Menopause and Culture

Gabriella E. Berger

Description

‘An extremely significant contribution to the field of medical sociology ... Menopause is an area which has been somewhat neglected in social science discourse.’ Dr Megan Jennaway, University of Queensland



‘Original ... well argued ... at the cutting edge of the field of sociology and health.’ Dr Mina Roces, University of New South Wales



In Menopause and Culture, Gabriella Berger questions the view of menopause as an estrogen-deficiency disease by examining how other vital influences, such as culture, mediate the menopause transition. Her positive and refreshing approach culminates in a cross-cultural examination of Australian and Filipino women's menopause experiences and concludes in an elegant demonstration of how intricate sociocultural belief systems impact on menopause. Set against a broad review of current and often contradictory literature in the fields of biomedicine, psychiatry, psychology, anthropology and sociology, her findings serve to demystify long-held stereotypical and misogynist views of women as diseased and useless. Menopause is unequivocally more about wellness than illness: this is a book at the cutting edge of medical sociology.
1. Menopause and Medicalisation



2. The Quick-fix Controversy



3. Menopause Across Cultures



4. Conceptualising Culture



5. Physical and Psychological Menopause Experience



6. The Sociocultural Mediation of Menopause



7. Analysing Menopause: A Change for the Better



Glossary



References



Index

Sujets

• Women's Studies
• Social Science
• Sociologie, société et politique
• Australia

Informations

• Publié par: Pluto Press
• Date de parution: 20 mars 1999
• Nombre de lectures: 0
• EAN13: 9781849640503
• Langue: English

Extrait

Gabriella E. Berger

Menopause and Culture

P Pluto Press LONDON • STERLING, VIRGINIA

First published 1999 by Pluto Press 345 Archway Road, London N6 5AA and 22883 Quicksilver Drive, Sterling, VA 20166–2012, USA

Copyright © Gabriella E. Berger 1999

The right of Gabriella E. Berger to be identified as the author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act 1988

British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library

ISBN 0 7453 1488 0 hbk

Library of Congress Cataloging in Publication Data Berger, Gabriella Elfriede, 1961– Menopause and culture/Gabriella Elfriede Berger. p. cm ISBN 0–7453–1488–0 1. Menopause—Cross-cultural studies. 2. Menopause—Social aspects. R6186.B48 1999 618.1'75—dc21 98–

Designed and produced for Pluto Press by Chase Production Services, Chadlington, Oxford, OX7 3LN Typeset from disk by Stanford DTP Services, Northampton Printed in the EC by T.J. International Ltd, Padstow

46899 CIP

Contents

List of Tables List of Figures Preface and Acknowledgements

1 Menopause and Medicalisation

2The Quick-fix Controversy

3 Menopause Across Cultures

4 Conceptualising Culture

5 Physical and Psychological Menopause Experiences

6 The Sociocultural Mediation of Menopause

7 Analysing Menopause: A Change for the Better

Glossary References Index

vi vii viii

19

1

36

48

87

112

164

184 186 207

List of Tables

1.1 The physical menopause experience 1.2The psychological menopause experience 5.1 Australian and Filipino women’s responses to health questions 5.2Comparison of positive and negative items of menopausal change for the Australian and Filipino samples

3 4

89

91

List of Figures

4.1 The major approach in the study of menopause 4.2Conceptualisation of the impact of cultural beliefs on menopause 5.1 Frequency of perceived positive changes during menopause 5.2Frequency of perceived positive changes in the postmenopause 5.3 Three themes underlying menopause experiences 7.1 An overview of culture in relation to other factors at menopause 7.2The impact of cultural beliefs about ageing on menopause experiences

