When I first started writing this blog, I did so because I perceived a dearth in both the medical and the popular literature on women’s health, particularly with respect to evolutionary perspectives. We might talk all day along about insulin and obesity and heart disease. But what about ovaries? 50 percent of the population has them. Or what about depression, anxiety, acne, and gut dysbiosis, all conditions that affect women at much higher rates than men? What about the enormous burden and joy and giving birth? 3 million 999 thousand women in the United States do so every year. That’s 12,000 every day. We needed to talk about women, and we needed to do so fast.
compared to women above the age of 45, reproductive women are virtually living in the limelight.
Much as I’ll malign contemporary health dialogues for neglecting the needs of reproductive women, post-reproductive women receive even less attention. But dealing with menopause — that’s even nastier for many women than dealing with PMS. Why do we give attention to one, but not to the other?
The answer is simple: women might be a pain in the ass, but at least the young ones are sexy. That’s what society would have us believe, anyway. Far more than we would like or that we would ever admit to, we reserve an enormous amount of a woman’s value based on her sex appeal. Squirm your own way out of it however you want. But it’s there, deep in your brain, I’d be willing to bet. We can’t help it — this is the product of hundreds of years of conditioning and billions of dollars in advertising every year. The value of a woman is skewed largely by her physicality (helllooo President Obama). It is skewed largely, then, by her youth. Largely by her reproductive fitness. Largely by her virginity, her potential, her sexual wiles.
This is evidenced most obviously by the film industry. From the Huffington Post:
A study released by USC’s Annenberg School for Communication & Journalism took a survey of the 4,342 characters in the top 100 grossing films of 2009 and compared it to results from the top films of 2007 and 2008. For women, nothing much has changed — in these top films, 33 percent of actors are female and 67 are male.
This means there are twice as many men in movies as women.
Only 17 percent of films are gender balanced, even though females make up half of the ticket-buying population.
Adding fuel to the fire, women are much more frequently sexualized when they appear on screen. They’re more likely to be seen in sexy clothing than men (25.8 percent to 4.7 percent – five times as much) and four times more likely to be partially naked (23.6 percent to 7.4 percent).
And then the proof, lying naking in the pudding: Teen girls feature in movies the most of all age groups. Women ages 21-39 are to be shown as sexy, or partially naked. Older women, aged 40-64, are a) less likely to be shown as attractive (3.8 percent) and b) less likely to be shown at all. Only 24 percent of all characters over the age of 40 are female.
All of which is to say: I don’t have an easy answer.
How do we give older women the respect and love and attention they deserve? How do we convince the rest of society to do the same?
De-objectifying women is the most important thing we can do in this case. It will be the biggest help, if the most entrenched battle. The more valuable women are for skills and personality, the less we will rank women based on physical appearance and sex appeal. The more these non-physical values are emphasized, the more and more older women will find definition, liberation, and empowerment in all of the non-physical valuable traits they contribute to the world. Right? This is how it is supposed to work for all of us, in any case.
Someday we’ll get there. We’re getting there.
I think film is a wonderful way to help us think about this issue and to identify the problems in our own brains. Why are there virtually no films about or featuring older women? Why are there films about older men? How might we be able to combine and blur those lines? If older roles are usually reserved for executives, mob bosses, and the like — well, women can do that every bit as well as men, can they not?
Another aspect of it is the expansion of sex appeal. Don’t get me wrong — I don’t want any woman to be an object. In fact, I don’t want any people to be objects. Period. Ever. Obviously. But I also want all people to be embodied and empowered in their own sex appeal. Just because a woman has wrinkles does not mean she is not sexy, people! What the hell! Certainly, she may be out of fantasy range for most young adult males and females. But that does not mean that she is a desexualized, de-feminized being.
Get the hell out of here. The idea is unreal. But we do it, don’t we? We see and enable men living into sexual roles well into older age — we do it all of the time. I’d leap into bed with George Clooney at the drop of a hat — who wouldn’t? But what of Meryl Streep? Helen Mirren? The idea is less automatically appealing. The sexuality of older women is egregiously overlooked and discouraged. I shall not stand for it!
