Introduction 

Elsie: Halo olgeta, I’m Elsie, welcome to the RoundTable Podcast. We’ve created this space for Ni-Vanuatu women to speak freely on issues affecting us today. Let’s navigate life in the islands together. Join me as I speak to a new guest every episode and ask the questions you’ve always wanted to ask. Ale yumi storian. This project is made possible with the support of the WeRise Coalition and PECMAS. 

TRANSLATIONS: Hello everyone, I’m Elsie, welcome to the RoundTable Podcast. We’ve created this space for Ni-Vanuatu women to speak freely on issues affecting us today. Let’s navigate life in the islands together. Join me as I speak to a new guest every episode and ask the questions you’ve always wanted to ask. Let’s discuss. This project is made possible with the support of the WeRise Coalition and PECMAS. 

 

Interview 

E: On this episode we’re going to be talking about the topic of menopause. What is it and what can we as women expect? With me to talk about this topic, and most importantly share information is Ellis Lee. Hi Ellis, thank you for joining me on The RoundTable. Before we start our conversation I would love for you to just tell us a little bit about yourself. 

 

Ellis Lee: So as you’ve heard, my name is Ellis. I am a registered nurse by trade, working in the health sector for quite a while before deciding to move to public health. I’ve spent about five years doing health coordinating in first aid training for the Red Cross before I decided to move on and do something different. And then I moved to World Vision where I spent the last six years working for World Vision and doing different roles. So I first started off with being the Health Technical Advisor, working within the different regions, different countries in the region for two years and then I moved on to doing Program Manager for Water for Women project in Santo and Torba. And then I moved to doing Inclusive Operations, raising voices of people with disability and then recently stepped into a new role of being Deputy Portfolio Manager for World Vision. 

 

E: Another World Vision representative. So Ellis, I tried to do some research beforehand to find, you know, statistics, maybe an article, any piece of information that shared if and how this topic is being talked about in the Pacific. Unfortunately, I couldn’t find anything that, you know, related specifically to menopause. It was mostly information around sexual reproductive health, menstruation, all of that under that particular topic. And so for me, that really, it speaks volumes like where is all this information? Why don’t we have this information? And so I just wanted to get your perspective, you know, why do you think there is little information on this topic and why do you think women should know about menopause? 

 

EL: Thank you Elsie. It’s a great question and before we take a dive into the question I’d like to just stress that I’m not a gynecologist, I’m not a doctor by trade. A lot of information, I’ll be sharing my opinion and how I see it as a development worker for the past ten years. So, yes, menopause is a very interesting topic, it’s little talked about, it’s little understood. There was a research that’s called The Last Taboo that was undertaken in 2016 to 2017, and that focuses not on menopause but on menstruation managed by women and girls. And that was carried out in the Solomon Islands, Fiji and Papua New Guinea, and it’s interesting to learn of one of the findings in the three countries. And the aim of the research was to determine the impact of how menstrual management practices on women and girls, participation affected women and girls, participation and education and income generation. One of the findings, the main findings in that research, was in all three countries education information has frequently, frequently, and I say it again, frequently excluded women and girls with disability. And there is often a generalization gap in awareness as older women may have missed out on receiving education about menstruation while in school. Even when menstruation is included in the school curriculum, teachers may feel ill-equipped to teach the topic and require specific resources and training to do so. So even as an honest conversation around women’s health has become more common, the menopause transition means a tabu or is never openly discussed in any Melanesian culture. 

 

E: That’s super interesting and it’s amazing that there was research done, that’s something that I’m going to look up after this conversation. It mentioned that there was a lack of information within schools from the report. And I think from my own experience, at high school I remember that there wasn’t anything. So from the report, there was mention of lack of information in schools, and I think a lot of people forget that schools should be having, you know, these conversations. I understand, and I think this is based on my own personal experiences as well from high school, that, you know, menstruation is talked about. But they never spoke about menopause or what to expect later on in life. Do you think that this topic should be introduced into the school curriculum? 

