Menopause: Various Meanings, and Sometimes No Meaning

In the case of menopause, the obscure, exotic societies quoted just regard it as the end of fertility and monthly involuntary bloodletting. When they ascribe other meanings to it, it’s the one of a woman becoming a man, or rather, a woman ceasing to be impure a few days out of the month; and often, menopause means obtaining new rights and powers, on top of those a woman might already have.

(I was discussing this book with a physician who told me some of her immigrant patients were very disoriented by the talk around menopause in Europe, and didn’t understand what the fuss was about.)

Menopause: Female Aging as a Dysfunction

The historical dive shows the menopause for an empty category (“end of fertility”) that was fleshed out by the growing medical institution. During the 18th century, definitions of male and female bodies became opposed rather than complementary. Since the female body was then defined by the ability to bear children (e.g., what the male body couldn’t do), menopause then became a dysfunction (all the while youth before fertility is not regarded as a dysfunction). In other words, menopause became a sort of disorder once fertility had been added to the definition of female health (an infertile man is generally not considered sick).

(the same physician told me that, rather than a woman’s thing, hot flashes are a human thing when nearing 50. It’s noticed and treated as a disease by and for women (“Just take this hormonal fix”), while men tend to just wonder, “Why am I hot today ?” and crank up the A/C.)

The 19th century, the century of scientific description, took care of fleshing out the disorder and its many consequences. A moral aspect of the disease developed (country women, closer to nature, do not have it as bad as city women, troubled by inappropriate literature and excited by theater) and wise advice is then shared (do not have sex after menopause, you have no reason to have sex anymore, you do not look as if you should have sex, and it’s going to make it worse).

From Humor to Hormone

In the 20th century, menopause became viewed as hormonal. Rather than a cause of diseases, it became itself a disease that can be treated – and, soon, a whole market. Synthetic hormones were developed in the 1930s and eventually found their use as a cure for the “disease” of menopause, thanks to the concerted efforts of two economic actors (medical and pharmaceutical industries). It culminates as a disease when it becomes official in the 1970s in the US: it gets its own journals and yearly conferences.

In France, where physicians are less sensitive about women’s quality of life concerns and are more suspicious of hormonal therapy, it is slowly adopted. That said, the same logic applies: a woman with menopause is compared to a fertile woman, and the difference defines the disease and justifies the treatment.

(that same physician told me she and her colleagues are somehow forced to maintain the myth of menopause despite solid evidence: because some patients expect it and can’t/won’t hear otherwise, because some of her colleagues’ income (endocrinologists for instance) depends on it, and because the art of the medical letter of recommendation is pretty well structured: key words such as “hot flashes” are expected to trigger care.)

And from there we stumble back into the arms of Ivan Illich.

Sociology, I love you.