Menopause, local biologies, and cultures of aging

Menopause marks the end of menstruation, once generally accepted as the clo sure of women's reproductive lives. The current medical view of menopause, however, is as a pathological event with its own distinct set of symptoms a nd diseases. Researchers have described women as facing a dramatic increase in the risk of heart disease, osteoporosis, stroke, and Alzheimer's, all a s the result of the impact of changing hormone levels, particularly the dec line in estrogen. The clinical literature has interpreted these findings in terms of the absolute necessity of replacing these lost hormones for all w omen who are menopausal regardless of any other physiological, social, or c ultural characteristic they might possess. Using research done in Japan, Ca nada, and the United States, this paper challenges the notion of a universa l menopause by showing that both the symptoms reported at menopause and the post-menopause disease profiles vary from one study population to the next . For most of the symptoms commonly associated with menopause in the medica l literature, rates are much lower for Japanese women than for women in the United States and Canada, although they are comparable to rates reported f rom studies in Thailand and China. Mortality and morbidity data from these same societies are used to show that post-menopausal women are also not equ ally at risk for heart disease, breast cancer, or osteoporosis. Rather than universality, the paper suggests that it is important to think in terms of "local biologies", which reflect the very different social and physical co nditions of women's lives from one society to another. (C) 2001 Wiley-Liss, Inc.