Blaffer-Hrdy 1999; Fadigan and Parelka 2015: 781-782). Briefly, the Grandmother hypothesis argues that there is an evolutionary benefit to having post-menopausal women survive well past menopause due to the vital socio-cultural roles that they fill in their societies. As Fedigan and Pavilla (2015) discuss, older females provide extremely important additional roles to that of mothers, including childrearing and caring. They also fill other fundamental roles as healers and political leaders which are often denied to younger women.

Menopause Bio-culturally

As a bio-cultural stage in the human life cycle, menopause is a perfect/ideal topic to exemplify the interplay of a biological process (menopause) with the socio-cultural and structural responses and meanings societies attribute to it. Menopause is an evolutionary old process as testified by its universality for human females and by some evidence that our closest living relatives, female chimps, also experience menopause (Blaffer-Hrdy 1999). There are finite universal physical manifestations of menopause for human females which include the following:

  • Menopause is a process that lasts several years, generally occurring between 45-55 years of age.
  • As a multi-year process, women are assumed to be fertile until 1 year after their last menstrual period or LMP). To avoid pregnancy, the use of effective, culturally-acceptable, birth control is recommended during this time. In the US, if a pregnancy occurs during this time it is often referred to as a “change of life baby.”
  • Fertility ends.
  • Due to a decrease in estrogen which maintains the vaginal walls and mucosa, thinning and drying of the vagina occurs (Northrup 1998; Crocetti 2015).

These are the only universal biologic aspects of menopause, and these changes are also structured and responded to by societal norms, beliefs, and values which influence how women in various cultures experience menopause and its changes.

Other physical events commonly ascribed to menopausal women in the US such as vasomotor changes (referred to as hot flashes, night sweats and flushes), osteoporosis, weight gain and reduction in muscle mass; and lack of interest in or enjoyment of sexual relations or painful vaginal sexual activity are neither universal across societies or even within the U.S. The mainstream U.S. perspective reflects larger societal views and beliefs that menopause is a period of “decline,” which is structured and reinforced by bio-medicine, Big Pharma, and the beauty industries.

The bio-medical narrative is one that menopause is a “degenerative process and a deficiency disease” that needs to be managed by the multi-billion dollar pharmaceutical companies and anti-aging vendors. Physician Christiane Northrup found that in the U.S., “15% of women are symptom free; 85% of women have hot flashes, of which 50% find them tolerable (Northrup 1998: 518, 525). While controversy exists about how to “manage menopause” bio-medically in the U.S., the current recommendation is to take the minimum amount of HRT (hormone replacement therapy) for the shortest period of time to address symptoms that are viewed as problematic or uncomfortable (NWHN 2015; Crocetti 2015; Utz and Nordmeyer 2015). A 2017 study by Manson et al., of more than 27,000 women followed over an 18-year period indicates that this treatment approach is medically safe for those who choose HRT.

Menopause in Socio-Cultural Context: How do Women in Cultures Outside the U.S. Experience Menopause?

Margaret Lock (1993) and Yewoubdar Beyene (1989) are two anthropologists who have conducted extensive research on the bio-cultural aspects of menopause cross-culturally. Lock, a pioneer of studying menopause anthropologically, worked with Japanese women in Japan as well as emigres to the U.S., and then with their offspring and succeeding generations. Lock’s research with Japanese women through time, space and generations found that the women in Japan and emigrant women to the U.S. did not experience hot flashes. However, as succeeding generations became more adapted to a mainstream U.S. diet and activity level, so did their experience of hot flashes and other menopausal symptoms. The changes in diet and mobility patterns contributed to this phenomenon.

Beyene’s (1989) seminal menopausal research was with peasant Mayan and Greek women. These women lived in rural and rather rugged terrain. Their daily activities provided them with both aerobic and weight bearing activities and their diets were rich in unrefined carbohydrates, dark green produce, and minimal animal protein. They did not experience either hot flashes or osteoporosis. These examples illustrate how culture can mediate biology.

Larger societal attitudes and norms concerning women’s roles, worth, contributions, and sexuality generally and as they age has an effect on how women experience menopause since it is through our cultural lens that we make sense and meaning of menopause.

These factors vary widely within and across cultures and over time. It has also been impacted by both colonization and more recently, globalization. As we suggested earlier in this essay, the U.S. has an overall negative view of aging, which bleeds over into attitudes about women’s sexuality, attractiveness, and usefulness. Ironically, a truly sex-positive society (one in which consensual and pleasurable sexuality is affirmed), would value post-menopausal heterosexual women’s sexuality since there is no threat or concern about pregnancy, only pleasure. However, the “youth centered” focus on beauty; as well as the health and cosmetic industries’ market for anti-aging products and Big Pharma’s push for HRT, and the sexual double standard that still accepts older men partnered with younger women more than older women partnered with younger men, contradicts this sex positive approach. These attitudes and behaviors result in a rather sex negative or ambiguous approach to women’s aging and sex in the US.

Menopause and post-menopause do not necessarily correlate with either a lack of interest or desire for sex, or a reduction in pleasure and orgasm regardless of a women’s sexual identity or orientation or what constitutes as “sex” for them. What seem to be greater issues for post-menopausal women regarding their expression of and interest in sexuality are the quality of their primary relationship and the presence of a partner; their overall health, stress, and the varied care-taking roles many women find themselves in (Fisher et. al 2010; Sivert 2015).

