Four women – an ex-hippie earth mother, a high-powered executive, a timid housewife and an ageing soap star – meet in a department store, fighting over the black lace lingerie. The only thing they have in common is their time of life. So, naturally, they discover their solidarity and break into song. And that’s how Menopause the Musical begins.

Martin Rowson's "witch" cartoon from New Humanist May/June 2007Well-known numbers from the ‘60s, when we 50-somethings in the audience would have been bopping to Ready, Steady, Go and listening to Luxembourg on our trannies, have been reworked as laments about night sweats, forgetfulness, insomnia, incontinence and facial hair. “We’re Havin’ a Heat Wave” becomes “I’m Havin’ a Hot Flash”; “Chain of Fools” transmutes into “Change of Life”; there’s the plastic surgery prayer “Please Make Me Over” and a cruel rumour: “I heard it through the grapevine, You no longer see 39.” The night I was there, the one that brought the house down was the mid-life version of “Wimoweh” with the memorable line: “In the guestroom or on the sofa, my husband sleeps tonight.”

According to the musical’s writer and producer Jeanie Linders, the idea came to her over “a hot flash and a bottle of wine.” She felt it was time to bring the menopause out of the closet. Sue Pollard, one of the actresses, agrees:

“A long time ago, male doctors and writers gave women the idea that once your reproductive life was over, life itself might as well be over. What was the point of non-reproductive women? Well, I’m not finished, I’m just hormonally challenged. And if you come through this without stacking on loads of weight, you feel liberated and good about yourself.”

Feeling good about yourself is the theme of the show. And it worked. We all managed to forget about mood swings and wrinkles as we sang along to the familiar numbers from our past, screaming like the Beatle-mad teenagers we used to be at the finale where all four women come out looking really great after shopping till they dropped.

This upbeat rallying call for women to be who they want to be is a welcome relief from the insistent whine of disapproval that has hijacked so much contemporary debate about the menopause. “Only when a woman ceases the fretful struggle to be beautiful can she turn her gaze outward, find the beautiful and feed upon it,” proclaims Germaine Greer in her 1991 exhortation to older women, The Change. “She can at last transcend the body that was what other people principally valued her for, and be set free both from their expectations and her own capitulation to them.”

It was Greer who set the tone for a bevy of prominent followers, eager to discard patriarchal notions of womanhood, which she derides as “centuries of conditioning of the female into the condition of perpetual girlishness called femininity”. So women like me, who prefer to disguise the visible signs of ageing and to preserve as much as we can of our youthful, energetic, sexual selves, are now in danger of being regarded as sex traitors. And the most striking characteristic of this new fundamentalism is a near-hysterical backlash against hormone replacement therapy (HRT).

The arguments raging about the benefits and dangers of HRT are now so polarised, so passionate and so partisan that it’s becoming impossible to separate the pragmatics from the politics. For some it’s a killer, for others a miracle cure. It causes coronaries but also prevents them. One in a hundred users gets breast cancer. Or is that one in a thousand? It strengthens your bones, if you accept they need any such strengthening.

It’s rather like the vexed question of how to teach reading, which when my children were small led to a violent clash of ideology between advocates of phonics and the real-books brigade. No matter that both had some value for some children. If you had a good word to say about phonics you were a class traitor. And now, if you admit to taking HRT, you’re in danger of being excommunicated by a certain strain of the sisterhood which has its roots in the ‘70s women’s liberation movement.

In her new book Fracture, for example, the celebrated feminist sociologist Ann Oakley describes HRT as “an international tragedy akin to thalidomide”, and as “the ultimate case study in pharmaceutical marketing”. She argues that the menopause has been falsely represented as an illness in order to make money for the drug companies, “because the medicalised body is also a medicated one.”

Hormone replacement is unnecessary, claims Oakley, because we’re not deficient in the first place. “The condition of the menopause and its (nearly) inevitable consequence – osteoporosis – suggest that there’s something about ageing in women that needs adjusting to prevent symptoms of decay. Enter the industry of hormone replacement therapy which has led millions of women to be medicated with harmful drugs that have made pharmaceutical companies fortunes.”

Oakley regurgitates Germaine Greer’s vociferous diatribe against the medicalisation of a condition that in her view need not be regarded as a problem at all. In a similar vein, Sandra Coney in The Menopause Industry blames the medical profession for “depoliticising the situation of mid-life woman by reducing her socially caused anxieties and complaints to symptoms of bodily processes that can be solved by medication.”

