The menopause, the backlash – it's all interrelated
There is a clear correlation between the history of feminism and the shifting of menopause taboos, says historian Jill Kirby in the latest The Backlash Q&A.
Last year, I was out at dinner with friends and I happened to be the youngest person at the table. We were all women, and every one of my dining companions was either menopausal, perimenopausal, or had been through the menopause. I felt like a younger sister, finding out about something secret that awaited me in a not far-off future. I remember saying that no one ever talks about the menopause, and the response being that, well, if I spent more time with menopausal women I would probably hear a lot more about it.
Menopause does seem to be increasingly a subject of public discussion, certainly here in the UK. Whether it’s the Labour Party promising to do more for menopausal women if they win the next election, or the Conservative government rejecting recommendations on how to deal with menopausal women being discriminated against, “the change” and its impact on lives – and on the economy! – is being talked about more openly.
Why is this shift happening now? And what — if anything — has it got to do with the backlash against feminism? In the latest The Backlash Q&A, historian Jill Kirby of Sussex University discusses what her research has uncovered.
The Backlash: Your research focusses on the social and cultural history of menopause in the UK in the 20th and 21st centuries. In what ways have attitudes towards menopause shifted over this period?
Jill Kirby: One thing that is certainly changing now is the breaking down of the perceived taboo about menopause. For most of the last century and the early part of this century menopause was simply something that wasn’t talked about. It was invisible in popular culture, with the exception of the odd article in women’s magazines until the 1970s and 80s. Among the general public it was not a topic that was ever discussed. Not even between mothers and daughters, nor very often with husbands and partners. Very often women did not even want to admit to themselves that they were menopausal, let alone to anyone else. There are a lot of reasons for this, some to do with taboos about blood and menstruation and sex – all of which people were taught were “not nice” to talk about. It was also because menopause was understood as such a negative thing that women were reluctant to either admit to it or find out about it; there was a sort of collective denial. That negative perception owed a lot to how the medical profession presented menopause but also to underlying sexism and ageism that dismissed the relevance of middle-aged and older women and devalued their experience.
TB: How do your findings correlate or map onto the history of feminism and the struggle for gender equality? Is there a connection between that history and how menopause is discussed or understood?
JK: There is a clear correlation with the history of feminism. The women’s liberation movement of the late 60s and early 70s was particularly focused on engaging women in actively taking responsibility for their health. This coincided with the growth of HRT prescribing in the US particularly, which then led to much feminist debate about the pros and cons of medicalising menopause. Some feminists saw therapies like HRT as analogous to the Pill, both liberating and a way to address centuries of suffering. Others saw HRT as a way for a patriarchal medical system to control women and their bodies. It’s a debate that is still very much alive today.
One of the other ways we can understand the correlation between the struggle for gender equality and menopause is the way that it raises questions about biological determinism. Feminists across the twentieth century fought for an acceptance of menstruation as something normal, that did not affect women’s ability to function and most importantly did not prevent their effectiveness in paid employment. Women were not their biology. The issue with menopause was and is that, when its effects are significant, it can and does affect women in the workplace. That is problematic in the face of a hundred years of feminism arguing the opposite!
For most of the century this did not really matter because the number of middle-aged women in full-time paid employment was relatively small, but since the 1980s women in Britain have made up a much larger proportion of the workforce and taken on senior-level professional roles. This means that serious menopausal problems could and did affect women and their careers quite badly. I have evidence of women giving up beloved jobs because they just could not cope with brain fog, anxiety, or flooding (or all three!). So, what we’re seeing now is that menopause is having to be recognised and faced in a more open way – because its potential impact on organisations is economically significant. Hence, we see the introduction of menopause policies in the workplace. We can see parallels elsewhere. Organisations began to take notice of and put in place policies and preventative training on workplace stress in the 1980s because the effect that employee stress was having on absenteeism and the bottom line became apparent. What’s happening with menopause is similar – it’s not altruism – it’s about the financial impact of losing women’s productive contribution to capitalism.
TB: The author Ursula K. Le Guin wrote that the menopause is when a woman “must become pregnant with herself, at last." She saw it as the third stage of a woman's life, and a welcome one at that. In your historical research, have you come across evidence of the menopause being seen as a positive life transition? Or is it mostly seen in a negative light?
JK: There is definitely evidence that women see menopause positively, if only because it means an end to menstruation. That sounds a bit trivial, but the hundreds of accounts that I have read show that many women suffer all through their reproductive lives with seriously debilitating menstrual problems, which are often not properly addressed or dealt with by doctors. For those women menopause is a huge blessing that they have actively looked forward to because of the relief it will bring. So to tie that to Le Guin’s comment, for some women menopause equals freedom. They can get on and live their lives unencumbered by menstruation.
Women also talk about the calmness of post-menopause in that it removes constant vigilance regarding contraception and pregnancy and the rollercoaster of pre-menstrual tension that some women experience. For some it means a better sex life and calmer family life. Some women also talk about having more energy and focus. I was surprised to find very few comments by women about sadness at the loss of fertility or femininity. Most women either had children and had not wanted more or did not have children either through choice or circumstance and had already accepted this by the time they reached menopause. I think it’s notable that in the accounts that I’ve studied from the late 20th and early 21st centuries, women were very clearly not tying their identity to their fertility in the way that has always been presumed. Again, I think this is another effect of feminism and women’s greater opportunities and choices in the late twentieth century. Women in earlier periods might well have felt differently as their roles in society were clearly much more constrained and therefore childbearing and raising were often seen as their only real purpose.
