The meaning and experience of menopause among Hmong women from Laos is examined in this paper. Hmong women see the menopause as part of growing old. A woman becomes menopausal only when she has borne all of her children. Although having many children is highly valued women do not see menopause as a negative stage since they have already borne many children and thus have ensured the continuity of lineage. Women also associate menopause with the polluted nature of menstruation. Once menstruation has ceased a woman becomes clean like a man and she is able to relax more. It appears that Hmong women perceive menopause as positive and that they experience few so-called menopausal symptoms. However, because of the availability of western health care and the relative unavailability of traditional herbal medicines and healers in Australia, women seek help from mainstream health services when they experience ill health of any kind. This inevitably puts women in mid life into contact with current medical interpretations of menopause. Will Hmong women be encouraged to interpret menopause as a medically oriented event and thus experience menopausal symptoms in the way many Australian women do? It remains to be seen.
INTRODUCTION
Menopause is a universal event in the lives of all women. Biomedically, menopause is seen as a biological event and prior to the mid-seventies it was seen as an estrogen deficiency disease (Wilson, 1966; Kase, 1974; Weideger, 1977; Kaufert & Gilbert, 1986). Social scientists argue, however, that menopause is a sociocultural event. The physical changes of menopause are only one part of women's life experiences. They are interwoven with the woman's social status, sex role, personal circumstances, life history and stage of health (Bart, 1969; Flint, 1975; van Keep & Kellerhals, 1975; Townsend & Carbone, 1980; Lock, 1982; Brown, 1982; Davis, 1986; Beyene, 1986; Barnett, 1988; Kaufert, 1982; Chirawatkul, 1992, 1993). Rosenberger, for example, (1986:15) points out that:
while menopause has a biological base, it is an experience that differs according to cultural values. Menopause draws its meanings from more basic concepts within the culture such as the meaning of women's reproductive power, the role of women in the social structure and the relationship of the physical and the psychological.
In her paper on "Myth and the menopause", Kaufert (1982:144) puts forward a similar argument. She states that:
like childbirth and menstruation, there are two levels of reality to menopause. One is the actual physical changes that occur in a woman... all women who survive and have intact ovaries pass through the menopause. 'Passage through the menopause' is also an event occurring within a socio- cultural context. It is this - the cultural dimension of the menopause - which forms the second level of its reality.
Kaufert argues that a woman who belongs to a culture that perceives the menopause as symptom free will not experience menopausal symptoms related to physical changes in mid life such as hot flushes and depression. These women then pass through the menopause without difficulty.
In this paper the experience of Hmong women who migrated from the high mountainous areas in Laos and are now living in Australia is used as a paradigm case to analyse the cultural interpretations of menopause. Following the framework of Kaufert, the paper examines two realities: the meaning of menopause and the experience of changes as perceived by Hmong women.
Perceptions and experiences of menopause in a more advanced society are changing. This is in part because of the development and availability of medical technologies (Chirawatkul & Manderson, in press). How do Hmong women who are now living in Australia and experiencing dramatic changes in the process of adaption to living in a western environment see and experience menopause? This is the focus of this paper.
THE HMONG
Hmong women are refugees from Southeast Asia. They have been accepted as immigrants in Australia since 1975. However, the majority of them are recently arrived . The Hmong in Australia come from Laos where they lived as hilltribes in the high mountainous areas. Embroiled in the fighting between the American forces and the Pathet Laos, the communist group in Laos, the Hmong were forced to move out of their homeland in the mountains and escaped to Thailand. The majority were accepted to resettle in the USA. In Australia the main concentration of the Hmong is in New South Wales, though there are some Hmong in Tasmania and also an increasing number in Queensland. In Victoria the Hmong live in close knit groups, mainly in highrise public housing in Fitzroy, an inner Melbourne suburb and in Coolaroo, an outer Northeastern suburb.
In general the Hmong are much poorer than other Southeast Asian refugees. The majority are unemployed. Most Hmong did not have any form of formal education in Laos because of the war and their geographic position. Because most Hmong are recent arrivals, they are still learning English.
The Hmong are animistic and follow Ancestral worship. They believe in reincarnation; the rebirth cycle. The Hmong are patrilineal and patrilocal. The family names follow the clan system. There are nine clans in Melbourne.
