Above: Artwork by Emma Bass

The negative messaging around menopause is a problem, writes Dr Jane Horan, social anthropologist and member of the Gender Justice Collective

If you are a person* who has or is menstruating, or you know people like this, chances are you haven’t grown up with others around you talking in any detail about the process of what happens when periods stop, as in ‘The Menopause’. ‍

[* Not all women menstruate, not all people who have or do menstruate consider themselves women, but this piece is more about the cultural construction of the category ‘women’ and the way menstruation and the cessation of this as in menopause, is used to culturally relegate women the category.]‍

Chances are, you haven’t read a great deal about it; and if you are a person who has, is, or will transition through the stages of menopause and have gone looking for information about it, what you will have found will be a specific list of a potentially harrowing array of symptoms.

Chances are, you don’t routinely discuss with your friends or other older women in your life who have gone through the process of menopause about not only what it is like and the array of changes that happen in a person’s body, but about what it means to be perimenopausal, menopausal, or post-menopausal.

Chances are, you are working with the assumption that menopause is about a demise, an inevitability of getting older and that this is a diminishment of something that was whole and is now less-then-what-it-was-before. Thereby establishing the naturalness of ageing being a negative, a loss, a process of diminishment.

Chances are that you have been learning for a long time that when menopause is on your horizon, and then finally arrives, and then the long barren years stretch from there, that it’s a case of goodbye-everything-you-hold-dear-about-yourself. Put it this way, you are unlikely to be throwing a party when it happens!

If this is your experience, chances are you have been brought up in a Western society like Aotearoa New Zealand. But some of those harsher edges may be mitigated by how you see the world, because here’s the thing, menopause is as much cultural as it is biological.  

Despite that silence, of late, there has been something of a ‘flush’ of content and commentary about menopause beginning to appear in mainstream media both here in Aotearoa New Zealand and overseas.

Even the latest series of The Crown got in the act: the character of Denis Thatcher, upon hearing that his wife was to be Prime Minister of the United Kingdom, and in reference to the Queen – both ‘women of a certain age’ – got to proclaim rather disparagingly: “What, two menopausal women running the country?”

I found the comment rather jarring and brutal, and more than likely an anachronism in the later ‘70s, but Denis was really uttering a sentiment that is current now and routinely said out loud.

Cue the witchy crone trope of the hot flushing, grumpy, unattractive menopausal hag. It’s hard to get away from this insidious portrayal: I am no fan of Judith Collins’ politics, but the spectre of the ‘lack’ embodied by older women verses younger, more fecund women like the Prime Minister or the Green women, made me wince at times in the build up to the election.

The wonderful Caitlin Moran, whose July 2020 The Times Magazine column literally punched off the page/screen with unabashed fury as she wrote about the anger of menopausal women, telling it like it is as she delineated the inescapable tyranny of ‘ageing in the patriarchy’ combo as she subverts that witchy caricature, instead pinning the blame on a toxic mix of biology and systemic injustices.

Here is a sample of her eviscerating words as she accounts for what happens as the hormones in a woman’s body recede through perimenopause, menopause, and post menopause:

“Suddenly, the poor behaviour of other adults comes sharply into focus, as you deal with your hormonal hangover. You don’t have any ‘lady forgiveness’ left in the tank. You don’t continue to presume that things will ‘just get better, in time’ because you’re now in your forties or fifties, and you can see they haven’t. You’ve changed, massively.

“Your body’s turning into an entirely new thing, but the things that felt unjust when you were 17 are still here at 45 and you start to realise the monolithic things you’re up against. The pay gap. The career slip involved in having children. The second shift. Emotional labour. Sandwich caring. The gender imbalance in politics and business.”  

I can’t disagree with her. But in between knowing the truth of Moran’s rage; of wanting to tell Denis and the script writers of The Crown to shut it; on wanting to focus on the inadequacies of Judith’s politics rather than her age; to noting the curious reticence that so many women around me have about talking about menopause – and when the silence is broached, there is seldom a positive word said; and then up pops another grim read online that relays the unremittingly negative message about menopause and therefore the process of ageing… I’m disquieted by it all.

