Of course, the symptoms are real. But is the menopause all in the mind?

WHAT i’m about to say will irritate a number of readers. Specifically, it may not go down well with women of a certain age. But here goes. The menopause might be all in the mind.

now, of course, there’s no doubt that there is a biological phenomenon whereby a woman’s reproductive cycle stops. But the associated symptoms that make up what we call ‘the menopause’ are not as clear-cut as you might imagine.

Before i’m inundated with angry letters from those of you plagued by hot flushes, let me reassure you: i’m in no doubt that your symptoms are real. it’s just that there’s no clear biological basis for them, making many doctors, scientists and anthropologists question whether there is something else going on.

There’s no doubt that menopausal symptoms can be crippling. This week, Yasmin le Bon made the news after speaking out about how the menopause affected her memory and weight, and how upsetting this was.

‘You ache all over, you’re tired and fractious and you develop a layer of padding all over,’ the supermodel told a magazine.

These are very common complaints. When i worked in a memory clinic, we’d often see menopausal women referred to us because they were convinced they had dementia, when in fact memory problems are common in this group and can be linked to ‘the change’.

Yet what causes such problems — and other associated physical complaints such as hot flushes, sleep disturbance and mood changes — is not understood. While there’s no clear biological mechanism that neatly explains them, one interesting theory is that the menopause is a result of the West’s obsession with youth.

HEAR

me out on this. There is a group of illnesses that in the Uk few outside of medicine know about. even within medicine, they are confined to a few footnotes in medical textbooks. And yet around the world, millions of people suffer from them.

The thing that sets them apart from other illnesses is that they only occur in specific cultures or societies and are known as ‘culture-bound syndromes’.

They are often regarded as types of mental illness and yet they are not like any mental illnesses we’d recognise. The bizarre symptoms can seem unbelievable to us, but to those affected, they’re very real. Dozens have been reported, but one example is koro.

This occurs in Asia and is a condition in which men suddenly believe that their genitals are shrinking inside their body and they are going to die. it can occur in epidemics, with whole villages and towns succumbing, overwhelming A&e departments.

What is interesting is that while for years Western doctors viewed these conditions as exotic anomalies, we have our own versions. Hysteria, agoraphobia, gulf War syndrome, ADHD, multiple personality disorder and the response to traumatic stress, such as PTSD, have all been considered Western culture-bound syndromes.

in fact, the flashbacks reported in PTSD are actually a relatively new phenomenon and first started being noticed shortly after filmmakers began using flashback sequences to represent past events in films. That’s not to say that these things aren’t real, but it does show the power the culture that surrounds us has on how we experience illness.

So what does this have to do with ‘the change’? Well, as amazing as it sounds to us, not all cultures have the menopause. At least, not in the way that women in the West experience it.

Certainly women stop having periods after a certain age, regardless of their culture. But academics have realised that many of the typical physical symptoms — the hot flushes, the mood changes, the night sweats — are not universally experienced.

in- depth research by medical anthropologist Margaret lock has described how in Japan, where the elderly are held in highesteem, women did not describe the same physical symptoms of the menopause. For Japanese women, entering old age is a positive experience because of the respect they will attract. The negative symptoms Western women experience are unheard of.

Some of the physical changes associated with decreased female sex hormones, such as dry skin, were still experienced, but were not felt to be as troublesome. in sharp contrast to our culture, the women rejoice in the fact that they are ageing.

it’s not a reason to dismiss women’s experiences of the menopause — and it doesn’t mean that what they experience isn’t real. it simply means that the underlying mechanism is far more complicated than being simply a biological process.

For me, this shows the power of the mind and how little we really understand the interaction between it and the body.