How to Treat a Menopausal Woman:
A History, 1900 to 2000
Judith A. Houck, MD
Address
University of Wisconsin-Madison Medical School, Center of Excellence
in Women’s Health, Meriter Hospital, 202 S. Park Street,
Madison, WI 53715, USA.
E-mail: [email protected]
Current Woman’s Health Reports 2002, 2:349–355
Current Science Inc. ISSN 1534-5874
Copyright © 2002 by Current Science Inc.
Over the course of the 20th century, physicians had a variety
of hormonal treatments to offer their menopausal patients.
This paper traces the development and deployment of these
therapies, which ranged from desiccated ewe ovary to the
modern estrogen replacement therapy. In addition, this paper
demonstrates that women often medicated themselves at
menopause, turning perhaps to Lydia Pinkham's vegetable
tonic or the more modern Change-O-Life elixir. Finally, this
paper discusses the larger societal approaches to eliminating
menopausal symptoms.
Introduction
A walk in the country. A talk with a doctor. A bit of desiccated ewe’s ovary. A shot of diethylstilbestrol (DES). Votes
for women. Women’s Liberation. Barbiturates. Paid
employment. A college education. Lydia Pinkham’s vegetable tonic. Hormones.
This seemingly disparate list illustrates the varied
personal, medical, and social responses to the question:
“What is the best way to help women through the sometimes difficult transition of menopause?” The range of
answers indicates that menopause is more than the loss of
fertility, more than the loss of estrogen. Instead, menopause is a social, cultural, and physiologic transition, and
anyone attempting to successfully shepherd women
through this period must consider all these factors.
This paper examines how women’s menopausal difficulties were addressed over the course of the 20th century
in the United States. Although changing medical therapeutics occupy the central position of this paper, it also
addresses the social solutions promoted by menopausal
women and their physicians. Even while navigating the
various new therapeutic options at their disposal, doctors
never lost sight of the complexities of menopausal
women's individual lives, and their larger social roles.
Many physicians believed that in order for women to suc-
cessfully travel through menopause, society needed to
examine the plight of middle-aged women.
What is menopause?
Technically, menopause refers to a woman’s last menstrual
period. A woman can be said to have reached menopause
when she has gone 1 year without menstruating. The
climacteric, or climacterium, was used to refer to the wide
variety of physiologic changes occurring in the years immediately surrounding menopause. (Perimenopause is a relatively
new term to designate the time prior to menopause.)
Although physicians understood the distinction between the
terms throughout the 20th century, they were often used
interchangeably in the medical and popular literature.
What menopausal difficulties?
Before exploring the treatments for menopause, it is
important to understand what women experienced at
menopause that warranted treatment. The “symptoms” of
menopause changed significantly over time, and differed
by culture [1,2]. In 18th-century England, for example,
physicians commonly referred to “hysterical vapors, plethora, bleeding piles, and fluor albus [leukorrhea]” as the
most common symptoms of menopause [3]. By the
middle of the 19th century, the list had grown extensively.
One British expert identified more than 100 “symptoms”
of menopause, including diabetes, epilepsy, and insanity
[4]. By 1900, physicians had pared the list considerably,
but the process of determining exactly what qualifies as a
symptom or consequence of menopause continues.
Between 1900 and 2000, menstrual irregularities
became the most widely recognized signs associated with
menopause. Women generally experienced longer intervals
between their menstrual periods, perhaps noticing
decreased or increased flow. Occasionally, this increased
flow could be quite alarming, leading women to seek
medical help. Throughout the 20th century, physicians
also identified vasomotor symptoms. The hot flash or hot
flush, a sensation of heat concentrated in the head and
neck, but which can overtake the entire body, attracted the
most discussion. Sweating, sometimes negligible, sometimes copious, was associated with these flashes. Other
symptoms connected to the vasomotor system and identified as menopausal included vertigo, heart palpitations,
and high blood pressure. Headaches, constipation, heartburn, numbness, insomnia, nausea, vaginitis, and general
350
Menopause and the Aging Woman
pruritus rounded out the list of commonly reported complaints. (Some of these symptoms are now understood as
vasomotor disturbances or linked to vasomotor disturbances, but the association has not always been clear.)