What’s making me bothered and uneasy, over and above the now routine (albeit on the mild side) hot flushes, is that the awful stuff is the only narrative that we get on our late night Google searches when sleep is eluding us, and in the flurry of media pieces that are coming at us of late.

We have a problem Houston when a natural, normal biological* process is expected by seemingly everyone to be unremittingly awful.

* [‘Biological’ is contingent here. Menopause is the moment after an individual has gone a full calendar year without mensuration, prior to this when their menstrual cycle is beginning to change, they are perimenopausal, and after that calendar year, post-menopausal. Some go into menopause because of illness or surgical removal of part(s) of their reproductive system, so the process happens for external reasons rather than natural ageing.]‍

Some women really do have the most horrendous and debilitating array of symptoms as a consequence of menopause. Their accounts which are emerging now as part of this effervesce that is breaking down the silence around menopause, are real lived experiences.

Dr Google is not concise about the percentage of women who suffer like this; one source said 15 percent of women get the most severe hot flushes. ‍

The Wellington Menopause Clinic notes that around “70 percent of women have significant symptoms with the menopause and 40 percent will attend a doctor for symptom control” so this is affecting a lot of us!

In the Gender Justice Collective’s recent survey rolled mid-2020, 2865 people answered questions on menopause: some 34 percent of respondents had an excellent or good awareness of the symptoms of menopause and the impact these can have on everyday life, but 62 percent only had a fair, poor, or very poor perspective on this.

Of the workplaces that the respondents worked in, less than 1 percent of these had a specific workplace policy around menopause, 67 percent didn’t, and 31 percent of respondents didn’t know if there was one or not; but 72 percent of people who did the survey thought it was very important or important that there be menopause policies in workplaces.

And 96 percent of respondents considered it very important or important to the health and wellbeing of women and non-binary people in Aotearoa New Zealand to have freely available info and advice about how to manage menopause.

But we need a more nuanced scope of information about menopause because that cultural stuff, as in the story about how menopause is so awful is true for many, but need not define the phase of life that menopause is part of – even for those suffering the most. Because while the horror stories are real, there is a whole lot more going on here than the array of symptoms.

Now, this is not a rant about not-all-experiences-of-menopause-are-bad, and to be fair, I have not had a hard run of menopause thus far (I’ve been post-menopausal for a few years now). But what I am here to say is that too much of the commentary about menopause conflates the biology of the process with the cultural constructions of what it means to be a woman who has stopped menstruating.

Separating the two is important, because the women who are really suffering through the process need visibility and support to live through it, but they could also do with a more empathetic and balanced perspective on what menopause is biologically and culturally in the wider context – in fact we all could.

Because when menopause gets to be understood as a cultural phenomenon as much as it is biological, we have a whole lot more to work with.

It shouldn’t be a surprise to anyone who has inhabited a female body of whatever form, that menopause as a biological process has been co-opted in the service of bigger power structures/making money/keeping women in a particular place.

Ann Neumann in The Baffler writes about the pharmaceutical industry’s systematic reduction of women ageing and menopause into a “deficiency disease” where “menopause is a business opportunity, a billion-dollar drug category for corporations – and the industry’s main sell is telling women over 50 that something is drastically wrong with them.”

So, there’s that. And while Hormone Replacement Therapy (HRT) is a literal god-send for many women, women’s bodies have long been the site of processes of power and control in western societies so that negative narrative about older women being less, being deficient, not worthy of visibility etc, etc, is constructed. The process is biology, but the story around it is cultural.

Gender (as in the rules around what it means to be a woman and man etc), like racism, classism, agism, disablism, are all technologies of power of those pernicious realties of patriarchy and capitalism that effectively comprise the system that we live in here in Aotearoa New Zealand.

We experience this system differently according to our ethnicity and the colour of our skin, our experience of colonialism, our degree of wealth, the luck of genetics, the luck of upbringing and the degree of privilege you have, i.e. it is a complex interplay of a great deal of variables.

So, the way biological processes play out in an individual’s life is as much about cultural ways of seeing and being in the world as it is about the human body ageing. So even a biology like menopause can be experienced differently according to cultural context – in fact even the symptoms can be different.

