It’s so confusing isn’t it? On the one hand, menopause is taboo: it’s the frontier between youth and decay, fertility and infertility, beauty and ugliness. Menopause - is sometimes seen as the unspoken event that turns a woman in her prime into an old and invisible hag...

The old crone view of the menopause was a dominant framing in our Western culture for most of the past century and still persists in our imaginations today.

But thankfully, another side to menopause is emerging. Nowadays women are likely to live as many adult years after as before their menopause. Women at midlife and beyond are strong, sexy and powerful. Sure of ourselves and our roles, women beyond fertility are elegant and purposeful. We know ourselves and our worlds and we’re out to create waves.

menopause ambiguity illustration

My Wife and My Mother-In-Law
, by the cartoonist W. E. Hill, 1915 Wikimedia Commons. Public Domain,

You may be familiar with this image. Depending on how you look, you can see one of two women. Some see an older woman with a long hooked nose and a resolute grimace, while others see a younger, elegant woman with a feather in her fine hat and a black necklace.

I think the image is a good illustration of how we understand menopause today. It’s all a matter of ways of seeing: Look at the old crone and sure enough you see her. Look for the elegant woman of style and purpose and there she is, staring you in the face.

Most healthy women, forging their way through the midlife river, want to understand what’s happening to them. We experience changes in our bodies, our feelings and even outlook on life.

But when we look for answers we so often come up against a fog of confusion and contradiction.

Just a few minutes surfing the net can leave us dizzy and disorientated:  Hormone deprivation or physiological re-alignment ?  Allopathic chemicals or homeopathic remedies? Lost libido or inner searching for a lost self?

Is there any way that we can get a clearer view of what’s going on?

Here’s another picture - what do you see?

ambiguity during menopause

Rubin Vase from Wikimedia Commons. Public Domain.

We make sense of our world because of the way we see it. But as the image shows, what we see can vary. Look at the picture one way and you see a vase, look at it another - and hey, now it’s two faces.

And the same ambiguity applies to menopause.

There are many, many voices talking about women’s midlife transition. Broadly speaking these fall into two main frames or viewpoints:

The dominant frame, let’s call it biology is destiny, sees female midlife in purely biological terms. From this viewpoint, our biology is seen to be responsible for all midlife symptoms, from the mild to the seriously uncomfortable. Physical solutions are found for discomforts, drawing on (at best) empirical, evidence-based research. This framework underpins most modern medicine and much alternative medicine too.

While it may seem surprising to group alternative remedies with mainstream medical treatments, this is because both are based on the same assumption. Whether you use the word treatment or remedy, the basic way of understanding what midlife discomforts are all about, is the same. The biology is destiny view of menopause, sees a woman’s body rather like a machine: something is wrong and needs fixing. Fix the biology and you fix the woman.

The only real difference between mainstream medical treatments and many alternative remedies is whether they have been widely tested by sound empirical methods. Some alternative solutions for menopause are harmless, but others are not. And since there’s limited evidence either way, neither the benefits nor the harms are clear - to anyone.

Let’s look at the other frame - the lived-experience view of women’s midlife.  This view is more nuanced and sees menopause biology as a part of a much broader process of each woman’s whole life. Every woman’s context for her midlife transition is as individual as she is. Our contexts are influenced as much by our culture, education, life stories and relationships as by our DNA.

Drawing on historical and ethnographic research, the lived experience viewpoint uses terms such as climacteric, from the German word Klimacterium meaning crisis, to refer to the whole process  of midlife transition. Importantly this view avoids the medicalizing language of dysfunction, failure and treatment - of something broken.

The lived experience view of women’s midlife sees menopause malaise as part of life’s flow. Symptoms come and go depending on how well we feel about ourselves, rather than on our dancing hormones.  Help is aimed at the whole woman in her individual life context and emphasizes lifestyle approaches such as diet and exercise. Complementary healing techniques that focus on the whole woman, provided they are safe, may also be relevant.

Recognizing these two ways of seeing midlife can help us see why information on menopause may leave us spinning and disorientated. The biology as destiny view of menopause dominates in Western industrialized cultures. While the lived experience view is more common in Eastern  traditional and non-industrialized societies, but is increasingly recognized in the West too. 

Two ways of seeing, two ways of being, but most important is this:

Just like the vase-face image, neither view is right or wrong. They co-exist at the same time. We women experience the shifting ambiguity through our lived experience, every day of our lives.

Dr Elinor Thompson is a British physician, educator and writer. You can read more of her writing on the midlife transition at