In the past 50 years, osteoporosis and arteriosclerosis were
increasingly mentioned in association with menopause.
While they have rarely been described as symptoms of menopause, they are frequently discussed as consequences of
declining estrogen levels. As a result, they have consistently
been listed as justifications for medical intervention.
In addition to the physical symptoms of menopause,
physicians linked menopause with a variety of mental and
emotional symptoms such as nervousness, irritability, anxiety,
depression, and insanity. Physicians have long debated the
genesis of the emotional and mental symptoms of menopause; some doctors maintained that fluctuating hormones
directly caused emotional difficulties, while other doctors
attributed them to the social changes coincident to middle
age. Although the distinction was theoretically important to
some physicians, in reality, women who sought relief at
menopause cared less about which symptoms were attributable to what mechanism, and more about what could be
done to help them feel better.
Women helping themselves
Most women during the last century did not seek medical
intervention at menopause, citing lack of money, lack of
knowledge, and lack of need as a few of the various
reasons. Just because women stayed away from physicians,
however, does not mean that they merely gritted their teeth
and waited for the symptoms to pass. Women have always
turned to a variety of remedies not controlled by the
medical profession.
Perhaps the most historic therapy for menopausal difficulties was liquor. Whether to help them sleep, take the
edge off nervous anxiety, or to steel themselves for uncomfortable intercourse, women frequently turned to alcohol
during the menopausal years [5]. But other products were
marketed directly for women for "female complaints."
Over the course of the 20th century, menopausal women
turned to various preparations, including Lydia Pinkham’s
vegetable compound, Famous Specific Orange Blossom,
Dr. Pierce’s Special Prescription, and Doan's Pills. In the
past 10 to 15 years, over-the-counter products for menopause proliferated. A woman visiting her local pharmacy or
health-food store could choose from a variety of herbal
remedies (chaste tree berry, black cohosh root), soy products, and progesterone creams, all promising relief from
the various symptoms of menopause.
Medical Solutions to Menopausal Problems:
1900–1937
Although over-the-counter remedies were always readily
available, some women turned to their physicians for help.
At the beginning of the 20th century, physicians had very
little to offer their menopausal patients beyond a sympathetic ear and some lifestyle advice. In general, physicians
agreed that menopausal women should acquire and maintain healthy habits, get lots of rest, and exercise daily in the
fresh air. They urged women to eat a moderate diet, shun
alcohol, and avoid tight clothing. Some doctors also
recommended a change of scenery to keep women's minds
from the details of domestic life.
At approximately the same time, a new therapeutic solution to menopause began to emerge—organotherapy. Also
known as ovarian therapy, this was the precursor to modern
hormone replacement therapies (HRTs). The emergence of
organotherapy as a treatment for menopause arose from the
fascination with "internal secretions," the mysterious and
elusive substances assumed to exist in the endocrine glands of
both men and women. Although the thyroid hormone was
isolated in 1891, the existence of such “internal secretions” in
ovaries and testes remained speculative until the 1920s.
Despite the tentative nature of their understanding at the
time, some scientists eagerly promoted the therapeutic use of
various extracts. French-born physiologist Charles-Edouard
Brown-Séquard, for instance, sparked the field by injecting
himself in 1889 with extracts from guinea pig and dog testes.
He reported renewed vigor as a consequence [6,7].
The first use of ovarian therapy for gynecologic disturbances occurred in Berlin in 1898, when fresh cow ovaries
were fed to a young woman who had her ovaries removed
and was suffering from severe vasomotor symptoms. By
1910, researchers in the United States began using ovarian
preparations to "combat the insufficiency or absence of the
ovarian function at the time of menopause" [8].
Between 1910 and 1929, organotherapy was crude at
best. At the beginning of the century, fresh animal ovaries
were ground up and fed to menopausal patients. Gradually, this method fell out of favor, and physicians increasingly relied on the desiccated ovaries of farm animals such
as ewes, cows, and mares. According to one source, the
most effective ovaries were harvested "during the time of
[the animals'] full sexual maturity" [8]. The most advanced
method relied on "ovarian extracts," suspensions created
by combining minced ovaries with alcohol.
