The Change – When Menopause Became A Disease
The Change – When Menopause Became A Disease
The medicalization of menopause is a process that has subtly been going on since the 1930's, although it wasn't until the 1960's that it really picked up momentum in the public eye. This medicalization has transformed the understanding of what is a natural process, into one defined as a disease.
When you define something as a disease, then treatment becomes compulsory. And the implication is that if you don't get treatment, or what is defined as acceptable treatment, then you are being irresponsible and negligent in your own health. Women's menopausal experiences were for a long time dismissed as the product of their own imaginations, then later embraced by pharmaceutical companies and subverted to push their shiny new pills.
And given that HRT has been so widely taken up by women, and is still used despite its risks, it has been a successful approach by the drug companies.
The celebrity factor in promotional campaigns has been very effective at selling both the idea of menopause as a disease, and the promises of hormone replacement therapy. The FDA and their comparative bodies in most countries require that product claims are verified by appropriate and legitimate studies. But celebrities in interviews are not subject to those rules, which are designed to protect the public from misleading and harmful information. So when an actress or aging supermodel enthusiastically enacts the lines of the drug company's scripts – that menopause is fraught with risks of diseases like alzheimers, heart attacks, colon cancer, cataracts, teeth loss, bone fractures and more (p43), in the guise of ‘education' and personal sharing, this is seen as legitimate. There is no reference to the fees they were paid for this work, the source of their information, or its scientific validity (or lack thereof). Nor is their any mention of the fact that even initially, though there were short term benefits, the long term effects of hormone replacement therapy were not known. These celebrities were either ignorant themselves of their own status as human guinea pigs, or didn't care.
Menopause is sold with the language of ‘decline', as though once a woman's estrogen ‘dried up', so did she. She was relegated to an image of being ‘less' than she was before, with the implication being that her value and contributions as a person were defined by something that time would take away. Unless of course she accepted the ‘help' of the drug companies with their ‘medicine' for her newly defined ‘disease'. So instead of being supported as her body moved into another phase of its life, women were basically told they were losing what defined them as ‘women', as though one hormone was responsible for what made them unique individuals. As though femininity was characterized not by their own choices and expressions, but driven by hormones. And as though ‘femininity' was equated with youth, and that once this passed, women would not enjoy their ‘best years' as they would otherwise. And, of course, if a woman wasn't feminine, in the appropriately defined way, then she was not really a woman…
Add to this mix the spectre of diseases that women would supposedly be in greater danger of getting, despite the fact that if scientists really knew the single cause of these diseases they would have triumphantly been marketing the cure to everyone – regardless of gender. When doctors treat alzheimers, heart attacks, colon caner, cataracts and teeth loss, they do not have one treatment for men and one for women. And in most cases, they don't guarantee a cure with their treatments anyway. So this suggests not only do they not have the cure, but they don't fully understand the cause. The murky waters of risk assessment are both complex and already muddied.
Women were given estrogen only in the early years of medical promotion. As studies emerged which showed women taking estrogen were more at risk of developing endometrial cancer, progestogen or progestin was added to form the combined hormone replacement therapy that became known as HRT. It was advertised for a long time as reducing the risk of heart disease, amongst other things. But in 1998, a high quality study, the HERS trial, found that in the group of 3000 older women they were studying over 4 years, who all had some form of heart disease, those on HRT were not in fact protected from heart attacks after all. And during the first year of the study, there was a higher incidence of heart attacks in the women on HRT compared with the placebo group. This was completely the opposite of what the drug companies had been advertising, based on their own observational studies, as opposed to the randomized control trial that the HERS study was.
The HERS trial was not the only one that would raise some niggly little facts about the menopause gravy train.
References: R Moynihan & A Cassels, Selling Sickness – How Drug Companies are Turning Us All Into Patients (Allen & Unwin, 2005)