A Woman’s Worth: Life After Menopause

Introduction

Femininity is a social construct that has been clearly defined in Western culture. Gender identity is so fixed that there is often a sense of guilt or shame associated with deviation from the status quo. Educated and privileged white males have primarily constructed many norms associated with gender binaries. One manner in which this has been achieved is through the medicalization of femininity, and, the classification of various natural female functions as diseases, in need of a cure, or, medical intervention. Specifically, the social construction of menopause was determined “first as a disease in 1930s and later as a deficiency disease in the 1960s.”[1] Some of these “diseases” include: menstruation, pregnancy, birthing, and, menopause.

Although the women’s health movement of the 1970s focused primarily on reproductive rights, menopause is increasingly becoming a topic of interest for many feminists in the Western world. As activists aged, menopause became a personal issue. With the most famous statement to come out of the feminist movement being, “the personal is the political,” the personal experience of this naturally occurring biological process became a political issue in need of review.

The following descriptive essay seeks to explore women’s biological, psychological, social, and, cultural experiences during and after menopause. In addition to this, I intend to identify how the status of postmenopausal women within the family structure of the ni-Vanuatu, Lebanese and First Nations cultures maintain their worth by doing a cross-cultural analysis of their narratives. In addition to this, I will discuss the attributes of vervets and langurs as they age, and, relate their behaviour to the Grandmother Hypothesis. Finally I will discuss how this issue relates to social work practice and why such an analysis is necessary.

THE UNFEMININE FEMALE

Though the idea of women’s biology being a source of weakness is a story created by the medical community, it is also a narrative perpetuated in popular media. As such, postmenopausal women are predominantly represented in a negative light. Ludicrous behaviour, and a lack of vitality, intelligence and health are some examples of the many ways in which post-menopausal women are presented and perceived. Aging is framed as a problem that is both irreversible and irreparable in such a way that it demotes the individual as less socially desirable and acceptable.

In 1966, Dr. Robert Wilson, a prominent gynaecologist from New York, published the book Feminine Forever. In exchange for promoting oestrogen in his work, Wilson received $1.3 million in grants from the pharmaceutical industry. According to his book, postmenopausal women ceased to be feminine and therefore desirable. “Women, he argued, had the right to remain women and should not have to live as sexual neuters for half their lives because of the neglect of the medical profession.”[2]

Three years later, Dr. David Reuben released Everything You Always wanted to Know about Sex but Were Afraid to Ask. This book further contributed to both the negative ways in which menopause is seen, and, the medicalization of femininity as a whole. Within his work the following quote can be found,

The vagina begins to shrivel, the breasts atrophy, sexual desire disappears… Increased facial hair, deepening voice, obesity…coarsened features enlargement of clitoris, and gradual baldness complete the tragic picture. Not really a man but no longer a functional woman, these individuals like in the world of.[3]

Additionally, following a published contribution by Robert Greenblatt, one-time president of the American Geriatrics Society, “the market value of oestrogen increased 3.8 times in the USA between 1963 and 1973 and HRT [Hormone Replacement Therapy] was endorsed in the medical journals during the 1970s.”[4] In 1974, the Journal of the American Medical Association concluded that oestrogen as a “youth drug” was unsubstantiated but, “that [a] high-dose oestrogen replacement therapy nevertheless could and should be continued because the menopause was a deficiency disease with potentially serious implications for women’s health.”[5]

The narrative presented by both the medical community, and, popular media has been so convincing that, “[w]hen older women get angry or depressed and seek medical assistance, they are frequently over tranquilized with valium or librium to keep them quiet and out of sight.”[6] As such, heavily medicating women became a better alternative to focussing on the other social, cultural, or, economic factors that may have also contributed to their experience.

