Betwixt The Sheets: The History of Sex, Scandal & Society - Menopause: History, ‘Hysteria’ & Hormone Revolutions

Episode Date: May 10, 2024

When you look into the history of menopause it’s steeped in misogyny, fear and demonising women’s bodies. But what is the truth behind some of the popular menopause myths? How has it been understood (or misunderstood) throughout history? And how have post-menopausal women essential to human evolution? Joining Kate today is Dr. Jennifer Gunter, author of the Menopause Manifesto and gynaecology physician of 30+ years.You can also read more of Jen’s writing on her blog here: https://vajenda.substack.com/This episode was edited and produced by Stuart Beckwith. The senior producer was Charlotte Long. Enjoy unlimited access to award-winning original documentaries that are released weekly and AD-FREE podcasts. Get a subscription for £1 per month for 3 months with code BETWIXT sign up at https://www.historyhit.com/subscription/You can take part in our listener survey here. Hosted on Acast. See acast.com/privacy for more information.

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Sign up to join me in locations around the world and explore the past. Just visit historyhit.com forward slash subscribe. Lovely betwixters, it's me, Kate Lister. I am here once more with your fair do's warning. Do you know why? It's because I care. I do. I really do care. So here it is.

This is an adult podcast book. Am I adults? Other adults about adulty things in an adulty way. Covering a range of adult subjects and you should be an adult too. And if you don't feel safer after that little lot, then just get out of here. Don't listen. Just give us a swerve. And for the rest of you.

Let's do it. Hello, betwixters. The year is 1870, and I am very keen to read this new publication by Dr. Edward Tilt. It is hot off the medical press. It's called The Change of Life in Health and Disease, a practical treatise on the Nervous and Other Affections Incidental to Women at the Decline of Life. Such a snappy title. Yeah, yeah, I'm not too sure about the decline of life.

bit there, Ed, but you do you. This book is a pioneering for its time study on the menopause, and it very helpfully lists the symptoms that you can expect. Let's see. We have got hysteria, hysterical fits, crying fits, monthly hysterical symptoms, or what I love this one, giggling fits. I don't even know

what that would be, just rolling around on the floor, or having the menopause and giggling. But he's starting to see a pattern here. Huh. Do you notice how a lot of these symptoms have the word hysterical attached to them? They're kind of leaning into the madness theme. Yeah, I noticed that too.

Dr. Tilt was writing this in the 19th century, but physicians have been writing about what we now call menopause all throughout our history. And it's not always as scientific as you would hope that it is. Hot flashes at the ready, Betwixtors. Let's do this. What do you look for a man? Oh, money, of course. You're supposed to rise when an adult speaks to you.

I make perfect copies of whatever my boss needs by just turning it up and pushing the funny. Yes, social courtesy does make a difference. Goodness, my beautiful time. Goodness has nothing to do with it, Derry. So, and welcome back to Betwixes Sheets, the history of sex scandal in society with me, Kate Lister. The knowledge of the menopause has been around, well, for as long as people have had uteruses, really. But how it's been thought of, how it's been understood, and how it's been treated, has changed radically throughout history. And that's what we're going to be looking at today. How have premenopausal, menopausal and postmenopausal women been treated throughout history?

And why is the menopause essential to human evolution? Joining me today is the quite wonderful Dr Jen Gunter, author of The New York Times Best Seller Menopause Manifesto. She's also a gynecologist and has been for over 30 years, so who better to speak to about menopause than Dr Jen? We also have a listener to thank for suggesting this episode topic. Over to you, Natalie. Hello, Betwixte team. My name's Natalie and I live in Shropshire. Just wanted to say how much been loving the podcast is so fun and such a different. way of exploring historical topics. So I was listening to your discussion around menstruation and wondered if you considered doing a follow-up episode on the history of the menopause. Having just

entered my 40s, I'd love to see how views around the menopause have changed, if they have, as well as how women were viewed once they could no longer have children. Keep up the fab work. Thank you so much, Natalie. And you know, Natalie, you weren't the only one to suggest this episode. It has been hotly requested. So it is with great pleasure that we bring this episode to you. And if you are out there with an idea for an episode, please do get in touch with us at betwixt at history hit.com. Now, without further ado, let's get on with it. Hello, and welcome to Betwixt the Sheets. It's only Jen Gunter. How are you doing? I'm doing great. I'm doing great. How are you doing?

I'm a little bit starstruck, if I'm completely honest. Well, I'm just so thrilled to be able to connect. And so, you know, be great if we were in person, but this is the next best thing. I am such a huge fan of your work and you wouldn't believe the amount of requests that we get for an episode on menopause and the history of menopause. So you are the most perfect person to talk to about this. So the question that I ask most people first of all is how did you come to study this, write this book? But you, of course, are a practicing gynecologist. This is your life's work. So I suppose we've got to go back even further for you, what brought you to the work that you do now?

