GRSJ224/medicalizationofmenopause

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Medicalization of Menopause

Menopause is defined as the time in a woman’s life when her period stops, as a result of the ovaries stopping production of two hormones, estrogen and progesterone.[1] When a woman reaches menopause, most commonly in her late 40s or early 50s, a series of body changes and symptoms can occur including hot flashes and night sweats, mood swings, and changes in menstruation. [1] Medicalization refers to the process by which natural aspects of life come to be considered as medical problems requiring attention.[2] The medicalization of menopause therefore treats the natural process of menopause as pathological.

History

The medicalization of menopause began in the mid-19th century.[3]

Historically, examples of ill health and undesirable characteristics in women were attributed to women’s reproductive organs and hormones.[4] Female hysteria was used to describe behaviours in women that were considered inappropriate or irrational, seemingly caused by the uterus. The term hysteria itself comes from the Greek hustera, meaning ‘womb’.[4]

Ovarian therapy began in the 1890s, aiming to alleviate symptoms of “hysteria, menstrual disorders, and menopause”.[5] One solution to hysteria and ‘menstrual madness,’ many women undertook ‘normal ovariotomies,’ the removal of normally functioning ovaries.[6] As a result many of these women experienced rapidly changing hormone levels and advanced menopause, ultimately returning to the doctor to help with their new distress.[4][5]

In 1929, Edward Doisy isolated the first sample of pure crystalline estrogen, and in the 1930s, hormone replacement therapy (HRT) first became popularized.[5] [7] In its first few years of production, HRT was not common due to limited availability and high cost.[8] In 1938, British biochemist, Sir Charles Dodds developed diethylstilbestrol (DES), a synthetic hormone that significantly dropped the price of hormone therapy.[8] In 1943, James Goodall developed a ‘safer’ estrogen extract to replace DES, again increasing availability.[8]

Hormone Replacement Therapy (HRT)

The medicalization of menopause lead to its’ “pharmaceuticalization”, in which a bodily function  is considered in need of medical intervention to the point of treatment.[2]

Menopause was promoted and came to be seen not as a natural process but, through doctor’s and pharmaceutical dissemination, actually a condition of ‘estrogen deficiency’ or ‘hormonal deprivation’.[9] Women were told that increasing estrogen levels through HRT would minimize menopausal symptoms such as hot flashes, help overall vitality, and protect them from other major health issues. Diseases such as Alzheimer’s, heart disease, and osteoporosis have all been linked to decreased estrogen levels, and publicity inciting fear of these diseases fostered dread of hormonal deprivation due to menopause.[4][9][10]

Many of these conditions are also closely related to natural ageing processes, such as bone fractures, diabetes, and cardiovascular diseases.[11] There is no evidence that it is in fact estrogenic levels causing these different risks, nor is there evidence that hormone replacement in postmenopausal women diminishes any such risks.[11]

In the 1990s, the National Institute of Health created the Women’s Health Initiative (WHI), a federally funded clinical trial of hormone replacement treatment, aiming to determine the ultimate risks and benefits of HRT.[12] In July, 2002, the WHI was terminated three years early, after undeniable evidence proved that the risks of taking hormone replacement treatment outweighed the benefits.[12] Specifically, the trial identified a an increased risk of breast cancer, cardiovascular issues, strokes, and blood clots.[12][13] After release of the study’s findings, prescriptions for all brands of HRT decreased by more than 33%.[13]

Medical Propoganda

When first introduced in the early 20th century, hormone replacement therapy was not widely prescribed by doctors, because of the cost. With the production and availability of lower-cost, synthetic estrogen, the popularity of HRT increased. Pharmaceutical companies advertised estrogen to women through popular media, most commonly in the form of magazines. Harper’s Bazaar, Time, Vogue, Reader’s Digest, and Ladies Home Journal all published articles and advertisements for estrogen replacement use, typically promoting youth and beauty.[7]

Premarin Advertisement New York Journal of Health

In 1966, Dr. Robert Wilson released his book, Feminine Forever, in which he detailed how the long-term use of estrogen could keep women young, healthy, and attractive.[4] He praised HRT as a ‘fountain of youth’ and a way to keep women from becoming “dull and unattractive”.[10] In 2002, Wilson’s son admitted that the pharmaceutical company Wyeth had funded the expenses to write and publish the book, and had paid Wilson and his wife to lecture and promote the book to women’s groups around the US.[14]

Collectively, Wyeth’s menopausal and estrogen products (which accounted for 70% of such products on the market) were in the fifty top-selling drugs in the US for nearly forty years.[10] By 1975, Wyeth’s premier estrogen pill, Premarin, was the fifth-leading prescription drug sold in the US.[14]

