My thoughts on Menopause

There are three questions driving my interest in menopause:
Why did menopause evolve?
Why do some women experience menopause at forty-two, while others cycle like clockwork to the age of fifty-eight?
Why does menopause pass unnoticed for some women, while others suffer from unrelenting hot flashes?

Oh! sorry. Its not over I got some other 'SERIOUS' questions too;
Why do human females close down childbearing long before the end of life, while most chimpanzees reproduce until shortly before death?
Why didn’t my mother have any hot flashes, while other women remove strategic layers of clothing and visibly sweat?

Bring up the topic of menopause, and I’m more than happy to contribute curious observations, interesting hypotheses, and leaps of biological faith. Yet there are so many questions that I can’t answer. Friends and colleagues at work ask, “I can’t remember names anymore. Is that menopause?” “My left arm goes numb. Is that menopause?” “I want to have sex twice a day. Is that menopause?” “I’m more depressed than I have ever been. Is that menopause?”

Variation in age at menopause and in symptom experience can be understood
at the level of the population by combining a familiarity with biology with observations of cultural difference. I have summarized much of what is known across a wide variety of populations, including those that are most familiar to me: upstate New York (where women talk about menopause as something natural, ordained by God), western Massachusetts
(where women proactively smear themselves with yam cream and eat blue-green algae for menopausal health), Puebla, Mexico (where marital stress is a constant topic of concern among women of menopausal age), the Selsa ka Valley, Slovenia (where menopause is an uncomfortable, taboo topic of conversation), and Asunción, Paraguay (where some women describe menopause as un alivio, a relief, but others volunteer the word desesparación, despair, as a menopausal symptom).

I focus on menopause both as a onetime event, the last menstrual period, and as an ongoing process, the transition from pre- to postreproductive life. These two points of view—event and process—reflect different approaches to the study of menopause, and both are necessary. I also examine the evolution and contemporary experience of menopause in a particular way—from a biocultural perspective.

“Oh, this must be menopause.”

We talk about the onset of menopause in various ways. Many cite the first time their menstrual period failed to make its regular appearance. Others describe the first time they threw off the blankets in the middle of the night. Some women complain of menstrual periods that flood more and more heavily each month; others encounter dusty, unused tampons in a bathroom cabinet. Although many women in the United States disdain the fuss made about menopause in the popular press, resent having to seek treatment for hot flashes, and dislike being reminded that the process of aging is marching forward, every woman who lives to sixty years of age with her uterus and ovaries intact is compelled, at one time or another, to say, “Oh, this must be menopause.”

In general, ovarian biology is experienced as down there somewhere, internal, private, seemingly immutable. Women tell me that menopause is “out of our control,” “natural,” “biological.” It is all of those things. Menopause—technically, the last menstrual period—is also a cultural phenomenon, “a time of despair,” “a new phase of life.” Culture, generally unacknowledged, alters the experience of menopause, the recognition of menopause, the timing of menopause, and the symptoms attributed to menopause. Culture is public, shared, and created. Culture is made visible in medical interventions, attitudes about aging, birth control policy, indications for hysterectomy, smoking practices, food resources, diet preferences, marital norms, breastfeeding customs, and timing of motherhood. All of these aspects of culture influence biology and contribute to variation in the age and individual experience of menopause.