Sex, Evolution, and Life after Menopause: Conversation with an Expert

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One woman's odyssey through the Trump presidency. My focus is centered on the many issues affecting women--but what doesn't? There's a new post every week.

Lynnette Leidy Sievert, BSN, PhD

Dr. Sievert is on the board of the North American Menopause Society, whose mission is to promote women’s health in midlife and beyond. Their membership is composed of researchers as well as physicians and Dr. Sievert is one of the former. However, finding a doctor with a NAMS certification could make all the difference between receiving good care and receiving the best care. Here’s their website: Menopause.org

“As a biological anthropologist I have focused on age at menopause and symptom experience at midlife as two aspects of human variation. I am also interested in the evolution of menopause and post-reproductive aging as a human trait. Fieldwork on the topic of menopause has taken me from western Massachusetts to Mexico, Slovenia, Paraguay, Hawaii, London, and Bangladesh.” Dr. Lynette Sievert.

 Dr. Sievert met with me earlier this fall when she was at a board meeting in Fort Lauderdale. She was kind enough to talk with me for quite a while, which makes this a long read. I was fascinated, so I am publishing the whole thing in full, hoping you will be too.

Lynnette Leidy Sievert, BSN, PhD

Lynette Sievert:        I’m working on a new book about the evolution of post-reproductive life.

Madeleine Burnside:     That’s a subject many people I’ve been talking to are really interested in.

LS        Yes, as our longevity increases we can be pretty sure that we’re going to spend some part of our lives in a post-reproductive period. It’s like adding a room onto your house, and when you do that you usually have to reconfigure the use of all your other pre-existing spaces. Now that we have this extra room on our life span we need to rethink not just what we do with our post-menopausal life period, but how our whole lives take on a different meaning and configuration.

MB     I believe that’s true and it’s a lot of what I’ve been hearing. If I think about who counted as old when we were growing up much of those perceptions wouldn’t pertain anymore.

LS        Yes, but there are still some senses in which we are old by 70, and University of Utah anthropologist Kristen Hawkes has written extensively about the grandmother hypothesis, that it’s because of post-reproductive grandmothers we even have menopause. She studies the evolution of longevity and post-reproductive life until about 70, and when she looks at the Hadza peoples of north-central Tanzania and other hunter-gatherers she’s observed that about a third of their women are living past menopause but aren’t really contributing to the family past the age of 70. So I think it’s fairly easy to explain the 50- to-70 post-reproductive life period because we’re still so vigorous at that time, but then the 70-to-100 period is a little harder to analyze, at least from the same point of view.

MB     We just haven’t made sense of that yet. I recently watched a wonderful video of President and Michelle Obama welcoming a woman to the White House named Virginia McLaurin who is 106, and she was so thrilled to be there that she was literally dancing around the Blue Room. And I’m fascinated by the science on whales and dolphins living to be 80 or 90 or longer, and there’s a whole grandmother phenomena there as well.

LS        Yes, but not all whales, and that’s where it gets interesting. Because the baleen don’t go through, or at least don’t live beyond, menopause and don’t have a post-reproductive life, but then the orca and pilot whales do, and researchers are trying to figure out what the differences are there. And among primates macaque monkeys can have a post-reproductive life but chimpanzees apparently don’t, at least in zoos or if you look at the histology of the ovary. Macaques are female bonded and chimpanzees are male bonded, so you would have to wonder if there’s some reason there that would go along with Kristen Hawke’s hypothesis where it’s the maternal grandmother who’s doing the investing. In compiling the literature now for my new book my focus is on fish through current humans, because I think the answer to why this happens goes all the way back to fish, and then the shift of continuing to make eggs past a certain point or not being able to do that happens somewhere in the reptiles.

MB     That’s fascinating because a lot of things people either take for granted or totally object to, based on cultural norms like homosexuality, are determined by laws of nature and have an evolutionary purpose. We should get over it but we don’t, instead we sort of puzzle it out; but in this case it’s something worthy of closer examination because it’s not so obvious and doesn’t apply to every species. If you can have gay penguins in Antarctica and even in a zoo then it would be safe to assume the same phenomenon occurs across many other species. But when most creatures don’t survive past their fertility then you’re looking at the question of what the exceptionality is about.