 

EL: That’s a really good question and we’ve come a long way Elsie, we’ve come a very long way like we have a section in the education in the school curriculums where they’re starting from an early age to talk about what changes happen to a girl from an early age and that has just been introduced into the curriculum and teachers are talking to them. But there’s still a need for ongoing awareness and information so that it trickles not in the urban settings but right down to the rural setting where you go to a remote community and teachers are willingly talking to their staff. Do they have the capacity, that’s the other thing to consider, do they have the capacity to talk through these topics in a remote setting? How are we understanding these topics at a national level where it trickles down, right down to our local communities so that we all are on the same page? 

 

E: I understand as well, so you did mention how it should be spoken about as well within the communities. And, you know, within a community there’s usually a clinic or a nurse that people can go to should they need any medical assistance. Do you think, you know, with the current health services that we have, do you think that they’re talking about menopause the way that they should? For me, personally I think that they should be talking about it more, making it, I feel that, yeah, they should be talking about it more, just creating more. I don’t know if awareness is the right word but just making it kind of normalized. I feel like we’re slowly, you know, talking more about periods and trying to break down the whole stigma around that, but I feel like they could maybe start or probably do the same around the topic of menopause. But, yeah, what do you think? 

 

EL: I think we’re taking baby steps considering Vanuatu has a strong patriarchal hold in most communities with decision making being taken up by the male citizens. There’s a lot of power play and power dynamics that contribute to decisions that are being made with less views taken from the female citizens. The topics covered concerning our female population aren’t openly discussed, therefore they’re framed as taboo. The struggle is much alive for many women and girls who face ongoing discrimination, injustices in all different sectors and that’s including the health sector. That’s affecting a lot of topics that are concerning women and girls. There are identified achievements, gaps and opportunities in areas where women and girls safety, protection, economic empowerment and leadership and gender are being mainstreamed across the sectors. But I think there’s still a lot of work that needs to be done and achieving increased knowledge and awareness begins at the home with how we discuss topics openly, that affect our lives now and in the future to enable gaining respect and support, our mothers, wives, sisters, aunts, daughters, granddaughters and other women and girls in our extended family and kinship, networks to better support and better, create better understanding so that we go through the different milestone and phases in life gracefully and with support. 

 

E: You know, as women, we are different, not everyone’s experience is the same and this is for everything from, you know, our periods to having a baby and then finally reaching menopause. So Ellis, since you are a certified nurse, could you tell us, you know, what is menopause and what should we expect when we reach menopause, like what are the symptoms? 

 

EL: Menopause is a big topic that’s not openly discussed in our homes, in our culture, in our workplaces. Although women face menopause, they go through it not knowing what it is. So menopause, the process of menopause is all about our hormones, your body begins to produce less estrogen and your ovaries start running low on eggs but it doesn’t happen all at once. So menopause is divided into three different stages, you have perimenopause, and then you have menopause, and then you have postmenopause. So perimenopause is when you’re approaching menopause and it lasts three to seven years, usually beginning in the late forties, early fifties. And then you step into menopause where it’s the end of the reproductive years, the average age to experience that is 51 years of age. And then you step into postmenopause where it’s the phase after menopause from when a person hasn’t had her period, menstrual period for twelve months until the end of their life. And there are different, the systems may vary, as you’ve mentioned, like all females are different and they all vary in their experience, their different symptoms and symptoms vary. So the possible signs and symptoms may vary, so there could be some sleep disruptions, anxiety, lack of sleep, difficulty with remembering and concentrating, there could be facial hair that’s growing, there could be thinning of hair, you could be gaining weight, changes in the skin, the blood pressure could be elevated, the breasts could be losing its size, those are possible signs and symptoms that we experience throughout the three different stages. And at the postmenopausal stage the symptoms start to slow down and maybe even disappear all together and then now you’re at a greater risk for other health concerns. That’s because there’s a decrease in the estrogen in your body and then you’re more prone to cardiovascular diseases, you’re more prone to osteoporosis and other mental health issues. So those are some of the conditions that come up during the postmenopausal stage. 

