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Menopause in highland Guatemala Mayan women
Donna E. Stewart *
Lillian Love Chair of Womens Health, University Health Network, 657 University Avenue, ML 2-004, Toronto, Ont. M2G 2N2, Canada
Received 14 February 2002; received in revised form 5 November 2002; accepted 7 January 2003
Abstract
Objectives: To explore any feelings and symptoms surrounding menopause among Mayan women in three
ethnolinguistic groups in highland Guatemala and compare these with previous reports from Mexico. Methods: This
was a qualitative exploratory study of the experiences around menopause of eight middle aged women and one local key
informant in each of three villages in western highland Guatemala (n0/27). Individual interviews were conducted in
women with irregular menses or whose menses has ceased in the last 3 years. Field notes were kept and then an analysis
undertaken by the author. Results: Twenty-four Mayan women, aged 38/55, and three Mayan key informants (all
women over age 50) were interviewed. Most women reported some symptoms, including hot flashes, night sweats,
changes in libido, irritability, moodiness, abdominal cramps and menstrual clots occurring at some stage during the last
3 years. Although women reported symptoms, they mostly accepted them with equanimity; and rejoiced at the cessationof their periods. Conclusions: Highland Guatemalan Mayan women reported symptoms that were not reported in
Mayan women in Yucatan, Mexico in the years surrounding menopause. The reasons for this disparity are unclear but
may reflect differences in body weight and diet. Despite these symptoms, Mayan women looked forward to menopause
and their newfound freedom and status. Symptoms in women in the years around menopause must be interpreted in
geographical, nutritional, biological, psychological and cultural context.
# 2003 Elsevier Science Ireland Ltd. All rights reserved.
Keywords: Menopause; Mayan women; Symptoms
1. Menopause in highland Guatemala Mayanwomen
Menopause is a complex biologic phenomenon
embedded in a sociocultural and psychologic
context that may affect the experience of this
normal life event [1]. Studies of women undergoing
menopause in other cultures or countries (Japan,Greece, Mexico) have found differences in symp-
toms and meaning than those commonly reported
by women in western industrialized nations [2/4].
One of the most frequently cited studies looked at
Mayan women in the Yucatan peninsula in
Mexico and found that menopause was not
associated with any changes other than cessation
in menstruation [4,5]. Specifically, there were no
reports of hot flashes, night sweats or emotional
changes. But Mayan women are not a single entity* Tel.: '/1-416-340-3846; fax: '/1-416-340-4185.
E-mail address: donna.stewart@uhn.on.ca (D.E. Stewart).
Maturitas 44 (2003) 293/297
www.elsevier.com/locate/maturitas
0378-5122/03/$ - see front matter # 2003 Elsevier Science Ireland Ltd. All rights reserved.
doi:10.1016/S0378-5122(03)00036-7
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as there are over 20 distinct Mayan ethnolinguistic
groups in Southern Mexico and Guatemala alone
[6]. The purpose of this study was to explore the
experience of menopause in Guatemalan Mayanwomen from three different ethnolinguistic groups
and to compare this with previous reports about
Mexican Mayan women.
Mayans were master architects, builders, scho-
lars, weavers, ceramists and farmers who flour-
ished in Southern Mexico and Central America for
over 1000 years [6]. Talented and clever, they
developed independent thriving city/states which
intermittently fought and traded with each other
until their mysterious decline around 800 AD
Despite this decline, over 8 million full-bloodeddescendents still occupy much of their original
homeland and maintain their own culture, lan-
guages, diet, health practices and customs away
from the eyes of prying strangers. Each village has
its own government and customs, which include
the wearing of traditional hand-woven garments
(traje) that are often unique to that village [6].
Although many men now wear western clothes,
most women in the villages reported in this
study continue to make and wear their traditional
blouses (huipils). Life in western highlandGuatemalan villages is hard and consists mostly
of subsistence farming by hand on volcanic
terraced slopes, supplemented by fishing in villages
around Lake Atitlan. Food scarcity is not un-
common.
1.1. Methods
This was a qualitative exploratory study of
Western Highland Guatemalan Mayan womens
experience and feelings around the time of meno-
pause. Individual middle-aged Mayan womenwere recruited from markets and small towns or
villages in the Western Highlands of Guatemala
through direct contact by the researcher (who has
visited these villages for over 30 years) or through
local key informants, women who were market
organizers or healers (curanderas or midwives).