Well, what got me into OBGYN, really, I was annoyed that there weren't enough abortion providers. That was really the, I do most things out of anger. So it's a very, you know, righteous indignation, I suppose, is a high, is a great motivator for me. So I was in medical school and it was a very pivotal time in Canada. In 1988, the abortion law was overturned in the country. And so abortion just became a medical procedure. Fancy that. And just always good to point out that the abortion rate is not higher in Canada. So laws don't do anything about affecting abortion rates. So that was very pivotal for me. And that was probably, it's always hard to think. I mean, it was like almost 40 years ago. So what was I thinking 40 years ago? But that was a big,

pivotal thing for me wanting to get involved with women's health. Because basically, there were so few people doing abortions, talking about abortions, and so that was really it for me. And then as I progressed through and I graduated, I my fellowship and years into practice, I started seeing this rise of disinformation. And this was before the internet existed. You know, this would be courtesy of people like books from Suzanne Summers or things seen on Oprah or, you know, what's covered in People magazine and those types of things, Christine Northrop. And so this is kind of like first generation of disinfluensers, I would say. And so you would find yourself in the office, well, no, you know, that doesn't work. You can do this. And how did you get that information? And then it just kind of progressed that I felt

that since people come in to the office with not knowing enough about their bodies to be able to have great conversations with their health care providers. And it's very difficult, especially in the time-contrained settings we're in to be able to give people the information. So I thought, wow, like, what if I could meet people where they are and get, you know, get more health information to people and also help them recognize, you know, the bad things that are out there. And sadly, the bad things are increasing. Oh, wow. Do you think so? That's extremely depressing that we're not winning the fight and misinformation. Yeah, I don't think so. I think with those short, the social media platforms with videos, I think those are really particularly, have skewed.

things in a really bad way. They get lots and lots of eyeballs on them, fear and crazy things sell. I just saw today on Instagram, somebody with a really large account, of course, promoting vaginal steaming, you know, and she's somebody who has up until recently, you know, had a lot of good health information. And it's like, what do you get from this? What do you get from teaching people less about their bodies? You know, I just, it's like, if you do the history of that, you would know, it's silly. And if you want to put something warm on your bottom, because it feels better, that's great. But you don't have to lie about it and say that it's ancient or has some special healing any different than if you got in a warm tub. No, vaginas don't need to be steamed or boiled or

fried or anything else. Yes, exactly. My God. But we are here to talk about the menopause. And this is a subject that, of course, people have had the menopause as long as people have had working wounds to have the menopause. But it seems to have gathered momentum in recent years. It's like we're finally ready to have the conversation. And what I loved about your book, and all of your books and your latest one about periods as well, is you really entwine the personal with the scientific. There's a real sense of, this is the science and this, this is my experience of it as well. I thought that was really powerful. What made you want to write about the menopause? Was it anger again? Well, yeah.

I mean, a little bit. So I had written the vagina Bible and I had gone on tour for the vagina Bible. And everybody wanted to talk about menopause in the questions. So not everybody, but, you know, questions would start. Oh, I have this question about my vagina, this and that. And then people started asking about menopause. And it was really amazing to me that it sort of in this space where I thought the vaginas and the vulvas were the last taboo, we sort of created space for people to talk about menopause. That's when I started thinking, okay, well, I guess my next book, this is something I need to write about this is a thread that I need to pull. And so that was really the impetus behind it. Let's start with a real basic page one question. What is menopause? We'll start there.

Yeah. So menopause is the end of ovulation. So when you go through puberty, that's when ovulation begins, basically when you start getting your first period or maybe a year or two after your first period is when ovulation is really established. And so menopause is really the end of that aspect of ovarian function, the ovulation. And so it's associated with, you know, significant decreases in estrogen levels and other compensatory hormonal changes. It's, you know, not a death sentence. It's something that has been around since recorded history. And I always like to point out that, you know, before hormones were discovered, so nobody could be prescribing them, you know, women had a longer life expectancy than men. So obviously, you know, it's not something that, you know, is evolutionarily bad or things from that standpoint.

But that doesn't mean that it's not problematic and doesn't cause symptoms. And I think a really good example is pregnancy, right? Some people have completely smooth pregnancies or like, I felt the best I ever felt my whole life when I was pregnant. And other people have catastrophic pregnancies. And then there's every permutation and combination in between. And so we should kind of think about, you know, menopause and puberty like that. These incredible sort of wide shifting hormonal changes can have a varied impact for different people. It's brilliant that people are talking. It's brilliant that people are about the menopause now, but what I'm noticing as well is in the space where people are having important conversations, there is the opportunity now for big businesses to cash in

and misinformation to start swirling again. Like I did a quick search on Amazon just before I came to speak to you and you can buy menopause face cream, menopause clothes, menopause bras, menopause vitamins, menopause, like it goes on and on and on and on and on. I'm thinking, do I really need special pants for the menopause? No, you don't. Although it would be nice if clothing designers actually, you know, made clothes that fit people who are older than, you know, 16. Because it is true.

