Reframing Menopause beyond Biomedicine 

As part of the Moving Bodies takeover, Cassandra Phoenix and Marjolein de Boer use an interdisciplinary approach to discuss the relationship between bodies, movement and sexuality

Menopause affects 50% of the population (The Lancet 2022) with global projections of “up to 1.2 billion post-menopausal women after 2030” (Foxcroft 2009, xiv). Recent years have been characterised by an unprecedented level of cultural conversation surrounding the menopause, to the extent that some suggest we are amidst the menopausal turn (Jermyn 2023). While its historical legacy of secrecy, stigma and taboo undoubtedly continues, today menopause is the subject of Government reports, workplace policies, TV documentaries, podcasts, a burgeoning self-help literature, newspaper headlines, and countless celebrity endorsed social media posts. Much of this has advocated for improved awareness, education, and access to support.  

Calls for Critical Scholarship 

As menopause becomes increasingly prominent within cultural consciousness, the importance of critical scholarship also intensifies. For example, while increased visibility of menopause has been welcomed, it has been confined to narrowly defined groups of typically white, cisgendered, able-bodied, middle-aged, middle classed women. Meanwhile, voices of LGBTQ+ people, those living with disability, encountering premature menopause, or having never given birth, are overlooked (Throsby and Roberts 2023). In addition, as knowledge of this “major life event” continues to be dominated by biomedical framings, which foreground menopause as a hormone deficiency; a health risk; a problem to be solved often through pharmaceutical intervention (e.g. Hormone Replacement Therapy), or lifestyle change (e.g. physical activity, diet) (Orgad and Rottenberg 2023).  

Senior retired couple kiss and embrace in a pool underwater while on vacation
Retired Couple on Holiday. Credit: SolStock.

Breaking the stronghold of taboo requires that we ask more nuanced questions of menopause, including questions that approach knowledge as being rooted in the lived experiences of people with a variety of life-contexts. This also involves questions concerning “the ways power and politics interact with bodies, biology, health and life itself” and challenge us to “consider how new knowledge is shaped, how it influences our understandings of ourselves and how such [biomedical] framings enable a seamless translation into response and responsibility” (Atkinson, Evans, Woods and Kearns 2015, 75). Exciting contributions to this endeavour include previous activities aimed at reinventing, rethinking and representing menopause at the University of Cambridge; a programme of work by Kings College London on normalising the menopause, the Menopause: New Perspectives project, and forthcoming transdisciplinary research MAUSI.Net.  

Through its broadening of sites and scales of ‘the medical’ beyond clinical encounters, and its robust commitment to new forms of interdisciplinary collaboration (Viney, Callard and Woods 2015), critical medical humanities has much to offer menopause research. Scholars working within sport and exercise sciences, and medical humanities rarely enter dialogue around research endeavours, despite the complementary work that is often taking place. The Medical Humanities and Sport & Exercise Sciences: An Invitation to Dialogue workshop enabled us to connect and explore our shared interest in advancing critical scholarship that works to expand and reimagine menopause beyond biomedicine.  

Movement and Sexuality  

Our contribution to the workshop involved a shared discussion of our separate research, which explores menopausal women’s lived experiences of movement (Phoenix), and sexuality (de Boer). Common to the contexts of both movement and sexuality, is how women’s bodies have often been excluded or framed as problematic. For example, historically, women’s participation in sport was seen as a threat to elite females’ fertility (Cahn 2015). The legacy of this exclusion can be seen in the under-representation of women in senior leadership roles and Board positions in the sport sector; the prevalence of sampling bias with sport and exercise sciences research (Walton et al. 2022), and by the lower participation rates for sport and physical activity among women and girls across the life course. Similarly, within persevering patriarchal cultural regimes wherein women’s bodies are objectified and sexualized, women are subjected to more violence, such as harassment and rape, expected to live up to demanding and often diametrically opposed norms of beauty, and to put themselves mainly in the service of others (Gervais et al. 2011). This can have repercussions for women’s sexual experiences, as evidenced in the persistent orgasm gap between men and women (Mahar et. al. 2020), the increasing demand for female genital cosmetic surgery (Kalampalikis and Michala 2023), but also in seeing their sexual organs and reproductive systems being misrepresented – or not represented at all – in popular culture (Nettleton 2015).

A mature black woman wearing casual sporty clothing in a public park on an overcast day in spring. She is celebrating after scoring a goal.
Woman Playing Football. Credit: SolStock.

Our respective health-related fields (SES, Phoenix; MH, de Boer) equip us well conceptually and methodologically to expand biomedical framings of menopause. Though different contexts, we share an attentiveness to the fleshy physicality of menopause as it shapes and is shaped by social structures and power relations. In the case of movement, ‘biological realities’ associated with menopause including bodily secretions such as bleeding, incontinence, and excessive sweating (often irregular, and unexpected), may need to be navigated within exercise settings such as the gym. This experience will be impacted by the social norms and structures of these spaces, which are typically gendered sites of body surveillance, in which highly disciplined bodies are cultivated, enacted, and celebrated (Cohen, Rosenberg and Davidson 2018). In the case of sexuality, vaginal dryness, night sweating, changed libido and orgasm can all require women to re-negotiate their sexual encounters with themselves and others, while simultaneously recalibrating, or indeed reclaiming their sense of womanhood, alongside pervasive norms of youthful and effortless femininity.  

