Bulletin of the History of Medicine

"What Do These Women Want?":
Feminist Responses to Feminine Forever, 1963-1980

Judith A. Houck

SUMMARY: In 1963, Brooklyn gynecologist Robert A. Wilson and his wife, Thelma, published a paper in the Journal of the American Geriatrics Society arguing that untreated menopause robbed women of their femininity and ruined the quality of their lives. In 1966 Robert Wilson published a best-selling book, Feminine Forever, in which he maintained that menopause was an estrogen-deficiency disease that should be treated with estrogen replacement therapy to prevent the otherwise inevitable "living decay." This paper explores the issues raised by the convergence of Wilson's campaign and the emergence of the women's movement. Between 1963 and 1980, feminists did not respond with one voice to Wilson's ideas: at first, some embraced them as a boon for aging women, while others resisted regarding female aging as pathological. In 1975, studies linking ERT and endometrial cancer challenged the wisdom of routine hormone therapy; this shifted the tenor of the feminist discussion, but it did not create a consensus about the meaning of menopause or its treatment. Nevertheless, the feminist discussion of menopause revealed a larger women's health agenda—namely, the unyielding belief that women should retain control of their bodies and participate fully in the decision-making efforts regarding their health. By controlling their bodies, all women, whether feminist or not, could ultimately control their lives.

KEYWORDS: menopause, women's health movement, aging, feminism, estrogen replacement therapy (ERT), Robert A. Wilson [End Page 103]

"The unpalatable truth must be faced that all postmenopausal women are castrates." ¹ So began a 1963 article by physician Robert A. Wilson and his wife Thelma, a nurse, which appeared in the Journal of the American Geriatrics Society. In this article, the Wilsons argued that untreated menopause robbed women of their femininity and doomed them to live the rest of their lives as mere remnants of their previous selves. Detailing the dire consequences of "Nature's defeminization," ² the Wilsons claimed that estrogen depletion, the cause of menopausal and postmenopausal afflictions, led to hypertension, high cholesterol, osteoporosis, and arthritis. In addition, they insisted that menopause frequently led to serious emotional disturbances; even women who escaped debilitating depression frequently acquired a "vapid cow-like feeling called a negative state." ³ According to the Wilsons, these women see the world "through a grey veil, and they live as docile harmless creatures missing most of life's values"; ⁴ indeed, they "exist rather than live." ⁵

Robert Wilson took his message of decay to a broader audience in 1966 with his book Feminine Forever, in which he reiterated the grim language of the earlier article and issued a further warning: in prose designed to alarm, he described menopause as a "deficiency disease" much like diabetes. But unlike diabetes, menopause did not merely rob women of their health—it also stole their youth, femininity, and sexuality. The Wilsons did not, however, abandon menopausal women to their dreary fate. Rather, they promised women a pharmaceutical escape route: estrogen replacement therapy (ERT). Comparing ERT to insulin, they insisted that replacement therapy could both cure and prevent estrogen-deficiency disease. By allowing women to remain "fully sexed," ⁶ long-term hormone therapy prevented the "supreme tragedy" of women's lives. ⁷

The popular media swiftly publicized the Wilsons' claims. By 1964, Time and Newsweek had published articles extolling the promise of hormone therapy to cure menopause, and women's magazines followed in [End Page 104] 1965. ⁸ Local newspapers also followed up on the story. ⁹ The publicity intensified after the publication of Feminine Forever. The book itself sold more than 100,000 copies in the first seven months after its release. ¹⁰ In addition, it was serialized in local newspapers and excerpted in popular magazines. ¹¹ It had been translated into four languages by 1970. Perhaps most important, it generated an interest in menopause that was reflected in a flood of popular articles and books between 1966 and 1975. ¹²

Another pathbreaking publication also appeared in 1963. In The Feminine Mystique, Betty Freidan documented the growing resistance among college-educated, middle-class, white women to the demands and limits of domesticity. While the book clearly did not foment the feminist revolution, it testified to women's smoldering dissatisfaction that led, within a few years, to the women's movement. Both the Feminine Mystique and FeminineForever invited women to consider the meanings of womanhood and their role within American society.

I will explore here the issues raised by the convergence of Wilson's campaign and the emergence of the women's movement. The disease model of menopause and its hormonal cure presented several dilemmas for the fledgling women's movement. Should feminists shun the "medicalization" of their normal physiological processes, or should they demand even more medical attention? What are the social costs of regarding menopause as a "deficiency disease" that requires pharmaceutical intervention? Are menopausal symptoms caused by defective physiology or a sexist society? Does medical technology help or hinder the cause of women's liberation? [End Page 105]

Between 1963 and 1980, feminists wrestled with these questions as they confronted the popular characterizations of menopause and the increasing popularity of estrogen replacement therapy. In the beginning of this period, some embraced Wilson as a boon for aging women, while others highlighted the dangerous implications of regarding female aging as pathological. In 1975, studies linking ERT and endometrial cancer challenged the wisdom of routinely prescribing hormone therapy. Although this shifted the tenor of the feminist discussion, it still did not create consensus about the meaning of menopause or its treatment. These divisions notwithstanding, the feminist discussion of menopause revealed a larger women's health agenda. Whatever their views of ERT, the health activists demonstrated an unyielding belief that women should retain control of their bodies and participate fully in the decision-making efforts concerning their health. By controlling their bodies, women could ultimately seize greater control of their lives.

This larger philosophy, then, rather than any one particular recommendation regarding hormones, represents the most important feminist contribution to the discussion of menopause. Significantly, while the discussion was limited to a fairly small number of participants, the broader agenda reached well beyond this narrow circle to affect the experience of many menopausal women not otherwise aligned with feminism. As these women demanded that their physicians provide ERT or sought out other women to talk with, they were influenced by the feminist approach to women's health. I will therefore examine both the varied feminist responses to menopause and its treatment, and the effect of feminism on the experience of menopausal women outside the women's movement. ¹³

Feminism and Women's Health

The women's movement of the 1960s and 1970s can be roughly divided into two strands: the women's rights movement, and the women's liberation movement. The women's rights movement drew its constituents primarily from middle-class, professional women. Their aim was to secure for women the same opportunities for professional and political [End Page 106] advancement that were traditionally enjoyed by men. The women's liberation movement generally attracted younger women whose dissatisfaction with women's roles in the Civil Rights and New Left movements engendered a more radical, more militant approach to attacking social problems. The campaign for women's liberation, however, was not itself a unified movement; rather, it was characterized by internal dissension over goals, tactics, and the roots of women's oppression. ¹⁴

By the end of the 1960s, the concern for women's health in both the women's rights and women's liberation movements had coalesced into a women's health movement. In 1969, for example, participants in a women's conference in Boston raised the issue of "women and their bodies" as an appropriate focus for feminist consideration. This gathering led to the formation of the Boston Women's Health Course Collective, a pathbreaking group that published their first collection of articles in 1971. ¹⁵ Inspired by the example of the Boston organization, women in New York sponsored the first Women's Health Conference in March 1971. A nationwide survey circulated in 1974 testifies to the willingness of the women's movement to embrace health issues as an important plank in its platform: the survey found that more than twelve hundred women's groups offered some sort of health service, and "tens of thousands" of individual women considered themselves participants in the women's health movement. ¹⁶ As part of their health education efforts, feminists published books and articles, gathered and analyzed information, sponsored workshops, designed and taught courses, and supported "consciousness raising" (CR) groups.

Initial feminist health efforts focused primarily on reproductive issues, including childbirth, birth control, and abortion rights. The first edition of Our Bodies, Our Selves did not even mention menopause, [End Page 107] perhaps reflecting the youth and interests of early feminist health activists. ¹⁷ But even within these discussions, feminists challenged the traditional doctor-patient relationship where patients relinquished control of their bodies to the more "knowledgeable" professional. As a strategy to loosen the medical profession's hold on female patients, feminist health activists urged women to be wary of the intentions of male physicians. Barbara Ehrenreich and Deirdre English, for example, claimed that misogyny was built into the medical profession and argued that medicine had been used as an agent of social control to preserve patriarchy and to oppress women. ¹⁸

Despite general agreement about the need for medical reform, feminists did not share a common vision of women's health care. Some activists sought to avoid entirely the male-dominated medical profession, and promoted female self-help and lay-controlled health facilities. Other feminists acknowledged that the medical profession had much to offer women, but they sought to establish health facilities that embraced feminist principles. One prominent activist even proposed that only women should be allowed to become obstetricians and gynecologists, and that all research on women should be carried out exclusively by women. ¹⁹ Feminists also disagreed about the nature of their bodies. According to Ehrenreich and English, feminists "seem to alternate between accusing the medical system of treating us as if we were sick and accusing them of not appreciating how sick we are." ²⁰

The feminist discussion of menopause between 1963 and 1980 reflects the larger divisions of the women's health movement. Nonetheless, two aspects of the larger movement provide the scaffolding for later feminist responses. Activists agreed that women must retain control of their bodies, first by refusing to see all bodily occurrences as medical events [End Page 108] and second, by participating energetically in the doctor-patient relationship. The self-help gynecology movement, for example, encouraged women to demystify their bodies and to use self-exams to diagnose gynecological disorders. The natural childbirth movement, while not exclusively feminist, urged women to see childbirth as a natural event rather than a medical emergency. Both movements acknowledged that medical intervention was sometimes required, but they insisted that women remain the ultimate decision makers in matters that concerned their bodies. These themes became central to the feminist discussion of menopause and estrogen therapy.