Despite the promise of organotherapy, most physicians
remained skeptical about its worth. Some physicians
objected to organotherapy because the methods of administration were so crude. Indeed, it was unclear whether
early ovarian extracts even contained the "active principle"
endocrinologists claimed resided within the ovary [9].
Other physicians objected on practical grounds, insisting
that ovarian therapy had not been proven effective in
relieving menopausal symptoms [10,11]. In general, while
most physicians agreed that ovarian extracts may eventually prove their worth, until the late 1920s, most physicians
believed that the results were too variable to recommend.
Despite these objections, some physicians, both gynecologists and general practitioners, recommended ovarian therapy during this period, sometimes enthusiastically. Even
How to Treat a Menopausal Woman: A History, 1900 to 2000 • Houck
organotherapy proponents conceded, however, that most
women did not need pharmaceutical intervention [12,13].
The position of the eminent Johns Hopkins gynecologist
Emil Novak is instructive. In a 1922 medical journal, Novak
reviewed the efficacy of ovarian therapy for gynecologic difficulties. While he concluded that ovarian therapy had not
been proven effective for disorders such as dysmenorrhea,
sterility, or morning sickness, he believed that for the "vasomotor symptoms" of menopause, hot flashes in particular,
ovarian extracts could be helpful. Despite his enthusiasm,
however, he insisted that most women “need no medical
treatment whatsoever” [14].
After 1929 and the isolation of estrogen, ovarian therapy
(now legitimately termed hormonal therapy) became more
refined and presumably more effective. Consequently, physicians began to shed their earlier skepticism about its value for
menopausal patients. For a very few women with severe and
debilitating symptoms, estrogen therapy emerged as valuable
therapeutic option. Nevertheless, its cost and relative scarcity
discouraged its widespread use.
Medical Solutions to Menopausal Problems:
1938–1962
The therapeutic options for menopausal women changed significantly after 1938. In that year, a British biochemist, Sir
Charles Dodds, developed a synthetic hormone, diethylstilbestrol (DES). With the development of DES, the cost of hormones dropped precipitously, placing hormonal relief of
menopausal symptoms "within the reach of any woman who
can pay from 3 to 8 cents a day" [15]. In 1943, James Goodall
developed an estrogen extract from the urine of pregnant
mares. This product, known as conjugated estrogen, had all
the benefits of DES with none of its potential side effects [16].
Despite the increased availability of hormone treatments after 1938, most physicians were slow to embrace
them. Instead, they still recommended reassurance as the
treatment of first choice. Doctors had many reasons for
promoting reassurance as the best therapeutic option.
Many physicians believed, for example, that women
acquired, whether from gossip around the bridge table or
from conversations with a maiden aunt, a great deal of
misinformation about what happened at menopause.
Consequently, they argued that merely educating women
about the changes in their bodies, reassuring them that
menopause did not bring calamity, would go a long way to
calm the jittery nerves and creeping anxiety associated with
these years. Furthermore, many physicians understood that
a woman’s nervousness at menopause might have nothing
to do with hormonal changes. Rather, doctors acknowledged that menopause coincided with many social and
familial transitions that might explain a woman’s irritability. Children moved out, parents moved in, businesses
failed, marriages fractured. Why treat women with
hormones, these physicians asked, when their problems
were caused by external rather than internal fluctuations?
351
Nevertheless, physicians understood that some women
needed more than a heart-to-heart talk and a lesson in physiology. For these women, many physicians recommended the
short-term use of mild sedatives, typically 15 mg of
phenobarbital, three times daily. Aware of the addictive
potential of barbiturates, most physicians recommended
sedation only as a short-term treatment to temporarily ease
the anxiety and nervousness many women experienced. In
theory, sedatives helped women adjust to their new social
circumstances or cope with their family crises.
Only if reassurance or sedation failed did most physicians
recommend hormone treatments for menopausal patients.
