FIRST NATIONS WOMEN AND MENOPAUSE
Breaking down barriers
Menopause is traditionally not a subject discussed among First Nations women, which can lead to awkwardness when discussing the subject with healthcare professionals. However, every woman has the right to be informed about what is happening to her body and to have access to helpful resources.
Menopausal Experience in Australian Aboriginal Women
Documentation of the experience of menopause in Australian Aboriginal women is scarce, making their menopausal experience relatively unknown. In one study of over 200 Indigenous participants, it was found that the average age of onset for menopause was five years earlier than non-Aboriginal Australian women. Additionally, only 36% of rural Aboriginal women reported symptoms¹. This indicates a potential underreporting or different perception of symptoms among Aboriginal women compared to their non-Aboriginal counterparts.
Several factors appear to influence the menopausal experience among women:
- Mother’s Age at Menopause: A hereditary factor impacting the age of onset.
- Age at Menarche: Early menarche has been linked to earlier menopause.
- High BMI: Associated with increased menopausal symptoms and earlier onset.
- Lack of Physical Activity: Can exacerbate symptoms.
- Smoking: Known to advance the age of menopause and increase symptoms.
- Diet Rich in Phytoestrogens: May reduce symptoms.
- High Parity and Long Duration of Breastfeeding: Associated with fewer symptoms.
- Use of Oral Contraceptives: Linked to lower reporting of menopausal symptoms.
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'The Change' is more commonly used than menopause amongst Aboriginal women
The experience of menopause is subjective and can be interpreted in many ways, both socially and culturally. There is no clear consensus on how Aboriginal women view menopause or what influences this view. It is uncertain whether menopause is influenced by poor health, what coping mechanisms are used, and whether this transition is a highly private experience⁴.
In a study of 25 Aboriginal women over a year using interviews and focus group discussions to explore how Aboriginal women view menopause, these major themes emerged³:
Language Used: Terms like 'The Change' or 'Change of Life' were more commonly used than menopause³. This reflects a recognition of menopause as a significant life transition rather than a medical condition.
Stages of Life: Menopause was often recognised as a significant life transition³. Many women viewed this phase as a natural progression of aging and a step towards gaining more respect and authority within their community.
Attitudes Towards Menopause: Symptoms were sometimes attributed to other health issues³. This misattribution can lead to confusion and delays in seeking appropriate care.
Symptoms Experienced: Varied widely among individuals³. Common symptoms reported included hot flushes, night sweats, and mood changes, but the perception and severity of these symptoms varied significantly.
Role of Men: Men often played a minimal role in discussions about menopause³. This lack of involvement may contribute to a sense of isolation among women experiencing menopause.
Lack of Understanding: Many women reported insufficient understanding and lack of information³. This highlights the need for culturally sensitive educational resources.
Attribution of Menopause to Other Causes: Symptoms were sometimes attributed to other health issues³. This misattribution can lead to confusion and delays in seeking appropriate care.
Coping and Treatment Methods: Varied, with some women using traditional methods and others seeking medical help³. Traditional remedies were often preferred, but access to modern healthcare was also valued.
Cultural Influences on Menopause
Considerable research shows significant variation across cultures in the menopause experience, influenced by biological, psychological, social, and cultural factors². In many Indigenous cultures, menopause can lead to an increased role in the family and religion, often elevating a woman's status in her community and leading to a more positive experience².
In Indigenous Australian cultures, menopausal women often gain increased respect and authority within their communities. This elevation in status can contribute to a more positive experience of menopause, contrasting with the often negative connotations associated with menopause in Western cultures⁴. The holistic view of health in Indigenous cultures, which integrates physical, emotional, and spiritual well-being, also plays a significant role in shaping the menopausal experience⁴.
Health Implications and
Access to Care
Cardiovascular disease (CVD) is the leading cause of death in women around the world. Among Aboriginal and Torres Strait Islander women, cardiovascular disease is more prevalent and often occurs 10-20 years earlier than non-Indigenous women⁵.
The intersection of cultural beliefs and access to healthcare services significantly impacts the menopausal experience for Aboriginal women. Many Aboriginal women face barriers to accessing healthcare, including geographical isolation, socioeconomic disadvantage, and cultural differences between patients and healthcare providers⁴. These barriers can lead to delayed diagnosis and treatment of menopausal symptoms, exacerbating health inequalities.
There is a critical need for culturally competent healthcare that acknowledges and respects the unique experiences and perspectives of Aboriginal women. Healthcare providers should be trained to understand the cultural context of menopause in Indigenous communities and to provide information and support in a way that is respectful and relevant to these women⁴.
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Symptoms vary widely among individuals
Research and Future Directions
Despite the insights gained from existing studies, there remains a significant gap in the literature regarding the menopausal experiences of Aboriginal women. More comprehensive and culturally sensitive research is needed to fully understand the diverse experiences of menopause⁴. Such research should be co-designed and collaboratively implemented to ensure that Aboriginal women’s voices are heard and their perspectives accurately represented⁴.
Future studies should also explore the effectiveness of different interventions, both traditional and modern, in managing menopausal symptoms among Aboriginal women. By building a robust evidence base, healthcare providers can develop better strategies to support Aboriginal women through menopause, improving their health and wellbeing.
The menopausal experience among Aboriginal women is influenced by a variety of factors, including cultural beliefs, social status, and access to healthcare. There is a need for more research to fully understand this experience and to provide appropriate support and resources. By recognising and addressing these unique experiences, First Nations women can be better supported through this significant life transition.
References
1. Jurgenson, J. R., et al. (2014). “Exploring Australian Aboriginal women’s experiences of menopause: a descriptive study.” BMC Women’s Health 14(1). This study references McKenna EM. Masters Thesis - Masters of Medical Science. Cairns: The University of Queensland; 2001. The experience, knowledge and relevance of menopause to aboriginal and Caucasian women in Far North Queensland.
2. Barthelus, E. D., et al. (2022). “Culture: An Influence on the menopausal experience.” Menopause 29(12).
3. Jurgenson, J. R., et al. (2014). “Exploring Australian Aboriginal women’s experiences of menopause: a descriptive study.” BMC Women’s Health 14(1).
4. Jones, E. K., et al. (2012). “Menopause and the influence of culture: another gap for Indigenous Australian women?” BMC Women’s Health 12(1).
5. Marschner, S., et al. (2022). “Randomised clinical trial using Coronary Artery Calcium Scoring in Australian Women with Novel Cardiovascular Risk Factors (CAC-WOMEN Trial): Study protocol.” BMJ Open 12(12).