The Feminist Responses, 1963-1975

Many scholars of menopause have rightly credited feminism with challenging both the disease model of menopause and the use of estrogen therapy to treat it. ²¹ It would be a mistake to assume, however, that feminists immediately rejected the message of Feminine Forever and the widespread use of ERT: ²² the evidence indicates that they did not overwhelmingly dispute either the disease model of menopause or the use of ERT, at least in print. ²³ Indeed, before 1975 very few feminists discussed menopause at all, and those who did engage the issues surrounding it [End Page 109] displayed a great deal of ambivalence about how to regard menopausal bodies and how best to cope with their changes. ²⁴

Far from rejecting Wilson and his ideas, some feminist health activists maintained that his model of menopause as a disease and estrogen therapy as its cure provided powerful weapons in women's fight for liberation. Research-scientist-turned-writer Belle Canon, for example, railed against the medical profession's general neglect of menopause and the women who suffered from it. During a trip to the public library she tried to find helpful information about menopause, but found only an endless stream of medical platitudes that menopause was normal and that its symptoms would eventually pass. Canon interpreted this to mean that it was a woman's fate to feel ill at certain periods of her life. To her relief, she discovered Feminine Forever and Wilson's assurance that women did not need to feel ill at menopause. She enthusiastically accepted his claim that menopause was a deficiency disease, a disease that could be easily cured. ²⁵

Canon credited Wilson with providing the "first and only stimulus to public and medical discussion of menopause," ²⁶ but she conceded that his revolutionary treatment had engendered a great deal of controversy. She claimed that many physicians retained an old-fashioned view of menopause by insisting that women weather the storm. In the face of this medical reluctance, she urged women to take charge of their relationship with their bodies and their physicians. After promoting estrogen therapy as the cure for menopausal difficulties, Canon complained: "You may or may not get it, depending upon how your doctor feels about it and depending no less on how actively involved you, yourself become to get relevant information and to demand help to be given to you." ²⁷ Her own fight to receive estrogen therapy lasted two years, but "the results turned out to have been worth every minute of the battle." ²⁸

British journalist Wendy Cooper embraced estrogen therapy even more enthusiastically, seeing it as an important tool in securing women's [End Page 110] liberation. ²⁹ Because estrogen allowed women "to control the biology that had for so long controlled them," Cooper believed that replacement therapy could lead to a biological revolution. ³⁰ She argued that until women could control their bodies, they could not "compete . . . on something like equal terms with men." ³¹ She challenged the assertion that because something was natural it must be allowed to progress unimpeded: she claimed that this argument had been used to prevent access to contraception and thereby kept women constrained by the demands of biology. She lauded Wilson for taking menopausal women and their unique problems seriously, and she celebrated the choices that estrogen provided. "No longer need any woman, unless she chooses, be fobbed off during the menopause with palliatives such as aspirin, Librium or Valium, or worse still, be dismissed with the words, 'It's just your age. There is nothing I can do. You must put up with it.'" ³² Indeed, she believed that estrogen allowed women to "age in a way that parallels that of a man." ³³

Cooper blamed misogyny for physicians' general neglect of menopausal women. She relied on the words of Dr. Francis Rhoades, who urged doctors to reconsider their relationships with their menopausal patients:

The physician should not let inherent male resentment of female longevity and biological superiority deter him from his medical responsibility. Because men do not experience the dramatic and often devastating changes represented by the menopause, they have come to regard it as normal for women to suffer the consequences of cessation of ovarian secretion. ³⁴

Cooper described Rhoades's contention as "splendid ammunition for Women's Liberation." ³⁵ [End Page 111]

Cooper drew inspiration from Feminine Forever, but she adjusted its message to fit her needs. Uncomfortable with Wilson's obsession with keeping women young and feminine, she amended his interpretation: she placed "less emphasis on femininity and more on feminism and on the right of women to have more say in decisions, medical or social, which affect their own bodies and their own lives." ³⁶

Medical anthropologist Paula Weideger did not embrace the disease model as enthusiastically as Canon and Cooper, but she similarly encouraged estrogen therapy as the best treatment for menopause. While she admitted that some problems of menopause represented "responses to the society's evaluation of the older woman's status," she embraced estrogen deficiency as a more satisfying and comprehensive explanation for women's physical and emotional symptoms. ³⁷ Although her widely cited 1976 book, Menstruation and Menopause: The Physiology and Psychology, the Myth and the Reality, did not explicitly recommend long-term ERT, Weideger tacitly communicated her leanings in several ways. First, she implied that women's bodies were not designed to live without the benefits of estrogen. She allied herself with Dr. Herbert Kupperman (and others), claiming that because medical science extended a woman's life span "much beyond her reproductive potential," ³⁸ medicine had an obligation to keep her healthy during her "extra" years. ³⁹ Weideger conceded that nature acted wisely by ending fertility at middle age, but she suggested that nature goofed by simultaneously decreasing the supply of ovarian hormones. Noting that natural selection could not shape women's postreproductive years, she complained that "women had to live with the results of nature's error." ⁴⁰ As a consequence, she claimed that menopausal women needed science and medicine to step in and fix the flawed design. Weideger thus refuted the idea that because menopause was natural, it should not be treated medically. Rather than relying [End Page 112] on women's bodies' ability to adapt, she preferred to put her faith in medicine as a way to improve women's lot.

Weideger simultaneously scolded physicians who withheld estrogen treatment until menopausal symptoms occurred, and condemned a medical system that neglected preventive medicine. She suggested that a physician "is a participant in the culture that views 'female complaints' as women's fate," and she therefore denounced the too-common practice of ignoring the problems of menopause until women experienced a "menopausal crisis," blaming this attitude on the sexism inherent in both medicine and society. ⁴¹

Finally, Weideger believed that women who chose ERT challenged society's perceptions of their bodies by insisting that menopause "need not be an infirmity." ⁴² She claimed that ERT allowed women to simultaneously affirm the physiological roots of menopausal symptoms and diminish the significance of those symptoms in their lives. Weideger saw both of these situations as empowering to menopausal women in the face of a sexist medical establishment. Yet, despite her generally positive characterization of replacement estrogens, she admitted that "any woman who now chooses ERT, is a guinea pig and a gambler." ⁴³ She insisted, however, that the risks associated with estrogen therapy were less than those that younger women faced with oral contraceptives. She argued that ERT, unlike oral contraceptives, merely brought "estrogen levels back up to the hormonal levels of the fertile years." ⁴⁴ In the end, she conceded that the safety of ERT was not guaranteed, nor could it cure all menopausal difficulties. Therefore, women must make their own choices—guided, perhaps, by friends and physicians. ⁴⁵

The views of Canon, Cooper, and Weideger reflect a feminist tradition that believed that biomedical technology complemented the goals of women's liberation. These feminists denied that the natural order of things, be it women's bodies or gender relations, benefited women. As Shulamith Firestone argued in her feminist classic, The Dialectic of Sex (1970), "humanity has begun to outgrow nature: we can no longer justify the maintenance of a discriminatory sex class system on grounds of its origin in Nature." ⁴⁶ She insisted that technology promised to help women [End Page 113] escape from the tyranny of their biology. She believed that before the technological development of birth control, women had been "at the continual mercy of their biology—menstruation, menopause, and 'female ills,' constant painful childbirth, wet nursing and care of infants, all of which made them dependent on males . . . for physical survival," and she demanded more technological developments to weaken further the biological demands of womanhood. ⁴⁷ Feminists who enthusiastically embraced hormone treatment similarly denounced the conflation of "natural" and "desirable" and insisted that technology could and should sever women's dependence on the demands and difficulties of their bodies.

Other feminists before 1976 were more ambivalent about estrogen and Feminine Forever than were Canon, Cooper, and Weideger. While they rejected Wilson's negative portrayals of menopause, they nevertheless thanked him for focusing much-needed medical attention on it and for publicizing a treatment that could alleviate the real suffering of many women. They tried to describe menopause in more positive ways while they simultaneously embraced hormone therapy as a valuable tool for menopausal women.