Your waist does expand a little bit in menopause. So that, and we don't really understand why people have a greater tendency, the weight that they gain to go around their middle. We don't actually understand the biology of that. And certainly, you know, yeah, no, it's, there's so many complex hormonal changes. I mean, I think that, you know, a lot of what we don't understand is due to obviously underfunding and lack of interest. But also some things are just like really difficult to study. And how do you, you know, we don't really understand the biological driver for it.

But certainly it is something that happens. And so if you think about your, for the average person's waistline when they're sort of 55 versus 35 is going to be different. And it is really sad, you know, not sad. It's disheartening to have clothes that just don't. don't take any of that into consideration I find. It's just something that I've noticed personally for me. Do you know the one that got me by surprise, perimenopause? I hadn't heard of that until relatively recently. And I suppose I'd always thought of menopause as this kind of hormonal end of level boss, this thing that's going to show up in your 50s. But now it's becoming apparent that like hormonal

changes start rocking much earlier than that. And perimenopause can do all kinds of crazy stuff. Yeah, I mean, it's, again, like puberty. I always told people to think about menopause as puberty in reverse. So just like you just didn't wake up one day and were like six inches taller and had your periods and had breasts, right? You had this series of changes that happened to your body over five, six, seven years, maybe longer for some people. And menopause is exactly that same in reverse. You have us winding down in the same way that you had that revving up. Menopause, like when your final period happens, you know, about a year or so after is when all the, you know, most of the hormonal changes have completed. But there's a lot of hormonal changes happening beforehand and they have a big varied experience.

Some people have very few symptoms. Many people have irregular periods or heavy periods. A regular periods are very common. I would say, you know, it's like 99.9% of people are going to have that, you know, as you start skipping periods before they end. Although there's obviously the person who's the unicorn who's like, I just woke up one day and it stopped. And that's like, well, aren't you lucky? I'm just like there's the person who says, I didn't find labor painful at all. What are you talking about?

You know, everybody's got, you know, we all have these varied biological responses. So, yeah. So and some people can have brain fog and lots of people have night sweats. For some people, their symptoms start before their final period. Other people, they don't start until after. And again, it's just this whole varied experience. And I think that because of a lack of, you know, systemic investment in curiosity in women's bodies, right? We don't, you know, maybe understand the full range of experiences or understand them maybe in the social context.

So, you know, our experiences for women who are in a Western society where you spend a lot more time sitting, are those different? Or, you know, how much do cultural expectations affect your symptoms? So there's all different things that we're just, I think, starting to unravel. Let's talk history because your book on the menopause has got a fantastic chapter where you really dig into what is the history of this. So let's try and think what are some of the earliest records of this? Because gynecology, the history of gynecology, it's oddly ignorant. It's about women's bodies, but it doesn't seem to care about them at all. It's very, very odd.

You know, you have to think, okay, well, with the resources they had at the time, you know, was just sort of like reasonable. You know, and sometimes I'm like, really? Like, because, you know, they didn't have a great understanding, for example, of human anatomy, the ancient Greeks, for example, because they didn't do autopsies. They didn't use cadavers the way that we do, right? But they also, like, cut animals open for butchering. So you could have had some, I think, more information.

So I think there was basically a. just a lack of curiosity about women's bodies in general. Women were considered inferior versions of men. And from the ancient Greek standpoint, really the biggest concern was, are you getting your period? Because that was viewed as a sign of getting rid of toxins, of getting rid of balancing humors, right? Because you have to think about the ancient Greeks. And many, many sort of ancient cultures thought of the body in terms of balance.

And from the Greek standpoint, it's black, black, bowel, yellow, blood. in phlegm. And so, you know, bleeding, menstrual bleeding was given as a sign that women were not imbalance, right? That was a sign of you being a problem. So if you were skipping periods, then they needed to do things to fix that imbalance. So either, you know, apply pulsuses and different things that would change temperature because blood was associated with being too hot, right? Or it was also to bleed you, right? Because the blood had to come out, you know. For a woman, if you had a nose bleed, that looked as good because that blood needed to come out, right? And if you're a man, I guess it's because you hit your nose, right?