Huzzah! This is a part of the revolution we can do ourselves. As a community of women of all ages, we can reinvigorate our own sexuality however we see fit. We can live into it. We can be natural women — not sexy because we have botox and the ridiculous like — but sexy because we are precisely our menopausal age and yes I have hot flashes sometimes and no my vagina does not unleash a daily cascade of lubrication, but I have been a woman for a damn long time and I know exactly how to own my natral body and to live in it and to love it and to use it for physical pleasure.*
And we can be more than sexual beings at all times of our lives! We always have value — enormous value. We are smart and productive and empathetic and talented and all of that other fancy crap.
Rawr, ladies. Rawr!
*At least I imagine these are ideas that helpful to think, 40 years down the road. Please share your thoughts and tell me what feels good for you. I’m rather guessing, here, and acknowledge that openly. The whole point being — let us not forget the embodied, sexual power nor the inherent asexual dignity of women at all ages.
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The range of reproductive years across both human and primate populations is choc full of fascinating data. What determines the range of reproductive years, and for what gain? Has menopause changed at all? In fact, it has not. As countries have continues to industrialize, the age of menarche (first period) has continually gotten younger (for better or for worse). So far as we can tell, however, the average age of menopause has not budged. It hasn’t moved with time, and it doesn’t move across populations. Women have a certain amount of eggs, and they appear to run their course by age 50 for virtually all women. What gives?
Chimp and baboon female reproductivity declines as they age, but neither species actually sees many of its members stop menstruating before they die. This conundrum may be answered for by the simple fact idea that most species, including humans, historically have died at ages younger than we see today. But this doesn’t seem to be the case. So far as evolutionary biologists can tell, about 5 percent of other primate females live past reproductive age; for humans in contemporary foraging populations, on the other hand, (Gurven and Hill, 1997) it’s about 30 percent. This seems to indicate that evolution has deliberately “chosen” menopause. Nature wants women to stop reproducing at a certain point. (*Of course, the better and more scientific way to say this is that having infertile older females in populations promotes the survival of the maximum amount of offspring).
The answer to our question, therefore, necessarily lies in evolution, too. There are likelytwo dominant aspects to the answer.
First is the consideration of cost. How much does it cost a woman, energetically, to carry a baby? A whole hell of a lot. It does not cost a man much at all. In fact, the act of conception is the only physiological necessity that the male contributes to the offspring. This is why men enjoy reproductive fitness often until the end of their days, and why optimizing male health very often leads to a full life of fit and kickass male libido. The healthier a man is, the more vital his sperm, and the more offspring he can have.
Unfortunately or not, it does not swing the same way for women. Women’s bodies are capable of an enormous miracle of gestation, but it takes a hell of a toll on her body. If she were to reproduce until her dying days, she may in fact die much sooner from energy expenditure. Menopause necessarily has to happen to women, because evolution wants to have older women around very, very much.
The human evolutionary strategy is now, far more so than many other species of primates, an emphasis on quality versus quantity of offspring. Instead of having 200 offspring per litter, as in fish, that require little care and also that have a vastly lower success rate, human beings – much like elephants! – carry babies in the womb for a long time, have radically dependent and weak babies, and invest a lot of energy in their young in order to assure the reproductive success of each offspring. Babies are investments. This means that humans have very few children relative to the rest of the animal kingdom, but that success rates are much higher.
Data from the whole vast array of human cultures as well as other primates demonstrates one recurring fact: grandmothers kick ass. Grandmothers enable their daughters to reproduce earlier, for example. They also enable more frequent reproduction, and they mitigate a significant amount of the stress of providing for a family and being a caretaker. This element of support makes this family unit much more evolutionarily successful than it might be otherwise. Without grandmothers, mothers would be more solitary, would have to look more broadly for food and shelter support, and would have to expend much more energy securing resources for her young. These things partly taken care of by grandmothers, mothers are free to reproduce more. What’s more, however, the additional support also makes for healthier offspring. This means that grandmothers give evolution a one-two punch: increased offspring quantity, and increased offspring quality. Across the board, grandmothers have real evolutionary purpose.