The usual Hmong family is large. Most Hmong women in this study have about four to six children and it is likely that they will continue to bear more children. Traditionally, the Hmong put a high value on having many children, particularly boys, since they could help in farming and continue traditional practices such as worshiping ancestral spirits and caring for their parents in old age. Such traditional customs (except for the farming) are still practised even though they are now living in Australia.
THE STUDY
This paper draws on data from on-going ethnographic research on the reproductive health of Southeast Asian women - Hmong, Lao, Vietnamese, Cambodian, and Thai women - now living in Australia. This paper only reports the data of Hmong women.
Ethnographic interviews were employed to elicit information. This was appropriate since the goal of this study was to discover and understand the respondents' perspectives (Spradley, 1979). I conducted interviews covering a number of issues concerning reproductive health, including the beliefs and practices related to childbearing, menstruation and menopause, with 23 Hmong women in Melbourne, Victoria. The majority of the women had experienced childbirth while living in Laos or in a refugee camp in Thailand as well as in hospitals in Melbourne.
The demographic characteristics of Hmong women in this study are presented in Table 1.
Table 1. Charateristics of Hmong women
| CHARATERISITICS | NO | PERCENTAGE |
| AGE | ||
| 20-30 | 6 | 25.09 |
| 31-40 | 8 | 34.78 |
| 41-50 | 4 | 17.39 |
| over 51 | 5 | 21.74 |
| MARITAL STATUS | ||
| Married | 18 | 78.26 |
| de facto | 1 | 4.35 |
| Widowed | 4 | 17.39 |
| NUMBER OF CHILDREN | ||
| 1-3 | 4 | 17.39 |
| 4-6 | 14 | 60.87 |
| 7-9 | 1 | 4.35 |
| 10 and over | 4 | 17.39 |
| LEVEL OF EDUCATION | ||
| None | 17 | 73.91 |
| Primary | 6 | 26.09 |
| CURRENT ACTIVITIES | ||
| Home duties | 16 | 69.57 |
| Learning English for migrants | 7 | 30.43 |
| No OF YEAR IN AUSTRALIA | ||
| 1-3 | 6 | 26.09 |
| 4-6 | 13 | 56.52 |
| 7 and over | 4 | 17.39 |
| No OF FAMILY MEMBERS | ||
| 1-3 | 2 | 8.70 |
| 4-6 | 8 | 34.78 |
| 7-9 | 39.13 | |
| 10 and over | 4 | 17.39 |
| LENGTH IN REFUGEE CAMPS (YEARS) | ||
| 1-3 | 4 | 17.39 |
| 4-6 | 2 | 8.70 |
| 7-9 | 5 | 21.74 |
| 10 and over | 12 | 52.17 |
| MENAPAUSAL STATUS | ||
| Premenapausal | 14 | 60.87 |
| Postmenapausal | 9 | 39.13 |
The women were recruited by word of mouth and through a Hmong community representative. The women were initially approached by phone, but for those who did not have telephone, in person. Once they agreed to participate, an interview time was organised to suit their demands. Twenty-three women were included on the basis of availability of participants. The women were individually interviewed in their own homes. All interviews were conducted in the Hmong language with the assistance of a bi-cultural research assistant (BL) who is a Hmong native born woman. She has worked for and represented the Hmong community in Melbourne for more than ten years and she is well known and accepted by most Hmong here.
Informed consent was obtained after the information about the research and the woman's participation were clearly explained to her.
Each interview was tape-recorded. The length of the interviews varied, depending on the women's responses. In general, each interview took between two and three hours. Most women were interviewed once. There were, however, a number of occasions when I needed to obtain more information. Those women were then visited for a second time.
In addition, a participant observation method was used to allow me to observe and record the Hmong cultural beliefs and practices and their experiences in Australia more fully. I attended a number of Hmong ceremonies and participated in Hmong activities. Prior to attending ceremonies and activities I sought permission from the women and their families for my presence. The Hmong community was aware and informed of my presence and of my research purpose. Prior to entering the community for my fieldwork I attended one of the community's fortnightly meetings and sought permission from the community leaders. Without their permission I would not have been able to enter the community and conduct my fieldwork.