49

49

92

92 98

165

165

Preface and Acknowledgements

This piece of work is assuredly the most lengthy I have undertaken, nearing its completion towards the end of a decade spent mostly in lecture theatres, offices or in front of computers. The fact that I have chosen a topic in women’s health is no accident, as my interest in health issues is a longstanding one spanning from childhood. There was, however, one woman instrumental in changing the direction of my educational endeavours, namely, Professor Helen Hardacre, who first pointed out that I may well want to combine Asian studies (I was preoccupied with Japan and Japanese language at the time) with health in a field called medical anthropology. This was indeed fabulous and new to me and I busily looked up new terms and read my way through the university libraries in an effort to try and understand this fascinating field. My first research project on premenstrual syndrome whetted my appetite and I soon scanned books and journals for another topic located in the ‘grey area’ of female reproduction. Suddenly, there it was – medicine’s preoccupation with menopause and the extensive media coverage concentrating on all types of menopausal woes. Initially I was somewhat flabbergasted by definitions of menopausal women as diseased and deficient, lacking in essential hormones for the remainder of their lives. The combination of menopause and culture that I happened to stumble upon is a unique one and its mechanisms remain for the most part hidden from the popular gaze. For me, the need for cross-cultural menopause research became ever more urgent and, coincidentally, Germaine Greer’s bookThe Change

PREFACE AND ACKNOWLEDGEMENTS/ix

was released on to the Australian market at that time. This well- known author gave numerous newspaper and television interviews but much to my dismay I had a prior engagement and was unable to attend her talk at the Hilton Hotel in Brisbane. However, when I finished the project some years later I did manage to meet her, this time informally, and was able to strike up an interesting discussion. I was also fortunate to speak to Sandra Coney, author ofThe Menopause Industry, when she promoted her new book in Australia. There were hundreds of reasons to keep my imagination and interest alive and hardly a day passed without some reminder about menopause. For five years I have been living, breathing, reading and writing menopause and never reached a point of saturation. In retrospect, the first six months proved to be the most difficult and soul-searching time of my research. Everything that followed did so with natural ease and various pieces of the puzzle seemed just to fall into place with little effort on my part. I consider these years as a time of intense learning, trial and tribulation that tested my endurance as never before. Especially when I gave birth near term to triplet daughters prior to analysing and writing up my data, I was left wondering just how and if ever I would manage to complete my work. Organisation became a key ingredient in my daily routine and periods that allowed for long stretches of concentration were secured whenever the babies slept or played. Looking back I now feel privileged by having been able to achieve my goals, professionally and privately, and regard my life since as particularly rewarding. Over the years I have been fortunate in receiving the encouragement and assistance of a number of people without whom this project would not have been possible. The many Filipino and Australian women who recounted their experiences in a frank manner, especially when sharing personal details, is much appreciated. The body of knowledge derived from this is entirely due to their much valued contributions. Various members of my in-laws in Manila, most notably Mrs Julita Uichanco, I thank for their many introductions to female friends and relatives and assistance with various tasks such as making me familiar with the complicated public transport system (jeepneys and buses) and photocopying. In Brisbane, my dear friend Mrs Maria Pizziolo secured me many private talks with women and for this I am indebted. Ms Carol Cragg from The Women’s Health Centre, Spring Hill, was generous in allowing me to observe and participate in her menopause workshops and recruit women for my focus-group discussions. I would also like

x/MENOPAUSE AND CULTURE

to thank the women from the Older Women’s Network (OWN) in Brisbane who agreed to take part in my research project. For their continuing efforts in terms of constructive criticism and helpful suggestions, Dr Cordia Chu and Dr Eberhard Wenzel, Faculty of Environmental Science, Griffith University, must be thanked wholeheartedly. The element of supervision was crucial for me to be able to press ahead speedily, ensure appropriate progress and break the relative isolation in which I worked on a daily basis over many years. My family deserves special mention. My husband, Dr Angelo Uichanco, has been supportive and understanding regarding my needs during this time and encouraged me along the way. In August 1995, having collected my fieldwork data in Manila, I gave birth to my three daughters, Amber Sofia, Laura Hannah and Evelyne Rose, and they represented an additional challenge. Due to their calm and content disposition, I was able to continue working every morning and afternoon while they either slept or played in my child-proof study. The many hours I deprived all of them of my company have been made up for in lengthy seaside holidays during the autumn months. This book is dedicated to the memory of my grandmother, Sofie, a woman without equal, so full of goodness and love, whose menopause experience we may never learn about.

