Abstract
Based on longitudinal mixed methods ethnographic research conducted in China from the mid-1990s to 2018, this article argues that Chinese lay language use divides what Americans and Canadians refer to as “menopause” into two distinct though overlapping concepts of the narrow juejing or end of menstruation and the broader non-gender-specific gengnianqi or “transition between middle and old age.” While comparison with research done by Lock in Japan shows that Japanese language uses a similar set of two overlapping yet distinct terms called heikei and könenki, there are important differences between Chinese and Japanese views and experiences of female midlife amidst the similarities. While views and experiences of juejing in China are very similar to notions of heikei in Japan, gengnianqi is quite different from könenki. Like in Japan, the end of menstruation tends to be welcomed by women in China. Also like in Japan, midlife women in China had a lower prevalence of hot flashes than that found in the US and Canada. Also similar to Japan, Chinese women rarely associate hot flashes with embarrassment. However, unlike in the Japanese sample, the Chinese women reported a higher rate of irritability than even the American and Canadian samples. Contrasting with könenki, which is primarly associated with bodily aches and self-restraint in Japan, gengnianqi is commonly viewed as a time of vulnerability to irritable outbursts which must be allowed, though managed carefully. Overall, I show how menopause and midlife aging as concepts and as lived experiences are subject to variation related to differences in language, cultural ideas and practices, local biologies, and culturally-mediated generational experiences of historical change.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
All research was conducted in accordance with the AAA Code of Ethics, and all names used in this article are pseudonyms.
The US survey, which came first, did not pose that question.
This notion of stale blood mirrors what Lock (1993: 17–19) and Zeserson (2001B) found on chi no michi (“path of blood”) symptoms in Japan in the 1980s and 1990s. Zeserson has noted how chi no michi symptoms in menopause were often attributed to poor care during childbirth, especially in situations with poor mother-in-law/daughter-in-law relationships. In 1990s China, I also found that some women attributed gengnianqi symptoms to having been prevented from engaging in proper postpartum recuperation, usually due to an “evil” mother-in-law. Postpartum neglect and mother-in-law problems were, however, less often linked by Chinese women to hot flashes from stale blood than they were to aching back and joints from insufficient tonic foods, inadequate rest, and exposure to cold things following childbirth.
Early on, Lock (1993) noted that research on circulating hormones and hot flashes had resulted in inconclusive and often contradictory evidence (38). Likewise, Beyene (1989) found Mayan and North American women similar in their hormonal characteristics, but North American women much more likely to report hot flashes. In reviewing clinical trials on phytoestrogen consumption and hot flash rates, Shea (2006A) found mixed results, with half of high-quality trials showing no relationship therein (342–44). Melby et al. (2005) has also noted mixed results and problems with studies with small sample sizes and short-term duration (502) and how ingestion of isoflavones does not guarantee their biochemical conversion in the body into bioactive estrogenic compounds like equol (502–03). More recently, a Cochrane Review by Lethaby et al. (2013) found that “No conclusive evidence shows that phytoestrogen supplements effectively reduce the frequency or severity of hot flushes and night sweats in perimenopausal or postmenopausal women, although benefits derived from concentrates of genistein should be further investigated” (4). Another recent systematic review of 62 randomized clinical trials by Franco et al. (2016) found that although use of phytoestrogens such as “dietary and supplemental soy” was linked with reduction in the frequency of hot flashes, three quarters of those RCTs “demonstrated a high risk of bias,” so “further rigorous studies are needed” (2554).
References
Astbury-Ward, E.M. (2009). Menopause, sexuality and culture. Core, https://core.ac.uk/download/pdf/51147221.pdf. Accessed 22 Dec 2018.
Beyene, Y. (1989). From Menarche to Menopause: Reproductive Lives of Peasant Women in Two Cultures. New York: SUNY Press.
Beyene, Y. (2009). Menopause: A biocultural event. In J. Sokolovsky, ed., The Cultural Context of Aging: Worldwide Perspectives (pp. 93–103). Westport, CT: Praeger.
Born, L., Koren, G., Lin, E., & Steiner, M. (2008). A new, female-specific irritability rating scale. Journal of Psychiatry and Neuroscience, 33(4), 344–354.
Cabot, S. (1995). Smart Medicine for Menopause: Hormone Replacement Therapy and Its Natural Alternatives. Pennsylvania: Avery/Penguin Putnam.
Deng, Y-C. (1984). 谈谈怎么样对待妇女更年期 [Discussion of how to handle women’s climacteric].中国妇女 [China Woman], 40(2), 6.
Flint, M. (1974). Menarche and Menopause of Rajput Women. Doctoral dissertation. New York: City University of New York.
Flint, M. (1975). The menopause: Reward or punishment? Psychosomatics, 16(4), 161–163.
Franco, O. H., Chowdhury, R., Troup, J., Voortman, T., Kunusor, S., Kavousi, M., Oliver-Williams, C., & Muka, T. (2016). Use of plant-based therapies and menopausal symptoms: A systematic review and meta-analysis. JAMA, 315(23), 2554–2563.
Healthline. (2018). Menopause: Symptoms, causes, treatment, timeline, and more. Healthline, https://www.healthline.com/health/menopause, posted January 17. Accessed 22 Dec 2018.
Kleinman, A. (1987). Anthropology and psychiatry: The role of culture in cross-cultural research on illness. British Journal of Psychiatry, 151(4), 447–454.
Lakanto. (2017). Why some women don't have hot flashes. Lakanto, https://www.lakanto.com/blogs/news/why-some-women-dont-have-hot-flashes, posted August 8, 2017, accessed December 22, 2018.
