Editing Menopause (section)

== Society and culture ==

=== Attitudes and experiences ===
The menopause transition is a process, involving hormonal, menstrual, and typically vasomotor changes. However, the experience of the menopause as a whole is very much influenced by psychological and social factors, such as past experience, lifestyle, social and cultural meanings of menopause, and a woman's social and material circumstances. Menopause has been described as a [[Biopsychosocial model|biopsychosocial]] experience, with social and cultural factors playing a prominent role in the way menopause is experienced and perceived.{{citation needed|date=January 2024}}

The paradigm within which a woman considers menopause influences the way she views it: women who understand menopause as a medical condition rate it significantly more negatively than those who view it as a life transition or a symbol of aging.<ref>{{cite journal |vauthors=Gannon L, Ekstrom B |year=1993 |title=Attitudes toward menopause: The influence of sociocultural paradigms |journal=Psychology of Women Quarterly |volume=17 |issue=3 |pages=275–88 |doi=10.1111/j.1471-6402.1993.tb00487.x |s2cid=144546258 |hdl-access=free |hdl=2286/R.I.44298}}</ref> There is some evidence that negative attitudes and expectations, held before the menopause, predict symptom experience during the menopause,<ref name=":0" /> and beliefs and attitudes toward menopause tend to be more positive in postmenopausal than in premenopausal women.<ref>{{Cite journal |last1=Brown |first1=Lydia |last2=Brown |first2=Valerie |last3=Judd |first3=Fiona |last4=Bryant |first4=Christina |date=2018-10-02 |title=It's not as bad as you think: menopausal representations are more positive in postmenopausal women |url=https://www.tandfonline.com/doi/full/10.1080/0167482X.2017.1368486 |journal=Journal of Psychosomatic Obstetrics & Gynecology |language=en |volume=39 |issue=4 |pages=281–288 |doi=10.1080/0167482X.2017.1368486 |pmid=28937311 |s2cid=24085899 |issn=0167-482X}}</ref>  Women with more negative attitudes towards the menopause report more symptoms during this transition.<ref name=":0">{{cite journal | vauthors = Ayers B, Forshaw M, Hunter MS | title = The impact of attitudes towards the menopause on women's symptom experience: a systematic review | journal = Maturitas | volume = 65 | issue = 1 | pages = 28–36 | date = January 2010 | pmid = 19954900 | doi = 10.1016/j.maturitas.2009.10.016 | s2cid = 486661 }}</ref>

Menopause is a stage of life experienced in different ways. It can be characterized by personal challenges, changes in personal roles within the family and society. Women's approaches to changes during menopause are influenced by their personal, family and sociocultural background.<ref>{{cite journal | vauthors = Hoga L, Rodolpho J, Gonçalves B, Quirino B | title = Women's experience of menopause: a systematic review of qualitative evidence | journal = JBI Database of Systematic Reviews and Implementation Reports | volume = 13 | issue = 8 | pages = 250–337 | date = September 2015 | pmid = 26455946 | doi = 10.11124/jbisrir-2015-1948 | s2cid = 21908463 }}</ref> Women from different regions and countries also have different attitudes. Postmenopausal women had more positive attitudes toward menopause compared with peri- or premenopausal women. Other influencing factors of attitudes toward menopause include age, menopausal symptoms, psychological and socioeconomical status, and profession and ethnicity.<ref>{{cite journal | vauthors = Dashti S, Bahri N, Fathi Najafi T, Amiridelui M, Latifnejad Roudsari R | title = Influencing factors on women's attitudes toward menopause: a systematic review | journal = Menopause | volume = 28 | issue = 10 | pages = 1192–1200 | date = September 2021 | pmid = 34520416 | doi = 10.1097/GME.0000000000001833 | s2cid = 237516036 }}</ref>

Ethnicity and geography play roles in the experience of menopause. American women of different ethnicities report significantly different types of menopausal effects. One major study found Caucasian women most likely to report what are sometimes described as psychosomatic symptoms, while African-American women were more likely to report vasomotor symptoms.<ref>{{cite journal |vauthors=Avis N, Stellato RC, Bromberger J, Gan P, Cain V, Kagawa-Singer M |year=2001 |title=Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic group |journal=Social Science & Medicine |volume=52 |issue=3 |pages=345–56 |doi=10.1016/S0277-9536(00)00147-7 |pmid=11330770}}</ref>

