Woman: An Intimate Geography (39 page)

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Authors: Natalie Angier

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BOOK: Woman: An Intimate Geography
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rejecting it, or may influence the compliance regarding its use." From Scotland: "In conclusion, women around the menopause . . . are often anxious about HRT use. Better health education might improve HRT uptake."
Nobody will argue against patient enlightenment. Let's all talk ourselves hoarse. Yet a more interesting point emerges from the parade of studies on the psychological profile of the middle-aged woman. It turns out that one of the biggest reasons that many women reject hormone replacement therapy is that they have positive feelings about menopause. They don't think of it as an illness, so what's to treat? In two separate U.S. studies comparing black and white women, researchers found that "the African-American women had significantly more positive attitudes toward menopause" than white women did, and that though they had the same number of menopausal symptoms as whites did, the blacks "perceived them as not very bothersome." The African American women surveyed also had a fairly good understanding of the "proper" order of health risks an aging woman faces, placing heart disease at the top, yet still they were far less likely than whites to be on hormone therapy. After noting ruefully that among Dutch women, the "mean duration of HRT use is only seven months" investigators at Elkerliek Hospital in Helmond, the Netherlands, went on to say, "The positive attitude of most women towards the climacteric is an explanation for this very short duration of use.'' Comparing a group of forty-five-year-old women who expressed an intention to use hormone therapy after menopause with a group who planned not to, London researchers found that there were no significant differences in the women's health or socioeconomic status, but that "HRT intenders reported significantly lower self-esteem, higher levels of depressed mood, anxiety, and negative attitudes to the menopause. They also expressed stronger beliefs in their doctors' ability as opposed to their own to control their menopause experience."
Women who like the effects of estrogen therapy, who feel smarter and more energetic with it than without, need no persuasion. They will be proactive patients, and many will be proselytizers too, telling their friends at the menopause Maginot, Try it, you won't be sorry. But the women who are noncompliers what of them? Are they necessarily ill-informed or misguided? Some may resist taking hormone therapy

 

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because they're afraid of breast cancer. Or they may try it but dislike the side effects, the breakthrough bleeding, the tender breasts, the moodiness, aqueousness, nausea, the pimples symptoms so reminiscent of the premenstruum. Many women simply resent the implication that menopause is a disease, and they express their resistance by tossing their pills in a drawer and forgetting the whole business. Women in their fifties often feel quite fit. They remember when women were considered unsuitable for higher office because of their fluctuating hormones, and when women had to quit a job the moment they became pregnant. Enough is enough; enough queasiness over the female body. Must a woman go to her grave with a speculum chained to her thigh? Menopause is an event, just as menarche was, a female rite. Their mothers and grandmothers went through menopause, their friends go through menopause. It happens to everyone. Women can't help but feel that menopause is natural. They say as much to their doctors menopause is natural. It's meant to be, it's what the body does, and why shouldn't I be pleased with, or at least tolerant of, what my body brings me?
Doctors have responded badly to this interpretation of menopause, this self-satisfied talk. They're faced with a challenge. If they're going to persuade large numbers of healthy women to take hormone replacement, they must dispel the notion of the good and natural menopause. They must raise the specter of infirmity, a weakening heart, a crumbling frame, an enfeebled mind. They contrast a woman's spectacular loss of ovarian estrogen with a man's far more gradual tapering of testoster-one levels: he ages gracefully, you age overnight. They describe menopause as a state of "estrogen deficiency," comparing it to endocrine disorders such as hypothyroidism and diabetes. Just as a diabetic should be treated with insulin, so an estrogen-deficient woman should be treated with HRT, and any woman past fifty is almost by definition estrogen-deficient. Even women who are still menstruating may be estrogen-deficient, may be "perimenopausal," as the melodious little phrase has it, and candidates for hormone therapy. If a woman asks why it might be that all women lapse into this precarious state of hormone deficit in midlife and why nature has not better equipped them for their sovereign years, a doctor will reply, If it were up to nature, we wouldn't be having this conversation and I wouldn't be writing this prescription. A long life is good, it is desirable, it is a tribute to human ingenuity and

 

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modern medicine, but one thing it decidedly is not is natural. If it were up to nature, you, my postreproductive doyenne, would already be dead.
Or would you? Let's ask that old woman out there in the field, the one with the shovel in her hands. She's digging up something, and it sure doesn't look like her grave.

