Pre-Collegiate Global Health Review
Menopause: Understanding the Implications of Society and Culture
Saanvi Gupta, Downingtown High School East Campus, Exton, Pennsylvania, USA
Each year, over 25 million women globally pass menopause, twelve months after a woman’s last menstrual cycle. Pressures from different societies and cultures have an influence over the menopausal experience and symptoms. Numerous studies reveal how women living in environments that negatively perceive menopause experience stronger physical and mental symptoms. Whereas non-western countries believe that menopause is a beautiful time of change, western countries generally associate menopause with aging and loss of sexual vitality. Such negative outlooks can detrimentally affect women, especially in a time when they are most vulnerable to mental health conditions, including anxiety and depression. Although non-western countries positively regard menopause, there is a reluctance to seek medical treatment for menopausal symptoms due to factors such as limited access to healthcare infrastructure and uneasiness to speak openly about women’s health. It is crucial to create an atmosphere for women to feel safe to voice their concerns and for others to provide the necessary support. Menopause is a fascinating period of change, so no woman should feel ashamed because of it.
Menopause, defined as a complete twelve months after a woman’s last menstrual cycle, is a time when women face another period of change to their bodies and their mental health (Mayo Clinic, 2020). In many cases, the added pressure of societal and cultural stigma surrounding the change can make menopause an extremely difficult time for women.
This transitional period can last almost twenty years; the female body takes eight to ten years in preparation for menopause (perimenopause) and can experience menopausal symptoms ten years after the occurrence of menopause (postmenopause). During all three stages - perimenopause, menopause, and postmenopause - a woman’s hormonal level of estrogen and progesterone continues to drop, most significantly during menopause, as shown in Figure 1. At this point, a woman will experience the strongest physical and psychological symptoms, occurring typically at the age of 51 for women in the United States (Cleveland Clinic, 2019).
Figure 1. The above graph depicts hormonal levels and symptoms in relation to age and menopausal stage (Cleveland Clinic, 2019).
Such hormonal fluctuations and shifts can leave women particularly vulnerable to mental health issues, including anxiety, depression, and major depressive disorder. Statistically speaking, a woman has twice the chance of developing depression during her menopausal years and an even higher chance if she has a history of mental health conditions (North American Menopause Society, n.d.). Mental health issues, exacerbated by grueling physical symptoms, can take a toll on women and their health.
Although women globally go through menopause, there is still a stigma. Especially in western countries, this stigma can quickly deteriorate a woman’s mental health. Menopause can be negatively perceived as a time when a woman truly starts to age, losing her fertility and sexual vitality (Rabin, 2020). Such societal outlooks lead to menopause rarely being discussed, which can become problematic when women feel ashamed of their symptoms and feel the need to hide them. Even within families, women can feel isolated when they believe that no one understands what they are going through and when family members do not provide support. If women have trouble coping with these feelings during menopause, they become more susceptible to mental health issues, especially anxiety and depression (Holland, 2020).
However, it is important to note that most physical symptoms, such as vaginal dryness and hot flashes, and mental symptoms, such as anxiety and depression, can be treated if a woman consults a medical specialist early (Rabin, 2020). Nevertheless, the stigma in many parts of the world hinders women from doing so. In fact, as seen in a study focusing on menopausal symptoms in Asia, Asian women were reluctant to find help and treatment due to the conservative nature of Asian cultures (Shorey & Esperanza, 2019). Limited access to healthcare infrastructure and hesitation in speaking about women’s health are limitations that hinder Asian women from finding necessary treatment.
Yet, menopausal symptoms are not universal to all women; instead, as observed in numerous studies, symptoms are strongly influenced by the cultural environment in which a woman lives (Jones et al., 2012). Dr. Mary Jane Minkin, an obstetrician and gynecologist at Yale Medical School, explains how women from cultures that perceive menopause positively experience fewer and less painful symptoms than women from cultures that associate menopause with aging (Rapaport, 2015). Although there is hesitancy in asking for treatment, many Asian cultures, such as that of India, do not negatively think of menopause. Menopause is often viewed as a time of freedom when women can show their sexuality. Moreover, in contrast to many western cultures, menopause does not affect social standing; for example, in South Asia, motherhood is valued more than biological fertility itself (Avis & Crawford, 2007). Despite the overall cultural barrier for Asians to gain proper treatment, menopause is still a celebratory experience for Asian women which allows for less distressing symptoms. Furthermore, women in countries such as Sweden, Denmark, and Norway, positively view aging and, similarly, menopause. In these countries, women experience fewer unpleasant effects and report that the menopausal experience was better than they expected (Rapaport, 2015). Not only does an optimistic environment allow women to feel more comfortable when their menstrual cycles come to an end, but it also correlates to an easier menopause.
Menopause and menopausal symptoms are evidently tied to a woman’s cultural environment. When part of an unhealthy atmosphere, women feel guilty and ashamed for experiencing a natural, biological process, leading to a heightening of both their physical and mental symptoms. Families and social groups should not neglect a woman’s symptoms and should instead provide the necessary compassion and comfort. There should be no underlying stigma equating menopause to aging or disease. Instead, menopause is and should be a time of celebration and development for all women. While global movements, such as PERIOD and Days for Girls focused on menstrual activism, are making progress to normalize taboo surrounding women’s health, we, as a society, need to create a haven for women to openly discuss the changes occurring to their bodies, especially concerning menopause.
Avis, N., & Crawford, S. (2007). Cultural differences in symptoms and attitudes toward menopause. Menopause Management. https://www.menopausemgmt.com/cultural-differences-in-symptoms-and-attitudes-toward-menopause/
Cleveland Clinic. (2019, December 24). Menopause, perimenopause, and postmenopause. Cleveland Clinic. Retrieved September 5, 2021, from https://my.clevelandclinic.org/health/diseases/15224-menopause-perimenopause-and-postmenopause
Holland, K. (2020, August 12). Mental health, depression, and menopause. Healthline. Retrieved September 16, 2021, from https://www.healthline.com/health/menopause/mental-health
Jones, E., Jurgenson, J., Katzenellenbogen, J., & Thompson, S. (2012). Menopause and the influence of culture: Another gap for indigenous Australian women? BMC Women's Health, 12(43). https://doi.org/10.1186/1472-6874-12-43
Mayo Clinic. (2020, October 14). Menopause. Mayo Clinic. Retrieved September 1, 2021, from https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397
North American Menopause Society. (n.d.). Depression & menopause. Retrieved September 7, 2021, from https://www.menopause.org/for-women/menopauseflashes/mental-health-at-menopause/depression-menopause
Rabin, J. (2020). Women have been shamed and stigmatized over menopause for years. Northwell Health. Retrieved September 14, 2021, from https://www.northwell.edu/katz-institute-for-womens-health/articles/women-stigmatized-over-menopause
Rapaport, L. (2015, June 5). Culture may influence how women experience menopause. Reuters. Retrieved September 27, 2021, from https://www.reuters.com/article/us-health-menopause-perceptions/culture-may-influence-how-women-experience-menopause-idUSKBN0OL1XH20150605
Shorey, S., & Esperanza. (2019). The experiences and needs of Asian women experiencing menopausal symptoms: A meta-synthesis. The Journal of the North American Menopause Society, 26(5). https://doi.org/10.1097/GME.0000000000001269
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