Most of the medical literature reserved hormonal therapy for
women with severe, unrelenting symptoms. Physicians typically claimed that only 5% to 10% of women seeking medical
attention at menopause met the criteria for hormone therapy
[17,18]. Most physicians agreed with Emil Novak, who
claimed that, in general, "it seems better to let nature take its
course except in those cases and at that those times when
symptoms become very troublesome" [19].
When physicians prescribed hormones between 1938
and 1962, most believed that the treatment should be discontinued as soon as possible, arguing that replacement
hormones merely prolonged menopause by postponing the
body's adjustment to diminished estrogen. According to one
physician, "hormone therapy is only a means of combating
nature's efforts to effect endocrinologic readjustment that
must come sooner or later" [20]. As a result, most physicians
advised that women be given increasingly lower doses, with
the goal of weaning off them entirely.
Fear of cancer prompted the cautious approach of
some physicians. By 1940, more than a dozen scientists
claimed that both synthetic and natural estrogens were
capable of causing cancer in female animals [21•,22,23].
Others voiced fear of the carcinogenic effects of estrogenic
compounds on the breasts and uteri [24]. The fear was
great enough for Edgar Allen, one of the pioneers of endocrinology, to condemn the "indiscriminate" use of estrogen
therapy in menopausal women [25••]. The cancer scare
became even more menacing in 1947, when Saul Gusberg
linked estrogen to cancer of the endometrium, leading him
to conclude that physicians overprescribed estrogens to
postmenopausal women. "The relatively low cost of stilbestrol [synthetic estrogen] and the ease of administration
have made its general use promiscuous," he warned [26].
Physicians differed sharply on the significance of the cancer threat. A very few found the evidence of a link between
estrogen and cancer so persuasive that they viewed the
increased availability of estrogen as a potential danger to
women [18]. On the other end of the spectrum, some physicians dismissed the cancer threat entirely [27]. The majority
stood somewhere in between, believing that "although there
is no proof that estrogenic substances are carcinogenic in
themselves, there is evidence that carcinoma occurs more frequently" in women with high estrogen levels [28]. Consequently, most physicians advocated a conservative approach.
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Menopause and the Aging Woman
When physicians prescribed estrogen therapy, most
viewed it as a short-term solution to a temporary problem.
In the mid-1950s, however, a few physicians began to
promote indefinite use. The probable origin of this therapy
was the work of Fuller Albright and his colleagues at
Harvard Medical School and Massachusetts General
Hospital. In a 1941 Journal of the American Medical Association article, Albright claimed that the "postmenopausal
state" was the most significant factor in osteoporosis, and
that estrogen therapy helped bones retain calcium [29••].
Following the implications of their mentor's work,
Albright's students, Philip Henneman and Stanley Wallach,
believed that long-term use of estrogens was important to
halt the progression of postmenopausal osteoporosis [30].
Making bolder claims than their teacher, Henneman and
Wallach also suggested that estrogen therapy benefited
women's "emotional stability, sleep patterns and sense of
energy," thus providing an "important dividend of estrogen therapy." This dividend alone provided "sufficient reason for the general use of prolonged estrogen replacement
of the postmenopausal woman" [31].
Other researchers made similar claims about the ability
of long-term estrogen therapy to reduce coronary atherosclerosis in postmenopausal women. As early as 1953,
researchers claimed that women's increased heart disease
after menopause was due to decreased estrogen, and by
1954, researchers claimed that estrogen therapy decreased
the incidence of heart disease. This encouraged the longterm prescription of hormones to prevent heart disease
[32•,33–35].
Medical Solutions to Menopausal Problems:
1963–1975
The therapeutic landscape for menopause changed in 1963,
not because of new pharmaceutical developments, but
because of a campaign led by a Brooklyn gynecologist, Robert A. Wilson. In a 1963 article published in the Journal of the
American Geriatrics Society, Wilson and his wife, Thelma,
argued that untreated menopause robbed women of their
femininity and doomed them to live the remainder of their
lives as mere remnants of their previous selves. Detailing the
dire consequences of "Nature's defeminization," the Wilsons
claimed that estrogen depletion, the cause of menopausal
and postmenopausal afflictions, led to hypertension, high
cholesterol, osteoporosis, and arthritis. In addition, the
Wilsons insisted that menopause frequently led to serious
emotional disturbances; even women who escaped debilitating depression frequently acquired a "vapid cow-like feeling
called a negative state." The authors knowingly maintained
that these women see the world "through a gray veil, and
they live as docile harmless creatures missing most of life's
values." Indeed, the Wilsons believed that these women
"exist rather than live" [36••].
