Journal of Aging Studies 25 (2011) 143154

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Journal of Aging Studies

j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / j a g i n g

Like mother, (not) like daughter: The social construction of menopause

and aging
Rebecca L. Utz
Department of Sociology, Center on Aging, and Institute for Public and International Affairs, University of Utah, Salt Lake City, USA

a r t i c l e

i n f o

Article history:
Received 24 March 2010
Received in revised form 10 June 2010
Accepted 26 July 2010
Keywords:
Women's health
Attitudes toward aging
Medicalization
Menopause
Generational differences

a b s t r a c t
In recent American history, the denition of menopause has shifted from a natural, developmental
transition to an increasingly more medicalized perspective that emphasizes biological decits of the
aging female body. Using qualitative data from two generations of women, this essay explores how
and why this redenition has occurred and what effect it has had on women's attitudes toward
health and aging. The physical experiences of menopause were remarkably similar across mother
daughter pairs; however, daughters (who represented a slice of the baby boom cohort) differed from
their mothers in how they talked about menopause, how they dened and treated menopause, and
how willingly they accepted or fought the changes associated with menopause. Major social
institutions, including the media and pharmaceutical industry, have played a signicant role in
reshaping the cultural lens through which women experience issues of health, body, and aging. This
essay emphasizes the baby boomers' desire to maintain control over their bodies and considers how
this cohort of women, as a result, may experience late-life issues of body and health.
2010 Elsevier Inc. All rights reserved.

Menopause just happened. We didn't do much about it, or

discuss it with others. It wasn't something that we, umm,
worried about.
Mother, Age 77

Menopause, Aging the women of my generation have all

decided that we aren't going to let that happen to us. .
haven't you seen the memo? I thought we made our point
loud and clear. Oh, yeah, and thank god for those little
pills! I don't know what I would do without them.
Daughter, Age 52
Introduction
The biology of menopause has not changed (Ellison, 2001;
Post, 1971); however, the cultural norms associated with
University of Utah, Dept of Sociology, 380 S 1530 E, Room 301, Salt Lake
City, UT 84112-0250, USA. Tel.: + 1 801 585 5496; fax: + 1 801 585 3784.
E-mail address: rebecca.utz@utah.edu.
0890-4065/$ see front matter 2010 Elsevier Inc. All rights reserved.
doi:10.1016/j.jaging.2010.08.019

menopause have undergone a radical transformation during

the latter half of the 20th century (Bell, 2006; Gannon & Stevens,
1998). What was once dened as a natural, developmental
transition of midlife is now considered an unpleasant marker of
old age that requires medical attention (Gannon & Eckstrom,
1993; Gannon & Stevens, 1998; Gullette, 1994; Guthrie,
Dennerstein, Taffe, & Donnelly, 2003; Meyer, 2003; Wilk &
Kirk, 1995). The two quotes above, from American women
whose lives span the time period in question, exemplify how
menopause has been socially re-constructed in recent decades.
Why, if menopause is a fact of biology, do women born
during different eras of American history offer such different
accounts? The answer relies on an assumption that biology
interacts with history and culture to produce a unique
individual experience of health (Datan, Antonovsky, &
Maoz, 1981; Lorber, 1997; Melby, Lock, & Kaufert, 2005).
Using qualitative data from two generations of American
women, this project specically explores how the dynamic
forces of culture and history have inuenced one's healthrelated attitudes and behaviors at midlife (Spiro, 2001). The
major strength of this study is that it combines historical
specicity of a cohort study with critical insight from medical
and feminist sociology to explore both how and why the

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R.L. Utz / Journal of Aging Studies 25 (2011) 143154

interpretive experience of menopause varies so signicantly

across two generations of American women. Qualitative data
provide rich description of these women's midlife health
experiences, while historical embeddedness provides timely
insight into how baby boom women may approach issues
related to later-life body and health.
Menopause: beyond biology
Menopause is the body's permanent cessation of menstruation. It is due to age-related changes in ovarian activity
(Gold, 2000). Although it can be surgically induced through
hysterectomy, it naturally occurs between ages 45 and 55
when a woman reaches midlife (Natchgill & Heilman, 2000).
Menopause is regarded as an undeniable end of a woman's
ability to procreate, as well as her symbolic entrance into the
second half of her life where she can take on nonreproductive social roles (Mead, 1974; Sheehy, 1974).
Past research has found that the physical experience of
menopause is similar across temporal and spatial boundaries
(Datan et al., 1981; Ellison, 2001; Post, 1971). However, a
woman's lived experience of menopause varies greatly,
depending on her personal characteristics as well as the social,
cultural, and historical contexts in which she experiences
midlife (Bowles, 1990; Daly, 1995; Flint & Samil, 1990; Fu,
Anderson, & Courtney, 2003; Gold, 2000; Goodman, 1980;
Kaufert, 1982; Lock, 1998). Judith Lorber (1997) explains these
idiosyncratic variations in lived experiences with a theory about
social group membership. This theory states that a woman's
self-reported experience of health will parallel the normative
denitions held by her primary social group. In other words,
because different cultures hold different notions regarding the
denition, treatment, and interpretation of health symptoms
(Zola, 1966), a woman of a particular cultural descent (e.g., race
or ethnicity) may be more likely to report symptoms or use
particular types of discourse to describe her experience if these
types of behaviors coincide with the normative denitions of
her primary social group. The current study expands this
theoretical perspective by exploring whether membership in a
particular birth cohort is an important social group, like race or
ethnicity, in understanding how the subjective experience of
menopause varies for women born during different moments in
American history.
The concept of cohort
Persons of the same birth cohort, dened as a group of
people born at relatively the same time in history, share a
common experience and reach the unique stages of the life
course under the same social, cultural, and political constraints
(Elder & Pellerin, 1998; Gilleard & Higgs, 2007; Kertzer, 1983;
Ryder, 1965). Thus, at any given stage of the life course,
members of a cohort may exhibit similarities with same age
peers, but not members of earlier or later born cohorts, simply
because they have experienced a unique set of historical and
cultural inuences during the earlier phases of the life course.
An analysis comparing the qualitative experience of multiple
birth cohorts seems to be an appropriate and efcient method
to assess which macro-level forces have shaped the way
middle-aged women interpret and express issues related to
health and body. Thus, women of different birth cohorts will

