Controversies in Science and Technology: From Maize to Menopause

12 The Medicalization of Menopause in America, 1897–2000: Mapping the Terrain

12 The Medicalization of Menopause in America, 1897–2000 Mapping the Terrain Judith A. Houck Menopause, the end of fertility in women, has long been associated in the United States with a bewildering array of symptoms. Hot flashes, memory loss, nervousness, vaginal dryness, night sweats, and inhibited sexual desire currently headline an ever-changing set of complaints. Throughout American history, most women have coped with their symptoms—should they occur—in a variety of ways: grinding their teeth, doting on grandchildren , drinking a shot of whiskey, buying a fan, running for office. In other words, most women have fought menopausal discomforts without calling on the ministrations of medicine. But in the last one hundred years or so, physicians have increasingly courted menopausal women as patients . Menopausal women, in turn, have sought medical care. As a result, during the twentieth century menopause became medicalized. Feminists, in the academy and out, have recently decried the medicalization of menopause, claiming that physicians and drug companies have worked in tandem to transform menopause from a natural biological process into a pathological condition warranting medical intervention and pharmaceutical armament (Rostosky and Travis 1996; Kaufert and McKinlay 1985; Worcester and Whatley 1992; Klein and Dumble 1994; 198 Seaman 2003; Coney 1994). Indeed, for many American women reaching menopause early in the twenty-first century, menopause has become associated with medical appointments and prescription drugs in ways unforeseen by their grandmothers. This increased medical involvement has assuredly relieved a variety of symptoms, but it has also exposed women to health risks, the extent of which remain unknown. Although menopause has undeniably come under increased medical scrutiny, the generalized critique of medicalization fails to adequately characterize the medical involvement with menopause at different moments in time. Medicalization is not an endpoint. Instead, it is a process that changes over time in response to cultural pressures and technological developments. Further, the discussion of medicalization too often credits medicine for the near-complete domination of the cultural meaning and personal experience of menopause. This overstates the reach of the biomedical model. In this chapter I attempt to describe the evolving role of medicine in the medical construction, popular understanding, and lived experience of menopause in the United States. I acknowledge the influence of medicine while simultaneously showing the limits of medicalization in the lives of menopausal women. 1897–1940: Physicians Notice Menopause Before the end of the nineteenth century, U.S. physicians paid scant attention to menopause except to note, with no small degree of foreboding , that it was serious business. To the extent that it was discussed, menopause was described as a “critical period,” a biological Rubicon that tested a woman’s emotional and physical fortitude (Smith-Rosenberg 1986). However, physicians in the United States seemed largely unconcerned. Few American journal articles focused on menopause, and no American doctor published a monograph on menopause until Currier did in 1897. By then, physicians had begun to take menopause more seriously. Paradoxically, when menopause began to attract medical attention, it seemed to have lost much of its medical significance. By the end of the nineteenth century, menopause no longer represented a biological Rubicon . Instead, the medical literature of the new century described it as an important milestone in a woman’s life but denied that it was fraught with danger (Findley 1913; Lowry 1919; Strongin 1933). For example, one physician remarked that menopausal changes “come about as gently as the Medicalization of Menopause in America 199 falling of the autumn leaves” (Cook 1903, 384). Others maintained that most women did not suffer at all during menopause (Drake 1902; Carr 1914; Hirst 1925). Most physicians in the early twentieth century encouraged menopausal women to seek medical attention, but they explicitly denied that women needed medical treatment. Instead, physicians believed that information and reassurance were more valuable “than all the therapeutic agents under the sun” (Peple 1905, 644; see also Upshur 1905; Anspach 1924). As late as 1935, the eminent Johns Hopkins professor of gynecology Emil Novak maintained that physicians “earn their fees better through education and prevention than by writing out a prescription” (1935, 97–98). Physicians generally believed that an explanation and description of the physiological changes of menopause could alleviate most women’s suffering. As one New York City gynecologist noted in 1933, if menopause were “properly understood by the woman herself . . . anxiety, together with actual dangers, might be largely eliminated” (Strongin 1933, 522). Physicians...