Why do so many women use hormone replacement therapy (HRT) to cope with the menopause, particularly when it might damage their health?
Recent research, published in the British Journal of Cancer, showed that the combined oestrogen/progestogen version of HRT almost trebled the risk of developing breast cancer. The authors concluded that the risk of developing breast cancer increases with duration of taking combined HRT.
Relative risks are likely to be substantially underestimated because women’s HRT status is not updated often enough. Almost all the medical literature about the menopause refers to symptoms and health problems. Last November the National Institute for Health and Care Excellence (Nice) in the UK published clinical guidelines on menopause “diagnosis and treatment” and these describe menopause almost exclusively from a medical perspective.
Terms such as “urogenital atrophy” are used by Nice and testosterone therapy is recommended for “symptoms” such as low libido. The fact that women with low sexual desire may be bored with their partners/husbands is not even considered. In fact, women’s life circumstances are hardly ever thought about when difficulties during menopause are discussed.
Menopause is not a disease. It is a natural life process which happens to 100 per cent of women at some stage of their lives, usually about 51 years of age. The truth is that any process related to women's reproductive organs, including menstruation, birth and menopause, have always been seen by medical experts as needing to be fixed or improved upon. Every year in Ireland women have nearly three times as many medical procedures performed on their reproductive organs as men. In 2014 women had 42,952 operations on their reproductive system and men had 17,167 on theirs. It is hard to believe that women's bodies evolved to be much less healthy than men's.
According to Áine McCarthy, in Hearths, Bodies and Minds: Gender Ideology and Women's Committal to Enniscorthy Lunatic Asylum, 1916-1925, (Irish Women's History, edited by Alan Hayes and Diane Urqhuart), in the 19th and 20th centuries, psychiatrists "linked their classifications of insanity to discoveries about women's reproductive systems, so that several distinctive forms of female insanity were "diagnosed" at this time including puerperal [post birth] mania, ovarian madness, insanity of lactation, and climacteric [menopausal] melancholia".
In fact, according to McCarthy, “the gendering of madness has remained constant since that time”. Prescribing HRT for menopausal “symptoms” is the modern version of seeing women’s natural life stages as inherently abnormal.
Germaine Greer, in The Change: Women, Ageing and the Menopause, argues that HRT is about "eliminating menopause and keeping all women both appetising and responsive to male demands from puberty to the grave, driving the dreaded old woman off the face of the earth for ever".
Menstruation is seen in the same way. Women who are not as easy-going or biddable before and after ovulation are judged to have “pre-menstrual tension”: another nonsense condition dreamt up by medical experts. There is no doubt that hormones do affect mood but they evolved in the way they have to ensure the survival of the human species and do not need to be fixed. Women have high libido around ovulation to maximise a pregnancy opportunity.
They are less accommodating, and more aggressive about their own needs and life circumstances, at other times of the month. This mild rebellion is labelled pre-menstrual syndrome and treated with hormones. It could be argued that men suffer from testicular temper syndrome because they are aggressive about their needs all the time but for some reason experts see male aggression as normal.
There is no doubt that many women find the years leading up to the menopause, and menopause itself, somewhat difficult to traverse but viewing it as a medical condition is not helpful. The physical signs of menopause are real enough, and often uncomfortable, such as hot flushes but these are normal and will pass. Emotional and mental health difficulties that can arise when women are in their 50s are more likely to be related to their stage of life than menopause. Children have grown up and, with a bit of luck, have left home.
Women’s parents and parents-in-law are getting older and perhaps need more care and support. Women are beginning to realise that that’s all there is.
They might be asking themselves hard questions about their own mortality. Men can also go through a hard time in their 50s but doctors do not blame a male menopause. Hormones are not the solution for either men or women. Jacky Jones is a former Health Service Executive regional manager of health promotion and is a member of the Healthy Ireland Council