Robert Wilson took his message of decay to a broader
audience in 1966 with his book, Feminine Forever. This
book reiterated the grim language of the Wilsons’ earlier
article, and issued a further warning. In prose designed to
alarm, Wilson described menopause as a "deficiency disease" much like diabetes. But unlike diabetes, he claimed,
menopause did not merely rob women of their health; it
also stole their youth, femininity, and sexuality [37•].
The Wilsons did not, however, abandon menopausal
women to their dreary fate. Rather, they promised a pharmaceutical escape route: estrogen replacement therapy
(ERT). Comparing ERT with insulin, the Wilsons insisted
that replacement therapy could both cure and prevent
estrogen deficiency disease. By allowing women to remain
“fully sexed," long-term hormone therapy prevented the
“supreme tragedy” of women’s lives [37•].
The popular media swiftly publicized Wilsons’ claims.
By 1964, Time and Newsweek had published articles extolling the promise of hormone therapy to “cure” menopause,
and women's magazines followed in 1965 [38–40]. The
publicity intensified after the publication of Feminine
Forever. The book itself sold more than 100,000 copies in
the first 7 months after its release [41]. Perhaps most
important, it generated an interest in menopause reflected
in a flood of popular articles and books.
Although Wilson did not represent medical orthodoxy,
his efforts to increase the use of hormone therapy
succeeded. Drug companies followed the free publicity
gained by Wilson's efforts with their own advertising
campaigns aimed at informing physicians of the wideranging benefits of hormone therapy. (Indeed, Wilson's
research foundation, devoted to the elimination of "estrogen deficiency disease," was funded in part by donations
from several drug companies.) Furthermore, some women,
encouraged by the promise of relief from hot flashes or
compelled by the image of a more youthful appearance,
demanded hormones from their physicians. In time, most
physicians acquiesced to pressure from both sides and
from the desire to help their menopausal patients. Some
doctors eventually saw HRT as a godsend for menopausal
women, providing both long- and short-term benefits with
no apparent drawbacks. Other physicians prescribed
hormones more reluctantly, giving in to their patients’
demands while still believing that most women needed
only an encouraging talk and a stiff upper lip to see them
through the rough times. Regardless of the lingering
doubts of some physicians, estrogen sales more than
quadrupled between 1962 and 1975 [42].
Medical Solutions to Menopausal Problems:
1975–Present
In 1975, at the height of estrogen's popularity, two articles in
the New England Journal of Medicine dealt the therapy a significant blow. Researchers at Kaiser-Permanente Medical Center
in Los Angeles (Ziel and Finkle) [43••] and at Washington
University in St. Louis (Smith et al.) [44••] independently
discovered a link between postmenopausal estrogen therapy
How to Treat a Menopausal Woman: A History, 1900 to 2000 • Houck
and endometrial cancer. The Ziel/Finkle study demonstrated
an endometrial cancer rate 14 times higher in women who
had used conjugated estrogens for 7 years or longer than
among women who had never used them [43••]. Although
researchers had proposed a link between estrogen and cancer
since the 1940s, these landmark studies supplied the best
evidence at the time that ERT posed a cancer risk in humans,
and sparked further research.
Physicians did not abandon HRT altogether after 1975.
Instead, they proceeded cautiously. Physicians wrote more
than 28 million prescriptions for replacement hormones
in 1975; in 1980, they wrote only 15 million [45]. Furthermore, they lowered the dosage and shortened the duration
of treatment [46].
The use of replacement hormones at menopause
rebounded after 1980, with the number of prescriptions in
1989 far outnumbering the 1975 peaks. Several factors
helped explain this phenomenon. First, the aging babyboomer cohort swelled the ranks of women facing menopause. Second, these women continued to want relief from
menopausal symptoms. Third, physicians routinely added
progestin to the estrogen treatment, a regimen that was felt to
eliminate the cancer risk. While this combination was prescribed for years, it became the standard hormonal therapy
for women with intact uteri only after 1975. Fourth, drug
companies began stressing the risk of osteoporosis after
menopause, and promoted HRT as a preventative therapy.