The interviews and participant observations were conducted between May 1993 and February 1994.
A content analysis approach was used to derive patterns in Hmong women's beliefs and practices. Put simply, recordings of interviews were transcribed for detailed analysis. The transcripts were examined for the women's explanations related to the concept concerned. From these, several themes were derived (Spradley, 1979).
THE MEANING OF MENOPAUSE
In the Hmong language there is no equivalent word for menopause. The concept of menopause is understood as 'tsis coj khaub ncaws lawm', which literally means 'no more menstruation'. In general, menopause is associated with 'pog laus': the terminology used for an old lady, an older person or a grandmother, and is seen as a natural part of 'growing old'. The women's interpretations of menopause are presented in the following sections.
NO MORE CHILDREN : NO MORE MENSTRUATION
Menopause is interpreted as the consequence of transition from fertility to infertility. Hmong women perceive that women reach menopause only when they are no longer fertile; they have borne all of their children. The following conversation illustrates the point:
Researcher: How old is a woman when her menstruation stops completely?
Informant: After you have all of your children... I don't know how old, it depends on the person. Some will have only seven or eight children and then their children will be finished and have no more, but some others will have over ten children before they finish their children, and that is when you have no more menstruation.
Women were quite definite about this.
With Hmong people their children are definitely finished before their menses stop.
My children have finished that is why I don't have it any more. After I had the youngest son in 1985, it just stopped since then.
However, most Hmong women believe that in a lifetime a fertile woman may become pregnant up to 13 or 14 times. Hmong women also believe that early menarche means early menopause. Hmong people say that if you have your menses when you are about ten or twelve and being that early it will finish early. Even if you are not very old it will stop. But if your menses start at the age of fourteen or fifteen then you will still have your menses when you are quite old.
All postmenopausal women in this study became menopausal relatively young; when they had just passed their forties (mean age is 43 years old).
MENOPAUSE : NO MORE CHILDREN
Women, once married, are expected to bear many children. Having born her first child, a Hmong woman has fulfilled her most important role for the family since she is able to provide continuity for the patrilineage. Most Hmong women believe that they must have at least as many children as their mother or mother-in-law (Symonds, 1991). Children are the assess of the family, particularly male children. Children are necessary for one's well-being, not only in this life but also the afterlife. If a woman does not bear children there will be no one to look after her in old age. More importantly, if she does not have sons, then there will be no one to care for the family altar and feed the ancestors, including herself when she dies. This makes having children an vital part of life for Hmong women.
Due to this, some women regretted being no longer able to bear children. However, the majority of Hmong women have already borne many children. They thought that menopause was a positive aspect of their life. The following conversation illustrates this:
Researcher: Do you think no more menses is a good thing or a bad thing?
Informant: It is a good thing.
Researcher: In what sense do you say it is a good thing?
Informant: It is good in that I will have no more children... I am getting old and very tired of looking after children and if I don't have anymore then it does not matter.
When I prompted the women with the importance of bearing children and if it would worry them once they had no more menstruation, their answers had much in common with the following explanation:
No more menstruation does not bother me. I think that I have no more children and I am happy that I have finished my children, I have done my duty of being a Hmong woman. So when my menstruation stops I am not worried about it.
MENOPAUSE AS CHANGE OF ROLE AND STATUS
Hmong girls and adolescents do not have equal social or familial status to Hmong boys and men. However, their status changes when they marry and are able to bear a child. The birth of the first child brings prestige to a Hmong woman. After giving birth to her first child a Hmong woman becomes "Pao's mother". She is no longer addressed as "my younger daughter" by her parents, nor as "woman of Vang Jia Lee" by others (Symonds, 1991). Women gain respect and status from all when they produce children. The woman's status changes again once she becomes old. Older women are referred to as 'cov txwj laus' (respected elders) and are addressed as 'pog laus' (grandmother) by all (Symonds, 1991). Since menopause is associated with old age, postmenopausal women are, therefore, respected and have higher status than when they were still young.
Once women reach menopause, their role is shifting from childbearing to childrearing; from caring for their own children to looking after their grandchildren. Women said that their life with children did not end with menopause. By the time Hmong women reach menopause their daughters or daughter-in-laws have already reached the childbearing stage. They help in rearing and looking after their grandchildren since their daughters or daughter-in-laws are engaging in childbearing and other domestic activities or working in the field.