espouse very different interpretations or lived experiences of

menopause because each cohort has lived through a certain
historical era, providing different types of resources, opportunities, and inuences. Inter-cohort differences would suggest
that a major historical or cultural shift occurred between the
years that separate those cohorts.
The cohorts chosen for this study have experienced overlapping, but distinct eras of American history. Their lifetimes
capture the historical moments when women's reproductive
health received considerable media attention and when
cultural denitions of menopause have dramatically shifted
(Coney, 1994; Gannon & Eckstrom, 1993; Gannon & Stevens,
1998). First, I focus on the women who represent the baby
boom cohort. Baby boomers are dened as those persons from
the very large cohort born after WWII during the years 1946
1964 (Macunovich, 2002). The second cohort is dened not by a
common year of birth, but by its relationship to the rst cohort.
The older cohort consists of women who bore and reared the
baby boomers; these mothers were typically born during the
1920s and 1930s. Thus, the women compared in this analysis
represent not only distinct historical exposures, but also
represent distinct generations within families (mothers and
daughters).
Medicalization of women's health
Perhaps the most important to the selection of these two
particular groups of women is the rapid inux of medical
technology that emerged during the decades that span their
lifetimes (see Fig. 1). In particular, the introduction of oral
contraception (The Pill) and hormonal replacement therapies
(HRT) are important for this analysis. These pharmaceutical
innovations radically altered the body's natural process of
hormonal production. Some feminist scholars have even argued
that the pharmaceutical industry manufactured the problems
or symptoms these drugs were designed to alleviate, rather
than seeing these hormonal changes as biologically-grounded
universals of female aging and development (Friedan; Lock). This
process whereby the medical industry has co-opted the female
body and redened the natural processes of development is
referred to as the medicalization of women's reproductive health.
Medicalization is dened as the way in which the
apparently scientic knowledge of medicine is applied to a
range of behaviors that are not self-evidently biological, or even
medical, but over which medicine has control (White, 2002,
pg. 42). Medicalization results from the changing societal
norms, bureaucratic organizations, and gendered social practices of a particular culture (Brown, 1995; Featherstone,
Hepworth, & Turner, 1991; Shilling, 1993; White, 2002). In
the specic case of menopause, the denition has shifted from a
natural, developmental perspective to an illness-based perspective which requires pharmaceutical treatment and medical
intervention (Bell, 2006). This paper not only explores how and
why the denition of menopause have become so medicalized
in recent decades, but also highlights the effect this redenition
has had on the cultural attitudes related to women's midlife
health and aging. More specically, this analysis elucidates the
individual experiences and attitudes of two generations of
women, mothers and daughters, whose lifetimes have spanned
the period in which the medicalization of menopause has been
most dramatic.

R.L. Utz / Journal of Aging Studies 25 (2011) 143154

Age of Mothers Age of Daughters

Date

Innovation in Reproductive Health Technology

1929
1938
1942

First human sex hormone, estrogen, is isolated and identified.

1956

(if born in 1920)

DES, the first synthetic hormone, is developed.

Premarin, the first post-menopausal form of HRT, hits the market.
Enovid, the first version of The Pill, was submitted to FDA for approval.
(general approval received in1957; approval for contraceptive use was granted in 1960)

1960s

Studies find that prolonged use of HRT (i.e., Premarin) protects bones, relieves
menopause symptoms, and reduces risk of breast & genital cancers. Other studies find
that The Pill (i.e., Enovid) is associated with blood clots and heart attacks.

1970

FDA mandates that all drug packaging include information about

the possible side-effects and dangers of The Pill.

1975-76

1980s

1990s
2002

145

Studies find that HRT is associated with endometrial and breast cancer.
Low-dosage versions of The Pill are introduced; high-dosage version (i.e., Enovid)
are removed from market. Estrogen-plus-progestin HRT (i.e., Prempro) enters the
market.
Studies find that the estrogen-plus-progestin HRT is associated with lower rates of
endometrial cancer, cardiovascular disease, & osteoporosis. Studies also find that postmenopausal HRT is associated with increased risk of cancer & cardiovascular disease.
FDA Consumer Report suggests that The Pill is considered safe and effective by the
government, medical establishment, and the public. During the 1990s, Premarin
(estrogen-only HRT) became most frequently dispensed drug in the United States.
Findings show that estrogen-plus-progestin HRT is associated with heart disease and
breast cancer. Doctors are urged to only prescribe HRT for short-term relief.

(if born in 1950)

9
18
22
36
40-49

6
10-19

50

20

55-56

25-26

60-69

30

70-79

40-49

82

52

Fig. 1. Historical timeline of the innovations in reproductive health technology. Note: much of the data for this table were drawn from Gonyea (1996), Gannon and
Stevens, (1998), Natchgill and Heilman (2000) and a special report of the US News & World Report entitled Making Sense of Menopause www.usnews.com/
usnews/nycu/health/menopause/meno_main.htm.

Method
Interview procedures
The majority of data were collected through in-depth
qualitative interviews. After formally consenting to participate and being ensured of anonymity, 24 middle-aged and
older women participated in a face-to-face interview in their
homes. I, the author of this document, served as the sole
interviewer for this project. I am a well-educated woman and
was younger than any of the women interviewed by at least
20 years. I initially asked, What was/is your experience with
menopause like? I would like to know the symptoms you
experienced, the age you rst started experiencing them, and,
most importantly, how you feel/felt about experiencing
menopause. The conversation that sprung from this initial
prompt provided rich insight on both the physical experience
of menopause (e.g., age of onset, treatment), as well as the
woman's perceptions and attitudes related to midlife and old
age. During the course of the initial interview, I also asked
each woman to elaborate on where she received information
about medical issues, what types of health regimens she
adopted, and whether her experience of menopause made
her re-evaluate perspectives on aging, health, or the female
body. Interviews lasted from 30 to 120 min. All interviews
were conducted in-person, usually at the woman's home.
In the six-year period following the initial interviews,
I conducted a number of follow-up interviews (16 additional
interviews) as well as one focus group with eight of the original
respondents to get a sense of how attitudes and experiences
might have changed over time. These follow-up data were, by
and large, consistent with what the women had discussed
earlier during their initial interviews and served as an

invaluable validity check since I could directly ask the

respondents whether my interpretations were salient and
relevant (Morgan, 1996; Stevens, 1996).
Sample
Women were initially identied after reading a local
newspaper article about a group of long-time high school
friends who were turning 50 years old and who had maintained
contact over the years with a monthly get-together (i.e., card
club). It was mentioned in the article that one of their gettogethers each year was a special celebration, usually around
the Christmas season or Mother's Day, that included all of their
mothers as well. I contacted one of the women featured in the
article and asked if she would introduce me to her friends and
their mothers. She then sent an invitation letter on my behalf,
which yielded a 100% participation rate and provided the bulk
of the middle-age and older women highlighted herein
(n= 18). Additional women (n= 6) were identied through
snowball sampling techniques in which the already interviewed mothers and daughters referred me to other mother
daughter pairs that t within the same age/birth criterion.
This sampling strategy resulted in two subsamples
representing distinct generations and birth cohorts: The
daughters (n = 13) were born in the early to mid-1950s and
graduated from a Midwest suburban high school in the late
1960s and early 1970s. They represent a subset of the early
baby boom cohort. They were roughly age 50 at the time of
the initial interview. The mothers (n = 11) consisted of the
biological mothers of the daughters, or the adoptive mother
in one case. They were born during the 1920s and 1930s and
ranged in age from 68 to 80 at the time of the initial interview.
Although the mothers had a greater age range than the