 

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13
There's No Place Like Notoriety: Mothers, Grandmothers, and Other Great Dames
The Hadza people are a small group of hunter-gatherers who live in the dry and rugged hill country of the Eastern Rift Valley, in northern Tanzania. There are only about 750 of them, but they're not going anywhere. They speak a distinct language, Hadza, a percussive tongue of clicks and hisses reminiscent of but unrelated to the language of the !Kung. And the Hadza refuse to be domesticated. Time and again over the past sixty years, church and government agencies have tried to transmute them into farmers, but the efforts always fail and the Hadza return to the bush. They hate gardening! They hate milking cows! Instead, the Hadza subsist almost entirely on wild pickings game, berries, honey, tubers. They're opportunists: see an impala, kill an impala. If the berries are ripening three miles away, they move three miles away. When the local bees slacken their honey production, the Hadza break camp to find busier ones. On occasion they'll steal a sheep from a neighboring herder, but usually they prefer barter, giraffe jerky for maize or tobacco.
The Hadza live a no-frills existence that supposedly retains some features of the Pliocene and Pleistocene conditions under which
Homo sapiens
evolved. They're Stone Age relics, more or less, which is why they attract the attention of Western anthropologists. What can they tell us about the essential us? For one thing, forget Hobbes. The Hadza's lives are not nasty or brutish, nor are they particularly short. As Kristen Hawkes, of the University of Utah, discovered when she and her colleagues descended on the Hadza and tracked their life histories, the women refuse to do what our forebears are said to have done routinely

 

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die by the time their eggs have run out. No, many Hadza women keep on going well past menopause, into their sixties, their seventies, sometimes their eighties, all without the purported life-extending benefits of the postindustrial age or even of the agricultural revolution. In the United States, demographers worry about the aging of the population and the potential drain of the elderly on the wealth and patience of the rest of us. The Hadza might worry about the opposite, what would happen if they didn't have their corps of old ladies. As the data from Hawkes and her colleagues reveal, postmenopausal Hadza women are the hardest-working members of the tribe. Every day they're out in the bush, digging, poking, reaching, clambering. They gather more food than any of their comrades. They share their food with young relatives who can't fend for themselves: grandchildren, great-grandchildren, great-nieces and -nephews, second cousins twice removed. When a young woman is breastfeeding a newborn and can't forage as effectively as usual for her older children, she turns for assistance not to her mate (where has that man got to now?) but to a senior female relative. Grandma, or her proxy, takes up the slack and keeps the kids in baobab and tubers. Hadza children are always thin, but without an elder's efforts they would become too thin, Karen Carpenter thin, whenever a new sibling arrives, and they might very well die early as a result. Hadza elders are truly great grandmas. They are not an option. They are not a Hallmark sentiment. In Hawkes's study, no nursing mother lacked a postmenopausal helper.
The Hadza are a small group. They have had extensive contact with bureaucrats, academics, cultural carpetbaggers, and exhortationists of all stripes, including some of their own members who received a Western-style education and came back preaching the gospel of agraria. The Hadza are not "pristine," and it's risky to draw too many conclusions about prelapsarian humans from them or any of the other hunter-gatherers remaining in the world. Nevertheless, if we're going to talk about the evolution of human menopause and squabble over whether it's natural or unnatural, meant to be or an unfortunate tag-along of our newfound longevity, we can't ignore all those Hadza matriarchs rooting around in the woods for the fruits of the future. To Grandmother's house we go.

