History of Menopause and Its Treatments

By the year 2030, approximately 1.2 billion women will be menopausal or postmenopausal worldwide. Greater than 85% of these women will experience disabling symptoms.

As recent as the 1970s, “Menopause was defined as a psychological crisis that would cause disease under certain conditions. The most important condition was social, a woman’s adherence to departure from her prescribed role. Thus, the way to prevent symptoms was to avoid being too educated, fashionable or sexually active and to provide adequate care for husbands and children.”

The history of menopause and its treatments are both fascinating and eye opening – this article dives deep into the history of menopause from ancient times to modern day.

Early History of Menopause

It is reported Aristotle noted menstruation ceased at 40 years of age but early references to menopause are scarce.

Referred to in the 1700-1800s as a “tragedy and catastrophic attack,” menopause resulted in women described as “dull, unattractive and cowlike.” Prior to the 1960s, women were expected to put up with their symptoms as doctors believed there was virtually nothing to offer.  In an attempt to help women “calm down,” they were often handed prescriptions for tranquilizers, a liquid made from bromide salts.

The years before and after last menstruation were described as “dodging time” in European medical circles in the mid-19th century. This midlife transition became known as the climacteric which occurred in both men and women. Bringing attention to this change specifically in women, French physician, Charles-Pierre-Louis de Gardanne, first coined the term menopause in the 1820s. 

Written by physician Robert Barnes in 1873, “Physicians do, indeed, talk of the climacteric in man…but…There is nothing to compare with the almost sudden decay of the organs of reproduction, which marks the middle age of a woman…The loss of these functions entails a complete revolution.” Medical interest in menopause increased in the mid-19th century and over decades to follow, the biological model of menopause unraveled little by little.

Competing models of menopause included psychological, environmental and biological. The central theme predominating the literature was the biological model in which menopause was described in the 1930-1940s as a deficiency disease with recommendations for estrogen replacement therapy.

Early Menopausal Therapies

An ancient form of treatment reported for both male and female climacteric was glandular and organotherapy in which Greeks and Romans prescribed donkey testicles and Egyptian men were known to eat donkey penises.

French physician, Brown-Sequard, referred to as the “father of modern endocrinology and hormone replacement theory,” reported in 1888, he had injected himself with “testicular juice.” As a result, he “rejuvenated himself,” demonstrated by better sphincter tone, intestinal activity and body vigor. He also reported his wife combatted physical weakness using testicular extract.

Tranquilizers were used in the pre-estrogen era as menopause was viewed as a mental illness and these drugs would dull the emotions and anxiety. Freud described menopause as “a crisis period during which a woman mourned the end of her feminine attractiveness and child bearing capacity.”

Various herbal remedies were used for the treatment of menopause. Black cohosh has a long history of use in Native Americans along with evening primrose, hops, Korean ginseng, flaxseed, red clover, St John’s wort and wild yam.  Black cohosh is known to increase estrogen levels.  Maca root was used in Andean cultures. Wild yams and dong quai have long been used in traditional Chinese medicine.  Today, bioidentical estrogen and progesterones are made from wild yam and some progesterones are also made from peanut oil.

By the end of the 19th century, ovarian therapy was used for dysmenorrhea, menopause and adiposity including ovarian juice, powdered ovarian tablets and crude ovaries. Once estrogen deficiency was attributed to menopause in the 20th century, treatment with estrogen finally became “not only legitimate but rather an obligation.”

Current Estrogen Therapy – Feminine Forever

In 1939, bioidentical estrogen pellets were first used in women after hysterectomy to treat deficient estrogen levels and keep them from devasting menopause symptoms.

However, menopause was still consistently viewed as a tragedy and mental illness until synthetic estrogen, Premarin, named as it is estrogen extracted from urine of pregnant mares, was released in 1942.

In the 1950s, Premarin was marketed as a treatment for symptoms of menopause but this campaign did not take off until gynecologist, Robert Wilson, MD, published a best-selling book called Feminine Forever.  In this book, he “maintained that menopause was an estrogen-deficiency disease that should be treated with estrogen replacement therapy to prevent the otherwise inevitable ‘living decay.’”  He stated the “tragedy” called menopause could finally be avoided with the use of Premarin, “from puberty to grave” and coined the concept of “Feminine Forever.”  This was also the beginning of the women being able to retain control of their bodies and ultimately control their lives.  It was the media ultimately advancing Premarin into the lives of all women along with the concept, “Feminine Forever.”

Tranquilizers were no longer necessary once Premarin hit the market because “all of a woman’s emotional complaints would now be abolished right along with her menopause, making her ‘Feminine Forever.’” Women began requesting estrogen from their physicians. The drug companies supported this and the concept spread via the media.

Articles were published in Newsweek and Time by 1964, praising the promise of estrogen therapy to cure menopause and by 1965, this made its way into women’s magazines and prescriptions for Premarin skyrocketed. Uncovered history shows the pharmaceutical company producing Premarin, Ayerst, funded Wilson’s foundation and book, Feminine Forever, selling more than 100,000 copies in just seven months after its release, subsequently being translated into four languages by 1970.

The idea of hormone therapy made its way to women all over the globe. Bioidentical pellet therapy was phased out as Premarin took the world by storm.

Hormone Controversy – How did Estrogen get to be the “Bad Guy”.

In 1972, the FDA published a Federal Register notice indicating Premarin effective in the treatment of menopause.  Estrogen was the most frequently prescribed drug in the US in 1975. A survey in Washington state in 1975 showed 51% of all postmenopausal women were reported to have used estrogens for at least 3 months with a median duration over 10 years.

Premarin was given to women extensively, remaining the most popular prescription medication through the 1980-1990s, improving the quality of life of millions until it all changed with the

Women’s Health Initiative. In 1994, the FDA granted approval of the hormone combination Prempro (synthetic estrogen and synthetic progesterone). The WHI studied Premarin and Prempro to prove its effects on cardiovascular disease, breast cancer, colorectal cancer and osteoporosis.

In 2002, a press release for the WHI announced hormone replacement therapy to be dangerous as the Prempro arm of the study was found to increase the risk of breast cancer, heart disease, stroke and blood clots.  Premarin was not found to be statistically harmful.  The negative findings of the Prempro arm of the study were the only ones to make headlines despite the study also finding a significant reduction in colorectal cancer and osteoporosis.  In addition, there were flaws in the interpretation of the results and no discussions about Premarin or any mention of the lack of distinction between synthetic and bioidentical hormone treatment. Mass frenzy occurred after this media release with abrupt discontinuation of Premarin and Prempro by physicians and their patients currently on those medications.

Follow up studies have showed the benefits of hormone therapy including Premarin although the WHI results implanted fear into the minds of doctors and women concerning the dangerous use of estrogen which is still felt today.

Conclusion

Even though the fear of blood clots, stroke, and cancer from use of estrogen perpetuates today, many more women are receiving benefits of hormone replacement, improving health outcomes and allowing them to reclaim their lives, taking their own lives back into their own hands.

Menopausal history from ancient to modern times reveals a change from a “catastrophic and tragic” time period in a woman’s life to one of health and vitality for many, many years beyond the end of menstruation thanks to hormone replacement therapy.

Have an awesome day!  Dr. D