The anthropologist Margaret Lock calls this “local biologies”. Lock found that when she was doing research in the late 1980s comparing how women in the US, Canada, and Japan experience menopause, only 19 percent of Japanese women reported experiencing hot flushes compared to 60 percent of the US and Canadian women.

Diet and other factors will have a bearing on this but the point is that biological and sociocultural processes are intricately entangled.

Linguistically, in Japan there are only vaguely equivalent words for menopause and hot flush, meaning that the experience is different. What Japanese women identified as the main symptom of what comes with ageing, was sore, achy shoulders. Women have a different but no less complicated positioning in Japanese society, but the way menopause and therefore the process of ageing is understood can be different.

Put it this way, the reality that ‘Whāeapower’ has a truth to it here in Aotearoa New Zealand that makes sense and is recognisable even if you are not Māori, because it is understood that older women are deferred to in Māoridom. Not always of course, and colonialism has severely messed with this, but there are values around seeking the wisdom of Whāea which reveals how valued older women generally are in whānau.

Whereas the idea of ‘older white lady power’ seems kind of ridiculous because in Pākehā culture, which dominates Aotearoa New Zealand society, we get the message that older is not good, and of course the narrative around menopause is very much a part of this.

This is the cultural bit. Culture is not natural, we learn how to be cultural, we learn what the rules are for the particular society that we grow up in so no baby is born knowing that menopause is a dreadful thing, but we can certainly grow up with that idea – which is why there is a difference cross culturally.

In Māoridom, age is not denigrated, because with age comes wisdom as the culmination of life experience and longer duration of relationship with tūpuna. Whereas amongst Pākehā, the reverse is truer.

So, while the effects that the body goes through during menopause are a thing, the way they are perceived is actually more contingent on the world view you have, and the way the society that you have grown up in construes the worth of women vis a vis men.

Knowledge is power, even if this does not stop the private heat wave moving through your body or that certain kind of dryness that comes with menopause. But given that there is a lot going on in menopausal bodies, having a fix on the broader societal constructions of what you are meant to be when you are menopausal can give you capacity to care a little less about it, thereby alleviating some of the pressure, or at least not turn up the heat more.

The burden of prescribed norms is something women grapple with their whole lives, and men too of course, knowing that this is a thing, is a start. This isn’t going to bust the gender pay gap overnight, but it is a start.

When you can get a fix on the idea that culture is what the most powerful say it is, you can begin to see the connect between what you are feeling, what you are perceiving, and what you have actually been taught to feel and perceive.

By understanding menopause as both biological and cultural, we stop conflating the array of symptoms that come with the cessation of menstruation with the cultural frameworks and constructions around what that means.

That harrowing list of potential symptoms are real and for those who experience the worst of these, their experiences need honouring and supporting with dynamic, well-funded medical research – because women’s bodies have actually been ignored too often in medical research; we need workplace contingency plans that help women suffering to whatever degree to be able to cope better to resume having meaningful work lives for their benefit and that of the organisations they work for; people who are suffering like this also deserve greater empathy at a societal level.

But that negative messaging around menopause is a real problem too. The symptoms are real, but the story around menopause and ageing being all bad, isn’t.

Time for a rallying cry? Not quite, I’m a little tired, but I actually like being 56 a lot more than I did being 26. It has taken me a while to understand that menopause isn’t just (!) a set of symptoms, it is also a whole lot of baggage that is foisted me, upon all of us by society.

Women, and men for that matter, have lived with this our whole lives to the extent that the ideals of beauty, of what women should wear at certain ages, how much men are meant to earn, who is meant to look after children etc., has become so taken for granted and normalised that it seems natural too – but actually it is far more constructed and a creation of those who have power to say what others do, than we realise.

In the midst of a hot flush, it is all a bit overwhelming! So, if invisibility is what I’m consigned to as a menopausal woman, whatever, but “if they can’t see us, they can’t stop us” said Lily Tomlin and Jane Fonda in one of those age affirming movies they have done, and there is something in that.

So, while the symptoms of menopause too often feel like a battle raging in our bodies, it actual helps to know that the war that we are all engaged in is about ageing in the patriarchy.