Issue in Focus : Women at "The Change of Life" - Janette Sunita
Women at "The Change of Life"
Do women feel that an active sex life at an older age is important, or would they rather have a cup of tea?
Are women continuing to enjoy an active sex life into older age or are they having problems and if so, are they seeking help or suffering in silence?
Twenty years ago if you were in menopause and wanted to wreck a social gathering, elicit a double take or wanted to deliberately shock people into paying attention you only had to blurt out, ‘I think I’m having a hot flush’ for all conversation to lurch to a halt. Why go that far? You needed only to mention casually that you might be approaching ‘the change of life’! Even this delicately referred to condition was a conversation stopper. These were confessions to be made only in the privacy of your bedroom or better still, not at all!
Women in urban settings, who were quite inhibited about all things personal, do not feel that way anymore. They are now more honest and open about things they were never so forthright about. More than that though, many women are even beginning to flaunt their menopausal symptoms. If they are not erupting in the proverbial heat of the moment, they are making jokes and wry quips punctuated by knowing looks and gestures. This is the new menopausal women’s club that has arrived!
Menopause signals the end of fertility. But this period could also signal the beginning of a very rewarding period of a woman’s life. However, there is stigma associated with menopause and reaching the age of 50! The stigma is associated more with the process of aging rather than the physiological symptoms that are associated with it. As Paula Doress-Worters and Joan Ditzion say in Our Bodies, Ourselves – The Boston Women’s Health Book Collective "Most of us want to live a long life; yet our ageist culture values neither aging nor being old and separates people by age and generation. Ageism is discrimination because of a person’s chronological age… it prevents us from seeing the diversity of older people…permeates all of our social institutions in subtle and unconscious ways that restrict our lives and affect our thinking …"
The first question that you may ask then is ‘Why 50?’ The answer is that this magical age of 50 is associated with menopause, and traditionally with being ‘past it’, ‘over the hill’, ‘long in the tooth’, ‘not a spring chicken’, and regarding sex, definitely ‘too old for that sort of thing!’ However, we now hear and see, time and time again that 50 is the new 30 and that life has never been better for women over 50 – all over the world – they are healthier (and perhaps wealthier!) than ever before!
So what does health have to do with it?
Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease. Sexual health means enjoying the sexual activity you want without causing yourself or anyone else suffering, physical or mental harm. There is some evidence that an active sex life helps to maintain physical and mental health.
Menopause is defined as the cessation of menstruation as a result of the normal decline in ovarian function. Technically one enters menopause after 12 consecutive months without a period. Menopause (‘the change in life’) is a natural event in life characterised by hormonal changes, and in a way, similar to life’s other significant hormone-related event, menarche. It is not a disease and should not be treated as one. It is a period of natural life transition that more often than not, requires support rather than medical treatment and intervention.
The diagnosis of menopause and the menopausal transition is often made from a combination of factors, with emphasis being placed on the pattern of periods and the presence of menopausal symptoms. In the mid 40s to the early 50s, the absence of periods, infrequent periods or heavy periods for longer than 5-6 days, along with hot flushes and sweats are symptoms that provide the benchmark to diagnose the menopausal transition and doctors consider blood or urine tests unnecessary when these symptoms are reported by women in this age group. The symptoms of menopause experienced, vary widely from woman to woman and from culture to culture. All women, however, undergo the same basic hormonal changes during menopause. The degree to which each woman’s body responds to these normal hormonal changes, also varies.
There are also mental and psychological changes that take place during this transition. In women it is the beginning of the end of the childbearing period with the end of her menstrual periods. She is free from the biological necessity of producing children and the constant concern for their welfare. She now has more time to think of herself and her own well being.
Many women choose to receive hormone replacement therapies (HRT), which can provide effective relief from distressing menopausal symptoms, and which is known to significantly improve the quality of life, for example by providing relief from debilitating diseases such as osteoporosis. For others, non-hormonal options (alternative or complementary therapies or natural remedies) are preferred. Menopause management encompasses essentially a holistic approach and should include recognition and discussion on life-style, as well as specific menopausal treatment options.
A cup of tea, instead?
So do women feel that an active sex life at an older age is important, or would they rather have a cup of tea? Are women continuing to enjoy an active sex life into older age or are they having problems and if so, are they seeking help or suffering in silence? Worryingly, most women over 50 do not seek help and are suffering in silence because most women feel that they could never discuss their sex lives with a doctor. This trend has been common in the past and continues to hold true today.
In this technologically progressive age, and with the internet becoming available to most women in urban settings, women are increasingly seeking help online. With the increasing use of the internet for general health information, menopausal women too are beginning to use these services online and are more and more likely to be representative of this population’s need for such information. Any online information service, allows women to share their views more openly, freely, and anonymously than would be the case in a more formal clinical setting.
Menopausal symptoms in women commonly affect relationships; yet, despite the huge impact of these symptoms very few women discuss their problems with a doctor or even a friend. There are many reasons for this behaviour. Possible reasons may include embarrassment, familiarity with health professionals, not enough time, sexual health not seen as a priority, and symptoms of menopause not seen as an illness. This results in an adverse impact on the sexual health of many women, since these problems are often poorly addressed, if at all!
