Chemical chaos and deathly data silence
- Tamsin Mackay
Menopause may be making itself heard in mainstream media but women across low- and middle-income countries need to shout louder.
“The menopause” has become popular. It’s a celebrity bandwagon, a podcast confession, a late-night show discussion. Yet research into the impact on women’s health is still gasping in its race to catch up, particularly in low- and middle-income countries (LMICs). As Nigel Crowther, Wits Research Professor in Chemical Pathology says, “There’s no data on the impact of menopause in women in Africa, which is a disgrace.”
‘Invisible’ women data dearth
Crowther and Dr Nicole Jaff, Honorary Lecturer in Chemical Pathology at Wits and a board member on both the International Menopause Society and the South African Menopause Society, recently wrote an editorial for the journal Climacteric commenting on the untold story of menopause and how, despite research into specific health risks that emerge during the menopause transition in western countries, there is a “scarcity of menopause-related research in LMICs”.
Jaff was appalled that there wasn’t visibility into how 80% of the women in the region aged reproductively, which inspired her work. In a study conducted in Soweto on 702 black, urban South African women, published in 2015, she explains: “We did strong quantitative research and staged menopause correctly by bleeding patterns, verifying them via blood assays and conducting a wide range of tests to determine cardiometabolic risk factors, menopause symptoms and cognitive changes across menopause stages.”
She explains that the women were delighted to be part of the study and to learn about menopause since it is not easy for women in the resource stressed public healthcare system to see a gynaecologist. Most study participants had never had an annual checkup or even a lipogram, a blood test to screen for heart disease which is especially relevant to menopause because hormonal changes affect a woman’s lipid profile and increase the risk of cardiovascular disease.
Crowther, Jaff and colleagues based at Wits are among the few groups looking into the health impact of the menopause transition, particularly around cardiometabolic and cardiovascular diseases in African women.
Heart health and menopause
“It has been surprising,” says Crowther. “We didn’t see any relationship between menopause and cardiometabolic or cardiovascular diseases in urban populations in South Africa or Kenya, but in rural communities in Ghana and Burkina Faso in West Africa, we did. While our hypothesis isn’t yet proven, we believe that this may be linked to the high prevalence of obesity in the urban populations but we still need to test this theory.”
SA mum on menopause
Why is research on menopause absent in Africa? While studies on menopause are well funded and the topic is highly visible in other parts of the world, in Africa the medical community is battling health on multiple fronts. There’s HIV, tuberculosis and limited access to funding and infrastructure. Menopause slips down the priority list in the face of infectious diseases and nominal healthcare.
“We’ve got a resource stressed public healthcare system alongside different cultural and ethnic attitudes and this is seen as a private issue. It isn’t the norm to talk menopause for many black, sub-Saharan African women,” says Jaff. “They don’t often discuss it with their mothers and there isn’t handed-down information. Our study was one of the first examining the menopause transition and reproductive ageing in black South African women.”
There is also silence around menopause but in Africa it’s the kind of silence that comes from limited understanding and knowledge. This is not a conversation banned by society; it’s one that isn’t being had properly.
Hot topic
“There isn’t silence on the topic – menopause has become the hottest topic on the planet in the past decade,” says Jaff. “However, in the public health sector in South Africa you have a resource stressed system with nurses and medical practitioners who have limited knowledge on menopause – it is undertaught and is not a topic that is widely discussed, though our study showed that women were aware of menopause.”
Now think of the impact of the symptoms on women who don’t know what’s happening to them or why they are suddenly experiencing night sweats, brain fog, hair loss and dry skin. They don’t know that fluctuating hormone changes and declines in oestrogen and progesterone may be putting them at risk of cardiovascular disease or osteoporosis.
Studies have shown that vasomotor symptoms (hot flushes and night sweats) are not necessarily harmless and may increase the risk of cardiometabolic disease and impact on the quality of life of women.
More research is needed to generate effective information on modifiable risk factors that may help alleviate these symptoms and improve midlife health in women in South Africa and beyond.
Education is critical, as is increased funding – because without adequate funding, menopause will keep losing ground to other healthcare claims.
- Tamsin Mackay is a freelance writer.
- This article first appeared in?CURIOS.TY,?a research magazine produced by?Wits Communications?and the?Research Office.
- Read more in the 20thissue, themed #Thrive, which explores what it truly means to flourish — across a lifespan, within communities, and on and with our planet.