Interestingly, they did recommend steaming vulvers to try and get a wandering womb back into place. Hashtag science. It's true, yeah, because the uterus was a wild animal within a wild animal, right? So women were seen as wild animals and how do you coax your dog back to, you know, to your house with a treat? So you use like fragrant herbs and things like that. And a lot of the recipes are awful if you look at them. You know, there are one recipe that I saw involved, you know, disemboweling a puppy and

stuffing it with herbs and then burning it. So, you know, it's not like people were like, you know, using laurel leafs around the vulva or something, you know. There was pretty involved processes that we would consider to be not Instagramable today. I was just having an image now for Poccrates on Instagram, trying to. Oh, no, I won't go there. When do we start getting medical texts referring to what we would now call menopause? When do people start writing about it as a medical issue?

Because if memory serves, the Greeks and the Romans mention it in passing, but there's no in-depth study of it. Yeah, so they definitely mentioned it. And I mean, the ancient Greece were pretty accurate about the age of onset of menopause. So I think that's really fascinating. But basically, they only cared about it because, you know, because afterwards you didn't really have any value. You were a breeder, right? So everything, your contribution to society was breeding. So in view of that context, why would we actually care about anything that happens to you afterwards? So it was, I think the first, you know,

real sort of treatise on what menopause might be was written, you know, in the 1700s. And obviously not correct at all by today's standards. And I think by the 1800s is definitely mentioned by many practitioners and many textbooks, really a wide variety of it's either, you know, the end of your life. It's every single disease in the world can be, you know, attributed to menopause. You know, again, you're a 55-year-old man and your shoulder is sore. It was because you were shoveling the day before. And if you're 55-year-old woman and your shoulders sore, it's obviously because you're in menopause, right? So I think it became this way to kind of lump everything together. And it's also important for people to understand.

You know, in the 1800s, we didn't know about hormones. They didn't know they existed. So, you know, it wasn't until kind of the early 1900s, this concept of hormones became understood. And then it was, I think, in the 1920s that estrogen was identified and progesterone and other reproductive hormones. And so they couldn't really have understood menopause and in the context that we understand it because they have the basic building blocks. But there was definitely more interest in it. And depending on the books that you read, I mean, I've read quite a few older textbooks. There is either faithful descriptions or things that sound absolutely ludicrous, which is probably,

you know, very common for any description about women. You know, one of the passages I found the most interesting was, you know, describing it as the experience of hot flushes as a hot flush. And then the physician actually saying, but, you know, women call it hot blooms, which is probably a more faithful description. but we're going to go with hot flashes anywhere, hot flashes anyway. Because they do really feel like that. It feels like it kind of like blooms up out of your head.

So obviously women were talking, if women had their own terms for some of the experiences, and obviously women were talking about it. But so much of what we know about medical history, we only know because it interests men. So if it didn't interest men, we don't know about it. So I think that hot blooms, which I love that term, I wish we could reclaim that. Yeah. Some of the historical language around this is just mean. Like one of the earliest terms for a woman in what we would now call menopause was an

unthrowned queen. Yeah, unthrown queens, death of sex, woman's winter. But erectile dysfunction gets erectile dysfunction. No one's ever saying penile winter, right? Like, why not? We should just call it penile winter or penal failure. I love that. Let's call it penal failure.

No, no, no. It's erectile dysfunction. Right, erectile dysfunction. You know, when we're talking about things that happen to a women's body, we often use very pejorative language. And men get all these lovely euphemisms. One of the texts, I read it and was fascinated by it, by a Dr. Edward Tilt, who published it in 1857. And he wrote The Change of Life in Health and Disease. And a shout out to Dr. Tilt is he is actually trying to talk about the menopause as a phase of life.

but one of my favorite bits is he's got a list of symptoms here, possible symptoms that can happen. And he says he's checked 500 women at the change of life. And I'll go through a few of them and you can tell me how accurate this is, right? As someone as a menopause specialist. We'll start with the easy ones. Nervous irritability. Is that quite common? No, probably not.

I mean, there's increased depression risk in the menopause transition for sure. And also, again, it's hard to know, like, what did they mean by that? What is that? If you're not sleeping well, you might be more irritable too, right? That's true. He's also got headache. He's got three different types of headache. He's got monthly headache, sick headache and headache.

Yeah, well, I don't know what those differences are, but maybe menstrual migraines is monthly headache. Certainly, some people absolutely can have worsening of their menstrual migraines during the menopause transition. And again, if you're not sleeping well, that could be an issue. Hysterical flatulence? Yeah, I don't really know what hysterical flagellance is, but I don't think so. He's got eight women down here is suffering from that.

