These methodological flaws do not arise from the random oversights of different researchers, but reflect underlying conceptual biases. This bias revolves around a heavy biological reductionism that flavors views about all women. In this section we elaborate three assumptions that underlie this biological focus and lead to concepts of women as opposite from the male norm—deficient and diseased, and weak and powerless.
First, women are presented in the medical literature on menopause as fundamentally Other in comparison to the male norm. For example, hormonal changes known to take place in mid-life men are not routinely pathologized as they are in women. The underlying assumption is that women are disabled by their reproductive physiology (including menstruation, childbirth, and menopause) and require medical expertise for diagnosis and treatment. This results in women’s health and sexuality being constructed and defined from a narrow and limiting perspective, and, in the case of menopause, one that pathologizes women’s natural aging processes and ignores broader sociocultural contexts.
Not only are women seen as other, they also are presented as sicker. Menopause in Western society is constructed in the popular and scholarly discourse as a biological event entailing unique types of discomfort although even the most common symptom, the hot flash, has been documented in women of all ages (Neugarten & Kraines, 1965). There are more than 40 symptoms commonly listed as part of the menopausal syndrome, yet many of these (e. g., depression, headaches, irritability, dizziness, etc.) are unique neither to menopause nor to women. Even the “defining feature” of menopause, the cessation of menstruation, is not unique to menopause, but may indicate pregnancy, athletic training, malnutrition, or some disease process (Kaufert, 1982).
Finally, the traditional biomedical model of menopause leads to conceptualizing women as weak and powerless in relation to medical and scientific authority. That is, if menopause is essentially a medical problem, then medical solutions are needed, including gynecological specialists, gynecological procedures, and pharmaceuticals designed for gynecological applications. Others have noted the parallel between the expansion of the medical profession and the treatment of women as patients with little power (Kaufert, 1982). By defining a menopausal syndrome or symptom package, the medical profession determines what menopause is, and, perhaps most important, how it will be experienced.
With the establishment of a medical authority in women’s lives, women themselves become disempowered. Evidence of the domination of the biomedical paradigm and the resulting construction of medical authority and expertise can be seen in qualitative studies of women’s experience of menopause (see Dickson, 1990; Gergen, 1989; Jones, 1994). Findings suggest that most women identify their physicians as the primary source of knowledge about menopause, yet continue to feel uninformed and unknowledgeable. Although frustrated with this lack of information, they continue to turn their care over to their physicians.
Sanctioned medical interpretations become filters through which women interpret their own experience (Bowles, 1990). The personal impact of this has been substantiated by Gannon and Ekstrom (1993) in a study finding that women who had adopted an implicitly biomedical model reported more negative attitudes about menopause than did women who focused on menopause as a developmental transition.
We certainly acknowledge that some mid-life and older women do encounter problems during menopause. However, the context of these problems is typically ignored in the biomedical literature. Instead, problems of menopause are viewed as embedded in women’s different, sick, and weak bodies while the psychosocial aspects of menopause, middle age, and aging are neglected. Despite this gloomy picture, there are signs of change as feminist researchers and health care specialists begin to challenge the traditional biomedical model and as women experience menopause in a changed historical coptext (i. e., longer lifespan and more power and privilege compared with past generations). It is to these changing conceptualizations and practices that we now look.