 

E: Well I didn’t know that there were three stages to menopause, I honestly thought that it was just menopause and you go through it for like several years and then it’s over and done with. But it’s funny you mentioned the symptoms, and I remember my mum talking about going through menopause and she would get really hot flashes, so she would just all of a sudden break out in like a sweat and just feel like super hot. And she would  look around and she would ask “aren’t you guys hot?”, and I’m like “no, I don’t know what you’re talking about”, and then she just said “oh it’s probably just my body going through menopause”. So that’s very interesting, so could you just tell us again what’s the first stage and what age is that again for perimenopause, menopause and then postmenopause? 

 

EL: So the perimenopause is looking at forty, early fifties and it lasts three to seven years. For menopause it’s looking at the ages of 51, around 51, so it could be 50, 51, 52, it differs for different people, different females, different women. And for postmenopause it’s the phase after menopause from the moment a person stops having a period for twelve months straight until the end of their life. So the first stage is perimenopause, it’s a transition period which marks the early stages of menopause and it can last for years. You may start to have menopause-like symptoms like irregular periods, hot flashes, frequent urination, dryness in the vagina, lack of sleeping and mood changes. Although skipping periods during perimenopause is common and expected, often menstrual periods will skip a month and return or skip several months and then start monthly cycles again for a few months. But periods also tend to happen on a shorter cycle so that they are closer together. Despite irregular periods, pregnancy is possible during the perimenopausal stage. So if you’ve skipped a period but aren’t sure whether you’ve started a perimenopausal transition, consider a pregnancy test. 

 

E: And that’s, like to me, that’s so interesting and it’s information that I sort of knew of but now I feel like I know, and that’s information that I find really interesting and I’m so glad that you shared it here because now I feel like I know what to expect. I know that there are three different stages between forty to around late fifties and that the first stage is probably going to last for a couple of years and I know all the different symptoms. And that’s information that I feel young women and just women in general should know, but it’s not and like why do you think that it’s not talked about here in Vanuatu, like do you think it’s because it’s still seen as taboo or is it more of an after thought because it happens later on in a woman’s life? 

 

EL: I mean the practical reason that I could talk to here is a lot of this is blanketed under just going through old age and then these things aren’t talked about or we don’t create spaces to talk through this. Another reason being as Melanesians, we don’t openly discuss our feelings, we don’t talk through the feelings, we talk to “I don’t feel well, I don’t think, I don’t feel well”. It’s either black or white, it’s either good or bad, you don’t unpack your feelings to really talk to it and openly discuss it. The other side of that coin is what would the other person do if you spoke to your feelings? Like even if I go to the clinic or even if I go to the health center, what advice would they give me? How would they respond in a way that I feel that I am supported? So a lot of people hold back how they feel and what they feel until they can find someone else that’s going through the same feelings, the same thoughts, same experience and then they can talk to that. Because we find that like a thing in Vanuatu where we create spaces for women to come together and just talk about what they’re going through. Because a lot of the time we go to talk about things like a structured meeting and talk about community activities but there’s lesser emphasis on creating spaces for women to just come and talk about what they’re going through. 

 

E: I totally agree with what you said. I do feel like, you know, there is that lack of just women, girls coming together to talk about what they’re going through, to share their own experiences so that it, you know, they can learn from each other, know what to expect and that’s one way that, you know, people in the community or just people in general can talk about this topic or any other kind of topic in fact. And that’s one way that we can share information and I guess is the main source of information for this topic is our health services. With our current situation concerning our health services, you know, do you think that they are talking about it the way they should? 