Lethaby A, J. Marjoribanks, F. Kronenberg, H. Roberts, J. Eden, & J. Brown. (2013). Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Systematic Review, 2013(12): CD001395.
Lock, M. (1994). Menopause in cultural context. Experimental Gerontology, 29(3-4), 307–17.
Lock, M., & Kaufert, P. (2001). Menopause, local biologies and cultures of aging. American Journal of Human Biology, 13, 494–504.
Lock, M. (1993). Encounters with Aging: Mythologies of Menopause in Japan and North America. Berkeley: University of California Press.
Martin, E. (2001). The Woman in the Body: A Cultural Analysis of Reproduction. Boston: Beacon Press.
Martin, E. (1997). The woman in the menopausal body, in P. A. Komesaroff, P. Rothfield, and J. Daly. Eds., Reinterpreting Menopause: Cultural and Philosophical Issues (239-54). New York: Routledge.
Melby, M. K. (2005). Vasomotor symptom prevalence and language of menopause in Japan. Menopause, 12, 250–257.
Melby, M. K., Lock, M., & Kaufert, P. (2005). Culture and symptom reporting at menopause. Human Reproduction Update, 11, 495–512.
Melby, M. K., & Lampl, M. (2011). Menopause: A biocultural perspective. Annual Review of Anthropology, 40, 53–70.
Melby, M. K., Sievert, L. L., Anderson, D., & Obermeyer, C. M. (2011a). Overview of methods used in cross-cultural comparisons of menopausal symptoms and their determinants: Guidelines for strengthening the reporting of menopause and aging (STROMA) studies. Maturitas, 70(2011), 99–109.
Melby, M. K., Sievert, L. L., Anderson, D., & Obermeyer, C. M. (2011b). Methods used in cross-cultural comparisons of vasomotor symptoms and their determinants. Maturitas, 70(2011), 110–119.
Organic Consumers. (2006). Why middle aged Japanese women don’t have menopausal hot flashes, https://www.organicconsumers.org/news/why-middle-age-japanese-women-dont-have-menopausal-hot-flashes-plant-based-diets-high. Accessed 22 Dec 2018.
Schwartz, V. (1996). The pane of sorrow: Public uses of personal grief in modern China. Daedalus, 125(1), 119–148.
Sexton, S. M. (2003). Review of potential treatments for hot flashes. American Family Physician, 67(4), 832–835.
Shea, J.L (1998). Revolutionary Women At Middle Age: An Ethnographic Survey of Menopause and Midlife Aging in Beijing, China. Doctoral disseration. Cambridge, Massachusetts: Harvard University.
Shea, J. L. (2006a). Cross-cultural comparison of women's midlife symptom-reporting: A China study. Culture, Medicine, and Psychiatry, 30(3), 331–362.
Shea, J. L. (2006b). Parsing the ageing Asian woman: Symptom results from the China study of midlife women. Maturitas: The European Menopause Journal, 55(1), 36–50.
Shea, J.L. (2013). Venting anger from the body at gengnianqi: Meanings of midlife transition among Chinese women in reform era Beijing. In C. Lynch and J. Danely, eds., Transitions and Transformations: Cultural Perspectives on Aging and the Life Course (pp. 49-63). New York: Berghahn Books.
Shen, R. (1987). At Middle Age. Beijing: Panda Books.
Sievert, L. L. (2006). Menopause: A Biocultural Perspective. New Brunswick: Rutgers University Press.
WHI, Writing Group for the WHI Investigators. (2002). Risks and benefits of estrogen plus progestin in healthy post-menopausal women: Principal results of the Women's Health Initiative randomized controlled trial. JAMA, 288(3), 321–333.
WHI, Women's Health Initiative Steering Committee. (2004). Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. The Women's Health Initiative randomized controlled trial. JAMA, 291, 1701–1712.
Yasgur, B.S. (2016). Mood changes in menopausal women: A focus on anxiety. Psychiatry Advisor, https://www.psychiatryadvisor.com/anxiety/mood-changes-menopausal-women-anxiety/article/466919/, posted January 22, 2016, accessed December 22, 2018.
Zeserson, J. M. (2001a). How Japanese women talk about hot flushes: Implications for menopause research. Medical Anthropology Quarterly, 15(2), 189–205.
Zeserson, J. M. (2001b). Chi no michi as metaphor: Conversations with Japanese women about menopause. Anthropology & Medicine, 8(2–3), 177–199.
Zhang, H. (2009). The new realities of aging in contemporary China: Coping with the decline in family care. In J. Sokolovsky, ed., The Cultural Context of Aging: Worldwide Perspectives (pp. 93-103). Westport, CT: Praeger.
Zhang, M. (2020). “Too busy to do anything else”: How caregiving and urban sojourning impact the aging experience of China’s migrant grandparents. In J. Shea, K. Moore, and H. Zhang, eds., Beyond Filial Piety: Rethinking Aging and Caregiving in Contemporary East Asian Societies (pp. 101-21). New York: Berghahn Books.
Funding
This research was funded by the National Science Foundation, the Committee on Scholarly Communication with China (now the American Council of Learned Societies), the Fulbright Commission, and the University of Vermont’s Peter J. Seybolt Research Award, Faculty Research Support Award, and Dean’s Fund Award for Faculty Research.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The author declares that she has no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Shea, J.L. Menopause and Midlife Aging in Cross-Cultural Perspective: Findings from Ethnographic Research in China. J Cross Cult Gerontol 35, 367–388 (2020). https://doi.org/10.1007/s10823-020-09408-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10823-020-09408-6