Book Smart

In her book, Houck charts the evolution of 20th century attitudes toward menopause.

“One hundred years ago, menopause barely attracted either medical or cultural notice. As the 20th century got under way, menopause was feared more for what it could do to a woman’s nerves than for what it could do to her body. By mid-century, many regarded it as a threat to domestic life, as women became cranky with their families and uninterested in maintaining their physical appearance. By the 1970s, once common construction of menopausal women characterized them as diseased, desexed, depressed and decayed. As this shift occurred, treatment protocols changed,” Houck says.

Until the 1940s, most doctors seemed to advise their menopausal patients to quit worrying and take up a hobby, Houck says. After the 1940s, sedatives and short-term hormone therapies emerged as possible additions to advice and reassurance.

“In the late 1960s and ’70s, the ‘disease’ model of menopause became more widespread. As a result, both long-term and short-term use of estrogen therapy increased,” she says.

A critical catalyst in this evolution was a paper that Brooklyn gynecologist Robert A. Wilson published in 1963. The paper later became the best-selling 1966 book “Feminine Forever,” which presented menopause as “living decay,” a hormonal deficiency that should be treated with estrogen replacement therapy (ERT). Houck says that research a decade later linking ERT with endometrial cancer challenged the wisdom of routine hormone therapy.

The feminist discussion of it revealed a much larger women’s health agenda that women should retain control of their own bodies and participate fully in decisions regarding their health,” she says.

Research for the book took Houck all over the country.

“Then I went in search of women’s own experiences,” she says. “Although I looked hard for menopausal experiences in diaries and letters, I found almost none, from any period during the last century. I did find a little evidence in some informal and academic surveys, from the 1950s through the ’70s,” she says.

Houck notes that as the multitude of boomers of both genders age, more attention will be paid to all kinds of aging issues from all kinds of perspectives.

“For example, drug companies see menopause and aging in general as an opportunity to sell drugs to healthy people — and those drugs indeed have helped countless numbers,” she says. “Some doctors see growing older as the beginning of an increased risk for many diseases. Some women see menopause as a harmless, natural passage, perhaps the beginning of a new spiritual life or a personal trial. Menopause has changed both culturally and medically in the last century — what’s clear is that different women need different options. We just need to be careful that our solutions don’t cause more problems than help.”