Menopause without Symptoms: The Endocrinology of Menopause Among Rural Mayan Indians

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Menopause without Symptoms: The Endocrinology of Menopause Among Rural Mayan Indians

Mary Martin, MD; JE Block, PhD; SD Sanchez, MSc; CD Arnaud, MD; and Y Beyene, PhD, American Journal of Obstetrics and Gynecology, Vol. 168, No. 6, Part I, June, 1993.

These researchers tell us they began their study of 52 post menopausal Mayan women with the hypothesis that menopause in these women was endocrinologically different from menopause in women from the United States. They based their guess on two observations: that Mayan women do not experience the hot flush and that both population and individual histories suggest that few Mayan women suffer from osteoporosis.

The authors report that their hypothesis was not borne out by the facts; the endocrine changes of the women studied were similar to those reported for women in the United States. Estrogen levels in the Mayan post menopausal women were at or below the values expected for women in the United States. Furthermore, the bone density measurements of the Mayan women showed that bone demineralization does occur with these women. But why so little osteoporosis? Why no hot flushes? (The expected incidence of hot flushes was 60 to 80 percent of menopausal women, and the incidence in this population was zero.)

A possible explanation, the authors tell us, might be difficulties of translation, but they point out that their primary interviewer was a Mayan woman who had completed a 3-month health aid course and functioned as a nurse's aide in the village. She was fluent both in Spanish and Mayan and was the friend of many of the women who were studied. They conclude the article by saying they cannot explain the markedly different symptoms between menopausal women in the United States and the group of Mayan women they studied.

They do mention, however, that menopause is welcomed as a favorable transition to a new niche in the village life-style, "characterized by relief from childbearing, acceptance as a respected elder, and a surrendering of many household chores to the wives of married sons." In other words, they describe a matrilineal system.

Just as interesting as the report itself is the discussion that follows. Dr. Purvis Martin of San Diego, California, wonders if the Mayan women's cardiovascular status might be improved by estrogen therapy. He asks if it might improve their quality of life and extend their life span. And, he adds, "May I also suggest that fractures are uncommon among these women because they are so short that they do not have far to fall?"

Dr. Tawfik Rizkallah, of Phoenix, Arizona, writes that he is not surprised to see no decrease in bone density among the Mayan women. "They are working people who exercise every day, working in the fields and doing other physically demanding chores. If menopausal women are placed on a walking exercise for 1 year, accompanied with a diet with about 800 mg of calcium per day, there is no decrease in bone density."

Ina May Gaskin.

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