LS        There’s something about the turning point of fifty years, where eggs seem to be viable for about that long, and then in animals that live beyond fifty there’s a post-reproductive life, with the exception of birds. There are no mammals that have viable eggs beyond fifty years, and that might be something intrinsic to the function of ovaries, and that’s the clock to watch.

MB     I only started developing the Sanity Papers website about eighteen months ago. I’m not that kind of a doctor, but I want to access as much of that clinical information for my project as possible in part because it informs the social aspects.

LS        Yes, and we need more social scientists to look at menopause, because the number of anthropologists studying menopause I can count on one hand. We don’t have enough sociologists and historians in the field either, and I think some of the reasons for that are often people don’t develop an interest in menopause until they’re older. In twenty-three years of teaching at the University of Massachusetts I’ve had only one graduate student who asked to work on menopause; the rest want to do childbirth or breast-feeding or pregnancy. There’s a willingness to do women’s health, but menopause is not a sexy topic when you’re in your twenties.

MB     What first interested you in working in menopause?

LS        Because I realized back in the 1980s that there were many people looking at menarche, which is the first menstrual cycle in female humans, but menarche has an age range of nine to 16, and I became interested in menopause, which is clinically normal from 42 to 58, and saw it as being much bigger and more interesting than menarche, and I wondered why more people weren’t studying it.

MB     I think you had a great idea. People are more reflective and have more to tell you when they’re 40 than when they’re nine. At nine, you’re not getting a certain caliber of interaction, you’re not dealing with people who are able to tell you that much beyond what you’re equipped to observe for yourself.

LS        That’s a terrific observation, and I’m going to write that down. The other project I’m working on and almost finished with is a volume that I’m co-editing with Daniel Brown, Professor of Anthropology at University of Hawaii at Hilo, called Measures of Biological Experience: Making Visible the Invisible. In the context of what you just said what we can learn from a child’s self-report about her menarche is very different than what we can learn from a woman about her menopause, and I never thought about how much richer the self-report and meaning of things is going to be at menopause, or at the least easier to access.

MB     My own story is a good example of that. As a child I only had crushes on men but with puberty I began to realize I might be gay. Then I was a perfectly happy lesbian for thirty years, and though I’d had occasional affairs with men I settled on being a lesbian because, frankly, the sex was more exciting. But—to my dismay at the time—menopause flipped me back and now I have no sexual interest in women whatsoever. I certainly miss all the camaraderie of being gay. There were times you’d be about to get a parking ticket and suddenly, after no more than a brief exchange of looks between you and the person writing you up, you wouldn’t get that parking ticket, and you knew it was because you’d spotted one another. There were so few of us that we tried to stick together, though perhaps that’s more of an experience from the 1970s when being gay set one at a farther remove from the culture. But when my sexuality flipped over I became very driven by sex in a way that I don’t recall ever having been before.

Another story that relates to this is one about an old friend of mine who I no longer really know. We had become Facebook friends in some fit of nostalgia a few years ago but, other than that, we never communicate. She’s about eight years my junior and had been a rather ordinary and typical but smart working mom, a paralegal, married for a long time with a teenage child, the kind of person who made a sensible presentation that was what one would expect in the context of her age and upbringing and socio-economic status. One day I was notified on my Facebook page that a friend had changed their profile picture, and initially I didn’t even connect her to this and only wondered who the person was. Out of curiosity I clicked on the link and there popped up my friend, who had changed her first name and was naked to just above her nipples, seductively tossing back her long dark hair. I realized she’d just turned 50 and my first reaction was “Oh, you poor thing, it’s hit you in exactly the same way it hit me.” There wasn’t a sexuality shift involved with her, but she had suddenly become very sexually driven in the same way I had when I went through menopause, which became even clearer to me as I scrolled through her many recent posts of hunky-looking men. I was so sorry she was going through this, but I thought she was absolutely insane to be doing it on Facebook!