Older women are not bearing more children. At that time your children will be older and you can just relax, but if they have some children then you help them with their children.
MENOPAUSE AND AGEING
Women associated menopause with ageing. When a woman reaches menopause she is old.
Now I think that I am old and that I will have no more children. I have had many children and that is why it is finished and that is why I don't have any more menses.
I think that when you are old you run out of that menstruation blood, you have no more of it.
The majority of Hmong women did not see ageing as problematic. By that time their children would have all grown up. They did not need to be as concerned about the survival and well-being of their children they had when the children were younger.
I am not too worried about getting old. By that time my children would have all grown up and I don't need to be worried about being poor, if it would be enough food to feed them, or if it would be enough clothes to keep them warm, that sort of things.
The Hmong have strong a belief in the Confucian values of filial piety. Adult children have the duty of looking after and taking good care of their aged parents. Among the Hmong the duty extends even to the period after the death of their parents. Male children continue to feed and worship their deceased parents to ensure their reincarnation (Yang, 1992).
However, some Hmong women felt worry about being old. They associated old age with the near death stage. This means they would not be with their children and grandchildren very long.
I am worried that I am getting old and I may not live long any more because when you get old then you will die, that is what I think about.
I feel sorry that I am getting old and that all that is waiting for me now is death.
MENOPAUSE AND MENSTRUATION
Menopause and menstruation are women's business. Hmong women believe that women and menstruation are inextricably linked at a conceptual level. Being a woman means to menstruate. In fact the term commonly used to mean menstruation by the Hmong is 'ua poj niam', which literally means "being a woman". Menstruation is essential for a woman to be able to bear children.
For women, menstruation is a natural part of life and if you don't have it then you will not be able to have children.
During the monthly cycle menstrual blood is retained in the woman's womb. The womb functions as 'a dam' and the blood is kept in it for being ready to 'make' and 'feed' the foetus. If the foetus is not 'made' at the end of that month, the blood then turns 'bad' and it needs to be got rid off. The retaining of the 'bad' blood causes ill health in women. Common symptoms include being pale and skinny, having dull eyes, and having no energy. It is also believed to lead to death if the bad blood is retained in the woman's womb for a lengthy period of time.
Despite its importance for conception, menstruation is seen as polluted, shameful and embarrassing. This was reflected in the interviews. Very often women made remarks about the embarrassment and shame of menstruation.
I am telling you this, if we talk about our body having that dirty thing, with the Hmong, it is the most embarrassing thing to talk about.
It is a shameful thing but you have to have it for you to have children. If you say it is a likeable thing, no it is not, I don't like it.
Because of the perceived pollution of menstruation, there are a number of prohibitions associated with menstruation. Sexual intercourse during menstruation period is avoided. Men do not wish to have intercourse with their menstruating wife due to the 'unclean' nature of menstruation. Women are warned not to cross rivers or streams while menstruating and the clothes worn while menstruating are not washed in rivers or streams. The Hmong believe that the spirits of the streams may become angry. The spirits are able to trace a woman through the smell of her menstruation and 'strike' her. This causes miscarriage whenever she conceives. Repeated miscarriages in turn cause infertility in the woman.
If you are menstruating and you go into the swamps or river at the moment the spirits wake up you will be struck by them... If the spirits touch you then you are going to miscarry... When you get pregnant they will come and destroy it.
When you have your periods you should not go to wash your clothes in a river or throw the dirty water into the river. If you do this you can be struck by the spirit and this will cause you to be sick. And when you get married it will cause you not to have any children and it is very hard to fix this.
Because menopause meant no more menses, menopause was then seen by the women interviewed as no longer being polluted and being clean. Women looked forward to this stage when they would no longer be seen as polluted and dirty. A postmenopausal woman made the following remark:
I hated that dirty thing very much so when I became clean then I was very happy I did not have any more of that, that I did not have to be embarrassed towards other people any more.
Very often the women compared themselves to "the cleanness" of a man when they have reached menopause. This was particularly so when I asked what they thought about ceasing menstruation. Typical answers were:
Good, it is the best thing that can happen to you, no more children and you are very clean like the men.
