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More on the medicalization of menopause (it refuses to go away)

A recent New York Times article implied since flaxseed and other alternative treatments have been found to be no better than placebo in relieving hot flashes, women should reconsider hormone therapy.
REUTERS/Lucy Nicholson
A recent New York Times article implied since flaxseed and other alternative treatments have been found to be no better than placebo in relieving hot flashes, women should reconsider hormone therapy.

I’ve written here many times before that despite all the studies linking it to serious health risks, menopausal hormone therapy is not going to go gently into the night. Too much money is at stake.

Still, I was surprised and dismayed to read an article in the New York Times Monday that seemed to be saying, well, since soy, black cohosh, flaxseed and other alternative treatments for menopause have been found in recent studies to be no better than placebo in relieving menopausal hot flashes, women should reconsider hormone therapy.

This is the same hormone therapy that has been shown repeatedly to raise the risk of blood clots, stroke, breast cancer, colon cancer, incontinence, dementia and gall bladder disease.

But the doctors quoted in the Times piece seem to think that those risks are worth it for many women. After all, says one doctor, women are willing to take migraine medications despite their side effects, so why not take hormones for hot flashes?

Correct me if I’m wrong, MinnPost readers, but I don’t recall any studies that show that migraine drugs raise a woman’s risk of cancer or stroke.

Another doctor tells the Times that “scaring” women off menopausal hormones “would be like telling someone with insulin-dependent diabetes that they should try to use other things besides insulin.”

Um, no, it wouldn’t be like that. People with diabetes who don’t take their insulin can die.

Not taking menopausal hormones isn’t going to kill anybody.

A generational shift in attitudes
Sometimes I wonder (despair?) if we’ll ever view menopause as earlier generations did — as a natural biological transition rather than some kind of “estrogen deficiency” condition that requires medical attention.

It’s a topic that medical writer Liz Scherer addresses this week in her Flashfree blog. (Hat tip: HealthNewsReview). Scherer focuses on an essay that appeared in the Journal of Aging Studies earlier this year. The author of that essay, University of Utah assistant professor of sociology Rebecca Utz, used data from two generations of women — those born in the 1920s and 1930s and their baby boom daughters, born in the 1950s — to examine the effect that the medicalization of menopause has had on attitudes toward menopause and aging.

These two generations of women see menopause very differently, Utz reports. Here’s Scherer’s summary:

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.

Media has a role, too
Unfortunately, the “Menopause Industry” (a “profit-seeking enterprise comprising pharmaceutical companies and perpetuated by the media,” according to Utz) remains intent on persuading 40 million baby boomers that menopause requires significant medical intervention.

“While the companies create the drugs,” writes Scherer, “the media (whose increased 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.”

It’s time we get over our fears about menopause and aging. Our health depends on it.

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Comments (6)

In my family ageing isn't the issue, it is the fact that hot flashes can occur multiple times during the day and cause disturbed sleep at night. The hot flashes and the resulting groggy days from disrupted sleep are the only reason anyone in my family sought medical treatment for menopause. If you know of a way to lose the hot flashes that would be great!

Thank you Susan for such a well written article on such a controversial subject. I am on the fence as to how I feel about HRT so a piece like this is especially helpful.

For Candace who is having trouble sleeping due to night sweats - I tried all the lotions and potions on the market and nothing helped with my night sweats. I was driven by desperation to create a garment that would absorb night sweat moisture because the polyester wicking garments did not work well for me. The result is Dry Babe - Absorbent Sleepwear for "Hot" Mamas which can be found on the web at www.drybabe.com. I wear mine every night and have been sleeping peacefully and dryly since.

Just wanted to pass this on because I know how debilitating not sleeping can be - this is a product developed for women out of love.

Thanks for this, Susan.

Speaking as a male who won’t have to deal with the same issues that aging brings for women, I’ve been an interested observer of how my sisters, all in their 60s now, have dealt with this. In at least once instance, the sister has taken, and continues to take, a daily regimen of “natural” substances and products to help her “deal with” menopause. She’s been doing this for more than a decade now, and without any success of which I’m aware. Hot flashes were a temporary phenomenon that went away some years ago, and I think you’re right on the mark about the “industry” growing up to dangle in front of women living in a youth-obsessed culture the attractive prospect of somehow stopping the aging process.