 

EL:  I think this is a very good question because a lot of the time people in the country raise expectations to a different level and they don’t really understand what’s going on around us. But I think there is definitely a commitment from the government of the people of this nation in developing different strategies and policies to achieve the best health outcome by drawing a roadmap for the people of Vanuatu so that it works as a guideline. There is a policy that’s called Health Sector Strategy, it’s a strategy for 2021 to 2030 and it has a monitoring and evaluation plan that comes with it. And in the strategy it talks about health systems being resilient and accelerating progress to improve care that comes for the people of Vanuatu and that already talks to a lot of the health priorities and challenges that may come up and the approach embraces opportunities for innovative and expose different paths to protecting and improving everyone’s health and wellbeing. And that includes topics like incontinence, topics like disability inclusion, topics like menopause in this case and the roadmap, like the government has already set the strategic way forward for that now it boils down to who are the actors and the players in the spotlight and I acknowledge the effort that the ministry of health has invested in developing this roadmap so that people and organizations can work to achieving greater health outcomes for people. It also talks about forming greater partnerships in addressing in an integrated way, better ways to work together innovative and creative so that we talk to a lot of these new upcoming, uprising health challenges that the ministry is currently going through. And a lot of the sectors are already moving forward it’s just that there are other priorities that have come up and the future will bring additional burdens on the health sector and that we know already and we’ve envisioned this to happen but beyond emerging health threats, our sectors will respond to rising priorities and a growing need for other services. Ongoing challenges associated with in our country, the NCD, the communicable diseases and the unfinished commitments for improved family health and that also includes menopause and incontinence and the other topics in there. So we’ve equipped, the HSS has developed to equip the sector, to rise to these challenges and ensure that all the people of Vanuatu benefit from these responsive actions and it also talks to organizations and partners to come together, talk about the uprising challenges and see where we could step in to support the government of the Ministry of Health to move our health deliverables to remote communities, to the people in the community so that we are benefitting from the services that we can provide. So with the shared decision making and integrative strategies, women and their providers can prepare and reflect on the transition in a healthy and holistic way and this of course is always referring to menopausal discussions. So one can build a relationship with your nurse in your area, with your healthcare provider, practice talking about menstruation and sexual health with health care providers, learn about common perimenopausal symptoms and signs so that you’re better equipped and have the knowledge to better care for someone that’s going through that stage or provide awareness and information to the girls and the daughters in the house. Create a space for others to talk about their menopause experiences so that we can share the knowledge around. I call upon the fathers, the husbands, brothers, uncles, sons, grandsons and other male population in our society, population in our communities as well as chiefs, churches and community leaders to join together, create this space to continue having these discussions about life changes in a female life. It is by combining forces and working together that we can be resilient as a nation and create a safe, just and secure society for women and girls in our lives and for our families and for all to enjoy. So before I finish I’d like to leave us with a quote from a civil rights female advocate that goes like this “We delight in the beauty of a butterfly but rarely admit the changes it has gone through to achieve that beauty”. So with that I’d like to conclude by saying information is power, the more information that could be accessed and made available to the different media platforms the better. Let’s encourage everyone to make use of the opportunities that may come across to enrich the knowledge that will improve the quality of life and make time to storian. Use creative ways in communication styles to depict, translate your messages with different people to get their views and learnings which has the potential to enrich and inform and improve your quality of life. 

   

E: I love that! Information is definitely power, the more information we share about this topic, the more understanding young women and girls will have and then slowly this will build on our confidence to better know our bodies so we’re not left in the dark when it comes to topics like this. Thank you so much Ellis for joining me at The RoundTable and for sharing such insightful information. Ladies if you want more information on menopause, go to your nearest clinic, there’s the Kam Pusum Hed Klinik at Wan Smolbag, Vanuatu Family Health Clinic, the NTM Clinic or of course Vila Central Hospital. 

Conclusion 

E: Make sure to check us out on Facebook, Instagram and TikTok at Sista Vanuatu and our website sista.com.vu. This is Elsie, from The RoundTable. If you want to hear more from The RoundTable podcast, make sure to tune in to the next episode.