You will just be like a man, if you don't have any of that menstruation, then it is good...it won't be difficult for you.
For me, my menses became very bad and I hated it so much I got some herbs and took them. After taking the herbs I became very clean like the men.
THE EXPERIENCE OF MENOPAUSE
Postmenopausal women in the study were asked if there were any physical changes which occurred after the cessation of menstruation. Interestingly, the women could not remember any physical changes after they became menopausal. However, all women could recall that their menstruation became irregular, lighter in particular, in the last year of their reproductive life.
When it nearly stopped it was lighter then usual, it did not come as heavy as usual, and then it stopped...and I have not had it since then.
It became lighter and lighter and then just stopped. It ran its normal cycle and when it was time it just stopped.
There was no report of hot flashes, flushes or night sweating among these menopausal women. They said nothing had changed physically.
I have no effect from not having the menses. I still have good appetite but may be I am old, that is why it is hard for me to have put on weight but my appetite is the same and my health is the same.
I have not had any bad health since it stopped. I am today the same as I was before, no problems.
However, a number of women were surprised to learn that many Australian women experience some ill health when they become menopausal. They interpreted this as not observing traditional restrictions after childbirth the way Hmong women would do. Hmong women, in common with women from other cultures in East and Southeast Asia, observe particular confinement practices in the first month after giving birth (Pillsbury, 1978; Mougne, 1978; Manderson, 1981; Laderman, 1987; Chu, 1993). A woman must lie near a fire for most of the day in the first three days after birth. They believe that because a woman loses blood in childbirth her body becomes 'cold'. The practices to regain the body heat lost in childbirth are therefore essential in order to avoid bad health in old age. During the confinement period, a woman must eat only hot rice and chicken soup cooked with several special green herbs. Any cold food such as fresh vegetables and fruits is prohibited. Cold water is particularly dangerous to a new mother (Rice, 1993, 1994). These confinement practices, the Hmong believe, are protective to a woman and hence she will not have any ill health in old age. Therefore, any symptoms of ill health which occur from middle age onward are interpreted as resulting from not following the traditional confinement practices during childbearing years.
Women were also asked if they had experienced any emotional change or difficulty after menopause. Again women said that they had not experienced any. Common answers given were:
There is nothing, I am very comfortable and very happy.
I am happy with my life, my children and my grandchildren. Nothing like that (emotional difficulty) has happened to me.
I also asked the women whether their health in general changed after menopause. Women found it rather amusing that I asked such a question. Some made remarks like:
This is a natural part of growing old and when it stops because you are old then there should not be anything wrong with your health.
When you are old and you just don't have it any more your health will still be the same as before, there is nothing wrong with not having any more menstruation because you are old.
The same question was raised with premenopausal women. Most women believed that the cessation of menstruation would not make them unhealthy. It would, however, have an effect on their 'strength'.
When you do not menstruate, when you are about forty-five or so, you are old and can't do many things. You won't be as strong as before so you can't do too many things.
Women also believed that once menstruation ceased a woman may gradually become blind and this was seen as being associated with old age.
They say that if you don't have that (menstruation) it makes you go blind. I can't thread the needle any more. That is what happens, it is a sign of getting older. When you get older you have no more blood so that you can't see as well as before.
DISCUSSION AND CONCLUSION
This paper examines the meaning and experience of menopause among Hmong women. Menopause is seen as a natural part of life which any 'pog laus' has to experience; it is part of growing old. By the time the women become menopausal they have borne all of their children and their children have grown up. They therefore have done their duty: the duty of motherhood being to ensure the continuity of the family lineage by giving birth to their sons or daughters to bring in son-in-laws. Once the women reach this stage they are more respected and they become a 'grandmother' to all. Women at this stage do not have to deal with the monthly business of menstruation. They no longer feel shameful about having menstruation and do not have to worry about being embarrassed from it. Women are able to feel more relaxed once their menstruation ceases. It is not surprising then that the Hmong women interviewed mostly welcome the menopause.
However, some women have ambiguity about the menopause. Some women see the menopause as the near death stage and thus they would not have much time left with their children and grandchildren.
