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Why Is Perimenopause Still Such a Mystery?

The shroud of secrecy around women’s intimate bodily functions is among the many reasons experts cite for the lack of public knowledge about women’s health in midlife. But looking at the medical and cultural understanding of perimenopause through history reveals how this rite of passage, sometimes compared to a second puberty, has been overlooked and under discussed.

Though the ancient Greeks and Romans knew a woman’s fertility ended in midlife, there are few references to menopause in their texts, according to Susan Mattern, a professor of history at the University of Georgia, in her book “The Slow Moon Climbs: The Science, History, and Meaning of Menopause.”

The term “menopause” wasn’t used until around 1820, when it was coined by Charles de Gardanne, a French physician. Before then, it was colloquially referred to as “women’s hell,” “green old age” and “death of sex,” Dr. Mattern notes. Dr. de Gardanne cited 50 menopause-related conditions that sound somewhat absurd to modern ears, including “epilepsy, nymphomania, gout, hysterical fits and cancer.”

Physicians in the 19th century believed that receiving bad news could cause early menopause, and that women who worked in “unwomanly” occupations, like fishwives, were most at risk, according to “The Curse: A Cultural History of Menstruation,” by Emily Toth, Janice Delaney and Mary Lupton. These Victorian doctors also believed that menopausal women grew scales on their breasts and experienced a “loss of feminine grace.”

Things did not get much better for women in perimenopause during the latter half of the 19th century. “A woman consulting the American gynecologist Andrew Currier in the 1890s would have been told that leeches were still an effective remedy for congested genitals,” more commonly known as pelvic pain, according to “The Curse.” Other physicians of the era thought that perimenopausal women were more susceptible to mental illnesses, “among them ‘morbid irrationality,’ ‘minor forms of hysteria’, melancholia and the impulses to drink spirits, to steal, and perchance, to murder.”

In the first half of the 20th century, the hormone estrogen was discovered and its role in menopause was clarified somewhat — after a woman’s period ceases, her estrogen levels are lower than they were during her fertile years. Even though doctors no longer thought menopausal women were murderous lizard people, cultural ideas about them did not improve.

It wasn’t until the 1980s that longitudinal studies — which followed the same cohort of women for years — deepened public knowledge about the role of hormones during menopause. Before that, doctors thought perimenopause was a slow draining of estrogen levels until you hit the end of your period. “But what we’ve learned is it is more of a turbulent process — hormones are bouncing around,” said Dr. Stephanie Faubion, the medical director of the North American Menopause Society.

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