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The Future is Menopausal

Post-reproductive women and the new feminism

An unhappy husband walks into Dr. Robert A. Wilson’s office in the mid-1960s and says, “Doc, they tell me you can fix women when they get old and crabby. She’s driving me nuts. She won’t fix meals. . . . She picks on me all the time.”

It sounds like the set-up to a joke—of the Rodney Dangerfield “my wife’s a lousy cook” vintage. Here’s the punch line: the aggrieved husband pulls out a .32 automatic and tells the doctor, “If you don’t cure her, I’ll kill her.” Cue the laugh track.

This story, told by Wilson in his bestselling 1966 book Feminine Forever, an extended advertisement for hormone replacement therapy (HRT), is worth repeating for a few reasons. One is Wilson’s strange self-reported reaction: “I have often been haunted by the thought that except for the tiny stream of estrogen . . . this woman might have died a violent death at the hands of her own husband.” Talk about misplaced blame.

And his conclusion—in my menopausal paraphrase, drug the bitch—is breathtakingly irresponsible. He hears a threat of domestic violence and immediately pathologizes the victim.

But this story also makes the rounds because Wilson is the one who is credited with turning HRT, pharmaceutical estrogen prescribed to women experiencing menopause, into an industry blockbuster. Wyeth Pharmaceuticals (a subsidiary of Pfizer since 2009) is the manufacturer of Premarin, which is (no kidding) made from the urine of pregnant horses. It was the bestselling drug in the United States in 1992. Today, in the era of #MeToo, greying models, and Menopause the Musical 2—and, presumably, fewer men who casually assume menopausal wives deserve lethal discipline—HRT continues to earn billions for its corporate manufacturers.

Hormone replacement therapy was first approved by the FDA in 1942, long before Wilson boosted the pharmaceutical market, but it was Feminine Forever that popularly reinforced the idea that women’s aging is a “deficiency disease.” Even as feminists pushed for liberation and equality through the 1960s and early 1970s, women of a certain age were still pressured to uphold the so-called feminine mystique—to be helpful, sexy, submissive, fuckable, and (at least seemingly) reproductive. Those who didn’t maintain some semblance of socially-defined femininity by any means possible became the hilarious butts of jokes, characterized as angry, witchy, and dangerous—or worse, they weren’t seen at all. (Or the very worst, I guess: they were dead.)

Pathetically little has improved for menopausal women since Wilson died in 1981. Our fears, degradations, and inequalities are still blamed on us—and are still well-used by corporate pill-pushers. Pharmaceutical industry watchers estimate that by 2022, the HRT market will be worth an estimated $28.4 billion. (By comparison, the annual revenue of one of the top ten pharmaceutical companies in the world, Johnson & Johnson, is $40 billion.)

I promise you that the many symptoms women experience when going through menopause are nothing to laugh at; the hot flashes, lethargy, and emotional ruptures can be debilitating. But Big Pharma’s attention to menopausal women over the past fifty years has unsurprisingly better served the industry’s own financial needs than women’s physical menopause symptoms—and I don’t mean the perceived loss of “beauty.” There is no rush to find scientific cures for the disruptive symptoms—today the cause of the cursed hot flash remains very much a mystery. Rather, menopause is a business opportunity, a billion-dollar drug category for corporations—and the industry’s main sell is telling women over fifty that something is drastically wrong with them.

Pharmaceutical companies could invest in research and development to create new alternatives to existing varieties of HRT—preferably ones that are not tainted with cancer concerns. But why bother improving on a nearly eighty-year-old treatment that pumps a hormone back into bodies that have, as nature intended, ceased to make it on their own? The objective has wrongly been to end menopause (to prevent women from—gasp!—aging) rather than to end the disruptive symptoms of menopause, however effectively HRT may relieve them. Why? Because culture—and the industries that benefit from it—has found more profit in playing on women’s fears of male disapproval than in providing women with ways to be healthy and comfortable.