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R.L. Utz / Journal of Aging Studies 25 (2011) 143154

daughters, the use of motherdaughter pairs turned out to be

a unique strength of this study. Motherdaughter pairs, as
opposed to two randomly selected cohorts of middle-aged
and older women, naturally controlled for confounding
factors such as ascribed familial characteristics and socialization inuences.
Both subsamples represented the full spectrum of labor
force participation, including full-time career women to fulltime homemakers. The women were all white, owned their
own homes, and reported generally favorable health conditions at the time of the initial interview. The majority was
married, despite a few cases of divorce among the daughters
(n = 2) and widowhood among the mothers (n = 4). All of
the mothers had grown children who no longer lived with
them; and all but one of the daughters had children, ranging
in age from 8 to 27 at the time of the initial interview.
Regarding menopause, all of the mothers were post-menopausal, while the daughters were mostly peri-menopausal.
Peri-menopause refers to the transitional period between
regular menstrual cycling and menopause when the body
experiences signicant hormonal uctuations. Peri-menopause usually spans the two-year period before and after a
woman's last natural period.
Analytic plan
All interviews were audio-recorded and then transcribed.
Transcripts from each interview were broken into separate
discussion threads and categorized as relating to one of the
following focus areas: how the women talked about, dened,
treated, or accepted menopause, whether the women were
discussing larger issues of aging or health, and where they found
information about menopause and aging. Any other discussion
thread, although often interesting, fell outside the scope of this
project and was not considered in the analysis presented here.
Identifying themes and patterns within each focus area was
achieved by searching for similarities and differences across the
two generations. Given the small homogenous sample, I focused
exclusively on inter-cohort comparisons and did not attempt to
identify intra-cohort variations.
The primary aim of this project was to identify cohort
effects, major differences between the two generations could
be attributed to sharing a unique social, political, and
economic history with similarly-born peers (Elder & Pellerin,
1998; Kertzer, 1983; Mannheim, 1952; Ryder, 1965). Cohort
effects were identied and interpreted by linking the
women's narratives to the historical context in which the
experiences occurred. Although conceptually distinct, cohort
effects are often confounded by human aging (age effect) or
historical inuence (period effect). For example, both the
mothers and daughters of this sample may exhibit a
heightened sense of awareness and sexual freedom as a
result of the Feminist Movement of the late 1960s and early
1970s (period effect). Or, the mothers may exhibit different
attitudes toward health and aging, not because they have
lived during a different period of history than their daughters
(cohort effect), but because they have revised their attitudes
and opinions about menopause as they aged through the life
course (age effect). The identication of age, period, and
cohort effects is especially problematic in cross-sectional
studies because it is impossible to distinguish between age

and cohort effects with only one wave of data (Palmore,

1978). In an attempt to isolate the potential differences
associated with aging and cohort membership, I had women
speak both retrospectively and prospectively about healthrelated issues (Scott & Alwin, 1998). I also did follow-up
interviews with a subset of the original sample to assess
whether attitudes and experiences might have shifted over
time as the daughters aged. Although future research might
adopt a cohort sequential design to more accurately isolate
the effects of age, period, and cohort on the redenition of
menopause and women's health, the current study design
and analytic strategies offered a rich set of results that
illustrate the qualitative differences between mothers' and
daughters' experiences with menopause, health, and aging,
and how these differences might have been shaped by larger
macro-historical forces.
Tales from the interviews
The earliest report of natural menopause was 38, while the
latest was approximately age 52. Most women reported that
menopause lasted for many months, if not several years. The
most common symptoms included hot ashes, night sweats,
changes in skin, and an inability to lose weight. Tension and
mood swings were also common, as women reected, I was a
bitch or I feel out of control. Some women found their
symptoms insignicant, while others found theirs to be more
incapacitating. These accounts are consistent with the documented effects of estrogen loss (Leidy, 1994; Natchgill &
Heilman, 2000). They were also remarkably consistent across
mothers and daughters, suggesting that the physiological
process of menopause has not changed in recent decades.
Talking about menopause
Despite the physiological similarities, the mothers were not
nearly as forthcoming in their narratives as the daughters were.
Several of the mothers initially told me that they did not really
have menopause or that they don't remember that. It is
possible that the mothers were not as comfortable talking with
me as the daughters were, given that my age was closer to the
daughter's generation than the mothers'. However, I doubt there
was much of an interview effect associated with my age because
as I built rapport with the mothers, they admitted that they
initially used such ippant responses in hopes that they could
avoid having a long conversation with me about menopause.
One dismissive respondent said her discomfort stemmed from
the fact that it [menopause] is related to babies, and sex, and you
know. We do not talk about sex like the kids do today. Another
mother remarked, I told my husband I wouldn't tell you about
our sex life. Several mothers remembered people referring to
menopause as the widows plague, or as a reason for making
women crazy, and grounds enough for divorce. It became
apparent that for the women in the mothers' generation, the
topic of menopause was intertwined with issues they considered
inappropriate for public discourse such as body, sexuality, and
emotional instability.
The following story, as told by one of the oldest women
interviewed (age 78), provides the most extreme case of the
societal reprimand or emotional chastisement that women of this
generation might have received when publicly acknowledging

R.L. Utz / Journal of Aging Studies 25 (2011) 143154

their experience with menopause. This woman suffered from

extreme mood swings and bouts of depression at the time of
her menopause (the late 1960s). When she approached her
physician, he admitted her to a mental hospital and wrote
suicidal on the top of her chart. She reected,
I had my wits about me. I just wanted some help. Something,
anything! I was suffering. . The day I walked out of that
hospital, I gave him back everyone of those little blue pills he
tried to feed me. I told him that he got it wrong. . My
depression was real, but I was NOT suicidal. I needed support,
not his pills.
In stark contrast, the daughters frequently and openly
discussed menopause with me, often with exquisite detail. A
typical response at the start of the interview included:
At rst, my periods were heavy, then just messed up, sometimes
spotting, sometimes heavy, you know, just not the normal,
regular bleeding I used to have. . The doctor took a piece of
umm, what's it called? The lining of the uterus? He ran tests to
rule out cancer I was pretty young, that's why he did that. My
[FSH: follicle-stimulating hormone] levels were only in the 20s,
and, umm, he told me they need to reach 40 [to certify me postmenopausal]. . Yeah, I began to notice skin changes, it just
wasn't as tight as it used to be. See. Look here around my eyes.
And weight gain, well, not really weight gain, my body just
changed. It is a different shape now.
The daughters reported speaking about menopause in the
workplace, with their friends, and with their husbands.
Sometimes it is even a topic of conversation at the dinner
table. A few of the daughters had joined a support group and
all had spoken with a physician about menopause. Thank
goodness menopause has come out of the closet. At least
now women who truly suffer can discuss it with their
physicians, or their families, remarked the falsely identied
suicidal mother.
Of course, retrospective recall bias may account for some of
the difference in the discourse offered by the mothers and
daughters: The daughters were experiencing menopause at the
time of the original interview, so therefore the issue of
menopause may have been more salient in their minds. The
mothers, on the other hand, experienced menopause many
years ago, perhaps minimizing their recall of the event and
making them appear less articulate or forthcoming than their
daughters. However, generational differences continued to exist
when the mothers spoke of other more-current and lesspersonal issues related to health or body. Compare the thoughts
of a mother and a daughter who were both facing knee
replacement surgery as a result of arthritis: The mother, who
had just recently undergone the surgery, offered very little
information about the surgery, her initial condition, or the rehab
she was currently facing. Her daughter, on the other hand,
showed me X-rays, pointed out exactly where the cartilage was
missing, and explained in great detail the surgical procedures
she was anticipating in the coming months. In the case of knee
surgery, just as with the case of menopause, the daughters'
narratives often displayed an awareness of body, openness, and
level of technical sophistication that was not as obvious in the