TB: What is the biggest change in attitudes about the menopause that you have come across in your research?
JK: There are two big changes. The first is the breaking down of the apparent taboo. In many ways that is still a work in progress, but it is having significant effects – in terms of workplace policies but also demands on doctors. Women are doing what the second wave feminists of the 1970s encouraged them to do: arming themselves with information and treating their conversations with doctors as a dialogue with shared authority over how menopause is dealt with, not a one-sided decision by the doctor (who may or may not have had much, if any, education about menopause). The downside of this is that the HRT supply chain in Britain has not been able to cope with increased demand and there have been frequent, significant shortages of products over the last four or more years. Currently there is a shortage protocol in place for the bio-identical progesterone tablet Utrogestan.
The other big change in attitude is that women’s sense of identity is less affected by menopause than it might have been in the past. Many women mention that menopause just happened and was only one of many important events going on at mid-life, and that other events such as career opportunities, health problems, or family changes were more significant. Few mention empty nest syndrome and even fewer seem to assume that menopause will be some massive upheaval.
TB: It seems very recent that the menopause has become a point of public discussion in the UK, whether it's Davina McCall's TV show about the menopause, or the Labour Party making policy pledges about menopause leave. What has changed in the last decade or so? And why has this taken so long?
JK: What has changed is the big question, isn’t it? I think it is a combination of factors. The number of women of menopausal age in the workplace is an important one. This is not the vanguard of Baby Boomers but the middle wave and I think that’s significant. Many of them are in positions of power within the media. Davina’s TV show was by no means the first. Kirsty Wark did one a few years ago and there has been a steady stream of writing about menopause since the millennium. These women are in positions to get programmes made and this contributes to raising public awareness. I think it’s also about changing views on HRT. There have been many scares about the safety of HRT over the last fifty years partly because it was such a new treatment and long-term, large-scale research just didn’t exist until the late twentieth century. Its formulations have also changed along the way (much as those of the contraceptive Pill did). The way that the media covered issues such as the reporting of the Women’s Health Initiative findings in 2002, that suggested much higher risks associated with hormone therapy, contributed to a lot of fear and anxiety about HRT. We are now seeing a somewhat more nuanced understanding of its risks.
Why has it taken so long for there to be public discourse? Again, several reasons. Firstly, the apparent taboo around menopause. No-one talked about it. Secondly, the lack of serious medical research into menopause. This is still an issue – there has been a lot of research on HRT but not on menopause itself. Women’s health has always been seen as secondary to men’s health. The modelling for many medical treatments, prescribing protocols, and so on, has all been based on male bodies —
’s book discussed this. But it’s also a cultural thing; women throughout most of the 20th century were brought up to expect to put husband and children’s welfare above their own. There was an expectation of female stoicism in dealing with menstruation, pregnancy, and menopause, as well as any other ailments that conditioned women and men to often dismiss women’s suffering as simply a “woman’s lot.” I have seen that a lot in the evidence that I’ve looked at. That expectation was a very powerful one and it has informed much of the way that many aspects of women’s health and well-being have been understood and treated for a very long time.TB: Despite these changes, there is still so little cultural space for the menopause. Why do you think that is? Is it the same societal "ickiness" (for what want of a better word) regarding women's bodies?
JK: I think it is partly the “ickiness” that is tied to menstruation, blood, etc. But I think it is also an area where women have been complicit in the silence. Many women have done their best to avoid admitting to going through, or discussing, menopause because they associate it with only negative things. This is partly because of how it has been understood in our culture as I’ve already explained, and partly because of the ageism and sexism that come together in how society values the older woman. Women have not wanted to admit to being menopausal or post-menopausal because of what that has implied: they are no longer young. Our society values youth disproportionately both in appearance and what youth signifies. In order to reclaim menopause in a positive way, we also have to undo some even more strongly ingrained beliefs about ageing and women – and that is going to be tough because our whole culture is focused around youth=positive, old=negative.
One thing that might help to change this is commerce. It has been very interesting to see how quickly all sorts of products have been suddenly marketed as “menopausal” in the last few years as menopause has become much more publicly discussed. Producers of consumer products have recognised a huge marketing opportunity in middle-aged women and firmly grasped it with both hands. Of course, most of it is marketing hyperbole – there will be nothing different in one face cream compared to another, other than the word “menopause” in the blurb. But if marketing and advertising starts to present menopausal women in more positive ways then this might just start to counter the overwhelming messages women (and men) get about what it means to grow older. Maybe.
TB: Do you see any relationship between the way we deal with menopause and the backlash against feminism?
JK: I think it is all interrelated. Feminism has done much to counter the insidious ways in which women, their rights, their opportunities, and their health have been subordinated for centuries. The treatment of menopause is just one more part of that situation. Those who oppose medicalisation can certainly argue that the increased use of HRT for menopause is a tightening of medical control of women – and as I mentioned earlier, the shortages of product and the effect that this has on women when they cannot get their HRT, demonstrate the effects of that control all too clearly. It does subordinate women to the medical system. However, I personally see the backlash much more obviously in the challenges to abortion and contraceptive rights being seen in the US, and in the continuing epidemic of violence against women and the continuing modelling of our world on male norms.