THE POLITICS OF MENOPAUSE: THE "DISCOVERY" OF A DEFICIENCY DISEASE*

Menopause, once regarded as a sign of sin, and later neurosis, was redefined as a deficiency disease by physicians in the 1960s, when synthetic estrogen became widely available. Estrogen therapy, promoted by physicians and the pharmaceutical industry as a way of avoiding menopause and preserving youth and beauty, was linked to cancer and other health problems in the mid-1970s. Feminists argued that menopause was a normal aging process and that women's health care was a social problem. This paper looks at how these opposing definitions of menopause evolved and examines the efforts of women to fight off the stigma of the disease label. In the 1960s the medical profession in the United States hailed the contraceptive pill as the "great liberator" of women, and estrogens in general as the fountain of youth and beauty. Prominent gynecologists "discovered" that menopause was a "deficiency disease," but promised women that estrogen replacement therapy would let them avoid menopause completely and keep them "feminine forever." Yet within a few years, U.S. feminists in the vanguard of an organized women's health movement defined the health care system, including estrogen treatment, as a serious social problem. The male-dominated medical profession was accused of reflecting and perpetuating the social ideology of women as sex objects and reproductive organs. Treating women with dangerous drugs was defined as exploitation and an insidious form of social control. These issues raised several questions: How did such diametrically opposed definitions evolve? How, under what conditions, and by whom does a certain behavior become defined as deviant or sick? In what context does a putative condition become defined as a social problem? I believe that definitions of health and illness are socially constructed and that these definitions are inherently political. "Deviant behaviors that were once defined as immoral, sinful or criminal," according to Conrad and Schneider (1980:1), "have now been given new medical meanings" which are "profoundly political in nature" and have "real political consequences." Indeed "in many cases these medical treatments have become a new form of social control." I interpret the definition of menopause from this framework. During the 19th century, Victorian physicians viewed menopause as a sign of sin and decay; with the advent of Freudian psychology in the early 20th century, it was viewed as a neurosis; and as synthetic estrogens became readily available in the 1960s, physicians treated menopause as a deficiency disease (McCrea, 1981). Perhaps more important than these differences, however, are four themes which pervade the medical definitions of menopause. These are: (1) women's potential and function are biologically destined; (2) women's worth is determined by fecundity and attractiveness; (3) rejection of the feminine role will bring physical and emotional havoc; (4) aging women are useless and repulsive. In this paper I first analyze the rise of the disease definition of menopause and show that this definition reflects and helps create the prevailing ageism and sexism of our times. Then I show how the disease definition has been challenged from inside the medical community. Finally I examine how feminists outside the medical community have also challenged the disease model, claiming that menopause is normal and relatively unproblematic.