Women are not alone in this ‘change of life’. Men too have a mid-life (andropausal) club of their own if only they’d acknowledge it! More recently, the print and electronic media have reported symptoms of menopause (or andropause) in males, which generally occurs for men between the ages of 40 and 55, though it can begin as early as 35 or as late as 65.
For men too, this is a multi-dimensional change of life that involves hormonal, physiological, psychological, interpersonal, sexual, social and economic changes. Too many men deny that anything is wrong, and when they finally recognize that there is a problem, they blame someone else for their unhappiness. Usually the blame falls on their women partners and relationships suffer! It follows then that if relationships are to survive or at the very least, not suffer as much as they seem to do, then better understanding and recognition of symptoms that are more or less common among both women and men, should be dealt with.
What do culture, society and emotions have to do with menopause?
A woman’s experience of menopause is influenced not only by her own personal emotions and attitudes but also by wider factors such as the role and status of women in society. Understanding how all these factors interrelate and impact on menopause can assist women to come to terms with changes occurring at midlife.
In India, rural menopausal women generally do not report suffering from any of the more commonly apparent symptoms associated with menopause such as hot flushes, perhaps because it is a transition that comes more naturally and is no big deal, or because of the healthier life style of rural women, e.g. the activities that are associated with keeping menopausal symptoms such as hot flushes at bay through daily strenuous household activities, eating simple diets, and getting a good night’s sleep. It is suggested that these differences could be related to dietary and life-style patterns too. Other explanations are that in the rural Indian cultures older women contribute more to the family and society they live in and women generally receive more recognition, so ageing is regarded more positively. Conversely, women in these cultures may never discuss menopause as openly as in the urban culture.
In urban society, ageing, especially in women, is not always valued and there is pressure on older women to maintain a youthful appearance. Representations of older women are limited and when they do occur they are often negative or stereotypical. This can all impact how a woman perceives and experiences menopause. While some women feel greatly relieved to cease menstruating, others may experience a sense of loss. For women who saw menstruation as a symbol of femininity and womanliness, its end may lead them to question their female identity. Other women may find it difficult to accept the loss of reproductive ability. Even for women who have made a considered decision not to have children (or more children), the loss of the capability and option may trigger feelings of sadness.
Women may also find menopause a time to reflect on the past. They may look at their past and present relationships, choices about children and work satisfaction. Some may experience regrets about certain decisions or unfulfilled dreams. Reflecting on past events and exploring choices made throughout life can prove difficult for some women.
A range of other life circumstances often occurring at midlife can impact on menopause. For women whose focus has been on family, adult children leaving home can result in feelings of emptiness (empty nest syndrome) and a loss of purpose. Conversely, adult children remaining at home or returning to live in the family home can be a significant source of tension. Women at this age also take on the additional responsibility of caring for elderly relatives or experience the loss of loved ones. Long-term health problems like diabetes, high blood pressure, high LDL cholesterol and arthritis can all arise at this time.
Now, some help is at hand. The Indian Menopause Society (IMS), based in New Delhi with affiliated clinics all over India, seeks to address menopause related health issues and educate women about the change in life. According to IMS there are currently 65 million women over the age of 45 in India. But the symptoms of menopause seem to be appearing in women as young as 30-35 years, so overall with an increasing population, there is likely to be a much greater need to address issues of menopause. The IMS founders discovered at its inception that – like most Indian women (including the urban elite) – doctors and health professionals themselves were quite clueless about menopause-related issues. Dr Meeta Singh, IMS secretary general says, "Even though awareness about menopause is growing, most Indian women have a history of self-denial and neglect. Their family’s needs take precedence over their own…"
The time has come for health professionals to address the needs of women of all age groups about sexual health. Most medical practitioners do not enquire about a 50+ woman’s sexual health and well being even if they notice some changes in the body during routine medical examinations. And most often, women do not mention the discomfort and distress that they might be experiencing at the time either. Public awareness initiatives should now include empowering women to feel more able to discuss their condition after the age of 50.
Women of all ages have a right to receive information, medical treatment and attention for their emotional and physical needs and well-being. Just because a woman has reached the age of 50, it does not follow that it’s time now for her to just sit back sipping a cup of tea!
To access easy-to-use, up-to-date information to help you transition through the ‘change of life’ go to this site brought out by the Third Age: http://www.menopauseonline.com
Find the signs, causes, complications, symptoms of menopause from this online source on women’s health care at: http://www.womenhealthfocus.com/women-
Check out The Indian Menopause Society which is a multidisciplinary national society. It was launched in 1995. It is committed to fostering the comprehensive well-being of the mature & elderly Indian women. The society provides a common forum for medical and other interested health professionals and people from all walks of life to work towards the goals of the society.
An article on World Menopause Day on October 18: ‘It’s a sign of the time’s when your roots are grey and when your mem’ry’s shorter; it’s a sign of the time’s when your hourglass shape becomes a glass of water’. (Menopause, A Musical, 2001). Read on in India Together – The News in Proportion at:
Read the latest International consensus statements on menopause and its treatment on the Asia Pacific Menopause Federation site at: www.apmf.net
Janette Sunita is with TARSHI, New Delhi since 2003. She has returned to the development sector by choice, after working in the banking and corporate sectors. Her personal experience has prompted her to take a special interest in women whose needs and rights are marginalised, after years of doing their "duty" and "giving".