Biological Effects

The phenomenon whereby women in higher socioeconomic classes are living approximately one third of their life as postmenopausal is relatively new. For instance, before the 1900s, the average age in which women began showing symptoms of menopause in the United Kingdom was 47 years, with their life expectancy being 49 years. Today symptoms begin to show at 51 years and women’s life expectancy in the developed world is 80 years. This change can be attributed to education, better health care and nutrition. Therefore, living without oestrogen post-menopause is something women never used experience. This is important to note because with this information women are better able contextualize the current literature and knowledge available. The following quote from the journal article, II. Soldiering On: An Exploration into Women’s Perceptions and Experiences of Menopause, by Geraldine Shore postulates that,

[t]he menopause is defined within the biomedical perspective as a ‘deficiency disease’ caused by diminishing levels of oestrogen – a view initially put forward by Robert Wilson in his book Feminine Forever. The control over the definition of menopause and the assumption that it is treatable with medication have been defined as the ‘medicalization of the menopause’.[7]

As such, women’s health is perpetually being framed in comparison to the biology of men. Specifically, “[w]hile appointing the male reproductive life cycle as normal, this viewpoint calls abnormal any aspect of the female reproductive life cycle that deviates from the males.”[8] Therefore, when the female reproductive life cycle “falls short” it is deemed deficient and in need of manipulation or correction.

Women’s reproductive processes may be categorized into three primary classifications: (1) Pre-menopausal (2) peri-menopausal, or, climacteric, and, (3) post-menopausal. The pre-menopausal stage refers to the period leading up to menopause. Climacteric is a ten-year period, in which menstruation slows. In the book entitled, Exploring Lifespan Development, author Laura Berk describes climacteric in the following way,

the production of oestrogen drops. As a result, the number of days in a woman’s monthly cycle shortens from about 28 in her twenties and thirties to perhaps 23 by her late forties, and her cycles become more irregular…. The climacteric concludes with menopause.[9]

The word menopause is a Greek term that directly translates as “monthly stop.” The roots of the term are “men” and “pauein,” which refers to the cessation of a lunar cycle. Some symptoms experienced by women during menopause include, intense migraine headaches, insomnia and fatigue, joint aches, lowered libido, hot sweats, night sweats and hot flashes and many flu-like symptoms, to name a few. Most scholarly sources available link the connection between menopause, decreased levels of oestrogen and osteoporosis. Further investigation and study of the complex history, ideology, and politics surrounding the idea that osteoporosis is a part of the menopause “syndrome” indicates that this ideology is a social construction that benefits the medical community, and, especially the pharmaceutical industry. For instance,

[i]n the 1960s and 1970s ‘depletion’ was equated with ‘deficiency’ and menopause, representing a state of estrogen deficiency, and was therefore considered a medical disorder warranting treatment… the WHO convened a special session and eventually came out with a consensus statement to counter the above which read: ‘Menopause is part the normal aging process which in itself does not require therapeutic intervention.[10]

Psychological Effects

According to the World Health Organization, climacteric is a major hormonal event in which many biopsychosocial symptoms are present. The most prevalent symptoms affecting the psychological wellbeing of women include irritability, anxiety, poor concentration, tearfulness, depression, memory loss and lack of motivation, to name a few.

A decrease in oestrogen is one cause that has been linked to the disruption in normal psychological functioning. Similar to the way it affects women’s biologically, a decrease in oestrogen has also been distinguished as a factor in the psychological health of women. For instance, it has been detected that oestrogen has a direct effect on the central nervous system. Specifically, it

regulates synaptogenesis, has a general trophic effect on cholinergic neurons and stimulates a significant increase in 5-HT_2A binding sites in areas which are involved in regulating both mood and cognition. It is therefore not surprising that estrogen has been shown to improve psychological functioning and well-being in non-depressed postmenopausal women.[11]

This may be one of the primary reasons that hormone replacement therapy is such a strongly recommended “treatment” for women experiencing peri-menopause and menopause. In addition to this, various preliminary studies have linked the positive effects in combining estrogen replacement therapy (ERT) with selective serotonin reuptake inhibitor (SSRI) medication in depressed postmenopausal women. It has also been proven that estrogen, “maintains verbal memory in women and may prevent or forestall the deterioration in short- and long-term memory that occurs with age” and that it may have a role in the prevention and treatment of Alzheimer’s disease.[12]

Furthermore, regardless of the fact that much of popular culture regards postmenopausal women in a negative light, for the most part, many women are embracing this biological event as a positive change to their psychological wellbeing. Some reasons for this includes a feeling of freedom from contraception, a cessation of menstruation, and, feeling more calm. For example, a study conducted by Avis and McKinley discovered that 42.2% of women “reported relief when they reached menopause.”[13] Conversely, 2.7% women reported feelings of regret, while 19.6% of women had mixed feelings. In another research study that focused on 505 women between the ages of 35 and 55, 74.9% of respondents said “they were looking forward to the cessation of menstruation,” 12% were looking forward to the cessation of premenstrual tension, 11.1 % freedom from contraceptives and 3.5% of women were looking forward to “becoming wiser with menopause.”[14] The wellbeing aspect of this research study included an investigation on the respondents sense of purpose during climacteric and measured their levels of acceptance and feelings toward their new role. Additionally, other studies have shown that African-American and Mexican-American women hold especially favourable views.

