When recommendations are made for the majority of postmenopausal women to take hormone replacement therapy for the remaining years of their lives, an assumption is made that the biological changes commonly associated in North America with the end of menstruation and the aging processes of the ensuing years are universal. Comparative survey research will be presented to show that the menopausal experience is very different in Japan from Canada and the United States. In particular, symptom reporting of hot flashes and night sweats is significantly different. When these findings are considered together with the well-known epidemiological reporting of a lower incidence of heart disease, breast cancer, and osteoporosis in Japan, as compared with North America, then, not simply culturally constructed expectations and values, but also biological difference, has to be considered as a contributory factor. Qualitative findings from Japan will also be presented to demonstrate the way in which both gynecological and popular knowledge about the end of menstruation is different from that in North America.The second part of the paper will discuss the discovery of menopause in Europe in the middle of the last century and give a very brief historical overview about the transformation of medical knowledge in connection with menopause throughout this century. The false assumption that menopause is a recent problem because the average life expectancy until the turn of this century was just under 50 years of age will be discussed. The implications of these data will be used to comment on current policy making in connection with hormone replacement therapy.