As Helen is beginning to experience, the major reproductive change in women during adulthood is the loss of the natural ability to bear children. Called perimenopause, this transition begins in the 40s, as menstrual cycles become irregular and some women experience things such as night sweats, and is generally complete by age 50 to 55 (National Women’s Health Information Center, 2008a). This time of transition is called menopause, and how long it lasts varies considerably (Mayo Clinic, 2002a). The gradual loss and eventual end of monthly peri­ods is accompanied by decreases in estrogen and progesterone levels, changes in the reproductive organs, and changes in sexual functioning (National Women’s Health Information Center, 2008a).

A variety of physical and psychological symp­toms may accompany perimenopause and meno­pause with decreases in hormonal levels (National Women’s Health Information Center, 2008b): hot flashes, night sweats, headaches, sleep problems, mood changes, more urinary infections, pain during sex, difficulty concentrating, vaginal dryness, less interest in sex, and an increase in body fat around the waist. Many women report no symptoms at all, but most women experience at least some, and there are large ethnic and cultural group differences in how they are expressed (Banger, 2003). For example, women in the Mayan culture of Mexico and Central America welcome menopause and its changes as a natural phenomenon and do not attach any stigma to aging (Mahady et al., 2008). In the United States, Latinas and African Americans, especially working – class women, tend to view menopause more posi­tively whereas European American women describe it more negatively (Dillaway et al., 2008).

Cultural differences are exemplified in Lock’s (1991) classic study of Japanese women. Fewer than 13% of Japanese women whose menstrual peri­ods were becoming irregular reported having hot flashes during the previous 2 weeks, compared with nearly half of Western women. In fact, fewer than 20% of Japanese women in the study had ever had a hot flash, compared with nearly 65% of Western women. However, Japanese women reported more headaches, shoulder stiffness, ringing in the ears, and dizziness than Western women. Why? The answer seems to be the power of sociocultural forces. In Japan, society considers “menopausal syn­drome” to be a modern affliction of women with too much time on their hands. With this official attitude, it is hard to know whether Japanese women actually experience menopause differently or may simply be reluctant to describe their true experience.

Similar findings were reported by Fu, Anderson, and Courtney (2003), who compared Taiwanese and Australian women. Significant differences were found in their attitudes toward menopause, menopausal symptoms, and physical vitality. These results clearly indicate that sociocultural factors are critical in under­standing women’s experience during menopause.

One way to address the symptoms associated with the climacteric is hormone replacement ther­apy. Many physicians point out that having women take hormones after menopause may also provide some protection against cardiovascular disease, as described earlier in this chapter. Although there

Physical Changes 91