The position of the Boston Women's Health Book Collective reflects this attitude. As noted earlier, the first edition of Our Bodies, Our Selves (1971) did not even mention menopause. The 1973 edition downplayed the negative aspects of menopause, condemning the popular images that portrayed menopausal women as "haggard, irritable, bitchy, unsexy and impossible to live with." ⁴⁸ The collective extolled the value of adequate information about menopause in order to demystify (and thereby ease) the experience. Further, the authors emphasized a woman's right to demand "good medical care and advice." ⁴⁹ At one point, they chided physicians who did not offer treatment (or at least an explanation) to women who were feeling tired during menopause. They repeatedly admonished the medical profession for not devoting more research to menopause and discovering more "cures," insisting that if "every male doctor went through menopause," a more thorough research program would be in place. ⁵⁰ They noted that "some doctors have gone so far as to declare menopause 'an estrogen deficiency disease,' which they claim [End Page 114] can be 'cured.'" ⁵¹ While the authors noted that most physicians supported a more conservative position, the collective did not dismiss or even challenge the disease model.

The collective accepted estrogen replacement therapy, regarding it as a valuable tool for alleviating menopausal symptoms such as hot flashes and vaginal dryness. Moreover, they maintained that estrogen was "necessary" for other areas of women's health, such as the maintenance of "general skin tone" and the prevention of osteoporosis and heart disease. ⁵² Although they also mentioned the benefits of diet, rest, and exercise to prevent the difficult effects of menopause, the membership of the collective nevertheless presented estrogen therapy as a safe and effective treatment for a wide range of physical and emotional symptoms. ⁵³

Despite the widespread acceptance of hormones and a grudging respect for Wilson and his work, a few feminists spoke out against Wilson's portrayal of menopause and menopausal women. Joan Solomon, writing for Ms. magazine in 1972, provided an early feminist voice of concern and caution. Unlike most of her feminist contemporaries, Solomon challenged the idea that menopause was a disease, asserting instead that it was "as inevitable and natural as menstruation." ⁵⁴ She did not, however, reject hormone treatments. She noted that estrogens were neither a "sexual godsend" nor a fountain of youth, and she reminded her readers that drug companies "are tremendously excited by the notion of 'estrogens forever.'" ⁵⁵ She also warned that many of the claims for ERT—that it prevented osteoporosis and heart disease, for example—remained unproven; the risks, she argued, were clear. While her portrayal of estrogen therapy clearly indicated her bias against it, she in no way condemned its judicious use, declaring unambiguously that a woman should make her own decisions: "It's a decision you alone must make, keeping in mind your medical history, psychological needs, and physicians' advice." ⁵⁶

Barbara Seaman, one of the eventual founders of the National Women's Health Network, made a similar argument in a 1972 Prime Time article. [End Page 115] Seaman attacked characterizations of menopause promoted by Robert Wilson and others that encouraged women to believe that their bodies and minds needed estrogen to avoid debility. Although she clearly believed that physicians and drug companies had the most to gain and menopausal women had the most to lose from hormone therapy, she did not explicitly recommend that women avoid it. Instead, like Solomon, she urged women to seek out physicians who treat their patients as "fully functioning autonomous adult[s]." ⁵⁷

Between 1963 and 1975, feminists did not promote one particular position on the disease model of menopause or the use of estrogen therapy. They did, however, agree on a larger issue that affected menopausal women. Barbara Seaman voiced the opinion supported by all feminist health activists: "We cannot gain autonomy over our minds unless we gain autonomy over our bodies as well. We must reject the majority of doctors who push us around or patronize us, and take our business to the few who are willing to treat us as full partners in our own health." ⁵⁸

Feminist Responses, 1976-1980

At the height of estrogen's popularity in 1975, two articles in the New England Journal of Medicine challenged its safety. Researchers at Washington University (Donald Smith et al.) and Kaiser-Permanente Medical Center (Harry Ziel and William Finkle) independently discovered a link between postmenopausal estrogen therapy and endometrial cancer. The Ziel/Finkle study demonstrated an endometrial cancer rate fourteen times higher in women who had used conjugated estrogens for seven years or longer than among women who had never used them at all; Smith found that ERT posed the greatest risk to women with no other predisposing conditions, such as obesity. ⁵⁹ Although researchers had proposed a link between estrogen and cancer since the 1940s, these landmark studies supplied the best evidence at the time that ERT posed a cancer risk in humans, and they sparked further research. [End Page 116]

These studies awakened an increased feminist interest in menopause and a more critical examination of hormonal therapy. Alerted to the ideological and physical price of considering menopause a disease, more feminists condemned the widespread use of long-term hormone treatment after the cancer disclosures; they remained divided, however, over the benefits of short-term treatments. Although feminists on both sides of the estrogen divide continued to affirm a woman's right to decide her own coping strategy, they urged women to think more broadly about the consequences of treatment.

Despite this continued ambivalence about the prudence of ERT, after 1975 feminists emerged newly united on the need to consider carefully the meaning and significance of menopause. They realized that menopause marked a social as well as a physical transition; as a result, they insisted that the real solution for menopausal difficulties required changes in women's relationship with their aging bodies and women's role within society. In particular, feminists united around three alternative approaches to menopause and the problems faced by menopausal women. First, they denied that menopause was a disease, portraying it instead as a natural transition; they believed that characterizing it as a normal life event eased women's symptoms by dispelling apprehension. Second, they urged women to break free of their socially sanctioned roles and to establish lives beyond home and family. Third, they insisted that individual choices would not eliminate the larger problems faced by menopausal women: for that, only women's liberation would serve. In short, then, many health activists interpreted the difficulties women faced at menopause as symptoms not of physical illness but of social pathology.

The feminist reconsideration of ERT emerged after a series of medical episodes that disproportionately affected women. In the early 1970s, for example, researchers began publishing startling findings about the increased incidence of an extremely rare vaginal cancer. A Boston physician, Arthur Herbst, reported eight cases among adolescent girls in his practice. Eight cases of this cancer among women would have gained some attention, but the cancer was previously unknown in girls; the evidence shocked the profession. Cancer experts quickly connected vaginal cancer in girls to the use of diethylstilbestrol (DES) to prevent miscarriage in the girls' mothers. DES was initially prescribed as a treatment for menopause in the 1940s, ⁶⁰ but it gained popularity in the [End Page 117] late 1940s and early 1950s as a preventive for miscarriage. Although the exact number is unknown, experts estimate that physicians prescribed DES to more than three million pregnant women, making the potential scope of the problem huge by epidemiologic standards. Further research linked the use of DES in pregnancy to other abnormalities in daughters, and more recently, in sons. In 1975, enraged that the FDA still allowed the administration of DES as a postcoital contraceptive, feminists urged the agency (unsuccessfully) to withdrawal approval of the drug for all women. ⁶¹

At roughly the same time, the dangers of the Dalkon Shield caught the attention of the women's health movement. In the 1960s and 1970s, the IUD (intrauterine device) emerged as a popular form of contraception among American women. Unfortunately, manufacturers of IUDs were not required to test their products for safety or effectiveness because the FDA did not consider "medical devices" part of its jurisdiction. Although complications appeared with several models of IUD, the Dalkon Shield proved particularly dangerous: by 1974, thirty-six American women had died and thirty-five hundred had been hospitalized as a result of complications from its use. Feminists, angered that women were being fitted with such potentially dangerous devices, lobbied the federal government for intervention. Partly in response to feminist efforts, in 1976 the FDA added medical devices to their list of products that must be proven safe and effective before being put on the market. ⁶²

These events prompted feminists to reconsider their relationship with medical technology: while most health activists did not reject all medical developments, they learned to keep "a watchful eye" on the industry. As a result, some feminists were primed to condemn ERT at the earliest sign of danger.

In the 1977 book Menopause: A Positive Approach, feminist health activist Rosetta Reitz presented several of the feminist positions that emerged after the cancer studies. First, she denied that menopause was a disease, insisting instead that it was a normal and natural process: "I accept that I'm a healthy woman whose body is changing. No matter how many [End Page 118] articles and books I read that tell me I'm suffering from a 'deficiency disease,' I say I don't believe it. I have never felt more in control of my life than I do now and I feel neither deficient nor diseased." ⁶³ Consistently, Reitz downplayed the significance of both the physical and the emotional effects of menopause. She claimed that only 50 percent of menopausal women experienced hot flashes at all, and she insisted that even at their worst, hot flashes were "harmless": "the worst thing about them is that they may be uncomfortable, but they are unaccompanied by pain." ⁶⁴ She urged women to accept "yourself and your hot flashes" rather than looking for a drug to treat them. ⁶⁵ Reitz approached depression at menopause the same way she viewed hot flashes: she urged women to accept it.

