Understanding the menopause: why it’s good to talk
Female health issues are often a stigma in minority communities. The solution is better education and more awareness
Shahnaz Latif experienced menopause for a decade before the national average age of 50. I asked her if she had ever had any conversations with her mother about the immediate and long-term effects of the menopause.
“Absolutely not. I still don’t speak about it with the immediate family, apart from jokingly,” said Latif, now 50, from Northamptonshire. “Women are male-dominated and that’s heightened in South Asian communities because the position of women is generally inferior.”
Latif is one of many South Asian women who feel they have been forced to “learn to be quiet” about female health issues. While menopause is experienced by a third of the female population in the UK, many minority communities lack sufficient knowledge about it.
Menopause, which can last up to a decade, occurs when a woman stops having her monthly period for 12 consecutive months. While the intensity and duration of symptoms can vary, doctors say menopause is a normal part of ageing and marks the end of a woman’s fertile reproductive years.
A number of prominent female campaigners have recently highlighted the need for better understanding of women’s health issues. The TV presenter Davina McCall shared her story in November as part of Menopause Awareness Month 2022, menopause expert Meera Bhogal runs an eight-week programme, and podcaster Karen Arthur hosts the popular Menopause whilst Black. These women have kicked off a national conversation, but in many communities, including South Asian, menopause is a topic that is often ignored owing to the shame and stigma surrounding it.
“A wall of silence forms because anything you share about your body, particularly around your vagina, is something so shameful and taboo,” said Dr Nighat Arif, a resident doctor on ITV’s This Morning and the BBC’s Breakfast.
Dr Arif, an NHS GP from Buckinghamshire, explained to me that one of the reasons why menopause is seldom mentioned in the community is the lack of simple words and medical terminology in some languages.
“We don’t have medical terminology for vagina or bladder. We have very derogatory, almost swear words that we use which are stigmatised and taboo words that women don’t want to use among their groups.
“In Punjabi, we use the phrase ‘Kapde khatam ho gaye’ which means ‘You’re off the rag now’. In Urdu, they have a word called ‘banjh’ which means barren and doesn’t directly translate to menopause.”
A lack of awareness meant that South Asian women are often reluctant to take part in research, Dr Arif added, which has resulted in a lack of ethnic diversity in the data available. “The biggest issue that we’ve had is the lack of education within our communities. For people of faith, the faith structure tells them how to look after themselves. Western medicine doesn’t meet that.”
Much of the available data surrounding menopause are still poorly understood by minority communities. This includes the success of hormone replacement therapy (HRT) — a treatment to relieve the symptoms of menopause.
“The stigma around HRT is that if I take this it will give me breast cancer, or if I take this, I’ve been told by people in my community that it will give me clots,” said Dr Arif. “But we must understand the fact that hormone replacement therapy is brilliant for the prevention of osteoporosis. Osteoporosis impacts black and Asian women more because we cover up. We don’t have a lot of sunshine and the lack of vitamin D also contributes to osteoporosis.”
Despite the lack of guidance and information directed at ethnic minority women, the Study of Women’s Health Across the Nation (SWAN) — a 23-year British study funded by bodies such as the National Institutes of Health — found that Black and Asian women tend to go through menopause much earlier than their white peers.
According to the study, Black women experience menopause around eight and a half months earlier, and for longer while facing more severe symptoms owing to a number of factors including tobacco and alcohol consumption and poor physical health.
Latif started perimenopause — a stage before menopause when the ovaries gradually produce less oestrogen — in her early 40s when she experienced brain fog, body temperature fluctuations and weight gain. “I wish I knew that for South Asian women, in particular, we go on this journey as early as 40, when the national average is 50,” she said.
The psychological symptoms of menopause lead to mental health issues, and speaking about mental health in itself is taboo. Fauzia Ahmad, from south-east London, entered perimenopause eight years ago, at the age of 46, when she first noticed changes in her periods.
Her symptoms ranged from hot flushes to fatigue and loss of sleep.
“My mother passed away nearly 10 years ago, but I remember one time she was cooking with beads of sweat running down her. She put a tiny fan in front of the cooker and said it was because of the heat of cooking,” recalled the senior lecturer at Goldsmiths, University of London. “I was a teenager at the time and never really recognised that she was actually going through the menopause.”
Ahmad said the lack of education about the menopause left her unprepared.
“The two significant issues coming from a Muslim background are emotional and sexual,” she said. “The sense that people think you’ve come to the end of your sexual life, you are no longer a sexual person because you’re not having periods any more.”
Dr Arif uses social media to try to cut through religious and cultural misunderstandings.
Through her TikTok videos and social media content, the mother of three tries to empower women to understand menopause and what support is available to them via the NHS. Being trilingual in Punjabi, Urdu and English means she can translate information to her patients, providing them with culturally appropriate care.
“Unfortunately, I get a lot of trolling from people from my communities because saying the word vagina and vulva, and wearing the hijab, just don’t sit right with people from a Muslim background who think these are such dirty words,” Dr Arif said.
To unwrap the taboo on menopause and break down the barriers, there need to be more safe spaces where South Asian women can come together, said Ahmad, who believes more up-to-date training should be provided for doctors and nurses.
“These are such difficult conversations, I know that, but they will only get easier if we empower everybody within our community to talk about it,” said Dr Arif.
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