The next one is prolonged fits of unconsciousness. Yeah, I don't know about that either. That doesn't sound like a thing, does it? Well, it sounds like a concerning thing. It sounds like a very concerning symptom of proline, you know, again, sometimes I think for many people in menopause, it also coincides with a time where, you know, you have a lot more life experience. And a lot of people are just like, oh, fuck it. So I don't know. Could you imagine some woman in the 1850s being like, I am not fucking getting.

up to come and whatever, do this for you, you useless sack of shit that I got stuck with when I was 18. So, you know, so who knows? Is this conscious objection or is this actual unconsciousness? I don't know. He's also got epilepsy, delirium, and insanity on this list as possible symptoms. It goes along with all the sort of whole like lack of curiosity and what actually is going on. And also these terms might have meant something.

different than they mean now. So I think it's kind of general, like we think women are going crazy. So I think it's kind of a reflection of that as opposed to what might actually be going on. I'll be back with Jen after this short break. Reading through the list here that Dr. Tilt's got, a lot of it is prefaced with hysterical. So like just reading through it, there's a real sense of this is an emotional catastrophe that's going to happen. And although this was written in 1857, what's your take on how menopause is still perceived to this day. I don't think that anyone is out there suffering from prolonged fits of unconsciousness or hysterical flatulence. But when you're like reading through this, how many menopause myths are we still dealing with? And what are some prominent ones?

Well, I think we're sort of still stuck with the problem that society views menopause as kind of an aging out of relevance, right? So, that makes it unimportant. It makes when you talk about just kind of colors everything in ways I don't think we quite understand. And so it's really important to sort of tease out cultural expectations from, you know, what's going on medically. You know, when you think about kind of the real myths, like looking at what we know to be true and what some people might think to be true, so one myth is that hot flashes only start after your period ends, right? But we do know for many women they can start before. Another myth would be haflashes only last for a couple of years, but, you know, the average

duration is seven to eight. Yeah. So average can be then 12 for some people, right? And one for somebody else. And another myth would be, you know, you need to check your hormones to see where you are in your kind of menopause transition, which is completely untrue. And I always tell people, well, when you were 11, we didn't need to check your hormones to see where you were in your puberty transition, did we? No. If your changes happen at the time that they're supposed to, like if you're 46 and your periods are irregular, it's not a shock. We expect them to be irregular. If you're 36, we don't. And that needs an investigation. So this idea that we need to track your hormones as you're entering the menopause transition or menopause is, you know, it's just a grift. So we see a lot of that too. So, you know,

there's myths that are born of not having accurate discussions. And then there's also myths that come out of, you know, this trying to take advantage of the gaps in medicine. The one that really bugs me, at least I think it's a myth from a historian's perspective, is the idea that more women live to see menopause. Oh, I hate that one. Oh, my God. That does my tits in that one. Yeah.

And you see some really, really large accounts from doctors promoting that absolute bullshit, misogynistic, you know, ignorance of everything that's ever been written in academia myth. it also erases everybody's grandma and great-grandma. If you think about it, right? Right. Like, it means that you didn't have a grandmother. Like, what the hell? And if women were so weak that they were all dying in childbirth, how did people have 10 pregnancies?

How did that happen? To reproduce so we're not, like, losing population. If you think about it historically, you know, people had to survive three, four, or five pregnancies, never mind all the miscarriages, right? because of the high rate of, you know, neonatal and, you know, infant mortality. So no, I mean, that is also one that really irritates me because it means that if you follow that myth through to its conclusion, it means that you think women are evolutionarily weaker than men.

Yes, it does. Like, so men could live to age 80, but women couldn't? Like, what the hell with that? Like, we're not supposed to be living long enough for this. If all women died in their 40s, how did the ancient Greeks know that the average age of menopause was 51? Like it's like obviously some people had to live beyond 51 for them to have figured that out. It's a proper bugbear for historians is that this myth that people were all dying in their 30s, that that was the average life expectancy.

Yeah. And it's not true. It's infant mortality rates pull the stats down. But if you made it past five, you were within a reasonable chance of getting to an older age. Yeah. I mean, and obviously maternal mortality was in childbirth was higher than it is now. But it wasn't 20%. otherwise you couldn't have had 10 children, right? So I think the statistics I've seen were maternal

mortality about like 1%, which is high. Don't get me wrong. You know, like I wouldn't get on an airplane if you told me there was a 1% chance it was going to crash. But it's not 100%, right? You know, so if that's the highest it was going to be, then obviously if you got through, yeah, I think I saw a statistic that in the 1700s, if you got to be sort of age 15, the chances that you were going to get to be over age 50 were really good. The origin of that myth, the best that I can tell, is from a book from 1966 called Feminine Forever, which was written by this Dr. Wilson and the whole idea, yeah, the whole idea was menopause is not just a disease, it's a disease of being unattractive to men. And that's one of the awful threads I see with some big menopause influencers, that there's this huge focus on sort of what sounds like how you look to the male gaze. And we have to be super careful how we talk about things because it's so easy for misogyny to creep in a ways that we don't understand.