There is no conclusive medical consensus on who can or should take HRT, though there are some categorical suggestions: women under sixty and without a history of cancer are considered to be safe from most of the drugs’ negative side-effects. Experts recommend a case-by-case analysis. While it is not usually recommended, some women continue to take a low dose of estrogen for as long as they live. As women age, the risks from taking the drugs increase. According to the National Cancer Institute, these risks can include a higher prevalence of bone fractures, urinary incontinence, breast cancer, strokes, vaginal bleeding, and dementia. Still, I recently met a glowing fifty-four-year-old friend for lunch after her doctor’s appointment. She’d found a cure for her brain fog and lethargy and fears of the future: the doctor had injected HRT pellets into her buttocks. “I’m taking this forever,” she said. The treatment gave her hope and made her feel good about herself again—and sometimes hope is enough! I have no doubt that my friend’s injections are improving her life. But HRT manufacturers, thanks to precision market research, know the power of women’s hopes of forever femininity—and the power of women’s culturally orchestrated fears of irrelevance.

This predatory state of affairs could see a change in future decades, however. The reproductive woman—youthful, sexy, ready to command a household and bear children—is less and less the norm as the overall population ages and life expectancy (at least for some racial groups) increases. As more and more women live into their eighties (eighty-one is today’s average life expectancy for women in the United States), they are spending more of their lives post-reproduction. And often the liberations of these later years give women a new lens on how very oppressed by unseen and under-appreciated labor they were throughout at least their twenties, thirties, and forties. A 2018 Boston Review article by James G. Chappel about this coming shift appeared under the headline “Aging into Feminism.” The rise of the witchy, independent, beauty-redefining, problem-solving, post-reproductive woman has the potential to change the world. Hello patriarchal predations, we crones see you, and we will check you.

Here’s the punch line: the aggrieved husband pulls out a .32 automatic and tells the doctor, “If you don’t cure her, I’ll kill her.”

The history of HRT is an allegory of sorts, a map to understanding how and why the liberation of women has in many ways failed, and what a keener social understanding of women’s later years can mean for the real issues the planet faces. In this narrative, the legacy of Robert A. Wilson and Feminine Forever has not aged particularly well. But in 2002, after a controversial study cast doubt on the safety of HRT—and women across the world questioned their reliance on it—Wilson’s son Ronald revealed just how Big Pharma gaslit women everywhere for profit: Robert A. Wilson had been bankrolled by Wyeth. Not only did the company pay Wilson to write Feminine Forever, but they financed his eponymous research foundation, located on Park Avenue in Manhattan, and, after publication of the book, paid for Wilson and his wife to speak to women’s groups across the country. Thanks to this astroturfing, Wilson’s work became profoundly influential. Scholar Nadine Marks told the New York Times in 2002, that “even textbooks for gynecologists and obstetricians in the 1960s would explain how a woman’s life could be destroyed if she didn’t have estrogen in her body.”

Flash! Ah-ah!

In her new book, Flash Count Diary: Menopause and the Vindication of Natural Life, Darcey Steinke isn’t having any of that “destroyed” bullshit. She writes that for menopausal women, “Freedom is on the horizon—freedom from child care and domestic duties, from trying to be beautiful, from the leering male gaze, from derailing sexual desires.” But she’s also not mooning over the golden years because she knows how society has, with determination and financial incentive, often failed to grant menopausal women such freedoms.

The book is a coming-of-a-certain-age tale, documenting Steinke’s entry into that new realm of life where estrogen ebbs, prior ideas of beauty, attraction, and priorities fall away, and women are able to conceive of their lives as their own. What she encounters along the way is so seldom documented—certainly in prose as meticulous and detailed as Steinke’s—that for other menopausal women, reading Flash Count Diary can feel revelatory and edifying. Steinke’s heart thwacks; heat radiates out of the top of her head; she feels trapped, afraid, animal, ungendered, mortal. “It’s as if a shard of a different and darker reality has been thrust into my current one,” she writes. Her metaphors are poignant to anyone, like me, who has spent a few years trying to carry on with life as her body and mind violently transform into something new and unknown. Steinke cites Saint Paul’s “thorn in the flesh” and the biblical conversion; the Hulk’s transformation from meek and kind Bill Bixby to wrathful Lou Ferrigno; and Lolita, the second oldest captive killer whale, who performs seven days a week in a warm and illegally small concrete tank at the Miami Seaquarium. How can life’s regular events—folding laundry, writing, meeting new people, commuting to work, surviving a summer heat wave—carry on when your body has a new and uncontrollable agenda? And how can this be one half of the population’s new normal when so few of us have been openly talking about it? Shame is one hell of a drug.