1

Menopause and Medicalisation

As we are approaching the third millennium, menopause, defined as the cessation of menstruation, has remained of primary concern in the field of women’s health. This topical issue has attracted the attention of health professionals and the lay public alike, with ever more books, research papers and articles in newspapers and journals publishing yet further evidence of often contradictory findings. Betty Friedan (1993, pp. 472–99) writes about ‘the new menopause brouhaha’ which seems to be intensifying at a time when fifty million women worldwide are hitting menopausal age. The Australian feminist Germaine Greer (1991) entitled her well-known bookThe Change: Women, Ageing and the Menopauseand delivered her perspective of this new ‘disease’ that affects half the world’s population. Menopause societies have sprung up like mushrooms on a wet spring morning to hold regular conferences to debate various aspects of the physical experience and to suggest appropriate treatment. Pharmaceutical companies, who are overly well 1 represented at conferences, are competing over the lion’s share of an ever-expanding market of prospective hormone replacement therapy users, not only in developed but also in developing countries. The marketing of menopause is not merely a fancy whim. One needs to consider the following facts. The majority of women tend to experience

1 My general practitioner told me that at a recent conference the area occupied by attendees was considerably smaller than the amount of advertising space taken up by companies offering their many products and generous giveaways. As I have found out personally, the presence of pharmaceutical companies cannot be overlooked at such gatherings. I have attended menopause conferences not only in Australia but also in the Philippines and received many free gifts, as did everyone else present.

2/MENOPAUSE AND CULTURE

their menopause around the age of 50 (Belchetz 1990). Increases in life expectancy mean that in Western countries more so than elsewhere women can now expect to live longer than ever before; this provides most women with the opportunity to live about one-third of their life past childbearing age in the postmenopause (McKinlayet al. 1992, p. 103). The reproductive lifespan now equals the non-reproductive lifespan in length. As the proportion of older women, together with life expectancy, continues to rise, spiralling healthcare costs associated with menopause treatment and ongoing check-ups can be expected (MacLennan 1988). With forecasts of a ‘greying’ of the population said to not only affect populations living in affluent Western but also in poorer Asian countries, the potential market share is ever expanding (Davis and George 1990; Hooyman and Kiyak 1991). According to various writings in the medical literature, physical and psychological discomforts affect up to 80 per cent of women approaching the end of reproduction and most commonly exert a negative impact on physical and mental health (Walsh and Schiff 1990). This transition is said to have such a detrimental effect on women’s wellbeing that medical treatment in the form of hormone replacement therapy (HRT) or estrogen replacement therapy (ERT), often lifelong, has been recommended (Barrett-Connor 1993).

PHYSICAL DISCOMFORTS

Historically, a woman’s experience of her menopause has not been the concern of the medical profession as women usually passed through this transition without the need for intervention. However, recent research seems to contradict such long-held views and suggests that this phase is more concerned with pathology than normality. Suddenly, a myriad of signs or ‘symptoms’ have been linked to menopause, primarily in women of Western cultures. The aches and pains which have been attributed to the menopause at one time or another embrace every body system: vasomotor, cardiovascular, metabolic, sensory, digestive, skeletal, muscular, glandular and central nervous. Investigators have listed arthralgia (pain in joints), headaches, vaginal dryness, dysuria (painful urinary discharge), dyspareunia (painful sexual intercourse), hot flushes, night sweats, palpitations and paresthesia (tingling skin) as the most common physical problems (Frey 1982; Voda and Eliasson 1983; de Aloysioet al. 1989; Kadri 1990;