The Slow Moon Climbs: The Science, History, and Meaning of Menopause, by Susan P. Mattern

In the mid-1960s, the manufacturers of a rudimentary hormone replacement medication funded the research of an American doctor, Robert Wilson. In a move that can have shocked no one who knew of his pharmaceutical paymasters, Wilson claimed, white knight-like, to have cracked how to rescue people from the “horror” of the menopause or, as he put it, from “living decay”. Wilson – not one, it appears, to aim for composure when hyperbole was available – wrote that “Every woman faces the threat of extreme suffering and incapacity.”

Wilson is one of a cast of thousands in The Slow Moon Climbs, an impressively wide-ranging work from the University of Georgia’s distinguished research professor of history, Susan Mattern. She sums up the extraordinary breadth and inclusivity of her research herself: “In this book, the modern era is only a coda to a much deeper, darker, more obscure, and more portentous past, the submerged part of an iceberg of which modernity is only the tip.”

That iceberg, from the lives and communities of Palaeolithic peoples to the very latest developments in hormonal and medical research, makes The Slow Moon Climbs a comprehensive and revealing guide not only to what the menopause is and does, but also to why and how it does it. Humanity’s long prehistory has played a significant role in shaping what it is that we are actually talking about when we talk about “the menopause”.

The “Man the Hunter” trope dominated anthropology for decades and Mattern’s elegant, detailed rebuttal of it reveals why that dominance proved so intractable. “Questioning Man the Hunter”, she writes, “meant questioning whether characteristics of human society long assumed to be fundamental – male dominance and the nuclear family – are really essential to human nature.” It was the emergence in the 1990s of the so-called Grandmother Hypothesis, coined by William Hamilton and developed most recently by Kristen Hawkes, that forced this paradigm to begin to shift. What if more was contributed to human survival and evolution by menopause and not by muscle – by grandmothers and not by hunters?

Mattern assesses this hypothesis against its main rivals (the “Patriarch Hypothesis” and the “Embodied Capital Hypothesis”) in an attempt to understand why women live so long post-reproductively. In the adaptive “Grandmother” theory, the post-menopausal assist younger members of their social groups in raising their children. In turn, these younger women can have more babies in less time. It’s a credible hypothesis, and Mattern goes so far as to suggest that there are strong arguments to support the idea that “grandmothering is in fact the force that drove the evolution of humans’ unique life history”. The menopause, rethought like this, becomes less “living decay” than ingenious evolutionary marvel.

The Slow Moon Climbs is audacious in its scope, and Mattern is well aware of its potential for both impact and controversy. It’s a deeply interdisciplinary book that both focuses on the specifics of the menopause and also compellingly maps these specifics against a broader milieu of entrenched misogyny. “Many of the assumptions about human psychology and behaviour that underlie modern economic and political thought”, Mattern argues, “are plain wrong, and should not be allowed to dictate a short future of greed, exploitation, and spiralling consumption leading to catastrophe.” Her book, then, is an enormous scholarly undertaking, traversing vast geographical space and time (about 2.5 million years). She handles the material in an accomplished and persuasive way, elevating the phenomenon of the menopause far beyond the familiarly condescending cardigan-on-cardigan-off rhetoric of the hot flush.

Not only does Mattern query why the human species has the menopause in the first place (the various arguments she summarises about whether or not any animals other than human beings experience the menopause are fascinating – whether we are more chimpanzee or aphid in this respect proves surprisingly difficult to answer), but she also considers when and why the menopause became medicalised. The analysis in this section of the book is less about adaptive evolution than about profit and loss (see again how Robert Wilson’s research into the “extreme suffering” of the menopausal was funded). The transition from reproductive to non-reproductive life was repackaged as a medicalised syndrome in need of a cure because cures make money for those who purport to offer them.

Mattern acknowledges that early menopausal “experts” such as Wilson both reflected and ramped up cultural anxieties. Gentlemen doctors such as Johannes Storch, who was practising in central Germany in the early 18th century, shored up their authority by advising menopausal women “against love and sex”, and occasionally even by prescribing “drugs and bloodletting, often with leeches applied to the vulva”. While many “women’s issues” that had cultural and medical traction in the 19th century – hysteria for one – have long since been debunked or dismissed, the pathologised model of the menopause persists. This is at least in part because of the discovery of oestrogen: Edward Doisy and Adolph Butenhaldt shared a Nobel prize in 1929 for their work in endocrinology. Oestrogen – or, more specifically, the ability to replace diminishing levels of oestrogen – became the menopausal golden calf. Fortunes have been gained from making those experiencing the menopause feel that they need a cure (just ask anyone based in the UK who’s been prescribed HRT about its current availability and it quickly becomes evident how just reliant on it so many people find themselves to be).

Mattern does not dismiss how difficult many people who experience the menopause do find it. “Menopausal syndrome is obviously a real phenomenon,” she writes, “from which millions of women around the world suffer.” So long as menopause is couched in terms of loss and deterioration, however, people experiencing it will inevitably experience it negatively: “culture-specific disease labels…arise that organize and assign meaning to our experience of symptoms”. The book resists a Eurocentric focus, too: Mattern looks at Chinese, Ache (Paraguayan) and Hadza (Tanzanian) communities, and considers how the menopause is understood in many countries and cultures, including Korea, Thailand and Gambia.

The Slow Moon Climbs is dense and well evidenced. It is also unexpectedly funny. It’s a skilled writer who can summarise a detailed, well-referenced and complex story of human evolution thus: “to longer lives, nature said, ‘Yes!’; but to longer reproductive lives, at least among women, nature said, ‘Meh’”. Further, surely far more books should have, as this one does, a section called “Why aren’t we more like mole rats?”

It really does feel, writing this review in the month when the world’s first Vagina Museum opened its doors in London, that there is a vulvar revolution in the air. Mattern’s remarkable book fits perfectly into this cultural moment, offering up new ways to think about how beliefs – even about something as intimately familiar to us as our own bodies – are shaped by dominant, often financially motivated, discourses. It lies in us, at least in part, to move our thinking about the menopause from a place of loss to a position of power.

Emma Rees is professor of literature and gender studies at the University of Chester, where she is director of the Institute of Gender Studies and the author of The Vagina: A Literary and Cultural History (2015).

The Slow Moon Climbs: The Science, History, and Meaning of Menopause
By Susan P. Mattern
Princeton University Press
480pp, £25.00
ISBN 9780691171630
Published 24 September 2019