Louise Foxcroft, Hot Flushes, Cold Science: A History of the Modern Menopause, London: Granta Books, 2009, £14.99,ISBN 978-1847080660, pp. xxii + 330.

Given how many popular works on the menopause are constantly being published in order to guide women through this stage of the life-cycle, it is surprising that no-one has previously written a popular and accessible work on its history. Perhaps it is assumed that because the menopause is an inevitable event in the lives of all women who survive into the middle years, it does not have a history, it just IS. Louise Foxcroft effectively explodes this unexamined assumption to demonstrate how much our ideas about the Change of Life, and individual and societal reactions to it, owe to its historical construction as a problematic event.

            She opens with a big bang:

The female body in medicine has been defined almost exclusively by male doctors. Overwhelmingly their attitudes have been mired in contradiction, negativity, undisguised disgust, and worse.

How greatly ideas could contradict one another she immediately demonstrates by quoting two authorities, one who claimed that post-menopausal women were sexually rapacious and the other that they became sexless ‘castrates’. While this difference may have something to do with the passage of four centuries and changes in medical beliefs between Giovanni Marinello and Dr Robert Wilson, what comes through very clearly in Foxcroft’s solidly documented study is that doctors’ ideas about what the effects of the menopause were differed wildly even with a similar time-frame, but they were pretty much all agreed that it was pathological, a bad and dangerous thing, and generally icky. (Which pretty much summed up their underlying ideas about the entire female sex.)

            She follows up this first blast of the trumpet by considering the modern menopause and its medicalisation since the early nineteenth century. There is a long list (p.7) of the assorted physical and mental effects which are associated with this time of life – all of them negative. She argues that many of these may be associated more generally with the ageing process rather than the specific hormonal changes. Perhaps the only symptom significantly related to these is the combination of hot flushes and night sweats: even these are not experienced by all women; while those who do have them, do so very diversely and individually. Research on different cultures and ethnic groups suggests that the menopausal model of Western medicine is very far from being universally valid.

Many women, even today in the intensely medicalised climate of modern Western culture, go through the change with minimal upheaval and take it in their stride. Male doctors, however, over the centuries were both much more likely to see women who were having unusual difficulties, and furthermore, to attribute any problems they encountered in women in middle life to this specifically female event. Preconceptions as to women’s value being their reproductive capacity also led doctors to minimise or completely ignore the relief many women feel at the cessation of menstruation and the possibility of conception. Attitudes around sexuality as essentially for reproduction caused them to regard menopause as the termination of a woman’s sex life.

There is a detailed account of the rise of the idea of menopause as pathological event. Classical, medieval and early modern sources mentioned the cessation of menstruation as a facet of ageing but as one among many issues to do with the older woman. As medical science developed, with the rise of anatomy and the emergence of ‘man-midwives’ encroaching on a sphere previously the purlieu of the midwife and her female knowledge, men claimed a new authority in understanding women’s bodies and their functions and denigrated traditional wisdom. Misogyny, as Foxcroft shows, was intricately interwoven throughout their assertions about the ageing female body. With the development of surgery in the nineteenth century following the discovery of anaesthesia and antisepsis, the medical profession became knife-happy in its proposed solutions.

It was not until the late nineteenth and early twentieth century that women themselves gained a voice in these debates, once they were admitted to the medical profession and therefore had an authority which male medics would recognise. One thing that would have added to this already excellent book would have been some idea of how women themselves, before that point, responded to the advent of menopause, beyond their role in male-authored clinical case-histories. Foxcroft mentions manuscript domestic remedy books of the sixteenth and seventeenth centuries: the Wellcome Library has recently made a large number of these available and searchable online. Published works, even of female authorship, tended to adhere to the patriarchal party line on the ageing woman, but it is possible that these private household documents may indicate different attitudes. Family letters and diaries may also provide further data. However, there is so much in this book already and digging up this evidence would constitute a massive task

Once women were able to intervene as equals (or near-equals) in medical and scientific debates, some remained respectful of, or had internalised, the professional party line on the dangerous age. But others, including the Medical Women’s Federation, made a strong case for treating menopause as a normal life event rather than a pathological upheaval. Management, by the woman herself being properly informed about the changes taking place, rather than ‘cure’ by a doctor, was the watchword.

Much of this book makes rather depressing reading, as it reveals the murky depths of medical men’s prejudiced and loathsome attitudes towards women, the female body, and in particular the ageing female body, over a long historical period and continuing into the present. In spite of this grim subject matter, it is well-written and extremely readable, and accurately researched (there is only one significant blooper: p. 159: famed clitoridectomist Isaac Baker Brown, who died in 1873, could not possibly have been influenced by Freud, who was only 17 at that date).  It provides a valuable resource for understanding why we think about menopause the way we do within modern Western culture, and how we might start thinking differently.


Lesley A. Hall, Wellcome Library, London.