My God, the history of the menopause is gothic: nasty potions, knife-wielding villains and swooning females. It was billed as "the gateway to death". No wonder women were terrified of it. They still are, according to Louise Foxcroft, who faces her own approaching menopause with cheery and indignant bravado. Her book Hot Flushes, Cold Science shows how and why the menopause remains a taboo.
The menopause is a strange biological process (strange because it is rare in mammals) that limits the number of productive eggs to a store which runs out usually in a woman's fifth decade. Scientists still don't know why such an adaptation should have occurred.
This entirely natural aspect of a women's life-cycle entered the new human sciences as a pathology around the time of the Bronze Age. The diagnosis took on a theoretical life of its own, reinterpreted by each generation and ending up thoroughly "medicalised" by doctors and commercial salesmen alike. Most were male, and many were grossly misogynist - women were designed for breeding alone, so menopausal women were therefore useless. Women's voices were rarely heard in this debate.
Ancient Greek medicine was relatively benign, concentrating on menopausal management rather than "cure". Aristotle's anatomy of the "wandering womb", however, was a bad idea; it focused the medical imagination on the uterus, and gave full licence for the invasive "treatments" that came later.
The menopause was classified as a disease around 1710, and the symptoms multiplied - "joint pains, deafness, dizziness, hot flushes, vomiting". Things reached a peak of horror in the 19th century, when the menopause was turned into a mid-life "crisis". Surgeons took control of the clitoris and uterus, and whipped them out to induce an artificial menopause that would "cure" the patient of almost any symptom, especially "hysteric" mental states such as depression or alcoholism. Nymphomania was a favourite: the disapproval of older women being sexually active for pleasure was enormous. Many women welcomed the menopausal relief from child-bearing, an aspect that Foxcroft does not fully address. But thousands of women died needlessly before sterilisation and anaesthesia were perfected. Hysterectomy is still a routine operation, with millions performed annually worldwide as a preventive measure. A recent trial on ovarian cancer screening reported that 845 women had surgery to remove their ovaries, of which only 45 were found to be cancerous.
In the 20th century, endocrinology provided a wonderful new magic bullet - control the sex hormones, and you control the menopause. Meanwhile (though Foxcroft does not include this) the invention of aspirin (1899), paracetamol (1956) and ibuprofen (1969) genuinely helped to relieve symptoms, while "neurotic" menopausal women were fed fluoxetine anti-depressants. But by the end of the century, hormone replacement therapy (HRT) had received its own health warning, after epidemiologists found that it pushed up cancer rates.
Liberate yourself from your fears is Foxcroft's final message. Ageing is not a disease and affects both sexes. The best treatment seems to be to manage the aches and pains and fork out for the beauty treatments. Anthropology seems to back up this classical hygienic view of low-level management. It is western Caucasian women who experience the worst menopausal symptoms. African and south east Asian women have far less trouble. It has recently been concluded that there is no such thing as a universal menopausal "syndrome". A lot of money has been made over the centuries - for what exactly?
• Virginia Smith is the author of Clean: A History of Personal Hygiene and Purity (OUP).
