Menopause and Midlife Aging in Cross-Cultural Perspective: Findings from Ethnographic Research in China.

Based on longitudinal mixed methods ethnographic research conducted in China from the mid-1990s to 2018, this article argues that Chinese lay language use divides what Americans and Canadians refer to as "menopause" into two distinct though overlapping concepts of the narrow juejing or end of menstruation and the broader non-gender-specific gengnianqi or "transition between middle and old age." While comparison with research done by Lock in Japan shows that Japanese language uses a similar set of two overlapping yet distinct terms called heikei and könenki, there are important differences between Chinese and Japanese views and experiences of female midlife amidst the similarities. While views and experiences of juejing in China are very similar to notions of heikei in Japan, gengnianqi is quite different from könenki. Like in Japan, the end of menstruation tends to be welcomed by women in China. Also like in Japan, midlife women in China had a lower prevalence of hot flashes than that found in the US and Canada. Also similar to Japan, Chinese women rarely associate hot flashes with embarrassment. However, unlike in the Japanese sample, the Chinese women reported a higher rate of irritability than even the American and Canadian samples. Contrasting with könenki, which is primarly associated with bodily aches and self-restraint in Japan, gengnianqi is commonly viewed as a time of vulnerability to irritable outbursts which must be allowed, though managed carefully. Overall, I show how menopause and midlife aging as concepts and as lived experiences are subject to variation related to differences in language, cultural ideas and practices, local biologies, and culturally-mediated generational experiences of historical change.

Revolutionary narratives of self-compassion among older women in post-Mao Beijing.

Drawing upon interviews and participant observation conducted with hundreds of middle-aged and elderly Chinese women in rural and urban neighborhoods in Beijing Municipality between 1993 and 2012, this paper explores the emergence of revolutionary new narratives of self-compassion among older women in reform-era Beijing. Taught before 1949 that they should first and foremost serve their families and after 1949 that they should put their own individual needs aside and serve the party and the masses, many older Chinese women in Beijing - after the seeds of market reform were sown in the late 1970s - slowly began to focus more attention than before on themselves, their past and present experiences, sources of and solutions to past and present distress, and their own personal enjoyment of everyday life. The analysis shows how western theories of both gero-transcendence and individualization as modernization are insufficient to account for the complex cultural formations of self-care that have developed among older women in the first decades of post-Mao China.

[Application of evidence-based medicine in Chinese medicine: debate and strategy].

Drawing on recent publications in English and Chinese, this article explores reactions to the use of randomized controlled trials (RCTs) and the standards of evidence-based medicine (EBM) to evaluate Chinese medicine. Some authors contend that RCTs should not be used to evaluate Chinese medicine, but a far greater number of authors advocate their use. This paper describes the position of the RCT detractors and points out how their arguments contain oversimplified representations of Chinese medicine, biomedicine, EBM, and RCTs. In describing the position of the RCT proponents, the article discusses how challenges of standardization and control in Chinese medicine research have been met with important innovations in clinical trial design. Overall, the article argues that not only Chinese medicine is modified in meeting the demands of RCTs and EBM, but clinical trial design is being transformed through the innovations of Chinese medicine researchers.

Cross-cultural comparison of women's midlife symptom-reporting: a China study.

Drawing on ethnographic and survey research conducted by the author in a general population sample in mainland China, this article presents findings on Chinese women's midlife symptom reporting in comparison with pivotal studies conducted by Lock, Kaufert, and McKinlay in Japan, Canada, and the U.S. Analysis of the China survey data (N = 156 women, age 45-55) reveals for sixteen core symptoms a reporting frequency that is much lower than depicted in classic biomedical models of menopause. At the same time, however, the China data indicates problems with the popular extrapolation that midlife Asian women are virtually symptom-free compared to their North American peers. Finding the Chinese level of symptom-reporting low to moderate depending on the symptom, the article reveals important differences between Chinese and Japanese women in their level and pattern of symptom reporting, as well as substantial overlap with North American women in this regard. Referencing ethnographic materials on Chinese women and the cross-cultural literature on menopause, the article assesses potential explanations for the cross-cultural variation observed, including: local reproductive endocrinology, phytoestrogen consumption, aspects of East Asian culture, the nature of social change, the cultural acceptability of monitoring and voicing symptoms, and differences in dominant conceptions of midlife.

Applying evidence-based medicine to traditional chinese medicine: debate and strategy.

Drawing on recent paper published literature in both English and Chinese, this explores reactions to the evaluation of Chinese medicine using randomized controlled trials (RCTs) and the standards of evidence-based medicine (EBM). The literature review revealed a few sources which contend that Chinese medicine should not be evaluated on the basis of RCTs, but a far greater number which advocate for applying RCT and EBM standards to Chinese medicine. This paper describes the position of the detractors and points out ways in which their arguments contain oversimplified representations of Chinese medicine, biomedicine, EBM, and RCTs. In describing the position of the proponents, the analysis outlines some of the numerous innovative techniques they are developing for dealing with issues of control and standardization in efficacy research. Overall, the analysis indicates that important refinements are being generated in Chinese medicine research and clinical trial design in response to the challenges posed by the forced encounter of these two paradigms.

Parsing the ageing Asian woman: symptom results from the China study of midlife women.

OBJECTIVES: It has become popular to assert that Asian women in general have low midlife rates of reporting a wide variety of symptoms and that these rates are much lower than those found among women in western countries. Comparable data from mainland China remains sparse, however. This study aimed to uncover the symptom reporting frequency for a general population sample of women in mainland China and to compare these results with rates from similar studies conducted in Japan and North America. METHODS: The author conducted a community-based survey of over 400 Chinese women aged 40-65 years living in a rural village and an urban neighborhood in northern China. The cross-cultural analysis was conducted on the 156 Chinese women within that sample who were between the ages of 45 and 55 years. Their rates of reporting 16 core symptoms in the previous 2 weeks were compared with those of women in the same age range in studies conducted in Japan [Lock M. Encounters with aging: mythologies of menopause in Japan and North America. Berkeley: University of California Press; 1993], Canada [Kaufert P, Lock M, McKinlay S, et al. Menopause research: the Korpilampi workshop. Soc Sci Med 1986;22(11):1285-9], and the U.S. [McKinlay SM, McKinlay JB. Research note: aging in a 'healthy' population. Soc Sci Med 1986;23(5):531-5]. RESULTS: The Chinese women had a low to moderate rate (below 50%) of reporting each of the 16 core symptoms. On most symptoms, the Chinese rates were higher than the Japanese and more similar to the North American. The only exceptions were hot flashes and headaches. CONCLUSIONS: Data from the China Study of Midlife Women showed that women's rates of midlife core symptom reporting in mainland China differ from the extremely low levels found in Japan. It is important to avoid generalizations about East Asian women relative to North American women in this regard.

Women's midlife symptom-reporting in China: cross-cultural analysis.

This report draws on data from the author's China Study of Midlife Women (CSMW) to test the popular notion that East Asian women have a low level of midlife symptom reporting compared with North American women. Symptom-reporting frequencies from a general population sample of 156 Chinese women of age 45-55 in China are compared with rates from published studies on midlife women in Japan, Canada, and the U.S. While the Japanese women's rates of reporting 16 core symptoms are uniformly low, the Chinese women's frequencies range from low to moderate. Except on hot flashes and headaches, the Chinese women's symptom-reporting rates tend to be more similar to the North American than to the Japanese sample. This analysis demonstrates that women's midlife symptom reporting in China cannot be equated with findings on women in Japan. Sources should be more cautious in making generalizations about East Asian women in this regard.