Last April at a weeklong retreat in Dartmoor I learned how to make fire from sticks, and baskets from switches of hazel. Our teacher, a buckskin-clad woman called Lynx, was visiting from the American West where she lives in a yurt and practices ancestral skills. One night she asked us to place ourselves around the campfire in age order. At fifty-one, I was the oldest woman in the group.
‘As elders,’ Lynx said addressing me and a sixty-something Frenchman called Bernard, ‘what would you like to pass on to the younger generation?’
Bernard said some very funny and wise things.
It was my turn.
‘Menopause,’ I blurted, ‘is wonderful!’ The fire popped and sparks flew. ‘It’s not something to be afraid of; it’s a trip.’ These words had come from somewhere very deep and took me by surprise. Despite being in the thick of menopause, I had not spoken about it to anyone.
It took being out in the wild to come to the shocking realisation that the thing preventing me from opening up about menopause was shame. I am embarrassed at losing my fertility, at seeing my looks fade, at getting old
The next morning at breakfast several young women approached to say they’d never heard anything positive about menopause. They were hungry for more. I knew when I went on this retreat that I would be getting closer to the Earth, I would be camping and foraging for food, but I hadn’t expected that in doing so I would get closer to my body.
It took being out in the wild to come to the shocking realisation that the thing preventing me from opening up about menopause was shame. I am embarrassed at losing my fertility, at seeing my looks fade, at getting old. In our youth-obsessed, consumer culture where surface beauty is valued along with our ability to make babies and stay ‘hot’, where would I find my currency as a middle-aged woman?
The word ‘menopause’ comes from the Greek meno for ‘moon’ – also the root for ‘month’ – and ‘pause’ meaning to ‘halt’. Technically menopause is our last menstrual cycle. The correct term for the stretch of time from peri-menopause until a year after our final period is the ‘climacteric’, which stems from the Greek word for ‘ladder’ and is also where we get ‘climax’. Looking at menopause as a dramatic event, ‘climax’ fits nicely.
For centuries menopause was understood to be a deficiency disease. Our loss of oestrogen was not considered a normal physiological function of aging, but an illness. In Victorian times, the ‘insanity’ brought on by menopause was treated with poisonous purges of lead and mercury, sedation and incarceration in an asylum. It was also recommended that women’s ovaries – their ‘organs of crisis’ – be removed. This, however, often proved lethal. In looking at its history, you begin to form a picture of menopause as a deadly business. Put bluntly, many women have died in the never-ending search for a ‘cure’ for its symptoms. When we weren’t being physically dismembered or drugged, Freudians like Helene Deutsch, founder of the Vienna Psychoanalytic Institute, dissected our psyches. In her 1945 opus, The Psychology of Women, she argues that a woman’s mental health was inseparable from her desire to be a mother and that women who embraced the end of their fertile years were ‘deviant, unfeminine, and shameful’.
Women have always been victims of what Susan Sontag called the ‘double standard of aging’. Men can seamlessly graduate from boy to man but for women there is no equivalent: ‘The single standard of beauty for women dictates that they must go on having clear skin. Every wrinkle, every line, every grey hair, is a defeat . . . even the passage from girlhood to early womanhood is experienced by many women as their downfall, for all women are trained to want to continue looking like girls.’
It was the swinging sixties that ushered in the way for middle-aged women to remain girl-like. This came in the form of physician Robert A. Wilson’s 1966 bestseller Feminine Forever. In it he promised that his prescribed oestrogen therapy (ERT) would allow us to retain our ‘straight-backed posture, supple breast contours, taut, smooth skin on face and neck, firm muscle tone, and that particular vigor and grace typical of a healthy female. At fifty, such women still look attractive in tennis shorts or sleeveless dresses.’ On the other hand, if we failed to take these prescribed hormones ‘from puberty to the grave’ we became ‘flabby’, ‘shrunken’, ‘dull-minded’, ‘desexed’ ‘castrates’ who risked ‘alcoholism, drug addiction, divorce and broken homes.’ It gets worse: ‘After menopause . . . the breast begins to shrivel and sag . . . Often the skin of the breast coarsens and is covered with scales.’
Scales! Wilson wasn’t looking to alleviate menopause, he was looking to eradicate it lest we become monsters.
Here he is in predator mode: ‘Roving about at a party, a footloose male might scan his surroundings at floor level, searching for a pair of trim legs . . . He assesses her face . . . her hands, teeth and throat.’ Reading Wilson’s book today is shocking. His abhorrence of our bodies is visceral and his distaste for the aging process in women is violent, even sadistic. I could barely finish it.