And when you start seeing people talk about framing menopause in this sort of weakness, then you're saying so women are weaker. So what does that actually mean? Like let's take that conversation all the way through to the end. But yeah, no. So it all came from Dr. Wilson, who was funded by Wyeth, you know, who had a pharmaceutical. but how do you get people to take a medication? So this coincided with being able to mass produce oral estrogen in large amounts. So before then, estrogen was all by injection and, you know, it wasn't that great.

And it was just really reserved for people with really bad symptoms. But if you now have been able to mass produce a drug, you want to get it to most people. And how do you do that in the 1960s? You know, you prey on, you know, your relevance and your, you know, sort of feminine currency. And I mean, it's so gross in that book he talks about. Men look at women sexually from the ankles up. Oh, that's not gross coming from a doctor at all, a gynecologist, is it? And I, you know, you see doctors talk about this book like it was prescient and it's like, oh my God. Yeah, it's like the Steppford wives. In that book, and this was the point where I threw it across the room. I was reading it, no, and I was going to come and talk to you. He describes a menopausal woman as a galloping catastrophe. Yeah. That's the phrase. A galloping catastrophe. Yeah. I know. It's just so offensive in so many ways. It's important to know about it so you know the history. But you start, you use and it's also to make sure that we're not repeating that same history, right? It's like I want to have that on a t-shirt, galloping. I know. So that's when we start getting estrogen and hormonal. I mean, science had been sort of discovering hormone therapy since the early 20th century, but it really starts to come into its main street with, is it in the 60s that? It stops being unmoxed.

Yeah. So until then, if you wanted to get a hormone injection in your 20s and 30s, you certainly could. I mean, people did sell ground up cow ovaries. So, you know, you could do that. But estrogen actually is, yeah, it's not well absorbed, you know, without pharmaceutical tinkering to the molecule, right? So you probably weren't getting any. Also, apparently it tasted awful. And you can still buy it on Amazon, by the way.

You can buy ground up cow ovaries, yeah, on Amazon because it's a supplement. So in the United States, sure, why not? they had ground up ovaries and they had hormone injections. And the hormones came largely from animal sources, right? They would extract them from hog ovaries and things like that. And then it's if some would be purified to some degree and not. And so often they contain multiple different hormones in them. So what happened was the technology to make hormones in a lab happened and the technology

to extract estrogens from horse urine happened. So Perman is conjugated equine estrogens and it's extracted from horse urine. And that's the only natural estrogen that's available. And it's got something like 21 or 25 or 28 different kinds of estrogens in it. It's quite a complex concoction. And then around that same time, too, a scientist called Dr. Marker discovered what we now call the marker degradation. And that's taking a molecule from yams.

They use soybeans now, but a molecule from yams and chemically breaking it and rebuilding it in the lab until it becomes estrogen or progesterone or. testosterone. And this is called semi-synthesis. And until the ability to do this was discovered, making hormones on a grand scale, this wasn't paused, too expensive. And so this is actually what prompted the birth control pill or part of the birth control pill research, because until they could get these hormones in large amounts, they couldn't really, it was too expensive to do the studies. This ability to make estrogen and progesterone in a lab opened this whole avenue of research and understanding and tinkering because, as I mentioned, for example, you know, estrogen and progesterone

aren't absorbed well from the body. We didn't evolve to absorb them that way. Our guts aren't designed for that. So what they could do is they could tinker with the molecules and do things to them to make them easier to absorb. They could tinker with the molecules and do things to make them stronger in some regards and to sort of play up different things. So this is sort of the hormone revolution and this is what was happening in the decade, 15 years before Wilson's book came out. So you've got now these highly purified hormones and you want to sell them and you need to create a market. And how do you create a market in the 1960s? You tell women that menopause means that you're going crazy. It's a sign of loss of relevance to society, you are losing your only worth, which is your looks, and we have

an answer for that. You're deloping catastrophe. So we're going to medicate you so you fit into society's belief of what a woman should be. You know, this is always a point we always have to say, because if someone's going to say, oh, you're so against hormone therapy. No, I'm not at all. I'm against lying to people about what drugs can and can't do. I'm against awful patriarchal messaging.