In this study the Hmong women experienced no physical changes apart from irregular menstruation in the last year of their reproductive life. Women did not recall any other physical symptoms that occurred in that year nor after their menstruation had ceased.
This positive attitude and experience of menopause can be discussed by examining the nature of menopause within the theoretical anthropological frameworks.
THE POSITIVE ATTITUDE TOWARD MENOPAUSE
Kaufert (1982: 145) writes:
The menopause marks the end of fertility, and attitudes towards the menopause will be the product of the status of women in society, to the extent that the latter reflects the value attached to their reproductive capacity. To understand what the menopause means in the lives of women in any particular society, the event must be set within the full context of women's role within that society.
As Kaufert has illustrated, Brown (1985) demonstrates that in traditional societies the change in a woman's life in middle age appears to be positive. In most of these societies a young woman is restricted and her life is "subservience and toil". One she is middle- aged, she has more authority and leisure. There are three major changes occurring in the life of middle-aged women in traditional societies. They are freed from many restrictions imposed on them when younger such as menstrual restrictions. They have authority over some younger kin including making important decisions for them. They are also eligible for special status and this allows them to have more freedom, not confined to the household. All of these changes improve the status of middle-aged women and it is this improvement that makes the meaning of menopause positive.
Bart's theory (1969) on the influence of status on women's experiences of menopause draws similar conclusions. Bart argues that the increased social status as women are ageing protects women from the negative effects of menopause. This is commonly found in traditional societies where kinship is practised. According to Bart there are six cultural characteristics that act to protect middle aged women. These are: "strong ties to family of origin and kin, extended family system, the residence patterns keeping one close to the family of orientation, strong mother-child relationship reciprocal in later life, institutionalised grandmother role, and institutionalised mother- in-law role" (Bart, 1969: 14). The Hmong are a patrilineal and patrilocal society. A woman moves into her husband's home after marriage but this does not reduce her strong ties with her natal kin. Extended family networks are practised and several generations reside together in one household. The Hmong also have a strong mother- child reciprocal relationship. An aged mother is looked after and taken good care of by her adult children. When her sons are married, daughter-in-laws are brought into her house. She then has the duty to teach and train her daughter-in-laws to be good wives and mothers. Once she becomes a grandmother her role changes from bearing her children to rearing grandchildren and she is respected by all.
Nevertheless, Bart argues that there are three significant cultural traits which improve women's status in mid-life: extended menstrual taboos, age valued over youth, and reproductive importance. The relationships between extended menstrual taboos and women's status are also found in the Beyene (1986, 1989) and du Toit (1990) studies of menopause among Mayan and Indian women. Both Beyene and du Toit found that the majority of the women in their studies did not see menopause as the end of life. Menopause was, in fact, seen as "a very liberating event" that led them to a higher 'status'. This was due to enforced taboos and rituals associated with menstruation in the women's cultures. Women achieved their 'status' when their reproductive role ended, and thus the taboos and restrictions of menstruation were lifted. The Hmong believe in the polluting nature of menstruation and women are perceived as 'polluted', 'unclean' when they are still menstruating. This is reflected in a number of taboos associated with menstruating women. A Hmong woman becomes 'like a man' who has higher status once she reaches menopause. As such, menopause is viewed positively.
The Hmong value age over youth. Women gain more status as they are ageing. Once a woman becomes a grandmother her status is much higher than before. These indeed make the meaning of menopause positive for Hmong women.
Kaufert (1982) argues that in some traditional societies, older women have more power and prestige. However, women gain their power and prestige only when they are able to bear and raise children. Women without children - either because they are infertile or their children do not survive - face economic and social deprivation. The menopause ends their hope of becoming pregnant and having children. Women in these situations may perceive menopause as negative and do not welcome it. From my data, Hmong women have gained all their power and prestige by fulfilling the importance of reproduction: having borne many children and having children survive to carry on their lineage.
Barnett's study in a small Peruvian town (1988) found most postmenopausal women were relatively satisfied with their menopausal situation. Barnett argues that their satisfaction was linked to sociocultural factors such as the cultural recognition of adulthood which is only granted to women and men over forty, the end of the daily and direct responsibility of caring for their children, and the satisfaction of filling their role of grandmother. Barnett also suggests that the internal rewards that accompany a woman's sense of accomplishment in her own principal role are equally important and are significant in determining the woman's perceptions of menopause. The present study indicates that at menopause Hmong women believe they have fulfilled their role as a Hmong mother and therefore menopause is seen as a stage to reap the rewards for this.
