Across South Africa's townships and rural clinics, women are breaking inherited silences to redefine reproductive ageing on their own terms. Menopause, defined as a year with no periods, marks the end of a woman's reproductive years. This natural transition is brought on as the ovaries stop releasing eggs and oestrogen levels fall, usually between the ages of 45 and 55. Joint and muscle pain, exhaustion, poor memory, and hot flushes are among the most common symptoms.
Research suggests that some women in South Africa never discuss menopause with a healthcare worker. A 2017 study of 450 black women in communities near Pretoria found that more than three-quarters had never sought medical help for their symptoms. This may be due to a cultural view of menopause as a positive natural process. However, a new review suggests there are up to 72 possible symptoms, and hormone replacement therapy is the most effective treatment to ease hot flushes.
Sostina Matina, a researcher who studied women's perceptions of menopause in Gauteng and North West, believes that the limited use of menopause treatments in South Africa's public healthcare sector should not be mistaken for a rejection of clinical care. Many women, she says, had simply never had their options explained to them. Xoli Madlala, who experienced menopause early, has made it her personal mission to bring menopause out into the open, speaking in settings ranging from corporate boardrooms to rural Bible study groups.
Midlife women seeking menopause symptom relief are often turned away by health workers, especially if they're experiencing symptoms earlier than usual or as a result of surgery. Matina says that health workers will often say, "it's just menopause, there's nothing we can do." However, treatment guidelines for clinics and hospitals include menopausal hormone therapy pills that can ease hot flushes and other symptoms.
Professor Lineo Matsela, an obstetrician, gynaecologist, and president of the South African Menopause Society, says it's become common for public sector doctors to write prescriptions for menopausal hormone treatments so that patients can buy them at a private pharmacy. However, there have also been sporadic private sector shortages of menopausal hormone therapy treatments over the past three years.
Access to medicines is only part of the problem, Matina says. Dismissing menopause can also mean the health system could be missing other health risks that can affect women in midlife, a phase that can span about 40% of their lives. The transition is also associated with bone loss, and the stakes might be slightly higher for women living with HIV.
People's experiences of menopause vary widely across countries, cultures, and generations. Women in four rural villages in Limpopo described menopause as a series of losses, of beauty, respect, and quality of life. However, research conducted in South Africa and Zimbabwe suggests that inter-generational support can make all the difference to help women approach the milestone with acceptance.
Key points
- Menopausal women in South Africa are challenging the silence and stigma surrounding menopause.
- Many women in South Africa have never discussed menopause with a healthcare worker.
- Access to menopause treatments and education is crucial to supporting women's health during this transition.