You don't have to run for help from a pill. Go along with the feelings; do not try to deny them. . . . By allowing "uncomfortable" feelings their full range, you are experiencing a fuller range of yourself. That is a way to get in touch with yourself. ⁶⁶

Because Rosetta Reitz denied the severity of menopausal symptoms, she easily condemned all but "natural" approaches to their relief. She began her chapter on ERT with the bold statement: "Estrogen replacement therapy is dangerous. It will raise your cancer risk. It may lead to vascular disease. It may even kill you." ⁶⁷ Just as Weideger saw choosing ERT as a revolutionary statement, Reitz viewed rejecting it as a political one: "If our refusal to tolerate carcinogens could become universal, we would shake the very fabric of this culture." ⁶⁸ [End Page 119]

Feminist publications widely promoted Reitz's position, ⁶⁹ and many health activists adopted her views. Nevertheless, other feminists acknowledged that some women suffered greatly at menopause and insisted that medical intervention was an appropriate decision. Although they refused to condone the routine use of estrogen therapy, they nevertheless wanted tools to relieve menopausal symptoms. The 1976 edition of Our Bodies, Ourselves reflects the continuing ambivalence toward estrogen: while the 1973 version had embraced ERT, the 1976 version was more circumspect. The authors in both editions hoped to "reduce the anxiety that results from a lack of knowledge," but whereas the 1973 edition indicted physicians for not taking their menopausal patients seriously, the 1976 edition denounced

doctors who put every woman on medication and, equally, . . . those who tell us that our symptoms are "only in the mind." There are situations when severe symptoms may require treatment, and we have a right to medical help that will provide such treatment. ⁷⁰

Both editions expressed the belief that women should exploit what medicine has to offer, but the 1976 edition acknowledged the risks of ERT and advised women to proceed with caution. ⁷¹

Other feminists took an even bolder position, condemning Reitz and others who dismissed as trivial the real suffering of some menopausal women. Irma Levine, for example, a founding member of a menopause support group, agreed that menopause was natural, but she argued that many women suffered severe symptoms nonetheless. She insisted that for these women, it is no more helpful "to say they should just take calcium and vitamin E than it is helpful to say if they just keep busy it will all go away." ⁷² Levine denied that women should feel guilty for feeling bad at [End Page 120] menopause, or for turning to the medical profession for relief. She resisted the notion that right living guaranteed an easy menopause.

Although feminist health activists did not promote one particular position on ERT after the cancer revelations, they did agree that social factors contributed to women's experiences at menopause. The 1976 edition of Our Bodies, Ourselves, for example, contended that the "most unpleasant aspects of menopause" might be social rather than physical because menopause arrives "at a time in a woman's life when her relationships may be changing." ⁷³ Maintaining that social problems demanded social rather than pharmaceutical solutions, some feminists proposed women's liberation as the ultimate solution to women's menopausal difficulties.

Marriage and family counselor and part-time college instructor Vidal S. Clay argued that women's troubles at menopause were not primarily medical but social:

A woman does not go through the climacteric . . . in a vacuum. How she deals with this continuing development of her life is determined by her feelings about herself as a woman at this time in her life. These feelings will reflect society's notions about women, about women who do not reproduce, about women who are middle-aged and growing older. ⁷⁴

In order to address the dilemmas of middle age, Clay called for a feminist revolution that would improve life for middle-aged women by improving life for all women. She insisted that "women must work together to continue to exert pressure for social change," and she considered the women's liberation movement the "most significant social force working for women today." ⁷⁵

Other feminist health activists agreed with Clay. Sociologist Pauline Bart and her part-time collaborator Marlyn Grossman, for example, denied that "individual solutions" could ultimately improve conditions for menopausal women: the real remedy for menopausal depression depended on the "organized efforts of many women working together to [End Page 121] structure alternatives for themselves and others." ⁷⁶ Only women's liberation, they argued, could improve the lot of menopausal women by supporting alternative lifestyles and deviations from ascribed roles. Women's liberation would help all women discover and develop their own potential. The authors of the Ms. Guide to A Woman's Health similarly recommended that women turn to the feminist movement: "it is preventative medicine for the awful feeling that you are suddenly in the denouement before the end of the play." ⁷⁷

After the 1975 cancer revelations, more feminists turned their attention to menopause, and they increasingly discouraged women from seeking a pharmaceutical solution for a natural process—but this was not a unanimous position. For the most part, they continued to support short-term estrogen use for women whose efforts to find relief from severe menopausal symptoms had failed. But the feminist discussion of menopause did not focus exclusively on treatment options. Instead, they examined the difficulties many women experienced at menopause against the social backdrop: they claimed that women's social roles as wives and mothers led to emotional depression and physical ailments after menopause, which forced them into "retirement." As a result, feminists saw changing women's role in society as a critical strategy for improving the lives of menopausal and postmenopausal women.

The Women's Movement and Menopausal Women

The feminist discussion of menopause between 1963 and 1980 was limited to a small group of women writing primarily in feminist publications such as Our Bodies, Ourselves,Prime Time, and Ms. The influence of the women's movement on attitudes toward menopause was not limited, however, to the women who read these periodicals or who participated directly in feminist organizing. Indeed, feminism empowered a wide spectrum of American women to examine their relationship with the medical profession and with their individual physicians: it encouraged them to view themselves as consumers of medical knowledge and to regard the doctor-patient relationship as negotiable. [End Page 122]

The women's movement affected many women's experience at menopause in at least four ways. First, it urged them to take control of their bodies and their health-care decisions. As a result, some menopausal women demanded both respectful treatment and specific therapies from their physicians; if their demands were not met, they took their business elsewhere. Second, prompted by the feminist critique of patriarchy, women began to articulate their dissatisfaction with their medical providers in terms of misogyny and male chauvinism. Third, women rejected the "suffer in silence" approach to menopause advocated by their mothers and grandmothers and turned to each other for support. And finally, realizing that their reaction to menopause was influenced by their limited social options, some women saw women's liberation itself as the cure for menopausal difficulties.

My understanding of menopausal women's experiences relies primarily (but not exclusively) on two sets of documents. Most importantly, I depend on the records of Women in Midstream (WIM), a support group and informational clearinghouse for menopausal women sponsored by the Seattle YWCA. ⁷⁸ In 1973, a nationally syndicated advice column mentioned that Women in Midstream was seeking volunteers to complete a questionnaire about menopause; through their letters and completed surveys, hundreds of women from across the country shared their experiences. ⁷⁹ Second, I rely on the files of the American Medical Association. After Wilson and his supporters championed hormone therapy as a cure for menopause, menopausal women and concerned physicians flooded the AMA with requests for information on Wilson and his methods. These letters, from the years 1964 through 1970, provide clues about the influence of the women's movement on menopausal women. ⁸⁰ In addition to these archival sources, I depend on evidence gleaned from published sources.

By 1973 physicians, particularly obstetricians and gynecologists, had begun noticing a change in their patients. Exhibiting in turn hostility, perplexity, and acceptance, they wondered what had come over their once-pliable patients: [End Page 123]

What is behind these demands that threaten the staid orderliness of the doctors' office? What is it that has caused many patients—even the more docile, soft-spoken ones—to suddenly start questioning every procedure, every prescription; to come out with shocking statements on pre-marital sex, lesbianism, and childless marriage. . . . What do these women want? ⁸¹

Physicians realized the far-reaching influence of the women's movement on women as medical consumers: "The philosophy has permeated far beyond the activist movement. Women who don't regard themselves as liberationists are embracing the new health care goals much as they have the right to equal pay." ⁸² Many physicians came to understand that "today's woman wants considerate respectful treatment from her physician, wants complete information about her bodily condition, and wants a voice in medical decisions that affect her." ⁸³

After 1963, women experiencing menopause had a great deal of information at their disposal. Books and popular magazines publicized the issues surrounding menopause, Robert Wilson, and hormone replacement therapy. As a result, many women contacted their physicians at menopause primarily to secure a prescription for hormones. If a physician refused, some women took their demands and their pocketbook elsewhere. One woman claimed, for example, that she had changed physicians at menopause because both her gynecologist and her general practitioner resisted treating menopause as "a deficiency disease." ⁸⁴ Another woman endured "six years in hell" before she finally tracked down a doctor who prescribed hormones. ⁸⁵ A WIM survey respondent advised women to find a physician who would provide hormones: "[it] takes a lot of patience to find the right help . . . but after you find the right Dr., it is well worth all your effort, time and money spent." ⁸⁶

The demanding nature of their menopausal patients caught the attention [End Page 124] of physicians. One doctor noted that it was "not unusual for a woman who is told she doesn't need [hormones] to go to one doctor after another until she finds one who will prescribe the medication." ⁸⁷ Exasperated by her patients' unrealistic expectations, another physician reported that "she had been besieged by women patients who [brought in] Dr. Wilson's book with paper clips attached to various pages." ⁸⁸ This occasional reluctance to prescribe hormones should not be interpreted as evidence of widespread resistence to the judicious use of hormone therapy. By the end of this period, most physicians willingly prescribed hormones for some of their menopausal patients. ⁸⁹ They did not believe, however, that all menopausal women needed estrogen. Further, they insisted that medical judgment rather than patient desire or demand should dictate therapeutic decisions.