147

mothers' accounts. The mothers were not unaware of their

medical conditions, they were just not as forthcoming nor as
medical or scientic in their descriptions.
Upon closer inspection of the data, the women were not
only using different communication styles. They were also
expressing characteristically different experiences that
seemed to be shared with their peers, but not necessarily
with their mother/daughter. For example, mothers and
daughters dened and treated menopause quite differently.
These inter-generational differences, which will be detailed
below, point to how menopause has become increasingly
medicalized throughout the decades that span the mothers'
and daughters' experiences.
Dening menopause
The mothers dened menopause as a developmental
transition and considered it a time of self-evaluation and
priority setting. A 72-year old mother of three eloquently
reected on how she viewed menopause as a life-stage,
rather than a specic medical condition or event:
Menopause was a time in life when I shifted priorities and
interests. It opened up possibilities and allowed me, for the
rst time, to focus on myselfnot on my children, their
school, my husband, my family, or my house. It allowed me
to honor myself, to dream of what I could still become. It
wasn't the end; it wasn't the beginning; it was a soulsearching transition, which set the stage for a whole new
phase of life.
This thought, which was quite common among the mothers,
is reminiscent of Margaret Mead's concept of post-menopausal zest (Mead, 1974; Sheehy, 1974).
Alternatively, the daughters dened menopause in terms
of the physiological processes of the aging body. For them,
menopause was a health problem or a disease that ought
to be treated and cured. They very much considered
menopause to be an estrogen deciency disease and adopted a
denition that is quite similar to the medicalized denitions of
menopause that are criticized in scholarly writings (Coney, 1994;
Daly, 1995; Gonyea, 1996).
Treating menopause
Differences in how the women treated menopausal
symptoms provided further evidence for the medicalization
that occurred during the 25 years separating the mothers and
daughters. Although the use of the word treatment and
symptoms is itself a clear manifestation of how medicalized
women's reproductive health has become, I have chosen to
adopt this terminology because I believe it provides a striking
image in which to contrast the women's acceptance and/or
internalization of the medicalized denition of menopause.
The mothers, who held a more developmental or life-stage
model of menopause, did not perceive it to be a problem or a
disease, thus treatment was not something they even spoke
of. As one mother put it, Menopause just happened. We didn't
do much about it. We waited for it to be over, reected
another mother. Conversely, the daughters, who espoused a

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R.L. Utz / Journal of Aging Studies 25 (2011) 143154

more medicalized view of menopause, sought medical treatment almost immediately: The moment I have hot ash or the
moment I have night sweats, I will go to my doctor. She will tell
me that I am starting menopause. And then I will go to the
pharmacy on my way home and pick up my prescription,
explained one daughter who had, as of the initial interview,
experienced very few physiological effects of peri-menopause.
The use of prescription drugs (HRT) was very common
among the women interviewed. Nearly all of the daughters
(11 out of 13) had tried or were taking HRT at the time of the
initial interview. Although the use of HRT was also fairly common
among the mothers (5 out of 11), most of them said they were
taking HRT as a result of a late-life (post-menopausal)
hysterectomy or osteoporosis prevention efforts. According to
data from the National Center for Health Statistics, nearly half of
post-menopausal women in the US had used or were using HRT.
Non-hispanic white women with higher education levels and
family incomes had signicantly higher rates of HRT use, which
may explain the disproportionately high rates of HRT use in the
particular cross-section of women interviewed for this study (For
data, refer to www.cdc.gov/nchs/nhanes.htm).
In addition to pharmaceutical intervention, the daughters
showed great interest and apparent knowledge of alternative
means for symptom relief (e.g., diet and exercise); however,
only one reported using natural supplements from her
nutritionist and another altered her diet by including more
soy and calcium and reducing caffeine and sugar. Every one of
the daughters boasted the benets of a healthful diet and
regular exercise, particularly the need for weight training, but
most admitted to an inability or lack of desire to maintain these
recommended diet or exercise regimens. Despite the growing
trend of complementary and alternative medicine in American
society (Eisenberg, 1998; Tindle, Davis, Phillips, & Eisenberg,
2005), the daughters typically preferred pharmaceutical intervention over lifestyle modication to reduce the adverse
symptoms of menopause. One daughter, aged 50, who was
overweight and had arthritis in her knee, explained:
I know what I should be doing, but it is hard. I am good for a
week or two, and then lapse back into my old habits. . See
that bike over there, you see, in the corner. I am sure it has a
nice layer of dust on it.
In her opinion, a pill taken once a day was far easier than
maintaining the physician recommended tness regimen and
restrictive dietary plan. Others explained that they saw more
consistent results when taking HRT than they did exercising
or altering their diet, reinforcing their preference for the
pharmaceutical intervention over lifestyle modication.

Acceptance of menopause
The differences in how the mothers and daughters dened
and treated menopause are consistent with claims that the
experience of menopause has become increasingly medicalized
over the past several decades of American history. However, the
next set of differences how willingly the women accepted the
bodily changes associated with menopause speaks to how the
forces that have medicalized menopause has also begun to shape
women's general attitudes toward midlife health and aging.

Similar to past research, both mothers and daughters agreed

that menopause was a relief from having periods every month
and worrying about unwanted pregnancies (Datan et al., 1981;
Hvas, 2001). Over and above this common feeling of relief,
however, the mothers typically accepted the changes associated with menopause, while the daughters hoped they could
delay or altogether skip this inevitable life transition. One
mother remarked, It's a fact of life. I know I can't do anything
about it. The daughters, on the other hand, said things like, I
will treat it [menopausal symptoms], or better yet, stop it before
it ever starts. Consider the words of one daughter, who had a
rather humbling introduction to menopause:
The rst time my period didn't come, I was 49. I went to my
doctor and told him I was pregnant. He laughed at me. It didn't
even cross my mind that I was OLD enough to be experiencing
menopause. God knows, I didn't want another child, but I
certainly didn't want to be experiencing menopause.

