Menopause a Menopause a cultural cultural

psychological psychological perspectiveperspective

Dr. Neeru Sharma,Asso ProfDr. Neeru Sharma,Asso ProfRoyal Gupta,Research ScholarRoyal Gupta,Research Scholar

Deptt of Home ScienceDeptt of Home ScienceUniversity of JammuUniversity of Jammu

JammuJammuneerusha@gmail.comneerusha@gmail.com

IntroductionIntroduction

• Middle age development marked by Middle age development marked by change in reproductive erachange in reproductive era

• Loss of periods known as MenopauseLoss of periods known as Menopause• Defined as the cessation of mensesDefined as the cessation of menses• A biological process shaped by social, A biological process shaped by social,

cultural, economic and political cultural, economic and political considerations particularly in traditional considerations particularly in traditional societies like Indiasocieties like India

• Accompanied by other changes like loss of Accompanied by other changes like loss of parents, empty nest syndrome etc, much parents, empty nest syndrome etc, much more evident in the western culturesmore evident in the western cultures

• For women it is a status shift.For women it is a status shift.

• Living through menopause is a new Living through menopause is a new phenomenonphenomenon

• Average life expectancy of the women has Average life expectancy of the women has increased to 78 years of age whereas in the increased to 78 years of age whereas in the 1919thth century it was 50 years. century it was 50 years.

• It was considered as a transition to old ageIt was considered as a transition to old age• Menopausal age in India is about 45 yearsMenopausal age in India is about 45 years• It indicates that the ovaries have become It indicates that the ovaries have become

refractory to stimulation by the hormone refractory to stimulation by the hormone from the anterior of the pituitary gland and a from the anterior of the pituitary gland and a waning of steroid hormone production below waning of steroid hormone production below the threshold level necessary to endometrial the threshold level necessary to endometrial function. function.

• Changes during this period are complicated Changes during this period are complicated by natural effects of aging and changes in life by natural effects of aging and changes in life situationsituation

• Menopause should not be viewed as a Menopause should not be viewed as a negative experience by the womennegative experience by the women

• Gynecologists reveal an increase in problems Gynecologists reveal an increase in problems related to menopause as women are not related to menopause as women are not aware of the process and stages of aware of the process and stages of menopause or symptoms that are result of menopause or symptoms that are result of hormonal imbalancehormonal imbalance

• They attribute such changes to causes such They attribute such changes to causes such as weakness, hypertension and ageingas weakness, hypertension and ageing

• Lack scientific knowledge about itLack scientific knowledge about it

Cultural Aspect Cultural Aspect

• The social construction of menopause as the The social construction of menopause as the entry point to old age represents a entry point to old age represents a challenging ,often difficult, timechallenging ,often difficult, time

• Women start perceiving themselves as less Women start perceiving themselves as less attractive and less fully functioning because of attractive and less fully functioning because of the end of reproductive periodthe end of reproductive period

• This happens more so in the western societies as This happens more so in the western societies as menopause is associated with loss of youth, menopause is associated with loss of youth, fertility, libido, health, hormones, feminity and fertility, libido, health, hormones, feminity and calciumcalcium

• Symptoms across cultures are poorly documentedSymptoms across cultures are poorly documented• For western women it is an exhaustible topic of For western women it is an exhaustible topic of

medical literaturemedical literature

Indian ConceptIndian Concept

• Prime quality of a woman is her Prime quality of a woman is her purity( virginity)purity( virginity)

• Her identity merged with the identity of Her identity merged with the identity of the familythe family

• Rituals performed during monthly periods Rituals performed during monthly periods due to beliefs of purity and prohibitiondue to beliefs of purity and prohibition

• The flow of blood associated with dirtThe flow of blood associated with dirt• Restrictions imposed on her during these Restrictions imposed on her during these

periods which are considered “dirty”periods which are considered “dirty”

• Menopause marks ending of this dirty Menopause marks ending of this dirty flow and a return to the pure selfflow and a return to the pure self

• Behavior at this phase is strongly Behavior at this phase is strongly influenced by norms of asceticism influenced by norms of asceticism (sanyas), non involvement and freedom (sanyas), non involvement and freedom from passionsfrom passions

• Menopause is eagerly awaited in cultures Menopause is eagerly awaited in cultures in which women gain higher social status in which women gain higher social status following menopause such as Indiafollowing menopause such as India

• Vasomotor InstabilityVasomotor Instability

. Marked by hot flush an uncomfortable . Marked by hot flush an uncomfortable feeling of the heat that usually subsides feeling of the heat that usually subsides within few minuteswithin few minutes

. Can be accompanied by tachycardia and . Can be accompanied by tachycardia and palpitationspalpitations

. They may be disturbed by night sweats . They may be disturbed by night sweats causing sleep disturbancecausing sleep disturbance

.Sleep difficulties may result in fatigue, .Sleep difficulties may result in fatigue, irritability and lack of concentrationirritability and lack of concentration

Symptoms associated with Symptoms associated with menopausemenopause

• Changes in menstrual patternChanges in menstrual pattern. Occurs in 90% women during 4 years of . Occurs in 90% women during 4 years of transition prior to menopausetransition prior to menopause. Bleeding can be irregular, heavy or . Bleeding can be irregular, heavy or prolongedprolonged.Often due to excess stimulation of the .Often due to excess stimulation of the endometrium( uterine lining) by estrogen endometrium( uterine lining) by estrogen and lack of progesterone to balance this and lack of progesterone to balance this .A doctor needs to be consulted to check .A doctor needs to be consulted to check for the growth of endometriumfor the growth of endometrium

