“Not Done Yet?!” Women Discuss the “End” of Menopause

Click to increase image sizeClick to decrease image size Notes 1In biomedical descriptions of menopause, there is an assumption that all “normal” women menstruate regularly before menopause; therefore, menopause can be defined by the cessation of menstruation after twelve months. This becomes problematic, however, when we think about all of the different kinds of women who might not menstruate (e.g., pre-pubescent girls, pregnant women, breastfeeding women, athletes, anorexics, women with severe health conditions, women who have experienced recent traumatic injuries, intersexed individuals). Thus, biomedical definitions of menopause may be faulty from the start, if they are based on cessation of regular menstruation. 2Women with hysterectomies are not labeled as having reached menopause until age 55; however, because researchers calculate that, statistically, most women with naturally occurring menopause would not have reached menopause before this time (Prior, n. pag). Thus, in absence of menstruation, clinicians resort to an age-defined menopause for those with hysterectomies. 3Although some studies only define surgical menopause as that which includes the surgical removal of the uterus and the ovaries (Shinberg), we designate interviewees as undergoing surgical menopause if they had the uterus only or uterus and ovaries removed. While this is a liberal definition, because biomedical definitions revolve around the cessation of menstruation, all of these women are “done” or “skipping” perimenopause as it is biomedically defined. Nonetheless, there may be important differences between women with partial or full hysterectomies, as our data analysis begins to show. 4Women with surgical menopause did not try to judge the end of menopause through the cessation of periods, because they no longer experienced periods after hysterectomy. 5Importantly, postmenopausal interviewees and interviewees with surgical menopause (especially those with partial hysterectomies) might have been the only ones to know this yet. Perimenopausal women were still hoping that the cessation of menstruation would be their end. Thus, women's experiences of reproductive aging thus far affected their views on the end of menopause. 6Perhaps because vasomotor signs or symptoms seem less important to biomedical researchers and doctors than the cessation of menstruation, doctors have spent less time researching these signs or symptoms. While we cannot confirm this possibility with our data, we thank Samantha Kwan and Chris Bobel for pointing out this possibility and encourage others to research this. 7Whether these two women were experiencing hot flashes because of menopause or because of another health condition is unknown, but their perception was that their hot flashes were due to menopause despite their full hysterectomies. 8Women's use of hormone therapies further complicates the notion of when or whether there is an end to reproductive aging, because these therapies not only mask/alleviate symptoms but also lessen or stop menstruation at times as well. Even women with “natural” menopause might not know what stage of the process they represent if on hormone therapies. 9Women with partial hysterectomies in this sample had some of the most poignant realizations of this fact, as they realized that the removal of the uterus (and therefore, the possibility of continued menstruation) did not finalize menopause. 10This longstanding history of discrimination is well-documented by Lopez, Nixon et al., and Nsiah-Jefferson. 11This seemed to be the case for a few women who experienced full hysterectomies as well, since two of these women in our sample still reported long-lasting hot flashes or night sweats that they attributed to menopause.