Maya Minding Menopause II

Socio/Cultural Factors

How a woman views or experiences menopause is a one-person, non-competitive sport; her processes in the short and long haul are uniquely hers. How a woman views menopause and the symptoms she reports have been linked, at least in part, to the views her culture holds of aging in general and the menopause transition specifically. Researchers, Watling et al., examined culture from three lenses and came to the conclusion that “culture resists a simple definition.” As we move across the globe and through regions, social norms vary widely. Other culturally related practices and customs, such as eating patterns and culture around dieting, lifestyle, medication use, substance use, beauty standards, weight bias as well as biological factors, influence how individuals experience the stages of menopause. Additionally, the individual’s experience itself is nuanced and impacted by any combination of the aforementioned practices and lifestyle routines. In a literature review exploring the relationship between culture and menopause, Melby suggested the existence of a complex interplay between biological and socio/cultural factors in the reporting of menopausal symptoms (Melby, MK. et al year).

Social determinants of health play a role in both how the menopause transition is experienced by women around the world and influences the strategies women use to mitigate negative health outcomes related to aging and menopause. What are “social determinants of health”? These are generally recognized as conditions in the environment where people live, work, study, and play that can impact their health outcomes. These variables include, but are not limited to the factors listed below:

• Socioeconomic status
• Employment
• Education
• Access to safe and affordable housing
• Access to quality healthcare and adequate health insurance
• Access to plentiful, affordable and nutritious food

Social determinants of health, health disparities, and health inequities directly influence and impact health outcomes, disease rates, and illness, including those associated with menopause and aging in women. Health inequities are defined as “avoidable, unfair differences in health status seen within and between populations.” The World Health Organization’s Global Commission on Social Determinants of Health identifies inequities in the conditions in which people are born, live, work, and age, which is driven by inequities in power, money, and resources, and have been present for centuries (Marmot, M., et al. 2008). In Latin America and The Caribbean cycles of poverty and disadvantage have resulted in poorer health outcomes (PAHO 2016). In the United States, social determinants of health have disproportionately disadvantaged communities of color, particularly Black, brown, and Indigenous communities, as well as recent immigrants and refugees.

Marginalized communities routinely experience food apartheid. People that live in lower-income underfunded areas are more likely to have to travel farther distances to a full-service grocery store. In general, we all eat what is affordable, tastes good, and is readily available. The foods that are in the closest proximity to where we live are the majority of what we will purchase and eat. Ideally, we are all able to make nutrition choices that support level blood sugars, level blood pressure, and a balanced lipid profile. As people move through the menopausal transition, there is an impact on the incidence and development of diabetes, high blood pressure, and elevated cholesterol that is related to where we live and work. Being able to make choices about nourishment and intentional movement has a significant impact on the management and development of these conditions. Having to manage a new or worsening diagnosis during the menopausal transition absolutely places a burden on the experience. Making space for these context-giving conversations in colloquial, everyday language will begin to demystify menopause and lessen the shame and apathy associated with these transitions that a significant percentage of women experience. For some women, perimenopause can start in their thirties. A menstruating woman who lives to 80, might manage menopause symptoms and outcomes for 40+ years so…yes, let’s talk more about it!

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