Speaking across our different disciplinary backgrounds, encountering the familiar and unfamiliar, enabled us to maintain a rich dialogue regarding how menopausal women navigate different ways of being in their bodies and the world. For example, in their attempts to continue moving through menopause, many of the women involved in Cassandra’s research employed varied and elaborate strategies to maintain comfortable temperature, accommodate unpredictable bleeding, and manage energy levels. These practices included route planning, resting, changes to diet, along with their engagement with a raft of ‘tried and tested’ material objects such as clothing, pads and patches. Meanwhile, several participants involved in Marjolein’s research described how they had purposefully ventured away from normative sexuality during menopause by participating in, for example, partner swapping, educational courses (all-female) for achieving orgasms, or experimenting with bondage, discipline, dominance, and submission (BDSM) (De Boer 2023). Experiences like these help to reframe menopause beyond the biomedical, by illuminating the creativity and care that menopausal women embody and enact across different contexts in their day to day lives.  

About the authors 

Cassandra Phoenix is a Professor in the Department of Sport and Exercise Sciences at Durham University. She is a critical social scientist and her research currently focuses on women’s experiences of movement during perimenopause and menopause (with collaborators Jo Ann Kay, Durham University; Meridith Griffin, McMaster University; and Erica Bennett, University of British Columbia). Cassandra leads the Moving Bodies Lab, which forms part of the Wellcome funded Discovery Research Platform for Medical Humanities in Durham’s Institute of Medical Humanities.

Marjolein de Boer is an assistant professor in the Department of Culture Studies at Tilburg University. Her research focuses on women’s experiences of illness and medicalization. Throughout her work, she combines qualitative social scientific research with philosophical reflection. She currently works on her research project ‘Bodies in Transition. Making Sense of Menopause’, which is funded by the Dutch Research Council (NWO) as a VENI-project. Together with Lisa Guntram (Linköping University), she recently founded the research network WOMAHN which aims to provide a platform for researchers who work on women’s marginalized health. Cassandra is one of the key members of WOMAHN.

References 

Atkinson, S., B. Evans, A. Woods, and R. Kearns. 2015. “‘The medical’ and ‘health’ in critical medical humanities.” Journal of Medical Humanities 36: 71-81. 

Cohen, S., M.W. Rosenberg, and J. Davidson. 2018. “’It’s gym, like g-y-m not J-i-m’: Exploring the role of place in the gendering of physical activity.” Social Science & Medicine 196: 29-36. 

de Boer, M. 2023.”‘Becumming’ oneself as one relates to others: An empirical phenomenological study about sexual identity work in menopause. Sexualities. Online first. 

Gervais, S. J., T.K. Vescio, and J. Allen. 2011. “When What You See Is What You Get: The Consequences of the Objectifying Gaze for Women and Men.”  Psychology of Women Quarterly 35 (1): 5-17.  

Jermyn, D. 2023. “‘Everything you need to embrace the change’: The ‘menopausal turn’ in contemporary UK culture.” Journal of Aging Studies 64: 101-114. 

Kalampalikis, A., and L. Michala. 2023. “Cosmetic labiaplasty on minors: a review of current trends and evidence.” International Journal of Impotence Research 35: 192–195.  

Mahar, E.A., L.B. Mintz, and B.M. Akers. 2020. “Orgasm Equality: Scientific Findings and Societal Implications.” Current Sexual Health Reports 12: 24–32.  

Nettleton, P. H. 2015. “Brave Sperm and Demure Eggs: Fallopian Gender Politics on YouTube.” Feminist Formations: 25-45.  

Orgad, S., and C. Rottenberg. 2023. “Mediating menopause: Feminism, neoliberalism, and biomedicalization.” Feminist Theory. Online first.  

The Lancet. 2022. Attitudes towards menopause: time for change. The Lancet 399 (10343): 2243.

Throsby, K., and C. Roberts. 2023. “‘Bodies of Change: Menopause as Bio-psycho-social Process’.” In: Menopause Transitions and the Workplace: Theorising Transitions, Responsibilities and Interventions, edited by Vanessa Beck and Jo Brewis. Bristol: Bristol University Press. 

Viney, W., F. Callard, and A. Woods. 2015. “Critical medical humanities: Embracing entanglement, taking risks.” Medical Humanities 41: 2-7. 

Walton, C. C., K. Gwyther, C.X. Gao, R. Purcell, and S. Rice. 2022. “Evidence of gender imbalance across samples in sport and exercise psychology.” International Review of Sport and Exercise Psychology. Online first. 

One thought on “Reframing Menopause beyond Biomedicine 

  1. Thank you for this thought-provoking text. Scholarship relating to menopause may also be hidden by matters of emphasis. In my own Polyphony post on Fluxambol (Oct 2021), I reflect on movement -in this case walking along the river- as a response to a health challenge. What I do not say is that the particular type of breast cancer I experienced is closely intertwined with menopause. It is typically diagnosed in women around the age of 52, as I was. The treatment and medication brings on a chemical menopause with a new set of symptoms, albeit preferable to the symptoms of advanced breast cancer. Your text means I will start to refer to menopause in my own research writing and practice. Thank you for prompting this.
    https://thepolyphony.org/2021/10/29/fluxambol-prototyping-a-medicine-of-uncertainty/

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