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The Timing and Experience of Menopause Among British Pakistani Women in Bradford and Leeds, West Yorkshire, UK

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The Timing and Experience of Menopause Among British Pakistani Women in Bradford and Leeds, West Yorkshire, UK Durham E-Theses The Timing and Experience of Menopause among British Pakistani Women in Bradford and Leeds, West Yorkshire, UK BLELL, MWENZA,THANDIWE How to cite: BLELL, MWENZA,THANDIWE (2009) The Timing and Experience of Menopause among British Pakistani Women in Bradford and Leeds, West Yorkshire, UK, Durham theses, Durham University. Available at Durham E-Theses Online: http://etheses.dur.ac.uk/291/ Use policy The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that: • a full bibliographic reference is made to the original source • a link is made to the metadata record in Durham E-Theses • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders. Please consult the full Durham E-Theses policy for further details. Academic Support Oce, Durham University, University Oce, Old Elvet, Durham DH1 3HP e-mail: [email protected] Tel: +44 0191 334 6107 http://etheses.dur.ac.uk 2 ABSTRACT Previous studies have shown considerable differences at both the population and individual levels in the timing of menopause and the experience of physical and emotional changes related to menopause (generally called symptoms). Attempts to understand this variation have not found a consistent pattern, suggesting that the existing approaches to the study of menopause may have failed to capture some of the complexity of the phenomenon. Previous research on British Pakistanis has not included in-depth study of menopause. The present study has sought to demonstrate that a biosocial research design can improve our understanding of the menopause transition both among British Pakistanis and more generally. This study used a range of methods including semi-structured questionnaire-based interviews and anthropometrics (n=257), life history interviews (n=19), and daily participant observation among middle-aged British Pakistani women in the Leeds/Bradford area of West Yorkshire. Statistical procedures were used on the quantitative data using SPSS 15; qualitative data were analysed using a thematic coding system and NVivo software. This study found that British Pakistani women of a higher occupational social class were more likely to experience hot flushes than women from lower social classes and women who perceive themselves to be of higher status were more likely to have an earlier menopause than their lower status counterparts. Women from the Choudhary Jatt biradari (a caste- related kinship group) were more likely to have a later menopause and were less likely to experience hot flushes than women from other biradaris. Levels of reported anxiety and acculturation were both positively associated with hot flush severity. Women reported a wide range of changes due to menopause and attributed changes to menopause that previous researchers considered to be unrelated to menopause. Attribution of symptoms to menopause was associated with menopausal status, age, and migration status. Women interpreted some items from a standard checklist in ways other than intended by the checklist‘s developers, based on local ideas about menopause. British Pakistani women‘s understandings and perceptions of menopause are intimately linked with their understandings of Islam, sexuality, menstruation, and ageing, as well as their ethnic identity and notions of purity and modesty. Social issues like acculturation, social support, kinship networks, class, and the history of tensions between Pakistanis and the wider society appear to be very important to consider in understanding menopause among British Pakistani women. Social issues such as these may play a role in influencing both the timing and the experience of menopause among women in other groups and thus should be considered in future studies. i TITLE PAGE The Timing and Experience of Menopause among British Pakistani Women in Bradford and Leeds, West Yorkshire, UK Mwenza T. Blell Submitted for the degree of Doctor of Philosophy Durham University Department of Anthropology 2009 ii TABLE OF CONTENTS ABSTRACT ................................................................................................................................ i TITLE PAGE ............................................................................................................................. ii TABLE OF CONTENTS ......................................................................................................... iii LIST OF TABLES .................................................................................................................... vi DECLARATION ..................................................................................................................... vii STATEMENT OF COPYRIGHT ............................................................................................ vii ACKNOWLEDGEMENTS ................................................................................................... viii PREFACE .................................................................................................................................. 1 CHAPTER ONE – REVIEW OF PREVIOUS RESEARCH ON MENOPAUSE .................... 4 Introduction ............................................................................................................................ 4 What Causes Menopause? ...................................................................................................... 4 Why is there a menopause? .................................................................................................... 5 Previous Research on Menopause .......................................................................................... 8 Variation in Timing of Menopause .................................................................................... 8 Intra-population Variation in Symptom Experience ........................................................ 15 Research on Menopausal Symptoms among South Asians .............................................. 18 Research on Attitudes and Beliefs Regarding Menopause ............................................... 20 Conclusion ............................................................................................................................ 27 CHAPTER TWO: REVIEW OF THE ETHNOGRAPHIC LITERATURE ON BRITISH PAKISTANIS .......................................................................................................................... 28 Biradari, Marriage, and Kinship .......................................................................................... 29 Women‘s Roles, Modesty, and Isolation ............................................................................. 32 The Body: Reproduction, Health, and Hygiene ................................................................... 36 Issues of Identity .................................................................................................................. 37 Racism .................................................................................................................................. 42 Conclusion ............................................................................................................................ 45 CHAPTER THREE: METHODS ............................................................................................ 47 A Biosocial Perspective, Epistemological, and Ontological Approaches ............................ 47 Approach to the population .............................................................................................. 49 Recruitment of participants .................................................................................................. 50 Data Collection ..................................................................................................................... 52 Quantitative Data Collection ............................................................................................ 52 iii Qualitative Data Collection .............................................................................................. 58 Data Analyses ....................................................................................................................... 61 Quantitative Data Analysis ............................................................................................... 62 Qualitative Data Analysis ................................................................................................. 77 Ethical Considerations.......................................................................................................... 80 Account of my ‗self‘ in the research .................................................................................... 82 CHAPTER FOUR – THE TIMING OF MENOPAUSE ......................................................... 90 Discussion .......................................................................................................................... 103 Conclusion .......................................................................................................................... 115 CHAPTER FIVE– EXPERIENCE OF THE MENOPAUSAL TRANSITION .................... 117 Limitations of Bypassing Women‘s Knowledge about Their Experiences ....................... 118 Limitations of Asking Only About the Symptoms on Checklists ...................................... 119
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