Doctor, is it hot flashes, or am I going through menopause?

Hot FlashesAmy Dickinson, my favorite advice columnist since the death of Abby, Ann and Ask Beth, had an interesting exchange with a reader on October 15. The reader took issue with Amy’s previous advice issued on September 30. To quote:

“Dear Amy … I assure you it is not appropriate to tell your students that you are “menopausal”. This sort of thing should never be disclosed in the classroom. –Also a Teacher.”

Amy’s response raised my eyebrows:

“Dear Teacher: I didn’t suggest “The Teach” should say she was “menopausal” – only that she was having a “hot flash”.”

Here’s what Amy actually wrote on September 30: “Let’s say you have a sudden hot flash in fifth-period calculus. You can say, “Sorry, class, I’m having a hot flash. Let me fan myself and take a drink of water and it should go away in a minute. Whew! Any students who are sufficiently fascinated can very easily do an Internet search to discover what’s going on and the reason behind it. Soon enough this will become just another aspect of the natural and quirky progression of your day.”

Amy has pointed out a great truth of the age, which is that people can avoid giving out Too Much Information (TMI) by using a short casual throwaway reference that listeners can explore in more depth at their leisure on the World Wide Web. If the listeners are high school students, they are likely to do this exploring long before they get home. In fact, if the listeners are anything like my graduate students, they are exploring the minute the teacher has finished her sentence.

There are at least three things that fascinate me about Amy’s exchanges. All naturally involve medical terminology and consumer health vocabulary.

(1) What high school student does not know that “hot flash” is absolutely synonymous with “menopause?” Under what rock has that student been living?
(2) How long has “hot flash” been a synonym for “menopause?”
(3) Why should saying “hot flash” be any better than saying “menopause” to a class full of high school students?

Answering question #1 would require copious amounts of federal funding, which seems unlikely at the present point in history. So I’m ignoring that one. Questions #2 and #3 are more answerable. Here are the answers.

How long … “Hot flash” is revealed by the Oxford English Dictionary to date from 1610. Sort of. It is first recorded in a play by John Fletcher (as in “Knight of the Burning Pestle”). This play title is just as much of a double entendre as it sounds; this play turned me on to the delights of consumer health vocabulary long before I thought to formally research it).

But the “hot flash” described by Fletcher does not resemble menopause much: “Farre from me are these Hot flashes bred from wanton heat and ease, I haue forgot what loue and louing meant.” Wanton heat and ease sounds like the opposite of menopause. The next entry in the OED isn’t much better: “They continued wandring too and fro for the space of two days, hearing loud Shrieks and Groans, and now and then felt hot Flashes, which so amazed them, that they wished they had never ventured in.” [Fortunatus, 1682]. Fortunatus got the shrieks and groans right, but “amazed?” I don’t think so. In fact, the first reference I find to a menopausal hot flash, or at least a female hot flash, dates from 1907, when the Perry (Iowa) Chief reported that “Such warning symptoms flashes, headaches..and dizziness are promptly heeded by intelligent women who are approaching this period of life.” Now we’re talking.

Hot flash vs. menopause: Amy Dickinson’s advice reminds me of one argument about consumer health vocabulary and why we need it. This argument proposes that people are more comfortable with informal speech when it comes to descriptions of sexually themed and/or potentially stigmatizing body parts or bodily activities. This phenomenon has actually been studied by medical researchers.

I published a whole paper about consumers use of very informal terms — obscenities — for health concepts, back in 2007. If you are 18 or older, you can read it here: “Nursery, gutter, or anatomy class”. This paper got standing room only attendance at the American Medical Informatics Association where it was presented. Some members of the audience came up to me afterwards and told me great anecdotes about obscenities they’d encountered in their clinical and/or IT practice, none of which are printable. This paper has been cited in places as diverse as a medical informatics textbook..

And a blog by an artist and arts educator. Two more different communities of readers you could not expect to find.

… which tells me I am on to something. But what? More research is needed. Maybe I should Ask Amy.

Readers of Elfshot can see the original letter, and response from Amy Dickinson, on Amy’s blog here. This is where I got the graphic, too. Her response is on the Chicago Tribune page here.

Oxford English Dictionary citation: “hot flash, n.”. OED Online. September 2013. Oxford University Press. 17 October 2013 .

Author: cat

Associate professor at the University of Wisconsin-Madison

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