The prevailing view of menopause as an endocrine deficiency has led to a “disease-based model” that leads to over-medicalisation of this inevitable life transition, according to the first paper in a major series published in The Lancet. The multinational author team urged a change in attitudes towards a more empowering approach that emphasises menopause as “an ordinary, healthy phase of women’s lives”.
Women’s experiences vary substantially, they said, and are influenced by psychological, social, and contextual considerations, many of which are modifiable. “Although the management of symptoms is important, the medicalised view of menopause can be disempowering for women, leading to overtreatment and overlooking potential positive effects, such as better mental health with age, and freedom from menstruation, menstrual disorders, and contraception.”
Co-author Myra Hunter, emeritus professor of clinical health psychology at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, told Medscape News UK that even physical symptoms can be influenced by prevailing attitudes. Her work has noted that psychological factors – including stress, negative beliefs about menopause, embarrassment, feeling out of control, and concern about the reactions of other people – are associated with more problematic menopause symptoms.
Menopause, Misogyny, Medicalisation…and Ageism
“The way that women view and react to hot flushes, for example with embarrassment or trying to hide symptoms, tends to be associated with negative beliefs about menopause,” she explained. She pointed out that it is inaccurate to manage menopause merely as a hormone deficiency requiring treatment, saying this fuels negative expectations that might be harmful to women.
She added that while there are similarities with other women’s health conditions, such as pregnancy, menopause differs in that “it is inextricably linked to age”. Attitudes, therefore, potentially involve “gendered ageism”.
In many Asian cultures, ageing in women confers respect and status, rather than stigma, the authors explained. Women tend to have worse experiences of menopause in countries where their value is predicated on youth and reproductive capacity, and ageing is associated with decline.
Hunter stressed: “Mid-aged and older women have key roles in society. Women aged 40 plus are the fastest growing sector in paid and voluntary work in high income countries and should be valued.”
Commercial Interests Frame Menopause as a Disease
The team noted also that much information about menopause “is driven by commercial interests” and that these have influenced how menopausal hormone therapy is presented, overshadowing evidence-based alternative options.
An editorial accompanying the series noted: “Appropriation of feminist narratives by commercial organisations, which position use of menopausal hormonal therapy as a way to empower women to regain control of their bodies, while downplaying risks, further endorses the framing of menopause as a disease.”
While stating that all women who request hormone treatment should be offered it, unless contraindicated, the editorial emphasised: “Menopause does not herald the start of a period of decay and decline but is a developmental life stage that can be negotiated successfully with access to evidence-based information as well as appropriate social and medical support.”
Hunter urged clinicians to acknowledge the variation in menopause experiences. “Empowerment means approaching the menopause with confidence and an open mind, being informed, and knowing that there are evidence-based treatments should symptoms be difficult to manage.”
Also commenting to Medscape News UK, Dr Sarah Gray, an independent GP in Truro in western Cornwall who specialises in women’s health and has sat on the British Menopause Society Council, said that, while the term menopause technically refers to the last menstrual period, in general conversation it is used to mean the transition from reproductive to post-reproductive life.
The effect on women varies greatly, she said. “While some may welcome the loss of periods; for others, the loss of ovarian hormones can have a dramatic effect on their mental and physical health.” Doctors need to treat all women as individuals and respond appropriately to their difficulties. Not all women need medical treatment, “but some undoubtedly do”, and it should not be denied due to concerns about over-medicalisation, she said.
Asked to comment by Medscape News UK, the British Menopause Society (BMS) similarly said that it is important that women experiencing severe symptoms that could potentially be relieved by hormone or other treatments were provided with appropriate care.
Paula Briggs, BMS chair and consultant on sexual and reproductive health, said: “Historically, there has been a lack of information about the menopause and some women have found it hard to get the treatment they need. This is changing for the better, and there is concern that the use of the word over-medicalisation could in fact lead to the disempowerment of women. A balanced approach is important to ensure that the women who need treatment get it.”
Helping Women to Ditch Negative Narratives
Medscape News UK also spoke with Rachel Lankester, founder of MenoClarity, an information hub about menopause, and Magnificent Midlife, a site aiming to help women “ditch negative narratives about ageing” that is based on the book of the same name. She said: “Menopause is a natural transition, like puberty, except our default position isn’t to medicate puberty.”
Hormone therapy has a role to play, and can be helpful for some women, “but it is just one tool in the toolbox”, she said. “Medicalisation is rooted in making money by making women fear that menopause is a deficiency disease, which can only be fixed with medication.”
It’s great that people are talking about menopause, “but negativity bias is real, especially in the media, where scary headlines get clicks and make sales”, she said. “It’s often those who have suffered most who shout the loudest, and those who’ve had a neutral or positive experience don’t get heard.”
Menopause Easier in Cultures Where Age Enhances Status
Gendered ageism also has an impact, she agreed. “In cultures where women’s status increases with age, menopause can be easier. If we fear menopause because we’ve been taught it’s the end of our value to society, that doesn’t bode well for our physical and emotional response to it. We also know that diet, lifestyle, mindset, environmental factors, stress, etc. massively impact how women experience menopause.
“Menopausal women are not on the fast track to ill health as some commentators appear determined to convince us we are, driving the medicalisation. We need more education and less fear mongering so we can be prepared, not scared.”