And then the 70s came and women's. liberation came. And so then it became, you're going to die without hormones. And that was the message that Wilson had put that in his book. When you actually just sit down and question what that particular statement is, it's basically saying really you should be dead if you can't produce children. Right. We don't know why you're even alive. Right. And of course, you know, we know now from, you know, the grandmother hypothesis that we have lots of research to show that women in menopause were incredibly useful. you know, it takes a village. And you know what? It takes a village. It takes a village to have somebody who has knowledge and how do you get knowledge? You get knowledge through experience. But if you're 55 and you're

weighed down with a two-year-old and a three-year-old, you're not particularly helpful to other people with your knowledge. Your knowledge is occupied, you know, looking after your next generation. But if you're not reproducing anymore, now you have all this knowledge and your hands are free. So you can actually do something, right? So in many ways, you know, I like to think about it as this is the time when, you know, you have all this knowledge, this experience, and the ability to apply it, right? Because you're now no longer, you know, sucked up with childbearing. And when you look at historical data from survival records, there's actually some great records from Canada. And I think it's also from Finland, I believe. When a child lived in the house with his or her mother, they had more

grandchildren. And when they moved away, they had fewer grandchildren. And that was the same for both a daughter or a son. So it wasn't like she was passing along genetics for an easier childbirth or genetics for reproducing more, you know, because obviously those are factors to consider too. And when you look at Kristen Hawkins' work from the Hazda, which is where the whole grandmother hypothesis comes from, when you look at a grandmother, she's spending 37 hours a week. foraging for food when her daughter's pregnant and breastfeeding. So that is a full-time laborer job, basically. But it's not just you have to have the knowledge to know where to get it, what to do. So you start thinking about all these things that are valuable to a collective. And you think, well,

knowing what happened the last time there was a drought 20 years ago, that would be super useful. Knowing that what to do when this route isn't available, where can you go for food, all of this important knowledge and have the freedom to go and do it. And I also like to point out that doesn't mean that we exist to reproduce now, that your only value isn't being a grandmother. I don't want anyone to think about that at all. But it is interesting to see it because then you think historically, wow. So that actually means women and menopause were incredibly useful to the collective. What happened in the 90s, I think, with HRT? I have a memory of it of suddenly these research studies came out and then everyone thought that it caused breast cancer and loads of people stopped taking it.

And what happened with that? Were those studies not right? So there was a women's health initiative and there's lots of people who want to tell you these were terrible studies and all the results have been walked back. And that's actually not true. The women's health initiative is probably the largest clinical trial that's ever happened. I think the issue with the women's health initiative was how that was results were communicated to the public. So instead of this coming out in a paper and people having time to digest it and saying, what does this mean? And so the first arm of the WHOI looked at taking primarin, which is one form of estrogen with progestin, which is the medication that you need to protect the lining of your uterus from otherwise the estrogen will give you

cancer. And the study was done to see if giving people estrogen protected the heart. And the safety signal, or one of the safety signals was, does this cause breast cancer? Because we'd already believed that there was an increased risk of breast cancer with hormone therapy. It just was, you know, fairly low. And what the women's health initiative was halted about three years in because of the risk of breast cancer hit, you know, the threshold for we should stop. And then the arm, there was just an arm with just estrogen as well. And that carried on for another couple of years and a year and a half or so, and that was stopped as well. And when all was sort of settled and looked at and has been followed up and analyzed over and over and over again, the process. The

Premarin, the estrogen-only arm, actually at a lower rate of breast cancer. But some people have converted that to all estrogens, and that's not true because Permanent's a different molecule. So remember I said at the beginning, it was made of a whole bunch of different hormones, a lot of different estrogens. Some of the estrogens in Permanent are also, or some of the molecules are anti-estrogens. They might actually block. So in the same way that we give tamoxifen to reduce the risk of breast cancer, maybe

Permerin has some of those benefits, too. There's also a timing hypothesis. So many of the women who started hormones in the WHOHI started in their 60s, which isn't reflective of how we give hormones today. So you have to kind of tease that out. And at the time, that was how they recruited, but that's not, you know, not reflective of what happens today. That was also the time when we didn't pay as much attention to symptoms people were having

in the menopause transition. This was more like what happens after menopause. So studies like everything else has to be looked at like in the context of the time that they were done and what they were appropriate for. So the estrogen plus progestin arm did show an increased risk of breast cancer. And all the other data since then has shown that there seems to be a risk of breast cancer associated with both estrogen and progestin given together. How much that increased risk has been bandied about in all different kinds of observational studies. And part of the problem is we can't translate the WHOHI data because, it's using different hormones than we use today. And it was starting at a different date.