By and large, the daughters resisted the fact that they, as

young and dynamic middle-aged women, were actually
experiencing menopause. One scoffed, It sucks I don't feel
old yet! Do I look old? My body is telling me that I am getting
old! What's next? I don't knowhealth problems, disability,
death! In her words, menopause was just the beginning of a
long downhill battle that I cannot possibly win EVER!
Throughout the daughters' narratives, it was common to hear
notions of fear (Golub, 1992) whether it was a fear of aging or
a fear of losing control was not as easy to discern. So, I began to
ask the women themselves why they thought they had such
intense feelings of discontentment or fear associated with
menopause and aging.
Much of daughters' disillusionment stems from the fact that
they could not maintain control over the changes occurring
within their bodies. I hate it. I feel out of control, said one 49year old daughter. I'm no longer able to lose weight, no matter
how much I diet, reected a baby boomer who has struggled
with excess weight all of her adult life. Similarly, a careerminded middle-aged daughter commented, Things keep
happening that I don't want to happen that's what's hard
for me to accept. The desire to personally control and selfmanage their lives, including their bodies, was the most
common theme found across the daughters' narratives. This
theme is consistent with the strong-willed and autonomous
nature of baby boom cohort (Posner, 2000), of which the
daughters in this sample represent, and is probably even more
pronounced in the white middle-class women of this sample.
The daughters often detested the thought of menopause
because it represented either a conscious decision or physiological mandate to give up some control of her life. This
potential explanation for why the daughters were so fearful
and/or resistant extends the common paradigm suggesting that
American women fear aging simply because they live in a
youth-oriented culture (Logan, Ward, & Spitze, 1992). The
alternative explanation offered by these data is more related to
the daughters' fear of losing or giving up control, rather than a
fear of not being youthful. Thus, perhaps the only way to
effectively cope with the pressures of living in a youth-oriented
culture is to address these women's underlying fears about
losing control or giving up.

R.L. Utz / Journal of Aging Studies 25 (2011) 143154

Women cannot psychologically will-away or single-handedly stop the course of menopause or aging in general.
Nevertheless, many of the daughters reveled in the fact that
they had crafted ways to maintain a bit of control over this
otherwise uncontrollable process. One daughter, who was
admittedly very attractive, said, Sure, I have gray hairs, I cover
them. I have more wrinkles now, but I can get a facelift or a
chemical peel My body no longer produces its own estrogen,
so I take hormones. This woman went on to say that she was
willing to use almost any means necessary to conceal, deny, or
lessen the physical appearance of aging. She also maintained a
very strict diet and exercise regimen that she hoped would keep
her looking and feeling youthful.
As mentioned previously, the most common strategy that
the daughters used to maintain control over their perimenopausal bodies was to use pharmaceutically-derived
intervention such as HRT. Taking hormones help delay,
umm, it is like I can suspend my old age. Yeah, uh huh, an age
suspension! I don't have to be old yet, if I keep taking my
hormone pills, said a daughter who had been taking HRT for
over 5 years. In general, the daughters were excited, almost
proud, when they revealed ways they had used over-thecounter drugs, anti-aging products, and medical or pharmaceutical intervention to conceal or delay the onset of menopause or other physical signs of aging that had befallen their
bodies without their proper consent. These efforts represented
both big and small victories in the daughters' self-waged battle
against old age. As has been suggested in other research (DavisFloyd, 1994), the use or even just the availability of medical
technology was empowering for these women. It allowed them
to maintain control over an otherwise uncontrollable process
(Conrad & Schneider, 1992).
Exploring the differences
By comparing the narratives of mothers and daughters, we
have seen that women of successive generations, although
reporting very similar objective or physiological experiences,
had very different attitudes and behaviors related to
menopause. The mothers typically accepted their fate and
did not make much of the menopause experience. The more
embattled daughters, however, expressed an overwhelming
need to control the physiological processes occurring within
their bodies. These differences provided an opportunity to
explore how the evolution of technology and culture during
the latter half of the twentieth century might have shaped the
way these two generations of women perceive their experiences of menopause, health, and aging. The remainder of this
analysis links the two generations' shared narratives to the
broader historical and cultural contexts in which they
occurred. This contextualized analytic strategy, in which
each generation is embedded within the historical exposures
associated with their shared lifetime and birth cohort, is used
to illustrate how macro-level factors can have both immediate and cumulative effects on the subjective health experiences of aging women.
The role of the pharmaceutical industry
The widespread availability and use of new medical
technologies throughout the last several decades (refer to

149

Fig. 1) have likely played a role in creating profoundly

different reproductive health experiences for the two generations of women interviewed here. In particular, the
availability of oral contraception, which received approval
from the FDA in 1960, set a precedent in the use of
pharmaceutical technology in women's health. Enovid, the
earliest prescribed birth control pill, was the rst drug to be
used by healthy persons for an extended period of time. As
one mother put it, The pill changed the world!
The Pill was introduced in the early 1960s, so the
daughters who represent a slice of the American baby boom
cohort (born 195053 in this analysis, 19461964 in the
general population) were among the rst cohort of women
to experience their entire adult lifespan with an ability to pharmaceutically control fertility and family planning (Posner,
2000). Nearly all of the daughters in this sample had used the
birth control pill for extended periods of time during their
reproductive years, whereas very few of the mothers even
tried it. The mothers often spoke of horror stories about
women using the high-dosage versions of The Pill which
caused severe bleeding and was associated with breast
cancer. The daughters, on the other hand, were exposed to
improved versions of The Pill that were considered safer and
had fewer side effects. Perhaps, as a result of their differential
exposure and experiences with The Pill, the daughters might
have been more willing to use (or at least consider using)
pharmaceutical interventions such as HRT at the time of
menopause than their mothers were.
Furthermore, the widespread availability and use of The
Pill, as well as other modern medical interventions that have
allowed women to control their fecundity, might also have
played a role in uncoupling the issue of menopause from
female reproductive potential. To illustrate, the daughters
usually demarcated the end of their reproductive capabilities
by a conscious decision made earlier in life (e.g., partial
hysterectomy or long-term contraceptive use), rather than by
the cessation of menstrual cycles that was occurring at
midlife. As a result, instead of associating menopause with the
natural end of their fertility, like their mothers did, the
daughters associated it with the end of life, or at least the
commencement of a new older stage in life that they did not
necessarily welcome.
Finally, as shown in Fig. 1, the documented effectiveness
and safety of reproductive technologies such as HRT and The
Pill have uctuated throughout history (Gannon & Stevens,
1998; Gonyea, 1996; Natchgill & Heilman, 2000), just as the
mothers' and daughters' willingness to use HRT or The Pill
differed. The mothers who typically experienced menopause
during the 1970s and early 1980s, a time when HRT was
associated with increased risk of cancer, were more likely to
espouse a natural, developmental denition of menopause.
The daughters who typically experienced menopause in the
late 1990s and early 2000s were likely to tout a highly
medicalized perspective of menopause. Thus, it appears that
the cultural denitions and suitable treatment expressed by
each cohort parallel and mimic the changing knowledge or
truth that has been produced by those persons who hold
the power (Foucault, 1980). In the case of menopause, the
pharmaceutical industry appears to hold much of that power
and has played an undeniable role in the social construction
and redenition of menopause.