Fifth, new research stressed the possible benefits of estrogen
on preventing heart disease. (This last claim is still
contested.) These various developments ensured hormonal
treatments for menopausal women a prominent and enduring place in modern therapeutics. Indeed, in 1998, 34% of
women older than 50 years of age took some form of
prescription hormonal therapy (up from 23% in 1993) [47].
Social Solutions to Menopausal Problems
Despite the many remedies for menopause that centered
on the needs of a woman’s body, physicians, menopausal
women, and various social commentators always understood that some of the difficulties women experienced at
menopause could be attributed to their nebulous social
roles. How could a woman prove her value to society after
she could no longer bear children? What activities were
appropriate for women older than 50 years of age? To fully
remedy the difficulties of menopause, society had to
address the situation of the middle-aged woman.
Physicians and other social commentators during the
first third of the 20th century believed that many women
became depressed and anxious at menopause because they
feared that their life’s work was behind them, and that they
no longer offered a valuable service. To offset this concern,
physicians assured women that they still had much to
offer. To stave off depression and self-pity, many physicians
and other health writers at the time urged menopausal and
postmenopausal women to turn their considerable talent
353
to “community housekeeping.” These authors urged
women to take up social causes, particularly those that
looked after the “welfare of others” [48].
Pouncing on what seemed to be the general agreement
that menopausal women needed useful work to avoid
menopausal debility, Clelia Duel Mosher pressed the point
further in 1918. Mosher, a physician at Stanford University,
argued that community housekeeping still left women’s
talents “shamefully wasted.” She insisted that only votes
for women would protect “the community from the
menace of the unoccupied middle-aged women,” while
also saving money otherwise “wasted in doctors’ bills,
sanatorium treatment, or dangerous fads” [49].
In the 1950s and 1960s, physicians continued to urge
menopausal women to throw themselves into community
service as an alternative to dwelling on their sleepless
nights or their graying hair. But some health writers proposed a more “subversive” therapy, paid employment.
"Careers for women," replaced the call for suffrage as a
cure for the menopausal blues. According to these writers,
professional women might experience menopausal disturbances, but their busy lives would not let them indulge
every twinge or inconvenience [50–52].
In the 1960s and 1970s, the widespread use of estrogen
therapy, the increasing involvement of women in politics,
and the growth of women in the work force still left
women wanting more assistance dealing with the physical
and social changes of menopause. They wanted the opportunity to talk with other women about how to fashion a
new life after a divorce, how to soothe a querulous motherin-law, and how to cope with the discomfort of vaginal dryness. They wanted the chance to revisit dreams deferred by
childbearing and homemaking. They wanted physicians
who treated them with respect. For some women, these
needs translated into support for the Women's Liberation
Movement. Indeed, some feminists proposed women's
liberation as the only sure remedy for the problems
women faced at menopause [53–55].
Conclusions
The story of menopause in the 20th century was dominated by the development of hormonal therapies.
Although, as this paper illustrates, hormones provide a
framework for examining the history of menopausal treatment, they do not tell the whole story. Throughout
the 20th century, menopausal women faced various
challenges, from coping with hot flashes and night sweats
to dealing with the discomfort of vaginal dryness, and
from wondering how to fill the day after the children left
home to imaging how to stretch a budget to accommodate
a recently widowed father. Over-the-counter remedies and
hormonal treatments focused on stabilizing unsteady
nerves and eliminating vasomotor symptoms. Menopausal
women (and sometimes their doctors) knew, however, that
a complete solution to their problems could not focus
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Menopause and the Aging Woman
exclusively on their bodies. Indeed, many women knew
that societal change was needed. A society that embraced
middle-aged women's nonreproductive contributions
could alleviate aspects of menopausal distress not reachable by a purely hormonal treatment.
References and Recommended Reading
Papers of particular interest, published recently,
have been highlighted as:
•
Of importance
•• Of major importance
1.