Social Implications

Though menopause is a personal experience, it may be mitigated by various social and cultural factors. Analyses of data taken from cross-sectional studies suggest that women’s personal experiences of, and, attitude toward, menopause is socially constructed. Variation in physical, psychological and emotional reactions, and, symptoms present indicates that menopause is not only a hormonal event but is also affected by various social and economic factors, including cultural beliefs and practices.

Conversely,

[i]nvestigations that make comparisons across cultures, and between ethnic groups within cultures, provide insight into whether developmental pathways apply to all people or are limited to particular environmental conditions.[15]

One theory that specifically talks about this phenomenon is that of Lev Vygostky, a Russian psychologist who focused on how culture and socialization played into the passing on of knowledge from one generation to the next. His theory was called sociocultural theory, which postulated that interaction between the younger generation with the older more knowledgeable ones in a society is necessary in maintaining cultural norms and folkways. Vygotsky was particularly focused on the interactions that take place in dialogue between experts and less experienced members of society.

Cultural Variation

Though the exact definition of the Grandmother Hypothesis has changed over time, it presupposes reasons why women past childbearing years continue to live long and healthy lives. The most recent interpretation by Kristen Hawkes in the 1990’s concludes that the overarching meaning is tied to the influential relationship of the grandmother on her grandchildren.

In chapter four of An Anthropology of Mothering, Alexandra Widmer shares her findings of an anthropological study that she conducted over a six-month period in the Vanuatu islands in the south Pacific. Though her study focused on the position of mother’s roles within the family structure, Widmer’s references to one woman’s mother-in-law gives the reader some clues as to the position of the grandmother in relation to the family. Through interviews and interactions with the ni-Vanuatu, the indigenous peoples of the region, Widmer gained knowledge concerning marriage traditions as well as the context within which the bride would live. For example, after the wedding, it is tradition that the bride will live with her husband and his family. As such, she shares in the household duties with her mother-in-law.

Thus, becoming a mother, while it meant a relationship with her child, also meant the daily negotiating of a relationship with her children’s paternal grandmother and the wives     of her husband’s brothers who lived close by.[16]

The above quote demonstrates the grandmother’s presence within the family structure as fully involved and participating. Furthermore, it presumes an interactive relationship with the grandchildren by virtue of her presence. Conversely, the preceding quote along with the following one indicate that the presence of the grandmother is necessary overall,

As the time of birth approached, the women would offer tinctures of leaves to make contractions strong so the labour would proceed quickly. Knowledge of such herbs was closely guarded, transferred from mother to daughter, following maternal lines of descent.[17]

This shows how sacred knowledge was passed from one generation to the next through the maternal line.

Chapter 12 of An Anthropology of Mothering, positions the grandmother as the ultimate ruler of the family. She has the last say in everything as her power is overarching. This is particularly true for the Muslim Lebanese community who believe that it is impossible to find fault in the mother regardless of her shortcomings. The Arabic phrase sit el bayt, “translates as ‘the power of the house,’ with the grandmother (sit) having seniority over her daughters-in-law as she is the matriarch and, as such, rules over domestic space.”[18]

Chapter 15 of the same book highlights how First Nations culture puts a great deal of emphasis on the respect for elders. It is very rare, if ever, that a family will remove the elder from the family unit into a care home. As a result the grandmother has a direct link to her grandchildren. In the Indigenous life cycle of development, the elder’s position within the community is to give back. In addition to this,

[i]t is not only the mothers, but the grandmothers who fill a prominent role in raising and caring for children. Again, though matrilocality is not strictly practiced any longer, grandparents are still very much involved in the lives of their grandchildren.[19]

In other words, spending time with grandchildren and teaching them through storytelling. The relationship between grandmother and grandchild is characterized as critical and enduring. Furthermore it is asserted that among dan k’e speakers, “their close relationships with their grandmothers, which often involved the learning and sharing of traditional language.”[20] In this way Hawkes scope of the Grandmother Hypothesis would be valid, in that a woman’s worth goes beyond her capability to reproduce.

