By Tania Elfersy
A girl born in the heyday of the Roman Empire had a life expectancy of about twenty-three years... Matters did not change much for centuries. A man was expected to outlive at least one wife, often two or three. The menopause rarely troubled short-lived women... Even in Victorian times, Mrs. Average launched her family and then died like a spent skyrocket in her mid-forties
So begins Chapter One of Feminine Forever, published in 1966. This influential book on menopause, written by Robert A Wilson, MD, has continued to impact how many Western societies view and treat women as they journey through midlife.
Categorizing a post-menopausal woman as a modern phenomenon became a central argument to support the medicalization of menopause. If throughout history women had never lived beyond their 40s, how could a woman be expected to live into old age without medicine supporting her?
Wilson, a New York based gynecologist, had an interesting bedside manner that included describing menopausal women as “castrates” and “living decay.” His book was filled with fabricated theories designed to revolutionize a woman’s understanding of her life-cycle. It was also promoted with funds from Wyeth-Ayerst, the manufacturer of Premarin, the best-selling hormone therapy of the time.
Wilson wanted a woman to fear and distrust her body. He proposed that a wonder drug, estrogen therapy, would not only relieve over 25 symptoms that he associated with menopause – from hot flushes to suicide to an “unfeminine appearance” – but that when taken for decades, estrogen would also protect women from heart disease, cancer and strokes.
Wilson needed the argument of “women never used to live beyond menopause” to convince half of the population (and their doctors) that from midlife onwards, women needed the cure he was promoting. It was the 1960s, he could no longer simply get away with trying to convince women that they were the weaker sex.
His claim that men outlived women has disappeared from the current dominant menopause discourse, not least because in every country in every year for which reliable birth and death records exist, women outlive men. Yet, the idea that women never lived beyond menopause remains popular. It is often shared in the media and used to explain why so many women experience symptoms come midlife, and why a medicalized menopause and post-menopause are deemed necessary.
So, is it true that women living decades beyond menopause in the modern age is somehow unnatural and unprecedented?
No! Although women were often written out of history, we have enough literary references from the last few millennia to inform us that post-menopausal women walked the earth in the pre-modern era without defying the laws of nature!
In the book of Genesis from the Old Testament, which is believed to be written approximately 2,500 years ago, the matriarch Sarah is described as “old, coming on in years” and having “ceased to have the way of women” (chapter 18, verse 11). When she overhears a prophecy that she will have a baby, she laughs. Do you think it’s because she believes she isn’t supposed to be alive at her old age? Or is it because she, or even the authors of Genesis, have an understanding of the workings of the female body post-menopause?
If we fast forward to the 12th Century, we discover Hildegard von Bingen, a German Benedictine abbess, mystic and healer. She wrote, among other things, about natural history and herbal medicine, giving attention to the challenges women face during their life-cycles.
Rather than dying off before the age of 40, Hildegard had a transformative spiritual awakening at the age of 42 (hello perimenopause!) and went on to live until the age of 81.
On menopause she wrote: “From her fiftieth and sometimes from her sixtieth year, a woman begins to feel irritation and dries around the openings of her body.” How could she have observed this if there were no post-menopausal women in her surroundings?
I wonder what Hôjô Masako (1156-1225) a formidable political figure from Japan would have thought of Dr Wilson and some modern-day doctors’ claims about women’s inability to live long lives. Likewise, what would England’s Queen Elizabeth I (1533 – 1603) or Ann Nzingha (1582 -1663), a national figure & military strategist of precolonial Angola, have told these doctors? Or any of the other women below?
But, you may say, surely women of certain classes were better looked after.
With records available, we can see what happened in England.
This chart shows that AVERAGE life expectancy at birth was similar for the aristocracy (the grey line) and total population (the black line) in Queen Elizabeth I’s era.
Historical data from A Theory of Medicine Effectiveness, Differential Mortality, Income Inequality and Growth for Pre-Industrial England by David de la Croix and Alessandro Sommacal, published in SSRN (2006).
Queen Elizabeth I’s life span is represented by the red dot. A woman’s potential life span does not equal AVERAGE life expectancy.
Average life expectancy was indeed low over the ages not because women (or men) did not have the potential to live long lives, and thus dropped dead before the age of 40. Rather, it was the horrifically high infant and child mortality rates of the times that brought the AVERAGE life expectancy to such low numbers.
Research suggests that in the 16th century, approximately a quarter of all children died before their first birthday, and almost half died before age 16. If we rely on this data to consider the possible life spans of a 16th century family with four children, within the family, at least two children would have had to live until an average of 72 years for the average life expectancy of all four of the children to be 40.
Similar patterns of high infant and child mortality rates, which bring down the average life expectancy from birth, can be seen among contemporary hunter gatherer societies. And yet, in these societies, among people who survive childhood “the effective end of human life course under traditional conditions seems to be just after age 70 years.”
Societies with a high prevalence of teenage birthing mothers (which puts babies and young mothers at risk), contaminated water supplies, poor nutrition, child labour and limited access to well-practiced medicine have high child mortality rates. Once living conditions are improved and there is more respect for teenage girls and the innocence of childhood, children thrive and average life expectancy increases.
The idea that women are suffering during menopause because they were never supposed to live so long is indeed a myth.
If we want to support women through the sensitive years of midlife change, it would be better that we stuck to truths. There is no evidence that women are designed to malfunction because post-menopausal women are living on borrowed time. Let’s promote the facts and start serving women better.