These detractors are at least in part reacting to earlier claims for HRT as a magic medicine that could offer eternal youth and ward off dangerous illnesses. According to Jenni Murray, in her down-to-earth advice manual Is It Me or Is It Hot in Here?, it was these extravagent recommendations and promises that led to what she describes as a battleground between enthusiasts and disapprovers.

One account in particular has raised the hackles of feminist commentators. Robert Wilson published his book Feminine Forever in 1966, with a mission to popularise HRT among American women. Oestrogen, he maintained, was the answer to eternal youth because it eliminated the menopause which he defined as abnormal. He even described menopausal women as “castrates”, to the fury of feminists everywhere.

Ann Oakley is particularly virulent about the harm Wilson has wreaked, especially as she reveals his research was funded by a pharmaceutical company who reaped huge profits from the massive new take-up in HRT prompted by his endorsement.

But to reject his findings and all of the subsequent research into the effects of menopause is also to deny the benefits that hundreds of thousands of women have experienced from using HRT. And Wilson’s breakthrough, however unpleasantly overstated, must also have come as blessed relief to those who, until then, would have received little sympathy from the medical profession. A typically dismissive and ill-informed doctor, quoted by Jenni Murray, told a patient that the menopause was an evolutionary aberration because women were not designed to live beyond their childbearing years. “No other primates have a menopause, so humans shouldn’t.”

So having the condition taken seriously was a definite advance. And even though some of the original claims for HRT have subsequently been questioned or overturned, it’s just as true that many of the dangers have been exaggerated or misunderstood. What is so disturbing about Ann Oakley’s approach is her categorical denial of benefits, based on partial evidence.

She claims that HRT can cause cancer of the lining of the womb, for example. In fact, while this is a danger associated with oestrogen, it can be neutralised with the addition of progesterone. She states with absolute certainty that HRT increases the risk of heart disease, while in fact the evidence for this remains inconclusive, with some indications that it can be beneficial.

Not only does Oakley massively overstate the link between HRT and breast cancer, she goes on to denigrate the benefits of breast and cervical screening, ignoring the substantial body of evidence of the thousands of lives saved by early diagnosis. She also advises against screening for bone mineral density, refuting the connection between oestrogen deficiency and osteoporosis. While it is true that many other factors contribute to brittle bones in old age, it is also widely accepted that loss of oestrogen is one of those causes and HRT can help reduce bone weakening. To come out against testing for what can be such an acutely disabling condition is not merely perverse, it’s downright dangerous, and a prime example of the hazards of imposing a political agenda on a medical condition.

According to Oakley, the menopause does not denote decay or deficiency. It is simply a natural process, a new phase bringing new freedoms and opportunities. In her eagerness to return us to nature she once again echoes Germaine Greer, who recommends that we should rejoice in our “climacteric” and create new rites of passage to welcome it. She even promises a fresh lease of serenity and joy once the inconvenient symptoms have taken their natural course.

But far too many of her devotees are still waiting to be overcome by serenity and joy, while bravely attempting to harness their hot flushes as “power surges”. And quite frankly, it doesn’t wash. The menopause may well be a natural process but that doesn’t make it desirable and I can’t see what is particularly noble about enduring its worst effects. If anything, nature is our enemy. The emancipation of women has been a long, deliberate process of conquering and quelling nature in order to resist its wayward cruelties.

This is certainly the view of Louann Brizendine, a neurosurgeon who in The Female Brain illustrates the ways in which women are driven by their biology and, in particular, by their hormones.

“What we’ve found is that the female brain is so deeply affected by hormones that their influence can be said to create a woman’s reality,” she explains. “They can shape a woman’s values and desires and tell her, day to day, what’s important.” It’s no use pretending that men and women are the same, she maintains. It’s much more useful to understand the emotional havoc that our hormones can wreak. That way, we can control it.

Brizendine is not promising the eternal youth or panacea of the early proponents of HRT. Instead, she simply suggests that chemical and therapeutic adjustments can often work wonders in restoring imbalance. Generally, she treats symptoms “with a combination of oestrogen, antidepressants, exercise, diet, sleep and supportive or cognitive therapy.” She is, if you like, in the business of helping women to return to their real selves.