Some feminist scholars have attributed women's demands for hormones to the dire depictions of menopause in the popular media—claiming, in essence, that these women were duped. ⁹⁰ Although they were obviously encouraged and perhaps inspired by the publicity surrounding hormone therapy, it would be a mistake to assume that all women rushed directly to their physicians after reading about hormone therapy and demanded the femininity pill. Perhaps some did—but others proceeded more cautiously, researching both the treatment and the physicians supporting it. [End Page 125]

Many women turned to the AMA for advice. A New York woman found the promise of hormone therapy appealing, but after talking to several local physicians about it, she discovered "a lot of controversy and division concerning its safety and effectiveness"; she did not want to take an unsafe product, but since she was a widow and had to "work for [her] support," she needed relief from the "headaches, fatigue, depression. . . and general imbalance." ⁹¹ Another woman, who thought Wilson's claims sounded "marvelous, fantastic, and scary all in one," sought further medical advice before asking for hormones. ⁹² Even women utterly convinced that they were ideally suited to Wilson's treatment nevertheless appealed to "experts" for further information. A thirty-nine-year-old Minneapolis woman described her situation: Seven years earlier she had had a hysterectomy after being diagnosed with a malignant uterine tumor. After the surgery, her surgeon refused "to give [her] any female hormones because he says, 'We do not want to stimulate any activity in the area'"; frustrated by his position, she found in Wilson an attractive alternative:

Last week I read a book "Feminine Forever" by Robert A. Wilson M.D. I related immediately and directly with virtually everything written in the book and felt as though I had been robbed of seven years of estrogen treatment and its resultant positive effects. I spoke to my doctor about it and he tells me Robert Wilson is a fraud . . . but doesn't give me anything in the way of direct positive answers. Would you tell me, please, what you have found in regard to the effects of administration of estrogen and female hormones to ex-cancer patients. ⁹³

These examples challenge the idea that women, frightened by the specter of losing their womanhood, reflexively rushed to their physicians for treatment. Although they were undeniably influenced by Wilson, some sought further information to better weigh the benefits of ERT against the risks.

It may seem peculiar to argue that feminism led women to demand a treatment promoted in part for its potential to keep women "feminine forever." My reading of the evidence, however, suggests that menopausal [End Page 126] women rarely sought hormones solely to maintain their femininity. Instead, they turned to hormones to relieve the more mundane but potentially debilitating symptoms: hot flashes, insomnia, headaches, genital atrophy, nervousness. Feminism, particularly the women's health movement, encouraged women to trust their perceptions of their own bodies and to refuse to be dismissed by patronizing physicians who regarded hot flashes and other menopausal symptoms as temporary inconveniences. Further, the women's health movement urged women to view their physician as a hired consultant, with valuable skills but not mystical powers. As one health activist advised: "view him as you view your accountant or TV repairman, or the seller of any other service." ⁹⁴ Many women seemed to take this message to heart as they negotiated for the treatment they thought best suited to their needs.

I am not claiming that before the women's liberation movement, women eagerly turned over complete control of their medical care to their physicians. Indeed, as Judith Walzer Leavitt and Elizabeth Watkins have demonstrated for twilight sleep and oral contraceptives, respectively, women have frequently demanded particular treatments. ⁹⁵ Further, the feminist critique of the medical profession coincided with a larger consumer movement that similarly recommended a healthy distrust of all so-called experts. ⁹⁶ In the case of ERT, however, feminism provided the theoretical foundation and social momentum that encouraged women to challenge the authority of their physicians to control all medical decisions.

The women's liberation movement also influenced women's experiences at menopause by providing a political framework for their relationships with the medical profession. Feminism invited women to have expectations for their treatment and to speak up when those expectations were not met. Unlike women of previous generations, menopausal women during this period expressed a great deal of dissatisfaction with their physicians. ⁹⁷ Even more significantly, they began doing so in terms of misogyny.

A few women claimed that male indifference to women's needs or men's inability to empathize with female patients led to unsatisfactory [End Page 127] care at menopause. One of the WIM survey respondents blamed her perceived mistreatment on male physicians' lack of interest in things female: "if more doctors were of the female sex, they would have been more interested in solving these problems." ⁹⁸ Another menopausal woman complained that her "male doctors simply felt I should grit my teeth and bear it." ⁹⁹ A third survey respondent reported that two weeks before she attempted suicide, "a male chauvinist doctor" had belittled her distress by insisting that she was "psychoneurotic and narcissistic." ¹⁰⁰ Although their specific complaints varied, women during this period began to believe that their physicians' "maleness" compromised their ability to treat female patients with sensitivity and respect.

Lynn Laredo, writing in the feminist publication Prime Time, articulated the grievances of many menopausal women. She admitted that she experienced some physical and emotional difficulties at menopause, but she nevertheless sensed a misogynist agenda behind much of the popular literature on menopause. Consequently she claimed that menopausal women were set up by the medical profession—women were expected to fall apart at menopause because they are unable to adjust, and simultaneously expected to "bear up and keep smilin'": "I begin to smell a (m.c.) pig," she said, one who punished women for "daring to outlive" their fertility. ¹⁰¹ Another woman discovered misogyny where she expected it least. Annette Henkin Landau's menopause rap group had invited a woman gynecologist to provide a medical point of view. Landau soon realized that "the doctor believed we were entitled to know only those things about our bodies that she thought we should know": the gynecologist refused, for example, to list common symptoms of menopause, claiming that menopausal women were "so suggestible that they might produce symptoms simply by knowing them." ¹⁰² The experience with this gynecologist led Landau to conclude that "male chauvinism is a point of view, an entrenched attitude not always related to the sex of the chauvinist." ¹⁰³ Clearly, then, the women's liberation movement gave women both the conceptual framework and the language with which to articulate their dissatisfaction with their medical experiences. [End Page 128]

Having challenged the absolute authority of physicians, women in this era rejected another medical position: that menopausal women should keep their difficulties to themselves. Whereas, earlier in the twentieth century, women believed (or said they believed) that menopausal distress was best borne in silence, ¹⁰⁴ women in the 1960s and 1970s eagerly sought out other women to share their experiences. The variety of topics they hoped to discuss testified to the range of social and physical changes occurring at menopause.

Not surprisingly, some women wanted to know how other women coped with the physical symptoms. One woman, for example, wanted to hear how others "weathered menopause and were able to work and be with people without becoming very nervous"; she hoped to discover how other women kept their "self confidence" and avoided "panic." ¹⁰⁵ Cathy Smith, suffering from "the worst part of my life so far," sought other women who could provide "any information" that would ease her suffering. ¹⁰⁶

But many who sought emotional support from other women understood that their experiences with menopause were not exclusively biological, and they wanted guidance for their changing social niche. Several noted that they wanted to discuss their feelings of uselessness that emerged after their children left home. One woman, for example, wanted help "adjusting to life when home and children [were] no longer [her] main interest." ¹⁰⁷ Another wanted to "talk to other ladies about the empty nest syndrome." ¹⁰⁸ Yet another wanted to learn how "to remain sane through the process of aging and changing your values as life itself forces you to adjust to a new you and a lack of purpose when your children no longer need you." ¹⁰⁹

Women also sought advice for coping with the dissolution of marriage at midlife, through either divorce or death. One despondent woman wrote to Women in Midstream seeking guidance. Her husband had recently "decided to live elsewhere"; she had never lived alone in her life and "would like to know about going back to work . . . how to master my emotions, how to begin establishing a social life." ¹¹⁰ Another woman had [End Page 129] recently lost her husband and therefore wanted information on "finances, home care, car care, job training, making new friends, etc." ¹¹¹

One woman experienced mounting anxiety at menopause and regarded "contact with other women" as the best way to understand her feelings and their origins. She called self-help centers in her area looking for a menopause "rap" group. When she found none, she started her own. Although the group initially focused exclusively on menopause, the discussions quickly moved on to the "middle-age syndrome and problems of the older woman in our society." ¹¹²

The influence of feminism can be seen here on at least two fronts. The Rap or Consciousness Raising group that some women sought at menopause was an integral tactic of the women's liberation movement: CR taught women to recognize their oppression, thereby providing the first step to overcoming it. Further, the women's health movement stood on the belief that women themselves were a legitimate and valuable source of information about their bodies. Classic texts like Our Bodies, Ourselves shared women's experiences in print and urged them to do the same in person.

