Midlife and Menopause

The Medicalization of Menopause

When I entered midlife, I experienced some of the same kinds of frustrations that I did as a woman giving birth. Once again, I found myself regarded by the medical profession as a patient in need of treatment. I was encouraged to view the natural process of menopause as a negative change that, if left untreated, would jeopardize my health. Thanks to the women’s health movement, I found my voice. My own hormones are keeping me a healthy, active sixty-six-year-old.

In our culture, major biological transitions that women experience, such as childbirth and menopause, are often medicalized. The term medicalization refers to treating a natural process as if it were a medical condition requiring intervention. The normal physical changes associated with menopause in particular tend to be perceived as pathologies requiring both medical and cosmetic “help,” perhaps because aging itself is so medicalized.

Some medical researchers, health care providers, and drug companies have defined menopause as a hormone “deficiency” condition due to ovarian “failure.” According to this view, menopause is a condition like thyroid deficiency or diabetes: If it is left untreated, we will be at greater risk for many chronic diseases, a lower quality of life, and premature death.

This view was the rationale for the widespread use of long-term hormone treatment for postmenopausal women from the 1960s to early in this century.¹⁰ After all, if our ovaries had failed us and we had become deficient, it made sense to replace our hormones, hence the term “hormone replacement therapy.” For decades, many doctors and women were convinced that boosting estrogen levels would treat all signs of menopause, make women feel younger, and ward off diseases of aging. This belief persisted even though no well-designed long-term clinical trial of hormone treatment had been conducted. We now know that hormone treatment is likely to carry more risks than benefits for most women. (For more information, see Chapter 7,“Hormone Treatment.”)

Several factors may help to explain why menopause has been perceived as a deficiency. One is the long history of attributing ill health and characteristics considered undesirable for women to our reproductive organs and hormones. For example, terms like hysteria (derived from the Greek word hustera, which means “womb”) reflect the former belief that behaviors considered inappropriate for a woman were somehow caused by her uterus. Some women in the nineteenth century had hysterectomies in attempts to treat a wide variety of problems. Similarly, some doctors believed that the ovaries were the source of ill health and advocated their removal. During the same era, higher education for adolescent girls was discouraged for fear that taxing girls’ brains would ruin their reproductive organs.

Another reason that so many doctors have viewed menopause as a deficiency condition is that they are more likely to see in their offices women who are experiencing distress than those who aren’t. Women who have a relatively easy time during and after the menopause transition simply don’t visit doctors as often. This makes it seem to doctors (and others) that menopause is more stressful for most women than it actually is.

Doctors are also more likely to see women who have severe distress immediately after their ovaries are removed (a procedure that often accompanies hysterectomies). The sudden change in hormone levels caused by surgical removal of both ovaries usually results in more distress than natural menopause does. (For more information, see Chapter 4, “Sudden and Early Menopause.”)

Finally, the pharmaceutical industry must be recognized as a driving force in the medicalization of menopause. Many studies on hormones have been sponsored by pharmaceutical companies, which influence both the way the studies are done and how the results are interpreted. These studies are then published in prestigious medical journals and become accepted as scientifically valid; legitimate criticisms of these studies often do not reach the lay public. The pharmaceutical industry also sponsors “continuing education” seminars for physicians, reinforcing the use of hormones either as a treatment for menopause or as a preventive measure for chronic diseases. Research has shown that doctors’ prescribing practices are often strongly influenced by promotional messages rather than by scientific evidence.¹¹

The story of the widespread prescribing of hormone treatment before long-term clinical trials had confirmed their safety is a dramatic example of the power of the pharmaceutical industry and inadequate research to influence women, doctors, and government agencies.  (For more information on hormone treatment, see Chapter 7, “Hormone Treatment”; for more information about industry influence on research, see “Can We Trust the Evidence in Evidence-Based Medicine?” page 24.)

End of excerpt
Excerpted from Chapter 1: Understanding Our Menopause Experiences in Our Bodies, Ourselves: Menopause © 2006 Boston Women's Health Book Collective.

10. Nancy Krieger et al. "Hormone Replacement Therapy, Cancer, Controversies, and Women's Health: Historical, Epidemiological, Biological, Clinical, and Advocacy Perspectives," Journal of Epidemiology and Community Health 59, no. 9 (September 2005): 740-8. [back to text]

11. Testimony of Michael Wilkes, M.D., Ph.D., before the U.S. House Committee on Government Reform, May 4, 2005.

Excerpted from Our Bodies, Ourselves: Menopause, © 2006, Boston Women's Health Book Collective.