Lock MM: Encounters with Aging: Mythologies of Menopause in
Japan and North America. Berkeley: University of California
Press; 1993.
2. Beyene Y: From Menarche to Menopause: Reproductive Lives of
Peasant Women in Two Cultures. Albany: State University of
New York Press; 1989.
3. Lord A: To Relieve Distressed Women: Teaching and Establishing
the Scientific Art of Man-Midwifery or Gynecology in Edinburgh
and London, 1720–1805 [dissertation]. Madison, WI: University
of Wisconsin Press; 1995.
4. Tilt E: The Change of Life in Health and Disease. A Practical Treatise
on the Nervous and Other Affectations Incidental to Women at the
Decline of Life. London: 1857.
5. McClellan M: Lady Lushes: Women Alcoholics and American Society, 1880–1960. Palo Alto, CA: Stanford University Press; 2000.
6. Oudshoorn N: Beyond the Natural Body: An Archaeology of
Sex Hormones. London: Routledge; 1994.
7. Borell M: Organotherapy and the emergence of reproductive
endocrinology. J Hist Biol 1985, 18:1–30.
8. [No authors listed] To combat the annoying symptoms of the
menopause. NY Med J 1910, 91:756.
9. Sanes K: The vertigo of the menopause. Am J Obstet Dis Women
Children 1919, 79:10–12.
10. [No authors listed] Oral use of ovarian products in
menopause not established. JAMA 1930, 95:1119.
11. Lisser H: Organotherapy: present achievement and future
prospects. Endocrinology 1925, 9:1–20.
12. Hirst J: A Manual of Gynecology, edn 2. Philadelphia:
WB Saunders; 1925.
13. Swanberg H: The control of menopausal symptoms.
IL Med J 1937, 72:442–443.
14. Novak E: An appraisal of ovarian therapy. Endocrinology
1922, 6:614–615.
15. Ross R: The involutional phase of the menstrual cycle
(climacteric). Am J Obstet Gynecol 1943, 45:504.
16. Bell S: Gendered medical science: producing a drug for
women. Fem Stud 1995, 21:469–500.
17. Danforth D: The climacteric. Med Clin North Am 1961, 45:52.
18. Hamblen E: The female climacteric. VA Med Monthly 1940,
67:24–29.
19. Novak E: Some misconceptions and abuses in gynecological
organotherapy. PA Med J 1945, 48:771–774.
20. Payne F: The postmenopausal patient. J Med Assoc Alabama
1952, 22:31–36.
21.• Cook J, Dodds E: Sex hormones on cancer-producing
compounds. Nature 1933, 137:205–209.
One of the first articles to suggest that estrogen may be a carcinogen.
22. Gardner W: Tumors in experimental animals receiving steroid
hormones. Surgery 1944, 16:8–14.
23. Perry I, Ginzton L: The development of tumor in female mice
treated with 1:2:5:6: dibenzanthracone and theelin. Am J
Cancer 1937, 29:680–682.
24. Geist S, Salmon U: Are estrogens carcinogenic in the human
female. Am J Obstet Gynecol 1941, 41:29.
25.•• Allen E: Ovarian hormone and female genital cancer. JAMA
1940, 114:2107.
Perhaps the first article to link estrogen to cancer in women.
26. Gusberg S: Precursors of corpus carcinoma: estrogens and
adenomatous hyperplasia. Am J Obstet Gynecol 1947, 54:905.
27. Rogers J: The menopause. N Engl J Med 1956, 254:697–704.
28. Jones G: Physiology and management of the climacteric.
Cal Med 1949, 71:345–348.
29.•• Albright F, Smith P, Richardson A: Postmenopausal osteoporosis: its clinical features. JAMA 1941, 116:2474.
The best early article connecting menopause with osteoporosis.
30. Henneman P, Wallach S: The use of androgens and estrogens
and their metabolic effects: a review of the prolonged use
of estrogens and androgens in postmenopausal and senile
osteoporosis. Arch Intern Med 1957, 100:715.
31. Henneman P, Wallach S: Prolonged estrogen therapy in
postmenopausal women. JAMA 1959, 171:1637–1642.
