History of menopause

I

t may seem surprising that a condition that will

affect half of the human population during part of

their lives remained unnamed for so long. Yet the

word ‘menopause’ was invented as recently as 1821,

by French doctor Charles-Pierre-Louis de Gar-

danne. True, the concept was not original to him;

by the time his book De la ménopause, ou de l’âge

critique des femmes (Menopause, or the critical age of

women) appeared in print, the idea he described was about 100

years old, though it had lacked a name.

Around 1700, doctors began to write about a condition they

called “the end of menstruation as the time for the beginning

of various diseases”, “the cessation of menstruation, and the

problems that it may cause”, and the “cessation of the period-

ical discharge, in the decline of life, and the disorders arising

from that critical change of constitution.” In other words, they

wrote about a syndrome of symptoms and problems affecting

one gender – women – at a certain time of life.

This was not the only syndrome of this kind recognised in

professional medicine and popular culture. Many syndromes

were staple features of the early modern European medical im-

agination, including ‘hysterical suffocation’ (called by several

different names in this period), melancholia, nymphomania,

and chlorosis or ‘green sickness’, a condition parallel to meno-

pause in some ways, thought to affect adolescent girls. Chlorosis

appeared in the medical literature earlier than menopause,

beginning in the 16th century. At that time, there was still virtu-

ally no mention of a syndrome associated with the end of men-

struation in European culture, or in any culture that produced

a written medical tradition.

Early medical writers on menopause associated a

huge variety of symptoms and conditions with the

newly named syndrome, some of them very severe.

De Gardanne’s book lists several dozen “illnesses

that are typically observed around the time of men-

opause,” including fevers, wasting, ulcerations of

the skin, cancers, haemorrhoids, coughing up

blood, hepatitis, strangury (slow and painful urina-

tion), epileptic seizures and many others. Several

physicians from the same era describe episodes of

flushing and sweating that sound like what people

in the modern world would call hot flushes (in the

United States, more commonly called hot flashes).

The first popular advice literature on menopause,

with such titles as Advice to Women of Forty Years,

appeared in the mid-18th century. During the

19th century, as doctors made exciting

discoveries about the nerves and began to

locate the cause of many disorders in

the nervous system and brain, behav-

ioural symptoms become more prom-

inent in writing about menopause. W

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Edward Tilt, author of the first full-length book on menopause in

English – The Change of Life in Health and Disease, best known in

its second edition of 1857 – thought that menopause could cause

alcoholism or mania, and could even make women murderous-

ly violent. Tilt was among the first physicians to quantify the

symptoms that he obser ved in his patients, the most common of

which were flushes, haemorrhaging, “nervous irritability”, differ-

ent kinds of pain, and something he called “pseudo-narcotism”,

a sort of semi-vegetative cognitive state. In his view, menopause

was a critical state of nervous irritation in which women’s health

was vulnerable but, once through that period, women could

look forward to many years of robust good health.

In the 18th and 19th centuries physicians blamed meno-

pause on plethora (the retention of blood) or, later, on the

nerves. In the early 20th century, the science of en-

docrinology came into being with the identifica-

tion of hormones: chemic a l signa ls produced in t he

ovaries and other glands, carried to remote regions

of the body through the blood. Scientists isolated

oestrogen, the primary female sex hormone, in

1929; within a decade, the first oestrogen replace-

ment drugs were available.

Menopause became redefined as a hormonal

problem and, in the long run, as a permanent

deficiency of oestrogen. No longer a critical

but temporary period of symptoms and suffer-

ing, physicians now described it as a persistent,

pathological state of hormonal deprivation and

higher risk. Gone was the notion that, once

through menopause, women might become

healthy and rejuvenated. Ovarian oestrogen

was assumed to be important to health at

all stages of a woman’s adult life, and

post-reproductive women didn’t pro-

duce enough of it – or so physicians

believed. This idea of menopause

Early medical writers on

menopause associated a

huge variety of symptoms

and conditions with the

newly named syndrome,

some of them very severe

Doctor Edward Tilt, author

of the first full-length book

on menopause in English,

pictured in 1861. He

quantified symptoms such

as “nervous irritability”