There are valid reasons for HRT. Even so, prescribing replacement hormones to every woman who walks in the door because she’s entered ‘the change’ points to questions about how women’s health is to be understood. Medicine views menopause as a medical problem.
In some ways, that makes sense. Medicine exists to treat medical problems, and we are the beneficiaries when we get sick or injured. In the natural course of things, though, there’s nothing about menopause that is medical. But all too often, menopause is seen as a medical problem even if women have no trouble.
Menopause is a natural transition in the ever-changing course of life. The body moves through the long arc of fertility, beginning well before the first whispers of menses to the final period and what follows long after that.
Who can say how many processes take place in the body to prepare for the first menstrual cycle, budding breasts, a womb that, soon, will be able to conceive and bear a child? Who knows what takes place in the years leading up to and following menopause – when the body eventually relinquishes all that energy given every month to prepare for another life? And who can say how the female body finally reserves all that energy for her own?
Unfortunately, a good 20% of women believe menopause is a disease.
Medicine has subtly colonized women’s health over the past two centuries. This is not to say medicine is a bad actor. It’s that along the way, the naturalness of many bodily processes has been forgotten or, worse, fought against.
You may wonder: How do I go about this? This, being menopause. The beginning of the second half of life. This, being how you choose to participate in our body’s arc of aging. You may wonder: Am I taking chances if I go on hormones? Am I taking chances if I don’t? These are just a few of a host of questions women ask and wonder about.
Looking for a Roadmap through Menopause
We would venture a guess that most women start talking with their healthcare provider about menopause because they’re looking for a roadmap more than a prescription pad. We want reassurance that echoes our values and maybe a welcome sign that says, “You’ve arrived at the middle passage. Stay with yourself.”
During an annual exam, you might be left wondering: Am I being close-minded? Am I being irresponsible about my body? I suspect that’s the last thing a sensitive healthcare provider would want for any of us.
At the same time, many women leave their physician’s office questioning their own judgment.
The quiet voice of the body wants her wisdom and know-how to be heard and honored.
That voice has been hushed and cast aside for much of our life. The body comes face to face with a medical authority while at the same time insisting she has her own authority.
Healthcare providers are not practicing bad medicine when they offer to help with the tools at their disposal. They are trained to see problems and treat them in medical ways: with prescriptions and procedures. But something inside so many women says, Wait. Nothing’s wrong. And yet, everything feels so unfamiliar.
Women feel unsure about how to relate with this passage, often not knowing you’re in it until a healthcare provider says so. Then you’re pulled in all directions: inner wisdom that says everything’s ok, the uncertainty of new territory, fear from horror stories about menopause, and doubt about hormone replacement.
The Medicalization of Menopause
“Medicalization” describes how things come to be understood in medical terms. Over recent years, this term has become more common. The concern is that medicalization makes medical problems out of things human bodies have been doing for eons. Especially women’s bodies. Among them, pregnancy, birth, natural menopause, and aging.
There is also concern that medicalization makes medical problems out of things that aren’t medical.
It’s not that these situations never need medical care. It’s that medicalization can alter the quality of life stages that don’t belong in the category of “medical.”
We are proposing that we pause and consider the growing diagnoses that claim human identities, what some say is a problem of over-diagnosing.
The Challenge of Medicalizing Natural Transitions
The challenge of medicalizing menopause and other natural transitions, too, is this. If we look at everything through the lens of ‘medical problem,’ very soon, we’re at risk of seeing every phase of life as a disease that needs to be treated – fixed. That’s a problem we are wise to pay attention to. The risk of medicalizing menopause is that it robs the body of inborn know-how to be well and narrows the expressive possibilities of each body-mind-heart.
Some people call medicalization disease-mongering. It’s a harsh term, but since it’s out there, let’s go with it for now. Disease-mongering comes with a close companion, fear-mongering. Fear-mongering looks like this:
If you don’t do A to address B, you’re at risk of C.
The fear of C happening outweighs the risks of doing A.
