The History of Menopause: How Understanding and Treatment Have Evolved

Imagine experiencing hot flashes in the 1600s, long before doctors understood hormones.

Women wrote about sudden waves of heat, restless nights, and unexplained changes in their bodies. At the time, there were no blood tests, no hormone therapies, and no clear medical explanation. For centuries, menopause was often misunderstood, joked about, or treated with remedies that reflected the medical thinking of the time.

Today, menopause is recognized as a major life stage that affects many systems in the body. But that understanding took centuries to develop.

Across history, menopause has been viewed in very different ways. At times it was seen as a natural transition. At other times it was treated as a medical problem or hormone deficiency.

Looking back at how menopause has been understood also tells a larger story about how women’s health has been studied and supported over time.

Before the 1800s: A Natural Life Transition

For much of history, menopause was not considered a separate medical condition.

Physicians used the word climacteric to describe a turning point in life associated with aging. This stage applied to both men and women and was thought to mark a shift in health and vitality.¹

Medicine at the time focused on maintaining balance within the body. Doctors believed that health depended on the balance of bodily fluids and internal heat. When women experienced symptoms such as sudden warmth, headaches, or sleep problems, these were thought to be signs that the body had become too “hot” or out of balance.

Historical writings even describe symptoms that sound familiar today. Some women reported sudden waves of heat, sweating, and flushing of the skin. These accounts closely resemble what we now call hot flashes.²

Treatments aimed to restore balance. Herbal preparations, dietary changes, and rest were commonly recommended. Cooling foods or drinks were sometimes suggested to calm the body.²

Menopause was not always viewed negatively. In many communities, women gained new roles once their childbearing years ended. Older women often became midwives, healers, or advisors.

It is also important to remember that in earlier centuries fewer women lived long past menopause. Life expectancy was lower and childbirth carried significant risks, so menopause was less visible in society than it is today.

The 1800s: When Medicine Took a Closer Look

The nineteenth century marked a shift in how menopause was understood.

As Western medicine became more scientific, doctors began studying biological differences between men and women more closely. Reproductive function became central to how women’s health was defined. When menstruation stopped, menopause was increasingly described as a significant biological change that could affect both the body and the mind.¹

Medical texts from this period often described the “change of life” as a difficult or unstable time. Symptoms such as anxiety, fatigue, headaches, and insomnia were commonly linked to menopause.

Some physicians also linked menopause to mental health conditions. Symptoms like irritability, anxiety, and mood changes were sometimes described as “nervous disorders” or hysteria. In some medical writings, the term “menopausal insanity” even appeared.¹

Without an understanding of hormones, emotional and physical symptoms were often interpreted through psychology rather than biology. Treatments reflected the medical practices of the time. Doctors sometimes prescribed sedatives, cold baths, or even leeching to try to calm the body and relieve symptoms.

At the same time, personal letters and diaries from women often described menopause much more simply. Many women noted the end of menstruation as a practical change rather than a medical crisis.

This gap between medical theory and women’s lived experience continued into the twentieth century.

The Early 1900s: The Discovery of Hormones

The early twentieth century brought a major scientific breakthrough.

Researchers studying the endocrine system discovered that the ovaries produce hormones that affect many parts of the body. By the 1920s and 1930s, scientists were able to isolate estrogen from ovarian tissue, linking menopausal symptoms to measurable hormone changes for the first time.¹

This discovery changed how menopause was understood. Instead of being explained through vague ideas about nerves or imbalance, symptoms could now be studied through biology and chemistry. Even so, psychological theories continued to influence medical thinking. Some physicians believed emotional symptoms during menopause were caused by the loss of fertility or shifting social roles rather than biological changes in the body.¹

Pharmaceutical companies soon began developing hormone-based treatments. In 1942, Premarin, an oral estrogen therapy derived from pregnant mares’ urine, was introduced in the United States.³ Hormone therapy quickly became a common treatment for menopausal symptoms.

The 1960s and 1970s: Menopause and the Promise of Youth

Public discussion of menopause expanded dramatically in the 1960s.

In 1966, physician Robert A. Wilson published the book Feminine Forever. The book argued that menopause was a hormone deficiency that should be treated with estrogen therapy.³ Wilson suggested that hormone therapy could help women maintain youthfulness and vitality. The message gained wide attention.

Menopause had become not only a biological event, but also a cultural one tied to ideas about aging and femininity.

By the 1970s, millions of women in North America were taking estrogen therapy, making it one of the most widely prescribed medications of the time.³,⁷ However, new research soon raised concerns. Studies found that estrogen-only therapy increased the risk of endometrial cancer. Doctors began prescribing progesterone alongside estrogen to reduce that risk.

2002: A Study That Changed the Conversation

In 2002, the Women’s Health Initiative released the results of a large study on hormone therapy.⁴ The findings suggested that certain hormone regimens were linked to increased risks of breast cancer and cardiovascular disease.

The results received widespread media attention. Many headlines presented the findings as proof that hormone therapy was dangerous, and prescriptions dropped sharply around the world.⁴,⁷ In the years that followed, researchers reexamined the data and emphasized that risks vary depending on factors such as age, health history, and when treatment begins.

The study marked a major turning point in how menopause treatment was discussed.

Today: A New Understanding of Menopause

Over the past two decades, research has continued to evolve.

Scientists now understand that hormone therapy risks depend on several factors, including timing, dosage, and delivery method. Lower-dose treatments and transdermal options have expanded care for many women.

At the same time, menopause is increasingly recognized as a whole-body transition. Changes in estrogen can affect many systems, including heart health, bone density, metabolism, sleep, brain function, and more.

Today, mood changes during menopause are better understood as the result of both hormonal changes and life-stage factors. Treatment approaches may include hormone therapy, supportive supplements, antidepressants, or behavioural therapies depending on individual needs.⁵

In 2025, the U.S. Food and Drug Administration updated boxed warning language for hormone therapy to better reflect modern evidence and more personalized prescribing.

Cultural attitudes are also shifting. For many years menopause was often treated as a punchline in media and popular culture. Today more women are speaking openly about their experiences and calling for better research and support.⁶ Some now describe menopause not only as a challenge, but also as a turning point that can bring greater confidence and freedom.

After centuries of misunderstanding, women are beginning to reclaim the narrative around menopause.

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References

¹ Stephens, E. (1999). The medical construction of the menopause. Sociology of Health & Illness, 21(5), 676–698.
https://journals.sagepub.com/doi/10.1177/136218079900500408

² Wellcome Collection. Herbal medicines and the early modern menopause.
https://wellcomecollection.org/stories/herbal-medicines-and-the-early-modern-menopause

³ AARP. The history of estrogen and hormone therapy.
https://www.aarp.org/health/conditions-treatments/menopause-symptoms-treatment-estrogen-hrt/

⁴ National Institutes of Health. Women’s Health Initiative (WHI).
https://www.nhlbi.nih.gov/science/womens-health-initiative-whi

⁵ The Menopause Society. Clinical guidance and menopause research updates.
https://www.menopause.org/publications/clinical-guidance

⁶ The Conversation. Menopause is having a moment: how a new generation of women are shaping cultural attitudes.
https://theconversation.com/menopause-is-having-a-moment-how-a-new-generation-of-women-are-shaping-cultural-attitudes-241784

⁷ New York Times Magazine. The Forgotten History of the World's Most Important Hormone.
https://www.nytimes.com/2023/02/01/magazine/menopause-hot-flashes-hormone-therapy.html