Menopause is not a disease. Experts demand a new narrative for this natural stage of a woman’s life

Learn to spot the symptoms of perimenopause 0:41 (CNN) — Women are not a monolith, their experiences of menopause are not all negative, and this stage of life should not be viewed as a medical issue, an international group argues of experts. In a review article published Wednesday in the British Medical Journal, obstetrician Martha Hickey, of the Royal Women’s Hospital in Victoria, Australia, and three professors of women’s health from the United Kingdom, United States and Australia, analyze social and cultural attitudes towards the stage of life in which most women stop having menstruation, usually between the ages of 45 and 55, and defend the need to “normalize” menopause. In 2021, a global survey revealed that between 16% and 40% of women experience moderate to severe symptoms during menopause, such as feeling tired, hot flashes, difficulty sleeping, and muscle or joint pain. One treatment currently offered to relieve these symptoms is hormone replacement therapy (HRT), which uses medications to replace hormones lost during menopause and, in turn, relieve these symptoms. Many studies have shown its effectiveness in helping women get through menopause, and while there are risks, such as an increased risk of breast cancer, the benefits are thought to outweigh these risks. However, Hickey and her co-authors argue that while effective treatments like HRT are important for those with bothersome symptoms, “viewing it as a medical problem can increase women’s anxiety and apprehension about this natural stage of life.” They add: “The medicalization of menopause risks reducing the wide range of midlife experiences associated with this natural process into a narrowly defined disease that requires treatment and tends to emphasize the negative aspects of menopause.” The four experts further argue that while “women with hot flashes and heavy night sweats often benefit from menopausal hormone therapy, most women view menopause as a natural process and prefer not to take medication.” Hickey told CNN: “The medicalization of menopause makes women fearful and reduces their ability to deal with it as a normal life event.” Preserving health and youthful appearance Medical caution about the use of HRT is not new. In Elizabeth Siegel Watkins’s book, “The Estrogen Elixir: A History of Hormone Replacement in America,” the health sciences history professor traces the causes of and responses to the growing HRT trend. Published in 2007, Watkins’ book explains that “[la medicalización de la menopausia] begins with the dynamic interactions between scientists, pharmaceutical manufacturers, and gynecologists in the production, marketing, and prescription of estrogens in the early decades of the 20th century.” According to Watkins, after half a century of research beginning in the 1890s, estrogen it was introduced in the United States as a short-term treatment for menopausal symptoms in the 1940s and 1950s. Between 1960 and 1975, hormone therapy boomed after some reproductive endocrinologists redefined menopause as a estrogen deficiency.” The approach to menopause treatment reveals not only the approach of the science, but also the stance of the culture when it comes to middle-aged women. Watkins writes of E. Kost Shelton, a clinical professor of medicine of UCLA who “promoted long-term hormone therapy as the solution to the woes of middle-aged women,” believing that estrogen would not only “prevent the development of osteoporosis [una condición en la que los huesos se debilitan, común durante la menopausia]… but it would also help maintain a youthful appearance, a positive attitude, and a happy marriage.” And if you are able to lobby, pressure, demand that governments and medical research communities do better by women and actually put in funding and resources into more research — Sunny Singh (@ProfSunnySingh) October 18, 2019 The book cites an article written by Shelton in 1954 in which he said that the lack of estrogen during menopause “is often accompanied by a regression to a mere memory of the old seductive woman…She becomes insecure, inadequate, and ultimately neglected during the most vulnerable period of her marital existence.” The language may have changed since Shelton’s time, but the association between HRT and the expectation of maintaining youth persists. The authors of the BMJ analysis write: “The belief that aging can be delayed or reversed by hormone replacement therapy (HRT) persists and is reinforced. by the media, the medical literature, and information directed at women. Then and now, why do these associations persist? Hickey and her co-authors offer an answer: “Menopause marketing is a lucrative business.” “In the 1960s, for example, it was suggested that all women should take hormone treatment when they went through menopause.” Hickey told CNN. “And there’s still a strong pharmaceutical push for women to take hormones to stay young, or to protect their skin, or their sex life and other things like that that haven’t been proven.” She and she adds, “If you have a medication that half the population should be taking, that’s a huge win.” Hickey and her co-authors advocate changing the narrative by promoting positives such as missed periods, pregnancy and contraception, as well as educating women on how to manage bothersome symptoms. They believe that focusing on these aspects “could empower women to manage menopause with greater confidence.” Factors Affecting Menopause Symptoms 1:00 Menopause Narratives Sunny Singh understands the power of narratives. In 2019, the novelist and Professor of Creative Writing and Inclusion in the Arts at London Metropolitan University wrote a highly engaged Twitter thread. In it she shares her own experience of going through perimenopause (having symptoms before your period has stopped). With great frankness and humour, Singh wrote: “Hot flashes are vaguely discussed, but this is my ‘peri’ experience. My body has decided it needs hot showers, but then overheats for the next hour. arms until cool enough to put on clothes. Note: add an extra hour to morning routine.” And she adds: “The current discourse oscillates between ‘everything is natural’ (yes, so is death) and total pathologization… We have to talk about menopause without hypermedicalizing it.” Singh claims that she benefited from her mother sharing her menopausal experience when she was in her thirties and she says this needs to happen more. “There has been very little sharing of information around menopause. We need women of all races and regions to talk about menopause,” she told CNN. The BMJ analysis comes to the same conclusion: “Normalizing aging in women and celebrating the strength, beauty, and accomplishments of middle-aged women can change the narrative and provide positive role models,” the authors write.