Cross-culturally the research on the roles and statuses of menopausal women varies not only by indigenous views on aging, including sexuality, but on the effect of culture change, most recently globalization and access to the world wide web where available. At one extreme, the Inis Baeg (fictional name) off the coast of Ireland believe post-menopausal women have mental health issues and are often secluded (Messenger 1971 in Bolin and Whelehan 2009). In foraging societies, in contrast, women’s status can increase and they can experience more social and sexual freedom as well as take on new leadership roles, politically, religiously and as healers. (Brown and Kerns 1985). In fact, Lee (1985:30) noted a marriage pattern of older women with younger men among the !Kung occurring in about 20% of the marriages. The Kgatla in Botswana, for example, believe menopausal women are at the height of their knowledge and competence (Bolin and Whelehan 2009). Colonization and globalization impact menopausal women in a non-linear fashion. Women who have been more “westernized” and who live in more urban areas tend to report having more freedom and more positive attitudes towards the loss of fertility. Their less “westernized” peers in the countryside experience the loss of fertility as a decrease in status (Utz and Nordmeyer 2015).

Even in the U.S. there is a difference between the openness to discuss menopause in all of its ramifications, not only among different ethnic groups, but generations as well. Boomer women and the older GenExers who are on the threshold of menopause are showing a more “take charge” approach to menopause than their mothers and grandmothers did who experienced “the change,” with little overt discussion of it. This applies to sexuality concerns as well which will be our next BLOG topic.

In conclusion, menopause and its symptoms vary a great deal globally and through time. While often seen as primarily a biological event in the U.S., menopause is rather a complex life cycle stage which involves the intersection of biology and culture. Culture has been discussed as a powerful lens which can impact menopause and its expression as well as the experience of menopause.

References Cited:

Beyene, Yewoubdar. 1989. From Menarche to Menopause: Reproductive Lives of Peasant Women in Two Cultures. Albany: State University of New York Press.

Blaffer-Hrdy, Sarah. Mother Nature. Maternal Instincts and How They Shape The Human Species. Ballantine Books, New York.

Bolin, Anne, and Patricia Whelehan. 2009. Human Sexuality. Biological, Psychological, and Cultural Perspectives. Routledge, New York.

Brown, Judith and Virginia Kerns. 1985. In Her Prime. A New View of Middle-aged Women. Bergen and Garvey, Publishers. South Hadley, MA.

Crocetti, Daniela. 2015. “Hormone Replacement Therapy.” In The International Encylcopedia of Human Sexuality. v. II. Wiley, London, pp. 560-564.

Fedigan, Linda Marie, and Mary S.M. Pavelka. 2015. Menopause (primates) in The International Encyclopedia of Human Sexuality. Anne Bolin and Patricia Whelehan (eds.), Wiley, London, pp 781-783.

Fisher, Linda, L., Amishi Takalkar. 2010. “Sex, Romance, and Relationships. AARP Survey of Midlife and Older Adults.” May 2010. AARP. Washington, D.C. https://assets.aarp.org/rgcenter/general/srr_09.pdf, Accessed, October 2, 2017.

Lee, Richard 1985. “Work, Sexuality and Aging Among !Kung Women. “In In Her Prime. K Brown and V Kerns, eds. South Hadley, MA:Bergin and Garvey Pub.

Lock, Margaret. 1993 Encounters with Aging: Mythologies of Menopause in Japan and North America. Berkeley: University of California Press.

Manson JE1, Aragaki AK2, Rossouw JE3, Anderson GL2, Prentice RL2, LaCroix AZ4, Chlebowski RT5,6, Howard BV7,8, Thomson CA9, Margolis KL10, Lewis CE11, Stefanick ML12, Jackson RD13, Johnson KC14, Martin LW15, Shumaker SA16, Espeland MA17, Wactawski-Wende J18; WHI Investigators. 2017. “Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women's Health Initiative Randomized Trials.” JAMA. 2017 Sep 12;318(10):927-938. doi: 10.1001/jama.2017.11217, accessed September 23, 2017.

Messenger, John C. 1971 “Sex and Repression in an Irish Folk Community.” In Human Sexual Behavior. D S Marshall and R C Suggs, eds. New York,NY: Basic Books.

NHWN (National Women’s Health Network. 2015. “Hysterectomy.” https://.www.nwhm.org/hysterectomy. Accessed, September 5, 2017.

Northrup, Christianne. 1998. Women’s Bodies. Women’s Wisdom. New York: Bantam Books.

Sivert, Lynette Leidy. 2015. “Menopause. Evolution.” In The International Encylcopedia of Human Sexuality. v. II. Wiley, London: pp. 777-781.

Utz, Rebecca L., and Kristjean Nordmeyer. 2015. “Menopause.” In The International Encylcopedia of Human Sexuality. v. II. Wiley, London: pp. 774-777.

Notes:

1This entry addresses “natural menopause.” It does not refer to the bio-cultural experiences of women who have hysterectomies [surgical menopause], the second most common surgical procedure in the U.S. after Cesarean Sections (NWHN 2015), or the hormonal and/or surgical transformations which occur with trans individuals who opt for biomedical intervention. Gender will be a separate topic in this BLOG series.

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