Medicine, Age and Gender: The Menopause in History

Abstract

Attitudes to the menopause in Western Europe and America have been shaped by changing ideas about age and gender. No concept of a biological process specific to the human female and due to the cessation of menstruation existed before 1821: doctors did not differentiate between the male and female ageing process, and the word “climacteric” was used to indicate the transition from one epoch of human life to the next, regardless of gender. In the 19th century, however, sharp boundaries were drawn between male and female, and reproduction became the defining quality of femininity. The construction of womanhood that emerged at this time served to focus the attention on the menopause as a crisis that had to be negotiated. During the Victorian period leeching, cold baths and sedatives were prescribed for the menopause, and the importance of hygiene and moral management was emphasised. By the early 20th century, ovarian extracts were also employed in clinical practice, although their efficacy was often disputed. The development of reproductive endocrinology in the 1920s led to the isolation of oestrogen, and hormonal preparations were soon developed for the treatment of menopausal symptoms. Hormonal therapy receded in importance after the Second World War as psychoanalytic theory briefly replaced the hormonal paradigm as a tool for understanding the menopausal syndrome. In the 1960s, however, the psychoanalytic model was once again displaced by the growing importance of endocrinological explanations. Both old and new notions of gender and age have affected medical and lay perceptions of the menopause in the 20th century: in particular the cult of youth that emerged in the early part of this century has dominated images of ageing and the menopause, influencing the messages women receive about the mid-life period.