In the spring of 2015, right before turning in my first book manuscript, I wrote with exasperation to a now-defunct women’s listserv:

For the past few months, I’ve thought I was going crazy. Depression, fatigue, lack of focus, bouts of crying. I’m surrounded by a lot of wise and accomplished women who are older than I am. Still, they don’t talk about menopause! How could I get here—to the age of 46—and not know what to expect from my changing body?

This listserv was populated with an age-diverse group comfortable with explicit conversations about all aspects of women’s lives and bodies: sex and sexual assault; ambition and inequality; reproductive justice and child birth; equal pay and the patriarchy. How could menopause and its attendant symptoms not have come up in the years I was on the list? The supportive responses rolled in, but the most helpful ones were sent to me in private—as if to confirm the stigma and shame, even amongst ourselves, of women’s experiences. Privately, women told me stories of lost friendships, lost relationships, lost jobs, and dark periods of lethargy and self-doubt.

I thought of these stories as I read Steinke’s book, and also about the full-throated email endorsements of HRT I’d gotten—even if you’re not trying to stay young and feminine, they advised, take it to stay sane and socialized. I felt I could endure most any symptom so long as I knew I wasn’t the only one experiencing it. Like any other life change, not knowing it was coming or what to expect added to the debilitation. “No one proposes we eliminate childhood, adolescence, or adulthood from the female life cycle,” Steinke writes. “Only menopause is considered something to be cured and reversed, done away with completely.”

Flash Count Diary is framed by Steinke’s fascination with one of the few animal species that experiences menopause: killer whales. Matriarchs lead their pods long after they’ve left their reproductive years, teaching the younger generations how to survive in trying times, which these times clearly are. J2, or Granny, who died in late 2016 at 105, lead the J, K, and L pods off the coast of Washington State. In Flash Count Diary, Steinke actually encounters J2 while bobbing in a kayak in the waters beyond the San Juan Islands. “I see a brown eye looking directly at me,” she writes, “the shining numinous expanse of body.” The purpose and respect the pods give Granny is a kind of salve for Steinke. Seeing another species defined by skills and values that extend beyond procreation shows her that the erasure of aging women is, if not a fluke, inconsistent in the animal kingdom.

Meat Market Logic

One night in the spring of 2017, while lying in bed with a book, I felt a tug in my lower left abdomen. When I ran my fingers over the spot, I felt a lump, large and protruding from my flat stomach. After a panic in the face of mortality and fearing the worst, I found a doctor who diagnosed endometrial masses. My ovaries, long denied their intended work by years of birth control and two abortions, were rerouting their estrogen to a different use: my internal organs were glutted with endometriosis. It had grown like kudzu, fusing my insides together. The only solution was surgical removal of both my ovaries and their product. I never liked those bitches anyway, I told myself, relieved by the diagnosis. I wasn’t going to die, after all, just lose a couple of organs I never really needed. At forty-eight, natural menopause was already coming for me.

Recovery from surgery was easy. Until menopause grabbed me by the collar and shook out everything I knew about my body like loose change falling to the floor. For a short time, I took low-dose estrogen, but the potential growth of new masses made me and my doctor uneasy. Ultimately, after a few months, I decided to wrestle with the lethargy, night sweats, hot flashes, and seizures of depression on my own. But the questions I asked myself were as real as they were irrational: How do I interact with the world and others without the veneer of femininity? What is attraction without our narrow definition of beauty? What the hell is my role in society, now that my biological self has caught up with my childlessness, a choice that was once the core of my defiant feminism?

The taboos of talking about menopause reiterate these questions in everyday interactions: a flirty new neighbor asks me what I am working on. In my pause, he says, “You’re blushing.” “No,” I blurt, “It’s a hot flash.” He hastily trundles away, red with his own embarrassment.

