This paper draws on data collected from village-based ethnographic research conducted in northeast Thailand in 1990-1991 and highlights the polarities and contradictions of perceptions of menopause that exist between village women and health personnel with whom these women interact. For village women until recently, the menopause has been regarded as a simple and natural biological event; for health professionals, it is consistently represented as a 'medical problem' indicating treatment. The paper highlights women's construction of menopause, and their recognition and management of its physical symptoms. It draws attention too to differences among women and to the dynamic nature of their understandings and consequent health-seeking behaviour. The paper also describes the way in which health providers, through their own training and reading of professional and popular journals, increasingly represent the menopause as a pathological process and treatable condition. Through the exploration of conflicting perceptions of the menopause among contemporary Thai women, the paper draws attention to the heterogeneity and fluidity in understandings of biological processes that are related to and reflect the wider social and economic changes to which they are subject.