Finally, the influence of the women's movement on menopausal women can be seen in women's understanding of the roots of their menopausal problems. While some sought a hormonal fix for their deficiency disease, others blamed their difficulties on broader social ills. In particular, some women blamed their constricted roles in American society. One woman explained the context for her menopausal depression:

I worked until I was 37 in outside employment—mostly offices, then stayed home with two small children. This seemed like a forced confinement to me—like being a shut in. However, this was considered being a good mother and my kids have "turned out well." Yet I feel I've missed the whole boat. . . . If our whole life is bent toward procreation without satisfaction—then we should change our thinking toward enjoying what we can while we can. ¹¹³

Another woman wrapped up the situation more succinctly, claiming that menopausal problems were "caused by the role of women in our culture—over-emphasis on youth—fear of aging—lack of meaningful occupation." ¹¹⁴ [End Page 130]

Taking this understanding one step further, one woman claimed that the women's movement had cured her menopausal symptoms. She had read about menopause before she reached it and had come to fear that the "desperation and foolishness" she had learned of was inevitable. ¹¹⁵ She believed what she read, and found herself at menopause severely depressed. She called upon a psychiatrist who told her she should be happy, because "you still have a husband, a lovely home, three beautiful children and soon you can look forward to being a grandmother"—unfortunately, neither husband, home, nor children relieved her depression, and she did not look forward to becoming a grandmother. ¹¹⁶ On the eve of her fiftieth birthday, her daughter told her about the women's movement. "I got so excited that I called my friend Sylvia (also menopausal and not looking forward to being a grandmother)" and they visited a Women's Center in New York City; although they needed a couple of stiff drinks for courage, they made it to the center and "have been in the Women's Movement ever since." ¹¹⁷ Now "I never think about my lack of estrogen, tragedy of declining breasts, loss of youth and beauty. . . . But best of all since that day Sylvia and I made it to the Women's Center, I have never again been depressed." ¹¹⁸

Conclusion

The feminist movement and the feminist critiques of menopause influenced the experiences of menopausal women in various ways—even those women not explicitly allied with feminism. Feminism encouraged them to expect respectful care from their physicians and publicized the presence of misogyny and male chauvinism; as a result, they began seeing their relationships with their physicians differently. Further, feminism urged women to talk about their experiences, and sometimes provided formal structures to promote the exchange of information among menopausal women. Finally, at least one woman considered women's liberation as the perfect antidote to her menopausal symptoms.

Between 1963 and 1980, feminists did not share a unified goal; they championed several efforts and attempted various strategies to relieve women's oppression. It is not surprising, then, that they were not of one mind about menopause and menopausal treatment. Before 1975, feminists [End Page 131] interested in menopause (and there were not many) advocated different positions in reaction to Robert Wilson and the hormonal revolution. Some lionized Wilson for taking women's menopausal complaints seriously and for publicizing the wonders of hormonal treatment. They believed that medical advances could further the feminist cause. In contrast, other feminists reacted more skeptically, carefully considering the risks of regarding aging women as diseased and the wisdom of relying on a medical "cure" for a natural process. After the cancer revelations of 1975, health activists increasingly rejected long-term hormone therapy, but many still acknowledged the relief that a short-term regimen provided. Significantly, however, the cancer studies sparked a broader reconsideration of the significance of menopause and the need for a social solution to the dilemmas of aging women. Rather than considering estrogen replacement therapy as a key to women's liberation, feminists increasingly argued that women's liberation was crucial for improving the lives of menopausal women.

 

Judith A. Houck is Assistant Professor in the departments of Medical History and Bioethics, Women's Studies, and History of Science at the University of Wisconsin, Madison. Her research focuses primarily on the history of women's health in the United States. She is currently finishing a manuscript on the history of menopause in America, tentatively titled, Not Just Hot and Bothered: Women, Medicine, and Menopause in America, 1897-2000. She can be reached at the Department of Medical History and Bioethics, 1300 University Avenue, Madison, WI 53713 (e-mail: jahouck@facstaff.wisc.edu).

Notes

Many people and institutions deserve my thanks for their help in bringing this paper to light. For their comments on an earlier version, I would like to thank Kathleen Clark, Eve Fine, Judith Walzer Leavitt, Michelle McClellan, Lisa Saywell, Karen Walloch, and two anonymous reviewers for the Bulletin. I would also like to thank the National Center of Excellence in Women's Health at the University of Wisconsin, Madison, for its financial support while I revised this and my larger work on the history of menopause in America. Finally, I am grateful to the University of Washington, the American Medical Association, and the Henry A. Murray Research Center, Radcliffe Institute, Cambridge, Mass., for letting me use their archives. An early version of this paper was originally presented at the annual meeting of the American Association for the History of Medicine in New Brunswick, N.J., 9 May 1999. My forthcoming book, Not Just Hot and Bothered: Women, Medicine, and Menopause in America, 1897-2000, will be published by Harvard University Press in 2004.

1. Robert A. Wilson and Thelma A. Wilson, "The Fate of the Nontreated Postmenopausal Woman: A Plea for the Maintenance of Adequate Estrogen from Puberty to the Grave," J. Amer. Geriat. Soc., 1963, 11 : 347-62, quotation on p. 347.

2. Ibid., p. 351.

3. Ibid., p. 352.

4. Ibid., p. 353.

5. Ibid., p. 351.

6. Robert A. Wilson, Feminine Forever (New York: Evans, 1966), p. 18.

7. Ibid., p. 105.

8. "No More Menopause," Newsweek, 13 January 1964, p. 53; "Durable, Unendurable Women," Time, 16 October 1964, p. 72; "How to Live Young at Any Age," Vogue, August 1965, pp. 61-64; Sherwin A. Kaufman, "The Truth about Female Hormones," Ladies' Home Journal, January 1965, pp. 22-23; "Oh, What a Lovely Pill!" Cosmopolitan, July 1965, pp. 33-37; Ann Walsh, "Pills to Keep Women Young," McCall's, October 1965, pp. 104-5.

9. See, for example, Ethel Hills Coogler, "Doctors Discuss Female Sex Hormone," Atlanta Journal, 11 May 1964, p. 33.

10. Morton Mintz, The Pill: An Alarming Report (Greenwich, Conn.: Fawcett, 1969), pp. 30-31. Feminine Forever remained in print through 2000.

11. Feminine Forever was syndicated by King Features. See, for example, Wisconsin State J., July 17-27, 1966; Robert A. Wilson, "A Key to Staying Young," Look, 11 January 1966, pp. 66-73; Robert A. Wilson, "Which Hormone to Take and When," Vogue, June 1966, pp. 92-95.

12. Kaufert and McKinlay argue that "ERT entered the public domain" only after 1975; this is clearly untrue: Patricia A. Kaufert and Sonja M. McKinlay, "Estrogen Replacement Therapy: The Production of Medical Knowledge and the Emergence of Policy," in Women, Health, and Healing: Toward a New Perspective, ed. Ellen Lewin and Virginia Olesen (New York: Tavistock, 1985), pp. 113-38, quotation on p. 133.

13. My application of the terms "feminist" and "feminism" is somewhat retrospective. The overwhelming majority of my sources explicitly aligned themselves with the women's movement by publishing in overtly feminist publications, acknowledging membership in feminist organizations, or proposing "women's liberation" as the primary solution to current social ills. There are a few others, however, whose connection to the women's movement is less certain. Nevertheless, all the women whom I regard as feminists see their work on menopause as empowering women to make educated decisions about their health.

14. For histories of second-wave feminism, see Judith Hole and Ellen Levine, Rebirth of Feminism (New York: Quadrangle Books, 1971); Flora Davis, Moving the Mountain: The Women's Movement in America Since 1960 (New York: Simon and Schuster, 1991); Alice Echols, Daring to Be Bad: Radical Feminism in America 1967-1975 (Minneapolis: University of Minneapolis Press, 1989); Sara Evans, Personal Politics: The Roots of Women's Liberation in the Civil Rights Movement and the New Left (New York: Knopf, 1979); Ruth Rosen, The World Split Open: How the Modern Women's Movement Changed America (New York: Viking, 2000).

15. The Boston Women's Health Course Collective, Our Bodies, Our Selves: A Course By and For Women (Boston: The Collective, 1970, 1971). Overwhelming demand persuaded BWHCC to turn publication over to Simon and Schuster in 1973. The group later changed their name to the Boston Women's Health Book Collective.

16. Helen Marieskind, "The Women's Health Movement," Internat. J. Health Serv., 1975, 5 : 217-23, on p. 218.

17. Sheryl Burt Ruzek, The Women's Health Movement: Feminist Alternatives to Medical Control (New York: Praeger, 1978), p. 190. See also Kaufert and McKinlay, "Estrogen Replacement Therapy" (n. 12).

18. See, for example, Barbara Ehrenreich and Deirdre English, Complaints and Disorders: The Sexual Politics of Sickness, Glass Mountain Pamphlet no. 2 (Old Westbury, N.Y.: Feminist Press, 1973); idem, Witches, Midwives, and Nurses: A History of Women Healers, Glass Mountain Pamphlet no. 1 (Old Westbury, N.Y.: Feminist Press, 1972).

19. Barbara Seaman, "Physician Heel [sic] Thyself," in Proceedings for the 1975 Conference on Women and Health (Boston, 4-7 April 1975), pp. 25-27. For an overview of different feminist health strategies, see Elizabeth Fee, "Women and Health Care: A Comparison of Theories," in Women and Health: The Politics of Sex in Medicine, ed. Elizabeth Fee (Farmingdale, N.Y.: Baywood, 1983), pp. 17-34.