Not long ago, though, the benefits of being on the other side of my reproductive years began to dawn on me. I wrote at The Revealer: “Women, I understood at my surgically-altered core, spend their early decades focused on how and when and if to have babies; once menopause arrives to undermine all of our prized ideas of youth and beauty, compatibility and deference, we acknowledge why such attributes are prized in the first place. Quite often the answer is: for our own subjugation.” The needs of a husband and children supersede everything else in mothers’ lives. Even for the childless, the preoccupation can be the maintenance of “sex appeal.” But when the period of reproduction is over, a kind of fog lifts. Your body can be whatever it is; it exists to please you.

Menopause grabbed me by the collar and shook out everything I knew about my body like loose change falling to the floor.

As the national median age climbs and the elder population increases, a “normal woman” is not one participating in all the labor associated with motherhood: looking and acting attractive enough to land a suitable husband, getting and staying pregnant, birthing and raising babies, maintaining a clean and pleasant household. Motherhood may be the role that confers women power and value, but for an increasing number of women, it’s no longer daily life. Over the past few years I’ve been drawn again and again to a quote from a 2011 piece by Sandra Tsing Loh for The Atlantic deliciously called “The Bitch is Back.” Tsing Loh writes about the paucity of books or information for women facing “The Change” and reassures us that a woman who is no longer reproductive is not some wild creature to be drugged up and disciplined, à la Feminine Forever, but is a woman free of the hormones that conned her into all that patient mothering for a few dozen years (though a neat correlation between hormones and parental desire is disputed by some scholars):

A sudden influx of hormones is not what causes 50-year-old Aunt Carol to throw the leg of lamb out the window. Improperly balanced hormones were probably the culprit. Fertility’s amped-up reproductive hormones helped Aunt Carol 30 years ago to begin her mysterious automatic weekly ritual of roasting lamb just so and laying out 12 settings of silverware with an OCD-like attention to detail while cheerfully washing and folding and ironing the family laundry. No normal person would do that—look at the rest of the family: they are reading the paper and lazing about like rational, sensible people. And now that Aunt Carol’s hormonal cloud is finally wearing off, it’s not a tragedy, or an abnormality, or her going crazy—it just means she can rejoin the rest of the human race: she can be the same selfish, non-nurturing, non-bonding type of person everyone else is.

Tsing Loh flips normal on its head for us, from the serving, mothering, domestically belabored woman, to the one who, with liberation, says, Cook your own damn leg of lamb. Even women like me, who never chose the domesticating baby trap, are still subject to its labors: the work and expense of looking like we might procreate. Our “street value” is used in those reproductive years to determine what dates, husbands, jobs, and respect we’re likely to get. When the wrinkles mar and the ass droops, our value under the male gaze—and, let’s be honest, the female gaze—is diminished. And we realize how narrow and limiting social concepts of attractiveness can be. Life experiences, wit and charm, competence, achievement, expertise; none of these cultivated attributes have anything on a pretty—by which I mean young—face.

Men can be so many things: young or old; dopey and cute or salt-and-pepper handsome. Money, power, nerdiness (which spell-checks to neediness, I’ll take it), a guitar, a hot car, carrying a baby or his own damn groceries—these can all confer attraction when it comes to men. Women? We must be the impossible: forever young, forever bound to the narrowest definition of feminine.

But wait, does it sound like I’m bitching? I rest my case.

Old Crone Medicine Show

Culture is shaped by endless variables. We are entering an era where normal women are reprioritizing culture’s values. In Britain, menopause is having a rare moment of visibility. The country is experiencing a broad—and as yet unexplained—shortage of HRT medication, causing media outlets there to sound like they’ve discovered menopause for the first time. Popular BBC TV host Louise Minchin made news when she “came out” about her struggles with the menopause, as the British call it. She was given her own setting on the studio’s air conditioning system to cope with those pesky hot flashes.

That same month, the Royal College of Obstetricians and Gynaecologists (RCOG), the British Menopause Society (BMS), and the Faculty of Sexual and Reproductive Healthcare (FSRH) acknowledged that the shortage is a serious health problem. They released a joint statement saying they were receiving queries from women unable to fill their prescriptions. About half of HRT varieties are unobtainable in the United Kingdom. (What remains unclear is what is causing the shortage: Chinese supply issues have been speculated.)

