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A brief history of the menopause taboo

Good Housekeeping UK logo Good Housekeeping UK 16/02/2021 Charlotte Haigh
chart: menopause © Hearst Owned menopause

More of us are now opening up about menopause. From TV presenter Zoe Ball discussing her hot flushes to campaigns pushing employers to recognise the effects of symptoms in the workplace, menopause hasn’t always been talked about in this way in our lifetimes. There’s still a lot of stigma to dismantle, though. Our society’s ingrained ageism and sexism have, for a long time, found a joint target in menopause, resulting in a sniggering attitude towards common symptoms like brain fog and vaginal dryness, and a dismissal of menopausal people as ‘past it’. No wonder many dread this natural transition phase as a sign we’ve passed through a doorway from ‘young’ to ‘old’.

Sadly, the stigma can mean not only that many people struggle with a confidence crisis around menopause, but also that lots don’t have the information they need or seek help or to manage symptoms. Meg Mathews, who launched her own menopause website after experiencing debilitating symptoms, admits to being in menopause denial when her first symptoms hit. “I was 50 and struggling with low mood and joint pain,” she said. “A female friend told me she thought I might be going through menopause and I was gobsmacked. Somehow, I didn’t think it was going to happen to me – not at that age, anyway. I associated it with being old.”

So where did those hot flushing, shrivelling stereotypes come from? Professor Susan Mattern is a US-based historian whose recent book, The Slow Moon Climbs, explores the history of menopause. “We don’t have evidence menopause was spoken about much at all until relatively recently in Western societies,” she said. “So it’s hard to say with complete certainty what the attitude was. But looking at today’s hunter-gatherer communities – which are less influenced by modern society and live in a more similar way to our ancestors – can give us some clues. These communities don’t have a word for menopause. We know societies have always recognised women stop bearing children in midlife. But there isn’t a concept of menopause as a syndrome that needs managing.”

text: There are signs attitudes to this life phase are shifting, but when did we start viewing it so negatively? © Getty Images There are signs attitudes to this life phase are shifting, but when did we start viewing it so negatively?

A survival advantage

Mattern’s research shows menopause isn’t a by-product of our longer lives. “It’s a common misconception that women used to die shortly before or after going through it, and that it’s just an accident of our modern life spans that women now live on after menopause,” she said.

text: menopause © Hearst Owned menopause

“Average life expectancy was certainly shorter among our early ancestors but that was because infant mortality was so high. A 15-year-old had a good chance of living to 45, and a 45-year-old had a good chance of living to 65. This means our early female ancestors were likely to have lived for at least two decades after going through menopause.” She argues that far from being an accident, menopause evolved to improve our survival as a species.

“Once women were past reproductive age, they had important roles, feeding the community, teaching, and learning new technologies to pass on, in a way that wouldn’t have been possible if they were constantly pregnant or completely focused on feeding children. Evidence shows it was more beneficial for our survival as a species for women to stop bearing children in midlife. Most animals reproduce until death. Humans don’t. Menopause is an adaptation that’s been vitally important for us to survive and thrive,” Mattern explained.

Wise women

This is still recognised in some traditional societies, where older women are honoured for their wisdom and experience and gain higher status after menopause. And it’s likely, says Mattern, that our ancestors also shared this view of women in midlife and beyond. It may have been a phase in which women became respected role models – and at the very least, it just probably wasn’t an issue. This attitude seems to have continued into more recent history. “In early modern England, a lot of women didn’t marry and therefore never had children,” said Mattern. “They became teachers and governesses, looked after households and so on. Post-reproductive women and those who’d never married weren’t looked down on – they were valued for their roles in society.”

Stigma in the ‘60s

So, when did it change in Western countries? “Around 1700, we see the first mention of menopause in medical literature,” said Mattern. “Doctors described various syndromes affecting upper middle-class women who didn’t work – menopause was one of them.” The word ‘menopause’ – which literally means the ceasing of menses - is thought to have been coined by a French doctor in 1821, the first time it’s known to have been written down. Supposed ‘remedies’ (such as crushed cows’ ovaries) were sold in the early 20th century.

But it probably didn’t become more widely thought about and talked about until a lot more recently. Surprisingly, perhaps, modern stigma probably has most of its roots in the 1960s, the era of the sexual revolution.

In 1966, Dr Robert Wilson published a book called Feminine Forever, persuading women to avoid the ‘living decay’ caused by falling oestrogen and maintain a youthful, body and appealing personality with the use of HRT. Wilson peppered his book with unflattering descriptions of menopausal women as ‘flabby’ and ‘desexed’, with ‘shrunken’ breasts and genitals. He had a promise, though – HRT could change all that. The book was a bestseller and, according to Mattern, had a huge influence on our views of menopause. “Women were told that ‘lack’ of oestrogen was a problem and it could be cured,” she said. Sales of HRT quadrupled. It later emerged Wilson had received payment for the book and speaking tours by pharmaceutical companies that produced Premarin, a type of HRT.

So, it seems, what we’re now shaking off is a stigma born in the West in the mid-20thcentury. Even physical symptoms of menopause might be affected by our cultural mindset, argues Mattern, pointing out that in many societies less influenced by Western attitudes, women don’t report significant menopausal symptoms. In these societies – for example, those in parts of rural Gambia – the end of periods is seen as a relief.

“Conversely, in the West, there’s a strong focus on coping with difficult menopause symptoms, although actually, not all women have them, and some feel great at this time,” said Mattern. “But if you’re told to expect fatigue and hot flushes, it may mean you’re more likely to experience them.”

Symptoms are real – nobody’s saying otherwise - but there could be a degree of social influence. Mattern reports that studies do show incidences of hot flushes and night sweats peak around 50, but in some cultures that still live in a more traditional way – such as Mayan communities in Mexico - they’re not linked to menopause. And, intriguingly, a Swedish study found one-third of men over 55 reported them as well, with half of those describing the flushes as troublesome.

A new era

Fortunately, there are signs the taboo is shifting. With high-profile people in midlife talking openly about all aspects of menopause, the view of it as a time of decline is changing. After all, many people enter perimenopause in their forties, when they probably still have half their lives left, possibly with a thriving career or growing families. It certainly isn’t a time for slippers and fading away. And having a more positive view of it may influence your experience.

text: menopause © Hearst Owned menopause

“Everything is related to everything else and all the body’s systems work together,” said consultant gynaecologist Ms Tania Adib. “When you’re happy at work and happy in a relationship, that is going to affect all your hormones. And women these days are much more likely to look after themselves well. Being physically healthy through diet and exercise means you’re more likely to have a positive experience of the menopause and less likely to be badly affected.”

HRT is, of course, an option if you need it – not to hold onto some myth of femininity, but to maintain bone health and help you manage symptoms, alongside a generally healthy lifestyle.

“There’s no need to struggle – go to see a doctor who can help you,” advised Adib. Emotionally, perhaps we need to view menopause as our female ancestors may have and some cultures still do – as freedom from the burden of reproduction and monthly bleeding. “It can be seen as a time of greater wellbeing and energy – a gift from nature,” said Mattern.

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