LS        That’s so interesting to me, because physicians target women who hit menopause and don’t want to have sex any more, and they focus exclusively on vulvovaginal atrophy because that’s what they see. When I did my very first study in rural Greene County in New York and asked women about their sexual desire half of them said it went down and half of them said it went up. And we’re not hearing from those women for whom menopause is a sexually enhancing experience. It seems to me that we target this estrogen-depravation model of menopause, which is what makes the vaginal tissues dry up and close down and for some women it’s horrible, but we don’t study the increase in androgens that come with menopause except to say that they bring on an increase in facial hair. But there are other good outcomes with the increase in androgens and one of those can be an increase in sexual desire, and perhaps even a change in orientation that may be related to the shift in hormones.

MB     That’s an important point. I had a physician who later became a very good friend who thought everything I’d experienced could be related to hormones. And of course I went through being easily perturbed and incredibly impatient and had some other totally standard symptoms, but this was a non-standard thing that I’d never heard about, and I’m convinced that many women who find their sexuality to be on the upswing simply don’t talk about it.

LS        Well they’re certainly not going to their physicians to complain. Speaking for myself, the only reason I brought this same subject up with my own physician was because there are times I’m away on field work for three weeks at a stretch, and when I come back home sex is a little uncomfortable for the first time or two, and my doctor suggested perhaps I should try using a vibrator. I was so amazed he said that, that he didn’t say I think we should start vaginal estrogen; he just thought I needed a substitute, which to me made complete sense. So I visited this little sex shop where I had never gone before but that happened to be right next to my local drycleaner and walked in and said I’m post-menopausal and my doctor said I should get a vibrator. The woman behind the counter said oh, what a great doctor you have, and she walked me over to an entire wall they had with vibrators and picked out this little purple one. And she was so kind and respectful to me and I was so pleased with the experience that now in April I’m going to be giving a talk at the store about menopause and sexuality and post-menopausal changes in the vagina and the vulvar region, because I think we don’t talk about it enough, and many women in their fifties who’ve maybe never been in a sex shop would benefit from the sorts of things they have. Even the gels they offer are of a much higher quality than KY or other commercial drugstore brands. I know I could have gone online but I had no idea what I really needed, and I wanted to do this through a personal interaction. Again, we don’t talk enough about the positive changes that many women experience: even if a woman doesn’t want to have sex with her husband anymore, which is what doctors often hear about, it might have a lot more to do with the state of her relationship than it has to do with sexuality or sexual drive or desire. And there are some good studies out there looking at how many women and men continue to have sex, and the kind of sex they’re having, until the age of 100; there’s a very interesting one that includes fifty thousand women by Dr Jan Leslie Shifren, Director of the Menopause Program at Massachusetts General Hospital in Boston.

MB     I do remember my friend’s uncle’s wife died when she was around 89 and they asked him if perhaps she hadn’t felt well, and he kind of grinned and said no, she felt quite well the night before!

LS        Well you still feel the same inside. I still feel 25 inside.

MB     Exactly. We tend to close people off because we think of them as being really old, but this couple knew they were really old and they didn’t let that stop them, and in my view that’s the way things should be. If you’re going to be old then you should at least have some fun with it.

LS        You’re right, but I get so focused on the biology that my strength is not looking at the broader picture of what women do with the span of their post-reproductive lives. That’s actually where Kristen Hawkes does a better job, because she collects data and studies what women do to model how that contributes to their evolutionary fitness. But the Sanity Papers is not looking at this from an evolutionary perspective, and I haven’t gotten to those chapters yet in my own book so I’m not certain how I’m going to address that either.

MB     I’m focusing on people who live in the United States, the world is too much to take on! But I also believe that the longer life expectancy in this country, compared to many others, makes it a valuable and appropriate thing to do here. Although we’re all not eating the same food because of cultural differences, there are many more similarities. We’re all drinking the water and we’re all invested in the global food chain; one’s responses to one’s own culture and its stresses can fall on anyone at any time, but what I’m dealing with are simply American stresses.

LS        It might be a good idea though to go to Britain for example, if you were to narrow your focus to sexuality, because we did a study in London and it was much harder to get women to talk about sexuality there than it has been in some other places.

