I have been writing about the medicalization of menopause for several years now. So I was intrigued when I stumbled across a review in the Journal of Aging Studies discussing how the social construct of menopause has shifted to “an increasingly more medicalized perspective that emphasizes the biological deficits of the aging female body.”
In this piece, researcher Rebecca Utz reports on qualitative interviews that she conducted with a small group of pairs of mothers and daughters, divided by generation and apparently, attitudes towards menopause. Medicalization, she writes, “is defined as the way in which the apparently scientific knowledge of medicine is applied to a range of behaviors that are not self-evidently biological or even medical, but over which medicine has control.” Therefore, in the case of menopause, our definition has shifted from something that a natural part of our development to an illness-based perspective “requiring medical intervention.”
Accordingly, when she interviewed both groups of women (mothers born during the 1920s and 1930s, and daughters born in early to mid-1950′s) she discovered that despite the commonality of physical symptoms, attitudes were significantly different:
- The older women did not perceive menopause as a problem or disease but rather, something that “just happened.” As such, it was not part of their narrative and most were uncomfortable discussing it, primarily because they considered it private and “inappropriate for public discourse” much like sexuality or emotional instability. And the steps taken to address it: Watch and wait for it to be over.
- The daughters, on the other hand, were likely to seek medical treatment as soon as symptoms appeared. This behavior is consistent with the premise that menopause has been increasingly medicalized. However, it wasn’t simply menopause that the younger women were fighting but on a larger level, aging. “In other words, menopause was just the beginning of a long, downhill battle that cannot possibly be won,” but can be controlled and self-managed. Moreover, these women’s fear was not necessarily entrenched in hot flashes and night sweats, but in what the start of menopause meant in terms of the delineation between youth and middle/old age and even “end of life as we know it,” a new older life stage that was unwelcome. The “cure” of course, were hormones and other pharmaceutically-derived interventions, which represented a way to “suspend old age” and control the physiological aspects of aging.
Not surprisingly, Utz also points to the ‘Menopause Industry:’ a “profit-seeking enterprise comprising pharmaceutical companies and perpetuated by the media intent on “turning 40 million baby boomer women into patients for life by defining menopause as an estrogen deficiency disease requiring significant medical intervention.” While the companies create the drugs, the media (whose increased attention attention to menopause, largely fueled by the wave of 1970s feminism and in part, funded by corporate interests) not only provide women with access to the information and resources that they seek but also contribute to perceptions of personal control among women who do not want to “sit back and let menopause just happen to them.” The result is that the Menopause Industry has not only developed products that these women crave that allows them to win their battle against old-age, but, continues to highlight the need for them.
Where does this leave us?
Although some women have fallen off the HRT wagon post-WHI study findings, others have remained. And even more expect the pharmaceutical industry to come up with something different to “quell the realities of their aging bodies.” Are we/they in for a surprise? Perhaps, because as Utz writes, aging is inevitable, even with quick fixes, and that at some point “the perceived autonomy and need for personal control may make [these women] more vulnerable or less prepared than their mothers to face the realities of old age.”
I’d like to offer another, more positive construct up for consideration:
Taking control doesn’t have to mean that the aging process is denied, stopped or obliterated, medicalized or industrialized. Rather, it means taking charge to feel better, more vibrant, healthier so that you/we/I can live the best life I can live while we are alive. For me personally, that doesn’t mean hormone replacement or botox or lipo; it means trying to make more healthier decisions, control or address my symptoms with evidence-based alternatives and accept the transition as a natural part of my journey. So, much like the mothers in this research, I consider this time an opportunity for shifting priorities and interests that open all sorts of possibilities. And like the daughters, I want to take the experience out of the closet and foster discussion and sharing. Ultimately, I’d like the see a more natural course driven by women themselves, as opposed to societal expectations and stigmatization of the aging process and as opposed to the Menopause Industrial Complex.
What about you?