There may be variations in experiences of women from different ethnic backgrounds regarding menopause and care. Immigrant women reported more vasomotor symptoms and other physical symptoms and poorer mental health than non-immigrant women and were mostly dissatisfied with the care they had received. Self-management strategies for menopausal symptoms were also influenced by culture.<ref>{{cite journal | vauthors = Stanzel KA, Hammarberg K, Fisher J | title = Experiences of menopause, self-management strategies for menopausal symptoms and perceptions of health care among immigrant women: a systematic review | journal = Climacteric | volume = 21 | issue = 2 | pages = 101–110 | date = April 2018 | pmid = 29345497 | doi = 10.1080/13697137.2017.1421922 | s2cid = 3653549 }}</ref>

Two multinational studies of Asian women, found that hot flushes were not the most commonly reported symptoms, instead body and joint aches, memory problems, sleeplessness, irritability and migraines were.<ref>{{cite journal | vauthors = Haines CJ, Xing SM, Park KH, Holinka CF, Ausmanas MK | title = Prevalence of menopausal symptoms in different ethnic groups of Asian women and responsiveness to therapy with three doses of conjugated estrogens/medroxyprogesterone acetate: the Pan-Asia Menopause (PAM) study | journal = Maturitas | volume = 52 | issue = 3–4 | pages = 264–276 | date = November 2005 | pmid = 15921865 | doi = 10.1016/j.maturitas.2005.03.012 }}</ref> In another study comparing experiences of menopause amongst White Australian women and women in Laos, Australian women reported higher rates of depression, as well as fears of aging, weight gain and cancer – fears not reported by Laotian women, who positioned menopause as a positive event.<ref>{{cite journal | vauthors = Sayakhot P, Vincent A, Teede H | title = Cross-cultural study: experience, understanding of menopause, and related therapies in Australian and Laotian women | journal = Menopause | volume = 19 | issue = 12 | pages = 1300–1308 | date = December 2012 | pmid = 22929035 | doi = 10.1097/gme.0b013e31825fd14e | s2cid = 205613667 }}</ref> [[Japanese women]] experience menopause effects, or ''kōnenki'' (更年期), in a different way from American women.<ref name="Lock 1998, pp. 4102">{{cite journal |vauthors=Lock M |year=1998 |title=Menopause: lessons from anthropology |journal=Psychosomatic Medicine |volume=60 |issue=4 |pages=410–9 |doi=10.1097/00006842-199807000-00005 |pmid=9710286 |s2cid=38878080}}</ref> Japanese women report lower rates of hot flashes and night sweats; this can be attributed to a variety of factors, both biological and social. Historically, ''kōnenki'' was associated with wealthy middle-class housewives in Japan, i.e., it was a "luxury disease" that women from traditional, inter-generational rural households did not report. Menopause in Japan was viewed as a symptom of the inevitable process of aging, rather than a "revolutionary transition", or a "deficiency disease" in need of management.<ref name="Lock 1998, pp. 4102" /> As of 2005, in Japanese culture, reporting of vasomotor symptoms has been on the increase, with research finding that of 140 Japanese participants, hot flashes were prevalent in 22.1%.<ref name="pmid161543012">{{cite journal |vauthors=Melby MK |year=2005 |title=Factor analysis of climacteric symptoms in Japan |journal=Maturitas |volume=52 |issue=3–4 |pages=205–22 |doi=10.1016/j.maturitas.2005.02.002 |pmid=16154301}}</ref> This was almost double that of 20 years prior.<ref name="Lock, M 2010, p.872">{{cite book |title=An Anthropology of Biomedicine |vauthors=Lock M, Nguyen V |date=2010 |publisher=Wiley-Blackwell |location=West Sussex |pages=84–89 |chapter=Chapter 4: Local Biologies and Human Difference}}</ref> Whilst the exact cause for this is unknown, possible contributing factors include dietary changes, increased medicalisation of middle-aged women and increased media attention on the subject.<ref name="Lock, M 2010, p.872" /> However, reporting of vasomotor symptoms is still "significantly" lower than in North America.<ref name="pmid151919362">{{cite journal |vauthors=Gold EB, Block G, Crawford S, Lachance L, FitzGerald G, Miracle H, Sherman S |date=June 2004 |title=Lifestyle and demographic factors in relation to vasomotor symptoms: baseline results from the Study of Women's Health Across the Nation |journal=American Journal of Epidemiology |volume=159 |issue=12 |pages=1189–99 |doi=10.1093/aje/kwh168 |pmid=15191936 |doi-access=free}}</ref>