In 2000, HRT Aware hired a public relations firm, The RED Consultancy, to create the Choices Campaign, an initiative to promote positive news about HRT and promote its usage with a healthy lifestyle.[10] HRT Aware itself was an industry group made up of a series of estrogen product manufacturers, including Wyeth, Novo Nordisk, and Solvay.[10]

In 2003, following the WHI results, Novo Nordisk hired another PR firm, Haas and Health Partner, to send letters out to doctors promoting estrogen and emphasizing that the risks for women were “quite minimal”.[10]

Implications For Women's Health

Medicalization of menopause has a number of immense effects on women’s psychological and physical health, as well as setting dangerous precedents and anomalies in gender equality. Placing an emphasis on estrogen and reproductive biology is reductionist, and distracts attention from other pertinent medical or social factors.[11] Medicalization of women’s bodies makes it seem as though they are defective, and naturally in need of scientific intervention.[11]

In the nineteenth century, men were strictly regulated by time through the work day, while women were associated with a ‘timelessness’ that was attributed to domestic life. Hence, women’s time was defined by the biological clock, visualized through reproductive processes and relation to motherhood.[3] This created a stark contrast between development in men and women, where men were not typically in need of medical intervention, while women where expected to be.[3]

Medicalization of menopause and promotion of HRT placed millions of women in a position of unjustified fear and anxiety over their bodies, encouraging the use of drugs with unknown side effects.[11] Such attitudes towards female biology not only propagate the idea that women are defined by their reproductive biology and ability, but stresses the social importance of keeping women young and feminine.[11]

  1. ↑ 1.0 1.1 "Menopause | Menopause Symptoms". U.S. National Library of Medicine. June 9, 2020.
  2. ↑ 2.0 2.1 Maturo, Antonio. “Medicalization: current concept and future directions in a bionic society.” Mens sana monographs vol. 10,1 (2012): 122-33.
  3. ↑ 3.0 3.1 3.2 Van de Wiel, L. "The Time of the Change: Menopause’s Medicalization and the Gender Politics of Aging." International Journal of Feminist Approaches to Bioethics, vol. 7, no. 1, 2014, pp. 74-98.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Pérez, Miriam Zoila, and Amie Newman. “The Medicalization of Menopause.” Our Bodies Ourselves, 9 Feb. 2017, www.ourbodiesourselves.org/book-excerpts/health-article/medicalization-of-menopause/.
  5. ↑ 5.0 5.1 5.2 Watkins, Elizabeth S. The Estrogen Elixir: A History of Hormone Replacement Therapy in America. Johns Hopkins University Press, Baltimore, MD, 2007.
  6. ↑ John Studd (2006) Ovariotomy for menstrual madness and premenstrual syndrome – 19th century history and lessons for current practice, Gynecological Endocrinology, 22:8, 411-415.
  7. ↑ 7.0 7.1 Gorrepati, Pavane. “What's Hormones Got to Do with It? The Medicalization of Menopause in Postwar America.” Hektoen International, 1 May 2019, hekint.org/2019/05/01/whats-hormones-got-to-do-with-it-the-medicalization-of-menopause-in-postwar-america/.
  8. ↑ 8.0 8.1 8.2 Houck, Judith A. "How to Treat a Menopausal Woman: A History, 1900 to 2000." Current Women's Health Reports, vol. 2, no. 5, 2002, pp. 349.
  9. ↑ 9.0 9.1 Meyer, Vicki F. "the Medicalization of Menopause: Critique and Consequences." International Journal of Health Services, vol. 31, no. 4, 2001, pp. 769-792.
  10. ↑ 10.0 10.1 10.2 10.3 10.4 10.5 Clark, Jocalyn. "A Hot Flush for Big Pharma." Bmj, vol. 327, no. 7411, 2003, pp. 400-400.
  11. ↑ 11.0 11.1 11.2 11.3 11.4 11.5 Santos, J. R. Rueda Martinez de. "Medicalization of Menopause and Public Health." Journal of Psychosomatic Obstetrics & Gynecology, vol. 18, no. 2, 1997, pp. 175-180.
  12. ↑ 12.0 12.1 12.2 Goldman, John A. “The Women's Health Initiative 2004 - Review and Critique.” Medscape General Medicine vol. 6,3 65. 9 Aug. 2004
  13. ↑ 13.0 13.1 Tobbell, Dominique. “Medicalizing Menopause.” Science History Institute, 7 Mar. 2017, www.sciencehistory.org/distillations/magazine/medicalizing-menopause.
  14. ↑ 14.0 14.1 Kolata, Gina, and Melody Peterson. “Hormone Replacement Study A Shock to the Medical System.” The New York Times, The New York Times, 10 July 2002,
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