Wilson’s aggressive promotion of oestrogen was as materialistic as it was misogynistic: the writing of Feminine Forever and his book tours were funded by the companies who were manufacturing oestrogen and looking for a market. He received millions of dollars from pharmaceutical giant Wyeth, among others. In its first seven months, Feminine Forever sold 100,000 copies. Bafflingly, this book-length advertisement is still popular. ‘A must-read for all women over 45!’ ends one Amazon review from 2013.
Conjugated equine oestrogen (CEE), the hormone Wilson advocated was – and still is – manufactured from the urine of pregnant mares. If you’re prescribed HRT today in the US or the UK, the chances are it will be Premarin (short for ‘pregnant mares urine’). And if you’re squeamish, do not read to the end of this paragraph. The urine needed for ERT and HRT will have been extracted from mares held captive in horse farms in China, western Canada or the US. These creatures are tied up and kept pregnant, with catheters permanently strapped to their urethras. After about twelve years, they ‘wear out’ and are slaughtered. Their foals are sold for meat. But none of this will be discussed during your visit to the doctor. It’s just another cog in the Big Pharma machine. And the chances are you won’t be told about bio-identical hormones made from yam and soy, but these are beginning to get backing from the medical establishment.
‘Almost any tranquiliser might calm her down, but at her age oestrogen might be what she really needs,’ claimed an ad for Wyeth in the Journal of the American Medical Association in 1975 – the height of ERT uptake. Despite advertisements like this, and Wilson’s contemptible proselytising, many feminists embraced oestrogen therapy. It would, they believed, release them from the trap of biological destiny. It wasn’t so long ago that ‘natural’ processes such as childbirth often killed us, so the quest to be free from the diktats of our bodies is understandable.
However, the HRT honeymoon was not to last. By the mid-seventies, several drug companies in the US had been selling dangerous and untested products, such as the intrauterine contraceptive device known as the Dalkon Shield which killed thirty-six women and hospitalized a further 7,900. Then there was DES (Diethylstilbestrol), prescribed to prevent miscarriages and to alleviate the symptoms of menopause. The only problem was it had no positive effect on those conditions. It did, however, cause vaginal, cervical and breast cancer, auto-immune diseases and a whole host of abnormalities in many girls whose mothers had taken the drug. Those who were on the fence about hormone therapy started to rethink the trustworthiness of Big Pharma.
The health campaigner and journalist Sandra Coney wrote in her 1991 The Menopause Industry, ‘Mid-life women have actually had no say in the services being provided for them. The “choices” available to them have been largely selected by commercial interests who have products and services to sell . . . The industry that has grown up around the provision of choices to mid-life women is primarily controlled by men.’ Looked at like this, why would we want to trust the very men who are out to make money from our symptoms?
I am writing this from the frontline of menopause: hot flushes, night sweats, forgetfulness, and truly bizarre dreams overwhelm me both regularly and randomly, like guerrilla attacks. Maybe it’s my love of stories, of always wanting to follow leads, but I cannot help but read these as part of a narrative – encouraged perhaps by the idea that I am indeed at a climax in this narrative. If I silence this metamorphosis, this strange falling away of my old self, then how will I be able to mourn its loss and welcome its renewal? All of my symptoms feel wild, unprocessed and extreme – like the weather, like an avalanche or a tidal wave. At any moment, I have no idea what is about to hit. Are we not wired for this any longer? If we could accept the wild in us, would this not help us face the parts of ourselves that ebb and flow out of our control? Perhaps our inner wilderness, despite its sometimes inhospitable landscape, is really the last remnant of ourselves from a time when we, and everything around us, were wild. Could our domestication be preventing us from walking this landscape?
The popular advice coming at me on the subject of menopause made me angry. Jenni Murray’s chirpy book, Is it me or is it hot in here? from 2001 gets very excited by the shiny hair and line-free skin enabled by HRT, without properly delving into the dangers: ‘It will be a few years yet before we really know the benefits or otherwise of taking Hormone Replacement Therapy. Until then, we’re all just guinea pigs in what may prove to be the greatest or the worst thing for women’s health.’ This understatement sadly came back to haunt Murray when she was diagnosed with breast cancer linked, she believes, to her HRT. She later wrote a piece in the Telegraph in which she confesses: ‘So, if I had known then what I know now, would I have taken it? The answer is no. I now know that the menopause is a pain, but it doesn’t last forever. Breast cancer, on the other hand, even if you survive it and I’m now in my tenth year, never leaves you.’
Too many of the conversations I hear around me focus on what brand of mare’s urine I should be smearing on my thighs, or what diet I need to be on to stay sexy, despite my age. This is not what I am looking for. I want to interpret the symptoms, understand them, not eradicate them.
