The Medicalization of Menopause

By OBOS Menopause Contributors | October 15, 2011

Major biological transitions that women experience, such as childbirth and menopause, are often medicalized in U.S. culture. The term medicalization refers to treating a natural process as if it were a medical condition requiring intervention.

The normal physical changes associated with menopause in particular tend to be perceived as pathologies requiring both medical and cosmetic “help,” perhaps because aging itself is so medicalized.

Some medical researchers, health care providers, and drug companies have defined menopause as a hormone “deficiency” condition due to ovarian “failure.” According to this view, menopause is a condition like thyroid deficiency or diabetes: If it is left untreated, we will be at greater risk for many chronic diseases, a lower quality of life, and premature death.

This view was the rationale for the widespread use of long-term hormone treatment for postmenopausal women from the 1960s to the early 2000s. According to the conventional wisdom of the time, if our ovaries had failed us and we had become deficient, it made sense to replace our hormones; hence the term “hormone replacement therapy.”

For decades, many doctors and women were convinced that boosting estrogen levels would treat all signs of menopause, make women feel younger, and ward off diseases of aging. This belief persisted even though no well-designed long-term clinical trial of hormone treatment had been conducted. We now know that hormone treatment is likely to carry more risks than benefits for most women.

Several factors may help to explain why menopause has been perceived as a deficiency. One is the long history of attributing ill health and characteristics considered undesirable for women to women’s reproductive organs and hormones. For example, terms like hysteria (derived from the Greek word hustera, which means “womb”) reflect the former belief that behaviors considered inappropriate for a woman were somehow caused by her uterus.

Some women in the 19th century had hysterectomies in attempts to treat a wide variety of problems. Similarly, some doctors believed that the ovaries were the source of ill health and advocated their removal. During the same era, higher education for adolescent girls was discouraged for fear that taxing girls’ brains would ruin their reproductive organs.

Another reason that so many doctors have viewed menopause as a deficiency condition is that they are more likely to see and treat women who are experiencing distress than those who aren’t. Women who have a relatively easy time during and after the menopause transition simply don’t visit doctors as often. This makes it seem to doctors (and others) that menopause is more stressful for most women than it actually is.

Doctors are also more likely to see women who have severe distress immediately after their ovaries are removed (a procedure that often accompanies hysterectomies). The sudden change in hormone levels caused by surgical removal of both ovaries usually results in more distress than natural menopause does. (For more information, see Premature or Early Menopause.)

Finally, the pharmaceutical industry must be recognized as a driving force in the medicalization of menopause. Many studies on hormones have been sponsored by pharmaceutical companies, which influence both the way the studies are done and how the results are interpreted. These studies are then published in prestigious medical journals and become accepted as scientifically valid. Legitimate criticisms of these studies often do not reach the lay public.

The pharmaceutical industry also sponsors “continuing education” seminars for physicians, reinforcing the use of hormones either as a treatment for menopause or as a preventive measure for chronic diseases. Research has shown that doctors’ prescribing practices are often strongly influenced by promotional messages rather than by scientific evidence. (For more information, see Who Paid For That Study? Identifying Conflicts of Interest in Medical Research.)

The story of the widespread prescribing of hormone treatment before long-term clinical trials had confirmed their safety is a dramatic example of the power of the pharmaceutical industry and inadequate research to influence women, doctors, and government agencies.