It might make for a radically different experience of menopause then - and of your sexuality now. Physical symptoms are the least of it; menopause goes to some dark, deep aspects of how women view themselves, their lives and their sexuality.



The psychological role models for menopause and beyond have been set or at least horribly infiltrated by thoughts and ideas that echo from out of a sad history. cultural misconceptions which haunt our psychic shadows.

There is the basic physical fact; menstruation winds down and stops. There are some accompanying symptoms ? for some. How widespread are these physical symptoms? How much are they just conditioned expectations now embodied in ailing flesh; how much is physiologically inherent in the human organism; how much is caused by physical neglect or negative cultural expectations?

What comes from biology, environment or culture? What is fact; what is fiction?

The very understanding of menopause is entangled with the dominating social and medical theories regarding aging, sexuality and beauty.

The theories set the context and the assumptions by which we live; and they fluctuate over time. They are the common truth of any period and generate the fulfilling prophecies for those who "believe" it is so. What we believe, we quite literally embody.

Historically, menopause was considered an illness that led to mania, depression, and madness. When procreation was considered the primary feminine purpose, post-menopausal woman became theoretically useless, and socially without function and the end of procreation was considered the end of sex as well.

* In 16th and 17th century Europe the doctors thought that the menstrual blood putrefied in women's bellies making them malignant and venomous. The stereotypical image of post-menopausal women was mainly that of witches; a 1550 view describes witches as "mostly old women who can find no lovers".

* In the rational and middle class 18th and 19th centuries, women were idealized and spiritualized as mother. Official sexuality was safely contained within marriage and linked only to procreation. Post-menopausal women were either old maids who were negatively stereotyped and isolated or the ageing grandmother. Granny was righteous, moral, good ? and totally asexual.

* The 20th century swung between menopause as pathology or as potential. Was it an illness, bringing inevitable breakdown of body and mind, or a time of renewed vigour, the "post-menopausal zest' so famously described and exemplified by anthropologist Margaret Mead.

The turn of the 20th century was forward-looking, buoyed by theories of vital ageing and medical support for the view that there was no pathology associated with menopause and that it might even increase the vital forces. But this viewing point did not last past the 1920s

Basically, the pathology version triumphed. Its various symptoms became the domain of medical specialists whose job it was to attend women through this period ? once a year, please, at least ? and, of course, through the post-menopause as well ? until death do us part. The newly established field of gynaecology took control of menopause, as it had taken childbirth over from the midwives. The growing size and structures of the medical profession in the early 20th century required an expanding patient population for economic viability. Menopausal and post-menopausal women formed the perfect client group ? large numbers, ample finances, and vague symptoms. The medicalization of menopause was great for doctors.

Endocrinology, the study of glands and hormones, joined gynaecology in describing an integrated, delicate feminine physiology that determined and dominated the female character ? and easily went awry. Hormone deficiencies and bone loss, and indeed just about every other ageing symptom, were added to the menopausal medical stew. (Oestrogen replacement therapy started in the 1940s.)

The new psychology exacerbated an already bad situation. Freud's view of menopause reinforced the view that it was biological and pathological bringing much psychological insecurity, and a return to neurotic, adolescent behaviours. Heightened sexuality was considered a pathology!

In 1949, even the brilliant Simone de Beauvoir was pessimistic, despite a classic French tradition of celebrating ageing women. She wrote that as women age and anticipate the end of beauty and love, "their minds became unbalanced" and "with bleak futures to anticipate, they turned into shrewish, paranoid versions of their former selves".

The obsession with youthful beauty which only really began in the early 20th century, had a huge and paralysing impact on the self-image of all women older than 30, but more so on post-menopausal women.

"Aging in women is a process of becoming obscene sexually," wrote feminist Susan Sontag in 1972. "One of the attitudes that punish women most severely is the visceral horror felt at aging female flesh." We are revolted by our own image and "turn from sex with self-disgust, seeing in men's eyes our own revulsion".

So how different is it now? Baby boomer haven't done that well at all in this regard; most of them are totally bought into the medical model. And even if they are into a "natural" menopause, the issues around self-image and sexuality are not that well grounded. Basically menopause "hit" them with all the dark stuff from the past that had not been properly untumbled. And already doctors are telling many women in their 30s and 40s that they are starting an early menopause. What is happening here?

Menopause should not be primarily a medical experience, but a process of soul that redefines self, life, spirit and sex. And its worth starting that process before the hot flashes hit ? if they do at all. Preparation of mind, soul, spirit ? and body ? might make a huge difference.