Additionally, while most women in the United States apparently have a negative view of menopause as a time of deterioration or decline, some studies seem to indicate that women from some Asian cultures have an understanding of menopause that focuses on a sense of liberation and celebrates the freedom from the risk of pregnancy.<ref>{{cite journal |vauthors=Maoz B, Dowty N, Antonovsky A, Wisjenbeck H |year=1970 |title=Female attitudes to menopause |journal=Social Psychiatry |volume=5 |pages=35–40 |doi=10.1007/BF01539794 |s2cid=30147685}}</ref> Diverging from these conclusions, one study appeared to show that many American women "experience this time as one of liberation and [[self-actualization]]".<ref>{{cite journal |vauthors=Stotland NL |date=August 2002 |title=Menopause: social expectations, women's realities |journal=Archives of Women's Mental Health |volume=5 |issue=1 |pages=5–8 |doi=10.1007/s007370200016 |pmid=12503068 |s2cid=9248759}}</ref>

In some women, menopause may bring about a sense of loss related to the end of fertility. In addition, this change often aligns with other stressors, such as the responsibility of looking after elderly parents or dealing with the emotional challenges of "[[empty nest syndrome]]" when children move out of the family home. This situation can be accentuated in cultures where [[ageism|being older is negatively perceived]].

=== Impact on work ===
{{Further|Menopause in the workplace}}
Midlife is typically a life stage when men and women may be dealing with demanding life events and responsibilities, such as work, health problems, and caring roles. For example, in 2018 in the UK women aged 45–54 report more work-related stress than men or women of any other age group.<ref>{{Cite web |date=31 October 2018 |title=Work related stress, depression or anxiety |url=http://greeningconsultants.co.uk/wp-content/uploads/2019/03/HSE-Stats-2018.pdf |journal= |publisher=Health and Safety Executive (HSE)}}</ref> Hot flashes are often reported to be particularly distressing at work and lead to embarrassment and worry about potential [[Social stigma|stigmatisation]].<ref>{{Cite book |last1=Griffiths |first1=Amanda |url=https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/595439/CMO_annual_report_2014.pdf |title=Annual Report of the Chief Medical Officer, 2014, The Health of the 51%: Women |last2=S Hunter |first2=Myra |publisher=Department of Health |year=2015 |editor-last=C Davies |editor-first=Sally |chapter=Psychosocial factors and menopause: The impact of menopause on personal and working life}}</ref> A June 2023 study by the Mayo Clinic estimated an annual loss of $1.8 billion in the United States due to workdays missed as a result of menopause symptoms.<ref>{{Cite journal |last1=Faubion |first1=Stephanie S. |last2=Enders |first2=Felicity |last3=Hedges |first3=Mary S. |last4=Chaudhry |first4=Rajeev |last5=Kling |first5=Juliana M. |last6=Shufelt |first6=Chrisandra L. |last7=Saadedine |first7=Mariam |last8=Mara |first8=Kristin |last9=Griffin |first9=Joan M. |last10=Kapoor |first10=Ekta |date=2023-06-01 |title=Impact of Menopause Symptoms on Women in the Workplace |url=https://www.sciencedirect.com/science/article/pii/S002561962300112X |journal=Mayo Clinic Proceedings |volume=98 |issue=6 |pages=833–845 |doi=10.1016/j.mayocp.2023.02.025 |pmid=37115119 |s2cid=258367393 |issn=0025-6196}}</ref>  This was one of the largest studies to date examining the impact of menopause symptoms on work outcomes. The research concluded there was a strong need to improve medical treatment for menopausal women and make the workplace environment more supportive to avoid such productivity losses.

