“Oh, this must be menopause.”

We talk about the onset of menopause in various ways. Many cite the first time their menstrual period failed to make its regular appearance. Others describe the first time they threw off the blankets in the middle of the night. Some women complain of menstrual periods that flood more and more heavily each month; others encounter dusty, unused tampons in a bathroom cabinet. Although many women in the United States disdain the fuss made about menopause in the popular press, resent having to seek treatment for hot flashes, and dislike being reminded that the process of aging is marching forward, every woman who lives to sixty years of age with her uterus and ovaries intact is compelled, at one time or another, to say, “Oh, this must be menopause.”

In general, ovarian biology is experienced as down there somewhere, internal, private, seemingly immutable. Women tell me that menopause is “out of our control,” “natural,” “biological.” It is all of those things. Menopause—technically, the last menstrual period—is also a cultural phenomenon, “a time of despair,” “a new phase of life.” Culture, generally unacknowledged, alters the experience of menopause, the recognition of menopause, the timing of menopause, and the symptoms attributed to menopause. Culture is public, shared, and created. Culture is made visible in medical interventions, attitudes about aging, birth control policy, indications for hysterectomy, smoking practices, food resources, diet preferences, marital norms, breastfeeding customs, and timing of motherhood. All of these aspects of culture influence biology and contribute to variation in the age and individual experience of menopause.