Menopause in Morocco: symptomatology and medical management☆
Introduction
Research on the menopause transition in diverse contexts indicates that the manifestations of menopause and the burden they represent may be a function of the cultural context. The association between the symptomatology of menopause and the life conditions of middle-aged women, however, is not uniform and studies have suggested that it may operate through different pathways [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. On the one hand, where women who come to the end of the reproductive years are freed of some of the constraints that they faced earlier in their lives—the fear of unwanted pregnancies, the inability to make independent decisions—menopause would bring greater liberty, and its symptoms would receive little attention or concern. On the other hand, where middle age is marked primarily by the loss of sexual attractiveness and reproductive potential, menopause would be experienced as a difficult phase, and its symptoms perceived as a considerable hardship. It is likely that in Arab culture as elsewhere, menopause is surrounded by a degree of ambivalence. Indeed, on the basis of the limited evidence available on aging and women's lives in Arab populations, it is possible to predict both that menopause is a welcome phase of life with few complaints, and that it is marked by numerous ailments—truly an ‘age of despair’ sinn al ya's, the term that is used in literary Arabic to refer to menopause.
The project was thus designed to contribute some evidence on the subject by measuring the extent to which women report menopausal symptoms and seek medical care to manage this phase of life in two different countries of the same region. The study on which this article is based was designed to assess the frequency of menopausal symptoms and patterns of recourse to medical care in Lebanon and Morocco, and it represents the first comparative investigation of menopause in Arab culture. In an earlier publication, we reported on the results of the Beirut study [11]; here, we present the findings of the investigation that was carried out in Rabat, Morocco.
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Data and methods
The study was based on a survey of women aged 45–55 years in the capital of Rabat, Morocco, a city of 1.2 million inhabitants [12]. The sampling frame was that of the 1995 Enquête PapChild (Pan Arab Child Health Survey), a national survey that used information from the census of 1994 to define 1500 clusters for the country as a whole, and draw a self-weighting sample of 45 000 households. For purposes of this study, and in collaboration with the Ministry of Health of Morocco, the strata for the
Results
The general socio-demographic characteristics of the sample are consistent with what is known of the urban population of Morocco. As shown in Table 1, the vast majority of the women in the sample are married (78%) while 15% are widowed and the rest are divorced, separated, or single. Two-thirds of the women were married by age 19 years. Early marriage is characteristic of currently middle-aged cohorts of Moroccan women (the mean age at marriage was 17.3 in 1970 and has risen rapidly; in 1992,
Discussion
These results indicate that most of the women in the sample report some symptoms related to health changes at midlife. The frequencies of specific symptoms are within the range of those found in other studies [16], [17], [18], [19], [20], [21], [22], but if we compare symptom reporting in Rabat with the findings of the Beirut study, we find that in general, women in Rabat report lower frequencies of most symptoms, with the exception of hot flashes and joint pains. These higher frequencies are
Conclusion
These results show that women in Rabat report symptoms of menopause that are comparable to those reported in other studies, and that hot flashes and joint pains are especially bothersome to them. The overall frequencies of symptoms are weakly associated with menopausal status, and the frequencies of specific symptoms are associated with socio-economic variables. Recourse to health care to manage menopausal symptoms is relatively infrequent, and differentials reflect levels of schooling and
Acknowledgements
This project was carried out with support from a grant from the National Science Foundation Behavioral Science Branch (SBR-9600721). We are grateful to the Ministry of Health of Morocco for facilitating the project and providing information regarding the sample. We also wish to thank (in alphabetical order) Mohamed Al-Jem, Mahmoud Archach, Fatema Artiba, Zouhour Erroumati, Mina Oualla, and Habiba Zhar for their help with the field research and the coding. We also thank Hatim Belyamani for his
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The views in this paper are the author's and do not represent those of the World Health Organization.