=== Etymology ===
Menopause literally means the "end of monthly cycles" (the end of [[monthly period]]s or [[menstruation]]), from the Greek word ''pausis'' ("pause") and ''mēn'' ("month"). This is a medical coinage; the Greek word for [[menses]] is actually different. In Ancient Greek, the menses were described in the plural, {{Transliteration|grc|ta emmēnia}} ("the monthlies"), and its modern descendant has been clipped to ''ta emmēna''. The Modern Greek medical term is ''emmenopausis'' in [[Katharevousa]] or ''emmenopausi'' in [[Demotic Greek]]. The Ancient Greeks did not produce medical concepts about any symptoms associated with end of menstruation and did not use a specific word to refer to this time of a woman's life. The word menopause was invented by French doctors at the beginning of the nineteenth century. Greek etymology was reconstructed at this time and it was the Parisian student doctor Charles-Pierre-Louis de Gardanne who invented a variation of the word in 1812, which was edited to its final French form in 1821.<ref>Moore ADM |2022|''The French Invention of Menopause and the Medicalisation of Women's Ageing, A History''|Oxford University Press |page 85</ref>

Some of them noted that peasant women had no complaints about the end of menses, while urban middle-class women had many troubling symptoms. Doctors at this time considered the symptoms to be the result of urban lifestyles of sedentary behaviour, alcohol consumption, too much time indoors, and over-eating, with a lack of fresh fruit and vegetables.<ref>{{cite journal |vauthors=Moore AM |year=2018 |title=Conceptual Layers in the Invention of Menopause in Nineteenth-Century France |journal=French History |volume=32 |issue=2 |pages=226–248 |doi=10.1093/fh/cry006}}</ref>

The word "menopause" was coined specifically for female humans, where the end of fertility is traditionally indicated by the permanent stopping of monthly menstruations. However, menopause exists in some other animals, many of which do not have monthly menstruation;<ref name="Walker22">{{cite journal |vauthors=Walker ML, Herndon JG |date=September 2008 |title=Menopause in nonhuman primates? |journal=Biology of Reproduction |volume=79 |issue=3 |pages=398–406 |doi=10.1095/biolreprod.108.068536 |pmc=2553520 |pmid=18495681}}</ref> in this case, the term means a natural end to fertility that occurs before the end of the natural lifespan.

=== In popular culture, law and politics ===
In the 21st century, celebrities have spoken out about their experiences of the menopause, which has led to it becoming less of a taboo as it has boosted awareness of the debilitating symptoms. Subsequently, TV shows have been running features on the menopause to help women experiencing symptoms. In the UK [[Lorraine Kelly]] has been an advocate for getting women to speak about their experiences including sharing her own. This has led to an increase in women seeking treatment such as HRT.<ref>{{Cite web |date=29 April 2022 |title='Breakthrough moment': how Lorraine Kelly helped shift the menopause debate |url=https://www.theguardian.com/society/2022/apr/29/breakthrough-moment-how-celebrities-helped-shift-the-menopause-debate |access-date=2 August 2022 |website=The Guardian |language=en}}</ref> [[Davina McCall]] also led an awareness campaign based on a documentary on [[Channel 4]].<ref>{{Cite web |title=Davina McCall: Sex, Myths and the Menopause |url=https://www.channel4.com/programmes/davina-mccall-sex-myths-and-the-menopause |access-date=2023-07-03 |website=www.channel4.com |language=en}}</ref>

In the UK, [[Carolyn Harris]] sponsored the Menopause (Support and Services) Bill in June 2021. It was to exempt hormone replacement therapy from National Health Service [[prescription charges]] and to make provisions about menopause support and services, including public education and communication in supporting perimenopausal and post-menopausal women, and to raise awareness of menopause and its effects. The bill was withdrawn on 29 October 2021.<ref>{{Cite web |last=House of Commons |date= 27 October 2021 |title=Menopause (Support and Services) Bill, House of Commons, Session 2021-22 |url=https://bills.parliament.uk/bills/2897}}</ref>

In the US, [[David McKinley]], Republican from West Virginia introduced the Menopause Research Act in September 2022 for $100 million in 2023 and 2024, but it stalled.<ref>{{Cite web |last=McKinley, David B. |date=September 6, 2022 |title=H.R.8774 - Menopause Research Act of 2022 |url=https://www.congress.gov/bill/117th-congress/house-bill/8774?s=1&r=13}}</ref>