While absence of evidence is not necessarily evidence of absence — as historians sometimes say — a silence across cultures and traditions that are interested in other aspects of women’s medicine is suggestive.

Until recently, it might have been tempting to dismiss these findings as a simple result of the fact that people before modernization did not live very long and that, therefore, few women experienced menopause. Before the mid-20th century, evolutionary biologists had not paid much attention to the question of postreproductive life and whether it is a naturally occurring phenomenon. But in 1966, in an article foundational to the theory of aging, the evolutionary theorist William Hamilton puzzled over some of the data on which he was basing his ideas: census records from early 20th-century Taiwan, then under Japanese rule, showed that in this population with high, premodern rates of mortality, many women outlived their reproductive lives — and for a long time at that. Research among foragers — peoples living in ways similar to our prehistoric ancestors, who do not use modern medicine and are isolated from the influences of modernization — has also found that the modal life span for humans surviving to adulthood is about 70 to 75 years. (Mortality is high in childhood, so that average life expectancies are low, but a child who survives to age 15 has an even chance of living another 45 years or so, and an adult of age 45 can expect another 20 to 25 years.)

There is also the further complication that the concept of menopause we are familiar with was invented around 1700, when significant mortality decline in Europe was still far in the future.

Menopause as we know it today was born out of a particular time, place and profession: 18th-century Europe and the emergence of a new medical establishment. The first dissertation on menopause, titled “On the End of Menstruation as the Time for the Beginning of Various Diseases,” was published in Latin in 1710 in what was then the kingdom of Prussia. After that, the concept we know as menopause became a dominant subject in gynecological literature and also in popular culture. The word “menopause” itself was coined by a French physician in 1821; by then, there were colloquial expressions for it in Europe, such as “women’s hell.”

Physicians in France, England and elsewhere associated a huge number of conditions, from scurvy to epilepsy to cancer, with this exciting new syndrome. Because they believed that a buildup of humors — especially blood — caused most medical problems, 18th-century physicians focused especially on hemorrhaging and white flux, which were symptoms, as they saw it, of an unhealthy retention of fluids. They also linked menopause to the fits associated with uterine (“hysterical”) suffocation, a disorder whose tradition was ancient in origin but that reached a new level of popularity in the Renaissance and later. It was defined by episodes of choking and other symptoms; the original explanation was that a woman’s uterus had migrated upward and suffocated her. European physicians in the 1700s and early 1800s reinterpreted hysterical attacks as signs of excess blood and thought they could be symptoms of menopause.