Menopause Chez Maya 2003

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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: [email protected] (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
mailto:[email protected]:[email protected]


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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.

D.E. Stewart / Maturitas 44 (2003) 293/297294


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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.

D.E. Stewart / Maturitas 44 (2003) 293/297 295


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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.

D.E. Stewart / Maturitas 44 (2003) 293/297296


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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].

References

[1] Stewart DE, Robinson GE. Introduction. In: Stewart DE,

Robinson GE, editors. A clinicians guide to menopause.

Washington, DC: American Psychiatric Publishing Inc,

1997:1/7.

[2] Weber GG. Cross-cultural menopause: a study in con-

trasts. In: Stewart DE, Robinson GE, editors. A clinicians

guide to menopause. Washington, DC: American Psychia-

tric Publishing Inc, 1997:45/62.

[3] Lock M, Kaufert P, Gilbert P. Cultural construction of the

menopausal syndrome: the Japanese case. Maturitas

1988;10:317/22.[4] Beyene Y. From menarche to menopause: reproductive

lives of peasant women in two cultures. Albany: State

University of New York Press, 1989.

[5] Beyene Y, Martin MC. Menopausal experiences and bone

density of Mayan women in Yucatan, Mexico. Am J Hum

Biol 2001;13:505/11.

[6] Mahler R. Guatemala adventures in nature, 2nd ed.. New

Mexico: John Muir Publications, 1999.

[7] Cleland WH, Mendelson CR, Simpson ER. Effects of

aging and obesity on aromatase activity of human adipose

cells. J Clin Endrocrinol Metab 1985;60:174/7.

[8] Seidl MM, Stewart DE. Alternative treatments for meno-

pausal symptoms. Systematic rev

iew of scientific and layliterature. Can Family Physician 1998;44:1299/308.

[9] Stephens C. Womens experience at the time of meno-

pause: accounting for biological, cultural and psychologi-

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[10] Lock M, Kaufert P. Menopause, local biologies, and

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D.E. Stewart / Maturitas 44 (2003) 293/297 297

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