Does menopause madness really exist? Middle-aged women shouldn't identify as crazy

The menopause had a “MeToo moment” the year I turned 45. It was 2020 and women were finally speaking out about their hot flushes and sleepless nights. The roots of this revolution could be tracked back to a 2017 interview with Lorraine Kelly, after which other well-known women started sharing their stories. The message to women my age was: “You are not alone.”

As a beneficiary of this new-found openness, I do not wish to appear ungrateful. Even so, there’s something about it that unsettles me. When Lisa Snowdon calls her show Midweek Menopause Madness, or the writer Kate Muir describes her “deranged perimenopausal mood swings”, or the actress Martine McCutcheon compares the approach of menopause with “losing your damn mind”, I am desperate to empathise. But I worry about the renewed embrace of the language of craziness to describe being an older woman.

“Thinking about menopause,” wrote Germaine Greer in The Change, “is like thinking about the menstrual cycle: there are two schools of thought”: “One holds that nothing of any significance is taking place, and the other that the stress and strain of what is taking place are so acute that sensible behaviour is not to be expected. Both kinds of arguments conceal crude misogyny. The ‘nothing happening’ school reserves the right to despise women who are encountering difficulties, and the ‘Sturm und Drang’ school allows itself to treat femaleness as a pathological condition.”

In talking about menopause, it seems that we are still in thrall to these two extremes. I fear that in its desire to reject the “nothing happening” state of affairs, which makes women who struggle with menopause feel wimpish and inferior, today’s menopause activism risks going all-out for “Sturm und Drang”. But what about those of us who do not want to be co-opted into this narrative, either?

The legacy of medical misogyny means there is pressure on women to emphasise the severity of symptoms in order to be taken seriously; we have so often been told our pain is “all in our heads”. Yet there is a simultaneous, overlapping history of female emotions — things which are indeed “all in our heads” — being pathologised. Women’s feelings have long been stripped of any social and political context, and therefore treated as purely biological, which makes it easier to apply the label of madness.

Given the ways in which women’s expressions of anger and anxiety are so often used to discredit us, I question just how liberating some of today’s “menopause madness” rhetoric is. “Some of our negative feelings about menopause,” wrote Greer, “are definitely the result of our intolerance for the expression of female anger.” For many of us, middle age is the first time we feel confident enough to acknowledge the validity of certain emotions. In her 2019 memoir Flash Count Diary, Darcy Steinke describes herself feeling “angry more often, a menopausal condition that doctors classify as hormonal irritability but that I’m starting to see as a gateway to authenticity”. If we see a woman’s expression of anger purely as an unpleasant biological symptom, rather than an acceptance of feelings that she might once have suppressed, we are in danger of undermining her. When I was younger, I was often told that my resistance to male authority was not “normal”, and I believed it. Is it pathological not to believe it anymore?

It is no small thing to tell the world that women your age are going insane, regardless of whether or not you blame this on hormonal depletion. As Elinor Cleghorn writes in Unwell Women, the discovery of oestrogen a century ago did not lead to a straightforward replacement of “old ideas about women being ‘naturally’ defective and deficient”: “Where female nature had, in the past, been blanketed as ‘hysterical’ and ‘neurotic’, now it was hormonal.” Personal accounts in a book produced by campaign group Menopause Mandate, entitled It’s Beyond a Joke, position the benefits of Hormone Replace Therapy as proof that women are not going “properly” mad, yet the distinction seems to me very fine. In the age of Karen, we have not evolved to a stage at which accounts of menopausal derangement can be treated as politically neutral. The shouty middle-aged woman is not taken seriously, regardless of whether she is categorised as mad, bad or simply medication deprived.

I am conscious that, in writing this, I may be accused both of being anti-scientific (because I find the biological realities politically inconvenient) and unsympathetic (because I am having a less extreme menopause than other women). In a piece for The Guardian, Kate Muir claims that “while some lucky women joyously ‘sail through’ the menopause with little more than red clover tea, the reality is that 80% have symptoms — from brain fog to anxiety, depression, sleeplessness, exhaustion, vaginal dryness and stiff joints”. I worry about being perceived as one of these “lucky” red clover tea women — a traitor to the menopausal cause, oblivious to the suffering of her peers.

I do not find this life stage easy. The reason I cringe every time a woman my age seeks to bond over our shared “craziness” is due to my own particular sensitivities. I have spent time as a patient in psychiatric hospitals; the credibility that comes with being perceived as “sane” is not something I treat lightly. I am not prepared to let go of it, in order to feel I am part of the “menopausal club”.

Besides, I am not the only person who finds the evidence base for “menopausal madness” shaky, and not all of us are feminists. Just how many women are having severe menopause symptoms is not a settled matter. Recent research puts those experiencing measurable changes in brain function during menopause at 23%. While this is not insignificant, it does not seem to justify the way in which all women are now primed to suffer from “menopause brain”.

It is also unclear why symptoms differ so much. A 2022 article in the BMJ argued that “social and cultural attitudes contribute to the varied experience of menopause”, and that over-medicalisation risks “collapsing the wide range of experience at the average age associated with this natural process into a narrowly defined disease requiring treatment”. The authors estimated the prevalence of moderate to severe symptoms to be 16-40%, based on a 2021 survey of 11,771 women. They also suggested that women’s expectations and experiences of menopause were strongly influenced by “personal, family, and sociocultural factors”, and by “social values around reproduction and ageing”.

The article was controversial. Some read in it a puritanical insistence that women should “keep calm and carry on”, despite there being treatments available to alleviate their suffering. To these readers, the authors’ resistance to medicalisation sounded like a return to the “nothing happening” school of thought described by Greer. The debate captured much about the push-pull nature of women’s relationship to medical authority. Are we validated by being labelled, or does validation come when we resist? And what might be the relationship between validation and truth?

My own view is that it is not in the least invalidating to acknowledge that how we feel about our bodies and minds is influenced by how we are told we should feel. Indeed, this is something with which women struggle at all stages of our lives. When teenage girls are described as prone to social contagion, some see in this a claim that their feelings are less real or painful. What I see is that women and girls are always presented with a limited range of acceptable things to express. Right now, “menopausal craziness” is socially and politically forgivable in a way that middle-aged women’s activism regarding other issues is not. This is not to say that hormones or bodily changes are irrelevant, but that the “mad” middle-aged woman is being constructed and discussed using only fragments of an experiential whole.

To be clear, this is not a call to be silent about menopause, or a dismissal of medical intervention when it is part of a holistic view of potential symptoms. Much good has been done in recent years by organisations such as The Menopause Charity and Menopause Mandate. I know women who say Hormone Replacement Therapy has changed their lives, and fully support attempts to make it more accessible and affordable for those who need it. Nonetheless, I resist the tendency to identify as menopausal crazy women. There are enough people in the world who will do this for us; we don’t need to do it to ourselves.

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