Thank you for the great article. I take BHRT, have done for the last year and half. Prior to that, I managed successfully my menopause for over 10 years with herbal remedies. I am now 60 years old. I switched to BHRT because I am a chronic pain sufferer and was taking morphine daily in order to alleviate the pain. It also altered my hormone levels thus BHRT. I feel I am fortunate to have an insurance that covers my hormone replacement prescriptions otherwise I would be totally a mess. BHRT has stabilized my mood, my hot flashes, night sweats. Why did I take the route of managing my menopause? I simply do not believe that being miserable is an option. I do not believe I have to be uncomfortable in order to say that I earned my grey hair, my wrinkles and what not. I believe I deserve to feel great within my body, my mind, to continue to grow as a woman either spiritually, physically, emotionally without the encumbrance of being at the mercy of my hormone levels. Perhaps having had difficult menstruations from day 1 convinced me that enough is enough and that I deserve to age gracefully. Before I em barked on the BHRT route, I read extensively about all the options available. For me, this was the best route, based on my life story. This is what should be promoted, to offer information and education for every woman so she can make an educated decision about her wellbeing, customized to her. Another point that is not talked about,BHRT keeps your libido up and running. I happen to believe that sex with my husband is very important. And I like feeling desirable. But let's be frank here, it does not mean that the hormones restore your youth and therefore I have sex everyday. On the contrary, my 60 year old brain is still in charge and common sense still prevails even though my body responds well to sexual desires. Male libido is kept up with viagra or cyalis and others, the female libido is also important. Do I look younger? yes, I am told very often that I do not look 60, even though I have grey hair, I am 30 lbs overweight. But I believe this is more genetic related, it also has something to do with taking care of my skin all my life and do not believe it is the result of my hormones. BHRT for me, is simply an alternative to feel better and to enjoy that period of my life, menopause. I also have a positive outlook in life regardless of my handicaps. I believe I will live until I am in my 100's because I am so curious to see what will happen. I might just decide to not die! In conclusion, it is about individual options to be available to women and not try to fit all of us into one mould. Thanks for offering the opportunity to speak out. Amitiés to every woman of this world.
What a thoughtful comment Louise and thank you for sharing. I will be writing a piece that addresses BHRT this week and have of course, covered it in the past. What strikes me as most important in what you are saying is that you did the research and selected the best route...for you. This has long been my mantra and mandate. Thank you!
thank you for your kind comment. This is what the feminist movement in about as far as I am concerned. It has never been about following trends, fashion, etc. I finally understood that in my 50's. Sigh! To wait so long to figure that one out! With todays technology, understanding and means to improve our well being, we have finally come to the point that we can ask for proper care to fit our body and soul. Personalized customer service for women should be standard. The same goes for every member of the family. Education and knowledge is power. I firmly believe in this statement.
Great article Liz I really don't agree with Ms Utz.I don't think you can compare women of the two different generations. Women view things differently now and expect more .Things that were accepted as normal when we were younger like teenage depression ,we now know is not just growing pains and everyone needs just to get over this phase in life. I have not came across any women who uses hormones to turn back the hands of time. For me hormones keep me at a state of wellness. I am glad we live in a time we have many options on how we handle menopause.
Thanks Jill. What I love about this forum is the differing opinions and the expressing of them. And I love that your choices has served you well. Thanks for reading and commenting.
Wow! Where do I begin? First, great article. You covered so much territory here. I think everything is over-medicalized in this country and I cringe at every TV commercial promoting prescription medicine. However, I don't consider women seeking BHRT or even OTC remedies to help with menopause symptoms necessarily a reflection of this attitude. There has been more research on HT since our mothers' era. The conclusions have been contentious, but as a result of the ongoing debate over the use of hormones, we have a better understanding of what is safe, what is risky, what doesn't work, and what works for some women, some of the time. We also lead different lives than our mothers did. So I'm glad to have as many options as I do and as many resources for information and discussion that our mothers didn't have. As you point out, I just want to feel well and age well. Most women I know feel the same way.
Wendy... I agree. And disagree. I think that there is plenty of evidence out there suggesting that aging is a four letter word and that there are options to stop it. HRT has been touted as a means to maintain sexual virility and skin appearance, promote bone health and slow the processes that are linked to declining estrogen levels. Unfortunately, "replacing" hormones is not without risk and women have been given nothing but mixed messages since 2002 and WHI. I hear a lot of questions regularly about what is safe and what's not and I strongly believe that alternatives are not being supported in ways that they should. Like you, I love the fact that we have the resources to have these discussions. It's the first step to overcoming some of these hurdles. Thanks so much for your comment.