20. Ehrenreich and English, Complaints and Disorders (n. 18), p. 88.

21. See, for example, Frances B. McCrea, "The Politics of Menopause: The 'Discovery' of a Deficiency Disease," Soc. Prob., 1983, 31 : 111-23; Frances B. McCrea and Gerald E. Markle, "The Estrogen Replacement Controversy in the USA and UK: Different Answers to the Same Question?" Soc. Stud. Sci., 1984, 14 : 1-26; Judith Posner, "It's All in Your Head: Feminist and Medical Models of Menopause (Strange Bedfellows)," Sex Roles, 1979, 5 : 179-90; Kwok Wei Leng, "Menopause and the Great Divide: Biomedicine, Feminism, and Cyborg Politics," in Reinterpreting Menopause: Cultural and Philosophical Issues, ed. Paul Komesaroff, Philipa Rothfield, and Jeanne Daly (New York: Routledge, 1997), pp. 255-72; Jacquelyn N. Zita, "Heresy in the Female Body: The Rhetorics of Menopause," in Menopause: A Midlife Passage, ed. Joan C. Callahan (Bloomington: Indiana University Press, 1993), pp. 59-78; Jane Lewis, "Feminism, the Menopause and Hormone Replacement Therapy," Fem. Rev., 1993, 43 : 38-56.

22. Medical sociologist Frances McCrea claims that within a few years of the publication of Feminine Forever, "U.S. feminists in the vanguard of an organized women's health movement defined the health care system, including estrogen treatment, as a serious social problem" (McCrea, "Politics of Menopause" [n. 21], p. 111).

23. In her analysis of feminism and menopause in the United States and Britain, Jane Lewis claims that "there is no one feminist view of menopause"; she nevertheless concludes that "feminist literature tends to be universally suspicious of HRT," thus obscuring feminist debates and shifts in those debates over time (Lewis, "Feminism" [n. 21], p. 50).

24. Although few feminists or feminist organizations gave menopause significant attention between 1963 and 1975, others mentioned it briefly in their larger critique of medicine. See, for example, Mary Daly, Gyn/Ecology: The Metaethics of Radical Feminism (Boston: Beacon Press, 1978), pp. 248-50; Ehrenreich and English, Complaints and Disorders (n. 18), pp. 87-88.

25. Belle Canon, "Menopause: A Deficiency Disease," Hum. Ecol., 1973, 4 : 8-10.

26. Ibid., p. 9.

27. Ibid., p. 8.

28. Ibid., p. 10.

29. Citing Cooper as their main example, Gerald Markle and Frances McCrea ("Estrogen Replacement Controversy" [n. 21]) have argued that the feminist demand for estrogen therapy was a uniquely British response to menopause. But Cooper's work, published both in England and in America and reliant upon letters written by American women, also fits within the larger American women's movement; consequently, it should be seen as part of the feminist viewpoint available in America.

30. Wendy Cooper, Don't Change: A Biological Revolution for Women (New York: Stein and Day, 1975), p. 16.

31. Ibid.

32. Ibid., pp. 12-13.

33. Ibid., p. 12.

34. Francis P. Rhoades, "Minimizing the Menopause," J. Amer. Geriat. Soc., 1967, 16 : 346-54; quoted in Cooper, Don't Change (n. 30), pp. 136-37.

35. Cooper, Don't Change (n. 30), p. 137.

36. Ibid., p. 20.

37. Paula Weideger, Menstruation and Menopause: The Physiology and Psychology, the Myth and the Reality (New York: Knopf, 1976), p. 71. Although this book was published in 1976, it was clearly written before the 1975 studies of estrogen and cancer.

38. Herbert Kupperman, "The Climacteric Syndrome," Med. Folio, 1972, 5 : 1-2, quotation on p. 1; quoted in Weideger, Menstruation and Menopause (n. 37), p. 65.

39. The belief that medicine had given women "extra years" is a common misconception founded on a misunderstanding of life-expectancy data. For example, a woman born in 1850 had, at birth, a life expectancy of forty-three years, which is below the average age of menopause. However, if she lived to be twenty, her life expectancy zoomed to over sixty. In other words, the increase in life expectancy does not reflect extra years added to the end of life, as Weideger and others claim: it primarily describes the decrease in child mortality.

40. Weideger, Menstruation and Menopause (n. 37), p. 65.

41. Ibid., pp. 69-70.

42. Ibid., p. 71.

43. Ibid., p. 67.

44. Ibid.

45. Ibid., p. 71.

46. Shulamith Firestone, The Dialectic of Sex: The Case for Feminist Revolution (New York: William Morrow, 1970), p. 10.

47. Ibid., p. 8-9.

48. The Boston Women's Health Book Collective, Our Bodies, Ourselves: A Book By and For Women (New York: Simon and Schuster, 1973), p. 229. (This is the first Simon and Schuster edition.)

49. Ibid., p. 230.

50. Ibid., p. 232.

51. Ibid., p. 230.

52. Ibid., p. 231.

53. See also the pamphlet Menopause (New York: HealthRight, 1975).

54. Joan Solomon, "Menopause: A Rite of Passage," Ms., December 1972, pp. 16-18, quotation on p. 16. Frances McCrea points to this article to support her claim that the feminists responded promptly to Wilson and the indiscriminate use of ERT: McCrea, "Politics of Menopause" (n. 21), p. 118.

55. Solomon, "Menopause" (n. 54), p. 17.

56. Ibid., p. 18.

57. Barbara Seaman, "Examine Your Doctor Thoroughly—for Symptoms of Male Chauvinism and a Propensity for Performing Unnecessary Surgery," Prime Time, November 1972, pp. 1-3, 10; quotation on p. 10.

58. Ibid., p. 2.

59. Harry K. Ziel and William D. Finkle, "Increased Risk of Endometrial Carcinoma among Users of Conjugated Estrogens," New England J. Med., 1975, 293 : 1167-70; Donald C. Smith et al., "Association of Exogenous Estrogen and Endometrial Carcinoma," ibid., pp. 1164-67.

60. Susan E. Bell, "Changing Ideas: The Medicalization of Menopause," Soc. Sci. & Med., 1987, 24 : 535-42; idem, "Gendered Medical Science: Producing a Drug for Women," Fem. Studies, 1995, 21 : 469-500.

61. Diana B. Dutton, "DES and the Elusive Goal of Drug Safety," in Worse than the Disease: Pitfalls of Medical Progress (Cambridge: Cambridge University Press, 1988), pp. 31-90; Roberta J. Apfel and Susan M. Fisher, To Do No Harm: DES and the Dilemmas of Modern Medicine (New Haven: Yale University Press, 1984); Robert Meyers, DES: The Bitter Pill (New York: Seaview/Putnam, 1983); Ruzek, Women's Health Movement (n. 17), pp. 38-42.

62. Morton Mintz, At Any Cost: Corporate Greed, Women, and the Dalkon Shield (New York: Pantheon, 1985); Susan Perry and Jim Dawson, Nightmare: Women and the Dalkon Shield (New York: Macmillan, 1985); Ruzek, Women's Health Movement (n. 17), pp. 43-44.

63. Rosetta Reitz, Menopause: A Positive Approach (New York: Chilton, 1977; reprint, New York: Penguin Books, 1979), p. 181. See also Barbara Seaman and Gideon Seaman, Women and the Crisis in Sex Hormones (New York: Rawson Associates, 1977), p. xi; Caroline Derbyshire, The New Woman's Guide to Health and Medicine (New York: Appleton Century Crofts); Belita H. Cowan, "Questions and Answers on Menopause," in Women's Health Care: Resources, Writings, Bibliographies (Ann Arbor: Anshen, 1977), pp. 22-26, on p. 22; Cynthia W. Cooke and Susan Dworkin, The Ms. Guide to a Woman's Health (Garden City, N.Y.: Doubleday, 1979), p. 281; Belle Canon, "Menopause: It's a Disease Says Insurance Company," Ms., March 1977, p. 22.

64. Reitz, Menopause (n. 63), p. 26.

65. Ibid., p. 28.

66. Ibid., p. 75.

67. Ibid., p. 180.

68. Ibid. See also Cowan, "Questions and Answers" (n. 63), p. 22; Fran Moira, "Estrogens Forever: Marketing Youth and Death," off our backs, March 1977, pp. 12-13, on p. 12; Cooke and Dworkin, Ms. Guide (n. 63), pp. 288-93; Rachel Gillett Fruchter, "ERT: A Risky Proposition," HealthRight, 1976, 2 : 7; Menopause (n. 53), p. 9.

69. See, for example, Rosetta Reitz, "Venerable Vaginas," Majority Rep., 26 November-9 December 1977, p. 7; idem, "Menopause Questions and Answers," in Menopause Resource Guide, 3d ed., ed. National Women's Health Network (Washington, D.C.: National Women's Health Network, 1980), pp. 7-19; idem, "Love My Menopause? You Must Be Crazy!" Prime Time, April 1976, pp. 17-18; idem, "What Doctors Won't Tell You About Menopause," in Seizing Our Bodies: The Politics of Women's Health, ed. Claudia Dreifus (New York: Vintage Books, 1977), pp. 209-11.

