Unsettling, irritating, and downright painful. Those are words that come to mind when one thinks of menopause, the physical changes marking the end of menstrual cycles in women. Though all women who live past a certain age go through this change, their experience of it may vary widely. This leaves scientists scratching their heads to figure out if there are patterns here and why women’s experience can be so different.
A couple of years ago, Eliana Ojeda from Cusco’s Andina University along with three Chilean colleagues, Juan E. Blümmel, María Soledad Vallejo, and Pablo Lavín published a study in the prominent scientific journal Maturitas in which they claimed to have found a pattern. Their data say, they claim, that Quechua women in rural Cusco experience menopause more strongly than urban “Hispano-Mestiza” women in the city of Cusco.
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Of course, these are statistical differences. The pattern may be reversed in any two women. Nevertheless, if they are right, Quechua women are more likely to suffer more from menopause than their Mestiza cohorts.
They obtained these results by administering the MRS questionnaire to a sample of more than 300 women in the city of Cusco and an equivalent amount in rural “villages” such as Anta, Checacupe, Chiara, Combapata, Curahuasi, Limatambo, Ocongate, Pampamarca and Pitumarca. They did this because the scientific literature indicated Latin America women experienced menopause more strongly than women of other origins. Some scholars argued, as a result, that Latin America’s Native peoples were the ones with particularly strong expression of menopause and others claimed the issue was one of the altitude above se level at which the women lived.
The authors decided to test these ideas by choosing women of different “ethnicities” who live at varying high altitudes. Their data suggest that ethnicity, not altitude, is the main factor in how strong a women’s experience of menopause is.
However, their study is severely flawed, despite being published in an important journal. The authors enter the domain of social science when they speak of ethnicity and they show no understanding of the complexity of the issues. Unfortunately that negates the sophistication of the statistics they bring to their study.
In Cusco, urban, Spanish speaking women are considered as different from rural Quechua-speaking women. Not only do they symbolically speak a different language, they dress differently and live differently. However, they article fails when it calls the Spanish speakers mestizas and translates that as “crossbred” while arguing the Quechua speaking women, who they unfortunately simply label as “Quechuas”, are Native. The urban women may be biologically indigenous and the Quechua women may be mixed European and Indian. Language and urban rural residence are simply not the same thing as ethnic identity nor the possession of particular phenotypical or genotypical markers, even if there is some statistical correspondence. The authors confuse social difference for ethnicity and that for genetic difference. The relevant issue is the social difference, i.e. one of residence, class, and life experience, not ethnicity or Native origin per se.
Despite this confusion, their study is importantly suggestive. But there is another flaw, perhaps a greater one. The MRS questionnaire, whose full name is the Menopause Rating Scale, was designed to be an international survey to assess experience with menopause across language differences and enable comparison. It registers a person’s perception of how severe their symptoms are, from a list of standard symptoms.
Bio-cultural anthropologists and cultural anthropologists have noted how varied people’s perceptions and awareness of symptoms can be according to individual experience, class, culture, and so on. As if to emphasize this, the MRS comes with a caution that data on Latin American women do not seem comparable to women from elsewhere. The scale of their reported experience seems different.
The MRS has been widely used and has standard and tested translations into many languages (although linguists and medical anthropologists know how troubled this statement is). Nevertheless, there is not standard translation for Quechua, much less the Quechua of Cusco with its town and altitude variations.
The authors claim to have taken this into account. They say they have created a Quechua translation whose validity has been tested though they do not publish the translation for independent assessment nor does their statistical measure of validity seem to appropriately demonstrate the translation’s validity or cultural appropriateness.
Whatever it is that they are ultimately measuring, all we can say is that a difference showed up between rural (or small town and small city) women in Cusco and those in the big city. This difference also corresponded to major differences in weight, body mass index, height, paid work, and school years, as well as number of children, hypertension, medical treatment, and smoking.
These are suggestive of a major difference in the ways the bodies of rural peoples are formed under stress of hard work and fewer calories over a lifetime and how the things that lead to that also result in different styles of life and access to medical care over that same lifetime. Given this, it is not surprising there would be differences in how people feel and experience menopause.
The reducing of those differences to ethnicity which suggests genetics, is simply not an adequate analysis. The article needs to carefully look at the impact of intermediate factors (economics, scarcity, hard physical activity, more child births, less formal medical care, etc.) on women’s bodies over a lifetime before they can discuss either altitude or ethnicity cogently.
The authors also need to address culture and language more thoroughly. The scale’s suggestion that Quechua women experience more vasomotor symptoms followed by anxiety, irritability, depressive mood as the primary manifestations while Hispanic Mestiza women express their concerns as involving osteomuscular discomfort primarily makes little sense until the authors have addressed the different ways in which woman discuss and describe symptoms in the two languages and how they are made culturally meaningful.
As a result, though a very troubled study, this work does suggest something interesting for future authors. It is worth looking carefully at menopause and the different lived experiences of women over a lifetime in Cusco where the difference between the lives of rural and urban women appear quite varied, though those variations may be far more bell-curved than categorical.
P.S. The English of the article is filed with errors and suggests the editorial standards of the journal Maturitas (whatever it scientific value) are simply not adequate. I personally wish the article had been in Spanish where the authors could have expressed themselves more authoritatively.
Eliana Ojeda, Juan E. Blümel, María Soledad Vallejo, and Pablo Lavín, “Climacteric symptoms in Quechua and Mestizo women from the Andean region of Cusco, Peru: Effects of altitude and ethnicity”, Maturitas, 77 (2014) 356–360.
Klaas Heinemann, Alexander Ruebig, Peter Potthoff, Hermann PG Schneider, Frank Strelow, Lothar AJ Heinemann, and Do Minh Thai, “The Menopause Rating Scale (MRS) scale: A methodological review”, Health and Quality of Life Outcomes, Vol. 2, 2004, PMC516787
Melissa K. Melby and Michelle Lampl, “Menopause, A Biocultural Perspective”, Annual Review of Anthropology, Vol. 40: 53-70 (2011)