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The role of the media

Like pharmaceutical technology, the availability of healthrelated media has also exploded in recent decades and has
likely shaped the way these mothers and daughters perceived
and reacted to their own experience of menopause, health, and
aging. Both mothers and daughters mentioned that they often
turned to books, magazines, internet, and televised media to
learn about health-related issues, making modern-day women
self-taught experts in the diagnosis, management, and treatment of common ailments and illnesses (Kukla, 2007). In terms
of menopause, however, the mothers and daughters differed in
whether they consulted media sources during the time of
menopause. By and large, the daughters actively consulted
various types of media for information about menopause,
whereas the mothers mostly talked to their doctor or simply
allowed the changes to occur without much research, reading,
or discussion about the subject.
This difference is likely because the availability of popular
media sources increased dramatically over the historical
period separating these two generations of women. A search
through a large internet-based bookseller (www.amazon.
com) revealed that 720 books have been published since
2000 with the word menopause in the title, but only 85
such books were published prior to 1975. Furthermore, the
internet provides daughters with access to over 11 million
sites that talk about menopause (www.google.com, 06/10/
2010, search term: menopause), but was not available to the
mothers at the time of their menopause since widespread
internet usage did not emerge until the 1990s.
Not only did the amount of media differ across the
generations, but the messages found within those sources also
varied. For example, corresponding to the Feminist Movement of
the late 1960s and early 1970s (and around the time of mother's
were entering middle-age), topics related to body, sexuality, and
women's health were beginning to be less taboo and more likely
to be found in public forums such as television broadcasting, but
the messages were not necessarily supportive or understanding.
Menopause rst hit prime-time television in 1972 during a
groundbreaking episode of All in the Family when the popular
housewife named Edith Bunker revealed to her husband, Archie,
that she was experiencing menopause after she uncharacteristically snapped at him. Upon hearing this news, Archie was not
exactly supportive of Edith: When I had the hernia I didn't make
you wear the truss. Now if you're gonna have a change of life, you
gotta do it right now. I'm gonna give you 30 seconds. Now
change! Archie also joked about how menopause is particularly
hard for nervous types like Edith and that a doctor recommended that he take three pills a day to handle her problem.
(Season 2, Episode 15; http://www.tvland.com/shows/aitf/).
Since then, menopause has been addressed both humorously and seriously on numerous sitcoms and movies. In
2001, there was even a satirical full-length broadway
production called Menopause: The Musical which discussed
the trials of menopause sung to the tune of golden-oldie pop
songs. Modern-day television also provides information
regarding menopause through the broadcast of talk shows,
documentaries, and news shows. One media hungry daughter
who regularly watched morning and afternoon talk shows
admitted that she learned almost everything she knew about
menopause from the TV: If Oprah or Good Morning America

says try it, I'll try it. Televised advertisements also provided a
source of information about menopause for the daughters,
but not the mothers. It was not until 1997 that the FDA
loosened restrictions allowing drug companies to provide
direct-to-consumer advertising, which prompted one of the
older respondents (age 75) to remark, lately, there is no
escape from hearing about menopause, particularly all those
commercials for estrogen. Both mothers and daughters said
they turned to televised media for much of their information
about health and health care. However, the messages and the
amount of information related specically to menopause
varied dramatically during the time periods in which the
mothers and daughters experienced their menopause.
When more than one daughter referred to her hot ashes as
power surges (a term coined in Gail Sheehy's bestselling book
entitled Menopause: The Silent Passage 1991) and mothers'
comments often resembled the ideas of post-menopausal zest
(introduced by anthropologist Margaret Mead in 1974), it
became clear that print media also inuenced these women's
narratives related to health and aging. Women, especially
daughters, turned to self-help books, magazines, and increasingly the internet. If I am standing at the checkout counter and I
see the word menopause, it will probably end up in my cart,
remarked one daughter who was experiencing her rst
symptoms of peri-menopause at the time of the initial interview.
Another daughter showed me her personal library, which upon
quick glance was dominated by books and magazines that had
the word menopause in the title. A third daughter told me that
she was constantly looking up information on the internet. The
mothers used these types of printed media sources as well, but
not with the same voracity that the daughters did.
In comparing the women's narratives to media-based
sources, I was struck by the similarities between the women's
words and the words used in the published forms of media.
For example, in a 2000 book entitled This is NOT Your Mother's
Menopause, Trisha Posner writes,
More than 20 million baby boomers will enter menopause
during the next ten years. As modern women, we take
control of our lives in a myriad of ways that our mothers
never contemplated. Approaching menopause, the one
journey in life that we all share, should be no different.
Our mothers were largely silent about what happened to
them as they passed through this midlife change. But a new
generation of women has already started to break the walls
of silence. More information and more alternatives are
available than ever before. We have the ability to control
naturally every aspect of this inevitable women's passage.
There is tremendous strength and satisfaction in assuming
more responsibility for our own well-being (pg ixx).
This passage is almost identical to the daughters' stated
desire to maintain control over their bodies. On the other
hand, the mother's denition of menopause as something
that just happened and that they did not worry about it
was reminiscent of the early feminist writings of Margaret
Mead (1974), whereas the negative stereotypes associating
menopause with the widows plague, making women
crazy, and grounds for divorce was similar to the unaccepting remarks made by Archie Bunker in 1972 which
forced his wife Edith to remain quiet and alone in her

