Menopause as a Normal Life Transition
I do not have any issue . . . all of a sudden it stopped and I was happy. (Kamla, 49, rural resident)
Accounts of menopause as a normal life transition showed that women tend to normalize their symptoms by peer comparisons and by acknowledging the universality of menopause. Women used phrases like “every woman’s issue” and “it’s like childbirth” to normalize the experience.
Every woman has to go through this, women are made to suffer, it’s like child-birth you know. (Meena, 56, rural resident)
It’s over now. . . . I had to suffer from heavy bleeding for six months which every woman has to suffer. . . . I have heard that menopause happens this way only. (Jyoti, 47, urban resident)
Many women reported having had no symptoms and abrupt cessation of menstruation; for these women, menopause was a natural transition. They considered menopause symptom-free; they mentioned joint pains or headaches but associated those with aging rather than menopause (Singh and Sivakami 2014). Similar results have been reported by other Indian studies as well, indicating that Indian women report fewer symptoms, as they frequently link menopausal symptoms with symptoms of aging (Aaron, Muliyil, and Abraham 2002).
In contrast to Western studies, where women are influenced by biomedical discourse and visit health providers to make sense of their experience and confirm their menopausal status (see Hyde et al. 2010), our study depends on “vernacular health theories”: using popular beliefs and perceptions in local communities to understand illness or a life transition (Goldstein 2000) and to make sense of their bodily changes. These women depend on the affirmation of their community, as Kamla (49, rural resident) offers: “I discussed with other women in my community and they told me, it’s menopause (mahina-bandh) for you. . . . . ” The conception of menopause as a normal life transition also comes from the accounts of women who expressed the insignificance of menopause in their lives once their family was complete. Many women stated that they did not need the menstrual cycle past age 40, as menstruation is equated with reproduction, especially among illiterate women. As one woman said, “Why you need this? . . . Once your family is complete, you don’t need it” (Gyani, 58, rural resident).
Biomedical discourse also influenced women’s perception of early menopause. Few who went to health providers mentioned their fear of getting uterine cancer. Most of the women acknowledged that they suffered from unmanageable, heavy, and painful bleeding during the menopause phase; however, they call it normal. They believe that if the ‘bad blood’ were to remain inside the body, they may develop cancer. This suggests the power of vernacular health theories in normalizing distress, which is crafted by the medical discourse of menopause (Goldstein 2000). Menopause became insignificant for those women who were busy managing the chaos of life, most notably poor women, whose struggle every day to ensure that their families get fed takes priority over reflection on their own health issues. Reena (58, urban resident), a domestic servant who did not recall her menopause experience, reflects this view: “I don’t remember how it stopped . . . it’s been 10 years now. . . . I think I had no complaints. . . . At that time I was busy doing my job [domestic servant]. I used to work in 10 houses and was busy whole day.” Seema (53, rural resident) is another woman who failed to recall her menopause experience: “I never had time to think about menopause and all. . . . I don’t even remember exactly when I stopped menstruating. . . . I was too busy managing my household chores and managing field work [agricultural fields].”
Beena (49, rural resident) has a daughter of marriageable age, which in their culture is as soon as they turn 18. Beena is more concerned about the marriage of her daughter than her menopausal status. The latter has no bearing on her identity, while the former shapes her identity as a mother. She said, “It’s a woman’s issue which she has to bear. . . . Now, it’s over but I have lot of other tensions. . . . I have to arrange for my daughter’s wedding, she is 26 now. . . . It’s getting late.” Here, menopause, as a midlife transition is overshadowed by other events, and it becomes a routine and normal midlife transition, consistent with Ballard, Kuh, and Wadsworth (2001) finding that other life transitions, such as changing relationships with one’s partner or children or changes in work life, often overshadow the experience of menopause.
Most women in our study reported that menopause was an insignificant life event that either passed without any symptoms or without any symptoms that they remember. Those who did have unwanted symptoms normalized them by ascribing them universality, as reflected through peer comparisons and phrases such as “every woman has to suffer this” and “women are made to suffer.”
Menopause as Distress
In this second thematic narrative, distress emerged mainly from somatic changes (heavy and painful bleeding, sleepless nights, irritability, anxiety, mood swings, and frequent headaches), often exacerbated by negative life events and an inability to share their experience with anyone. Rajni (52, urban resident) recalls her struggle with painful and heavy menstruation during her perimenopause phase: “I suffered during menopause for 2 years. . . . It was heavy and painful bleeding which kept me awake . . . [I] used to feel very hot, couldn’t sleep, had frequent headaches . . . was feeling depressed. . . . . During that time my husband died . . . It was a tough time.”
In Rajni’s account, there is no mention of depression or other body changes emerging from menopause. Rather, she reports that perimenopause became tough at the point where her husband died. That is, it was the death of her husband and her inability to share her distress with anyone that made perimenopause a difficult time for her. Sarla (51, rural resident), who is currently postmenopausal, recalls suffering and difficulties during perimenopause, particularly managing menstrual bleeding and maintaining hygiene in the presence of a male family member (her son). In her culture, it is unacceptable to discuss issues such as menarche and menopause with male members, as she mentions,
It’s a suffering. . . . I suffered heavy and painful bleeding for nine years. . . . I used to bleed continuously for 15–20 days, was exhausted. . . . I had sleepless nights due to fear of spoiling the bed-sheet. . . . I used to be so tired . . . had no energy to stand and work . . . wished I had someone to understand my situation and help with household chores. . . . My daughters were married by that time and I can’t discuss all this with my son. . . . Whenever I used to lie down in bed, he used to ask me what has happened to you . . . and I had no answer. . . . Now I am free from all such tensions.
