Surveys of climacteric semeiology in non-Western populations: a critique

Traditionally regarded as limited to Western women, the menopausal syndrome has the characteristics of a culture-bound syndrome. Yet, pointing to the results of recent surveys in non-Western populations, several investigators claim that the latter are also affected. Despite faults in collection, the salient data of these surveys are acceptable. This does not mean that the conclusions drawn from them are invariably correct. Many, including the claims referred to, are contestable. Researchers have failed to distinguish between the spontaneous symptoms of women subject to climacteric disturbances and the sensations others admit to on questioning. They do not differentiate between symptoms and semeions. Lack of discrimination between the two categories also confounds Western surveys of climacteric semeiology, obscured by a cultural context where acceptance of the climacteric syndrome transforms semeions, sensations, into incipient symptoms. Once outside, among non-Western populations, the distinction becomes vividly apparent. This is of great theoretical importance, both in the structuring of medical surveys and in explaining symptom formation. It may also clarify the effects of cultural/personal attention on the level of physiological activity associated with symptoms.