Women were recruited from three villages repre-
senting three distinct ethnolinguistic groups, Na-
huala (who speak Quiche), Santiago Atitlan (who
speak Tz, utujil) and San Pedro la Laguna (who
speak Cakchiquel). San Pedro la Laguna and
Santiago Atitlan are villages surrounded by volca-
noes on the southern shore of Lake Atitlan, while
Nahuala is a traditional highland village that until
recently did not permit non-villagers to stay over-
night. Traditional religious and cultural beliefs and
behaviors are common in all three villages,
although Catholicism and Protestantism are also
practiced in concert with animist beliefs and
ceremonies [6].
Women were asked in Spanish or their local
language (translated by key informants) to de-
scribe What happens around the time when
women finish having their menstrual periods at
midlife? Probe questions included any specialfeelings or experiences, special foods, herbs or
practices that the women engaged in during the
time when their periods were becoming irregular,
different or after stopping.
Women, none of whom could read or write,
were informed that the researcher was interested in
womens health and wished to privately discuss
this with any woman who was in midlife and
noticed her periods changing or whose periods had
stopped during the last 3 years. After some initial
hesitance and negotiation, permission was givenfor the interview, which lasted 1/2 h in the
womans home. The negotiation resulted in an
agreement that the researcher would visit the
womans home for the interview and would
purchase a handmade huipil at the market price
($20 US) from each eligible woman who partici-
pated, up to eight per village. In keeping with local
practice, women continued their household tasks
during the interview and many continued to care
for children and spin cotton or weave on their
back strap looms while engaged in animatedconversation. Permission was sought to tape
record or take contemporaneous field notes during
the interviews but this was refused by all women
with comments such as you will be guided to
remember that which is important and will forget
that which is not. Field notes were written
privately by the researcher immediately following
all interviews and summaries of key points and
themes were constructed before leaving each
village.
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1.2. Results
In total, 24 women and three key informants
participated; comprised of eight women and onekey informant for each village. All women ap-
peared to be middle aged and reported either
irregular periods or cessation of menses in the last
3 years as a criteria for inclusion. They ranged in
age from 38 to 55-years of age, among those who
knew their age in Gregorian calendar years.
Women who had not had a period for over 12
months reported a mean age of menopause of 48
years. All women were married and had a mean of
seven children (range 3/15) with a mean age at
first birth of 18 years. The women were short instature and thin, and nine appeared malnourished.
All reported daily strenuous activity of hauling
water, working in fields, carrying firewood, and
hand-washing laundry, spinning and weaving.
Women from all three villages reported being
pleased that their periods had or were stopping as
they felt this gave them greater social and religious
freedom: then you can go anywhere and do
anything without worrying. Twelve explained
this meant being free of menstrual taboos or the
inconv
enience of bleeding. Twenty women wereexplicit in saying they welcomed the knowledge
that they could no longer become pregnant. Five
women reported more sexual freedom but 11
reported a loss of sexual interest or discomfort
with sexual intercourse. Seven women felt stron-
ger as a result of no longer having heavy periods
or pain associated with periods.
Eighteen women in all three villages reported
feeling heat or hot during the months or years
surrounding the cessation of periods. Eight women
described this as a continuous feeling of hotness in
their bodies while ten described it as hot spellslasting a few seconds to minutes. Ten described
hot spells with sweating at night, which disturbed
their sleep. Twelve women reported more vivid
dreams, which awakened them. An unexpected
revelation occurred while interviewing women
from Nahuala who reported changing their tradi-
tional heavily woven blouses (huipils) to lighter, V-
necked, cotton huipils bearing only an embroi-
dered seam stripe (randa) to counteract the
increased body heat during and following meno-
pause (see Fig. 1 and Fig. 2). Women were careful
to emphasize that not all-older women changed
their huipils permanently but most did it when the
heat bothered them most. The author subse-
quently noted many middle aged and older women
Fig. 1. Nahuala. A heavy huipil worn by younger women.
Fig. 2. Nahuala. V-necked light cotton huipil preferred by
middle-aged women.
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(but no younger women) in the market wearing
these lighter, V-necked huipils.
Fourteen women in Nahuala and Santiago
Atitlan reported increased irritability, moodinessand anger during the years their periods were
changing or stopping. Three Santiago women
reported having more arguments while four
Nahuala women felt that their true nahual
(supernatural animal double) was being exposed.
