hotflash inc.: hormone replacement therapy 'is not a panacea for total happiness and bliss'
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menopause is a normal life phase when ovarian hormones return to stable, low, non-reproductive levels of childhood. getty
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when it comes to menopause, britain is pretty much leading the world.
thanks to an array of doctors, activists, celebrities, journalists and politicians, recent years have yielded a national menopause policy, the subject being introduced into the high school curriculum, more training for ill-equipped gps, and national recognition of the need for menopause workplace policies.
channel 4, a u.k. public service broadcaster, has screened two popular documentaries on the subject, each hosted by tv presenter and leading celebrity menopause campaigner davina mccall. even singer rod stewart got into the act, appearing on the chat show loose women with his wife penny lancaster
to talk about what men can do to support their partners through the change.
the u.k.’s #menopauserevolution has boosted awareness of and access to menopause hormone therapy, particularly in underserviced areas, and in many ways that is a good thing. according to the national health service business services authority, the number of units prescribed grew by 35 per cent in 2021 and 2022 compared to the previous year.
if there is one thing those of us in north america can learn from the u.k. on this, however, it’s how to avoid the medicalization of menopause, and the intense division it has developed in its wake.
this stems from a concerted effort to have menopause rebranded as a female hormone deficiency, and linked directly to very real risks for future diseases of the heart, brain and bones, for which menopause hormone therapy is depicted as the treatment, cure and preventative, all in one.
one driver is british menopause champion dr. louise newson: a tireless campaigner, favourite of celebrities and frequent television guest. she also runs a chain of private clinics delivering hormone therapy and menopause care, a non-profit and an app.
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newson’s rebranding attempts extend to all people in menopause, whether they are having symptoms or not. hormone levels will always be low after periods stop, she reasons, hence the deficiency. behind the scenes, however, frustrated british doctors have lamented the focus on hormone therapy as a silver bullet rather than one potentially effective tool to be used in combination with a variety of lifestyle changes.
in the last year, that opposition has come increasingly out into the open. for example, in an article in the bmj, susan davis, an australian endocrinologist and an advisor to britain’s national health service menopause group steering committee, called the situation “menopause hysteria.” british gp irene redolat-castella told the journal that the rise in demand for hrt has created its own issues, including “unrealistic expectations of hrt being the panacea for total happiness and bliss.”
dr. robert wilson popularized the term “hormone deficiency”
it was back in 1966 that dr. robert wilson popularized the “hormone deficiency” narrative in his pharma-funded book, feminine forever, including this wretched line: “many physicians simply refuse to recognize menopause for what it is — a serious, painful and often crippling disease.”
the hormone deficiency narrative he espoused is not only incorrect, but also offensive. menopause is a normal life phase when ovarian hormones return to stable, low, non-reproductive levels of childhood. this is a biological fact. it’s no more a disease of hormone deficiency than childhood is.
two leading canadian voices in this arena — obstetrician-gynecologist dr. jen gunter and author and naturopathic doctor lara briden — point to the “grandmother hypothesis” to explain why we evolved to be in menopause in the first place, with the argument being that post-reproductive women are so good at caring for others and keeping our descendants alive, it helps to pass on our hearty genes.
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another common argument for the deficiency narrative — ‘menopause is new because we all used to die by 50’ — is also untrue. aristotle spoke about menopause. the actual name was coined by french physician charles-pierre-louis de gardanne in the 1820s, and those who remain doubtful need only wander through an old british cemetery and check out the dates on the headstones.
fear sells, so this narrative is not going anywhere. neither is a lot of its fuel. the commercial interests involved in this #menopauserevolution are in plain sight, even though they are rarely part of breathless british media coverage. as scottish general practitioner margaret mccartney wrote in the bmj earlier this month, the u.k. government’s all party parliamentary group on menopause is funded by drug companies. “menopause is now seen as a problem to be solved, and of course, there are problem solvers in the wings,” she writes.
menopause is supposed to happen, and saying that doesn’t mean we are required to suffer through it in silence. mislabelling such a profound event in our lives diminishes the power that comes with the end of our fertile years, and the wisdom, peace, contentment, vitality and renewed sense of purpose that many of us are feeling. it casts a shadow over all the important things we have left to do.
at a time in my life when i’m starting to feel more myself than ever before, i simply won’t be told i’m deficient. and i’m not about to let anyone going through puberty hear that a dark and inevitable diagnosis is waiting for them some 40 years down the road, either. they deserve better than that, and so do we.
ann marie mcqueen is a journalist with 25 years of experience covering health, wellness, science and more, and when she realized she was in perimenopause five years ago, she decided to make this transition her beat. she has since become a global expert on the subject through her platform hotflash inc, where she helps people navigate the gap between medical and holistic treatments with evidence and experience-based research. she will be writing regularly on all things related to menopause and mid-life.
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