So if you look at the wealth of observational studies, there is an increased risk of breast cancer associated with taking hormone therapy that involves estrogen plus a progesterone or a progestin. Our conventional belief has been that if you're taking a progesterone, that that risk might be lower, but we probably don't really know for sure. But we think it's lower. And so that's why, you know, if you're getting hormone therapy, you need to have mammograms and you need to have follow-up and you should have your, you know, your risk assessment done. And that doesn't mean that it's not a therapy people shouldn't use. The risk is quite low depending on how you look at risk, right? You could equivalent, you know, make it that it's

about a glass of alcohol a day, maybe a little bit, you know, maybe a little bit less than that. But, and again, alcohol is also associated with breast cancer, something people should know about. And so you have to look at your own individual risk benefit ratio. Overall, we know that the data, it doesn't suggests that taking hormone therapy increases mortality. So the idea that this is something that's going to shorten your life doesn't seem to be supported by any of the literature. There's lots of people who talk about, oh, well, it's going to reduce your risk of dementia. We do not have good data support that. And we don't recommend prescribing hormone therapy for that, although I know there's lots of doctors on social media who talk about that. The data for reducing the risk of heart disease

is still something that I think has been really parsed out. So I think that it's currently, it's not a recommendation to prescribe hormone therapy to reduce the risk of heart disease. The reasons we recommend it are for hot flashes, night sweats, and for people at high risk for osteoporosis. Very good for those categories. There's also some softer reasons like people who have depression in the menopause transition. People have very high risk for type 2 diabetes. So there's some other benefits that people might get from it. And so, you know, these are all conversations. But this idea that you're going to die without it, which is something that I see promoted, is really not in general sort of a messaging especially because the majority of women have to take estrogen plus a progestin or a progesterone.

And the data just doesn't seem to be there for that combination. But, you know, that's the thing about science is if more data comes out and it changes your mind, then that's fantastic. We should always be open to whatever direction good research is going to take us. Exactly. So bringing it right up to the modern day, we have been through unthrowned queens and... Exactly, hot blooms, scalloping catastrophes. The menopause today is it's, I'm so glad that we're talking about it, but when you look at its history, it's steeped in misogyny and fear and demonising women's bodies. And I was really interested, there was a series published in The Lancet a couple of months ago, I'm sure you know all about it, about the risk of overly medicalizing the menopause and about creating fear around the menopause.

And just as a final question to you, what's your take on that? Do you think that we are at risk of over-medicalizing and creating fear around the matter? Oh, absolutely. I see that every single day. I read those series in The Lancet. And I agreed with some of it and some of I didn't agree with. Like lots of things that are written in medical journals. So yeah, I think that we're at great risk of medicalizing menopause. We're also a great risk of under-treating people who have symptoms. And I think that two things can be true, which I think that. think is something that they didn't do well in those pieces. So there are definitely people online who are telling you you're going to die without hormone therapy. You're going to crumble up. You're

going to die. And you should get started when you're 39. So there's that which is not supported by research. And then there's also people who are struggling with real symptoms who can't get access to care. And so both of these things can be true. Right. And so to write about that in the manner that you need to be. And then I think it's really important for people to understand that who's leading the conversations. How do they profit from it? Sometimes the profit is from their practice of selling hormones, the fact that they charge $1,100 for a concierge visit, right? Or they have a line of supplements are selling. But yeah, they've got a vagina steamer to sell. Or it's just some people just do it for clicks, right? And then there's people who are also

invested in telling people that, oh, everything needs to be natural and you just need to eat these kinds of foods. And I think that the problem is science is often clugi, and we don't have lots of absolutes. And what we can say is, well, this is the best that we have at this time. And that doesn't play very well on social media. And that doesn't play actually very well anywhere, but that's, unfortunately, the way it is. And so I just think it's important for people to be aware of the biases that are out there. And that in general, the guidelines from the professional societies are quite good. So I always tell people, you know what, you should always fact-check with the guidelines. Jen, you have been wonderful to talk to today. Thank you so much. You have been anything but a galloping

catastrophe. If people want to know more about you and your work, where can they find you? Yeah, you can find me on Substack at the Vigenda with a J. And you can find me on Instagram at Dr. Jen Gunter, on Twitter, because I'm not going to call it, whatever the dude calls it, at Dr. Jen Gunter. and those are the three places, substack, Instagram, and Twitter that I hang out the most. And you can find all the information about my books and my new bookblood on my sub sack as well. Thank you so much. You have been wonderful. Oh, thanks so much for having me. I had a great time. I'm so glad I got to actually have a conversation with you. And next time we're going to do it in person. I know. Yes, please. I'm buying. Thank you so much, Jen. You've been brilliant.

Thanks. Thank you for listening. And thank you so much to Jen for joining me. And if you like what you heard, please don't forget to like review and follow along whatever it is that you get your podcasts. If you'd like us to explore a subject or if you just wanted to say hello, much like Natalie did for this episode, then you can email us at betwixt at history hit.com. We've got episodes on everything from medieval torture to a mini-series on the real Bridgeton all coming your way. This podcast was edited and produced by Stuart Beckwith, the senior producer with Charlotte Long. Join me again Betwixt the Sheets, the History of Sex Scandal in Society, a podcast by History Hit.

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