When I get up out of a chair, my knees sound like a bowl of Rice Krispies as they’re drenched in milk at the breakfast table – plenty of Snap! Crackle! and Pop! They function well enough, but they make a lot of noise, and they won’t continue to function as they do now forever. We all get old, if we’re lucky, and our bodies are neither designed nor built to last indefinitely and without problems. Some of us got better genes than others, but getting old and losing some degree of vitality and what we call “beauty” is just the way it goes.

That the natural process of menopause has become “medicalized” seems of a piece with the rise in prescription drugs (expensive, of course) to deal with a host of other issues that, a generation ago, were simply accepted. If you ate a large pizza at 11 PM and had trouble sleeping, your mother might chastise you for eating so big and spicy a meal right before you went to bed. Now we look to antacids and more to “fix” the consequences of our bad judgment – and the natural process (heartburn) that it produced.

As you said, there’s a lot of money at stake, and this is a society that places a lot of importance on money, so the purveyors of hormone therapy are unlikely to simply accept a greatly diminished income, or go into some more legitimate line of work. They still have a lot of snake oil to sell…

This issue - medicalization of menopause - is just one facet of the medicalization of EVERYTHING in the US, which is why we pay 4X more per capita for health care than Costa Ricans but have exactly the same life expectancy. No matter what the problem, annoyance or irritation is, someone somewhere is looking for or has found a drug that will "alleviate" it. But some of the things we've found drugs to alleviate aren't diseases or disorders at all. We've built our medical-industrial complex to the point that you can't sneeze without someone saying "I have a drug that will fix that." Sometimes - MOST TIMES - a sneeze is just a sneeze, a cough is just a cough, and a viral infection will run its course in 7-10 days whether you treat it or not.

Great piece, Susan. It's so easy to feel reassured by an institution as august as the Times, particularly when one is feeling flushed and desperate.

"This is the same hormone therapy that has been shown repeatedly to raise the risk of blood clots, stroke, breast cancer, colon cancer, incontinence, dementia and gall bladder disease." The hormones shown to increase the risks of the above noted condition are Premarin and Prempro---used in the massive Women's Health Initiative Study that was halted in 2002. Premarin and Prempro are synthetic (and sometimes aptly labeled monster) hormones made from pregnant mare's urine----if you are a horse having hot flashes, great, but otherwise.....
Hormones affect every system in the body, and when I went on BIODENTICAL hormone replacement therapy 5 years ago, not only were my hot flashes cured in 3 days (and they were severe) but my restless leg syndrome, acid reflex, and seasonal allergies were all cured in less than two weeks. I was able to get off a total of seven medications, including the antidepressants I had taken for many years (we have a hormone deficiency ladies, not an antidpressant deficiency as we reach the peri/menopausal stage of our lives). Every one of those medications had side effects and were not molecularly identical to what was in my body when I was younger. Menopause itself might not seem life threatening, but the effects of hormonal deficiencies on every system in the body accelerate the aging process and diminish the quality of life. My osteopenia was cured with bioidentical testosterone/Vitamin D/DHEA and regular weight training, and yes, a broken hip can be life threatening (25% of women over 65 who break a hip die within the 12 months after the injury). My cholesterol dropped by 135 points (cardiac issues are a life and death matter), and oh, by the way, the bioidentical hormone optimization helped me lose 120 pounds (and yes, that level of obesity was lifethreatening). Menopause is a hormone deficiency, and that IS a medical matter. I am blessed to have a doctor who "gets it" and wants the best for his patients, I travel from NC to Southern CA to be his patient and its the smartest thing I have ever done. If anyone would like a list of resources to help you find a doctor/compounding pharmacy who practices with bioidentical hormones, I can be reached through my blog address above. You are very fortunate in MN to have a great practice that specializes in biodentical hormones and takes insurance (it's absolutely not true that insurance will NEVER pay for bioidentical hormone care----I get so angry when I hear opponents of BHRT use that line). Best wishes to all for hormonal health!