Sarla’s wish for someone to understand her situation points to a lack of emotional and social support in her life. Though she mentions a number of symptoms—sleeplessness, exertion, dizziness—she does not intend to seek medical intervention. Rather, she expressed the need to be understood. In Sarla’s account, the narratives of freedom and distress coexist. Initially, her difficulties managing menopause and its associated symptoms in the presence of male members in her house made her feel distressed about menopause; however, once her period stopped completely, she felt liberated from monthly tensions. In her culture, menstruation or menopause is a women’s issue and should not be discussed with men.
We found that women who lacked a support system were more likely to feel the distress of menopause. For Sita (54, urban resident), the postmenopausal phase became very difficult because she had no one with whom to share her grief over the death of her husband. Her complaint about God highlights her helplessness and distress. She complains of frequent headaches and joint pains:
For two years, I suffered from heavy bleeding and painful menstruation. . . . It was difficult, you know very difficult . . . it was painful. . . . Now I am not menstruating, but I have all sorts of pain, headache I get every day, my vision has diminished, all my joints ache. . . . My husband died three months back [tears roll down her eyes] . . . my daughter-in-law is not good . . . my son is busy with his own life. . . . [There is no one] whom to tell my problem . . . even God doesn’t listen to my prayers.
Similarly, Geeta (59, rural resident) remembers her menopause experience and calls it a “suffering.” She mentions her frequent fights with her husband and even her son. She expresses the need to be understood in the following excerpt:
During menopause, I suffered a lot. . . . I had very heavy bleeding . . . which was unmanageable. . . . I tried many home-remedies . . . but nothing worked. . . . I was unable to sleep, fully exhausted . . . didn’t wanted to talk to anyone, became anxious, used to get irritated over small things . . . had frequent fights with my husband . . . and even with my son. . . . They don’t understand what a woman is going through . . . and you can’t explain them. . . . It was a difficult time.
On the other side, Gita (52, rural resident) boasts about her daughter-in-law and mentions that she is enjoying this carefree life as a grandmother:
There was very heavy bleeding before I stopped menstruating . . . but that’s normal . . . every woman has to go through this. . . . My daughter-in-law is very nice . . . she managed all the household chores at that time . . . she helped me a lot. . . . Now she works and I look after her kids . . . now I am free and enjoying life.
Menopause as Freedom
The third thematic narrative carried two meanings of freedom: freedom from the stressful management of menstruation and freedom from societal restrictions. Most women acknowledged that managing heavy and painful menstrual bleeding is difficult at an older age, thus they are happy when menstruation ends. The management is further complicated by the taboos attached to menstruation and menopause, which leads them to suffer in silence. Gita (52, rural resident) mentions, “Three to four years back it stopped. . . . It’s good that it stops when you become old.” Women expressed their difficulties in managing the pain and chaos of menstruation every month and thus embraced menopause as entry into a carefree phase of life. Women are happy in their new roles (mother-in-law or grandmother), which they would have found difficult with menstruation. As Gita adds, “It’s good it stopped before I became grandmother as it’s difficult to manage menstruation in old age.”
For some women, the narrative of distress and freedom co-occurred. When they reflect back on their experience during perimenopause, they call it “suffering” but they ended with phrases like “I am free now,” “I am enjoying now,” and “ít’s over now.” For these women, the narrative of freedom has emerged from the narrative of distress. For instance, Nirali, (53, urban resident) mentions, “two to three months I was bleeding heavily and then it stopped. . . . It was difficult to manage . . . it was annoying, now it’s over.”
For most of the rural and some urban women, ending menstruation liberated them from the societal restrictions on entering sacred places and participating in sacred rituals like wedding pheras. Rekha (48, rural resident) recalls that she was barred from entering wedding mandap of her daughter. She mentions, “Even during my daughter’s wedding I was menstruating and thus could not perform many rituals.” Seema (47, rural resident) earns a living by organizing kirtans (spiritual gatherings). In her community, it is not acceptable that she attends a kirtan while she is menstruating, as menstruation is considered to be polluting. She is happy that she has reached menopause, as now she can plan and organize spiritual gatherings any time: “I am happy that it stopped. . . . I run a mandli (group) for performing spiritual gatherings (kirtan). . . . It was so difficult to manage when I was menstruating. . . . I cannot plan a kirtan when I am menstruating. . . . Now, I am free.”
All of these women are happy that they have attained menopause. They can freely go to temple, plan outings, and lead a carefree life. Women were more concerned about their new roles as grandmothers, and they felt liberated from monthly distress; by contrast, Western studies report that women are more concerned about their fertility status (Nosek, Kennedy, and Gudmundsdottir 2012). Some sociological and anthropological studies have reported that Indian women enjoy greater control over resources when they enter postmenopause and when they become mothers-in-law (Kaufert 1982; Inhorn 2006; Patel 2007). Also, Indian women enjoy higher social status in post-reproductive years due to freedom from the so-called ‘polluting’ menstruation and power dynamics (Vatuk 1998
, 289–306; Aaron, Muliyil, and Abraham 2002).