Two women from Nahuala felt the animal spirit
was proven by the presence of irregular heartbeats
or occasional feelings of lightheadedness or faint-
ness. One woman from San Pedro reported
changes in mood like the ripples that play across
Lake Atitlan in the afternoon breeze*/changingthis way and that.
Fourteen women from all three villages reported
episodes of heavy periods accompanied by abdom-
inal cramps and clots at some stage of the
menopausal transition. They reported treating
this with steam baths, lower abdominal massages
from midwives and sometimes herbs from the
mountains. Although women found these symp-
toms inconvenient, they emphasized they usually
lasted only a few months and the problem
usually cured itself. Six women, howev
er, hadexcessive bleeding which resulted in weakness and
fatigue.
During the years leading up to menopause
women continued to eat their usual diet which
consisted mostly of maize, beans, sweet potatoes,
fruit, fish and occasional fowl or meat. None of
the women reported seeking western medical care
for the symptoms reported, although consultations
with curanderas and midwives and discussions
with friends were common. Despite reporting
symptoms the women accepted these with equani-
mity and regarded them as a natural part of life.
1.3. Discussion
Mayan women from all three rural villages
representing distinct ethnolinguistic groups
(Quiche, Tzutujil and Cakchiquel) in Western
Highland Guatemala described symptoms similar
to those reported by women in western industria-
lized societies including hot flashes, night sweats,
changes in libido, irritability, mood lability, anxi-
ety, palpitations, lightheadedness, menstrual
flooding and irregularity prior to the cessation of
menses. As these women were illiterate, lead a
traditional Mayan village lifestyle, had infrequentcontact with outsiders, had only recently had
access to electricity and had not consulted Western
health care providers about their symptoms, it is
unlikely that the reporting of these symptoms had
been learned or suggested to them. The author was
careful during the interviews to refrain from
asking leading questions and to restrict herself to
inquiring about details or explanations. Key
informants confirmed that many of these symp-
toms or complaints were discussed in the village or
market among middle-aged women. Curanderasand midwives confirmed that the womens descrip-
tions depicted the common complaints brought to
them by midlife women for treatment over the
years.
The differences in these findings with those
previously reported by Beyene and Martin in
Yucatan [5] is perplexing given the similarities in
genetic background, parity and lifestyle in our
Mayan women. Whether differences in diet, body
weight, location or time since the previous study
can explain these apparent differences remainsunknown. It is noteworthy that Yucatan Mayan
women were described as stocky with a high
body mass index [5] while the women I inter-
viewed in highland Guatemala in general appeared
malnourished and thin. It is known that adipose
tissue is the principal site of estrogen formation in
menopausal women by conversion of adrenal
androstenedione to estrone by aromatase activity
[7]. Slimmer North American women compared
with women who are fatter are more troubled by
hot flashes [1], and this may also be true for
Mayan women. Phytoestrogens have also beenshown to diminish menopausal symptoms related
to estrogen deficiency [8] and it is possible that
differences in diet or herbal remedies between
Mayan women in the Yucatan and Guatemala
may also explain symptom differences. Whatever
the explanation, it is clear that traditional Mayan
women in the three villages described in Western
Highland Guatemala, reported a range of symp-
toms around menopause unlike their sisters in
Yucatan.
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Despite differences in symptom reporting, Ma-
yan women in both Yucatan and Guatemala
shared feelings and views on the significance of
menopause that are at variance with the majorityof women in westernized, industrialized, youth
oriented cultures. The Mayan women in both
countries rejoiced at the cessation of periods and
felt increased freedom and status, perhaps partly
because they had spent most of their lives from
puberty to menopause either pregnant or nursing.
Menopause not only liberated them from preg-
nancy and infant care but also allowed them more
opportunity to participate in village ceremonies,
religious activities, socialization and governance.
In highland Guatemalan women the inconve-nience of temporary symptoms around the time of
menopause was seen as normal and manageable
with the support of midwives and friends. Perhaps
the overall harshness of the highland Guatemalan
womens daily lives, their ability to cope with
transient symptoms at menopause, and to see them
as natural events in the progression of moving
towards greater status and freedom lead to an
acceptance of any symptoms associated with
menopause. This is hardly surprising, in the
context of a high maternal and child death rate,chronic poverty, malnutrition, unremitting toil
and 30-years of bloody civil war experienced by
highland Guatemalan Mayan women. These find-
ings again highlight the importance of interpreting
symptoms around the time of menopause in a
nutritional, biological, psychosocial, economic,
political, geographic and cultural context [9,10].
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