Hormone imbalance or just life?

What do YOU see?

Look at this famous picture. Do you see the older woman with her pointy chin or the younger woman with her long eyelashes?

The way we see midlife and menopause can have a big influence on how we live these important years. Are you suffering from hormone imbalance or are your aches and pains due to general stress and life changes?

My Wife and My Mother-In-Law,
by the cartoonist W. E. Hill, 1915
Wikimedia Commons. Public Domain

If you’re finding it all rather confusing, take heart - because there are good reasons for your confusion.

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Menopause – Biology is destiny
Western medicine defines menopause in biological terms. The medical definition of menopause is the end of ovulation and menstruation, the end of fertility.

Menopause occurs with the final menstrual period of a woman’s life. This is the strict medical definition of menopause, but there is confusion (even in medical circles) about the use of the words menopause and perimenopause.

The biology is destiny view tends to see the life phase surrounding the end of ovulation, from a biological perspective. Aches and pains, worries and concerns are called symptoms of perimenopause – regardless of whether or not they are really caused by hormone imbalance or simple aging. Doctors recognise that lifestyle plays a part in menopause age, but the conventional medical view of menopause is often dominated by the biology of hormone imbalance and change.

But there is a more subtle effect of this viewpoint:

The Body Machine – a dominant metaphor
Biomedicine very frequently uses the metaphor of the human body as a machine(1). Diseases are machine malfunctions, while a healthy body works like a well-oiled engine.

Machine failure metaphors are very common in medical talk about menopause. Menopause is discussed as if it were a disease. We hear about the time when the ovaries “fail” and the body becomes “deprived” of oestrogen, creating hormone imbalance and symptoms of malfunction. These metaphors rely on an assumption that “normal” female hormone levels are those of a fertile 30 year old, rather than being dependent on age.

The menopause as disease metaphor extends to include aging and death, using words of decay, degeneration and atrophy.

This language creates powerful negative expectations and fears that resonate throughout our culture, and contribute to the taboo that currently surrounds the dreaded “M” word.

But the logic develops more, as physicians come in to save the day: malfunctioning caused by hormone imbalance and “estrogen deprivation” can be “treated” by “replacing” those lost hormones.

The biology is destiny view sees midlife discomforts as being caused by menopause. It uses the body as machine metaphor to imply that something is wrong and needs fixing: Fix the biology with a physical cure and hey presto, you fix the woman.

Ingrained medicalisation
Taking a normal life phase and making it into a medical condition that requires treatment is known as MEDICALISATION.

The biology is destiny view that so-called symptoms of perimenopause are caused by a hormone imbalance, is so pervasive that it also underpins most alternative health approaches.

Alternative health practitioners promote products and remedies that are supposedly “more natural” than those prescribed by physicians. But these practices often implicitly adopt the language of the midlife female body as needing to be fixed. And many “natural” remedies are problematic because they have not been tested in high quality clinical trials, so neither their benefits nor their side effects have been properly assessed.

So what exactly IS the meaning of natural?

Midlife transition - a Lived Experience

The lived experience view comes from anthropologists, who have studied how women live through midlife in non-Western cultures.

According to the lived experience perspective of midlife, a woman undergoes a gradual transition from one state of being to another. This life phase incorporates biological menopause but biology is coincident rather than dominant.

How a woman experiences her midlife transition is influenced as much by social, cultural, psychological and life history factors as by her hormone profile.

Ethnographic studies suggest that in cultures that give older women high social status, women tend to experience less discomfort around the time of menopause than Western women.

In cultures where the biomedical model of menopause is not dominant, women do not complain about symptoms of perimenopause. In some languages there is not even a word for menopause.

Do these women lack a vocabulary for menopause talk because these discussions are forbidden– or because they do not need words to talk of something unknown? Perhaps a culture does not permit women’s complaints or perhaps they simply have too many other concerns?

There is of plenty of fuel for debate here.

But for sure, midlife brings emotional, social and psychological changes in all cultures. Families change, relationships evolve, responsibilities shift.

If viewed positively these changes can create a sense of new freedom, creativity and confidence.

But there is also potential for feelings of uncertainty, insecurity and depression that may create an unpleasant and challenging time.

Women need to support each other in their search for answers to the many questions and conflicts that arise during this period of life transformation and growth.

Choosing your view

Women’s midlife transition is neither only about biology nor only about cultural beliefs and attitudes.

Like the old lady-young lady image above, both views co-exist at the same time.

We women experience these shifting viewpoints every day of our lives and it’s our privilege to choose for ourselves the path we wish to take.

Choose confidence, freedom and flourishing and this will be the path that you will follow.

Published August 5th 2012


1) Martin Emily. The Woman in the Body: a Cultural Analysis of Reproduction. Beacon Press, 2001.

Go back to WHY is it so confusing?

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The experts say:

"Menopause is 'medicalized' in contemporary US society. There is great need to develop and disseminate information that emphasizes menopause as a normal, healthy phase of women’s lives and promotes its demedicalization."

NIH State-of-the-Science Panel. US National Institutes of Health, 2005

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