Menopause, Modern Medicine, and the Celebrity Spin
The medicalization of menopause is a process that has subtly
been going on since the 1930's, although it wasn't until the
1960's that it really picked up momentum in the public eye. This
medicalization has transformed the understanding of what is a
natural process, into one defined as a disease.
When you define something as a disease, then treatment becomes
compulsory. And the implication is that if you don't get
treatment, or what is defined as acceptable treatment, then you
are being irresponsible and negligent in your own health.
Women's menopausal experiences were for a long time dismissed as
the product of their own imaginations, then later embraced by
pharmaceutical companies and subverted to push their shiny new
pills.
And given that HRT has been so widely taken up by women, and is
still used despite its risks, it has been a successful approach
by the drug companies.
The celebrity factor in promotional campaigns has been very
effective at selling both the idea of menopause as a disease,
and the promises of hormone replacement therapy. The FDA and
their comparative bodies in most countries require that product
claims are verified by appropriate and legitimate studies. But
celebrities in interviews are not subject to those rules, which
are designed to protect the public from misleading and harmful
information. So when an actress or aging supermodel
enthusiastically enacts the lines of the drug company's scripts
- that menopause is fraught with risks of diseases like
alzheimers, heart attacks, colon cancer, cataracts, teeth loss,
bone fractures and more (p43), in the guise of 'education' and
personal sharing, this is seen as legitimate. There is no
reference to the fees they were paid for this work, the source
of their information, or its scientific validity (or lack
thereof). Nor is their any mention of the fact that even
initially, though there were short term benefits, the long term
effects of hormone replacement therapy were not known. These
celebrities were either ignorant themselves of their own status
as human guinea pigs, or didn't care.
Menopause is sold with the language of 'decline', as though once
a woman's estrogen 'dried up', so did she. She was relegated to
an image of being 'less' than she was before, with the
implication being that her value and contributions as a person
were defined by something that time would take away. Unless of
course she accepted the 'help' of the drug companies with their
'medicine' for her newly defined 'disease'. So instead of being
supported as her body moved into another phase of its life,
women were basically told they were losing what defined them as
'women', as though one hormone was responsible for what made
them unique individuals. As though femininity was characterized
not by their own choices and expressions, but driven by
hormones. And as though 'femininity' was equated with youth, and
that once this passed, women would not enjoy their 'best years'
as they would otherwise. And, of course, if a woman wasn't
feminine, in the appropriately defined way, then she was not
really a woman...
Add to this mix the spectre of diseases that women would
supposedly be in greater danger of getting, despite the fact
that if scientists really knew the single cause of these
diseases they would have triumphantly been marketing the cure to
everyone - regardless of gender. When doctors treat alzheimers,
heart attacks, colon caner, cataracts and teeth loss, they do
not have one treatment for men and one for women. And in most
cases, they don't guarantee a cure with their treatments anyway.
So this suggests not only do they not have the cure, but they
don't fully understand the cause. The murky waters of risk
assessment are both complex and already muddied.
Women were given estrogen only in the early years of medical
promotion. As studies emerged which showed women taking estrogen
were more at risk of developing endometrial cancer, progestogen
or progestin was added to form the combined hormone replacement
therapy that became known as HRT. It was advertised for a long
time as reducing the risk of heart disease, amongst other
things. But in 1998, a high quality study, the HERS trial, found
that in the group of 3000 older women they were studying over 4
years, who all had some form of heart disease, those on HRT were
not in fact protected from heart attacks after all. And during
the first year of the study, there was a higher incidence of
heart attacks in the women on HRT compared with the placebo
group. This was completely the opposite of what the drug
companies had been advertising, based on their own observational
studies, as opposed to the randomized control trial that the
HERS study was.
The HERS trial was not the only one that would raise some niggly
little facts about the menopause gravy train.
References: R Moynihan & A Cassels, Selling Sickness - How Drug
Companies are Turning Us All Into Patients (Allen & Unwin, 2005)