Cultural Contexts and Cross-Population Comparisons of Symptoms at Midlife

This presentation will address women’s health in Bangladesh, Mexico, and the U.S. with a focus on symptoms associated with the menopausal transition.  Many of these health-related concerns, e.g., hot flashes, fatigue, joint pain, and urinary incontinence, are under-discussed, but distressing in terms of quality of life during midlife and aging.  The frequency and experience of these and other symptoms at midlife will be compared to examine how different climates, religions, and socioeconomic resources shape the context of women’s health.  National data will be reviewed, and then anthropological studies of women’s health in Hilo, Hawaii; Campeche and Puebla, Mexico; and Sylhet, Bangladesh will be detailed.  In each country, a similar symptom list was asked of women in the same age range (40-60 years).  This makes for very comparable data, and shows, for example, that hot flashes are more frequent in Mexico (48-50%) and Bangladesh (46%) than in the U.S. (34%).  The description of the discomfort associated with hot flashes was surprisingly consistent across countries, despite differences in culture-specific stressors and socioeconomic circumstances.  To further understand the experience of hot flashes, ambulatory hot flash monitors were worn by women in Hilo (n=200), Sylhet (n=30), and Campeche (n=152).  The concordance between reported hot flashes and objectively measured hot flashes differed across the populations, and may be associated with climate.  Beyond hot flashes, there are ways in which culture impacts the experience of symptoms at midlife and associated quality of life.  For example, in a Muslim country like Bangladesh, prolonged or heavy menstruation during the menopausal transition and urinary incontinence with increasing age affects religious observance because women feel that they are unclean.  In Campeche, the frequency of urinary incontinence is 53% and is associated with feelings of depression, nervousness, and a loss of interest in sexual activity.  In Campeche, urban/rural residence was more important than Mayan/not-Mayan ethnicity in symptom report and use of health-care services.  Women’s health and quality of life are associated with climate, socioeconomic, and cultural contexts.   Funding:  NSF No. BCS-1156368, No. 0548393, No. 9805299, NIH No. S06-GM08073-35.