• Psychological/cognitive DisturbancesPsychological/cognitive Disturbances. including depression, irritability and other . including depression, irritability and other mood changes, poor concentration and mood changes, poor concentration and forgetfulnessforgetfulness. This is the time for many life shifts like change . This is the time for many life shifts like change in sexual functioning, change in husband’s in sexual functioning, change in husband’s attitude, recognition that many of life’s attitude, recognition that many of life’s expectations may not be fulfilled, a fear of not expectations may not be fulfilled, a fear of not being needed ,and that of old age and infirmitybeing needed ,and that of old age and infirmity

The causes are more of psychological than The causes are more of psychological than physiological and may require psychological physiological and may require psychological interventionintervention

• Sexual DifficultiesSexual Difficulties

.Estrogen levels may decline leading to .Estrogen levels may decline leading to sexual difficultiessexual difficulties

. This may cause tension in spousal . This may cause tension in spousal relationshipsrelationships

. Counseling may be required . Counseling may be required regarding the normal progression of regarding the normal progression of these changes as women attribute such these changes as women attribute such changes to interpersonal reasonschanges to interpersonal reasons

• Somatic SymptomsSomatic Symptoms

.Estrogen access can cause fluid retention in .Estrogen access can cause fluid retention in the body making one feel bloatedthe body making one feel bloated

. It can cause breast tenderness, insomnia, . It can cause breast tenderness, insomnia, anxiety, palpitation and dizzinessanxiety, palpitation and dizziness

. It has a stimulant effect on brain causing . It has a stimulant effect on brain causing irritabilityirritability

. Osteoporosis may also result from estrogen . Osteoporosis may also result from estrogen statusstatus

• Cardiovascular ChangesCardiovascular Changes

. Pre menopausal women taking . Pre menopausal women taking estrogen replacement therapy have estrogen replacement therapy have less than one-half the risk of strokeless than one-half the risk of stroke

. Screening of risk factors is . Screening of risk factors is required and life style change may required and life style change may be recommendedbe recommended

Management of Management of MenopauseMenopause

• Use of both Hormone replacement therapy Use of both Hormone replacement therapy and psychotherapy, individually or together, and psychotherapy, individually or together, as may be required or recommended by as may be required or recommended by specialstsspecialsts

• Psychotherapy may be required where Psychotherapy may be required where physical symptoms are not relieved by physical symptoms are not relieved by estrogenestrogen

• It may also be required to help her adapt to It may also be required to help her adapt to physiological changesphysiological changes

• HRT is required for all symptomsHRT is required for all symptoms• Form and dose of estrogen and progesterone Form and dose of estrogen and progesterone

may vary according to circumstancesmay vary according to circumstances

• Dietary modifications will also be requiredDietary modifications will also be required• Obesity should be avoided Obesity should be avoided • Avoiding beverages and spicy foods also Avoiding beverages and spicy foods also

helphelp• High protein low carbohydrate diet , soft High protein low carbohydrate diet , soft

drinks and snack foods increase dietary drinks and snack foods increase dietary phosphate at the expense of calciumphosphate at the expense of calcium

• A regular exercise program can prevent A regular exercise program can prevent and minimize many of these problems and minimize many of these problems

• A lot of help from the family is required to A lot of help from the family is required to understand and help the women in this phaseunderstand and help the women in this phase

• Their irritability , mood swings , cognitive Their irritability , mood swings , cognitive functioning are not to be laughed at or argued functioning are not to be laughed at or argued withwith

• Give her peace of mind and reassure her that Give her peace of mind and reassure her that she is still wanted and desiredshe is still wanted and desired

• Encourage regular visits to doctor and proper Encourage regular visits to doctor and proper treatment if any complications arisetreatment if any complications arise

• Women have a tendency to overlook their Women have a tendency to overlook their problems so as a family we have to encourage problems so as a family we have to encourage her to share her fears and discomforts so that her to share her fears and discomforts so that she may be relieved of themshe may be relieved of them

• Urban and Rural health agencies too should have Urban and Rural health agencies too should have some policies regarding this some policies regarding this

• Till now they are catering more to the needs of the Till now they are catering more to the needs of the women in the reproductive period i.e. 15-45 yearswomen in the reproductive period i.e. 15-45 years

• The aged population will reach 177million in 2025 The aged population will reach 177million in 2025 and 84.96 million of them are expected to be women and 84.96 million of them are expected to be women who are also expected to outlive males who are also expected to outlive males

• Till now 54% women are 60+, 18.36 million Till now 54% women are 60+, 18.36 million widows, 42% of them illiterate ,40% below poverty widows, 42% of them illiterate ,40% below poverty line and 80% population of aged residing in the rural line and 80% population of aged residing in the rural areas and India having second largest old population areas and India having second largest old population in the world the work cannot be accomplished by in the world the work cannot be accomplished by the governments alonethe governments alone

• The effort for quality life are to be initiated by The effort for quality life are to be initiated by everyoneeveryone

Role of volunteers

Community social service

BRONFENBRENNERS ECOLOGICAL SYSTEMS THEORY

VOLUNTEER

Listening to them

Thinking

Working with them

Feeling responsible

Understanding their rights and health needs

Decision making

Our role in Our role in women’s welfarewomen’s welfare

I think I may have been able to set some thought process in motion

We can be helpful ad useful to our ecosystems provided we know from where to start

A lot of women are at stake of developing serious complications due to ignorance of their developmental changes and me and you can help a lot

Begin from your own home

THANK YOU