The History of Menopause

{Alternate title: Why Women Are Mad}. When it comes to menopausal attitudes, we tend to think that they have always been overwhelmingly negative, painting women as crazy, withered grandma’s or bitter harpies clinging to youth - but actually, if we go back far enough, older women were once matriarchal pillars, providing a font of wisdom that is now lost, as well as strong family support systems.

Historically, until the 1900’s, the average lifespan for women was 50, which means ‘post-menopause’ is a relatively modern concept. So, what changed? After the industrial and medical revolutions, women started living a lot longer, and menopause (like pregnancy) became less a stage of life and more of a ‘condition’ - except, as it turned out, no one was really helping to treat this condition…

Women were stuck between modernist (i.e., post industrial) socially negative views held of older women and the fact that this condition was left untreated. Synthetic hormones were introduced as a replacement for traditional remedies - some of which held actual merit and didn’t have side effects, and thus the ‘curing menopause’ cycle was born.

Women could choose to use synthetic hormone replacement therapy (HRT) or grin and bear it through the symptoms. The mood swings and rages became a common "joke" about women of a certain age.

There was more to come. The rapidly growing advertising industry promoted a wide range of products focused on beauty, maintaining a youthful appearance, and promoting the importance of looks for women. Both men and women were "taught" to value youth over age. Elder women's wisdom became an afterthought, and the cult of chasing youth led women to feel "less than" as they got older. Add the symptoms related to changing hormones in peri and post menopause and, well, women felt even worse about themselves...and so did society.

It’s a grim history, with older women caught in the crosshairs of having lost what society said they needed, and having been stripped of what they could have inhabited instead. And through it all, one thing remained crystal clear, still, no one really understood what was actually happening to women in menopause, or how to help them manage it.

Understanding Menopause

Many of us grew up with mothers who were prescribed synthetic hormones. Some made it out unscathed, but for many women, these hormone substitutes led to a wide range of symptoms including increased risks for cardiovascular conditions and cancer. These hormones made from pregnant mares' urine contained hormones that are unnatural to human women, and did not play well in human bodies. Long term studies have found estrogens have proved to be helpful overall when closely monitored and used topically. The biggest area of risk was the hormone combinations - a combined equine estrogen PLUS a synthetic progestin.

But, they did seem to catch a budding idea - that hormones were at the crux of many problems related to menopause. In 2024, thankfully, there is a growing (if sometimes slowly growing) understanding of the intricacies of menopause, starting with hormone changes and how these impact women from their brains and breasts, to their sex lives and symptoms.

Hormones and their changes are topics we write about at length in our articles, detailing how hormones like progesterone, estrogen, DHEA, and testosterone all play a crucial role in our bodies - from weight to neurotransmitters - but also, in how they impact other hormones like cortisol, insulin, and melatonin.

Hormones play a critical role in our brain chemistry, a fact which is consistently overlooked by many practitioners. The epidemic of mental health issues so many people face today is influenced by altered hormone patterns - often brought on by hormone disruptors in our food, air, and water. Add the changes in hormones associated with the menopausal transition and women are understandably struggling for sanity. And yet this is still portrayed as a comedic meme. If you're not mad because of hormone fluctuations, we think you should be mad because women's health is so poorly understood.

Mental Health & Menopause

The mental health of women in menopause is no secret; research shows that women in menopause suffer both common symptomatological issues related to the brain, such as brain fog and sleep issues, but also from increased rates of anxiety, depression, and DSM 5 diagnosed disorders related to personality changes.

Studies suggest that menopause can perhaps exacerbate pre-existing mental health conditions (i.e., bipolar disorder) that have not yet been noticed or diagnosed. Additional research linked pre-existing personality traits with the increased likelihood of mental health changes of women in menopause; in a nutshell, women who had more incidences of mood swings were more likely to suffer from anxiety, depression and chronic stress.

Is it all hormones? Probably not. After all, menopause often marks other key shifts: children leaving home, becoming a grandparent, retiring, loss of loved ones, and of course - there is often an imperceptible change in how you are viewed in society. We may not experience all these things, and some of them may have more or less of an effect on us, but like becoming a new parent, changing careers, or getting married - significant life changes are likely to affect our mental health, and many aspects of menopause are connected to loss or change.

Retiring and children leaving home can offer cause for sadness, or space for travel, hobbies, or reinvention - sadly, it is often framed as the former, with little time or energy being directed towards the joys that women can have as grandparents, new business owners, aspiring senior pickleball pros, or late-life learners enrolling in college. Let’s face it, sometimes we feel both loss AND excitement.

The other puzzle piece, aside from socioemotional changes, is changes in our brain chemistry.

Hormones & The Brain

Estrogen, progesterone, and DHEA are all linked to the production of key neurotransmitters that regulate our emotions - notably serotonin, dopamine, and GABA. You can read more about each of those neurotransmitters and the role that they have in brain function and mood here, but the bottom line is that optimal balance and quantity of our sex hormones (estrogen, progesterone, testosterone) is directly correlated to the brain’s ability to produce important neurochemicals, and thus, to our mood and mental health.

When we look at statistics, we see significant numbers of women in menopause are being prescribed anti-anxiety medication, depression medication, mood stabilizing medications, and of course - sleep aid medication. Some, like paroxetine, even come with the ‘benefit’ of helping relieve hot flashes…

Except, these medications side step the more pressing question - are women really experiencing mood disorders and mental health changes, or is the medical community just giving out medications to avoid delving into the underlying issues…

Studies suggest that, for many women, correcting the hormonal imbalance with hormone replacement therapies significantly reduces many of these mental health concerns and symptoms - and without the side effects. In case you didn’t know, many antidepressants and anti-anxiety medications come with side effects like weight gain, low libido, headaches and insomnia - issues we already have a hard enough time with in menopause.

Doctor, Help!

Many doctors are wary of prescribing bioidentical hormones to women in menopause. This may be due to lack of training, or a lack of understanding of the current research, or because protocols provided by health systems reduce practitioners options for providing individualized care. Sadly, for many women, the prognosis from the doctor isn’t great. Women often hear comments such as:

Deal with it. Use more lube. Try this anti-anxiety med. Try this synthetic hormone pill. Stay away from all hormones. Give up sex. Try this antidepressant.

Even as research does begin to catch up - as in the 2022 North American Menopause Society updates, many women are still left scratching their heads, finding naturopathic doctors, or using their wits to find information on their own.

I Am Woman… (Hear Me Out)

Older women are everywhere in TV and advertising, but not in the places that matter.

Where is the representation of women’s health in medical research and training? Where is the representation of women in business? Where is the lost wisdom of the women who have raised children, worked, and managed their menopause as best they could while society told them to shuffle off into the corner and be old quietly and out of sight?

Is it any wonder women’s mental health has taken a hit?

In our latest Ask Dr. Robyn, one client asked how women could fight back against insurance companies and medical providers who refused to listen to them, to look at their packet of research, pay for their treatments, or consider their bottle of Silky Peach… Her response? Keep going. Keep advocating.

Once upon a time, older women held a place of power - the matriarchs who ruled with wit, wisdom, and often - the steely fortitude of having birthed eight children. Who said modern women can’t have that too? In the era of negative menopause representation in the media, maybe it’s time we get to be the ones who decide what menopause looks like.

After all, we are older and wiser than everyone else… 😉