The underexposed side of the menopause

Reports about menopause are often negative; they are often about getting older, the loss of femininity or the symptoms that come paired with it. Many women are therefore anxious about this period. According to PhD student Hanneke de Boer, it is quite possible that this negative view of the menopause makes the symptoms worse for many women; She will investigate this in a new M20 study. 

The menopause is the last menstruation, on average occurring in women at age 51. It is a period in which the hormone cycle changes. In the years surrounding menopause, many women suffer from symptoms such as hot flushes, muscle and joint pain, mood swings and headaches.  In the media, these complaints are increasingly discussed at length, which may make many women dread the menopause even more.

"It is also a historical theme. We have seen this anxiety since the 16th century. Anxiety is also really something that doctors say worsens symptoms,” says Rina Knoeff, professor of health and humanities at the University of Groningen. Knoeff, together with Tineke Oldehinkel, professor of life course epidemiology of common psychiatric disorders, and newly appointed PhD student Hanneke de Boer, started a study thanks to an M20 grant. The research is about the link between historical socio-cultural perceptions of menopause and the experience of menopause. 

A paradox of sorts

There is quite a lot of attention for menopause these days, Oldehinkel argues. This is partly due to an increasing medicalisation of menopause. For example, it is increasingly suggested that employers should take better note of menopausal symptoms in the workplace. “On the one hand, that does justice to the experience of some women, which is also very important,” Oldehinkel says. “But it could possibly have the side effect that increasing medical attention makes menopause symptoms worse for other women.” 

“We are in a paradox of sorts,” says Knoeff. "It is of course good that menopause is being taken seriously through medicalisation. But the other side of the coin is that this medicalisation partly determines and perhaps worsens the experience of menopause."  That social and cultural part is almost never taken into account when talking about menopause, according to Knoeff. 

Knoeff welcomes the fact that there is now more money and attention dedicated to menopause, but the downside should be taken into consideration as well. "We are used to medicalising this kind of issue and seeing it exclusively as a medical problem. We often forget how much is culturally determined and how many cultural factors influence our thinking,” Knoeff explains. Oldehinkel agrees. "We don't mean that the medical model is bad. There is just a certain one-sidedness."

With the new research, Knoeff, Oldehinkel and De Boer want to make an attempt at reducing that one-sidedness by finding out whether the mostly negative views about menopause actually influence the experience of menopause.

New research

To achieve that, they will first look from a historical perspective at how menopause was viewed in journals and other such publications, and try to discover trends in them. De Boer has only been working on this for a short time, but already sees that many of the views in today's popular scientific literature and self-help books on menopause were formed in the 19th century. “We still have the same views today, sometimes with a slightly different twist,” De Boer argues. 

According to De Boer, this is also the point of historical research. "You can show that these views are also all just ideas that arose at a certain time. Ideas that have been passed down from generation to generation and still influence how we deal with things today and how, in the case of menopause, this can influence ideas and experiences." 

In addition to the historical literature review, the researchers will use Lifelines, a large population study which 167,000 people from the northern Netherlands participate in and provide their data for. The researchers are going to add additional questionnaires to this population study for women around menopausal age. Through the questionnaires, the researchers want to find out how women before menopause view menopause and how women who have already experienced menopause view it now. “This could potentially make the picture of menopause more complete,” says Oldehinkel.

If the researchers can show that cultural factors such as the media really play a role in women's experience of menopause, they would also like to inform women about it. “That may also help it in reducing the factors that make them feel anxious or cause them to dread menopause,” Knoeff says.

Interdisciplinary work

The new research is an interdisciplinary project in which psychology and history both play an important role. “The interdisciplinary approach really adds value to this project,” says Knoeff. Oldehinkel agrees. "But most of all, I just really enjoy it. I learn a lot from it myself and it makes me happy." Both researchers agree that the project would not be possible without the different disciplines. 

Interdisciplinary working does lead to unexpected obstacles. "We do have to kind of invent the wheel for some things. That is quite fun,” Oldehinkel states. “What a dissertation should look like, for example, is quite different in our fields.” Also, terms are not always common. "I had written a discourse analysis, within the field of history that is quite common. But then we found out that a discourse analysis is not known at all within psychology,” de Boer explains. “Therefore, we are now going to make a list of terms with an explanation attached, so that everyone understands exactly what is meant.”

The project is funded by The Ubbo Emmius Foundation as part of the 2023 M20 grants through the Aletta Jacobs School of Public Health. The M20 grants are there to support interdisciplinary projects and to give researchers the finances necessary to appoint a PhD student like De Boer. "We were very happy with the M20 grant, I also liked that it was a quick process. Within a few months of applying, we knew we would get the grant,’ Oldehinkel says.