I am not demonising anyone for choosing HRT, but I do wonder whether we would find it easier to bear our symptoms if society valued us for our accrued wisdom rather than our pert breasts
Because there is so little in the mainstream about reframing our attitudes towards women and aging, I turned to anthropologists Faye Ginsburg and Rayna Rapp who tell us that, ‘Menopause can never be understood apart from other social circumstances – marriage status, fertility history, access to property – through which women’s power and experiences are constructed.’ They go on, ‘our own culture’s conflation of . . . the loss of biological fertility with a reduction in status, is challenged by the fact that in many other societies post-menopausal women may adopt and foster children and have new authority over kin, especially daughters and daughters-in-law.’ Finally! Here was a view of menopause that placed it in a wider context as a fluid and natural physiological process with myriad cultural, historical and personal interpretations, rather than as a monolithic obstacle to be drugged out of existence. Organisations like the Red School or Hands Inc. are working more in this vein.
Among some of the women I have spoken to, this social perspective is crucial. Friends who were sent into a premature menopause due to chemotherapy had to deal with the symptoms of their illness, the loss of parts of their bodies, the challenge of chemo itself and the even more profound distress of facing their mortality. Some feel ‘aggrieved’ at having menopause ‘forced on them’ and not being able to ‘experience it naturally’, which will inevitably mark their menopause specifically for them. Among those who wanted children but didn’t manage to have any, menopause represents an acute and very private pain all of its own. One friend who became suicidal turned to HRT, which she feels ‘saved’ her. Another found intercourse too painful and claims HRT brought the joy back into her sex life. I am not demonising anyone for choosing HRT, but I do wonder whether we would find it easier to bear our symptoms if society valued us for our accrued wisdom rather than our pert breasts.
Most of us at some point in our lives have struggled to accept our bodies. I don’t need to list the statistics – we all know girls and women with eating disorders, who are full of self-hatred, who desire to be other than what they are. Menopause is no exception. In order for us to begin to understand it, it might help to look into why menopause exists. The only other female mammals to live beyond their reproductive years are pilot whales and killer whales (orcas). The theory behind this is called the Grandmother Hypothesis.
Almost uniquely, orcas live in multi-generational pods: their offspring don’t leave to set up their own family units but stay together as a tribe. If female killer whales were to carry on reproducing until death, their focus would be shifted away from the generations of existing offspring – but this doesn’t explain the theory fully. It took Darren Croft and Ken Balcomb, scientists at Exeter University, to pin it down. Since the 1970s they have been studying killer whales in the Pacific Northwest, and the answer they have come up with is: salmon. These unpredictable fish make up 97 per cent of an orca’s diet. ‘They’re not distributed equally in space,’ says Croft. ‘There are hotspots that differ with season, year, tide.’ Because of their accumulated wealth of knowledge, the older females are more skilled at finding food when stocks are scarce or particularly unpredictable. ‘Adult females are more likely to lead a group than adult males, and older post-menopausal females (who make up a fifth of the pod) are more likely to lead than younger ones. This bias was especially obvious in seasons when salmon stocks were low.’
A reliance on older women with their stores of accrued wisdom was a common thread in hunter-gatherer societies, which is perhaps what Lynx was keying us into around that campfire. Today however, adult women are encouraged to be silicon replicas of their younger selves. The knowledge we gain as we age is getting lost or being devalued and yet, as I saw in Dartmoor, the hunger for it is there.
But there is something else going on here, to do with the colonisation of the female body. Undoing my domestication and calling back something wild are the messages that keep coming at me from my hot flushes, night sweats and outlandish dreams. Germaine Greer, in her visionary 1990 book The Change, posits that menopause is a time to slow down, take stock and feel liberated from one’s sexual objectification as well as from one’s sexual desires. She advocates reclaiming the idea of the witch, the wise woman, the elder. And with our ‘scaly breasts’, why not? For me this is another opportunity in the narrative of menopause: Could we rewrite our stories and turn them into something more open-ended? Should we be exploring the unfamiliar plot lines, the places in ourselves we haven’t been to? If we’re lucky, our partners will come with us on the journey. Without dismissing those women for whom HRT is the difference between surviving menopause and not, I do wonder if a reframing of our worth as humans might help us cope where hormones can’t. Recent studies in Europe and North America suggest a correlation between the severity of a woman’s menopausal symptoms and her sense of being valued.
Despite all the good that the pharmaceutical industry has given us – the life-saving drugs, the cures for childhood diseases – it is fair to say that Big Pharma can be rapacious and reckless. I do not want the changes going on inside me to be silenced with drugs. I want to learn this new language coming at me deep from inside my body. At the moment, I have gleaned a few words, and so far they are telling me this: stop, be quiet, and listen, only then will you understand.