70. BWHBC, Our Bodies, Ourselves: A Book By and For Women, 2d ed., completely revised and expanded (New York: Simon and Schuster, 1976), p. 330 (italics in original).

71. See also Jane Page, The Other Awkward Age: Menopause (Berkeley: Ten Speed Press, 1977), pp. 7, 48; National Women's Health Network, Menopause Resource Guide (n. 69), pp. 15-18.

72. Irma Levine, unpublished 1978 letter to Prime Time, ACC 1930-14, box 8, Young Women's Christian Association (YWCA), Women in Midstream (hereafter cited as WIM Papers), Manuscripts and University Archives, University of Washington, Seattle, Wash.(All subsequent WIM references are to ACC 1930-14). The WIM collection comprises four types of surveys: the vast majority, printed on blue paper and given arabic numbers (for example, WIM #395); those printed on blue paper and marked with both the roman numeral III and an arabic number (for example, WIM III #12); those printed on white paper (designated, for example, WIM White #35); and unnumbered surveys.

73. BWHBC, Our Bodies (n. 70), p. 335.

74. Vidal S. Clay, Women: Menopause and Middle Age (Pittsburgh: Know, 1977), p. 22.

75. Ibid., p. 112. See also BWHBC, Our Bodies (n. 70), p. 335.

76. Pauline B. Bart and Marlyn Grossman, "Menopause," Women and Health, May/June 1973, 1 : 3-11, quotation on p. 10. See also, for example, Pauline B. Bart, "Depression in Middle-Aged Women," in Female Psychology: The Emerging Self, ed. Sue Cox (Chicago: Science Research Associates, 1976), pp. 349-67.

77. Cooke and Dworkin, Ms. Guide (n. 63), p. 295. See also "Menopause: Let It Be," off our backs, Summer 1971, p. 12; Marcha Flint, "The Menopause: Reward or Punishment?" Psychosomatics, 1975, 16 : 161-63, on p. 163.

78. This group was originally the Ad Hoc Committee on Menopause of the University of Washington YWCA. They switched to the less unwieldy Women in Midstream by the autumn of 1974.

79. The letters and surveys are in the WIM Papers. To protect the privacy of the women who wrote to Women in Midstream, I have provided pseudonyms.

80. Wilson Research Foundation, American Medical Association, Department of Investigation, AMA Archive, Chicago (hereafter cited as AMA Archive). To protect the privacy of the women who wrote to the AMA, I have provided pseudonyms.

81. "And Now, the 'Liberated' Woman Patient," Amer. Med. News, 7 October 1974, pp. 14-18, quotation on p. 14.

82. "Women's Liberation and the Practice of Medicine," Med. World News, 22 June 1973, 33-38, quotation on p. 34. See also "And Now" (n. 81), pp. 14-18; Barbara L. Kaiser and Irwin H. Kaiser, "The Challenge of the Women's Movement to American Gynecology," Amer. J. Obstet. & Gyn., 1974, 120 : 652-65.

83. "Women's Liberation" (n. 82), p. 34.

84. Nora Stevens to WIM, undated, WIM Papers, box 11, file "Incoming letters," folder 4. See also Canon, "Menopause: A Deficiency Disease" (n. 25).

85. WIM Survey #367. See also WIM #470, #395. (All surveys are from WIM Papers, box 11.)

86. WIM #93. See also Edith Morrow (pseudonym), who, although she never received hormones, visited three physicians trying to get a prescription: Marjorie (Lowenthal) Fiske, Majda Thurnher, and David Chiriboga, "Longitudinal Study of Transitions in Four Stages," Henry A. Murray Research Center, Radcliffe Institute, Cambridge, Mass.

87. Edward Davis and Donna Meilach, A Doctor Discusses Menopause and Estrogens (Chicago: Budlong Press, 1969), p. 50. See also Kenneth C. Hutchin, "The Change and What Husbands Should Know About It," Today's Health, September 1966, p. 54; "How to Live Young" (n. 8), p. 64; Lawrence S. Sonkin and Eugene J. Cohen, "Treatment of Menopause," Mod. Treatment, 1968, 5 : 545-63, on p. 549; Estelle Fuchs, The Second Season: Life, Love, and Sex: Women in the Middle Years (Garden City, N.J.: Anchor Press, 1977), p. 141.

88. Faye Marley, "Sex and the Older Woman," Sci. News, 29 April 1967, p. 413.

89. See Judith A. Houck, "Common Experiences and Changing Meanings: Women, Medicine, and Menopause in the United States, 1897-1980" (Ph.D. diss., University of Wisconsin, Madison, 1998).

90. Kathleen I. MacPherson, "Menopause as Disease: The Social Construction of a Metaphor," Adv. Nursing Sci., 1981, 3 : 95-113, on p. 106; Reitz, Menopause (n. 63), pp. 180-85; Nancy Worcester and Mariamne H. Whatley, "The Selling of HRT: Playing on the Fear Factor," Fem. Rev., Summer 1992, pp. 1-26, on p. 3; Madeline Goodman, "Toward a Biology of Menopause," Signs, 1980, 5 : 738-53; Sandra Coney, The Menopause Industry: How the Medical Establishment Exploits Women (Alemeda, Calif.: Hunter House, 1994), pp. 23-25; Sharon Scales Rostosky and Cheryl Brown Travis, "Menopause Research and the Dominance of the Biomedical Model 1984-1994," Psychol. Women Quart., 1996, 20 : 285-312, on p. 301; Renate Klein and Lynette J. Dumble, "Disempowering Midlife Women: The Science and Politics of Hormone Replacement Therapy (HRT)," Women's Studies Internat. Forum, 1994, 17 : 327-43; Kaufert and McKinlay, "Estrogen Replacement Therapy" (n. 12).

91. Jane Cross to AMA, 4 April 1968, AMA Archive, "Correspondence 1967-1973."

92. Mrs. Harold Nielson to AMA, 21 October 1965, AMA Archive, "Correspondence 1964-1965."

93. Mrs. Dennis H. Blink to AMA, 9 November 1970, AMA Archive, "Correspondence 1967-1973." See also Ann M. Reed, Dearborn, Mich., to AMA, 27 April 1966; Mrs. Roy Glick, Rego Park, N.Y., to AMA, 15 August 1966; Mrs. Paul Grant to AMA, 1 September 1966 (telephone message); Mrs. Beth Clark to AMA, 1 September 1966; Mrs. Mary Stokes, Kennewick, Wash., to AMA, 9 May 1966, AMA Archive, "Correspondence 1966."

94. Seaman, "Examine Your Doctor" (n. 57), p. 3.

95. Judith Walzer Leavitt, Brought to Bed: Childbearing in America, 1750-1950 (New York: Oxford University Press, 1986); Elizabeth Siegel Watkins, On the Pill: A Social History of Oral Contraceptives, 1950-1970 (Baltimore: Johns Hopkins University Press, 1998).

96. Robert N. Mayer, The Consumer Movement: Guardians of the Marketplace (Boston: Twayne, 1989).

97. See Houck, "Common Experiences" (n. 89), chaps. 3-4.

98. Patty Boland to WIM, 23 October 1976, WIM Papers, box 10, folder A-F.

99. WIM unnumbered survey.

100. WIM #120.

101. Lynn Laredo, "Garbage Pail Syndrome," Prime Time, May 1974, pp. 5-6, quotation on p. 5.

102. Annette Henkin Landau, "Some Thoughts on the Menopause Rap," Newsl. Women's Liberation Center of Nassau County, N.Y., Inc., June 1974, 3 : 7.

103. Ibid.

104. For a discussion of women's menopausal experiences earlier in the century, see Houck, "Common Experiences" (n. 89).

105. WIM #217.

106. Cathy Smith to WIM, October 1976, WIM Papers, box 11, file "Incoming letters, O-Z."

107. WIM #364.

108. WIM #441. See also WIM #158, #433, #403, #364, #383; Daphne Cryer to WIM, October 1976, WIM Papers, box 11, folder A-F.

109. WIM #402. See also WIM III #12.

110. WIM unnumbered survey.

111. WIM #257. See also WIM #368, #460; Jennifer Stang to WIM, 16 March 1973, WIM Papers, box 10, folder "Testimonials and Comments."

112. Sarah Seidlitz, "Menopause Speak-Out," Prime Time, April 1974, pp. 7-10, quotation on p. 8.

113. WIM #402.

114. WIM White #35.

115. Florence Rush, "A Woman of That Age," Prime Time, April 1976, p. 3.

116. Ibid.

117. Ibid.

118. Ibid.

103. Bull. Hist. Med., 2003, 77 : 103-132