R.L. Utz / Journal of Aging Studies 25 (2011) 143154

experience with menopause. These examples provide further

evidence that the media plays an active role in shaping the
cultural discourse and/or in recording the changing zeitgeist
of American culture.
In summary, it would seem that the explosion of
menopause-related media in recent decades has served two
primary functions in shaping these two generation's cultural
attitudes about menopause: First, because media is often
funded by the advertising dollars of pharmaceutical companies, it has played an undeniable role in redening menopause as a medical problem that needs to be treated or
controlled with medical intervention (Conrad & Schneider,
1992; Gannon & Stevens, 1998). Second, it has brought the
topic of menopause out of the closet and into public
discourse. Increased media attention is likely related to the
wave of feminism that swept the country in the early 1970s
and continues to bring feminine issues into the realm of
public concern. These two parallel trends have armed the
daughters, much more so than their mothers, with easily
accessible information about menopause, but the messages
have increasingly reinforced the medicalized view of menopause that daughters exhibited in their narratives.
The emergence of a menopause industry
Together, the pharmaceutical industry and the media have
reshaped the cultural lens through which successive generations of women have experienced menopause. Past research
has termed this conglomerate of institutions the Menopause
Industry and has suggested that this prot-seeking enterprise intends to turn the 40 million baby boom women into
patients for life by dening menopause as an estrogen
deciency disease that requires signicant medical intervention (Coney, 1994; Klein & Bumble, 1994). Rather than
criticizing the Menopause Industry for subjugating the female
body or for reducing the natural processes of human aging to
medical terms, I nd it more instructive to consider how the
relationship between the capitalist-driven Menopause Industry and the control-seeking women of the baby boom cohort
has reshaped the way women think about and react to the
realities of their aging body.
These narratives, especially those of the daughters, suggest
that the Menopause Industry has cunningly crafted a symbiotic
relationship with middle-age and aging women: the drug
companies will continue to develop new products, while the
media will continue to market the benets of these products
because they both prot from women's continued long-term
use of these products (Coney, 1994). The women, on the other
hand, will continue to demand greater pharmaceutical intervention and seek out health-related media because without the
drug companies' products or the media's provision of knowledge, the women would not have the necessary ammunition
with which to ght back against menopause and old age
(Lupton, 1996). In other words, the Menopause Industry has
both created and answered these women's calls it has
convinced them that they do not want to sit back and let
menopause happen, while at the same time armed them with
knowledge, pills, and alternatives so that they can win (or at
least appear to win) their personal battle to maintain control
over their bodies. In this regard, the daughters often expressed
feeling empowered by the availability of medical information

151

and technologies (Davis-Floyd, 1994). Ironically, then, the

success of the Menopause Industry rests on its ability to create
perceptions of personal control among the very women it
wishes to gain power over (Worcester & Whatley, 1992). How
will this need for personal control weather the transition into
older ages? Will the daughters, who represent the baby boom
cohort, differ from their mothers in how they approach their
own process of aging?
A glimpse into the future
Throughout their lives, the baby boom cohort has forged new
paths and created new opportunities at every stage of the life
course. Part of this cohort's impact comes from its disproportionately large size (Connelly, 1986; Macunovich, 1998; Uhlenberg & Miner, 1996) and part of it from the trailblazing spirit that
has been culturally imbued to the members of this cohort from
growing up during the 1960s in America (Gilleard & Higgs, 2007).
As a result, new industries have emerged and old industries have
completely revolutionized as this cohort reached each new stage
of life. Those industries related to education and occupation
provide the most striking example of how this cohort has
reshaped societal norms and institutions (Light, 1988) for
example, in childhood, the primary and higher education systems
had to adapt to this disproportionately large cohort (Hudson,
2009). Then, during middle-age, the workplace has had to
accommodate the unique needs of the baby boom cohort as more
females entered the workforce than any generation before them
(Dailey, 2000). As a result, vast industries related to childcare and
eldercare have emerged to help working women balance the
responsibilities associated with work and family. At every lifestage, the baby boom cohort has rewritten the rules and spawned
societal transformation.
Not surprisingly, then, as the women of this cohort approach
the later stages of the life course, they also question whether
they really have to age in the same manner as their mothers and
grandmothers did (Apter, 1996; Blanchette & Valcour, 1998).
Recall the middle-aged daughter who remarked, I'm not going
to be old yet. I've decided that I wouldn't do that yet. The
daughters within this sample often talked about denying,
delaying, or concealing the effects of aging on their body and,
according to the words of this woman, they were able to
achieve this goal with some level of success:
I can't say we age more gracefully, just differently. Since we
were young, we have been taught to not stop until we get what
we want. So, now that I approach aging, I will kick and scream
every step of the way. Hell, I am not ready to be old. . I am
going to do it my way.
As suggested earlier, the Menopause Industry is an example
of another industry that has emerged in response to the baby
boomers' unique spirit or alternatively, to capitalize on the
prot-potential associated with this disproportionately large
birth cohort. The Menopause Industry, which relies heavily on
the baby boomers' medicalized notions of menopause and their
desire for personal control, provides these women with the
resources they need to win their self-waged battle with old age.
It has manufactured an illusion that they can and ought to
control the processes associated with normal aging, and has
proted from it. As a result, the emergence of the Menopause

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R.L. Utz / Journal of Aging Studies 25 (2011) 143154

Industry has reshaped the way that American women approach

issues related to aging and health.
Compared to their mothers, the daughters have substantially greater access to health-related technology, received
more education, and posses a greater overall awareness of their
bodies (Blanchette & Valcour, 1998; Macunovich, 2002). They
also have greater nancial resources than any generation before
them, allowing them to purchase aging-related services and
products (Dailey, 2000). These resources should ideally put
them in a better position to weather the transition into older
ages. However, aging is not something one can control. Even if
companies market products that delay, minimize, or conceal
the signs of physical aging, not one has produced or will
produce a product that can eliminate aging all together. Thus, as
much as the daughters claim that they will ght old age and
even though they may have some ammunition with which to
ght (or at least more so than any cohort before them), they too
will have to join the ranks of the elderly in the not-so-distant
future. In this regard, the perceived autonomy and need for
personal control espoused by the daughters in this sample may
actually make them more vulnerable or less prepared to face
the realities of old age than their mothers. At the very least, the
daughters will have to alter their perceptions about how much
personal control they can actually have over the biologicallydetermined course of human aging.
During the course of this study, an unexpected event
occurred that foreshadows how the baby boom cohort, as
represented by the daughters in this study, might respond to
the realities of old age and aging as they enter those nal stages
of the life course. In July of 2002, the Women's Health Initiative
(WHI) discontinued a large randomized drug trial three years
earlier than it had anticipated when preliminary ndings
showed that the long-term use of HRT was associated with
higher risk of heart disease, invasive breast cancer, stroke, and
blood clots (Chlebowski et al., 2003; Writing Group for the
Women's Health Initiative, 2002). The WHI's research ndings
about the potential dangers of HRT were contrary to many of
the more-common widely-promised claims of the 1990s and
until 2002 that long-term HRT use was safe and even protective
against things such as heart disease and osteoporosis.
Based on data from follow-up interviews and focus groups
(conducted primarily with the subsample of daughters), I was
able to capture whether these women might feel out of
control or whether their attitudes toward old age and aging
were altered after realizing that their present coping
strategies (e.g., HRT) were potentially harmful to their health.
One daughter, who had been taking HRT for about 6 months
at the time of the initial interview, said,
I'm kinda scared of HRT; I don't want to take it, don't really
understand why I have to take it, or for how long I have to
take it, so I may look into natural supplements and other
stuff. . I guess, I'll continue taking it because she [the
doctor] gave me the prescription. It can't hurt, huh? Can it?
Not surprisingly, this skeptical woman stopped using HRT
immediately after she learned that the WHI drug trials were
stopped. She said,
I just stopped, didn't even ask a doctor. I thought why would
I put that pill in my body . I stopped smoking cause I

