International Research Journal of Social Sciences_____________________________________ ISSN 2319–3565Vol. 2(8), 1-4, August (2013) Int. Res. J. Social Sci. International Science Congress Association 1 The Knowledge of Menopause and its Treatment among Orang Asli in Gombak Nurazzura Mohamad Diah Department of Sociology and Anthropology, KIRKHS, International Islamic University Malaysia, MALAYSIAAvailable online at: www.isca.in Received 24 th April 2013, revised 14th June 2013, accepted 5 th August 2013 Abstract Menopause is a time of life where women make the transition from a reproductive stage to a non-reproductive stage. Although it is biologically universal, menopausal experiences are not homogeneous in nature and there have been significant differences reported by women within and across cultures. The objective of this study is two-fold: to investigate the prevalence of menopausal symptoms among Orang Asli and to identify ways how they treat their menopausal symptoms. This is an exploratory study conducted among Orang Asli women at Batu 12, Gombak, Kuala Lumpur, Malaysia. A group of twenty Orang Asli menopausal women between the ages of 50-56 participated in this study. These women were from different clans - Semai, Temiar, Temuan and Semelai. The respondents were chosen using the snowball sampling due to the sensitivity of the topic. Unstructured interviews and participant observations were used to assess their understanding about menopausal symptoms and how the symptoms are being treated. Data analysis was performed using the qualitative process. Analysis reveals that Orang Asli women viewed menopause as a positive and natural biological change. Knowledge about menopause is obtained from friends and siblings who are already in their menopausal stage. Decrease in sexual feeling is a common menopausal symptom followed by muscle aches, joint pains, sleeplessness and more trouble remembering things. Very little is known about the knowledge and use of medicinal plants in treating menopausal symptoms among these Orang Asli women. However, among the common plants used to treat their menopausal symptoms are pucuk sendap, kacip Fatimah, bunga pakma, tongkat Ali and cendawan hutan. These plants are easily found in their backyards. They expressed strong belief in the effectiveness of these plants to help alleviate their menopausal symptoms. Briefly, menopausal symptoms among Orang Asli women are common and are apparently untreated through biomedical intervention. Keywords: Menopause, Orang Asli, medicinal plants, symptoms, sensitive topic. Introduction Menopause is a time of life where women make the transition from a reproductive stage to a non-reproductive stage. Although it is biologically universal, menopausal experiences are not homogeneous in nature and there have been significant differences reported by women within and across cultures. The study of menopause is pertinent in anthropology because how menopause is seen, experienced and managed, rests upon social and cultural factors. Our understanding of menopausal experiences is primarily derived from studies conducted among Western women. Little is known about the menopausal experiences of the Orang Asli in Malaysia. In general, menopause is a subject which gains relatively little attention in anthropology. The rareness of anthropological research on menopause is best explained through the relative importance placed on menstruation and pregnancy as significant events in the life cycle of a woman compared to menopause. In the anthropological literature on menopause, there has been a general agreement that social and cultural factors have strongly shaped women’s menopausal experience. Menopause is a process of ageing that comes with emotional, psychological and physiological changes similar to menstruation and pregnancy. These events are associated with hormonal and bodily changes coupled with a range of emotional and psychological factors that vary across cultures. There have been relatively few anthropological studies on menopause conducted among the indigenous people. In fact, little baseline information exists from which to understand what constitutes menopausal experience among Orang Asli women in Malaysia. Among the Mowanjum indigenous people of Western Australia, they are reported to have minimal knowledge about the etiology of their menopausal symptoms and do not seek any medical assistance or use bush medicine to alleviate their symptoms. This is one of the reasons the researcher has chosen to focus on the menopausal experience of Orang Asli women in Malaysia. It is clear that menopausal experiences and symptoms vary across and within cultures. It appears that some women exhibit severe symptoms, others encounter only mild symptoms and some women report no symptoms at all6,7. The existing anthropological literature reviewed does not discuss how Orang Asli women in Malaysia experience menopause. Issues like the International Research Journal of Social Sciences___________________________________________________ISSN 2319–3565Vol. 2(8), 1-4, August (2013) Int. Res. J. Social Sci.International Science Congress Association 2 role of the family members in women’s experience of menopause, women’s perception of their doctors and of treatment have not been studied, at least not within the Malaysian context. In this study, the researcher has attempted to examine menopause experience within a different setting and to focus on women from different social and cultural backgrounds. While previous anthropological studies have successfully shown the link between menopause and social and cultural factors, the researcher has found little attention has been given to addressing the issue of menopause among the indigenous women. In addition, there has been little, if any, attention paid to a non-Western setting, particularly among the indigenous people of how older women experiencing menopause may think about femininity, sexuality and beauty in relation to becoming older. This topic is worth studying because it affects women’s well-being in the later part of their lives. The relationship between health and well-being is important because women today play multiple roles in society. Women’s life expectancy is longer and they will spend a significant proportion of their lives in a postmenopausal state so it is very important to understand how menopause both enriches and challenges their lives.Objectives: This research explores how Orang Asli women experience and attach meaning to menopause. With this in mind, this research has three objectives. The first is to explore the women’s personal attitudes to, and perceptions of, menopause. The second objective is to identify how menopause is learnt in the Orang Asli family. Finally, to explore the diverse range of treatments Orang Asli use to reduce their menopausal symptoms. Methodology This research employed a qualitative approach. Many social researchers found the flexibility inherent in qualitative research has helped them to understand meanings, interpretations and subjective experiences of vulnerable groups. Since this research employed an open-ended approach, it allowed Orang Asli women to speak about their feelings and experiences using their own words rather than to follow a set of pre-determined questions that are usually employed in a survey research. Unstructured interviews and participant observation have helped the researcher to unravel the complexity of this topic, which in the Malaysian society is considered private and dealt with in silence. In a similar vein, other researchers noted that through qualitative methods, a researcher learns about people’s lives, stories and behavior as well as the meanings and interpretations that people give to their behaviours10. Thus, qualitative methods can be used to discover the meanings people attach to their experiences of the social world and how they make sense of that world. This study was conducted principally on twenty Orang Asli women in Gombak. They arefrom different clans - Semai, Temiar, Temuan and Semelai. All of them are in their menopausal stage and experiencing natural menopause. The study did not include women who had experienced surgical menopause because these women who had surgical menopause have significant differences in their health and health behaviour. The respondents were chosen using the snowball sampling due to the sensitivity of the topic. The sample size in this study is admittedly small. It was not possible to randomize. However, it is best to be sufficient because the information given is consistent and each corroborates with others and no new categories have emerged (saturation of categories). To understand how Orang Asli women conceptualise menopause, data analysis from the in-depth interviews was performed using qualitative process.Results and Discussion Differing definitions of menopause: Menopause is not clinically or scientifically defined by some women. Studies have shown that the term menopause is neither known nor popularly used to refer to menopause. The term used by women in the general public derives from the local context of what menopause is understood to be. The respondents of this research however, have used different terms in table-1 to describe menopause. Table-1 Local terms used to describe menopause Clans Local terms Meaning Temiar and Temuan naasoot / soot no blood Semelai kering maham blood has dried Semai walah bihip / dit bihip end of blood From the local definitions, menopause in general, indicates the end of child bearing years but it can also mark the end of the ‘bad blood’ in a woman’s body. The concept of bad blood is associated with menstruation. When a woman is menstruating, the menstrual blood is regarded as ‘dirty’ or ‘polluted’11. Women are prohibited from having sex with their husbands. They are not allowed to perform some religious duties and are subjected to food and social taboos and restrictions12. In some societies, menstruating women are secluded from the rest of the society. Variations of menopausal symptoms: Most Orang Asli women in this study associated the beginning of menopause with irregular periods. The most apparent