Joan Smith
NO NEED TO GET HEATED
Hot Flushes, Cold Science: A History of the Modern Menopause
By Louise Foxcroft (Granta Books 330pp £14.99)

Exclusive from the Literary Review print edition. Subscribe now!

There is one certain thing I can tell you about the menopause, which is that your periods will stop - always assuming, of course, that you are a woman. You may also get hot flushes, and there's a chance that you'll feel tired and a bit depressed, but then who wouldn't? Most of us have had a lifetime's preparation in which we are taught to dread the menopause as a horrible event that will usher us into the anteroom to extinction. Invisibility comes first, of course, and some women seem to take a perverse pleasure in warning younger friends that they shouldn't expect anyone to notice their existence after the age of fifty. The terrible prospect of oestrogen deficiency is enough to send millions of women to their GPs, often before they've experienced a single menopausal 'symptom'.

I use inverted commas because so many of the things that women expect from the menopause also happen to men. They too get wrinkles, lose weight, gain it, become grumpy, lose interest in sex, wear inappropriate knitwear and experience sensations of hopelessness, but the attempt to create a male menopause - a manopause? - has never really caught on. A man in his late forties or early fifties who complains to his doctor about any of these alterations (not the knitwear, obviously) won't be offered a male version of HRT, although he might come away with a prescription for Viagra. But the female menopause is still regarded with such horror that women in their early forties are already being prepared for the moment when they start HRT, despite medical evidence linking it with breast cancer and strokes. I've lost count of the conversations I've had with friends who are contemplating this step, not because there's anything wrong with them but because they're terrified that they might suffer from hot flushes, vaginal dryness and - this is the subtext of all this medical intervention - not being a real woman any more.

So let me tell you the good news, based on personal experience and reinforced by Louise Foxcroft's lively and well-researched book. Some women sail through the menopause with very few changes, finding a huge release in no longer having to fiddle around with tampons, sanitary towels, caps and coils. Hot flushes may be a nuisance but they aren't lethal, and sex after the menopause depends more on how you feel about yourself than external factors; you don't have to resign yourself to celibacy, but you will need to protect yourself against STDs, which are no respecter of age. You can certainly forget all that nonsense about embracing cronehood, which creates unnecessary anxiety in the under fifties and may persuade sexually active older women that there's something wrong with them when they're perfectly normal.

The reason why it's necessary to state all of this can be found in Foxcroft's book. Most of the ideas you will encounter about the menopause have been informed and distorted by the most grotesque misogyny, stretching back two and a half thousand years, which she documents in forensic detail. The usual culprits are here, from Plato, Aristotle and Galen to eighteenth-century anatomists whom Foxcroft accuses of being the first modern doctors to characterise the menopause as a disease; in 1739 an anonymous doctor threatened menopausal women with a long list of symptoms, including severe pain in the head and back, violent vapours, feverish heat, rheumatic pains and loose bowels. (No wonder, with all this in prospect, that they also might be troubled by a 'general Uneasiness'.) In 1800 a French doctor even claimed to have documented a dozen cases of spontaneous combustion, most of them involving post-menopausal women (Charles Dickens read this essay in translation and used it in his research for Bleak House). Things didn't improve much in the twentieth century when the American gynaecologist Robert Wilson published his book Feminine Forever (1966), which has become notorious for its role in the medicalisation of the menopause. Wilson considered the climacteric a tragedy 'borne bravely by women, but ... hardly endurable' as it turned them into 'castrates'. Clearly these sad creatures were urgently in need of HRT, the only thing that could make them acceptable again to their horrified husbands.

Down the years too many women have listened to this sort of tosh instead of talking to older women who've actually experienced the menopause. Louise Foxcroft's book is an essential counterblast and the best piece of advice in it comes from another woman writer, Marie Stopes. Her message is as pertinent today as it was in 1936: 'Do not anticipate any trouble at all at this time.' Give that woman a medal, and let's demolish the entire menopause industry at a stroke.

Joan Smith is one of the contributors to 'In Bed With', a collection of erotic fiction, although she isn't allowed to reveal her pseudonym. Last year she helped launch an appeal for children's books for Sierra Leone, which has recently shipped 50,000 books to schools in the town of Waterloo, near Freetown.