 

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The "grandmother hypothesis" of the origins of human menopause got its start in a paper that is nearly old enough to be a grandmother itself. In a classic 1957 essay about the charming inevitability of aging, the renowned evolutionary biologist George C. Williams addressed the strange case of the climacteric. He pointed out that most depredations of age, such as failing eyesight, arthritis, wrinkling, and the imperialism of flab, occur at varying rates and to varying degrees among individuals. Some aspects of aging can be forestalled for decades, through exercise or by wearing a hat in the sun. Not so menopause. Whatever a woman does, however rigorously she attends to her health, at the half-century mark, give or take a few years, she will go into what Williams called "premature reproductive senescence." Not every person ends up needing reading glasses, but all women who reach the age of menopause stop ovulating. By contrast, other female mammals, including our close relatives the apes, continue bearing young practically to the grave. Orangutans do not go into menopause. Chimpanzees do not need extract of mare pee. Men too can father children they may be too arthritic or cataracted to hold or behold. Only in human females, Williams said, does the fertility program shut down years before death. How unlike nature, in designing women, to forget her beloved multiplication tables.
For the apparent conundrum Williams proposed a brilliant solution: blame it on the kids. Human children are so damned expensive. Each one requires years and years to rear to independence thirteen or fourteen years at a minimum. They need to be fed, clothed, housed, schooled in whatever skills their environs require, protected from the wrath of the bored and the bullying. Assuming that mothers have always been the primary caretakers of their children and that in the past a child without a mother was a child without a prayer, Williams suggested that it behooved a woman to persist long enough to usher her children to puberty and autonomy. If a woman remained fecund to the bitter end, becoming pregnant even as her body was faltering, she risked dying in childbirth or its draining aftermath when she still had several dependent young. And all those kids could very well die in her wake, or at least fail to reach their potential. Better the woman should forgo the hazards of late-stage maternity and devote herself to mothering the children she already had. Better her ovaries should be programmed to

 

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senesce in advance of the rest of her. Better she should live to be a grandmother.
The Williams hypothesis was an instant success. Everybody loved it, especially women over fifty. It had the same clever, simplified appeal as Desmond Morris's proposal that a woman's breasts are bowsprit buttocks. Menopause is natural. It's built into the system, a registered trademark of humanity. We're smart, our kids are smart, and our ovaries show it: they cease production just in time to give us a fighting chance to see our last child out the door. Menopause is good, and it can feel good; Margaret Mead famously talked in the 1960s of the "zest" of the postmenopausal woman.
Others seized and expanded on the hypothesis. Jared Diamond, of the University of California at Los Angeles, has argued that older women have been crucial in human history not only for their mothering skills but as repositories of information, Alexandrian libraries for preliterate tribes. Elders keep track of where the edible plants are, and they can recall natural disasters of long ago that may have affected the distribution and safety of local resources. Writing of his experiences in New Guinea and the Pacific islands, Diamond has described how, whenever he would ask questions about the island's flora and fauna that stumped the young or middle-aged natives, he invariably would be led into a dark hut, where he would meet the Oldest Living Member of the Tribe sometimes a man, but usually a woman who knew the answer to his interrogations. It sounds like a trope of Rousseau's, or Hollywood's, but the wise elder had her synapses and priorities straight. Eat that plant, sir, and your body will shake and your eyes will bulge from their sockets and you will be dead by sunrise. Anything else I can help you with today? As Diamond sees it, young relatives profited from the memories and advice of old relatives, and so selection extended human longevity. Men can live for decades with spermatogenesis proceeding apace, but childbearing gets riskier over time. If women were to survive to the encyclopedia years, the mechanism of menopause had to be born.
Jocelyn Peccei, who decided to go back to graduate school at UCLA when she was close to menopause and then chose to study why not? the evolution of menopause, has calculated that menopause might have arisen quite early in the hominid lineage, perhaps 1.5 million years

 

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