Learning What We Do Not Know: The History and Experience of Menopause
In January 2021, I willingly underwent a procedure to implant testosterone pellets into the flesh at my hip.
I had arrived at my medical provider’s clinic because of the many and varied symptoms of perimenopause that were disrupting my life. I wasn’t sleeping; I had low energy and terrible brain fog; I couldn’t regulate my body temperature; I was suffering from truly monstrous bouts of PMS; and my periods were as heavy, painful, and irregular as they had been when I was a teen. Blood tests showed that while my estrogen looked fine, my testosterone levels were extremely low. The solution was to have a compound pharmacy create slow-release pellets that would, over four months, bring me to a better T level and provide relief. I underwent the procedure a few weeks later. Everything was done under local anesthetic, and I was in and out of my provider’s practice in about half an hour. None of this was covered by insurance.
The promised relief from my symptoms never materialized. Instead, I developed acne, grew hair under my chin, and the hair atop my head became a greasy mop. I decided, well before the four-month appointment to have new pellets inserted, that this experiment was a dud, and canceled future visits.
And then I learned from Dr. Jen Gunter’s The Menopause Manifesto: Own Your Health with Facts and Feminism that the entire thing was a scam. Testosterone pellets can elevate estrogen in the body to dangerous levels and, as hormone levels regularly fluctuate in a person’s body throughout the day, no blood test can provide reliable information about where a person is in the long transition we call menopause (200–201, 36–37). The pellets are unregulated by the FDA and are a major moneymaker for unscrupulous practitioners (258–269).
I am not an especially naive person when it comes to thinking about my body. I’m 49 years old, have read widely on perimenopause, and frequently teach about the history of birth control and reproduction in the United States. I’m not only well informed about contemporary problems, debates, and activism surrounding the decision to have – or not have – children and to care for a reproductive system involving vaginas, wombs, and ovaries, but I’m trained in the history of how those experiences have evolved over time. But I was still scammed. One reason for this is that menopause is “shrouded in secrecy,” as Gunter writes (4). It is profoundly historically understudied, and there is a dearth of good information about the process available to those experiencing menopause in the here and now. “This information vacuum has been created by a toxic combination of medical providers being unable to meet the educational needs of their patients,” Gunter argues, “and medical misogyny, meaning medicine’s long history of neglecting women” (6).
It’s not just cisgender women who go through menopause, and it’s a major omission of Gunter’s book that she does not address the experiences of trans and nonbinary individuals. While there is much in the book that will be helpful to trans and nonbinary people if they use the index to look up particular experiences or terms, Gunter ignores the different circumstances under which they may experience menopause and the extra challenges they face in accessing appropriate healthcare. These extra burdens are considerable, and it would strengthen Gunter’s arguments about the pernicious effects of patriarchy on medical care to fully integrate trans and nonbinary experiences into the text.
There is still much in this book that is revelatory. There are small details – like the fact that the practices of wiping front to back after going to the bathroom or peeing directly after having sex are based in myth. The book also offers larger interventions in the way we think about midlife health and understand the workings of bodies. I learned that heart disease is not only of increasing concern for people during the menopausal transition and after, but that people who have periods may not recognize the pain of a cardiac event because their cramping during menstruation is more intense. I also learned that Adverse Childhood Experiences (ACEs, such as abuse, assault, and neglect) rewire the biology of the body, and therefore significantly impact an individual’s symptoms during menopause on every front (11, plus this entry on Gunter’s substack, “The Vajenda”). Genetics are of critical importance to us when assessing menopausal experiences and risks, as are cultural norms about what it’s permissible to talk about. Do women in Japan truly experience fewer hot flushes, for example, or is it simply rude to talk about them? (101–103)
Gunter provides incredible detail about the biology of menopausal bodies, and offers thorough footnotes that link to more in-depth studies for those who’d like to know more. She is attentive to the ways in which class, race, culture, and nationality all contribute to a person’s experience of menopause, sometimes alleviating symptoms (in cases where individuals have access to good healthcare and insurance, for example) or compounding them (such as when a person lacks access to nutritious food). She has little patience for supplements and non-FDA recommended “treatments” for menopause, while extending enormous understanding to those who have been taken in by marketing that exploits how little most people know about this period of their lives.
Part of what we don’t know about menopause is its history. While Gunter offers a good summary of how published western medical texts have talked about menopause since 1582, we know from critical scholarship in the history of women, gender, and reproduction that the authors of such texts were often far removed from the actual business of living with a vagina. Well into the nineteenth century, for example, birthing and healing in the United States were the business of women. While midwives were skilled professionals who presided over most births, they were also assisted by neighbors and friends of the laboring individual. Knowledge about bodies was thus primarily passed between community members, and the idea of having a man present as an attending physician caught on slowly, depending deeply on location (urban or rural) and the class of the person giving birth. As more individuals turned to doctors to help them give birth, community knowledge about bodies declined, perhaps reaching its nadir in the 1950s and ’60s when a not insignificant number of people got pregnant without knowing how.
Given this, what attention can we bring to our historical understanding of menopause? It seems likely that understanding and managing menopause was also something community members shared with one another before the rise of men as OB/GYNs, and that this knowledge may have been lost as the experience of reproduction became an isolating event. It would be rewarding to know more about the lived experience of menopause that has ultimately left so many of us – myself included, testosterone pellets and all – without the knowledge we need to make informed decisions about our bodies. We are so used to hearing of the menopause spoken of as the “change of life.” Gunter’s book offers the promise of a change of thought, one which may well help historians of women, gender, and medicine write about this subject well into the future.
- Gunter prefers to call the entire experience of moving toward a final menstrual period as menopause, or the menopause transition. Perimenopause is, however, a term widely used to signal the time period where an individual feels the effects of their reproductive system experiencing puberty in reverse (3), reserving “menopause” for the milestone of having had no menstrual periods for twelve months. ↑
- For an introduction to some of this history, see Linda Gordon, The Moral Property of Women: A History of Birth Control Politics in America (University of Illinois Press, 2003); Ann Fessler, The Girls Who Went Away: The Hidden History of Women Who Surrendered Children for Adoption in the Decades Before Roe v. Wade (Penguin, 2007); Dorothy Roberts, Killing the Black Body: Race, Reproduction, and the Meaning of Liberty (Vintage, 1998); Rebecca J Tannenbaum, The Healer’s Calling: Women and Medicine in Early New England (Cornell University Press, 2002); Brianna Theobold, Reproduction on the Reservation: Pregnancy, Childbirth, and Colonialism in the Long Twentieth Century (University of North Carolina Press, 2019); Laurel Thatcher Ulrich, A Midwife’s Tale: The Life of Martha Ballard, Based on Her Diary, 1785–1812 (Vintage, reprint 1991). ↑
Catherine Denial is the Bright Distinguished Professor of American History, Chair of the History department, and Director of the Bright Institute at Knox College in Galesburg, Illinois. A member of the Educational Advisory Committee of the Digital Public Library of America, Cate is also a 2018-2021 Distinguished Lecturer for the Organization of American Historians. Cate’s current research examines the early nineteenth-century experience of pregnancy, childbirth and child-rearing in Upper Midwestern Ojibwe and missionary cultures, research that grew from Cate’s previous book, Making Marriage: Husbands, Wives, and the American State in Dakota and Ojibwe Country (2013).