didn't want lung cancer, you know. So, why would I take a
pill that may or may not cause breast cancer. Hardly seems
worth it. Or a heart attack? No way. Why chance it?
This particular woman also mentioned that her mother, who
had taken HRT for nearly ten years for osteoporosis prevention
efforts, also decided to stop her treatments after hearing the
results of the drug trial. These women made and revised their
actions based on the instability of scientic knowledge and the
lack of a known truth about the efcacy and safety of
pharmaceutical intervention (Devisch & Murray, 2009).
Other daughters, however, continued taking and had
planned on requesting new rells from their physicians. It
works for me, explained one baby boomer who was not at all
deterred from the negative scientic ndings. Until they come
up with something better, I'll keep it up, remarked another
middle-aged daughter who earlier had said, Thank god for
those little pills! I don't know what I would do without them.
The benets the daughters felt from the drugs far outweighed
any potential side effects they might face by continuing to take
them. And statistically speaking, they were willing to assume
that level of risk: We are all going to die of something. I mean, I
could walk out the door and fall over from a, uh, falling branch
or, uh, something like that, you know. So, why not take them
[the HRT pills]? Anymore, everything is risky.
Similar to the woman who discontinued the use of HRT,
one daughter who was still taking HRT expressed frustration
with the ckle nature of medical truths:
I don't know what to believe anymore. We hear it [HRT] is
good, then it's bad. And we hear it is gonna save us from a
heart attack, but tomorrow it is gonna cause a heart attack. I
mean, whatever. When are they gonna REALLY know? And,
in the meantime, what should I do? . I will continue taking
it, but I'll step up my weight workout and maybe go to that
new health food store, I guess. You think they have anything
that will work?
Another daughter who stopped using HRT after her doctor
informed her of the WHI study results remarked, Yeah, I
stopped. It didn't seem worth it. Though, I do hope, though,
that they come up with something new. My hot ashes, ugh,
have returned. Interestingly, these women did not express
feeling out of control when the promise of HRT fell short of
its claims. Instead, they just expected that the pharmaceutical
industry or the newer complementary and alternative
medicines would come up with an even better technology
or treatment tomorrow. Their reliance on medical technology
and future innovation further illuminate the strength of
the symbiotic relationship that the Menopause Industry has
fostered with the women of the baby boom cohort, and how
these women will continue to rely on and seek out medical
intervention to quell the realities of their aging bodies.
Just as the school system and workforce have shifted in
response to the disproportionately large and historically
unique baby boom cohort, the network of aging service
providers will likely need to accommodate this highly
educated, choice-demanding, health-conscious, and disproportionately large cohort (Blanchette & Valcour, 1998). Some
have suggested that the social activism of the late 1960s and

R.L. Utz / Journal of Aging Studies 25 (2011) 143154

the early 1970s is hypothesized to show up again when the

boomers reach old age (Williamson, 1998). Given the
experiences of the daughters' interviewed in this study,
some of that activism may be directed at revolutionizing the
health care industry in a way that allows these women to selfregulate or manage their own care (Schwarzer, 2001), and
much of the protest may be associated with an unwillingness
to accept the traditional norms associated with old age
(Apter, 1996). Health care providers must begin preparing for
the baby boom woman, proclaiming as one of the daughters
did, I do not like it [aging/menopause] and I am denitely not
going to sit back and let it happen. I am going to do it my
way. The projective nature of the data provided by the
daughters of this study suggests that health care providers
must be able to accommodate the baby boomers' need for
control, their internalization of the medicalized paradigm,
and their steadfast proclamation to rewrite the traditional
norms associated with previous generations. Innovation and
creativity, therefore, are the characteristics that a forwardlooking health care industry ought to be embracing. This is
yet another industry that will likely transform under the force
of the disproportionately large baby boom cohort entering
the latest stages of the life course where health care is most
needed.
Conclusion
I started this essay by asking, Why, if menopause is a fact
of biology, do individual women experience it so differently?
I was most interested in exploring how two generations of
American women adapted to the shifting denitions and
cultural attitudes associated with menopause (Gannon &
Eckstrom, 1993; Gannon & Stevens, 1998; Gullette, 1994;
Meyer, 2003; Wilk & Kirk, 1995), even though the biology of
menopause has not changed over history (Ellison, 2001; Post,
1971). Using qualitative data from 24 mothers and daughters,
this essay examined how the cultural denition of menopause has become increasingly medicalized over the last
decades of the twentieth century and how this process of
medicalization has impacted the attitudes and behaviors of
two distinct generations and/or cohorts of aging women.
The narrative accounts detailed in this essay capture how
the cultural acceptance of medicalization has affected the way
women talk about, dene, treat, accept, or ght the bodily
changes associated with menopause. By extending the
analysis beyond the frame of menopause, this study has
also illustrated how medicalization has perpetuated negative
cultural attitudes toward aging. Furthermore, by linking the
women's narratives to the larger context of their lives, this
essay also depicted how the social construction of menopause
has paralleled concomitant changes in women's social roles,
the rapid expansion of medical technology, and other cultural
inuences of the twentieth century. Thus, this study has
highlighted an important social process whereby women's
subjective reality is shaped by the macro-historical context
that denes an individual's experience.
The methodological use of the cohort concept (Elder &
Pellerin, 1998; Gilleard & Higgs, 2007; Kertzer, 1983; Ryder,
1965), which has been largely underutilized in health-related
research (Hummer, Rogers, & Eberstein, 1998), has proven to
be both an effective and efcient way to illustrate how

153

technology, biology, and culture have all simultaneously

evolved to create distinct subjective realities of menopause
and aging for the mothers and daughters interviewed in this
project (Datan et al., 1981; Lorber, 1997). This approach has
extended our sociological imaginations (Mills, 1952) by
integrating the individual experience of health within the
larger social structure and historical context it is embedded. It
has given us a glimpse not only into why the two groups of
women express such different attitudes toward the experience of menopause, but also how this cultural (re)denition
has impacted the way women think about aging in modern
American society.
These ndings, because they are derived from a small
homogenous group of women, tend to focus on the similarities
within generations, rather than differences between women of
the same generation. Although there was inter-cohort variation
even within this homogenous sample, the small sample size
made it difcult to adequately address how particular individual-level characteristics (e.g., career histories, family characteristics, wealth, hysterectomies, and personal values) may further
stratify the experience of menopause over and above the
differences attributable to cohort membership. Future research,
using either quantitative or qualitative methods, should
consider how the experience and interpretation of menopause
might vary for women of different racial/ethnic identities, social
strata, and other personal characteristics. Additional research
might also explore whether this phenomenon, whereby the
lived experience of menopause has so dramatically shifted
across a single motherdaughter generation, has occurred in
other modern western nations, or whether it is unique to the
American baby boom cohort (Meyer, 2003).
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