That’s what Greer and Oakley are recommending, too. But in their case it’s a different, virago-like self they’re inviting us to celebrate. “There is no point in growing old unless you can be a witch,” asserts Greer, “and accumulate spiritual power in place of the political and economic power that has been denied you as a woman.” If we all do as she says, she promises, we will acquire “peaceful potency . . . a feeling of tenderness so still and deep and warm that it gilds every grassblade and blesses every fly.”

It sounds enticing, unless like me you’d rather strive for some of that political and economic power that Greer appears to believe is beyond our reach. If peaceful potency was that great, you can bet that men would have snatched it centuries ago. On the other hand, if we choose to aim for the boardroom rather than the wild woods then there’s not much use in looking like Miss Haversham or dressing like Red Riding Hood’s granny. That, perhaps, is why when the Guardian asked a series of prominent women which single development had done most to advance their cause, the screenwriter Nora Ephron answered without hesitation, “hair dye”. Not only does young hair make us feel good. It actually helps us through the glass ceiling.  

But Ann Oakley clearly doesn’t hold with women getting above themselves. Otherwise, she wouldn’t so carelessly advise us to take pleasure in our wrinkles, as “a map of all you’ve been through”. Nor would she be so coy when admitting another supposed advantage of age: “I feel I have acquired a little of something I hesitantly call ‘wisdom’.” If we learn to love our lines and exercise our wisdom, she implies, we can opt out of the vicious male-dominated world of money and power and instead, Greer-like, become happy old hags.

“Older women don’t have to obey the conventions of femininity any more,” Oakley enthuses. “We don’t have to watch people watching us because we no longer care what they think. As one old woman said to a social researcher, ‘You can get away with all sorts of things when you’re old because they think you’re batty anyway’.”

The drawback of adopting unconventional old witchy ways is that, rather than representing a new form of womanhood, it could well lead us to deny our female selves altogether.

The epitome of this idealised form of elderly eccentricity is Jenny Joseph’s much-loved poem “Warning”, which announces:

When I am an old woman I shall
   wear purple….
With a red hat which doesn’t go,        
    and doesn’t suit me,
And I shall spend my pension on        
    brandy and summer gloves
And satin sandals, and say we’ve        
    no money for butter.

Intriguingly, an almost identical sentiment is voiced by one of the most famous old women figures of folklore, the Mere Sotte. “The minute I stop being perverse,” she cries, “I’ll die.” The Mere represents a rather sinister androgyny dating back to the Feast of Fools in mediaeval France, when a man dressed as a woman would have the authority to overturn laws and punish wrongdoers, especially wife-beaters and neglectful husbands.

The figure of the Mere has its roots in a deep ambivalence to the older woman – a mixture of scorn, awe and fear. “Folklore is disturbingly hag-ridden,” writes Laurence Senelick in The Changing Room. “Recurrent archetypes of ghastly harridans and wicked witches pullulate in the collective unconscious, embodying fears almost too intense for telling, at least among men.”

Senelick argues that the underlying reason why such powers and malice are imputed to post-menopausal woman is that “many tribal cultures, such as the Zulus, hold that after menopause women ‘become men’ in pilosity, voice and other traits; so the laws of sexual taboo no longer apply to them.”

These primitive cultures may have had a point, according to Louann Brizendine. There really is a tendency for women in mid-life to become less nurturing and less interested in taking care of others. It’s one of the effects of the reduction of oestrogen, which in turn reduces levels of oxytocin and dopamine. Once these caring hormones have diminished, women are in danger of becoming just like men. So much for peaceful potency.

Some women might enjoy the adventure of a new crone identity. Others will welcome hormonal assistance to hang on to the old one. What matters, advises Brizendine, is that women follow the regime that suits them, making sure they stay informed about new research and new treatments. Recent evidence of the link between HRT and ovarian cancer only makes it more important to get the facts rights.

“The only thing that counts in all this is how you feel,” concurs Jenni Murray. “You shouldn’t be bamboozled either way by practitioners who are propagandists for the therapy or those who think the whole HRT business is a waste of NHS resources to serve a bunch of neurotic middle-aged women. Both extremes are wrong and whether you take HRT or not is your choice, not theirs.”

So whether you become a happy crone or a lifted lady, get high on hormones, go skydiving, wear purple, take a young lover, enter a humanist nunnery or dance in the aisles to a bunch of middle-aged women strutting their stuff to baby-boomer hits, it all comes down, as ever, to a woman’s right to choose. I heard that through the grapevine. ■