symptoms highlighted by most women in this study are experiencing less sexual desire and reduced sexual activity. Some women described the situation as tak ada perasaan (no feeling) or kurang minat (less interest) in having sex with their husbands. Other symptoms which would become distressingly apparent are hot flushes, sleep disturbances, vaginal dryness, joint pains, more trouble remembering things and fatigue. Interestingly, there is also an indication of the so-called ‘empty-nest syndrome’13 among Orang Asli women. Orang Asli women in this study feel lonely when the children leave home due to employment or marriage. International Research Journal of Social Sciences___________________________________________________ISSN 2319–3565Vol. 2(8), 1-4, August (2013) Int. Res. J. Social Sci.International Science Congress Association 3 Table-2 List of medicinal plants commonly used by Orang Asli women in Gombak to alleviate menopausal symptoms Scientific name Native name Part used Traditional use Consumption Arcypteris irregularis (Presl.) Holtt Pucuk sendap Leaf Improve skin and general appearance Every day (cooked/raw) Eurycoma longifolia Jack Tongkat Ali Root As sexual stimulant, maintain general health Twice a month (drink) Rafflesia hasseltii Bunga pakma Flower Regain abdominal shape Once a month (drink) Labisa pumila Kacip Fatimah Leaf Strengthen vagina muscle, sexual stimulant Twice a month (drink) Lignosus rhinoceros Cendawan hutan Leaf Maintain general health Every day (cooked) Etlingera elatior Bunga kantan Flower Improve skin and general appearance Every day (cooked) Learning menopause from stories: Based on this research, in most instances, information about menopause is passed on by friends who are older or the nearest kin. Most women in this study mentioned that their mothers had not taught them openly about menopause because their mothers died when they were still young. Most women said that stories about menopause were told ‘around’ the topic through reference to the symptoms, but the word “menopause” was not mentioned. So, the story was not literally ‘about’ menopause.In addition, Orang Asli women discussed topics like menstruation, pregnancy and post-partum period at length, but not menopause. The women, the researcher spoke to, felt that menopause is either private or too insignificant to discuss even with their own daughters. This situation is similar to the urban Malay women in Kuala Lumpur14. The majority of the women that the researcher interviewed was experiencing menopause and admitted that they sought information from friends by listening to stories and some from doctors in the Orang Asli hospital nearby. Family members, especially sons and daughters, tended to know very little about their experiences of menopause. Many were uncertain when their mothers acted out of character whether the behaviour was associated with menopause or not. In fact, most of them had no idea about menopausal symptoms. Treating menopausal symptoms: Menopausal symptoms among Orang Asli women are common and are apparently untreated through biomedical intervention. The Orang Asli women mentioned that they had sought advice outside their family on how to reduce their menopausal symptoms as their mothers had not given them any information. Like the African American women15, the Orang Asli women too had no examples to use as a frame of reference regarding the use of Hormone Replacement Therapy (HRT) or other kinds of treatments. They expressed strong belief in the effectiveness of certain medicinal plants in table-2. These plants grow wildly in the jungle or planted by them in their backyards to help alleviate their menopausal symptoms. From the list, Orang Asli women use various medicinal plants to treat mild to severe menopausal symptoms. However, the knowledge of these medicinal plants has not gained popularity among their children as they are not consuming these plants to treat their illnesses. Instead, their children prefer to take medicine from the nearby Orang Asli hospital. Conclusion Indeed, menopause, particularly when it is associated with difficult symptoms, is seen by people in the medical arena as well as in a more public sense as a condition that needs urgent treatment in order to live life to the fullest. Unfortunately, this does not apply to the Orang Asli women in Malaysia. Of course, while there is still a kind of silence around menopause, there have been changes made at the level of policy to educate women more about menopause. Nevertheless, most of this effort is translated in terms of biomedical discourse. However, it is also important for the nation to keep middle-aged and older women healthy and productive because they are important members of the society. Acknowledgement The researcher thanked the Department of Orang Asli Development (JAKOA), Nor Ashikin Salim, Husin Ngahyin and Jaluma Long Salleh for their assistance in the field. This study is supported by the International Islamic University Malaysia under Research Endowment Fund (Type A). 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