Of the three human cultures I studied none differentiated between the paternal and maternal grandmother. However, the patriarchal system present within the Vanuatu and Lebanese family structures do suggest that the paternal grandmother would have a stronger presence in the life of the grandchild. This is primarily because in both traditions the young family would live with or near the husband’s parents.

Hawkes spin on the Grandmother Hypothesis is not only relevant to humans but can also cross over into various primate species. One example of this is the langur, an Old World monkey that lives to be almost 30 years old. Although female langur’s begin to withdraw from the normal activities within its group as it ages, her mothering and protective instincts become elevated. This is in specific instances where she might feel an infant is in mortal danger. That is to say,

[i]n an emergency, however, these same socially marginalized old matrons become the       most active in defending the group’s feeding grounds from neighboring groups. They are also the most daring in defending infants attacked by infanticidal males.[21]

In addition to the langur is the vervet. Vervets are also Old World monkeys. As these primates age their importance lies with their daughters who feel more secure when she is around. Furthermore, “having a grandmother nearby has a significant impact on the childrearing success of younger kin.”[22] The grandmother is trusted in such a way that a mother vervet will let her infant roam freely when its grandmother is near.

As demonstrated, these two primate species as well as the three human examples I have given are an excellent illustration of the worth of females beyond their years of fertility and reproduction. Although there does not seem to be a particular pattern that indicates a difference in the presence of the paternal grandmother over the maternal one, or vice versa, in more patriarchal cultures it would seem that the paternal grandmother would have a more involved role to play in the lives of her grandchildren by virtue of living within the same home. Finally, the Grandmother Hypothesis could serve as a valid representation as to why female primates and humans live past their child bearing years. Human grandmothers have knowledge to share and care for subsequent generations more patiently and with more understanding. Conversely primate species are more vocal in protecting others because they have less to lose than their younger counterparts, and they may provide security to others in the troop.

Relation to Social Work Practice

There are a multitude of problems in communities across Canada, and, beyond, that social workers have a hand in trying to address. Some women’s negative experiences within society is an example of this. Therefore, knowledge of menopause can help social work practice in many ways. For instance, it can help a service provider empathize with clients going through this transition and address the issue from a systems theory perspective, which proposes that an intersection of experiences, or, systems exist which contribute to difficulties. One example of how having this knowledge is empowering for social work practice is that it gives the social worker more authority to create support groups and workshops, or, to advocate on behalf of women who are climacteric or menopausal. Therefore, a social worker would, in theory, be given the opportunity to contribute to people’s lives in more meaningful ways.

Another way in which having this knowledge would be empowering for social work practice, is that the service provider would be better equipped to know what information is authoritative. This is of particular interest because the Internet has a lot of misinformation and many people try to self diagnose with their good friend Google Search. Having this knowledge will assist the service provider in addressing the topic in a knowledgeable and professional manner. Conversely, not having this awareness may mean there is a gap in their professional knowledge which may work against supporting service users. Knowledge could include having access to information, or pamphlets, or knowing where to refer service users.

In the peer reviewed journal article entitled, At Midlife, Intentionally Childfree Women and Their Experiences of Regret, author Gail Delyser suggests that there is a gap in literature and research by social work clinicians surrounding childfree postmenopausal women both in North America and abroad. She further states,

[m]ost areas of treatment are open for future exploration, including those that focus on issues of sameness and difference between the patient and therapist. For example, the potential emergence of countertransference and transference reactions between a therapist who is a mother and a childfree woman should be investigated.[23]

There is a clear lack of clinical social work expertise in this area. Further exploration from the social work perspective could provide rich insight for service providers. As a result, the service user could potentially be supported in a more holistic way.

Conclusion

The medicalization of women from menstruation to menopause has been a source of contention that feminists have been fighting against from the beginning of the women’s health movement. The idea of women’s biology being a source of weakness is a narrative created by the medical community, and further perpetuated in popular media. The scientists contributing to this ideology are predominantly university educated and privileged white males. As a result many naturally occurring female functions have been framed as syndromes or diseases in need of curing. One reason for this is because women’s health is perpetually being framed in comparison to the biology of men. As such, when the female reproductive life cycle “falls short” it is deemed deficient and in need of manipulation or correction.