MB     What changes in our metabolism is definitely meaningful. I was always a terrible stutterer until I was around 42 when I realized that caffeine was my problem. Having been born and raised in London I drank English children’s tea starting around the age of four, which is when my stuttering began to manifest. Then in my teens I started drinking coffee, and after that I lived in Paris for a time where there is more and even better coffee. But looking back and trying to figure out the origins and triggers for my stuttering in terms of when and where it had been the worst brought me to this picture of being on a balcony in Paris on a beautiful day and a waft of coffee rising up, and then another picture of myself in graduate school in California coming downstairs for breakfast where there was always a huge pot of fabulous coffee ready and waiting. And I looked back on those incredibly difficult periods of my stuttering where I was sometimes incapable of human speech and could clearly see that they were all strongly associated with coffee. So I stopped drinking it and after two or three weeks it was like surfing, I realized oh, I think I can kind of do this! And then after a couple of years it really straightened out and I became fluent, though I couldn’t touch coffee or tea or anything with caffeine if I wanted to maintain. But now, in another shift, I’m drinking coffee again, and it doesn’t have the same negative effect at all on my speaking. These systemic biological changes are weird.

LS        I had the same issue with milk, I used not to be able to drink it at all, but now I eat everything that’s made with it and have no problems. But yes, things like that definitely change, and we don’t study them.

MB     And the links between nutrition and hormones and biology and metabolism. I have a big commitment to the Sanity Papers project, and what people decide to do with the rest of their lives is of considerable interest to me as a social historian. When I retired a couple of years ago I came to discover that I wanted to do something different from my work in museums. My values are the same in the sense that I strongly believe people need access to information, and that’s a primary function of history museums, but they need to have knowledge that applies to their lives now, they need to understand how they got from where they were to where they are, and the Sanity Papers is that different thread. And I’m a popularizer by nature, I like to try and make things accessible and amusing. I was an Atlantic slave trade historian for many years and that was difficult for me, because there’s nothing light about it.

LS        That’s what a lot of academics are not good at, we’re not good at popularizing, so there’s a real value there.

MB     Do you know Professor Eun-Ok Im from University of Pennsylvania?

LS        I know her work, I don’t know her personally.

MB     I think what she does is of interest particularly because she’s worked a great deal with immigrants.

LS        Yes, but the only caution there is that almost all of her work is internet based, so it’s for women who have that kind of comfort level with and access to the technology. And there’s a lot of time required to participate in her surveys. For example when she asks about symptom frequencies she has over seventy questions, so it’s a select group of women who have the time and ability to be involved. I think the Study of Women’s Health Across the Nation, known as SWAN, is richer in the sense that it’s a better cross section of women who are Chinese, Japanese, Hispanic, African-American and European-American. The study started in 1994 with an enormous cross-section telephone survey of fourteen thousand women, which was then narrowed down to a longitudinal epidemiologic study with around thirty-three hundred women between the ages of 42 and 52. So far around fourteen hundred of those women have gone through menopause, and that’s how we know the average age of menopause is probably 52, which seems to be a little later than we’d originally thought. And what we’ve learned about ethnicity (because there are two groups in California that are Asian, and another group of Hispanics in New Jersey, five sites of African-Americans, and nine sites of European-Americans) when we look at menopause and control for things that affect the age of its onset like smoking, is that there’s no difference across the board, which goes to your argument that we’re all living in more-or-less the same environment. Even though the stressors and socio-economics are different, the environment and childhood nutrition are effectively very similar. Where I go in Bangladesh I see a median age of menopause at 47, and I compare that with Bangladeshi immigrants in London and their neighbors and their median age is 52. We ask the same questions in the same way of these cohorts and we see these disparities. I think if Bangladeshi women had levels of childhood nutrition similar to their relatives in London you’d see a difference that would be more like what’s the case in the United States.

SWAN now has hundreds of different publications covering a wide variety of women’s health topics that occur with menopause from cardiovascular disease to joint pain and bone mineral density to ovarian markers. There’s a lot of risk correlation and it’s a terrific study, and it’s been well funded by the National Institutes of Health, among others. But they’re not good at getting to personal experiences the way that you’re able to, and they’re not as good at popularizing either.

MB     Speaking of popularizing, I look to Studs Terkel as the modern-day master of some of that. When I first moved to the States and was trying to get a grasp of the physicality of living in a place quite this large I read his book Working, and thought I learned more about America from that than anything else. That’s a bit of how I model my approach to social history in what I’m attempting to accomplish here.

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