Rethinking menopause: Authors argue dreaded life change has an upside

Originally published on September 5, 2019.

Menopause has a bad reputation. Hot flashes, mood swings, insomnia the long list of symptoms makes it a time of life dreaded by many women. It's also seen as the end of good things.

But what if we're looking at menopause incorrectly? According to historian Susan Mattern, this is a narrow way to consideran essential life stage.

"Nature has given us this gift of freedom from fertility, freedom from reproduction and we should absolutely appreciate it," Mattern told IDEAS.

In her book, The Slow Moon Climbs: The History, Science, and Meaning of Menopause, Mattern travels deep into our Paleolithic past and provides new ways of understanding life beyond fertility.

In fact, she says menopause is key to how our species has evolved and thrived.

"It's not a mistake, right? It's not a time of life when we live past some test of usefulness or anything like that. This is ... how we became human," Mattern said.

Menopause as a cultural syndrome

Menopausal syndrome was an idea first advanced by male doctors starting in Europe during the 1700s. But before then, physical complaints around theend of menstruation were not a significant part of medical literature during that time not even in women's own writings, such as intimate diaries.

Matternsaysit was the rise of modern Western medicine in the 19th and 20th centuries that is responsible for framingmenopause as a deficiency "as some kind of hormonal failure."

In the 1966 bestseller Feminine Forever, Dr. Robert A. Wilson declared menopause to be a crisis of femininity and desirability, best countered with supplemental hormones. Mattern believes that women themselves have been affected by that societally-based idea. But she goes further, calling menopause a cultural syndrome.

As our bodies respond and we get more worried, we get more anxious. We create symptoms and these can take quite specific forms. They can be quite severe.- Susan Mattern

The University of Georgia research professor acknowledges that some women suffer extreme symptoms, requiring drugs. But she contends that symptoms such as hot flashes are a mix of mind and body.

"How a cultural syndrome works ... is a sort of feedback loop between what we think and what we believe and how our bodies respond," Mattern explained.

"And as our bodies respond and we get more worried, we get more anxious. We create symptoms and these can take quite specific forms. They can be quite severe."

Mattern makes a parallel with panic attacks: located physically, yet amplified with anxiety.

"We ... believe that cognition is a really important part of panic attack, and it can be treated with cognitive behaviour therapy. So I'm saying that menopause has some of that character."

Menopause specialist Dr. Wendy Wolfman has not yet read Mattern'snew book. But she says that current medical research proves that vaso-motor symptoms hot flashes are verifiably physiological and they are among the most common, medically-validated symptoms of menopause.

"We now know the cells in the brain that are responsible...get bigger after menopause. We know that they have connections to the thermo-regulatory centre within the brain," said Dr. Wolfman.

Still, could a broader more inclusive assessment of menopause be helpful? Mattern suggests there's ample evidence for menopause as a life stage with benefits for women, and our species as a whole.

The Grandmother Theory

Mattern is convinced by the Grandmother Theory of evolution. It proposes that post-reproductive women in the long hunter-gatherer period of ourhistory led their clans in the gathering of food and knowledge. Menopause, and longer life in humans, evolved in this Paleolithic era period to ensure that ease of morereproduction, better brain development, and group mobility.

Another writer on menopause also points to coming upon the Grandmother Theory as her "defining moment."

Darcey Steinke is behind a genre-defying book called Flash Count Diary: Menopause and the Vindication of Natural Life. Suffering many hot flashes a day, and discouraged by pop cultural misogyny around menopause, Steinke sought greater meaning in her experience.

Inspired by the idea of older women as leaders,Steinke also found kinship with killer whales one of the only other species to experience a long post-reproductive life.

Fascinated with a Pacific orca nicknamed Granny, Steinke calls the mammal matriarch "a conduit out to the greater world for me."

"That's kind of what menopause is. You feel a certain way because of hormones, but once that's over there's a strong feeling of ... freedom, in a spiritual sense."

Guests in this episode:

• Susan Mattern is Distinguished Research Professor of History at the University of Georgia, and author of The Slow Moon Climbs: The Science, History, and Meaning of Menopause (2019, Princeton University Press).
• Darcey Steinke is a writer based in Brooklyn, and the author of Flash Count Diary: Menopause and the Vindication of Natural Life (2019, Sarah Crichton Books/Farrar Straus Giroux).
• Dr. Wendy Wolfman is director of the Menopause Clinic at Mount Sinai Hospital in Toronto, University of Toronto professor, and board member of the International Menopause Society.