WELLCOME^ IMAGESas a deficiency of oestrogen remains influential in medicine
to this day.
Pharmaceutical companies promised that their oestrogen-
replacement products would miraculously cure the many
symptoms and conditions that people had, by then, been asso-
ciating with menopause for about 200 years. Some went fur-
ther. In 1966, US physician Robert Wilson (whose research
was mostly funded by the makers of Premarin, the best-selling
oestrogen replacement therapy at the time), changed the con-
versation on menopause with the publication of his book Fem-
inine Forever. He painted a lurid picture of the fate that awaited
women past menopause, describing it as “a serious, painful,
and often crippling disease”. Comparing the effects of oestro-
gen on post-menopausal women to those of insulin for people
with diabetes, he promised that hormone replacement therapy
would enable women to preserve their youth, vigour, mental
acuity and sexual attractiveness.
Another mid-20th-century trend began to link menopause
specifically to depression. From early in its history, the syn-
drome of menopause had included behavioural and psycholog-
ical symptoms. Freudian psychoanalysis, meanwhile, linked
menopause to grief, loss and mortification. Helene Deutsch, in
her book The Psychology of Women published in 1944–45, was
especially influential; she began her epilogue on ‘The Climacte-
rium’ with the pronouncement that “with the cessation of this
function [menstruation], she [woman] ends her service to the
species”. The term ‘involutional melancholia’ (or ‘involutional
psychosis’) had already been coined to describe a depressive
disease thought to be associated with menopause.
Exporting understanding
As the idea of menopause became established in
modern medicine, it was exported around the
world. For example, when China’s Maoist govern-
ment was modernising Chinese medicine (creating
the system now known as Traditional Chinese
Medicine), a chapter on menopause was added
to the second edition of the official textbook on
gynaecology in 1964. There is little evidence that
Chinese medicine or culture included a concept of
menopause as a medical problem before then.
The concept came to Japan somewhat earlier,
around the turn of the 20th century, after that
country had ended its self-imposed geopolitical
isolation and opened its doors to western science.
The term konenki was coined to signify meno-
pause as it was described in western – especially,
German – medical literature. The Chinese bor-
rowed their word for menopause, gengnianqi,
from the Japanese konenki.
Over time, the notion that menopause is a
deficiency condition that can be cured with
replacement oestrogen has not held up as well as physicians
such as Wilson expected; oestrogen turned out not to be the
wonder drug they promised. Efforts to treat ‘involutional mel-
ancholia’ with oestrogen proved ineffective. The disappointing
results of The Women’s Health Initiative (WHI), a massive
study designed to test the effects of prescribing hormonal sup-
plementation to all women by default, have been well reported.
This practice of prescribing hormones to prevent health prob-
lems was a logical consequence of the oestrogen-deficiency
model of menopause; in 2002 alone, 90 million prescriptions
for hormone therapy were written in the United States. But the
WHI ended early that year, because the risks of treatment
seemed to out weigh the benefits.
Today, many researchers continue to study physical, cogni-
tive and behavioural symptoms thought to be associated with
menopause, but without understanding the history of the ideas
and assumptions on which their research is based.
Furthermore, new research in the fields of anthro-
polog y and psychiatr y might change some of those
assumptions. Early modern syndromes were not
purely literary or imaginary. Real people suffered
real problems; they wrote about them in letters and
diaries, and doctors described them in case histo-
ries. But culture played a big role in shaping their
experiences. Today, transcultural psychiatrists study
what are sometimes called ‘cultural syndromes’ or
‘distress syndromes’, and have proposed intriguing
and convincing models of how they work.
Menopause the syndrome – the collection of
symptoms – has a lot in common with distress
syndromes worldwide. Symptoms of distress syn-
dromes are of a kind that overlap with the physio-
logical effects of anxiety or fear – the ‘fight–flight’
response that is also called sympathetic nervous
system arousal. This is a broad cluster of phenome-
na including heating and flushing sensations,
heart palpitations, chilling of the extremities, pain,Hormone replacement
therapy, it was claimed,
would enable women
to preserve their youth,
vigour, mental acuity
and sexual attractiveness
History of menopause
The oestrogen substitute
eticyclin. Since the mid-20th
century, such compounds
have been prescribed to
millions of women to treat
symptoms of menopause