32.• Wuerst J, Dry T, Edwards J: Degree of coronary atherosclerosis
in nilaterally oophorectomized women. Circulation 1953,
7:801–809.
An early article on the connection between menopause
and atherosclerosis.
33. Rivin A, Dimitroff S: Incidence and severity of atherosclerosis
in estrogen-treated males and in females with hypoestrogenic or hyperestrogenic state. Circulation 1954, 9:533–539.
34. Robinson W, Higano N, Cohen W: Increased incidence of
coronary heart disease in women castrated prior to menopause. Arch Intern Med 1959, 104:908–913.
35. Robinson W: Estrogen replacement therapy in women with
coronary atherosclerosis. Ann Intern Med 1958, 48:95–101.
36.•• Wilson R, Wilson T: The fate of the nontreated postmenopausal woman: a plea for the maintenance of adequate
estrogen from puberty to the grave. J Am Geriatr Soc 1963,
11:347–362.
In this landmark article, the Wilsons launch a campaign to prescribe
hormone replacement therapy for all women from "puberty to
the grave."
37.• Wilson R: Feminine Forever. New York: M. Evans and Company;
1966.
This best-selling book, widely serialized and excerpted in newspapers
and popular magazines, publicized the idea that menopause was
an estrogen deficiency disease, and promoted estrogen replacement
therapy as its cure.
38. [No authors listed] No more menopause. Newsweek 1964,
1(13):53.
39. [No authors listed] Durable, unendurable women. Time
1964, 10(16):72.
40. Kaufman S: The truth about female hormones. Ladies' Home
Journal 1965, 1:22–23.
41. Mintz M: The Pill: An Alarming Report. Greenwich, CT:
Fawcett Publications; 1969.
42. Greenwald P, Caputo TA, Wolfgang PE: Endometrial cancer
after menopausal use of estrogens. Obstet Gynecol 1977,
50:239.
43.•• Ziel H, Finkle W: Increased risk of endometrial carcinoma
among users of conjugated estrogens. N Engl J Med
1975, 293:1167–1170.
One of two articles published in 1975 designed to provide strong
evidence that estrogen replacement therapy increased the risk of
endometrial cancer.
44.•• Smith DC, Prentice R, Thompson DJ, Herrmann WL:
Association of exogenous estrogen and endometrial
carcinoma. N Engl J Med 1975, 293:1164–1167.
The other of the two articles published in 1975 to provide strong
evidence that estrogen replacement therapy increased the risk of
endometrial cancer.
45. Worcester N, Whatley M: The selling of HRT: playing on
the fear factor. Fem Rev 1992,6:1–26.
46. Pasley B, Standfast S, Katz S: Prescribing estrogen during
menopause: physician survey of practices in 1974 and
1981. Pub Health Rep 1984, 99:424–429.
How to Treat a Menopausal Woman: A History, 1900 to 2000 • Houck
47.
48.
49.
50.
Collins KS, Schoen C, Joseph S, et al.: Health Concerns Across a
Woman's Lifespan: The Commonwealth Fund 1998 Survey of
Women's Health. New York: The Commonwealth Fund; 1999.
http://www.cmwf.org/programs/women/
ksc_whsurvey99_332.asp
Fielding W: What the Woman Past Forty Should Know.
Girard, KS: Haldeman-Julius; 1925.
Mosher C: Health and the Woman’s Movement. New York:
The Woman's Press; 1918.
Miller L: Changing life sensibly. Independent Woman
1939, 9:297.
51.
52.
53.
54.
55.
355
Davis M: Facts About the Menopause. New York:
McGraw Hill; 1951.
Gray M: The Changing Years; What to Do About the Menopause.
Garden City, NY: Doubleday; 1951.
Cooke C. Dworkin S: The Ms. Guide to a Woman's Health.
Garden City, NY: Doubleday; 1979.
Clay V: Women: Menopause and Middle Age. Pittsburgh:
Know Inc.; 1977.
Bart P: Depression in middle-aged women. In Female
Psychology: The Emerging Self. Edited by Cox S. Chicago:
Science Research Associates; 1976:349–367.