Regardless of the fact that much of popular culture regards postmenopausal women in a negative light, studies show that many women are embracing this biological event as a positive change to their psychological wellbeing. Furthermore, though menopause is a personal experience, it may be mitigated by various social and cultural factors. Analysis of data taken from cross-sectional studies suggests that, women’s personal experiences of, and, attitude toward menopause is socially constructed. As such, the Grandmother Hypothesis is one theory that offers reasons as to why women past childbearing years continue to live long and healthy lives.

Gail Delyser suggests that there is a gap in literature and research by social work clinicians surrounding the topic of childfree postmenopausal women both in North America and abroad. Filling the gap about menopause can help the practice of social work in many ways. For instance, it can help a service provider empathize with clients, address client issues from a systems theory perspective and have an opportunity to contribute to people’s lives in more meaningful ways. As a result, further understanding of a community’s needs will ensure a more resilient community.

Endnotes:

[1] Pg. 12. MacPherson, Kathleen I. “Osteoporosis and Menopause: A Feminist Analysis of the Social Construction of a Syndrome.” Advances in Nursing Science 7.4 (1985): 11-22. Web. 6 Apr. 2016.

[2] Pg. 42. Lewis, Jane. “Feminism, the Menopause and Hormone Replacement Therapy.” Fem Rev Feminist Review 43.1 (1993): 38-56. Web.

[3] Pg. 292. Reuben, David R. Everything You Always Wanted to Know about Sex, but Were Afraid to Ask. New York: D. McKay, 1969. Print.

[4] Pg. 42. Lewis, Jane.

[5] Pg. 42. Lewis, Jane.

[6] Pg. 15. MacPherson, Kathleen.

[7] Pg. 169. Shore, Geraldine. “II. Soldiering On: An Exploration into Women’s Perceptions and Experiences of Menopause.” Feminism & Psychology 9.2 (1999): 168-80. Web.

[8] Pg 176 Fausto-Sterling, Anne. “Menopause: The Storm Before the Calm.” Feminist Theory and the Body: A Reader. Ed. Janet Price and Margrit Shildrick. New York: Routledge, 1999. N. 169-77. Print.

[9] Pg. 403. Berk, Laura E. “Exploring Lifespan Development.” 3rd ed. Boston, MA: Allyn & Bacon, 2014. Print.

[10] NP. Steiner, Meir, Edward Dunn, and Leslie Born. “Hormones and Mood: From Menarche to Menopause and Beyond.” Journal of Affective Disorders 74.1 (2003): 67-83. Print.

Please note: the quotes from this author are marked “NP” because it was an article found in summons that did not have page numbers associated with it.

[11] Pg. 389. Deeks, Amanda A., and Marita P. Mccabe. “Well-being and Menopause: An Investigation of Purpose in Life, Self-acceptance and Social Role in Premenopausal, Perimenopausal and Postmenopausal Women.” Qual Life Res Quality of Life Research 13.2 (2004): 389-98. Web.

[12] NP. Steiner, Meir.

[13] Pg. 390. Deeks, Amanda A.

[14] Pg. 390. Deeks, Amanda A.

[15] Pg 19. Berk, Laura E.

[16] Pg. 108. McPherson, Naomi, and Michelle Walks. An Anthropology of Mothering. Bradford, Ont.: Demeter, 2011. Print.

[17] Pg 106. McPherson, Naomi.

[18] Pg 211. McPherson, Naomi.

[19] Pg 120. McPherson, Naomi.

[20] Pg 115. McPherson, Naomi.

[21] Pg. 250. Blaffer Hrdy, Sarah. Mothers and Others: The Evolutionary Origins of Mutual Understanding. Cambridge: Harvard UP, 2009. Print.

[22] Pg. 253. Blaffer Hrdy, Sarah.

[23] PG. 73. Delyser, Gail. “At Midlife, Intentionally Childfree Women and Their Experiences of Regret.” Clinical Social Work Journal Clin Soc Work J 40.1 (2011): 66-74. Web.