The evolutionary advantage of grandmothers indicates – and importantly for us in the modern world – that women are not intended to melt away or fade into the background as they age. In fact, most women in contemporary foraging societies continue to contribute to societal wellbeing and production at least until age 60. It is not just grandmothers who are important, but grandmothers who are powerful producers and caretakers. The healthier a grandmother is, the healthier her family and her society are. Physical health is important. Mental health perhaps even more so.
Which brings us to the last and perhaps most fascinating point, the one that may account for the distinction between humans and other primates on the survivability of women beyond reproductive age: humans have language. Humans have complex cultures, and we have complex histories, and complex stories, and complex knowledge. Some anthropologists argue that longevity (for males, of course, as well as females) appeared as recently as 30,000 years ago in human history. In their view, longevity increased more and more throughout evolution, with the greatest increase occurring recently, as culture and creativity blossomed (Caspari and Lee, 2004). “Longevity” says Wenda Trevathan, “appears to be advantageous to a species that depends so heavily on information handed down through the generations; in other words, for a species so dependent on culture.”
So why do we undergo menopause? Because we are meant to keep living. We are meant to continue to care for our families, and we are meant to contribute to our societies. If we have kids, we can help them. If we do not, we can help others. And we are meant to keep learning, to stay sharp, to share our stories and to pass on the wisdom of experience. That image of the wizened, serene, gray-haired woman – it’s one inherent to human nature. We need to embrace it. Older women are not for nothing, and I, as a youngling, don’t want to be for nothing, either. Life is for the strong and vital and loving and living at all ages. Nature asks us and provides us the tools to stay strong as we age. Our job is only to say yes.
Menopause is inevitable. It happens to every person near 50 years of age, and nothing we do short of serious medical intervention will ever stop it. The body has supremely intelligent biological clocks in it. When the time comes to stop, it stops.
Yet through experimentation with serious medical interventions, we have learned more and more about the precise nature of that clock. We have known for some time that estrogen supplements mitigate menopause symptoms. This is because menopause is largely tied to decreases in estrogen levels, and most of menopause’s irritances such as hot flashes come from having low estrogen levels. Yet what causes the clock to spring and estrogen to decrease in the first place?
Scientists have recently begun exploring a method of feritlity extension that deals primarily with ovarian implants. Surgeons can now surgically extract tissue from a woman’s ovaries in her twenties or early thirties, and then re-insert slices of it at regular intervals in later life. What this does is it keeps the ovarian tissue pumping estrogen. While sounding vastly unnatural, this is actually a better and more natural method of menopause delay than estrogen supplementation. This is for two reasons: 1) the estrogen is completely natural, produced by your own body, and 2) this method actually prolongs fertility in addition to acting as a bandaid to symptoms, which is the only thing estrogen supplementation can do.
These experiments have demonstrated that it is the state of tissue health and egg availability that determines the onset of menopause.
The female body starts off with around two million eggs. By puberty, this number has decreased to 300,000 eggs. It then releases these eggs slowly over time, with each menstrual cycle. Usually in the mid-thirties, women’s fertility naturally decreases. By age 35, 5 percent of women are already infertile. This means that fertility drops off before menopause symptoms set in, a stage called perimenopause. This is important for all women thinking about having children into their later 30s and 40s to take note of. Menopause symptoms might not settle in until until your 50s, but perimenopause can be a significant reality by 35.
Factors that accelerate ovarian aging include…
Smoking (by about two years)
Never having children, or having children later in life
Having short menstrual cycles
Low socioeconomic status
A vegetarian diet (by about two years)
That’s right! According even to conventional wisdom, vegetarian diets are linked to increased ovarian aging at nearly the same rate as smoking! No one knows precisely why, though it may have to do with nutrient status, with fiber content of the diet (high fiber can decrease estrogen levels), soy intake, or correlations with restrictive behavior. None of these ideas are proven– they’re just hypotheses I am posing.