Liz, great post, thank you! There is a dichotomy between women's genuine discomfort with the extremes of menopausal symptoms and the Complex's motives. The needle must necessarily keep moving toward pathologizing the normal in order to coddle (and grow) the market. This move toward medicalization of aging is just one aspect of disease mongering, of course. But it also fits nicely with the entire body of our PR industry, where promoting adolescence is the norm. I think this is because the adolescent brain is perfect for being marketed to -- very little influence from the executive prefrontal cortex, and therefore no need to struggle with the human condition; just buy, buy, buy, because you want and therefore deserve it. We are all victims of the advertising geniuses who push on our vulnerabilities, particularly around aging. What gets lost is the beauty and appeal of the mature mind, which inevitably lives in a maturing body. Allowing ourselves to grow and mature is the uphill battle of our culture, but what a glorious end result it can bring. May we all care just a little less. Again, thanks for a great post! Marya
What an interesting and inspiring comment Marya! "What gets lost is the beauty and appeal of the mature mind, which inevitably lives in the mature body." I believe that that was what Utz was getting out when she commented about the inevitability of the process. I would add that when that inevitability hits, it is almost a shock. And let's face it, all the 'work' in the world doesn't relieve an aging body of the realities of aging tissues, organs and the like. As I wrote, I'd love to see a bit less of the influence of the Complex and a bit more thinking on our own feet while accepting certain inevitabilities. That may be utopia but it's mine and I'm sticking to it! Thanks again!
Sadly there are very few evidenced based treatments other then HRT for hot flashes that are any more effective then placebo.. Mine happen every 1 hour and 20 minutes or so and are totally disabling at night. Black Cohosh and soy and many of the alternatives haven't been shown to work.. so what do other women do?
Georgi - if you read through the archives, there is some good evidence for both black cohosh and acupuncture vis a vis randomized trials. The S-equol component of soy has also shown effect in some women. Personally, a combination of standardized black cohosh (i.e. Remifemin) and chinese herbs have completely shut down 99% of my symptoms. And I know a lot of other women who have had equally good luck. I encourage you to at least try the alternatives before shunning them completely.
Sadly there are very few evidenced based treatments other then HRT for hot flashes.. Mine happen every 1 hour and 20 minutes or so and are totally disabling at night. Black Cohosh and soy and many of the alternatives haven't been shown to work.. so what do other women do?
My mom was born in 1935. She did menopause cold turkey. Hormones would never have occurred to her. If she had a hot flash in the winter, she just went outside (granted, being in North Dakota helped.) I was born some 20 years later. While I never would have wanted to sign up for hormones, even if I could, when I told my doctor I was starting to have pretty frequent night sweats, he said a lot of his patients had good luck on a very low dose of antidepressants (about 1/4 what you'd take for depression.) I tried it and it did help but I stopped taking them to see if I can get through it on my own. The night sweats seem to have subsided but if they get a lot worse I may try it again. What I found interesting was how many women I talked to who thought my little dose of antidepressants was part of some big male-dominated medical industrial conspiracy (I don't). I seem to see women on one side of the spectrum or the other and I hope there's some room for middle ground in terms of symptom relief. I wholeheartedly agree with you that old fashioned techniques like exercise, diet (and staying interested!) will do more than any drug in terms of helping us with overall aging. How sad if we can't embrace who we are. I figure I've earned every one of these wrinkles and gray hairs.
Thanks for sharing your story Jody. I don't believe that the 'complex' is male-dominated but I do believe it exists; medicine like any business, is, well, a business. However, I was a bit surprised to learn about the drivers of health behavior and the lengths women said that they would go to halt the aging process. It's a shame because as long as the youth-aging myth is perpetuated, the less likely it is that we can simply enjoy the journey. I would love to have more women weigh in; it's a highly relevant challenge for our generation.
You know I'm with you on this one, Liz. Interestingly enough, the increasing medicalization also occurred as women continued to enter the workforce in bigger numbers. Now the pressure NOT to age is everywhere, with excellent PR from the American Society of Plastic Surgeons (or whatever their official body is) placing feature articles about the rise in boomer surgery. This leaves the impression that plastic surgery to the face, breasts, stomach and labia is simple alternative to "drooping and dragging." I hate it. And I hate it when I run to the mirror after reading something like that to do a wrinkle count. I dislike the fact that there's a flash of envy when a friend says her hormones have helped her enormously, since I can't have them, and wouldn't anyway. But I love your attitude and the fact that there is strength in numbers. It actually can be easier just to say no, I just don't buy that anymore. Thanks for another great post, Jody
Thanks Jody! I was fascinated to find this piece and by its take on the Menopause Industry. More importantly, however, I am interested in the attitudes by the daughters in the study and how their attitudes have been molded by the changes in society, both from a feminist and a medical perspective. I may do a follow up with the author, if for no other reason than to express my admiration.