THE menopause is an unfashionable subject, and mention of it tends to be followed by a long, silent pause.

Maybe it is because we don't like things associated with ageing - though bring up the word "dementia" these days and everyone's talking. Or maybe it is because, in this sex-preoccupied world, we don't like anything female that isn't fertile. Either way, despite the literary efforts of feminist writer Germaine Greer and American author Gail Sheehy, it remains about as welcome in most watercooler conversations as a hot flush.

Mariella Frostrup is the latest to challenge the silence - even if her comments confirm just how confused we remain about this inevitable bodily change. We want to say it is natural, but we also seem to want to purge it like an ­annoying dose of the flu.

What vexed Frostrup was the fact that her private health insurance provider did not seem to cover the costs of treating her ­menopause-related symptoms, when she was seeking alternative treatments that are not available on the NHS. The broadcaster and columnist was having anxiety attacks, waking in the night worrying about tiny things like whether she had put carrots on her online shopping list.

Yet, when she rang her provider, AXA PPP, she was told it doesn't cover anything to do with the menopause, as it is deemed by the insurer to be a natural process - which, of course, it is.

Back in the 1970s, feminists fought against the prevailing notion that the menopause was a "deficiency disease" to be countered with doses of oestrogen. They battled to have it reframed as a natural process, not as an illness. Yet here in 2014 is Frostrup, frustrated that her £400-a-month medical insurers are saying exactly that.

She said: "The woman on the phone agreed it would be better if my symptoms were a mental-health issue as they could cover that. Clearly, madness is more palatable to them than menopause."

The insurer's comments, she said, were a symptom of "ageism" and "attitudes towards women".

But it is possible to see them as the reverse - refusing to see the menopause as an illness can also be a refusal to see its effects as abnormal, or to look purely through our culture's youth-obsessed prism of sexual objectification.

Something has changed since the original 1970s backlash against hormone replacement therapy - and it is not our attitudes to women and fertility, but rather it's that what we expect of medicine has changed.

All those decades ago, feminists were worried that the menopause was being medicalised. But now almost all aspects of life - from our moods to relatively healthy cholesterol levels - have been medicalised at least to some degree.

Even as we worry over the NHS, predicting a future in which it is burdened by the obese and the old, we expect it to enhance our lives in ways we once would never have done. We expect it to medicate not just disease but also the potential of disease. We look at what was once deemed senility, a quirk of old age; we call it dementia and, seeing the suffering it causes, want to cure and prevent it.

And, I can imagine - particularly if you've paid money for health insurance, as Frostrup had done for more than 30 years - you expect it to provide help for anxiety attacks.

On one level, I agree with Frostrup. The insurer seems to simply be taking advantage of the fact it is now widely acknowledged that the menopause is natural. It is also arguable - and she makes this point - that many aspects of ageing and health deterioration are natural. (The word "natural" here becomes almost meaningless. Even disease is a product of nature. Most of the sagging and disintegration that happens as we get older is also part of the process.)

I suspect it is not the fact the menopause is natural that is the issue for AXA PPP; it is that they know it is something every woman goes through. Any insurer is going to be reluctant to cover for something that will definitely happen.

However, though the menopause may happen to every woman, we can't know exactly how it will happen. Frostrup may have it bad, and in such a way that some combination of treatments only available outside the NHS might make a profound difference to her ­quality of life. Who would begrudge her that?

Those 1970s feminists were right, of course, that the menopause is not a disease. Though often talked about as if it is some extra bit of life that got tacked on the end when we started living longer, the truth is it was always there.

And in earlier times, it often happened younger - Aristotle mentions it happening at the age of 40. Indeed, the anthropologist Sarah Blaffer Hrdy theorises that it is a necessary part of human evolution. The menopause gave the human race grandmothers, and grandparenting and a whole new social phase of parenting which enhanced our survival.

Nevertheless, it seems only fair that women should have the right to use medicine to enhance their lives as they pass through the menopause.

We don't need it to be a disease to make that a right. We just need to believe that where there is suffering, we should alleviate it.