The Medicalization of Menopause

The term 'medicalize' describes a process where a condition or behavior is becomes accepted "as deserving of or appropriate for medical treatment," according to the Random House Dictionary (2009). Beginning in the 1960s and accelerating in the 1980s, menopause began to be seen not as a natural part of a woman's life but as a deficiency that required fixing. It seemed that boosting estrogen levels became a cure-all for a woman's problems as she aged.

History

• Menopause was recognized as a part of female life at least as far back as the ancient Greeks. Aristotle wrote of menopause. The word itself comes from the Greek, 'men' for month, and 'pausis' for pause. It seems to have been regarded as a natural progression. But by the seventeenth century, things seemed to have changed. Although there are not many writings related to menopause, those that exist seem to have taken a more negative turn. Menstruation was alternately seen as a positive good that rid the body of 'ill humours' that were thought to cause illness, or as an evil itself that caused no end of other problems, ranging from bad skin to insanity. Menopause was just an extension of the condition.

Early Treatments

• In the eighteenth century, medical thought on menopause was a mirror of the social prejudices of the day. Peasant women were thought unaffected by menopause, but upper-class woman was considered to be sensitive, refined and in need of assistance. Since it was believed that menstruation cleansed the body of toxins, women were sometimes treated with leeches or phlebotomy when menstruation slowed. Physicians seemed to view menopause as a problem that needed to be fixed, not a natural part of life.

  And while leeches went out of style, this perception of menopause remained, although there were few treatments. In the 1960s, however, hormone replacement therapy (HRT) began to become more common, and by the 1980s, HRT was routinely prescribed for women as soon as they reached menopause, even if only mild symptoms were reported. Pharmaceutical companies marketed long-term HRT use not only for temporary relief of symptoms, but as a way of preventing further health problems in the future. HRT was the new wonder-drug for women.

Benefits

• A number of studies had found HRT a useful treatment for temporary symptoms associated with menopause, including hot flashes, night sweats and vaginal dryness. These benefits are associated with short-term and temporary use, which is considered to be less than five years. There are also studies that have shown long-term HRT to be beneficial in preserving bone mass, which could make it worthwhile for women with osteoporosis.

Risks

• In 2002, the medical community was shocked when the National Institutes of Health announced that they were stopping a clinical trial of HRT drugs. The drugs being tested combined estrogen and progestin, routinely described to menopausal women since the mid 1980s. Designed to determine the benefits and risks of such therapy, especially in preventing heart disease, the study had revealed risks that far out-weighed the benefits.

  Women on HRT for more than five years have a 41 percent greater risk of stroke. There is a 29 percent greater risk for heart attacks and a double risk for blood clots, along with a 22 percent higher risk for cardiovascular disease. There is also a 26 percent greater risk for breast cancer with long-term HRT use.

Considerations

• With what is known from the research today, it is important that menopausal women discuss treatment options with their physicians. Women having few or no symptoms may choose to forgo treatment entirely, since the primary benefits of HRT seem to be in alleviating symptoms on a short-term basis. Long-term HRT should only be undertaken after serious consideration of the associated risks.