In the case of menopause, women might wonder:
If I don’t take hormones [A] during and after menopause [B],
am I setting myself up for osteoporosis [C]?
Heart disease risk [C]? Accelerated aging and decline [C]?
It can be a challenge to make sense of things. Menopause is not a disease. There’s nothing wrong with our changing bodies and hormone landscape. Yes, there may be medical concerns that arise along the way that need attention, but we need to go gently here. Medicalizing menopause can make us look for something wrong. Together, women can write a new story that changes the perspective on not only menopause but also aging.
Plenty of voices have been inserted into women’s transition through menopause. Not all of them are friendly. In the 1800s, people saw menopause as a sign of sin and decay. By the 1900s, women in midlife were thought to suffer from insanity. Insanity was another way of saying middle-aged women were hysterical.
One possible way to deal with ‘the troublesome woman’ was to administer estrogen from mares. Perhaps the thought was that it would make women more docile – like a well-trained mare. It’s hard to say looking back from this vantage point. In fact, the first researcher to use animal hormones aimed to find a remedy for male impotence. Failing that, it seems the interest shifted quickly to the ‘troublesome’ women.
By the 1960s, a physician named Robert A. Wilson pushed the menopause story deeper into disease-mongering. Wilson described menopause as a “deficiency disease.” By pinning a diagnosis on this transition, Wilson paved the way for the need to treat it.
Hormone replacement therapy (HRT), first introduced in the 1930s with diethylstilbestrol (DES), now promises to ward off menopause symptoms and preserve youth. Wilson wrote that menopause was a malfunction that threatened women’s “feminine essence.” Recalling the 1800s, he described menopausal women as “living decay.”
Gosh, who wouldn’t want to ward off this descent into, dare we say it, decay, with a little pill? To be free from hot flashes, night sweats, weight gain, and vaginal dryness.
By the 1980s, millions of women were taking hormone therapy for the menopause transition and well beyond.
But something shifted in the early 2000s. Concerns about the link between hormone replacement and cancer started to bubble up. Women started choosing not to renew their prescriptions or have them filled in the first place.
Widespread use of estrogen alone or in combination with a progestin by menopausal women was thrown into doubt when researchers discovered that using these drugs increased risks for heart disease, breast cancer, and dangerous blood clots among users- with no benefit evident on symptoms like hot flashes. The study, known as the Women’s Health Initiative, suddenly raised questions about whether using hormones to prevent women’s menopausal symptoms was worth a potential increased risk of disease.
The report also revealed that while hormone therapy showed effectiveness against night sweats, hot flashes, vaginal dryness, and sleep disturbance, other symptoms, including mood changes, memory problems, and urinary incontinence, have shown little evidence of responding to menopausal hormone therapy.
Did they need them? It depends on where you sit in the hormone debate. Science has brought no conclusive evidence to date confirming menopause as a disease of hormone deficiency that can be remedied by replacing hormones. You’ll find plenty of reports saying that’s true. You’ll find just as many saying it’s not.
Women’s Conundrum about Menopause
But let’s put the hormone issue aside for a moment. At the heart of it, we face the difficult position of “problematizing” and needing to “fix” something natural to our bodies. This can pose a genuine conundrum.
Conundrums leave us scratching our heads, looking for answers. We don’t suppose to have them. Only you know what’s best for you. In truth, not all the changes during midlife can be pinned on menopause. And not all of menopause is a challenge. But the hormone changes in midlife are real, and the body needs to adapt.
The point here is that when there’s a prevailing view, it’s easy to fall into that view if we’re not surefooted in our own – getting clear about what we think, how we feel, what our values are. It’s a good idea to be receptive to perspectives that come our way, certainly. But unless we know where we stand, we’re likely to wash into the river of others’ ideas without realizing it.
Gateway to Vibrant Wellbeing
- What sensations, images, words, or reflections come to you as you reflect on how menopause has become medicalized?
- What sensations, images, words, or reflections come to you as you imagine getting “washed into the river” of others’ beliefs before recognizing how those beliefs square with your own?