The menopause is having a moment. Once only spoken of rarely, and with embarrassment, it is now sensationalised in the media. This has been accompanied by a massive increase in prescriptions for Hormone Replacement Therapy, which have more than doubled in England in the past 5 years. But is this hormone revolution really helping women?
It is true that misogyny prevails in the medical profession and that women’s healthcare is often overlooked and under-researched: just look at the current attitude towards endometriosis and the crisis in childbirth and after-care. But there is a greater philosophical question here that needs to be interrogated: Is menopause a disease of oestrogen and ageing that should be treated? Or are we instead pathologising and medicalising a normal part of the female life cycle?
This week, The Lancet medical journal published a series of articles examining the current media narrative, saying it’s “time for a balanced conversation about menopause”. Its editorial states that, while some women experience severe symptoms, others have mild or no symptoms. And despite the frequent claims that menopause is associated with poor mental health, it states that “there is no strong evidence that the risk of first-onset clinical depression is increased over the menopause” — although some women with previous mental illness may be at risk.
Menopause wasn’t always taken so seriously. There was a time when women were expected to shut up and put up with their hot flushes. We darkly referred to this stage of life as “the Change”. But then, the bestselling book Feminine Forever, by gynaecologist Dr Robert Wilson, changed that narrative forever. He made the case that menopause was a serious disease and that post-menopausal women were deficient: “a woman’s physical, social, and psychological fulfilment all depend on one critical test: her ability to attract a suitable mate and to hold his interest for many years.” He described menopause as “a mutilation of the whole body” and HRT was a way to “be restored along with a fully feminine appearance”.
Though some feminists fought back, many health activists embraced the view that, like contraception, HRT was a key to women’s liberation. But what wasn’t common knowledge at the time was that Wilson was funded by the HRT industry.
There followed an inevitable surge in demand for HRT until, in the early 2000s, a large study from the Women’s Health Initiative reported an increased risk of breast cancer associated with long-term HRT use. Overnight, the treatment fell out of fashion. That study has now been contested, and in the past decade, the medication has had a renaissance. Parliamentarians are calling for menopause health checks, and leave from work, and social media is full of doctors recommending it to women — and women recommending it to each other — not just as a way to reduce hot flushes, but as a way to save marriages, skin tone, and sex lives — as well as reducing future cardiac and dementia risks.
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