THE EXPERIENCE OF MENOPAUSE
While menopause is inevitable for all women, physiological and emotional symptoms are not universal (Voda, 1993). Women in some cultures do not experience menopausal symptoms and in some cultures experience them more than others (Kaufert, 1982). Flint (1974), for example, has found that very few Indian women of the Rajput caste in the states of Rajasthan and Himachal Pradesh have problems with their menopause other than changes of menstrual cycle. Flint reports that "there were no depressions, dizziness, no incapacitation nor any of the symptoms associated with what we call 'the menopausal syndrome" (Flint, 1975: 162). Similar to Flint, Beyene (1986, 1989) reports the absence of any menopausal symptom in the Mayan women.
Flint (1975) argues that the absence of the menopausal symptoms among Indian women can be explained by the "reward" gained by women when they reach menopause. The "reward" is granted to a woman when she no longer bear children. At menopause she is allowed to partake of the "forbidden" occurring during childbearing years. For example, the Rajput women have to live in "Purdah" (veiled and secluded) until their menopause. They are then no longer considered to be polluted. More importantly, their status is much more elevated than before menopause. Flint further argues that most American women suffer severe menopausal symptoms since menopause is a time of "punishment". At the time most American women reach menopause their children will have left home, leaving the women with the "empty nest" syndrome. Their husbands may also suffer a male climacteric and may be out looking for younger women to prove their virility. American women do not gain their status in old age either. The life of Hmong women fits very well with Flint's theory of "reward and punishment" and this may help to explain the absence of symptoms among them.
Beyene (1989) proposes a "biocultural analysis" to explain the absence and presence of menopausal symptoms. She puts forward three hypotheses for the absence of symptoms. First, this may be due to the women's positive attitudes toward menopause. When childbearing is over, a woman can be free. Second, the low nutritional status of the women may lead to early onset of menopause and asymptomatology in the Mayan women. Beyene found that Mayan women were already postmenopausal, in their mid-forties, while most women in industrial nations are just entering the menopause. Hmong women in this study reach their menopause when they are about mid-forties. Similar to the Mayan women, their nutritional status is low. Their living situations in Laos were relatively poor due to their geographic location and the war. Even when they were placed in refugee camps in Thailand and re-settled in Australia this has not improve their situation a great deal. Last, Beyene argues that interference with normal reproductive function through the use of contraceptive drugs and interventions to prevent pregnancy, commonly among Westernised women, may cause menopausal symptoms among them. The majority of Hmong women interviewed did not use any western birth control drugs or devices until they came to refugee camps in Thailand or after settlement in Australia. Traditionally, Hmong women keep bearing children until menopause, with little interference with reproductive function. Beyene's three hypotheses may indeed explain the absence of menopausal symptoms among Hmong women in this study.
At present it appears that the Hmong women interviewed in Melbourne continue to perceive menopause as positive and that they experience few so-called menopausal symptoms. However, the longer most Hmong women live here, the greater the process of adaption to living in a western environment will be. They are faced with many changes and these changes may have consequences for the way in which the menopause is perceived and experienced. Because of the availability of western health care and the relative unavailability of traditional herbal medicines and healers in Australia, women seek help from mainstream health services when they experience ill health of any kind. This inevitably puts women in mid life into contact with current medical interpretations of menopause. Roberts (1985) has pointed out that once a woman reaches forty years of age doctors tend to bring the menopause into all their discussions of her health. The question to be asked here is: will Hmong women be encouraged to interpret menopause as a medically oriented event and thus experience menopausal symptoms in the way many Australian women do? Although evidence from previous studies which have examined women's lives in rapidly changing societies has indicated this may be the case (Datan et al., 1981; Flint & Samil, 1990; Lock, 1991; Chirawatkul, 1992, Chirawatkul & Manderson, in press), it remains to be seen what will happen for Hmong women now living in Australia.
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Southeast Asia Community Resource Centre, Rancho Cordova, California.