In August, Labour MP Carolyn Harris called for workplace protections and accommodations for menopausal women. “Menopause is the last taboo because it is still hidden and it only affects women and it only affects older women,” Harris told the Guardian. “It’s ageism, it’s sexism, all rolled into one.”

The reproductive woman is less and less the norm.

Even that other great male inconvenience—often described as the decline of female desire, but more accurately known as vaginal dryness and purportedly solved by HRT—is being questioned. Are women less interested in sex, or just tired of having sex out of marital obligation? After news broke that a new procedure could postpone the onset of menopause by up to twenty years, British writer Grace Dent shot down the medical breakthrough with characteristically slicing wit: “Very few sane women actually want to begin popping out babies at fifty years old.” What they do want is to carry on with their own work—“book-writing, owning businesses, living and laughing and being”—unencumbered by male expectation . . . and limitation.

“What she disliked in men was not their eroticism, but their assumption that women had none,” writes Marian Engel in her seminal 1976 novella Bear, about a woman who falls into a passionate, bestial love affair on a Canadian island, “which left women with nothing to be but housemaids.” For fifty years we’ve known that to be more than a housemaid is not too much to ask; now post-reproductive women are experiencing the opportunity to embody new roles.

Working on The Change Gang

Forty-nine-year-old author Naomi Klein recently tweeted: “Just your morning reminder that disdain for women’s bodies and disdain for the earth are deeply connected. Both remind idiotic baby men like Bolsonaro and Trump that they are part of a web of interdependent life and not the lone heroic figures [they] pretend to be. Topple it all.” Klein was responding to news that forty-one-year-old French President Emmanuel Macron had rebuked sixty-four-year-old Brazilian President Jair Bolsonaro over his comments about Macron’s sixty-six-year-old wife Brigette. When a Bolsonaro supporter had posted a disparaging meme on his Facebook page, accompanied by a photo of the men and their wives, Bolsonaro replied, “Do not embarrass the guy.” Bolsonaro is married to thirty-seven-year-old Michelle.

Female beauty has long been treated as a male trophy, something that lends them security, credibility, the benefit of the doubt, and that serves as a prophylactic against accusations of lewd, even murderous, behavior. “You have a charming and attractive wife, a magnificent apartment, and a villa in La Baule . . . ” the detective Jules Maigret says to a businessman suspected of murder in Georges Simenon’s 1971 Maigret and the Loner. A wife’s beauty and fertility heighten the respect and power her husband receives; her youth can make an older husband younger, more influential, important. But the “charming and attractive” wife is still herself a commodity, still bound to the duties of domesticity, still fated to become old—at which point she can be traded in for a younger model.

What then is to be done with the women who “age out” of this vastly limited and limiting social value? What are we to do with the thirty or forty years that follow our service to male authority, children, and households? To be honest, my eye wrinkles and I are still figuring it out.

In “Aging into Feminism,” Chappel offers some pointers. “Within a few years, the number of people in the world over the age of sixty-five will surpass the number of those under five,” he writes, and most of those mature years will belong to women. “This is an opportunity,” he asserts. “The emancipatory feminism of the future, if such a thing will exist, will teach us not only how to parent and how to work, but how to age well and justly.” Domestic care that typically falls to women includes care for the elderly—and this work, these later years, are being “subsumed by the logic of neoliberalism”: low-wage jobs or no jobs at all, increasing and increasingly underfunded caretaking, including health care. Chappel calls for feminism to embrace a new kind of social justice—a woman’s work is never finished!—but he’s onto something.

The “arc of history,” as we were all sharply reminded in the wake of Trump’s election, doesn’t bend toward shit. Progress will always need a solid push. And the hill is particularly steep right now, with nothing short of the fate of humankind threatened by climate change. Increasingly, as Klein notes, we’re forced to acknowledge that climate denialism and misogyny go hand in hand. As we age into this new feminism, all those women who are embodying their new post-reproductive normal have the opportunity to not just change the future of their aging lives but the future of the world.

In Flash Count Diary, Steinke reminds us of this sharp Katha Pollitt wisdom: “Questing is what makes a woman the hero of her own life.” No joke—we’re in serious need of some witchy, angry, questing heroes right now.