Shortening menstrual cycles and decreasing the age of and amount of time a woman spends pregnant ages the ovaries because it makes them work longer and harder throughout life. Having a shorter menstraul cycle increases the amount of eggs released over time. This accelerates the onset of both perimenopause and menopause.
Factors that delay ovarian aging include…
Irregular menstrual cycles
High socioeconomic status
Giving birth early and/or frequently
Moderate alcohol consumption (correlation?)
Longer menstrual cycles
All of these factors act in contrast to those listed above. They promote longer menstrual cycles and/or a decreased amount of menstrual cycles, which means they can decrease the amount of eggs released over a lifetime. This both prolongs fertility and postpones menopausal symptoms.
Factors that have unknown effects
Age of menarche (onset of puberty)
Oral contraceptive use
Endometriosis and/or estrogen dominance
All of these questions are exacerbated by the fact that we’re looking at two slightly different phenomena. Perimenopause is the onset of infertility characterized by decreased egg production and fluctuated estrogen levels. Menopause is the cessation of menstruation characterized by very low estrogen levels and almost entirely absent egg production.
Postponing perimenopause requires optimizing the health of your ovaries, preserving eggs, and decreasing amount of menstruation enacted throughout a lifetime. This means it is entirely possible that having a condition such as hypothalamic amenorrhea–which halts egg production–early in life will delay perimenopause, presuming that the woman has recovered between then and now. The effect that PCOS might have on this is tricky because each woman is individual. Some women might still produce a lot of eggs with PCOS, but others might not.
One this we do know with absolute certainty, however, is that increased health, stabilized hormone balance, and decreased stress are all key players in postponing perimenopause.
Postponing menopause, on the other hand, requires not just optimizing the health of your ovaries but optimizing your estrogen production. How do you do this? How do you optimize estrogen production?
This means that having a low estrogen condition such as hypothalamic amenorrhea might accelerate the onset of menopause. On the other hand, having a high estrogen condition such as estrogen dominance or endometriosis might do the opposite. This is why eating soy can be helpful for women struggle with menopause symptoms. It replaces estrogen where otherwise it has gone missing.
Yet, again, those are uncertain phenomena, and no one knows the precise effects of PCOS, hypothalamic amenorrhea, or endometriosis on menopause. What is certain is that optimized health, reduced stress load, having happy adrenal glands and a normal range of body fatness are all significant boosts to menopausal wellness.
So does the paleo diet help?
Yes. Being happy and healthy seems to be the best way to simultaneously delay perimenopause and menopause. The paleo diet is also supremely good for hormone balance, for healthy egg development, and for a regular and fertile menstrual cycle. This is because a diet built around evolutionary foods evades the insulin-poisoning effects of high calorie, high sugar, and inflammatory meals. It avoids soy, which is complicated, but can be definitively detrimental to fertility status. It decreases the risk for reproductive diseases such as PCOS, endometriosis, and hypothalamic amenorrhea, as well as metabolic and autoimmune diseases such as diabetes and celiac. And it is finally because paleo foods maximize nutrient status, which is necessary for reproductive success (for example, without sufficient calcium and vitamin D, a woman’s eggs will never full develop).
Stress reduction and play are also crucial. I consider these a part of the evolutionary framework–what does my body demand of me? Yes, it does demand laughter– so we can throw that on top of the paleo wagon as well.
All of which is to say that a wide variety of factors influence the onsets of perimenopause and menopause. But the specific health- and reproduction- enhancing and balancing effects of a paleo diet are a serious help. No studies have come out so far as I can tell that deal with whether or not the average ages of these events have changed in recent years. I wouldn’t be surprised at all, however, if in coming decades we find out that the landscape of menopause and perimenopause shifts along with the rapid decline in public health.